Chapter 01 - History of Respiratory Care Kacmarek et al.: Egan’s Fundamentals of Respiratory Care, 12th Edition MULTIPLE CHOICE
Which of the following is an expected role of a respiratory therapist? Promoting lung health and wellness Providing patient education Assessing the patient’s cardiopulmonary health status Selling oxygen (O2 ) therapy devices to patients 1 only 1 and 4 only 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
Respiratory care includes the assessment, treatment, management, control, diagnostic evaluation, education, and care of patients with deficiencies and abnormalities of the cardiopulmonary system. Respiratory care is increasingly involved in the prevention of respiratory disease, the management of patients with chronic disease, and promotion of health and wellness. DIF: Recall
REF: p. 3
OBJ: 1
Where are the majority of respiratory therapists employed? Skilled nursing facilities Diagnostic laboratories Hospitals or acute care settings Outpatient physician offices ANS: C
Approximately 75% of all respiratory therapists work in hospitals or other acute care settings. DIF: Recall
REF: p. 3
OBJ: 1
Who is considered to be the ―father of medicine‖? Hippocrates Galen Erasistratus Aristotle ANS: A
The foundation of modern Western medicine was laid in ancient Greece with the development of the Hippocratic Corpus. This collection of ancient medical writings is attributed to the ―father of medicine,‖ Hippocrates, a Greek physician who lived during the fifth and fourth centuries BC. DIF: Recall
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REF: pp. 3-4
OBJ: 2
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In 1662, a chemist published a book that described the relationship between gas, volume, and pressure. What was the chemist’s name? Sir Isaac Newton Robert Boyle Anthony van Leeuwenhoek Nicolaus Copernicus ANS: B
The chemist, Robert Boyle, published what is now known as ―Boyle’s law,‖ governing the relationship between gas, volume, and pressure. DIF: Recall
REF: p. 6
OBJ: 2
Who discovered O2 in 1774 and described it as ―dephlogisticated air‖? Robert Boyle Jacque Charles Thomas Beddoes Joseph Priestley ANS: D
In 1774, Joseph Priestley described his discovery of O2 , which he called ―dephlogisticated air.‖ DIF: Recall
REF: pp. 6-7
OBJ: 2
Who is credited with first describing the law of partial pressures for a gas mixture? John Dalton Joseph Prestley Jacque Charles Thomas Young ANS: A
John Dalton described his law of partial pressures for a gas mixture in 1801 and his atomic theory in 1808. DIF: Recall
REF: p. 7
OBJ: 2
Who was the first scientist in 1865 to suggest that microorganisms caused many diseases? Thomas Young Louis Pasteur Henry Graham Robert Koch ANS: B
In 1865, Louis Pasteur advanced his ―germ theory‖ of disease, which held that many diseases are caused by microorganisms. DIF: Recall
REF: p. 7
OBJ: 2
Who discovered the x-ray and opened the door for the modern field of radiology? John Dalton William Smith
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William Roentgen Thomas Young ANS: C
In 1895, William Roentgen discovered the x-ray and the modern field of radiologic imaging sciences was born. DIF: Recall
REF: p. 7
OBJ: 2
What was the primary duty of the first inhalation therapists? Provide airway care. Support O 2 therapy. Aerosol therapy to patients. Maintain patients on mechanical ventilation. ANS: B
The first inhalation therapists were really just O2 technicians. DIF: Recall
REF: p. 7
OBJ: 3
When did the designation ―respiratory therapist‖ become standard? a. 1954 b. 1964 c. 1974 d. 1984 ANS: C
In 1974, the designation ―respiratory therapist‖ became standard. DIF: Recall
REF: p. 7
OBJ: 3
Who was the first to develop the large-scale production of O2 in 1907? Robert Dalton David Boyle Thomas Anderson Karl von Linde ANS: D
Large-scale production of O2 was developed by Karl von Linde in 1907. DIF: Recall
REF: p. 7
OBJ: 4
When was the first Venti-mask introduced that allows the precise delivery of 24%, 28%, 35%,and 40% O2 ? a. 1945 b. 1954 c. 1960 d. 1972 ANS: C
The Campbell Venti-mask, which allowed the administration of 24%, 28%, 35%, or 40% O 2 , was introduced in 1960.
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DIF: Recall
REF: p. 8
OBJ: 4
When were aerosolized glucocorticoids for the maintenance of patients with moderate to severe asthma first introduced? In the 1950s In the 1960s In the 1970s In the 1980s ANS: C
The use of aerosolized glucocorticoids for the maintenance of patients with moderate to severe asthma began in the 1970s. DIF: Recall
REF: p. 8
OBJ: 4
Which of the following medications has never been delivered as an aerosol by a respiratory therapist? Inotropes Anticholinergic Mucolytic Antibiotic ANS: A
There has been a proliferation of medications designed for aerosol administration, including bronchodilators, mucolytic, antibiotic, anticholinergic, and antiinflammatory agents. DIF: Recall
REF: p. 8
OBJ: 4
Which two names are linked to the development of the iron lung, which was extensively usedto treat the polio epidemic in the 1950s? Allison and Smyth Drinker and Emerson Drager and Bennett Byrd and Tyler ANS: B
The iron lung was developed by Drinker, an engineer at Harvard University. Jack H. Emerson developed a commercial version of the iron lung that was used extensively during the polio epidemics of the 1930s and 1950s. DIF: Recall
REF: p. 8
OBJ: 5
Which of the following was one of the first positive-pressure ventilators developed? MA-1 Bird Mark 7 Dräger Pulmotor Engstrom ANS: C
Early positive-pressure ventilators included the Dräger Pulmotor (1911), the Spiropulsator (1934), the Bennett TV-2P (1948), the Morch Piston Ventilator (1952), and the Bird Mark 7 (1958).
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DIF: Recall
REF: p. 8
OBJ: 4
When was positive end expiratory pressure (PEEP) first introduced to treat patients with acute respiratory distress syndrome? a. 1935 b. 1946 c. 1958 d. 1967 ANS: D
Positive end expiratory pressure (PEEP) was introduced for use in patients with ARDS in 1967. DIF: Recall
REF: p. 9
OBJ: 4
When was synchronized intermittent mandatory ventilation (SIMV) first introduced? a. 1975 b. 1985 c. 1995 d. 2005 ANS: A
SIMV was introduced in 1975. DIF: Recall
REF: p. 9
OBJ: 4
Who introduced the first laryngoscope, in 1913? Thomas Allen Chevalier Jackson Jack Emerson Forrest Bird ANS: B
In 1913, the laryngoscope was introduced by Chevalier Jackson. DIF: Recall
REF: p. 10
OBJ: 5
Who introduced the use of soft rubber endotracheal tubes around 1930? Davidson McGill Haight Murphy ANS: B
Ivan McGill introduced the use of soft rubber endotracheal tubes. DIF: Recall
REF: p. 10
OBJ: 5
In 1846, who developed a water seal spirometer, which allowed accurate measurement of the patient’s vital capacity? Hutchinson
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Strohl Tiffeneau Davis ANS: A
In 1846, John Hutchinson developed a water seal spirometer, with which he measured the vital capacity. DIF: Recall
REF: p. 10
OBJ: 5
What was the name of the first professional organization for the field of respiratory care? American Association for Inhalation Therapy National Organization for Inhalation Therapy Inhalation Therapy Association Better Breathers Organization ANS: C
Founded in 1947 in Chicago, the Inhalational Therapy Association (ITA) was the first professional association for the field of respiratory care. DIF: Recall
REF: p. 10
OBJ: 7
In which year did the respiratory care professional organization American Association for Respiratory Therapy (ARRT) change its name to American Association for Respiratory Care (AARC)? a. 1954 b. 1966 c. 1975 d. 1982 ANS: D
The ITA became the American Association for Inhalation Therapists (AAIT) in 1954, the American Association for Respiratory Therapy (ARRT) in 1973, and the AARC in 1982. DIF: Recall
REF: p. 10
OBJ: 7
What organization has developed an examination to enable respiratory therapists to become licensed? American Respiratory Care Board National Board for Respiratory Care American Association for Respiratory Care National Organization for Respiratory Therapist ANS: B
During the 1980s, the AARC began a major push to introduce state licensure for respiratory care practitioners based on the National Board for Respiratory Care (NBRC) credentials. DIF: Recall
REF: p. 10
OBJ: 6
Today, respiratory care educational programs in the United States are accredited by what organization? National Board for Respiratory Care (NBRC)
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American Association for Respiratory Care (AARC) Committee on Accreditation for Respiratory Care (CoARC) Joint Review Committee for Respiratory Therapy Education (JRCRTE) ANS: C
Today, respiratory care educational programs in the United States are accredited by the CoARC. DIF: Recall
REF: p. 13
OBJ: 6
The majority of respiratory care education programs in the United States offer what degree? Associate’s degree Bachelor’s degree Master’s degree Certificate degree ANS: A
There are approximately 300 associate, 50 baccalaureate, and 3 graduate-level degree programs in the United States. DIF: Recall
REF: p. 13
OBJ: 8
Which of the following are predicted to be a growing trend in respiratory care for the future? Greater use of respiratory therapy protocols Increased need for patient assessment skills Increased involvement in smoking cessation programs Clinical decisions will increasingly be data-driven and 2 only and 3 only 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: D
Dr. David Pierson, a prominent pulmonary physician, described the future of respiratory care in 2001. Among other things, he predicted greater use of patient assessment and protocols in disease state management in all clinical settings; a more active role for respiratory therapists in palliative care; increasing emphasis on smoking cessation and prevention; early detection and intervention in COPD; and an increase in the use of respiratory therapists as coordinators and caregivers for homecare. The science of respiratory care will continue to evolve and increase in complexity, and clinical decisions will increasingly be data-driven. DIF: Recall
REF: p. 14
OBJ: 9
How is competency to practice Respiratory Care determined? Achievement of good grades in school and graduating from an approved program. Applying for a state license. Only by graduating from a CoARC approved program. Obtaining a passing grade on a credentialing examination administered by the NBRC after graduation from a CoARC approved program. ANS: D
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State licensing laws set the minimum educational requirements and the method of determining competence to practice. DIF: Recall
REF: p. 10
OBJ: 6
Due to the aging of the majority of the population, which of the following will be the focus ofthe Respiratory Therapist of the future? Verifying insurance information Disease management and rehabilitation Patient and family education Tobacco education and smoking cessation 1 and 3 only 1, 2, and 3 only 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: C
In the future, there will be an increase in demand for respiratory care due to advances in treatment and technology, increases in the aging of the population, and increases in the number of people with asthma, COPD, and other cardiopulmonary diseases. Due to this the RT of the future will be focused on patient assessment, care plan development, protocol administration, disease management and rehabilitation, and patient and family education, to include tobacco education and smoking cessation. DIF: Application
REF: pp. 14-15
OBJ: 9
According to the AARC’s ―2015 and Beyond‖ project, all of the following are included in the seven major competencies required by Respiratory Therapists by the Year 2015 except: chronic disease state management. bronchoscopy. evidence-based medicine and respiratory care protocols. leadership. ANS: B
According to the AARC’s ―2015 and Beyond‖ project, the seven major competencies required by Respiratory Therapists by the Year 2015 will be, diagnostic, chronic disease state management, evidence-based medicine and respiratory care protocols, patient assessment, leadership, emergency and critical care, and therapeutics. DIF: Recall
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REF: pp. 14-15
OBJ: 9
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Chapter 02 - Delivering Evidence-Ba sed Respirato ry Care Kacmarek et al.: Egan’s Funda menta ls of Respira tory Care, 12th Editio n MULTIPLE CHOICE
Quality in the practice of respiratory care encompasses which of the following? Personnel performing care Equipment used Method or manner in which care is provided Level of experience of respiratory care providers 1 and 2 only only 1, 3, and 4 only d. 1, 2, 3, and 4 ANS: D
Quality, as applied to the practice of respiratory care, is multidimensional. It encompasses the personnel who perform respiratory care, the equipment used, and the method or manner in which care is provided. DIF: Recall
REF: p. 18
OBJ: 1
Who is professionally responsible for the clinical function of the respiratory care department? Shift supervisor Department head Medical director Clinical supervisor ANS: C
The medical director of respiratory care is professionally responsible for the clinical function of the department and provides oversight of the clinical care that is delivered (Box 2-1). DIF: Recall
REF: p. 19
OBJ: 1
What is the most essential aspect of providing quality respiratory care? Care being provided is indicated. Care is delivered competently and appropriately. Physician appropriately evaluates patient before care is initiated. 1 and 2 only 3 only 2 and 3 only 1, 2, and 3 ANS: A
The medical director of respiratory care is professionally responsible for the clinical function of the department and provides oversight of the clinical care that is delivered (Box 2-1). DIF: Recall
REF: p. 19
OBJ: 2
The medical director of respiratory care is responsible for which of the following?
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Supervision of ongoing quality assurance activities Supervision of respiratory therapists performing pulmonary function testing Participation in the selection and promotion of technical staff Medical direction of the in-service and educational programs 1 only 1 and 4 only 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: D
Perhaps the most essential aspect of providing quality respiratory care is to ensure that the care being provided is indicated and that it is delivered competently and appropriately. DIF: Recall
REF: p. 19
OBJ: 1
What is the chief reason that respiratory care protocols were developed and are currently being used in hospitals throughout North America? Enhance proper allocation of respiratory care services. Decrease patient care costs to hospitals and insurance companies. Expand patient care skills among respiratory care providers. Enhance efficiency of respiratory care personnel in providing patient care. ANS: A
Misallocation has led to the use of respiratory care protocols that are implemented by respiratory therapists (as described under ―Methods for Enhancing the Quality of Respiratory Care‖). DIF: Application
REF: p. 19
OBJ: 1
Which of the following factors is important in determining the quality of care delivered by a respiratory therapist? Education Experience Training All of the above ANS: D
The quality of respiratory therapists depends primarily on their training, education, experience, and professionalism. DIF: Recall
REF: p. 19
OBJ: 1
Respiratory care education programs are reviewed by which committee to ensure quality? Committee on Accreditation for Respiratory Care American Association for Respiratory Care Education Joint Review Committee Respiratory Care Education Respiratory Care Education Committee ANS: A
Respiratory care education programs are reviewed by the Committee on Accreditation for Respiratory Care (CoARC).
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DIF: Recall
REF: p. 19
OBJ: 1
The word ―credentialing‖ in general refers to what? Recognition of an individual in the profession Licensure by a state or national organization Successful completion of entry-level board examination Voluntary certification by state agency ANS: A
―Credentialing‖ is a general term that refers to the recognition of individuals in particular occupations or professions. DIF: Recall
REF: p. 20
OBJ: 1
What term is used to describe the process in which a government agency gives an individual permission to practice an occupation? Certification Licensure Registry Credentialing ANS: B
Licensure is the process in which a government agency gives an individual permission to practice an occupation. DIF: Recall
REF: p. 20
OBJ: 1
What agency is responsible for ensuring quality in respiratory care through voluntary certification and registration? JRCRTE CoARC NBRC AARC ANS: C
The primary method of ensuring quality in respiratory care is voluntary certification or registration conducted by the National Board for Respiratory Care (NBRC). DIF: Recall
REF: p. 21
OBJ: 1
What organization is responsible for credentialing respiratory therapists? AARC ATS NBRC ACCP ANS: C
The primary method of ensuring quality in respiratory care is voluntary certification or registration conducted by the National Board for Respiratory Care (NBRC). DIF: Recall
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REF: p. 21
OBJ: 1
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Which of the following are characteristics of a respiratory care professional? Participates in continuing education activities. Obtains professional credentials. Adheres to a code of ethics. Completes an accredited education program. 1, 2 and 3 only 2, 3, and 4 only 1, 2, and 4 only d. 1, 2, 3, and 4 ANS: D
A professional is characterized as an individual conforming to the technical and ethical standards of a profession. Respiratory therapists demonstrate their professionalism by maintaining the highest practice standards, by engaging in ongoing learning, by conducting research to advance the quality of respiratory care, and by participating in organized activities through professional societies such as the American Association for Respiratory Care and associated state societies. Box 2-3 lists the professional attributes of a respiratory therapist. DIF: Recall
REF: p. 21
OBJ: 1
HIPAA was established in 1996 to set standards related to sharing confidential health history inform ation about patients. What does the letter ―P‖ stand for? Privacy Portability Patient Protection ANS: B
HIPAA is the Health Insurance Portability and Accountability Act. DIF: Recall
REF: p. 22
OBJ: 1
Which of the following is an essential element of a comprehensive protocol program? Carefully structured assessment tool and care plan form Active quality monitoring Comprehensive delineation of boundaries between respiratory care, nursing, and physician personnel Both b and c ANS: A
Carefully structured assessment tool and care plan form (Figures 2-3 and 2-4) are essential elements for a comprehensive protocol program. DIF: Recall
REF: p. 22
OBJ: 2
What voluntary accrediting agency monitors quality in respiratory care departments? JRCRTE AARC FDA The Joint Commission ANS: D
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The Joint Commission requires a hospital service to have a quality assurance plan to provide a system for controlling quality. DIF: Recall
REF: p. 21
OBJ: 1
Current Joint Commission standards for accreditation emphasize which of the following? Continual quality improvement Therapist-driven protocols License and registration of health care providers Health, welfare, and safety of patients using respiratory care equipment ANS: A
Current Joint Commission standards for accreditation emphasize organization-wide efforts for continuous quality improvement (CQI). DIF: Recall
REF: p. 21
OBJ: 1
To monitor correctness of respiratory care plans, which of the following should be used? Nursing care plans Physician progress notes Care plan auditors and case study exercises Dailypatient rounds with medical director ANS: C
Specific methods to monitor the quality of respiratory care protocol programs include conducting care plan audits in real time and ensuring practitioner training by using case study exercises. DIF: Application
REF: pp. 27-28
OBJ: 2
What is one advantage that has been shown of respiratory care protocols? Increase in the number of procedures performed by respiratory care providers Decrease in the overordering of respiratory care services Decrease in the cost savings to respiratory care departments Decrease in the cost of performing each respiratory care procedure ANS: B
Most studies show a significant decrease in overordering respiratory care services. DIF: Application
REF: pp. 22-23
OBJ: 2
Treatment based on careful review of available literature is known as: evidence-based medicine. protocol-based medicine. review-based medicine. team-based health care. ANS: A
Evidence-based medicine refers to an approach to determining optimal clinical management based on several practices. DIF: Recall
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REF: p. 30
OBJ: 5
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What term is used to describe the work done by a researcher who reviews numerous studieson a single topic and gives more weight to the more rigorous ones before making recommendations? White paper Meta-analysis Alpha review Apical review ANS: B
Meta-analyses assess the quality of available evidence and give weight to better-designed, more rigorous studies. DIF: Recall
REF: p. 32
OBJ: 5
How are competencies being used to monitor the quality of respiratory care? They focus on cost saving strategies. They are used to check the skill and knowledge of respiratory through the use of clinical simulations. They are used to educate therapist on new treatments and procedures. They are used to review protocols. ANS: B
The purpose of competencies is to check for having suitable and sufficient skills, knowledge, and experience for specific tasks. DIF: Recall
REF: p. 26
OBJ: 3
What is/are the essential component(s) comprise(s) disease management programs? An integrated health care system that can provide a full range of a patient’s needs A knowledge regarding prevention, diagnosis, and treatment of diseases A commitment to CQI A sophisticated clinical and administrative information system that helps assess patterns in the clinical practice and 3 only only and 4 only d. 1, 2, 3, and 4 ANS: D
All of the above are the essential components for a disease management team to be successful at meeting the clinical needs of the patients and hospital. DIF: Recall
REF: pp. 31-32
OBJ: 4
What is a cohort study? Comparing the clinical outcomes from two different groups Single patient study A literature-based review Collection of patients with similar clinical situations ANS: A
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Cohort studies, which compare the clinical outcomes in two compared groups (or cohorts), generally have greater scientific rigor than case studies or case series and consist of two broad types of study designs: observational cohort studies and randomized controlled trials. DIF: Recall
REF: pp. 31-32
OBJ: 5
What are the key outcomes that are looked at in different types of studies? Patient survival Discharge from ICU Organ system failure All of the above ANS: D
All three are important key outcomes that are evaluated and compared when looking at study results. DIF: Recall
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REF: pp. 31-32
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Chapter 03 - Quality , Patient Safety, and Communicatio n, and Recordkeeping Kacmarek et al.: Egan’s Fundamentals of Respiratory Care, 12th Edition MULTIPLE CHOICE
Which of the following is/are potential area(s) of risk to patients receiving respiratory care? Movement and ambulation Electrical shock Fire hazards 1 only and 3 only only 1, 2, and 3 ANS: D
The key areas of potential risk are (1) patient movement and ambulation, (2) electrical hazards, and (3) fire hazards. DIF: Recall
REF: p. 42
OBJ: 2 | 3
Lifting heavy objects is best done with which of the following techniques? Straight spine, bent legs Straight spine, straight legs Bent spine, bent legs Bent spine, straight legs ANS: A
Note that the correct technique calls for a straight spine and use of the leg muscles to lift the object. DIF: Application
REF: p. 43
OBJ: 1
Which of the following factors are most critical in determining when a patient can be ambulated? Willingness of patient Stability of vital signs Absence of severe pain 2 and 3 only 1 and 2 only 1, 2, and 3 1 and 3 only ANS: A
Ambulation should begin as soon as the patient is physiologically stable and free of severe pain. DIF: Application
REF: p. 43
OBJ: 2
Which of the following statements is false about patient ambulation? Ambulation is necessary for normal body functioning.
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Patients must be carefully monitored during ambulation. Chairs or emergency supports must be available during ambulation. Patients with intravenous (IV) lines should not be ambulated. ANS: D
Place all equipment (e.g., intravenous [IV] equipment, nasogastric tube, surgical drainage tubes) close to the patient to prevent dislodging during ambulation. DIF: Application
REF: p. 43
OBJ: 2
Which of the following parameters should be monitored during ambulation? Skin color Breathing rate and effort Level of consciousness Urine output 1 and 2 only 3 and 4 only 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
Skin color, breathing rate and effort, and level of consciousness provide clues to how well the patient is tolerating ambulation. DIF: Application
REF: p. 43
OBJ: 2
Which of the following terms describes the power potential behind electrical energy? Voltage Current Ohms Resistance ANS: A
Voltage is the power potential behind the electrical energy. DIF: Recall
REF: p. 44
OBJ: 3
Which of the following is used to report electrical current? Ohms Voltage Amps Cycles ANS: C
Current is the flow of electricity from a point of higher voltage to one of lower voltages and is reported in amperes (or amps). DIF: Recall
REF: p. 44
OBJ: 3
What is the primary factor determining the effect of an electrical shock? Current Temperature
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Resistance Voltage ANS: A
It is important to note that current represents the greatest danger to you or your patients when electrical shorts occur. DIF: Recall
REF: p. 45
OBJ: 4
Which of the following are key factors determining the extent of harm caused by an electrical current? Duration for which the current is applied Path the current takes through the body Amount of current flowing through the body The location the current enters the body and 4 only and 3 only 1, 2, and 3 1, 2, and 4 only ANS: C
The harmful effects of current depend on (1) the amount of current flowing through the body, the path it takes, and (3) the duration the current is applied. DIF: Application
REF: p. 45
OBJ: 4
If 120 V are applied to a system with 1000 Ohms of resistance, what is the current? 100 A 100 Ohms 120 mA 120 A ANS: C
The current is now calculated as amps = 120 V/1000 Ohms = 0.12 A or 120 mA. DIF: Application
REF: p. 45
OBJ: 3
Which of the following organs is the most sensitive to the effects of electrical shock? Liver Heart Kidneys Lungs ANS: B
Because the heart is susceptible to any current level above 100 mA, the 120 mA represents a potentially fatal shock. DIF: Recall
REF: p. 45
OBJ: 4
In which of the following clinical situations is the normally high resistance of the skin bypassed? In patients with external pacemaker wires
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In patients with saline-filled catheters In patients with intact, dry skin 2 and 3 only 1, 2, and 3 1 and 2 only 3 only ANS: C
Current can readily flow into the body, causing damage to vital organs when the skin is bypassed via conductors such as pacemaker wires or saline-filled intravascular catheters. DIF: Application
REF: p. 45
OBJ: 4
When a relatively high current (usually >1 mA, or 1/1000 A) is applied externally to the skin, which of the following conditions exists? Macroshock hazard Grounding hazard Microshock hazard Isolation hazard ANS: A
A macroshock exists when a high current (usually >1 mA) is applied externally to the skin. DIF: Application
REF: p. 45
OBJ: 4
When a small, usually imperceptible current (usually <1 mA) is allowed to bypass the skin and follow a direct, low resistance pathway into the body, which of the following conditions exists? Macroshock hazard Grounding hazard Isolation hazard Microshock hazard ANS: D
A microshock exists when a small, usually imperceptible current (<1 mA) bypasses the skin and follows a direct, low-resistance path into the body. DIF: Application
REF: p. 45
OBJ: 4
High amperage (6 A or more) applied externally to the skin can cause which of the following? Sustained myocardial contraction Respiratory paralysis Skin burns 1 and 2 only 2 and 3 only 1, 2, and 3 1 and 3 only ANS: C
Table 3-1 summarizes the different effects of these two types of electrical shock. DIF: Recall
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REF: p. 47
OBJ: 4
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Which of the following currents passing through the chest can cause ventricular fibrillation, diaphragm dysfunction (due to severe, persistent contraction), and death? 100 mA 100 A 100 µA 10 µA ANS: A
Higher currents (exceeding 100 mA) that pass through the chest can cause ventricular fibrillation, diaphragm dysfunction (due to severe, persistent contraction), and death. Table 3-1 summarizes the different effects of these two types of electrical shock. DIF: Analysis
REF: p. 47
OBJ: 4
What is the primary purpose of grounding all electrical equipment used in the hospital setting? To prevent the dangerous buildup of voltage in the equipment To make the equipment more secure and less likely to break down To avoid excessive energy costs To convert electrical power from DC to AC ANS: A
In these cases, the third (ground) wire prevents the dangerous buildup of voltage that can occur on the metal frames of some electrical equipment. DIF: Application
REF: p. 46
OBJ: 3
Where do most hospital fires initially start? Clinical laboratory Kitchen Electrical engineering post Patient’s room ANS: B
Approximately 90% of fires in health care facilities occur in hospitals and the most common site for the origin of the fire is the kitchen. DIF: Recall
REF: p. 47
OBJ: 6
Which of the following are true about fires in oxygen (O 2 )-enriched atmospheres? They are more difficult to put out. They burn more quickly. They burn more intensely. 1 and 2 only 2 and 3 only and 3 only 1, 2, and 3 ANS: D
Fires in O2 -enriched atmospheres are larger, more intense, faster burning, and more difficult to extinguish.
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DIF: Application
REF: p. 47
OBJ: 7
Which of the following conditions must be met for a fire to occur? Temperature high enough for combustion Presence of O2 Presence of flammable material 1 and 2 only and 3 only and 3 only 1, 2, and 3 ANS: D
For a fire to start, three conditions must exist: (1) flammable material must be present, (2) O 2 must be present, and (3) the flammable material must be heated to or above its ignition temperature. DIF: Application
REF: p. 47
OBJ: 7
Which of the following statements are true regarding the use of O2 ? O 2 is flammable. O 2 accelerates the rate of combustion. Increased O2 concentration accelerates the rate of combustion. 1 and 2 only and 3 only 1 and 3 only 1, 2, and 3 ANS: B
Although O2 is nonflammable, it greatly accelerates the rate of combustion. Burning speed increases with an increase in either the concentration or partial pressure of O 2 . DIF: Recall
REF: p. 47
OBJ: 7
How can the risk of fire because of static electrical discharge in the presence of O 2 be minimized? Use only wool or polyester fabrics in the area of use. Keep O2 concentrations well below 21%. Maintain high relative humidity in the area of use. Keep O2 in high-pressure storage cylinders. ANS: C
The minimal risk that may be present can be further reduced by maintaining high relative humidity (>60%). DIF: Application
REF: p. 48
OBJ: 7
In the standard approach to hospital fires, the RACE plan has been suggested. What does the letter ―C‖ stand for in this approach? Capture Contain Call for help Collapse Type here]
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ANS: B
The third step is to contain the fire as much as possible by closing doors and turning O2 zone valves off. DIF: Application
REF: p. 48
OBJ: 7
Nonverbal communication includes which of the following? Gesture Touch Voice tone Space 1 and 3 only only and 4 only d. 1, 2, 3, and 4 ANS: D
Nonverbal communication includes gestures, facial expressions, eye movements and contact, voice tone, space, and touch. DIF: Recall
REF: p. 49
OBJ: 9
Which of the following components of communication is a method used to transmit messages? Sender Channel Receiver Feedback ANS: B
The channel of communication is the method used to transmit messages. DIF: Application
REF: p. 49
OBJ: 9
Which of the following are methods for communicating empathy to your patients? Use of touch Use of key words Use of eye contact Use of the authority 1, 2, and 3 only 1 and 3 only c. 1, 2, 3, and 4 d. 2, 3, and 4 only ANS: A
The use of touch and proper eye contact can demonstrate genuine concern for your patient. Key words and phrases such as ―I und erstand‖ can let the patient know you are listening and interested. DIF: Application
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REF: p. 50
OBJ: 9
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Which of the following factors can have an impact on the outcomes of therapeutic communication between patient and practitioner? Verbal and nonverbal components of expression Environmental factors (e.g., noise, privacy) Values and beliefs of both patient and practitioner Sensory and emotional factors (e.g., fear, pain) 1, 2, and 3 only and 3 only c. 1, 2, 3, and 4 d. 2, 3, and 4 only ANS: C
Many factors affect communication in the health care setting (Figure 3-11). DIF: Application
REF: p. 50
OBJ: 9
Which of the following techniques should not be used to improve one’s effectiveness as a sender of messages? Share information rather than telling. Emphasize agreement over disagreement. Eliminate threatening behavior. Use effective nonverbal communication. ANS: B
Others will not always agree with what you say. Do not become defensive when others disagree with you; simply try to understand their perspective and be open to their input. DIF: Application
REF: p. 52
OBJ: 12
Which of the following techniques can be used to improve one’s listening skills? Resist distractions. Maintain composure and control emotions. Keep an open mind (be objective). Judge the sender’s delivery, not the content. 2 and 3 only and 4 only 1, 2, and 3 only and 4 only ANS: C
The content of what is being said is the issue to focus on. How it is delivered is not that important. Some people are more articulate than others, but the message is most important. DIF: Application
REF: p. 52
OBJ: 12
Maintaining eye contact, leaning toward the patient, and nodding your head are all good examples of what communication technique? Clarifying Empathizing Attending Reflecting
Type here]
Verified test bank
[Type here]
ANS: C
Attending involves the use of gestures and posture that communicate one’s attentiveness. Attending also involves confirming remarks such as, ―I see what you mean.‖ DIF: Application
REF: p. 52
OBJ: 12
Techniques to help ensure that understanding is taking place between the parties involved inan interaction include which of the following? Clarifying Paraphrasing Perception checking Attending 1, 2, and 3 only 1 and 3 only c. 1, 2, 3, and 4 d. 2, 3, and 4 only ANS: C
All four techniques can be useful to enhance communication. DIF: Application
REF: p. 52
OBJ: 12
A patient’s response to an interview question is initially unclear. Which of the following responses on your part would be most appropriate? ―Please go on.‖ ―You seem to be anxious.‖ ―Please explain that to me again.‖ ―Yes, I think I understand.‖ ANS: C
Requesting clarification is done by asking the patient to explain his or her thought again. DIF: Application
REF: p. 52
OBJ: 12
A therapist who says ―You seem to be anxious about your surgery‖ to a patient just admittedfor bypass surgery is using what interpersonal communication technique? Clarifying Paraphrasing Perception checking Reflecting feelings ANS: D
Reflecting feelings is the process of telling patients about how you perceive their feelings. It encourages patients to discuss their feelings further. DIF: Application
REF: p. 53
OBJ: 11
Which of the following strategies for conflict resolution represents a middle-ground strategythat combines assertiveness and cooperation? Avoiding Competing Compromising Type here]
Verified test bank
[Type here]
Accommodating ANS: C
Compromising is a middle-ground strategy that combines assertiveness and cooperation. DIF: Recall
REF: p. 54
OBJ: 13
What form of patient record is most designed to succinctly report data in a time-oriented format and to decrease time needed for documentation? Subjective, objective, assessment, and plan (SOAP) record Problem-oriented, medical record (POMR) record Flowsheet Progress note ANS: C
Flowsheets are designed to briefly report data and to decrease time spent in documentation. DIF: Recall
REF: p. 56
OBJ: 14
The elements of a POMR entry would include which of the following? Patient’s subjective complaints and concerns Objective data gathered by the health professional Assessment of the subjective and objective data Plan to address the identified problem(s) 1, 2, and 3 only and 3 only c. 1, 2, 3, and 4 d. 1, 3, and 4 only ANS: C
The POMR progress notes contain the findings (subjective and objective data), assessment, plans, and orders of the doctors, nurses, and other practitioners involved in the care of the patient. The format used is often referred to as SOAP. ―S‖ = subjective information; ―O‖ = objective information; ―A‖ = assessm ent; ―P‖ = plan of care. DIF: Application
REF: p. 56
OBJ: 14
Information about a patient’s nearest kin, physician, and initial diagnosis can be found in which section of the medical record? History and physical exam Admission sheet Physician’s orders Consultation sheet ANS: B
See Box 3-6. DIF: Recall
REF: p. 55
OBJ: 14
To verify a physician’s prescription for a drug that you need to give to a patient, you would goto which section of the medical record? History and physical exam
Laboratory sheet Physician’s orders Medication record ANS: C
See Box 3-6. DIF: Recall
REF: p. 55
OBJ: 14
To determine the most recent medical status of a patient whom you are about to start treating,you would go to which section of the medical record? Progress sheet Nurses’ notes Physician’s orders History and physical exam ANS: A
See Box 3-6. DIF: Recall
REF: p. 55
OBJ: 14
To find out what drugs or intravenous fluids a patient has received recently, you would go to which section of the medical record? Progress sheet Nurses’ notes Physician’s orders Medication record ANS: D
See Box 3-6. DIF: Recall
REF: p. 55
OBJ: 14
What is a time-based record of measurement during a specialized procedure such as mechanical ventilation? Consultation sheet Specialized flowsheet Progress notes Graphic sheet ANS: B
See Box 3-6. DIF: Recall
REF: p. 55
OBJ: 14
A pulmonary specialist has been called in by an internist to examine a patient and assist with a diagnosis. Where in the patient’s medical record would you look for the pulmonary specialist’s report? Progress sheet Consultation sheet Physician’s orders History and physical exam
ANS: B
See Box 3-6. DIF: Recall
REF: p. 55
OBJ: 14
Which of the following is the correct way to sign a medical record entry? CAW, LRCP, CRT CAW, Respiratory Department C. White, LRCP, CRT Cathy White, Therapist, Respiratory Department ANS: C
See Box 3-7. DIF: Application
REF: p. 56
OBJ: 15
Which of the following is an acceptable practice in medical recordkeeping? Leaving blank lines Erasing incorrect entries Using ditto marks Using standard abbreviations ANS: D
See Box 3-7. DIF: Recall
REF: p. 56
OBJ: 15
If you make a mistake when charting a patient treatment, what should you do? Make a new entry (called ―correction‖) just below the mistake. Erase the mistake and have your supervisor countersign it. Draw a line through the mistake and write ―error‖ above it. Have your supervisor make the chart correction later. ANS: C
See Box 3-7. DIF: Recall
REF: p. 56
OBJ: 15
Which of the following are unacceptable practices in medical recordkeeping? Specifying when you will return to provide patient therapy Providing your own interpretation of a patient’s symptoms Recording the patient’s complaints and general behavior Charting several separate tasks under a single chart entry and 4 only 1 and 2 only 1 and 4 only 1, 2, and 4 only ANS: A
See Box 3-7. DIF: Recall
REF: p. 56
OBJ: 15
What is the role of the RT during a disaster situation? Transporting the critically ill patients to safety first Shutting off the main O 2 supply in the hospital Getting themselves to safety Going to look for a backup generator ANS: A
Part of the RT’s role of disaster preparedness includes transport and transfer of the critically ill patients. DIF: Application
REF: p. 48
OBJ: 8
What was one of The Joint Commission’s (TJC) goals for 2010? To improve accuracy of patient identification To lessen costs To enforce proper infection control To have more case studies ANS: A
TJC’s goals for 2010 were to improve accuracy of patient identification. DIF: Recall
REF: p. 50
OBJ: 10
Improper storage or handling of medical gas cylinders can result in which of the following? Increased risk of fire Explosive releases of high-pressure gas Toxic effects of some gases A contained environment 1, 2 and 4 only 1 and 2 only 1 and 4 only 1, 2, and 3 only ANS: D
All of the above result from improper storage and handling of medical gas cylinders. DIF: Recall
REF: p. 49
OBJ: 8
Which group or organization regulates the storage of medical gases? The Department of Transportation (DOT) National Fire Protection Association (NFPA) The Joint Commission (TJC) HIPPA ANS: B
National Fire Protection Association (NFPA) regulates the storage of medical gases. Monitoring is done by The Joint Commission. DIF: Recall
REF: p. 49
OBJ: 8
An RT is instructing a patient on a particular piece of equipment and should use which scenario on educating the patient? Call Back Read Back Teach Back A short quiz ANS: C
A Teach Back scenario will be helpful for the RT to know if the patient understands what is being explained regarding equipment use. DIF: Application
REF: p. 51
OBJ: 12
Chapter 04 - Principles of Infection Prevention and Control Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE
Approximately what percent of hospitalized patients develop a health care–associated infection? 1% 4% c. 10% d. 25% ANS: B
Patients are at risk for developing infections during their hospital stay. A recent study estimated that 4% of hospitalized patients in the United States develop a health care– associated infection. DIF: Recall
REF: p. 60
OBJ: 1
Which of the following is considered the primary source of infection in the health care setting? Medical equipment Humans Food and water Carpet ANS: B
Humans (patients, personnel, or visitors) are the primary sources for infectious agents in the health care setting. DIF: Recall
REF: p. 60
OBJ: 1
How do endotracheal tubes increase the risk of infection? By increasing bleeding risks Providing surfaces for biofilms to develop By reducing neutrophil effectiveness By increasing mucociliary escalator clearance ANS: B
Endotracheal tubes allow pathogens to increase the risk of infection by impeding local host defenses and providing biofilms that may facilitate adherence of pathogens. DIF: Application
REF: p. 60
OBJ: 5
Which of the following factors increase the risk of surgical patients for developing postoperative pneumonia? Obesity Prolonged intubation History of smoking Elderly
and 3 only and 4 only 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: D
Patients at highest risk include elderly persons, the severely obese, those with chronic obstructive pulmonary disease (COPD) or a history of smoking, and those having an artificial airwayin place for long periods. Strong cough mechanism actually helps to prevent atelectasis and pneumonia. DIF: Recall
REF: p. 60
OBJ: 4
What is the most common route of pathogen transmission in the hospital setting? Indirect contact Droplet transmission Airborne transmission Surgical transmission ANS: A
Indirect contact transmission is the most frequent mode of transmission in the health care environment. DIF: Recall
REF: p. 61
OBJ: 3
Which of the following is an example of indirect contact transmission involving fomites? Use of a sterile needle on a pneumonia patient Use of a dirty laryngoscope blade on another patient Drinking tap water Inhaling tuberculosis pathogens in the emergency department ANS: B
Instruments that have been inadequately cleaned between patients before disinfection or sterilization are an example of indirect contact transmission involving fomites. DIF: Application
REF: p. 62
OBJ: 3
If you are caring for a patient who is suspected of having SARS, at what distance from the patient is it recommended to wear an effective filtration mask? 6 ft 10 ft 12 ft 15 ft ANS: A
Current HICPAC guidelines state it may be prudent to don a mask when within 6 ft of the patient or upon entry into the room of a patient who is on droplet isolation. DIF: Application
REF: p. 62
OBJ: 9
Which of the following diseases are transmitted primarily by airborne transmission? Tuberculosis
Measles Smallpox Viral hemorrhagic fever 1, 2, and 3 only and 4 only 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: A
The pathogens transmitted by the airborne route include Mycobacterium tuberculosis, varicella-zoster virus (chickenpox), and rubeola virus (measles). Airborne transmission of variola (smallpox) has been documented and airborne transmission of SARS, monkeypox, and the viral hemorrhagic fever virus has been reported, although not proved conclusively. DIF: Recall
REF: p. 62
OBJ: 3
What techniques are used by most hospitals to reduce host susceptibility to infection? Immunization Blood testing Surveillance Having patients wear N95 mask ANS: D
Hospital efforts to decrease host susceptibility focus mainly on employee immunization and chemoprophylaxis. DIF: Recall
REF: p. 64
OBJ: 6
What vaccination does OSHA require hospital employers to provide? Tuberculosis Smallpox Hepatitis B Streptococcus pneumoniae ANS: C
OSHA mandates that employers offer hepatitis B vaccination. DIF: Recall
REF: p. 62
OBJ: 6
What is the first step in equipment processing for reuse on another patient? Drying the equipment Cleaning the equipment Disinfecting the equipment Sterilizing the equipment ANS: B
Cleaning is the first step in all equipment processing. DIF: Recall
REF: p. 63
OBJ: 8
Which of the following statements is NOT true regarding the use of soaps to clean equipment? Soaps act by lowering the surface tension.
Soaps work poorly in hard water. Soaps have good bactericidal activity. Soaps can help remove organic material. ANS: C
Soaps act by lowering surface tension and forming an emulsion with organic matter. Unfortunately, soaps have little bactericidal activity and work poorly in hard water. A detergent refers to a substance (usually a chemical agent but sometimes a physical one) applied to inanimate objects that destroys disease-causing pathogens but not spores. DIF: Application
REF: p. 63
OBJ: 7
What should be used to wipe down the surface of devices that cannot be immersed in water? 70% ethyl alcohol Warm soapy water Strong detergent Bleach ANS: A
The surface of the device should be disinfected using a 70% ethyl alcohol solution or the equivalent. DIF: Recall
REF: p. 70
OBJ: 7
Which of the following organisms is NOT destroyed by a disinfection agent? Gram-negative cocci Bacterial spores Gram-positive rods Viruses ANS: B
Disinfection describes a process that destroys the vegetative form of all pathogenic organisms on an inanimate object except bacterial spores. DIF: Recall
REF: p. 70
OBJ: 7
What solution should be used to disinfect the surfaces of the room of a patient who was infected with C. difficile? 70% ethyl alcohol 5.25% sodium hypochlorite 1% sodium benzoate 5% iodine solution ANS: B
Because C. difficile may form spores that are resistant to commonly used surface disinfectants, the CDC recommends the use of 1:10 dilution of 5.25% sodium hypochlorite (household bleach) and water for routine environmental disinfection in the rooms of patients with C. difficile. DIF: Recall
REF: p. 73
OBJ: 7
Which of the following statements is false regarding the use of alcohol disinfectants?
Their activity drops when diluted below 50% concentration. Alcohols are good for surface cleaning of stethoscope bells and diaphragms. They can damage rubber tubing. They are considered sporicidal. ANS: D
Alcohol disinfectants in the health care setting refer to either ethyl alcohol or isopropyl alcohol. Neither is considered a high-level disinfectant as a single agent, they are not sporicidal, and they do not penetrate protein-rich materials. Their activity drops when diluted below 50% concentration. Alcohols are inactivated by protein and can damage rubber, plastics, and the shellac mounting of lensed instruments. Alcohol wipes are a good choice for disinfecting small surfaces, such as medication vial tops. Alcohols are also useful as surface disinfectants for stethoscopes, ventilators, and manual ventilation bags. DIF: Recall
REF: p. 73
OBJ: 7
Which of the following characteristics is false for iodophors as disinfectants? Water soluble Nonstaining Less irritating to tissue Bacteriostatic ANS: D
Unlike iodine tinctures, iodophors are water soluble, nonstaining, and less irritating to tissue. Iodophors are bactericidal, virucidal, and tuberculocidal. DIF: Recall
REF: p. 73
OBJ: 7
Which of the following statements is false regarding the use of glutaraldehyde? It is a true sterilizing agent when used properly. It can retain activity up to 90 days once activated. It is used for disinfection on surfaces due to cost. It can cause significant tissue inflammation in workers who use it. ANS: B
Glutaraldehyde (saturated dialdehyde) is a commonly used high-level disinfectant/sterilant. When aqueous solutions of 2% glutaraldehyde are alkalized (―activated ‖) to a pH between 7.5 and 8.5, glutaraldehyde can kill vegetative bacteria, M. tuberculosis, fungi, viruses, and spores in less than 10 min (see Table 4-3). This sporicidal activity qualifies glutaraldehyde as a true sterilizing agent. DIF: Recall
REF: p. 74
OBJ: 7
What is the recommended dilution level of bleach according to the CDC for cleaning up blood spills? a. 1:1 b. 1:5 c. 1:10 d. 1:20 ANS: C
The CDC recommends a 1:10 dilution of bleach (or an Environmental Protection Agency [EPA]-registered disinfectant) to disinfect blood spills. DIF: Recall
REF: pp. 77-78
OBJ: 7
What is the most common, efficient, and easiest sterilization method? ETO Flash sterilization Steam sterilization Use of hydrochlorofluorocarbon ANS: C
Moist heat in the form of steam under pressure is the most common, efficient, and easiest sterilization method. DIF: Recall
REF: p. 71
OBJ: 7
Which of the following statements is false regarding the use of ETO for sterilization? It is harmless to rubber and plastics. It will penetrate prewrapping. Acute exposure is of little consequence. It is useful for equipment that cannot be autoclaved. ANS: C
Unfortunately, acute exposure to ETO gas can cause airway inflammation, nausea, diarrhea, headache, dizziness, and even convulsions. DIF: Recall
REF: pp. 70-72
OBJ: 7
Which of the following is the most common source of patient infections? Large volume nebulizers Small volume nebulizers Internal circuits of a ventilator Oxygen therapy devices ANS: A
Large volume nebulizers are the worst offenders. DIF: Recall
REF: p. 73
OBJ: 4
Which of the following steps for disinfection of a bronchoscope is false? The first step is cleaning the scope. Disinfection is done by immersion in a liquid disinfectant. The device is stored lying flat to promote drying. Drying techniques can include forced air. ANS: C
Store in a manner so that the bronchoscope is vertical to prevent recontamination and facilitate drying. DIF: Recall
REF: p. 72
OBJ: 7
Which of the following organisms has/have been associated with health care–associated infections in patients using a poorly disinfected bronchoscope? M. tuberculosis Pseudomonas aeruginosa Klebsiella and 3 only and 3only 2 only 1, 2, and 3 ANS: A
Health care–associated infections associated with bronchoscopes have been most commonly reported with M. tuberculosis, nontuberculosis mycobacterium, and P. aeruginosa. DIF: Recall
REF: p. 79
OBJ: 4 | 5
Which of the following statements is/are true regarding the use of disposable respiratory care equipment? Recent research supports their use as a cost-effective measure. Many quality issues exist. Reusing the equipment is often done. 1 and 3 only and 3only 2 only 1, 2, and 3 ANS: D
Three major issues are involved in using disposables: cost, quality, and reuse. DIF: Recall
REF: p. 80
OBJ: 8
Which of the following are categories under Expanded Precautions? Contact Precautions Droplet Precautions Standard Precautions Airborne Infection Isolation 1 and 2 only 1, 2, and 4 only 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: B
There are four categories of Expanded Precautions: Contact Precautions, Droplet Precautions, Airborne Infection Isolation, and Protective Environment. DIF: Recall
REF: p. 69
OBJ: 8
What is the minimum recommended time for handwashing in the health care environment? 5 sec 15 sec 30 sec
60 sec ANS: B
Hand hygiene includes handwashing with both plain or antiseptic-containing soap and water for at least 15 sec. DIF: Recall
REF: p. 63
OBJ: 6
Which of the following diseases is transmitted through direct contact? HIV Pertussis Hepatitis B Hepatitis C ANS: A
The only one of those diseases that is transmitted through direct contact is HIV. Hepatitis B and C are both indirect contact, and pertussis is through droplet transmission. DIF: Recall
REF: p. 61
OBJ: 4
Which of the following diseases travels through droplet mode? Influenza Rickettsia Malaria Lyme disease ANS: A
Influenza travels through droplet mode. Rickettsia, Lyme disease, and malaria are vector-borne. DIF: Recall
REF: p. 61
OBJ: 4
What is included in a Prevention Bundle? The use of multiple evidence-based best practices to prevent device-related infection. Recent research supports the use of cost-effective measurements. An ongoing process of monitoring patients and personnel for the acquisition of infection in the health care setting. Using prophylactic antibiotic therapy on all hospitalized patients. 1 and 2 only 1, 2, and 3 only 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: B
Prevention Bundle is the use of multiple evidence-based best practices to prevent device-related infection. DIF: Recall
REF: p. 62
OBJ: 6
Small volume nebulizers produce bacterial aerosols that have been commonly associated with which of the following diseases? Pseudomonas aeruginosa
Measles Small pox Nosocomial pneumonia ANS: D
Small volume nebulizers produce bacterial aerosols that have been associated with nosocomial pneumonia. DIF: Application
REF: p. 73
OBJ: 5
What is the purpose of an inspiratory HEPA filter in a ventilator circuit? The purpose is to serve as a heated thermistor that prevents condensation from forming in the circuits. It prevents pathogens from being expelled into the surroundings. When placed between the ventilator and the circuit, it can eliminate bacteria. None of the above. ANS: C
The purpose of an inspiratory HEPA filter, when it is placed between the ventilator and the external circuit, is to eliminate bacteria from the driving gas and prevent retrograde contamination back into the ventilator. DIF: Application
REF: p. 73
OBJ: 8
The unit residence asked you to reduce the risk of contamination caused by condensation in the circuit of a mechanically ventilated patient. Which of the following would help to reduceor eliminate condensation in this patient’s circuit? Using a heat and moisture exchange (HME) By draining the circuit on a daily basis By not using any form of heater at all By lowering the temperature in the heater ANS: A
By replacing an active humidification system by a passive humidification one (HME), there will be less condensation in the circuit because no water is being used to heat and moisten the air, but instead the patient’s own body heat is used. Draining the circuit daily, not using heat, or lowering the heater temperature is not acceptable and may place the patient at risk of infection caused by inspissated secretions among other consequences. DIF: Analysis
REF: p. 73
OBJ: 6
Which of the following is the simplest level of infection control based on the recognition thatall blood, body fluids, secretions, and excretions may contain transmissible infections agents? Contact Precautions Droplet Precautions Standard Precautions Airborne Infection Isolation ANS: C
The term Standard Precautions refers to the simplest level of infection control based on the recognition that all blood, body fluids, secretions, and excretions (with the exception of sweat) may contain transmissible infectious agents.
DIF: Recall
REF: p. 63
OBJ: 8
Chapter 05 - Ethical and Legal Implications of Practice Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE
Which of the following sanctions can apply when one breaks a law? Reparations or fines Incarceration Licensure suspension Professional censure 1 and 2 only 1, 2, and 3 only 3 only d. 1, 2, 3, and 4 ANS: B
The force behind law is statutory punishment, ranging from reparations and fines to licensure suspension and incarceration. DIF: Recall
REF: p. 82
OBJ: 1
What simple question does ethics attempt to answer? Who is right and who is wrong? How should we act? What treatment is best? Who benefits most? ANS: B
Ethics is primarily concerned with the question, How should we act? DIF: Recall
REF: p. 82
OBJ: 1
What ethical issue has recently become a significant concern for respiratory therapists and all health care providers due to a congressional act? Patient’s right to privacy Patient’s right to care Patient’s right to consultation Patient’s right to refuse treatment ANS: A
The new century has brought one particular challenge, although not new to health care or to respiratory therapists: a heightened awareness of the patient’s right to privacy. DIF: Recall
REF: p. 82
OBJ: 1
In most professions, specific guidance in resolving ethical dilemmas is provided by which ofthe following? An ethical theory A code of ethics Civil statutes
Criminal statutes ANS: B
Specific guidance in resolving ethical dilemmas is usually provided by a professional code of ethics. General approaches involve the use of ethical theories and principles to reach a decision. DIF: Recall
REF: p. 83
OBJ: 2
The AARC Code of Ethics holds professionals to which of following principles? Actively maintaining and improving one’s competence Following sound scientific procedures and ethical principles in research Promoting disease prevention and wellness Respecting and protecting the rights of patients they treat a. 1, 2, 3, and 4 2 and 4 only 1, 2, and 3 only 4 only ANS: A
The current code appears in Box 5-1. DIF: Recall
REF: p. 83
OBJ: 3
Primary guiding principles in contemporary ethical decision making include which of the following? Nonmaleficence Autonomy Justice Role fidelity a. 2, 3, and 4 only b. 1, 2, 3, and 4 3 and 4 only 2 and 3 only ANS: B
Autonomy, veracity, nonmaleficence, beneficence, confidentiality, justice, and role fidelity are primary guiding principles in contemporary ethical decision making. DIF: Recall
REF: pp. 85-86
OBJ: 4
Which ethical principle obliges a respiratory therapist to uphold a patient’s right to refuse a treatment? Autonomy Veracity Role fidelity Beneficence ANS: A
Under the principle of autonomy, a respiratory therapist’s use of deceit or coercion to get a patient to reverse the decision to refuse a treatment is considered unethical.
DIF: Application
REF: p. 85
OBJ: 4
A health professional who withholds the truth from a patient, saying it is for his or her own good, is engaged in what practice? Fraud Infidelity Benevolent deception Nonmaleficence ANS: C
Problems with the veracity principle revolve around issues such as benevolent deception. DIF: Application
REF: p. 85
OBJ: 4
What ethical principle can be used to justify the pain that might occur in drawing blood from a patient for a diagnostic test? Nonmaleficence Benevolent deception Do no harm Double effect ANS: D
The double effect brings us to the essence of the definition of the word dilemma. DIF: Application
REF: p. 86
OBJ: 4
The debate over prolongation of life versus relief of suffering in elderly patients mainly involves differing opinions regarding what ethical principle? Autonomy Beneficence Role fidelity Justice ANS: B
This presents real dilemmas for those who are confronted with the ability to prolong life but not the ability to restore any uniquely human qualities. DIF: Application
REF: p. 86
OBJ: 4
What type(s) of advanced directives can patients use to help resolve ethical dilemmas involving their life-sustaining care? Durable power of attorney Written interrogatory Living will 2 and 3 only 1 and 2 only and 3 only 1, 2, and 3 ANS: C
The two types of advanced directives currently available and relatively widely used are the living will and the durable power of attorney for health care.
DIF: Application
REF: p. 86
OBJ: 13
Under what conditions can the principle of confidentiality be breached? When the welfare of the community or a vulnerable individual is at stake When the health professional believes that the information is not vital When a patient tells the health professional that there are no secrets When a lawyer tells the health professional that the information must be revealed ANS: A
For example, if the patient were planning to marry, the harm principle would require that confidentiality be broken because of the special vulnerability of the spouse. DIF: Analysis
REF: pp. 86-87
OBJ: 4
The moral basis for rationing health care services falls under what ethical principle? Compensatory justice Harm Distributive justice Role duty ANS: C
The principle of justice involves the fair distribution of care. DIF: Recall
REF: p. 88
OBJ: 4
Which of the following has played a minor role in increasing the cost of health care? Beneficence Compensatory justice Distributive justice Role fidelity ANS: B
The Congressional Budget Office estimates that less than 2% of the cost of health care is related to medical malpractice. Studies by Zurich Insurance Company, Harvard University, and Dartmouth University showed little, if any, impact on the cost of health care. The Harvard study showed patients were uncompensated in the presence of actual malpractice more frequently than physicians were held accountable in the absence of actual malpractice. DIF: Recall
REF: p. 88
OBJ: 1
When a respiratory therapist defers a patient’s questions about a condition to the attending physician, what ethical principle is being practiced? Autonomy Beneficence Role fidelity Harm principle ANS: C
For example, because of differences in role duty, a respiratory therapist might be ethically obliged not to tell a patient’s family how critical the situation is, instead having the attending physician do so.
DIF: Analysis
REF: p. 88
OBJ: 4
A clinician who justifies support for withdrawing life support from a patient because ―in theend, it would be best for all involved‖ is applying what ethical viewpoint? Relativism Formalism Consequentialism Virtue ethics ANS: C
The principle of utility, in its simplest form, aims to promote the greatest general good for most people. The most common application of consequentialism judges acts according to the principle of utility. DIF: Analysis
REF: pp. 88-89
OBJ: 4
A clinician who justifies not billing a poor patient for services rendered because ―that’s what a professional should do‖ is applying what ethical viewpoint? Relativism Formalism Consequentialism Virtue ethics ANS: D
When the professional is faced with an ethical dilemma, he or she needs to only envision what the ―good practitioner‖ would do in a similar circumstance. DIF: Application
REF: p. 90
OBJ: 4
Before making any ethical decision, one should take which of the following actions? Identify the individuals involved. Identify what ethical principle(s) apply. Identify who should make the decision. Consider the alternatives. a. 2, 3, and 4 only b. 1, 2, 3, and 4 3 and 4 only 3 only ANS: B
See Box 5-2. DIF: Analysis
REF: p. 91
OBJ: 5
Divisions of public law (the relationships of private parties and the government) include: Administrative Civil Criminal and 3 only and 2 only and 3 only
1, 2, and 3 ANS: C
The two major divisions of public law are criminal law and administrative law. DIF: Application
REF: p. 92
OBJ: 6
What branch of law is concerned with the recognition and enforcement of the rights and dutiesof private individuals and organizations? Administrative Civil Criminal Common ANS: B
Private or civil law protects private citizens and organizations from others who might seek to take unfair and unlawful advantage of them. DIF: Recall
REF: p. 92
OBJ: 6
What is the term for a civil wrong committed against an individual or property, for which a court provides a remedy in the form of damages? Tort Misdemeanor Felony Litigation ANS: A
A tort is a civil wrong, other than a breach of contract, committed against an individual or property, for which a court provides a remedy in the form of an action for damages. DIF: Recall
REF: p. 92
OBJ: 6
Which of the following are necessary to validate a claim of professional negligence? The practitioner owed a duty to the patient. The practitioner was derelict with that duty. The breach of duty was the direct cause of damages. Damage or harm came to the patient. a. 1, 2, 3, and 4 2, 3, and 4 only and 3 only and 4 only ANS: A
See Box 5-3. DIF: Application
REF: p. 92
OBJ: 7
In a case of professional negligence, all of the following are required to support a claim of resipsa loquitur except: evidence must exist to show that the defendant acted with malfeasance or intent. the action responsible for the injury was under the control of the defendant.
the harm was such that it would not normally occur without someone’s negligence. negligence or voluntary risk-taking by the plaintiff did not contribute to the injury. ANS: A
The legal principle res ipsa loquitur (―the thing speaks for itself‖) may apply. Res ipsa loquitur is sometimes invoked to show that the harm would not ordinarily have happened if those in control had used appropriate care. DIF: Application
REF: p. 93
OBJ: 7
A physician who participates in active euthanasia is committing what type of malpractice? Civil Professional Criminal Ethical ANS: C
Criminal malpractice includes crimes such as assault and battery or euthanasia (handled in criminal court). DIF: Analysis
REF: p. 94
OBJ: 7
A nurse who practices below a reasonable standard of care is committing what type of malpractice? Civil Statutory Criminal Ethical ANS: A
Civil malpractice is negligence or practice below a reasonable standard. DIF: Application
REF: p. 94
OBJ: 7
A respiratory therapist who engages in a questionable business practice is committing whattype of malpractice? Civil Statutory Criminal Ethical ANS: D
Questionable business practice is an example of ethical malpractice. DIF: Application
REF: p. 94
OBJ: 7
Which of the following are considered intentional torts? Negligent practice Assault and battery Defamation of character Invasion of privacy 1, 2, and 3 only
and 4 only 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: C
Examples of intentional torts are those that involve defamation of character, invasion of privacy, deceit, infliction of mental distress, and assault and battery. DIF: Recall
REF: p. 94
OBJ: 6
When a practitioner performs a procedure that involves physical contact without the patient’s consent, it can result in what charge? Assault Negligence Battery Slander ANS: C
The major element of battery is physical contact without consent. DIF: Application
REF: p. 94
OBJ: 8
Which of the following are legitimate defenses against an intentional tort? Lack of intent to harm the patient Performance of ordinary procedures Informed consent given by patient 1 and 2 only and 3 only 1, 2, and 3 and 3 only ANS: D
The first defense is that there was a lack of intent to harm and that only clinicians who engage in intentional conduct are liable. DIF: Recall
REF: pp. 94-95
OBJ: 7
A physician specifies an incorrect dose in a prescription for a powerful bronchodilator drug to be given to an asthmatic patient. When the respiratory therapist gives the prescribed dose, the patient suffers a fatal response and dies. Based on the principle of duty, against whom could a suit of negligence be brought? Respiratory therapist Attending physician Dispensing pharmacist 1 and 2 only and 3 only 1, 2, and 3 and 3 only ANS: C
The suit could be brought against the physician for negligence for ordering the overdose, against the nurses and the respiratory therapist for failing to recognize that the dose was incorrect for the child, and, possibly, against the pharmacist for failing to gain adequate information as to the nature of the patient so that an appropriate dosage could be calculated. DIF: Application
REF: p. 95
OBJ: 8
HIPAA is primarily referred to as the Privacy Rule and is concerned with PHI. What do the letters PHI stand for? Patient health information Protected health information Past health information Protected health insurance ANS: B
The letters PHI stand for protected health information. DIF: Recall
REF: p. 96
OBJ: 12
What legal doctrine holds superiors responsible for the actions of their workers? Res ipsa loquitur Respondent superior Caveat emptor Promissory estoppel ANS: B
The legal framework for this liability is found in the principle respondeat superior (―let the master answer‖). DIF: Recall
REF: p. 96
OBJ: 8
What conditions are necessary to incur liability under the doctrine of respondeat superior? The injury caused must be the result of an act of negligence. The act must occur within the subordinate’s scope of employment. The act must involve willful intent on the part of the subordinate. 1 and 2 only and 3 only 1, 2, and 3 and 3 only ANS: A
For this liability to be incurred, two conditions must be met: (1) the act must be within the scope of employment and (2) the injury caused must be the result of an act of negligence. DIF: Recall
REF: p. 96
OBJ: 8
Which of the following is not a common element in a professional practice act? Scope of professional practice Requirements and qualifications for licensure Penalties and sanctions for unauthorized practice Professional code of ethics
ANS: D
Some practice acts emphasize one area over another but most acts address the following elements: Scope of professional practice Requirements and qualifications for licensure Exemptions Grounds for administrative action Creation of examination board and processes Penalties and sanctions for unauthorized practice DIF: Recall
REF: p. 97
OBJ: 9
If a respiratory therapist refers a Medicare patient to a particular home care company and receives a finder’s fee in return, this is an example of: moonlighting. Medicare referral. providing care without physician direction. Medicare fraud. ANS: D
Generally, these statutes state that anyone who knowingly or willfully solicits, receives, offers, or pays directly or indirectly any remuneration in return for Medicare business is guilty of a criminal offense. DIF: Analysis
REF: p. 98
OBJ: 8
How can ethical obligations be used in legal proceedings? As a tool of cross examination To prevent perjury To prevent a health care provider from self-incrimination Penalties and sanctions for unauthorized practice ANS: A
In addition to the moral obligations that ethical duties impose on therapists, ethical obligations are also often cited in legal proceedings as a tool of cross examination. DIF: Recall
REF: p. 84
OBJ: 3
In tort law, what is ―proximate causation‖? It turns on foreseeability to decide whether it is fair to impose damages on a defendant. It helps keep record of all Medicare patients. The collection of any needed evidence before filing charges. It finds legal aid for those in need ANS: A
Proximate causation or legal causation usually turns on foreseeability and whether it is fair to impose damages on a defendant. It tends to be a retrospective analysis. DIF: Application
REF: p. 92
OBJ: 6
What are the economic damages that can be imposed on a defendant during a negligence lawsuit? Loss of employment or business opportunities Loss of use of property Loss of past and future earnings 1, 2, and 3 and 3 only 1 and 2 only 1 only ANS: A
All of the above are considered economic losses in a negligence lawsuit. DIF: Application
REF: pp. 92-93
OBJ: 6
What can be effective tools in preventing malpractice litigations? Active risk management practices Appropriate guest relations policies Continuing education and certifications for facility maintenance staff Having supervisors on every shift 1, 2 and 3 only 1 and 3 only 1, 2, and 4 only 1 and 2 only ANS: D
Active risk management practices and appropriate guest relations policies are two of the most effective tools in preventing malpractice litigation. DIF: Application
REF: pp. 95-96
OBJ: 7
What is the role of the corporate compliance officer (CCO) in a health care setting? To oversee the hospital’s business practices and make sure that they conform to thelaw To ensure the hospital staff is working within the annual budgets To enforce the hospital’s recycling policies To ensure a high level of performance by the CFO ANS: A
CCOs are appointed by the board of directors, oversee the hospital’s business practices, and make sure that they conform to the law. They are freely available to discuss legal or ethical issues arising in the course of care. DIF: Recall
REF: p. 98
OBJ: 11
What does The National Labor Relations Act (NLRA) do for each individual health care worker? It provides protections to hospital workers whether they are organized into a unionor not. It oversees the hospital’s business practices. It provides legal aid only for those in an organized union.
It provides legal aid only for those NOT in an organized union. ANS: A
The National Labor Relations Act (NLRA) provides protections to hospital workers whether they are organized into a union or not. DIF: Recall
REF: p. 99
OBJ: 12
Chapter 06 - Physical Principles of Respiratory Care Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE
Which of the following statements correctly describe gases? Gases exhibit the phenomenon of flow. Molecular forces of attraction are minimal. Gases are difficult to compress. Gases expand to fill their container. 1 and 2 only 1, 2, and 4 only 2, 3, and 4 only 3 and 4 only ANS: B
In a gas, molecular attractive forces are very weak. Thus, gas molecules, which lack restriction to their movement, exhibit rapid, random motion with frequent collisions (Figure 6-1, C). Gases have no inherent boundaries and are easily compressed and expanded. Moreover, like liquids, gases can flow. DIF: Application
REF: p. 103
OBJ: 1
At what temperature do all kinetic activities of matter cease? 0K 0° C 32° C 0° F ANS: A
The SI (Systeme Internationale) units for temperature are degrees Kelvin, with a zero point equal to absolute zero (0 K). DIF: Recall
REF: p. 105
OBJ: 3
A patient has a recorded body temperature of 106° F. What is this temperature in degrees Celsius? 41° C 98° C 39° C 22° C ANS: A
To convert degrees Fahrenheit to degrees Celsius, use the following formula: ° C = 5/9 (° F – 32). DIF: Application
REF: p. 106
OBJ: 3
A near-drowning patient has a recorded body temperature of 30° C. What is the equivalent temperature in degrees Fahrenheit?
–4° F 86° F 32° F 77° F ANS: B
To convert degrees Celsius to degrees Fahrenheit, simply reverse the formula given in question 4: ° F = (9/5 ° C) + 32. DIF: Application
REF: p. 106
OBJ: 3
By which of the following means can the internal energy of a substance be increased? Cooling the substance Performing work on the substance Heating the substance 2 and 3 only and 2 only only 1, 2, and 3 ANS: A
You can increase the internal energy of an object by heating it or by performing work on it. DIF: Application
REF: p. 104
OBJ: 2
What term is used for the transfer of heat by the direct interaction of atoms or molecules in ahot area with atoms or molecules in a cooler area? Radiation Convection Condensation Conduction ANS: D
Conduction is the transfer of heat by direct contact between hot and cold molecules. DIF: Recall
REF: pp. 104-105 OBJ: 2
Which of the following would be the worst heat conductor? Water Glass Air Copper ANS: C
With fewer molecular collisions than in solids and liquids, gases exhibit low thermal conductivity. DIF: Application
REF: p. 104
OBJ: 2
What is the primary means by which heat transfer occurs in fluids? Convection Radiation
Conduction Evaporation ANS: A
Heat transfer in both liquids and gases occurs mainly by convection. DIF: Application
REF: p. 104
OBJ: 2
Which of the following is a good clinical example of using the principle of convection to transfer heat? Humidifiers with immersion heaters Heated, enclosed infant incubators Wire-heated pneumotachometers Heated ventilator exhalation valves ANS: B
This is the principle behind forced-air heating in houses and convection heating in infant incubators. DIF: Application
REF: p. 104
OBJ: 2
Which of the following methods of heat transfer requires no direct contact between the warmer and cooler substances? Conduction Convection Evaporation Radiation ANS: D
While conduction and convection require direct contact between two substances, radiant heat transfer occurs without direct physical contact. DIF: Application
REF: p. 104
OBJ: 2
Which of the following would help to decrease a patient’s loss of body heat? Increase the temperature of the room. Increase the exposed skin surface area. Move the patient away from cold windows. 1 and 2 only 2 and 3 only 1, 2, and 3 1 and 3 only ANS: D
In simple terms, for an object with a given emissivity, the larger the surface area (relative to mass) and the lower the surrounding temperature, the greater is the radiant heat loss per unit time. DIF: Application
REF: p. 105
OBJ: 2
Which of the following is false about evaporation? Evaporation is a type of vaporization.
The process of evaporation warms the surrounding air. Evaporation is the change of a liquid substance into a gas. For evaporation to occur, heat energy is needed. ANS: B
Vaporization is the change of state from liquid to gas. Vaporization requires heat energy. According to the first law of thermodynamics, this heat energy must come from the surroundings. In one form of vaporization, called evaporation, heat is taken from the air surrounding the liquid, thereby cooling the air. DIF: Application
REF: p. 105
OBJ: 5
What is the physical process whereby the gaseous form of a substance is changed back into its liquid state? Condensation Sublimation Vaporization Radiation ANS: A
During condensation, a gas turns back into a liquid. DIF: Application
REF: p. 105
OBJ: 4
Which of the following are true of liquids? They are easy to compress. They exert pressure. They exert buoyant force. They conform to their containers. 2 and 4 only 1, 2, and 3 only 1 and 3 only 2, 3, and 4 only ANS: D
Liquids exhibit flow and assume the shape of their container. Liquids also exert pressure, which varies with depth and density. Variations in liquid pressure within a container produce an upward supporting force, called buoyancy. DIF: Application
REF: p. 106
OBJ: 1
Which of the following equations can be used to calculate the pressure exerted by a liquid? Liquid pressure = liquid depth ÷ liquid density Liquid pressure = liquid depth surface area Liquid pressure = liquid density liquid viscosity Liquid pressure = liquid density liquid depth ANS: D
The pressure exerted by a liquid depends on both its height (depth) and weight density (weight per unit volume), which is shown in equation form: PL = h dw.
DIF: Analysis
REF: p. 106
OBJ: 4
According to Pascal’s principle, the pressure exerted by a liquid in a container depends on which of the following? Depth of the liquid Density of the liquid Shape of the container 1, 2, and 3 and 2 and 3 and 3 ANS: B
The pressure exerted by a liquid depends on both its height (depth) and weight density (weight per unit volume), which is shown in equation form: PL = h dw. DIF: Application
REF: p. 106
OBJ: 4
Archimedes’ principle is applied clinically in which of the following devices? Nebulizer Capillary tube Hydrometer Humidifier ANS: C
Clinically, Archimedes’ principle is used to measure the specific gravity of certain liquids. A hydrometer is used to measure the specific gravity of certain liquids. DIF: Application
REF: p. 107
OBJ: 4
What is the internal force that opposes the flow of fluids (equivalent to friction between solid substances)? Conductivity Kinetic energy Viscosity Density ANS: C
Viscosity is the force opposing a fluid’s flow. DIF: Recall
REF: pp. 107-108 OBJ: 4
Which of the following is false about viscosity? The greater the viscosity, the greater is the opposition to flow. Viscosity is most important under conditions of turbulent flow. The stronger the cohesive forces, the greater the viscosity. Fluid viscosity is equivalent to friction between solids. ANS: B
Laminar flow consists of concentric layers of fluid flowing parallel to the tube wall at velocities that increase toward the center.
DIF: Application
REF: pp. 107-108 OBJ: 4
After placing a liquid into a small-diameter glass tube, you observe the formation of a convex (upwardly curved) meniscus. What conclusion is correct? The liquid must have a very low surface tension. Strong adhesive forces exist between the liquid and glass. The liquid must have an extremely high viscosity. Strong cohesive forces exist among the liquid molecules. ANS: D
When the liquid is water, the meniscus is concave because the water molecules at the surface adhere to the glass more strongly than they cohere to each other. In contrast, a mercury meniscus is convex. In this case, the cohesive forces pulling together the mercury atoms exceed the adhesive forces trying to attract the mercury to the glass. DIF: Application
REF: p. 108
OBJ: 4
What force is responsible for the spherical shape of liquid droplets and their ability to keepthis shape when placed into an aerosol suspension? Cohesion Adhesion Viscosity Surface tension ANS: D
Surface tension is a force exerted by like molecules at a liquid’s surface. A small drop of fluid provides a good illustration of this force. As shown in Figure 6-8, cohesive forces affect molecules inside the drop equally from all directions. However, only inward forces affect molecules on the surface. This imbalance in forces causes the surface film to contract into the smallest possible surface area, usually a sphere or curve (meniscus). This phenomenon explains why liquid droplets and bubbles retain a spherical shape. DIF: Application
REF: pp. 108-109 OBJ: 4
The ratio of the density of one fluid when compared with the density of another reference substance, which is typically water, describes the fluid’s: specific gravity. specific weight. atomic mass. atomic volume. ANS: A
The term specific gravity refers to the ratio of the density of one fluid when compared with the density of another reference substance which is typically water. DIF: Application
REF: p. 107
OBJ: 8
What is the phenomenon whereby a liquid in a small tube tends to move upward against the force of gravity? Capillary action Shear stress
Surface tension Buoyancy ANS: A
Capillary action is a phenomenon in which a liquid in a small tube moves upward against gravity. DIF: Recall
REF: p. 109
OBJ: 4
Which of the following is/are good clinical example(s) of the principle of capillary action? Capillary stick blood samples Absorbent humidifier wicks Certain surgical dressings 1, 2, and 3 and 2 only and 3 only only ANS: A
Capillary action is the basis for blood samples obtained by use of a capillary tube. The absorbent wicks used in some gas humidifiers are also an application of this principle, as are certain types of surgical dressings. DIF: Application
REF: p. 109
OBJ: 4
What is the temperature at which the vapor pressure of a liquid equals the pressure exerted onthe liquid by the surrounding atmosphere? Boiling point Dew point Triple point Melting point ANS: A
The boiling point of a liquid is the temperature at which its vapor pressure equals atmospheric pressure. DIF: Recall
REF: p. 110
OBJ: 4
Which of the following are true about boiling? Boiling a liquid requires more energy than does evaporating it. A liquid’s boiling point varies with the atmospheric pressure. The greater the ambient pressure, the lower is the boiling point. 2 and 3 only 1 and 3 only 1 and 2 only 1, 2, and 3 ANS: C
Because the weight of the atmosphere retards the escape of vapor molecules, the greater the ambient pressure, the greater is the boiling point. DIF: Application
REF: p. 110
OBJ: 4
What is the change in state of a substance from liquid to gaseous form occurring below its boiling point? Evaporation Sublimation Boiling Vaporization ANS: A
A liquid can also change into a gas at temperatures lower than its boiling point through a process called evaporation. DIF: Application
REF: p. 110
OBJ: 4
Which of the following are true about molecular water vapor? Water vapor exhibits kinetic activity. Molecular water vapor can be seen. Water vapor exerts pressure. and 2 only and 3 only 1, 2, and 3 and 3 only ANS: D
To be distinguished from visible particulate water, such as mist or fog, this invisible gaseous form of water is called molecular water. Molecular water obeys the same physical principles as other gases and therefore exerts a pressure called water vapor pressure. DIF: Application
REF: p. 110
OBJ: 5
What occurs during the evaporation of water? The adjacent air is warmed. The adjacent air is cooled. The water temperature rises. Heat is given up to the air. ANS: B
As the surrounding air loses heat energy, it cools. This is the principle of evaporation cooling. DIF: Recall
REF: p. 111
OBJ: 5
What is the equilibrium condition in which a gas holds all the water vapor molecules that itcan? Evaporation Stabilization Saturation Bodyhumidity ANS: C
At this point, the air over the water is saturated with water vapor. However, vaporization does not stop once saturation occurs.
DIF: Recall
REF: p. 111
OBJ: 5
Which of the following methods would increase the rate of evaporation of a container of water? Increase the temperature of the surrounding air. Decrease the pressure of the surrounding air. Increase the temperature of the water. 1 and 2 and 3 1 and 3 1, 2, and 3 ANS: D
The warmer the air, the more vapor it can hold. Specifically, the capacity of air to hold water vapor increases with temperature. The warmer the air making contact with a water surface, the faster is the rate of evaporation. DIF: Application
REF: p. 111
OBJ: 5
Which of the following represents a direct measure of the kinetic activity of water vapor molecules? Absolute humidity Water vapor pressure Percent body humidity Relative humidity ANS: B
Water vapor pressure represents the kinetic activity of water molecules in air. DIF: Application
REF: p. 111
OBJ: 5
What is the term for the actual content or weight of water present in a given volume of air? Percent body humidity Water vapor pressure Absolute humidity Relative humidity ANS: C
Absolute humidity can be measured by weighing the water vapor extracted from air using a drying agent. DIF: Recall
REF: p. 111
OBJ: 6
What is the absolute humidity (water vapor content) of saturated gas at normal body temperature (37° C)? 47.0 mg/L 37.0 mg/L 98.6 mg/L 43.8 mg/L ANS: D
For example, air that is fully saturated with water vapor at 37° C and 760 mm Hg has a water vapor pressure of 47 mm Hg and an absolute humidity of 43.8 mg/L. DIF: Recall
REF: p. 112
OBJ: 6
What is the water vapor pressure of saturated gas at normal body temperature (37° C)? 47.0 mm Hg 43.8 mm Hg 37.0 mm Hg 98.6 mm Hg ANS: A
For example, air that is fully saturated with water vapor at 37° C and 760 mm Hg has a water vapor pressure of 47 mm Hg and an absolute humidity of 43.8 mg/L. DIF: Recall
REF: p. 111
OBJ: 6
What is the term for the ratio of the actual water vapor present in a gas compared with the capacity of that gas to hold the vapor at a given temperature? Relative humidity Absolute humidity Water vapor pressure Percent body humidity ANS: A
When a gas is not fully saturated, its water vapor content can be expressed in relative terms using a measure called relative humidity. DIF: Application
REF: p. 112
OBJ: 6
At a room temperature of 22° C, air has the capacity to hold 19.4 mg/L of water vapor. If the absolute humidity in the air is 7.4 mg/L, then what is the relative humidity (RH)? a. 45% b. 58% c. 70% d. 38% ANS: D
If the absolute humidity is 7.4 mg/L, then the RH is calculated as follows: %RH = 7.4 mg/L ÷ 19.4 mg/L 100 %RH = 0.38100 %RH = 38% DIF: Analysis
REF: p. 112
OBJ: 6
When the water vapor content of a volume of gas equals its capacity, what is the relative humidity (RH) of this gas? a. 80% b. 100% c. 40% d. 60%
ANS: B
When the water vapor content of a volume of gas equals its capacity, the RH is 100%. When the RH is 100%, a gas is fully saturated with water vapor. DIF: Application
REF: p. 112
OBJ: 6
A gas at 50° C with a relative humidity of 100% is cooled to 37° C. Which of the followingwill occur? Condensation on surfaces Visible droplet formation Warming of the adjacent air 1, 2, and 3 1 and 2 only and 3 only and 3 only ANS: A
Condensed moisture deposits on any available surface, such as on the walls of a container or delivery tubing, or even on particles suspended in the gas. Condensation returns heat to and warms the surrounding environment, whereas vaporization of water cools the adjacent air. DIF: Analysis
REF: p. 112
OBJ: 6
What is the term for the temperature at which the water vapor in a gas begins to condenseback into a liquid? Triple point Critical pressure Dew point Boiling point ANS: C
The temperature at which condensation begins is called the dew point. DIF: Recall
REF: p. 112
OBJ: 6
What occurs when the temperature of a saturated gas drops down to its dew point? Excess water vapor will condense as visible droplets. The temperature of the surrounding air decreases. Any liquid water present will quickly evaporate. The relative humidity of the gas begins to decrease. ANS: A
Cooling a saturated gas below its dew point causes increasingly more water vapor to condense into liquid water droplets. DIF: Application
REF: p. 112
OBJ: 6
The American National Standards Institute has set a water vapor content level of 30 mg/L asthe minimum absolute humidity required for patients whose upper airways have been bypassed. This equals what body humidity (BH)? a. 68% b. 47%
c. 75% d. 100% ANS: A
The %BH of a gas is the ratio of its actual water vapor content to the water vapor capacity in saturated gas at body temperature (37° C). Thus, %BH is the same as relative humidity, except that the capacity (or denominator) is fixed at 43.8 mg/L. DIF: Analysis
REF: p. 113
OBJ: 6
If the absolute humidity in a medical gas being delivered to a patient is 14 mg/L, then what isthe body humidity (BH)? a. 7% b. 16% c. 24% d. 32% ANS: D
The %BH of a gas is the ratio of its actual water vapor content to the water vapor capacity in saturated gas at body temperature (37° C). Thus %BH is the same as RH, except that the capacity (or denominator) is fixed at 43.8 mg/L. DIF: Analysis
REF: p. 113
OBJ: 6
What is the term for the ratio of the amount of water vapor in a volume of gas compared to the amount of the water in gas saturated at a normal body temperature of 37° C? Percent body humidity (BH) Relative humidity (RH) Absolute humidity Water vapor pressure ANS: A
The %BH of a gas is the ratio of its actual water vapor content to the water vapor capacity in saturated gas at body temperature (37° C). Thus, %BH is the same as RH, except that the capacity (or denominator) is fixed at 43.8 mg/L. DIF: Application
REF: p. 113
OBJ: 6
Which of the following properties of gases distinguish them from liquids—that is, are uniqueto the gaseous phase of matter? Gases fill the available space. Gases exhibit viscosity. Gases exert pressure. Gases are readily compressed. 2, 3, and 4 only and 3 only and 4 only and 4 only ANS: D
Unlike liquids, gases are readily compressed and expanded and fill the spaces available to them by diffusion.
DIF: Application
REF: p. 113
OBJ: 1
Which of the following occurs when the temperature of a gas rises? The kinetic activity of the gas increases. The rate of molecular collisions increases. The pressure exerted by the gas rises. 1, 2, and 3 and 2 only and 3 only only ANS: A
The velocity of gas molecules is directly proportional to temperature. As a gas is warmed, its kinetic activity increases, its molecular collisions increase, and its pressure rises. DIF: Recall
REF: p. 113
OBJ: 7
According to Avogadro’s law, which of the following is/are TRUE? One gram of any substance contains the same number of particles. Equal volumes of gases at standard temperature, standard pressure, dry (STPD) have the same number of molecules. Equal numbers of gas molecules at STPD occupy the same volume. 1 and 2 only 1, 2, and 3 and 3 only only ANS: D
Avogadro’s law states that the 1-g atomic weight of any substance contains exactly the same number of atoms, molecules, or ions. DIF: Recall
REF: p. 113
OBJ: 7
In International System (SI) units, what is any quantity of matter that contains 6.023 1023 atoms, molecules, or ions? Pound (lb) Gram (g) Ounce (oz) Mole (mol) ANS: D
One mole of a gas, at a constant temperature and pressure, should occupy the same volume as 1 mol of any other gas. This ideal volume is termed the molar volume. DIF: Recall
REF: p. 113
OBJ: 7
According to Avogadro’s law, under standard conditions of temperature and pressure (0° Cand 760 mm Hg), 1 mol of any gas occupies which of the following? a. 1.34 L b. 22.40 L c. 7.48 L
d. 28.30 L ANS: B
At standard temperature and pressure, dry (STPD), the ideal molar volume of any gas is 22.4 L. DIF: Analysis
REF: p. 113
OBJ: 7
What is the density of a mixture of 40% oxygen (O 2 ) and 60% helium at STPD? a. 0.34 g/L b. 0.55 g/L c. 0.68 g/L d. 1.25 g/L ANS: C
For the density of a gas mixture to be calculated, the percentage or fraction of each gas in the mixture must be known. For example, to calculate the density of air at STPD, the following equation is used: dwair = (FN 2 gmw N2 ) + (FO 2 gmw O 2 ) ÷ 22.4 L dwair = (0.79 28) + (0.21 32) ÷ 22.4 L dwair = 1.29 g/L DIF: Analysis
REF: p. 114
OBJ: 7
What is the physical process whereby atoms or molecules tend to move from an area of higher concentration or pressure to an area of lower concentration or pressure? Sublimation Melting Diffusion Capillaryaction ANS: C
Diffusion is the process whereby molecules move from areas of high concentration to areas of lower concentration. DIF: Application
REF: p. 114
OBJ: 7
Which of the following best describes the physical concept of pressure? Weight ÷ unit volume Mass acceleration Force distance Force ÷ unit area ANS: D
Pressure is a measure of force per unit area. DIF: Recall
REF: p. 114
What is the common British unit of pressure? Newton (N)/m2 dyne/cm2 Pascal (Pa)
OBJ: 7
lb/in2 (psi) ANS: D
Pounds per square inch (lb/in2 ), or ―psi,‖ is the British fps pressure unit. DIF: Recall
REF: p. 114
OBJ: 7
One atmosphere (1 atm) of pressure is equivalent to which of the following? 29.9 in Hg2. 14.7 lb/in2 3. 1034.0 g/cm2 4. 760.0 mm Hg 1, 2, and 3 and 4 1 and 3 d. 1, 2, 3, and 4 ANS: D
At sea level, the average atmospheric pressure will support a column of mercury 76 cm (760 mm) or 29.9 in in height. If we also know that mercury has a density of 13.6 g/cm3 (0.491 lb/in3 ), then the average atmospheric pressure (PB) is calculated as follows: cgs units: PB = 76 cm 13.6 g/cm3 = 1034 g/cm2 fps units: PB = 29.9 in 0.491 lb/in3 = 14.7 lb/in2 DIF: Analysis
REF: p. 114
OBJ: 7
You obtain a mercury barometric reading of 760 mm Hg at 17° C. Using the following factor table, compute the corrected pressure. °C 740 750 760 17 2.17 2.20 2.23 18 2.29 2.32 2.35 19 2.38 2.41 2.44 223.0 mm Hg 747.7 mm Hg 757.8 mm Hg 762.3 mm Hg ANS: C
The U.S. Weather Bureau provides temperature correction factors for barometric readings (see Appendix 1). DIF: Analysis
REF: p. 115
OBJ: 7
The peak pressure on a ventilator reads 40 cm H2 O. What is the equivalent pressure in mmHg? 37.0 mm Hg 29.6 mm Hg 68.3 mm Hg 4.9 mm Hg
ANS: B
Because of mercury’s high density (13.6 g/cm3 ), it assumes a height that is easy to read for most pressures in the clinical range. Water columns can also be used to measure pressure (in cm H 2 O), but only low pressures. Because water is 13.6 times less dense than mercury, 1 atm. DIF: Analysis
REF: p. 115
OBJ: 7
The peak pressure on a ventilator reads 30 cm H2 O. What is the equivalent pressure in kilopascals (kPa)? 37.0 kPa 68.0 kPa 4.9 kPa 2.9 kPa ANS: D
One kPa equals approximately 10.2 cm H 2 O or 7.5 mm Hg. DIF: Analysis
REF: p. 115
OBJ: 7
From a bedside capnograph (CO2 measuring device), you obtain a ―dry‖ gas reading of 5.3% CO2 in a patient’s exhaled gas. Given a barometric pressure of 765 mm Hg, what is the partial pressure of CO 2 in this patient’s exhaled gas? 347 mm Hg 41 mm Hg 164 mm Hg 35 mm Hg ANS: B
Dalton’s law describes the relationship among the partial pressure and the total pressure in a gas mixture. According to this law, the total pressure of a mixture of gases must equal the sum of the partial pressures of all component gases. Moreover, the principle states that the partial pressure of a component gas must be proportional to its percentage in the mixture. DIF: Analysis
REF: p. 116
OBJ: 7
In the lung’s alveoli, there are four gases mixed together: O 2 , carbon dioxide, nitrogen, and water vapor. At a normal barometric pressure of 760 mm Hg, alveolar O 2 exerts a partial pressure of 100 mm Hg, CO2 40 mm Hg, and water vapor 47 mm Hg. What is the alveolar partial pressure of nitrogen? 187 mm Hg 713 mm Hg 660 mm Hg 573 mm Hg ANS: D
Dalton’s law describes the relationship among the partial pressure and the total pressure in a gas mixture. According to this law, the total pressure of a mixture of gases must equal the sum of the partial pressures of all component gases. Moreover, the principle states that the partial pressure of a component gas must be proportional to its percentage in the mixture. DIF: Analysis
REF: p. 116
OBJ: 7
Which of the following factors determine how much of a given gas can dissolve in a liquid? Solubility coefficient of the gas Temperature of the liquid Gas pressure above the liquid 2 and 3 only and 2 only and 3 only 1, 2, and 3 ANS: D
Henry’s law predicts how much of a given gas will dissolve in a liquid. According to this principle, at a given temperature, the volume of a gas that dissolves in a liquid is equal to its solubility coefficient times its partial pressure. DIF: Application
REF: p. 117
OBJ: 7
At 37° C and 760 mm Hg pressure, 0.023 ml of O 2 can be dissolved in 1 ml of plasma, whereas at the same temperature and pressure, 0.510 ml of CO 2 will dissolve in 1 ml of plasma. What explains this difference? CO 2 diffuses more rapidly than O 2 . CO 2 is more soluble in plasma than O 2 . CO 2 has a greater molecular weight than O2 . O 2 has less affinity for plasma than CO 2 . ANS: B
For example, the solubility coefficient of O2 in plasma, at 37° C and 760 torr pressure, is 0.023 ml/ml. Under the same conditions, 0.510 ml of CO2 can dissolve in 1 ml of plasma. DIF: Application
REF: p. 117
OBJ: 7
Which of the following will occur when a gas undergoes expansion? The pressure of the gas increases. Molecular collisions decrease. The gas temperature increases. 1 and 2 only and 3 only only 1 and 3 only ANS: C
If a gas-filled container could be enlarged, the gas would expand to occupy the new volume. Figure 6-19 illustrates the concepts of gas compression and expansion. DIF: Application
REF: p. 117
OBJ: 7
If a given mass of a gas is maintained at a constant temperature, what will decreasing its pressure do? Decrease its volume. Increase its mass. Increase its volume. Decrease its mass.
ANS: C
If a gas-filled container could be enlarged, the gas would expand to occupy the new volume. Figure 6-19 illustrates the concepts of gas compression and expansion. DIF: Application
REF: p. 118
OBJ: 7
In what processes of gas compression or expansion does the temperature remain constant? Isothermal Adiabatic Hypothermal Neutral kinetic ANS: A
During isothermal conditions, the temperature of an ideal gas should not change with either expansion or contraction. DIF: Recall
REF: p. 120
OBJ: 7
Both a compressed gas cylinder and its regulator are at room temperature with all valves inthe off position. After the cylinder is opened and gas begins flowing, you note that the regulator is extremely cold to touch. Which of the following principles best explains this observation? Adiabatic compression Gay-Lussac’s law Joule-Thompson effect Venturi principle ANS: C
The rapid expansion of real gases causes substantial cooling. This phenomenon of expansion cooling is called the Joule-Thompson effect. Adiabatic compression can also occur in gas delivery systems where rapid compression occurs within a fixed container. The rise in temperature caused by this rapid compression can ignite any combustible material in the system. It is for this reason that RTs must take care to clear any combustible matter from high-pressure gas delivery systems before pressurization. DIF: Application
REF: p. 120
OBJ: 7
Respiratory therapists must ensure that any oil or dust is cleared from high-pressure medical-gas delivery systems before pressurization. Why is this action needed? Inhaled dust particles can cause pneumoconiosis. The oil or dust can cause a leak in the system. Oil or dust does not easily mix with medical gases. Adiabatic compression could ignite the oil or dust. ANS: D
In an adiabatic process, the container is insulated, resulting in no heat transfer into or out from the system. If the volume increases, the internal energy decreases to perform the work and thus the temperature decreases. If the volume is increased the internal energy is also increased, resulting in a higher temperature. DIF: Application
REF: p. 120
OBJ: 7
Which of the following occur(s) when water vapor is added to a dry gas at a constant pressure? The volume occupied by the gas mixture decreases. The relative humidity of the mixture increases. The partial pressure of the original gas is reduced. 1 and 2 only 1 and 3 only 1, 2 and 3 3 only ANS: C
The dry volume of a gas at a constant pressure and temperature is always smaller than its saturated volume. The opposite is also true. Correcting from the dry state to the saturated state always yields a larger gas volume. The pressure exerted by water vapor is independent of the other gases with which it mixes, depending only on the temperature and RH. Therefore, the addition of water vapor to a gas mixture always lowers the partial pressures of the other gases present. DIF: Application
REF: p. 119
OBJ: 7
During some pulmonary function tests, saturated gas exhaled from a patient’s lungs is gathered at room temperature. Which of the following correction-factor tables would you useto determine what volume this gas occupied in the patient’s lungs? Standard temperature, standard pressure, dry (STPD) to body temperature, ambient pressure, saturated (BTPS) BTPS to STPD Ambient temperature, ambient pressure, saturated (ATPS) to BTPS ATPS to STPD ANS: C
Correction from ATPS to standard temperature and pressure (0° C and 760 torr), dry (STPD). DIF: Application
REF: p. 119
OBJ: 7
A combination of neutral atoms, free electrons, and atomic nuclei describes: potential energy. kinetic energy. plasma. compressed gases. ANS: C
Plasma has been referred to as the fourth state of matter and is a combination of neutral atoms, free electrons, and atomic nuclei. Plasmas can react to electromagnetic forces and flow freely like a liquid or a gas. DIF: Recall
REF: p. 103
OBJ: 1
For every liquid there is a temperature above which the kinetic activity of its molecules is so great that the attractive forces cannot keep them in a liquid state. This temperature is called the: critical temperature.
melting point. flash temperature. triple point. ANS: A
When a liquid is heated to its critical temperature, it converts to a gas. This temperature is called the critical temperature. DIF: Application
REF: p. 119
OBJ: 4
Which of the following is a false statement about O2 ? No pressure can keep it in a liquid state above –118.8° C. Below its boiling point, it remains liquid at ambient pressure. Its critical temperature is above normal room temperature. It cannot be turned into a liquid at room temperature. ANS: C
Liquid O2 is produced by separating it from a liquefied air mixture at a temperature below its boiling point or critical temperature (–183° C or –297° F). After it is separated from air, the O 2 must be maintained as a liquid by being stored in insulated containers below its boiling point. As long as the temperature does not exceed –183° C, the O 2 will remain liquid at atmospheric pressure. If higher temperatures are needed, higher pressures must be used. If at any time the liquid O 2 exceeds its critical temperature of –118.8° C, it will convert immediately to a gas. DIF: Application
REF: p. 119
OBJ: 7
Which of the following medical gases can be maintained in the liquid form at room temperature? Nitrous oxide Carbon dioxide O2 Helium and 2 only 2, 3, and 4 only and 3 only 2 and 4 only ANS: A
Both CO2 and N2 O have critical temperatures above normal room temperature (Table 6-5). DIF: Recall
REF: p. 119
OBJ: 7
What temperature is necessary to liquefy O 2 at 1 atm pressure? a. −118.8° C b. −181.1° F c. −463.3° F d. −183.0° C ANS: D
Liquid O2 is produced by separating it from a liquefied air mixture at a temperature below its boiling point (−183° C or −297° F). After it is separated from air, the O 2 must be maintained as a liquid by being stored in insulated containers below its boiling point. As long as the temperature does not exceed –183° C, the O 2 will remain liquid at atmospheric pressure. If higher temperatures are needed, higher pressures must be used. If at any time the liquid O 2 exceeds its critical temperature of –118.8° C, it will convert immediately to a gas. DIF: Recall
REF: p. 120
OBJ: 7
With all else equal, under which of the following conditions would the drop in pressure occurring while a fluid flows through a tube be greatest? Tube Diameter Fluid Viscosity A. A Small Low B. B Large Low C. C Large High D. D Small High A; Small; Low B; Large; Low C; Large; High D; Small; High ANS: D
Available energy decreases because frictional forces oppose fluid flow. Frictional resistance to flow exists both within the fluid itself (viscosity) and between the fluid and the tube wall. In general, the greater the viscosity of the fluid and the smaller the cross-sectional area of the tube, the greater is the drop in pressure along the tube. DIF: Analysis
REF: pp. 120-121 OBJ: 8
The resistance to flow of a fluid through a tube can be computed according to which of the following formulas? Resistance = flow viscosity Resistance = flow ÷ pressure Resistance = pressure ÷ flow Resistance = flow pressure ANS: C
For any given tube length, flow resistance equals the difference in pressure between the two points along the tube divided by the actual flow. This is expressed as a formula: R = (P1 − P2 ) ÷ V DIF: Application REF: pp. 120-121 OBJ: 8
What is the pattern of flow in which a fluid moves in discrete cylindrical streamlines? Transitional Turbulent Laminar Tracheal ANS: C
During laminar flow, a fluid moves in discrete cylindrical layers or streamlines. DIF: Application
REF: pp. 120-121 OBJ: 8
According to Poiseuille’s law, the pressure needed to drive a fluid through a tube will increase under which of the following conditions? Increased fluid viscosity Decreased tube length Decreased rate of flow Decreased tube radius 1 and 2 2, 3, and 4 1 and 4 1, 3, and 4 ANS: C
The difference in pressure required to produce a given flow, under conditions of laminar flow through a smooth tube of fixed size, is defined by Poiseuille’s law: P = 8nl/r4 ,where P is the driving pressure gradient, n is the viscosity of the fluid, l is the tube length, is the fluid flow, r is the tube radius, and 8 is a constant. DIF: Application
REF: pp. 120-121 OBJ: 8
Under conditions of turbulent flow, what is the driving pressure? Proportional to the square of the flow Inversely proportional to the flow Linearly proportional to the flow Inversely proportional to the density ANS: A
This changeover from laminar to turbulent flow depends on several factors, including fluid density (d), viscosity (h), linear velocity (v), and tube radius (r). In combination, these factors determine Reynold’s number (NR): NR = v d 2r/h DIF: Application
REF: p. 122
OBJ: 8
Which of the following conditions tend to cause laminar flow to become turbulent (producinga high Reynold’s number)? High linear gas velocity High gas density Low gas viscosity Smaller tube diameter 2, 3, and 4 only 2 and 3 only 1, 2, and 3 only 1 and 4 only ANS: C
In a smooth-bore tube, laminar flow becomes turbulent when NR exceeds 2000 (the number is dimensionless). According to the previous formula, conditions favoring turbulent flow include increased fluid velocity, increased fluid density, increased tube radius, or decreased fluid viscosity. In the presence of irregular tube walls, turbulent flow can occur when NR is less than 2000. DIF: Recall
REF: p. 122
OBJ: 7
Assuming a constant flow, what will happen to a fluid if the cross-sectional area of the tube in which its flows decrease? a. Its velocity will increase. b. Its velocity will decrease. c. Its density will decrease. d. Its viscosity will decrease. ANS: B
Throughout the tube, the fluid flows at a constant rate of 5 L/min. At point A, with a cross-sectional area of 5.08 cm2 , the velocity of the fluid is 16.4 cm/sec. At point B, the cross-sectional area of the tube decreases to 2.54 cm2 , half its prior value. At this point, the velocity of the fluid doubles to 32.8 cm/sec. DIF: Application
REF: pp. 122-123 OBJ: 8
According to Bernoulli’s principle, as a fluid flows through a narrow passage or stricture, which of the following will occur? Fluid velocity will decrease. Lateral pressure will fall. Total energy will increase. a. 2 and 3 only b. 1 and 2 only c. 1 and 3 only d. 2 only ANS: D
When a fluid flows through a tube of uniform diameter, pressure decreases progressively over the tube length. When the fluid passes through a constriction, the pressure drop is much greater. This large pressure drop can be observed in the fourth water column in Figure 6-24. The eighteenth-century scientist Daniel Bernoulli was the first to carefully study this effect, which now bears his name. According to the law of continuity, as the fluid moves into the narrow or constricted portion of the tube, its velocity must increase (v b > va). According to the Bernoulli’s theorem, the higher velocity at point b should result in a lower lateral pressure at that point (Pb < Pa). Thus, as a fluid flows through the constriction, its velocity increases and its lateral pressure decreases. DIF: Analysis
REF: p. 123
OBJ: 8
What is the most common application of Bernoulli’s principle in respiratory care equipment? a. Fluidic ventilator b. Pneumotachygraph c. Air injector d. U-tube manometer
ANS: C
In respiratory care, the most common application of fluid entrainment is the air injector. DIF: Recall
REF: p. 123
OBJ: 8
Which of the following design components of an air injector would result in entraining the greatest amount of air? Small orifice jet Large entrainment ports Low-velocity gas flow a. 1, 2, and 3 b. 1 and 2 only c. 1 and 3 only d. 3 only ANS: B
The amount of air entrained depends on both the diameter of the jet orifice and the size of the air-entrainment ports (Figure 6-27). For a fixed jet size, the larger the entrainment ports, the greater is the volume of air entrained and the higher is the total flow (Figure 6-27, B). The entrained volume can still be altered, with fixed entrainment ports, by changing the jet diameter (Figure 6-27, C). A large jet results in a lower gas velocity and less entrainment, whereas a small jet boosts velocity, entrained volume, and total flow. DIF: Application
REF: p. 123
OBJ: 7
For which of the following purposes might a Venturi tube be used? To restore fluid pressure distal to a restricted orifice To help keep entrainment ratios constant with varying flows To make possible entrainment of large volumes of gas a. 1, 2, and 3 b. 2 and 3 only c. 1 and 2 only d. 1 and 3 only ANS: A
The Venturi tube, as compared with a simple air injector, provides greater entrainment. Moreover, this design helps keep the percentage of entrained fluid constant, even when the total flow varies. A Venturi tube widens just after its jet or nozzle. As long as the angle of dilation is less than 15 degrees, this widening helps restore fluid pressure back toward prejet levels. However, the Venturi tube has one major drawback—any buildup of pressure downstream from the entrainment port decreases fluid entrainment. DIF: Application
REF: pp. 123-124 OBJ: 8
What physical principle underlies most fluidic circuitry? a. Poiseuille’s law b. Bernoulli’s principle c. Law of continuity d. Coanda effect ANS: D
The primary principle underlying most fluidic circuitry is a phenomenon called wall attachment, or the Coanda effect. This effect is observed mainly when a fluid flows through a small orifice with properly contoured downstream surfaces. DIF: Recall
REF: pp. 123-124 OBJ: 8
What are the forms of vaporization? Boiling Freezing Evaporation Sublimation a. 1 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 4 only ANS: C
Both boiling and evaporation are forms of vaporization. DIF: Application
REF: p. 111
OBJ: 5
What is the motion referred to when solid molecules travel until they collide? a. Jiggle b. Jingle c. Surface tension d. Boiling point ANS: A
Solids have a fixed volume and shape. The molecules comprising the solid have the shortest distance to travel until they collide with one another. This motion has been referred to as a ―jiggle.‖ DIF: Application
REF: p. 103
OBJ: 1
Solids maintain their shape because their atoms are kept in place by strong mutual attractive forces, called: a. van der Waals forces. b. thermodynamic equilibrium. c. buoyancy. d. fluidics. ANS: A
Solids maintain their shape because their atoms are kept in place by strong mutual attractive forces, called van der Waals forces. DIF: Recall
REF: p. 103
OBJ: 1
Chapter 07 - E-Medicine in Respiratory Care Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. For which of the following is there the most interest in using eHealth applications to improve
health outcomes in a cost-effective manner? a. Lung cancer b. Pediatric heart disease c. Chronic diseases d. Heart attack victims ANS: C
Thus, there is much interest addressing the historically disjointed, misallocated processes of chronic disease management through advances in eHealth technologies, to improve health outcomes in a cost-effective manner. DIF: Recall
REF: p. 127
OBJ: 3
2. Which of the following is included in the purposes of Telemedicine? a. e-mailing test results to patients. b. Support health care at a geographically different location from the patient to
increase access to specialty care.
c. Allow access to patient’s family members remotely. d. Acquire patient assessment information in order to skip a patient home care visit. ANS: B
Telemedicine is the use of telecommunication and computer technology to promote access to diagnosis, monitoring, clinical decision support, and treatment for patients at medically underserved sites that are distant from health care providers. DIF: Recall
REF: p. 134
OBJ: 8
3. Hospital-based applications for clinical decision support include:
1. Cardiac ischemia 2. Decreasing fluid given in resuscitation efforts 3. Appropriate tidal volume and plateau pressure monitoring in acute respiratory distress syndrome 4. Decreasing exacerbations in asthma patients a. 1 and 2 b. 1, 2 and 3 c. 1, 3, and 4 d. 1, 2, 3, and 4 ANS: C
Clinical decision support has also resulted in decreased unnecessary hospital admissions for inappropriately diagnosed cardiac ischemia, appropriately decreased tidal volume, and more consistent monitoring of plateau pressure in patients with acute respiratory distress syndrome and decreased exacerbations in asthma patients.
DIF: Application
REF: p. 133
OBJ: 3
4. Computerized reminders increase:
1. The proportion of indicated influenza vaccinations 2. Adherence to medications 3. Necessary hospital admissions for appropriately diagnosed cardiac ischemia a. 2 only b. 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Computerized reminders increased the proportion of indicated influenza vaccinations, and rates of screening, counseling, and adherence to medications. They have also resulted in decreased unnecessary hospital admissions for inappropriately diagnosed cardiac ischemia. DIF: Application
REF: p. 131
OBJ: 3
5. When coupled with electronic health records, clinical decision support is particularly useful
in: a. b. c. d.
disease management. influenza care. respiratory therapy. post-trauma care.
ANS: A
When coupled with other computerized tools such as clinical decision support applications, EHRs have enhanced treatment and disease management. DIF: Application
REF: p. 127
OBJ: 3
6. Therapists-driven protocols are used to: a. extend the length of stay. b. allocate and titrate respiratory care services. c. resist automation of treatment based on patient data. d. avoid confrontation with nurses regarding patient care. ANS: B
Practitioners use evidence-based patient-driven protocols to extend the length of stay, allocate and titrate respiratory care services, resist automation of treatment based on patient data, avoid confrontation with nurses regarding patient care. DIF: Application
REF: p. 130
OBJ: 2
7. Which of the following is/are advantage(s) of a wireless hand-held computer for charting
patient care? 1. Documentation is more legible. 2. Documentation is available to others more quickly. 3. It is less expensive. 4. There is improved fulfillment of physicians’ orders. a. 1 only b. 1 and 2 only
c. 2, 3 and 4 only d. 1, 2, and 4 only ANS: D
Wireless hand-held computers offer several advantages in comparison to nonwireless systems and paper charts. Hand-held computers facilitate the organization and assignment of workload and the fulfillment of physicians’ orders, and improve documentation. Documentation of patient assessment then becomes immediately available to other members of the health care team in the hospital information system. Moreover, by comparison, computerized documentation is more legible. DIF: Application
REF: pp. 130-131 OBJ: 4
8. In what automated respiratory care protocol has it been shown that use of a hand-held
computer helped shorten the patient’s stay in the intensive care unit? a. Ventilator initiation b. Ventilator weaning c. High-flow oxygen (O 2 ) therapy d. Airway care ANS: B
An automated protocol for discontinuation of mechanical ventilation with use of a hand-held computer has been associated with a shortened time to the first spontaneous breathing trial and a decreased length of stay in the intensive care unit. DIF: Application
REF: p. 130
OBJ: 3
9. Computers are often used to interpret which of the following tests in respiratory care patients? a. Chest radiograph b. Complete blood count c. Pulmonary function testing d. EEG testing ANS: C
Computer algorithms use standard reference predicted values to aid in the interpretation of pulmonary function tests (PFTs), including spirometry, lung volume, diffusing capacity, and bronchodilator response. DIF: Recall
REF: p. 129
OBJ: 3
10. In what area are computers used to apply quality assurance measures in respiratory care
departments? a. Arterial blood gas analyzers b. O 2 delivery systems c. Interpreting ECGs d. Equipment cleaning and sterilization ANS: A
Computer-assisted quality assurance in a blood gas laboratory is a critically important function in a respiratory care department, because the accuracy and precision of blood gas data influence clinical decisions and patient safety.
DIF: Application
REF: p. 129
OBJ: 6
11. Which of the following is considered an emerging application of information technology that
may improve national health care issues in the future? a. Clinical simulation for training b. A nationally available electronic health record c. Medical ID bracelets d. The national database for organ donors ANS: B
In the aftermath of Hurricane Katrina and in the face of a flu pandemic threat, many have begun to focus attention on the development of a seamless network of transferable, widely accessible, electronic health records. DIF: Application
REF: p. 135
OBJ: 2
In what way do computers assist smokers who want to quit? a. By providing Internet sites with smoking cessation plans b. By measuring blood carbon monoxide levels c. By providing genetic information on the risk of smoking d. By allowing smokers to order low-risk cigarettes through the Internet ANS: A
Multifaceted, Internet-based, tobacco cessation programs that assess the needs of and tailor treatment to the characteristics of individual patients have demonstrated good outcomes. DIF: Application
REF: p. 132
OBJ: 8
13. Clinical decision support systems perform which of the following tasks?
1. Match individual patients with proper drug doses. 2. Provide standing patient care orders. 3. Remind patients of when to reorder meds. 4. Provide directions to the best local pharmacy. a. 2 and 4 only b. 3 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
Clinical decision support systems match the characteristics of individual patients and their clinical interventions, drugs, and diagnostic tests to databases of scientific evidence and drug calculations and then generate tailored recommendations, reminders, or even standing orders. DIF: Application
REF: p. 133
OBJ: 3
14. Microprocessors can benefit mechanical ventilation by doing which of the following?
1. Equilibrate measured values with target values on a breath-by-breath basis. 2. Control ventilator alarms. 3. Archive the history of set and measured values. 4. Change clinician set parameters as needed. a. 1 and 3 only b. 1 and 4 only
c. 1, 2, and 3 only d. 1, 3, and 4 only ANS: C
Microprocessors can equilibrate measures of values with target values, control ventilator alarms, and archive the history of set and measured values, but they cannot change ventilator setting on its own. DIF: Application
REF: pp. 130-131 OBJ: 3
15. Which of the following are advantages of computerized ventilator charting applications?
1. Improve the consistency of ventilator charting. 2. Improve the accuracy of ventilator charting. 3. Automate ventilator charting with verification by respiratory therapist. 4. Other clinicians not allowed to monitor their progress. a. 1 and 4 only b. 2 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
Computerized ventilator charting applications have the potential to improve the quality and consistency of ventilator charting. Automated ventilator charting, verified, in turn, by respiratory therapists, takes that a step further, with the potential to improve completeness, accuracy, and consistency, as well as efficiency. However, the therapist still has to do all the charting. DIF: Application
REF: pp. 130-131 OBJ: 2
16. Which of the following is/are step(s) to help prevent computer infiltration by malicious
software? 1. Users should never share or use their password on public unsecured devices. 2. Users should install a virus scanning program and regularly update it. 3. Users should refrain from updating their computers with security patches. 4. Users should be careful when opening e-mail file attachments and refrain from downloading applications from unknown sources. a. 1 only b. 1 and 2 only c. 1, 2, and 4 only d. 1, 2, 3, and 4 ANS: C
Users can take steps to help prevent computer infiltration by malicious software by doing the following: Users should never share or use their password on public unsecured devices. Users should regularly update their computers with security patches from authorized sources; Users should install a virus scanning program and regularly update it. Most importantly, users should be careful when opening e-mail file attachments and refrain from downloading applications from unknown sources. DIF: Application
REF: p. 139
OBJ: 7
17. Which of the following are ways health care workers and facilities conform to HIPPA
regulations concerning securing patient confidentiality within electronic medical records? 1. Refraining from sharing passwords 2. Accessing electronic personal health information on a need-to-know basis 3. Utilizing thumbprint protected security 4. Allowing only close family members to view personal health information in the hospital computer a. 1 and 2 only b. 1, 3, and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
To emphasize two important points concerning electronic personal health information, users of hospital and respiratory care information management systems and researchers must refrain from sharing passwords and access personal health information only on a need-to-know basis. Some respiratory care information management systems, for example, now feature thumbprint protected security. DIF: Application
REF: p. 138
OBJ: 7
18. Which of the following is/are benefit(s) of the computerized physician order entry (CPOE)
system? 1. Saves time and reduces transcription errors resulting from handwriting clarity issues. 2. Has built in stop-gaps and prescribing templates. 3. Alerts RTs and other clinicians of new, expired, or changed orders. 4. Helps facilitate patient care and reduce medical errors. a. 1 only b. 1 and 2 only c. 1, 2, and 4 only d. 1, 2, 3, and 4 ANS: D
A subset of EHRs is the computerized physician order entry (CPOE) system. Through CPOEs, orders can be electronically transmitted to the EHR, saving time and reducing transcription errors resulting from handwriting clarity issues. Built in stop-gaps and prescribing templates, alert physicians about potential dosing problems and drug interaction concerns. The interfacing of CPOE systems with other hospital computer systems also alert RTs and other clinicians of new, expired, or changed orders. Thus CPOE has helped facilitate patient care and reduce medical errors. DIF: Application
REF: p. 127
OBJ: 7
19. Which of the following is an application that allows for imaging storage, portability
communication, and clinical integrations of all imaging modalities? a. PACS b. POCT c. HITECH d. CPOE ANS: A
A picture archiving and communication system (PACS) is an application that allows for imaging storage, portability, communication, and clinical integration of all imaging modalities with the HER. POCT is point-of care testing and refers to blood gas analysis performed at or near the site of a patient, in a setting that is different from a normal hospital clinical laboratory. HITECH is Health Information Technology for Economic and Clinical Health Act that is part of a national strategy for building a national health information infrastructure. CPOE is computerized physician order entry. DIF: Recall
REF: p. 129
OBJ: 7
20. Which of the following refers to a set of tools that permit capture, storage, and transformation
of data into useful and actionable information? a. Key performance indicators b. Business intelligence c. Clinical decision support d. Computerized physician order entry ANS: B
Key performance indicators (KPI) are indicators of quality and efficiency that are selected based on reporting or operational requirements. Business intelligence (BI) refers to a set of tools that permit capture, storage, and transformation of data into useful and actionable information. Clinical decision support (CDS) has been defined as ―Health information technology functionality that builds upon the foundation of an EHR to provide persons involved in care processes with general and person—specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care.‖ A subset of EHRs is the computerized physician order entry (CPOE) system. Through CPOEs, orders can be electronically transmitted to the EHR, saving time and reducing transcription errors resulting from handwriting clarity issues. DIF: Application
REF: p. 133
OBJ: 8
21. The process by which the underlying primary, secondary, and other notable causes of a
medical error are identified is referred to as? a. Continuous quality improvement b. A root-cause analysis c. Value-based purchasing d. Web analytic ANS: A
However, it is important to note that many tools used in the continuous quality improvement (CQI) model, for both enhancing and monitoring quality, are computer-based. For example, a root-cause analysis is a process by which the underlying primary, secondary, and other notable causes of a medical error or other safety issues are identified, and then an action plan is created and implemented. CMS has introduced value-based purchasing (VBP) system, whereby reimbursement by CMS to hospitals and health care providers is partially based on their ability to meet a predefined set of standards. Web analytic is a generic term which encompasses the study of the impact of a Web site on its users. DIF: Application
REF: pp. 136-138 OBJ: 8
Chapter 08 - Funda menta ls of Respira tory Care Research Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. What are the three basic missions of academic medicine? a. To research, to discover, and to publish b. To research, to discover, and to cure disease c. To heal, to teach, and to discover d. To teach, to research, and to cure ANS: C
Academic medicine has three basic missions: to heal, to teach, and to discover. DIF: Recall
REF: p. 147
OBJ: 1
2. Which of the following describes a database that is a structured collection of facts? a. Synthesized databases b. Portal databases c. Electronic journal databases d. Bibliographic databases ANS: D
Synthesized databases are prefiltered records for particular topics. Portals are web pages that act as a starting point for using the Web or Web-based services. Bibliographic databases are a structured collection of facts. DIF: Recall
REF: p. 147
OBJ: 2
3. In what section of a paper are you likely to find exactly what was done to answer the research
question? a. Introduction b. Discussion c. Methods d. Results ANS: C
The purpose of the Methods section is to explain to the reader exactly what was done to answer the research question and/or test the hypotheses described in the Introduction. DIF: Application
REF: p. 154
OBJ: 3
4. In what section of a paper are you likely to find the definitions of the general concepts
discussed? a. Introduction b. Discussion c. Methods d. Results ANS: A
The Introduction should also contain definitions of the general concepts discussed in the manuscript. DIF: Application
REF: p. 154
OBJ: 3
5. What entity is responsible for approving experimental procedures prior to collecting data? a. AARC b. IRB c. NBRC d. NIH ANS: B
A description of the experimental protocol should be approved by the hospital’s institutional review board (IRB). If the study involves humans or animals, state that IRB approval was received prior to collecting data (as is required). A description of the experimental procedure should include the actual steps involved in gathering the data and the time elapsed during each phase of the experiment. DIF: Application
REF: p. 154
OBJ: 2
6. What Web site is known for well-respected rigorously conducted systematic evidence-based
reviews and provides free access to abstracts and summaries pertaining to relevant clinical questions? a. Cochrane.org b. Medsearch.org c. Wikepedia.com d. Systemview.org ANS: A
Synthesized databases are prefiltered records for particular topics. They are usually subscription based with relatively large fees. This type of database may provide the ―best‖ evidence without extensive searches of standard bibliographic databases. The leading database in this category is the Cochrane Collaboration. DIF: Recall
REF: p. 148
OBJ: 2
7. What search engine looks for scholarly publications in a wide range of fields and includes
peer-reviewed manuscripts, abstracts, theses, and books from academic publishers, professional societies, and university libraries? a. Medline.org b. Google Scholar c. Minimed.org d. Cochrane.org ANS: B
Google Scholar (scholar.google.com) is a search engine for scholarly publications in a wide range of fields. It includes peer-reviewed manuscripts, abstracts, theses, and books from academic publishers, professional societies, and university libraries. DIF: Recall
REF: p. 147
OBJ: 2
8. What is the name of the search engine sponsored by the National Library of Medicine for
information on health care? a. PubMed b. HotMed c. Up-to-date-Med d. NationalMedline ANS: A
PubMed (www.pubmed.com) is the National Library of Medicine’s free search engine for health information. DIF: Recall
REF: p. 147
OBJ: 2
9. What is the name of the database often purchased and used by hospitals and university
libraries to provide key research information on a large variety of medical topics? a. SPAN b. OVID c. CINUP d. MITO ANS: B
OVID is an extensive collection of Web-based information resources, including databases, journals, books, and searching software. In the United States, medical libraries and large hospitals almost universally purchase and use OVID in some form. DIF: Recall
REF: p. 148
OBJ: 2
10. Which of the following are explanations of why you should write a study plan?
1. The process of writing it out will help you clarify the goals of the study and methods of investigation. 2. You must often present a plan to obtain permission or approval to proceed with the study. 3. Provides an operational guide for the entire research team. 4. Allows you to improve your statistical analyses. a. 1 and 4 only b. 1, 2, and 3 only c. 1, 3, and 4 only d. 1, 2, 3, and 4 ANS: B
Here are three reasons why: First, the process of writing it out will help you clarify the goals of the study and methods of investigation. Second, you must often present a plan to obtain permission or approval to proceed with the study. Third, the research plan, or research protocol, as it is often called, provides an operational guide for the entire research team. DIF: Application
REF: p. 150
OBJ: 3
Chapter 09 - The Respiratory System Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1.
What is the primary purpose of the respiratory system? a. Continuous absorption of oxygen (O2 ) and excretion of carbon dioxide b. Filtering to prevent allergens and microbes from reaching the lungs c. Transport oxygenated blood to the tissues d. Warm and humidify inspired gas ANS: A
The respiratory system’s primary function is the continuous absorption of O 2 and the excretion of carbon dioxide. DIF: Application 2.
REF: p. 159
OBJ: 1
What is meant by ―internal respiration‖? a. Any gas exchange that occurs inside the body b. Consumption of O 2 in the mitochondria c. Continuous absorption of O2 and excretion of carbon dioxide d. Exchange of gases between the blood and the tissue ANS: D
This process supports internal respiration, which is the exchange of gases between blood and tissues. DIF: Application 3.
REF: p. 159
OBJ: 1
By what mechanism does gas exchange across the lung occur? a. Active transport b. Facilitated diffusion c. Facilitated transport d. Simple diffusion ANS: D
This close ―match‖ of gas and blood across a large but extremely thin blood-gas barrier membrane enables efficient gas exchange to occur by simple diffusion. DIF: Application 4.
REF: p. 159
OBJ: 1
Developmental morphogenesis of the human respiratory system can be categorized into: a. three periods. b. five stages. c. 6 weeks. d. 40 weeks. ANS: B
Figure 9-1 shows the various stages of lung development, and Table 8-1 summarizes the major developmental events in each phase.
DIF: Application 5.
REF: p. 160
OBJ: 1
The fetus is potentially viable if born prematurely after how many weeks of gestation? a. 12 to 16 weeks b. 18 to 20 weeks c. 24 to 26 weeks d. 28 to 32 weeks ANS: C
At the end of the canalicular period (24 to 26 weeks of gestation), the fetus, if born, is capable of sufficient gas exchange and is viable if supported completely with an artificial airway, O 2 , ventilatory support, and surfactant administration. DIF: Application 6.
REF: p. 160
OBJ: 1
The fetus is potentially viable if born at the end of which stage of development? a. Alveolar b. Canalicular c. Pseudoglandular d. Saccular ANS: B
At the end of the canalicular period (24 to 26 weeks of gestation), the fetus, if born, is capable of sufficient gas exchange and is viable if supported completely with an artificial airway, O 2 , ventilatory support, and surfactant administration. DIF: Application 7.
REF: p. 160
OBJ: 1
During which phase of fetal development do mature alveoli appear? a. Alveolar b. Canalicular c. Pseudoglandular d. Saccular ANS: A
The development of mature alveoli, accompanied by capillary proliferation within the walls, marks the final phase of lung development and is known as the alveolar period. DIF: Application 8.
REF: p. 160
OBJ: 1
Which of the following is an index commonly used to determine relative lung maturity? a. FRC/TLC ratio b. L:S ratio c. RQ ratio d. SP-A ANS: B
Quantification of these phospholipids (the L:S ratio and PG concentration) provides a predictive index of the lung maturity in the fetus before birth and the risks of developing respiratory disease. DIF: Application
REF: p. 162
OBJ: 1
9.
What maintains lung inflation during fetal development? a. Fetal lung fluid b. Radial tethering c. Rigidity of the chest wall d. Surfactant ANS: A
Fetal lung fluid is constantly produced and keeps the fetal lung inflated at a slight positive pressure with respect to amniotic fluid pressure and is important in promoting normal lung development. DIF: Application 10.
REF: p. 163
OBJ: 2
By which of the following routes does blood flow through the umbilical cord between the placenta and the fetus? a. One umbilical vein and one umbilical artery b. One umbilical vein and two umbilical arteries c. Two umbilical veins and one umbilical artery d. Two umbilical veins and two umbilical arteries ANS: B
Maternal blood flows into the intervillous space through the spiral arteries, while fetal blood is supplied to the villi from two umbilical arteries. Oxygenated fetal blood leaves the chorionic villi capillaries through placental venules and returns to the fetus through a single umbilical vein. DIF: Application 11.
REF: p. 165
OBJ: 3
Abnormalities of the placenta that can cause intrauterine growth retardation or fetal asphyxia include which of the following? 1. Abnormal implantation of the placenta 2. Separation of the placenta from the uterine wall 3. Decreased placental blood flow a. 2 and 3 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
Abnormal implantation of the placenta, tearing of the placenta from the uterine wall, or decreased placental blood flow can retard intrauterine growth and in severe cases can cause fetal asphyxia and increases the risk for brain damage and respiratory distress in the immediate postnatal period. DIF: Application 12.
REF: p. 164
What would be a normal P50 for a fetus? a. 10 b. 15 c.
20
OBJ: 3
d.
25
ANS: C
Figure 9-6 illustrates how the increased O 2 affinity is manifested by a leftward shift of the fetal oxyhemoglobin dissociation curve. The P50 (PO 2 that saturates 50% of the hemoglobin) is 6 to 8 mm Hg less than adult hemoglobin (HbA), which indicates the degree of the shift toward higher affinity. DIF: Application 13.
REF: p. 165
OBJ: 3
In the fetal heart, the foramen ovale allows blood to flow between which two structures? a. Bypass the liver and enter the inferior vena cava. b. Pulmonary artery to aortic arch. c. Right atrium to left atrium. d. Right atrium to left ventricle. ANS: C
Approximately 50% of this blood is shunted from the right atrium into the left atrium through an opening in the interatrial septum called the foramen ovale. DIF: Application 14.
REF: p. 165
OBJ: 3
Which factors contribute to maintaining a patent ductus arteriosus during fetal life? 1. Large amounts of fetal hemoglobin 2. Low PaO 2 3. Presence of LDH 4. Presence of prostaglandins a. 1, 2, and 3 b. 2 and 4 c. 3 only d. 1, 2, 3, and 4 ANS: B
The relatively low PO2 and various prostaglandins in fetal blood cause the ductus arteriosus, a muscular vessel attached to the trunk of the pulmonary artery and the aorta, to dilate and the pulmonary arteries to constrict. DIF: Application 15.
REF: p. 167
OBJ: 3
What percentage of right ventricular output is circulated through the fetal lungs? a. 10% b. 35% c. 75% d. 100% ANS: A
As a result, 90% of the blood flow entering the pulmonary artery takes the path of least resistance by shunting through the ductus arteriosus and flows to the aorta. Only 10% flows into the lungs. DIF: Recall
REF: p. 166
OBJ: 3
16.
During a vaginal delivery, what facilitates the removal of fetal lung fluid from the pulmonary system? a. High PaO 2 b. Low intrapulmonary pressures c. Thoracic compression d. Triaging of core functions ANS: C
During normal vaginal delivery, approximately one-third of the lung fluid is cleared by compression of the thorax in the birth canal. DIF: Application 17.
REF: p. 167
OBJ: 3
What strong stimulus to the infant provides the impetus for the first breath? a. Acidosis b. Exposure to warmth c. Fright from passing through the birth canal d. High PaO 2 ANS: A
The newborn infant is stimulated by new tactile and thermal stimuli, all of which stimulate breathing. In addition, as placental gas transfer is suddenly interrupted, the newborn quickly becomes hypoxemic, hypercapnic, and acidotic. DIF: Application 18.
REF: p. 167
OBJ: 4
Which of the following would NOT promote transition from fetal circulation to a normal extrauterine circulatory pattern? a. Closure of the foramen ovale b. Constriction of the ductus arteriosus c. Decreased pulmonary vascular resistance d. Decreased systemic vascular resistance ANS: D
Figure 9-9 summarizes the major cardiopulmonary changes that take place during the transition from the fluid-filled lung to an air-filled lung. As the lung expands with air and gas exchange starts within the lung, pulmonary blood PO 2 increases, PCO 2 decreases, and the pH rises. This results in pulmonary vasodilation, lower pulmonary vascular resistance, and constriction of the ductus arteriosus. This facilitates greater blood flow through the pulmonary circulation. Ductus arteriosus closure is further stimulated by the loss of maternal prostaglandins. The combination of increasing alveolar air content and constriction of the ductus arteriosus promotes progressive improvement in the matching of ventilation and blood flow, which, in turn, increases the PO 2 and decreases the PCO 2 of blood leaving the lungs. Cessation of umbilical and placental blood flow, following the clamping of the umbilical cord, causes closure of the ductus venosus and a rapid rise in systemic vascular resistance. The combination of the above events establishes a normal extrauterine circulatory pattern. DIF: Application 19.
REF: p. 167
OBJ: 3
Which factor contributes to increased likelihood of an upper airway obstruction in an infant compared to an adult?
a. b. c. d.
Higher percentage of body fat Higher volumes of sinus discharge Relatively smaller head size Tongue that is proportionally larger
ANS: D
Infant neck flexion causes acute airway obstruction. Although the head is larger, an infant’s nasal passages are proportionately smaller than are an adult’s. In addition, the infant’s jaw is much rounder and the tongue is much larger relative to the size of the oral cavity. These anatomic differences increase the likelihood of airway obstruction when an infant becomes unconscious and loses muscle tone. DIF: Application 20.
REF: p. 168
OBJ: 10
What is the length of the trachea in a small preterm infant? a. 2 cm b. 4 cm c. 6 cm d. 8 cm ANS: A
In small preterm infants, the trachea may be only 2 cm long and 2 to 3 mm wide. DIF: Recall 21.
REF: p. 168
OBJ: 5
Approximately how many alveoli are there in a 10-year-old’s lung? a. 50 million b. 200 million c. 350 million d. 480 million ANS: D
The human lung continues to develop alveoli for years until it reaches a stable stage where the total numbers have increased to approximately 480 million alveoli. All of the development is complete by 10 years of age. DIF: Recall 22.
REF: p. 161
OBJ: 5
What is unique regarding the blood supply to the lung? a. It receives blood from right and left ventricles. b. It requires no dedicated blood supply as it exists in a gas environment. c. Pulmonary venous drainage contributes to the normal anatomic shunt. d. The pulmonary arteries are the primary source of O2 for lung structures. ANS: A
The respiratory system is a unique organ in that it receives a double blood supply: one from the left ventricle and one from the right ventricle. DIF: Application 23.
REF: p. 169
OBJ: 8
What is the physiologic result of the infants’ more compliant thorax compared with that of an adult?
a. It is easier for infants to breathe. b. Their functional residual capacity is reduced based on predicted body weight
(PBW). c. They breathe larger tidal volumes based on IBW. d. They have less of a tendency to develop atelectasis. ANS: B
With a more compliant thorax, the resultant balance of these static forces in the infant favors a reduced FRC and total lung capacity (TLC). Proportionately lower lung volumes in the infant can lead to early airway closure, atelectasis, ventilation/perfusion mismatch, shunting, and resultant hypoxemia. DIF: Application 24.
REF: pp. 169-170 OBJ: 6
Infants can generate auto-PEEP by which of the following methods? a. Active expiration b. Increased diaphragmatic excursion c. Laryngeal braking d. Retractions ANS: C
The infant, especially one in distress, can actively end expiration and begin the next inspiratory phase to cause gas trapping, which leads to elevated FRC and better ventilation/perfusion matching. This can be accomplished actively using their diaphragm during exhalation to slow expiration and to adduct (close) their vocal cords and narrow the glottis. The combination of these two maneuvers effectively regulates volume in the lung and dynamically elevates the FRC. The narrowing of the glottis or larynx during exhalation is referred to as ―laryngeal braking.‖ DIF: Application 25.
REF: p. 171
OBJ: 5
Running vertically down each hemithorax anteriorly is an imaginary line that is used as an anatomical landmark. What is that line called? a. Anterior axillary line b. Midaxillary line c. Midclavicular line d. Midsternal line ANS: C
The left and right midclavicular lines are parallel to the midsternal line. These are drawn through the midpoints of the left and right clavicles, respectively (Figure 9-13). DIF: Application 26.
REF: p. 172
What is the function of the thorax? a. Facilitate digestion. b. Heat, humidify, and filter gases. c. Protect the vital organs. d. Vocalization. ANS: C
OBJ: 6
The thorax is a cone-shaped cavity that houses the lungs and the contents of the mediastinum (Figure 9-16). It functions to protect the vital organs within and has the capability of changing shape to enable air to be moved into and out of the lungs. DIF: Application 27.
REF: p. 171
OBJ: 6
What is the name of the thin serous membrane that covers the inner layer of the thoracic wall? a. Cupula b. Mesothelioma c. Parietal pleura d. Visceral pleura ANS: C
The inner layer of the thoracic wall is lined with a serous membrane called the parietal pleura. DIF: Recall 28.
REF: p. 173
OBJ: 6
What is the name of the upper portion of the sternum? a. Angle of Louis b. Manubrium c. Vertebral process d. Xiphoid process ANS: B
The sternum is a long, vertical flat bone found on the anterior side (Figure 9-18). It is comprised of three bones including the manubrium which comprises the upper portion. DIF: Recall 29.
REF: p. 174
OBJ: 6
Where does the sternal angle lie? a. At the depression in the body of the sternum to which the clavicles attach b. At the join between the manubrium and sternal body c. At the superior edge of the sternum d. Where the xiphoid process connects to the sternum ANS: B
The fused connection between the manubrium and the body is known as the sternal angle. It is also known as the angle of Louis. DIF: Recall 30.
REF: p. 172
OBJ: 6
What is the name of the external landmark that identifies the point at which the trachea branches into the right and left main stem bronchi? a. Sternal angle b. Cricoid cartilage c. Suprasternal notch d. Xiphoid process ANS: A
The sternal angle is an external marker of the point where the trachea divides into the left and right main stem bronchi.
DIF: Recall 31.
REF: p. 172
OBJ: 6
Which of rib pairs connect directly to the sternum? a. 1 through 4 b. 1 through 7 c. 1 through 12 d. 11 through 12 ANS: B
Rib pairs 1 through 7 are known as the true ribs because they are attached directly to the sternum. DIF: Recall 32.
REF: p. 174
OBJ: 6
What are rib pairs 11 and 12 known as? a. False ribs b. Faux ribs c. Floating ribs d. True ribs ANS: C
Rib pairs 11 and 12 are called floating ribs because they are not attached to the sternum. DIF: Application 33.
REF: p. 174
OBJ: 6
The intercostal arteries, veins, and nerves run through which of the following? a. Costal groove on the top of each rib b. Costal groove on the bottom of each rib c. Fibers of the intercostal musculature d. Surface of the parietal pleura ANS: B
Just below each rib are a thoracic artery, vein, and nerve that supply blood flow and nerve communications to that region of the chest wall (Figure 9-17). DIF: Recall 34.
REF: p. 173
OBJ: 6
What does the ―pump handle‖ movement of rib pairs 2 through 7 achieve? a. Anchor of the upper chest for diaphragmatic contraction b. Diminish of the energy wasted by inefficient muscular contraction c. Increase in the anteroposterior diameter of the chest d. Increase in the lateral dimensions of the chest ANS: C
Ribs 2 through 7 move simultaneously about two axes (Figure 9-20). As each rib rotates about the axis of its neck, its sternal end rises and falls. This movement increases the anteroposterior thoracic diameter in what is commonly referred to as a ―pump handle‖-like motion. DIF: Application 35.
REF: p. 175
OBJ: 6
Which of the following muscles are considered primary muscles of ventilation? 1. Diaphragm
2. Intercostals 3. Scalenes 4. Sternomastoid a. 1, 3, and 4 b. 1 and 2 c. 3 only d. 1, 2, 3, and 4 ANS: B
The diaphragm and intercostal muscles are the primary muscles of ventilation. DIF: Recall 36.
REF: p. 178
OBJ: 7
What external landmark can be used to show the highest point the dome of the right hemidiaphragm reaches in a healthy individual? a. Fifth rib posteriorly b. Sixth rib posteriorly c. Seventh rib posteriorly d. Eighth rib posteriorly ANS: D
The highest portion of the right dome sits at the eighth or ninth thoracic vertebra posteriorly and at the fifth rib anteriorly. DIF: Recall 37.
REF: p. 181
OBJ: 7
Approximately what percent of the normal changes in thoracic volume during quiet inspiration is due to the action of the diaphragm? a. 15 b. 25 c. 50 d. 75 ANS: D
During quiet breathing, the diaphragm is responsible for approximately 75% of the change in thoracic volume. DIF: Recall 38.
REF: pp. 178-179 OBJ: 7
How far is the diaphragm pulled down during tidal breathing? a. 1 to 2 cm b. 3 to 5 cm c. 6 to 8 cm d. 8 to 10 cm ANS: A
When the muscle fibers of the diaphragm are tensioned during inspiration, the dome of the diaphragm is pulled down 1 to 2 cm. DIF: Recall
REF: pp. 178-179 OBJ: 7
39.
Compared to a normal diaphragm, contraction of a diaphragm that is low and flat may result in which of the following? a. Compression of the thoracic cavity b. Enhanced venous return and thus cardiac output c. Greater diaphragmatic efficiency d. Larger than normal change in thoracic volume ANS: A
Increased lung volume causes the diaphragm to flatten out. Contraction of a flattened diaphragm can result in tension on the lower ribs that causes them to be pulled inward, which results in compression of the thoracic cavity. This condition can occur in individuals with severe gas trapping as a result of emphysema or asthma. To compensate for this, these individuals must recruit other muscles to enlarge the thorax. This results in less efficient breathing and excessive muscle work. DIF: Analysis 40.
REF: pp. 178-179 OBJ: 7
What pulmonary disorder could lead to acute flattening of the diaphragm? a. Adult respiratory distress syndrome b. Asthma c. Atelectasis d. Pneumonia ANS: B
Increased lung volume causes the diaphragm to flatten out. This condition can occur in individuals with severe gas trapping as a result of emphysema or asthma. DIF: Application 41.
REF: p. 176
OBJ: 7
Which of the following nerves innervates the diaphragm? a. Glossopharyngeal b. Phrenic c. Seventh cranial d. Vagus ANS: B
Functionally, the diaphragm is divided into a right and left hemidiaphragm. Each hemidiaphragm is innervated by a phrenic nerve that arises from branches of spinal nerves C3, C4, and C5. DIF: Recall 42.
REF: p. 169 |p. 176
OBJ: 7
The nerves that innervate the diaphragm arise from which area? a. Lumbar region of the spine b. Sacral vertebrae 4 and 5 c. Spinal plexuses at T2 to T11 d. Spinal nerves C3 to C5 ANS: D
Functionally, the diaphragm is divided into a right and left hemidiaphragm. Each hemidiaphragm is innervated by a phrenic nerve that arises from branches of spinal nerves C3, C4, and C5.
DIF: Recall 43.
REF: p. 176
OBJ: 7
What is the lowest level on the spinal cord that an injury could cause diaphragmatic impairment or paralysis? a. C3 b. L2 c. S5 d.
T4
ANS: A
Spinal cord injuries at or above the level of the third cervical vertebrae result in diaphragmatic paralysis. DIF: Application 44.
REF: p. 176
OBJ: 7
Limited, short-term spontaneous ventilation is possible in a patient with a paralyzed diaphragm because of . a. reflex diaphragm activity b. accessory muscle use c. active exhalation d. high intraabdominal pressures ANS: B
Although the diaphragm is the primary ventilatory muscle, it is not essential for survival. Limited, short-term ventilation is possible using accessory muscles, even if the diaphragm is paralyzed. The diaphragm does not actively participate in exhalation. During exhalation, it returns to its resting position during the passive recoil of the lungs and thorax. During forced exhalation, abdominal wall muscles compress the abdominal cavity and increase pressure in the abdominal cavity. This forces the diaphragm upward and compresses the lungs and forces gas from them. The diaphragm performs important functions other than ventilation. It aids in generating high intraabdominal pressures by remaining fixed while the abdominal muscles contract. This facilitates vomiting, coughing, sneezing, defecation, and parturition. DIF: Application 45.
REF: p. 169
OBJ: 7
Which accessory muscles are active during resting and active inspiration and pull up on all the ribs expanding the thorax? a. External intercostals b. Internal intercostals c. Scalenes d. Sternocleidomastoids ANS: A
The external intercostals (Figure 9-22) originate on the upper ribs and attach to the lower ribs. The fibers of these muscles run at an oblique angle between the ribs. When they generate tension, they lift the ribs upward and cause the thoracic cavity to enlarge the thorax. DIF: Application 46.
REF: pp. 178-179 OBJ: 7
Which of the following is the most important ventilatory function of the scalene muscles? a. Activate if intrathoracic pressure falls to −40 cm H 2 O.
b. Elevate and fix the first seven ribs. c. Lift upper chest particularly during times of high ventilatory demand. d. Support the trachea within the thorax during heavy exercise. ANS: C
Three pairs of scalene muscles (scalenus anterior, scalenus medius, and scalenus posterior) arise from the lower five or six cervical vertebrae and insert on the clavicle and first two ribs (Figure 9-23). They lift the upper chest when active. DIF: Application 47.
REF: p. 176
OBJ: 7
As ventilatory muscles, the sternocleidomastoids do which of the following? a. Theyelevate the upper chest, increasing chest anteroposterior diameter. b. Theyelevate the ribs and decrease chest anteroposterior diameter. c. Theyincrease lateral chest movement during inspiration. d. They lower the sternum, thus increasing chest anteroposterior diameter. ANS: A
The sternocleidomastoid muscles can function to lift the upper chest. They receive nerve impulses from branches of the accessory nerves (cranial nerve XI) and cervical nerves C1 and C2. These muscles are active during forceful inspiration and become visible as thick bands on either side of the neck during the inspiratory phase in an individual who is in respiratory distress. This motion increases the anteroposterior diameter of the chest. DIF: Application 48.
REF: p. 178
OBJ: 7
When a COPD patient leans forward braced in a tripod position, this lends particular advantage to which accessory muscles of inspiration? a. External intercostals b. Pectoralis c. Scalenes d. Sternocleidomastoids ANS: B
The major and minor pectoralis muscles are broad fan-shaped muscles of the upper anterior chest (Figure 9-25). The pectoralis major originates on the humerus and inserts onto the clavicle and sternum. The pectoralis minor originates on the scapula and inserts on the anterior portions of ribs 3 through 5. When these muscles receive impulses from the pectoral nerves, they normally function to adduct the arms in a hugging motion. They are also capable of generating some anterior thoracic lift when the arms are braced on a surface in front of a subject. Those individuals who suffer with chronic shortness of breath often utilize these muscles by sitting in a ―tripod‖ position. This is performed by sitting upright and leaning forward with both arms braced on a table. DIF: Application 49.
REF: p. 179
OBJ: 7
Which accessory muscles of ventilation work to pull the ribs closer together? a. External intercostals b. Internal intercostals c. Scalenes d. Sternocleidomastoids
ANS: B
The internal intercostal muscles (Figure 9-22) lie between the ribs and just behind the external intercostal muscles. They originate along the inferior border of the upper ribs and insert into the superior border of the lower ribs. The muscle fibers of the internal intercostal muscles run downward and less obliquely than the external intercostal muscle fibers. This orientation causes these muscles to pull the ribs together, which results in compression of the thoracic cavity. DIF: Application 50.
REF: p. 176
OBJ: 7
Which of the muscles below when stimulated will contract and push up on the diaphragm? 1. External intercostals 2. External obliques 3. Internal obliques 4. Rectus abdominous a. 1, 2, and 3 only b. 1 and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: C
When the abdominal wall muscles contract, they compress the abdominal cavity. This forces the diaphragm upward and compresses the thoracic cavity. The abdominal muscles include pairs of external oblique, internal oblique, transverse abdominis, and rectus abdominous muscles (Figure 9-27). DIF: Application 51.
REF: p. 176
OBJ: 7
The abdominal muscles can actually contribute to inspiration by: a. contracting at end-exhalation. b. contracting at end-inhalation. c. causing a cough. d. increasing end-inspiratory lung volume. ANS: A
The abdominals can also contribute to inspiration by contracting at end -exhalation. This reduces end-expiratory lung volume, so the chest wall can recoil outward, assisting the next inspiratory effort. DIF: Application 52.
REF: p. 178
OBJ: 7
To what structures do the parietal pleural membranes adhere? a. Fissures b. Intrapulmonary bronchi c. Lung d. Mediastinum ANS: D
The parietal pleural membrane lines the chest wall and mediastinum, while the lungs are covered by the visceral pleura. DIF: Recall
REF: pp. 180-181 OBJ: 6
53.
What is the function of the very small amount of pleural fluid that is found in the pleural space? a. Composes part of anatomic shunt. b. Liquid barrier for pathogens. c. Part of pulmonary blood flow. d. Reduces friction. ANS: D
The small volume of pleural fluid is spread out over the entire surface of both lungs and functions as a lubricant to reduce friction as the lungs move within the thorax and as an airtight seal that adheres together the two pleural membranes. DIF: Application REF: pp. 180-181 54.
OBJ: 6
What is the name given to the acute angle formed by the costal pleura joining the diaphragmatic pleura? a. Angle of Louis b. Costophrenic angle c. Diaphragmatic groove d. Oblique fissure ANS: B
The angle where the costal parietal pleura joins the diaphragmatic parietal pleura is known as the costophrenic angle. DIF: 55.
Application REF: pp. 180-181
OBJ: 6
What will most commonly blunt the costophrenic angle as seen on chest radiograph in an upright individual? a. Air b. Bile c. Excess fluids d. Liver on the right, intestines on the left ANS: C
Excess fluids between the visceral and parietal pleura tend to pool here in an upright individual. This causes the angle to appear blunted or flattened to 90 degrees when viewed in the chest radiograph. DIF: Application 56.
REF: pp. 180-181 OBJ: 6
What is the mediastinum? a. Membranous sac surrounding the heart and great vessels b. Middle layer of muscle fibers constituting the heart c. Point of division of the trachea into the bronchi d. Structure separating the right and left thoracic cavities ANS: D
The mediastinum lies between the left and right pleural cavities that contain the lungs (Figure 9-16).
DIF: Recall 57.
REF: p. 181
OBJ: 6
Why is the left lung narrower than the right lung? a. Liver compresses the left lung. b. Mediastinal organs push laterally into the left hemithorax. c. There is poorer blood flow during fetal development. d. There is upward pressure of the abdominal contents. ANS: B
The organs within the mediastinum bulge into the left hemithorax, resulting in a narrower and slightly smaller left lung. DIF: Application 58.
REF: p. 181
OBJ: 6
Approximately how far do the normal adult lungs extend above the clavicles? a. 2 cm b. 3 cm c. 4 cm d. 5 cm ANS: A
The lungs extend from the diaphragm to a point 1 to 2 cm above the medial third of the clavicles. DIF: Recall 59.
REF: p. 181
OBJ: 6
Which of the following statements describes a normal adult lung? a. The left lung is bisected by two fissures. b. The left lung has an upper, a middle, and a lower lobe. c. The right lung has only an upper and a lower lobe. d. The right lung has three lobes and two fissures. ANS: D
Each lung is divided into two or three lobes (Figure 9-28), which are separated by one or more fissures. The right lung has upper, middle, and lower lobes. The left lung has only an upper and a lower lobe. Both lungs have an oblique fissure that begins on the anterior chest at approximately the sixth rib at the midclavicular line. These fissures extend laterally and upward until they cross the fifth rib on the lateral chest in the midaxillary line. The fissures continue on the posterior chest to approximately the third thoracic vertebra. The right lung also has a horizontal or ―minor‖ fissure that separates the upper and middle lobes. DIF: Recall 60.
REF: p. 181
OBJ: 6
What will happen when the lung is surgically removed from the thorax? a. The lung will appear to undergo no change. b. The lung will collapse. c. The lung will expand. d. The response of the lung will depend on its age and pathology. ANS: B
When a lung is removed from the chest cavity, it quickly collapses to a smaller size.
DIF: Application 61.
REF: p. 183
OBJ: 6
What is the primary mechanism that stops the lungs from collapsing at the end of exhalation? a. Radial tethers, stretched to their maximum length, then halt lung collapse. b. Surfactant neutralizes the tendency of the lung to collapse. c. There is a tendency of the chest wall to lock at the level of FRC. d. There is an equal opposing tendency of the chest wall to expand. ANS: D
This tendency of the lung to collapse is counteracted by the thoracic wall’s tendency to spring outward and to hold the lung inflated. DIF: Application 62.
REF: p. 183
OBJ: 6
What forces establish the sub-atmospheric pressure found in the pleural space? a. Contraction of accessory muscles of inspiration b. Contraction of expiratory muscles c. Equal opposing tendency of the chest wall to expand and lung to collapse d. Effect of gravity, particularly at the base of the lungs ANS: C
This tendency of the lung to collapse is counteracted by the thoracic wall’s tendency to spring outward and to hold the lung inflated. The ―tension‖ developed by these two opposing tendencies results in development of sub-atmospheric intrapleural pressure. DIF: Application 63.
REF: p. 183
OBJ: 6
Fluid transport to and from the lungs is provided by which of the following? 1. Bronchial circulation 2. Lymphatic system 3. Pulmonary circulation a. 2 and 3 only b. 1 and 3 only c. 2 only d. 1, 2, and 3 ANS: D
The vascular supply of the lungs is composed of the pulmonary and bronchial circulations. The pulmonary circulation carries mixed venous blood from the systemic circuit to the lungs to increase O 2 and reduce carbon dioxide content of blood. The bronchial circulation provides systemic arterial blood to the airways and pleura to support their metabolic needs. A network of lymphatics is also involved in fluid transport from the lungs. The lymphatic system removes fluid from the lung tissue and pleural space and returns it to the systemic circulation. DIF: Application 64.
REF: pp. 184-185 OBJ: 8
The pulmonary arterial circulation does which of the following? 1. Delivers oxygenated blood back to the heart. 2. Delivers deoxygenated blood to the lungs. 3. Originates on the left side of the heart. 4. Originates on the right side of the heart. a. 1 and 4 only
b. 2 and 4 only c. 1 and 3 only d. 2 and 3 only ANS: B
The pulmonary circulation arises from the right heart (Figure 9-30) and carries the entire cardiac output through the lung each minute. O 2 -reduced systemic venous blood returns to the right heart via the inferior and superior venae cavae. This blood is pumped to the lungs by the right ventricle through the pulmonic semilunar valve and on to the trunk of the pulmonary artery. DIF: Application 65.
REF: pp. 184-185 OBJ: 8
The pulmonary venous circulation does which of the following? 1. Delivers oxygenated blood back to the heart. 2. Delivers deoxygenated blood to the lungs. 3. Empties into the left atrium. 4. Empties into the right atrium. a. 2 and 3 only b. 1 and 4 only c. 2 and 4 only d. 1 and 3 only ANS: D
The pulmonary venous system drains the capillary beds that have received O 2 from the alveoli and delivers the oxygenated blood into the left atrium. DIF: Application 66.
REF: pp. 184-185 OBJ: 8
Which of the following describes a function of pulmonary circulation? a. Breakdown of angiotensin II b. Filtering of blood clots c. Production of erythropoietin d. Regulation of breathing ANS: B
The third function is nonrespiratory and participates in the production, processing, and clearance of a large variety of chemicals and blood clots. DIF: Application 67.
REF: pp. 184-185 OBJ: 8
Compared with the systemic circulation under normal conditions, pressure in the pulmonary circulation is: a. higher. b. lower. c. the same. d. not connected. ANS: B
While the entire cardiac output passes through both pulmonary and systemic circuits, the pulmonary circulation offers much lower resistance and, as a result, has a much lower blood pressure.
DIF: Application 68.
REF: pp. 184-185 OBJ: 8
Pressures in the pulmonary circulation are lower than those in the systemic circulation because of what characteristic of the pulmonary circulation? a. Higher resistance than the systemic circulation b. Less blood flow than the systemic circulation c. Lower resistance than the systemic circulation d. More blood flow than the systemic circulation ANS: C
While the entire cardiac output passes through both pulmonary and systemic circuits, the pulmonary circulation offers much lower resistance and, as a result, has a much lower blood pressure. DIF: Application 69.
REF: pp. 184-185 OBJ: 8
Which of the following statements is false regarding the pulmonary circulation? a. Pulmonary blood flow is highly dependent on gravity. b. The pulmonary circulation is a low-pressure system. c. Toward the top of the upright lung, blood flow is high. d. Toward the top of the upright lung, blood flow is low. ANS: C
As a consequence of having a low blood pressure and being susceptible to gravity, blood flow is much higher in the lung bases in resting upright subjects. Gravity-related effects also occur in recumbent positions but are less pronounced. DIF: Application REF: pp. 184-185 OBJ: 8 70.
How would lung perfusion in a ―zone 1‖ area best be described? a. Increased b. Normal or average c. Reduced d. Unaffected ANS: C
Areas that experience higher airway pressure (e.g., during positive pressure ventilation) that equal or exceed local arteriole and capillary pressure will have reduced blood flow as a result of the opposing airway pressure (zone 1 airways). DIF: Application REF: pp. 184-185 OBJ: 8 71.
How does the lung respond to regional lung hypoxia? a. Bronchial artery vasoconstriction b. Bronchial artery vasodilation c. Pulmonary artery vasoconstriction d. Pulmonary artery vasodilation ANS: C
Areas of regional lung hypoxia, as the result of reduced ventilation, congestion, and/or airway obstruction, can result in local pulmonary arterial vasoconstriction and cause blood flow to be shifted from these areas toward areas of higher O2 content and pulmonary vasodilation. DIF: Application REF: pp. 184-185 72.
OBJ: 8
How does the lung parenchyma receive most of its O2 ? a. From the alveolar gases b. From the bronchial arteries/capillaries c. From the pulmonary arteries/capillaries d. From the pulmonary lymphatic system ANS: A
A separate arterial supply called the bronchial circulation supplies blood to the airways from the trachea to the bronchioles and to most of the visceral pleurae. The metabolic needs of the lung are comparatively low, and much of the lung parenchyma is oxygenated by direct contact with inspired gas. DIF: 73.
Application
REF: pp. 184-185
OBJ: 8
Via what pathway does much of the bronchial venous drainage occur? a. Bronchial veins emptying into the inferior vena cava b. Bronchopulmonary veins emptying into pulmonary veins c. Direct connections between bronchial and pulmonary arteries d. Thebesian venous drainage into the heart chambers ANS: B
Bronchial venous blood drains through the azygos, hemiazygos, and intercostal veins to the right atrium, and some drains through the pulmonary capillaries to the pulmonary veins and to the left atrium. DIF: 74.
Application
REF: pp. 184-185
OBJ: 8
How does the body compensate for a pulmonary embolus that occludes a branch of the pulmonary artery? a. Increased bronchial arterial flow to the area b. Increased cardiac output c. Pulmonary arteriole and metarteriole vasodilation d. Release of prostaglandins to fight inflammation ANS: A
The bronchial and pulmonary circulations share an important compensatory relationship. Decreased pulmonary arterial blood pressure tends to cause an increase in bronchial artery blood flow to the affected area. This minimizes the danger of pulmonary infarction, as sometimes occurs when a blood clot (pulmonary embolus) enters the lung. DIF: Application 75.
REF: p. 185
OBJ: 8
Which of the following statements is/are true of the pulmonary lymphatic system? 1. It consists of both superficial and deep vessels. 2. It drains into the right lymphatic or thoracic duct. 3. Vessels begin as dead-end lymphatic channels in the lung.
4. With phagocytes, it defends against foreign material. a. 1, 3, and 4 only b. 2, 3, and 4 only c. 2 only d. 1, 2, 3, and 4 ANS: D
The lymphatic system plays an important role in the specific defenses of the immune system. It removes bacteria, foreign material, and cell debris via the lymph fluid and through the action of various phagocytic cells (e.g., macrophages) that provide defense against foreign material and cells that are able to penetrate deep into the lung. It also produces a variety of lymphocytes and plasma cells to aid in defense. Both roles are essential for maintaining normal function of the respiratory system. Most of the pulmonary lymphatic system consists of superficial and deep vessels. The superficial (pleural) vessels that drain the lung surface and pleural space are more numerous over the lower half of the upright lung. Both drain the blind lymphatic capillaries in the respective regions. The deeper lymph vessels are closely associated with the small airways but do not extend into the walls of the alveolar-capillary membranes. Lymph fluid is collected by the loosely formed lymphatic capillaries and drains through the lymph vessels toward the hilum. The lymph fluid rejoins the general circulation after passing through the right lymphatic or thoracic duct, which drains into the jugular, subclavian, and/or innominate veins. The lymph fluid then mixes with blood and returns to the right heart. DIF: Application 76.
REF: pp. 185-186 OBJ: 8
What does the detection of lymphatic channels on standard chest radiographs indicate? a. Abnormally low pressures in the lymphatic channels b. Anastomoses with the pulmonary circulation c. Normal fibrotic changes that occur with aging d. System that is overwhelmed by excessive fluid ANS: D
Lymphatic channels are usually not visible on chest radiographs. They may be detected if they are distended or thickened by disease. The ―butterfly‖ pattern that radiates from the hilar region of both lungs during acute development of pulmonary edema is thought to largely be the result of interstitial and lymph vessel distension with fluid. In this situation, the lymphatic drainage system has been overwhelmed by a sudden and excessive surge of fluid from the circulation. The development of a pleural effusion is also evidence that the lymphatic system is unable to remove excess fluid in the lung. DIF: Application 77.
REF: pp. 185-186 OBJ: 8
What is the effect of damage to the recurrent laryngeal nerves? a. Diaphragmatic paralysis b. Pulmonary circulatory failure c. Inactivation of pulmonary surfactant production d. Vocal cord impairment or paralysis ANS: D
Damage to laryngeal nerves can cause unilateral or bilateral vocal cord paralysis, depending on which branches are involved. This may result in hoarseness, loss of voice, and an ineffective cough. DIF: Application 78.
REF: p. 193
OBJ: 9
What determines the airway diameter in the normal lung? a. Balance between sympathetic and parasympathetic tone b. In large part, the amount of patient effort c. Activity level of the submucosal glands d. Amount of dopamine present in the airway walls ANS: A
Both sympathetic and parasympathetic postganglionic efferents innervate the smooth muscle and glands of the airways. They influence the diameter of the airway by causing more or less tension in the smooth muscles that wrap the airway and influence glandular secretion. The combined effects of the parasympathetic and sympathetic nervous activity, which generally oppose each other’s action, result in a balanced control of airway diameter. DIF: Application 79.
REF: pp. 186-187 OBJ: 9
What is the name of the negative feedback reflex associated with the termination of inspiration? a. Carotid sinus b. Head’s paradoxical c. Hering-Breuer d. Vagovagal ANS: C
Pulmonary stretch receptors progressively discharge during lung inflation and are linked to inhibition of further inflation. This is a type of negative feedback known as the inflation reflex or the Hering-Breuer inflation reflex. DIF: Recall 80.
REF: p. 188
OBJ: 9
What is the name of the reflex associated with the sensory stimulation of the pulmonary stretch receptors that stimulates a deeper breath upon inspiration? a. Carotid sinus b. Head’s paradoxical c. Hering-Breuer d. Vagovagal ANS: B
Another reflex that is associated with stretch receptor activity is head’s paradoxical reflex. This reflex stimulates a deeper breath rather than inhibiting further inspiration. It may be the basis for occasional deep breaths or gasps. Deep breaths or sighs occur with normal breathing, presumably preventing alveolar collapse. Head’s reflex may also be responsible for gasping in newborn infants as they progressively inflate their lungs. DIF: Recall 81.
REF: p. 188
OBJ: 9
What may happen if the irritant receptors in the lung are stimulated?
1. Bronchoconstriction 2. Reflex closure of the glottis 3. Reflex slowing of the heart (bradycardia) a. 2 and 3 only b. 1 and 3 only c. 2 only d. 1, 2, and 3 ANS: D
When the irritant receptors are stimulated, it can result in bronchoconstriction, hyperpnea, glottic closure, cough, and sneeze. Stimulation of these receptors can also cause a reflex slowing of the heart rate (bradycardia). DIF: Application 82.
REF: p. 188
OBJ: 9
The upper respiratory tract traditionally ends at what point? a. Branching of the trachea into right and left main stem bronchi b. Hypopharynx c. Inferior border of the larynx d. The end of the conducting airways ANS: C
The upper respiratory tract is defined as those airways starting at the nose and mouth and that extend down to the trachea (Figure 9-36). DIF: Application 83.
REF: p. 189
OBJ: 10
What are the three bony projections that arise from the lateral walls of the nasal cavity that enhance filtration and humidification? a. Alar nasi b. Frontal sinuses c. Palatine tonsils d. Turbinates ANS: D
Three shelflike bones protrude into the cavity from the lateral walls. These bony shelves are called the superior, middle, and inferior concha or turbinates. The concha functions to increase the surface area of the nasal cavity, which enhances filtration and humidification. DIF: Application 84.
REF: p. 189
OBJ: 10
Which of the following are the primary functions of the nasal cavity? 1. Conduction of gases 2. Filtration and defense 3. Gas exchange 4. Heat and humidify a. 1 and 2 only b. 2 and 3 only c. 2, 3, and 4 only d. 1, 2, and 4 only ANS: D
The primary functions of the nasal cavity are to serve as a gas passageway, and to filter, humidify, and heat inhaled gases. DIF: Application 85.
REF: p. 189
OBJ: 10
Which of the following help(s) comprise the defense system of the nose? 1. Clearance of foreign matter by ciliary action 2. Gross filtration by the large hairs of the nasal vestibule 3. Impaction of particulate foreign matter on the nasal mucosa 4. Laminar flow through the concha a. 1, 2, and 3 only b. 2 and 4 only c. 3 only d. 1, 2, 3, and 4 ANS: A
Filtration of inhaled air is carried out by the hair in the anterior portion of the cavity and the sticky mucous membrane that covers the complex surface of the cavity. Filtration is enhanced by the flow pattern through the nasal cavity. Inspired gas is accelerated to a high velocity through the anterior nares. It then changes direction sharply as it enters the internal nasal cavity. This pattern causes particles larger than 10 µm in diameter to impact on the nasal mucosa. Ciliary action or nose blowing then clears these particles. Past the external nares, the cross-sectional area increases. This results in a decrease in gas velocity. Turbulence increases because of the narrow convolutions of the passages. Low velocity and turbulence combine to remove any remaining particles. DIF: Application 86.
REF: p. 189
OBJ: 10
What are the vascularized lymphoidal tissues that have a particularly active immunological role in children? a. Lingual tonsils b. Palatine tonsils c. Pharyngeal tonsils d. Superior turbinates ANS: B
The palatine tonsils are vascularized lymphoidal tissues that play an immunologic role, especially in childhood. DIF: Application 87.
REF: p. 191
OBJ: 10
What is your primary concern if you discover that a patient does not have a gag reflex? a. Fear of aspiration of bacteria or food b. That their tonsilar tissues are grossly swollen c. That they will not be able to breathe adequately d. Tracheal collapse ANS: A
Reflexes of the mouth, pharynx, and larynx help to protect the lower respiratory tract during swallowing. These protective functions can be severely compromised during anesthesia or unconsciousness. Loss or compromise of these important reflexes can result in aspiration of bacteria colonized saliva or food and can cause pulmonary infection and asphyxiation in severe cases. DIF: Application 88.
REF: p. 192
OBJ: 10
The subdivisions of the pharynx include which of the following? 1. Nasopharynx 2. Oropharynx 3. Laryngopharynx a. 2 and 3 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
The pharynx is subdivided into the nasopharynx, oropharynx, and hypopharynx or laryngopharynx. DIF: Recall 89.
REF: p. 191
OBJ: 10
Into what structure do the eustachian tubes drain? a. Larynx b. Nasopharynx c. Oropharynx d. Vestibule ANS: B
In the lateral nasopharynx, there are two openings into the left and right eustachian tubes that link the upper airway with the middle ear (Figure 9-36). The eustachian tubes drain fluid out of the middle ear and allow gas to move in or out of the middle to equalize pressure on either side of the tympanic membrane. DIF: Recall 90.
REF: p. 192
OBJ: 10
What results in partial or total obstruction of the airway in an unconscious patient? a. Closed mouth coexistent with nasal congestion. b. Epiglottis relaxes and occludes the laryngeal opening. c. Relaxation of tongue and hypopharyngeal muscles. d. The uvula occluding the airway. ANS: C
During unconsciousness, the muscles of the tongue and hypopharynx can relax and allow the tongue and other soft tissues to collapse and occlude the opening of the hypopharynx. This condition can result in partial to complete blockage of the upper airway and limit air movement to and from the respiratory tract. This is a primary cause of obstructive sleep apnea. DIF: Application REF: pp. 191-192 OBJ: 10
91.
What is the primary function of the larynx? a. Cover the glottic opening during forced expiration. b. House Waldeyer’s ring of tonsilar material for airway defense. c. Protect airway during eating or drinking. d. Provide a common passageway for food and gas. ANS: C
Generally, it functions to protect the respiratory tract during eating and drinking and in phonation. DIF: Application 92.
REF: p. 192
OBJ: 10
What is the cartilage that is commonly referred to as the Adam’s apple? a. Arytenoid b. Cricoid c. Cuneiform d. Thyroid ANS: D
The thyroid cartilage forms most of the upper portion of the larynx and is generally referred to as the Adam’s apple. DIF: Recall 93.
REF: p. 192
OBJ: 10
What is the only complete circular cartilage of the larynx? a. Arytenoid b. Corniculate c. Cricoid d. Thyroid ANS: C
Just below the thyroid cartilage is the cricoid cartilage, which is the only laryngeal structure that forms a complete ring of cartilage around the airway and is the narrowest region of the upper airway in infants. DIF: Recall 94.
REF: p. 192
OBJ: 10
What is the leaf-shaped cartilage that extends from the base of the tongue and is attached by ligaments to the thyroid cartilage? a. Arytenoid cartilage b. Cricoid cartilage c. Cuneiform cartilage d. Epiglottis ANS: D
The cartilaginous and leaf-shaped epiglottis lies within and is attached to the thyroid cartilage by a flexible joint. DIF: Recall 95.
REF: p. 192
OBJ: 10
Three-folds of tissue between the posterior base of the tongue and the epiglottis form a small space that is a key landmark in oral intubation. What is this called?
a. b. c. d.
False vocal cords Palatine fold Taurus tubularus Vallecula
ANS: D
The base of the tongue is attached to the epiglottis by three-folds. These folds form a space between the tongue and the epiglottis called the vallecula, which is a key landmark in oral intubation (Figure 9-36). DIF: Recall 96.
REF: p. 193
OBJ: 10
What is the space that separates the true vocal cords? a. Epiglottis b. Glottis c. Vallecula d. Vestibule ANS: B
The opening formed between the vocal cords is called the glottis. DIF: Recall 97.
REF: p. 193
OBJ: 10
The interaction of the laryngeal muscles and the movement of which cartilage causes changes in the tension on the vocal cords, allowing phonation? a. Arytenoids b. Corniculates c. Cricoid d. Cuneiforms ANS: A
The laryngeal component of speech is called phonation. It requires the adjustment of vocal cord tension and position relative to one another. The action of the posterior cricoarytenoid muscles causes the arytenoid cartilages to rotate and opens the vocal cords. Closure of the vocal cords is carried out by rotating the arytenoids in the opposite direction through the action of the lateral cricoarytenoid and oblique arytenoid muscles. DIF: Application 98.
REF: pp. 192-193 OBJ: 10
What could the ―effort closure‖ of the larynx facilitate? a. Crying b. Talking c. Whispering d. Yelling ANS: D
Tight closure of the larynx and the buildup of intrapulmonary pressure through muscular effort is called effort closure. Effort closure of the larynx is necessary for generating loud sounds and for effective coughing and sneezing. DIF: Application
REF: p. 194
OBJ: 10
99.
What position is used to open the airway in an unconscious patient? a. Neck extension b. Neck flexion c. Recovery position d. Sniff position ANS: D
With loss of consciousness, the head flexes forward, which can partially or completely obstruct the upper airway (Figure 9-41, A). Extension of the head and lower jaw into the ―sniff‖ position alleviates this obstruction (Figure 9-41, C). Extension of the head moves the tongue away from the rear of the pharynx. This technique is used to maintain the airway in unconscious patients and facilitates placement of artificial airways. DIF: Application 100.
REF: p. 194
OBJ: 10
Approximately how long is the trachea of an adult? a. 5 to 8 cm b. 10 to 12 cm c. 16 to 18 cm d. 20 to 24 cm ANS: B
The adult trachea is approximately 12 cm long and has an inner diameter of about 2.0 cm. DIF: Recall 101.
REF: p. 195
OBJ: 10
At what point does the trachea branch into two main stem bronchi? a. Carina b. Cricoid cartilage c. Glottis d. Manubrium ANS: A
At the base of the trachea, the last cartilaginous ring that forms the bifurcation for the two bronchi is called the carina. The carina is an important landmark that is used to identify the level at which the two main stem bronchi branch off from the trachea. DIF: Application 102.
REF: p. 195
OBJ: 10
Why do most aspirated objects and fluids end up in the right main stem bronchus instead of the left main stem bronchus? a. The left bronchus is more in-line with the trachea. b. The left bronchus is shorter than the right. c. The right bronchus is larger than the left. d. The right bronchus is more in-line with the trachea. ANS: D
The right bronchus branches off from the trachea at an angle of approximately 20 to 30 degrees, and the left bronchus branches with an angle of approximately 45 to 55 degrees (Figure 9-44). The right bronchus’s lower angle of branching results in a greater frequency of foreign body passage into the right lung because of the more direct pathway.
DIF: Application 103.
REF: p. 195
OBJ: 10
What portion of the left lung corresponds anatomically to the middle lobe of the right lung? a. Cardiac notch b. Lingula c. Medial segment d. Superior segment ANS: B
See Table 8-8. DIF: Application 104.
REF: p. 190
OBJ: 11
Which of the following statements about the terminal bronchioles is true? a. They are generally five divisions below the segmental bronchi. b. They are the smallest of the purely conducting airways. c. They average 3 to 4 mm in diameter. d. Theyhave well-defined and predictable amounts of cartilage. ANS: B
Terminal bronchioles are the smallest conducting airways and function to supply gas to the respiratory zone of the lung. DIF: Application 105.
REF: p. 197
OBJ: 13
What type of flow is seen in and beyond the terminal bronchioles? a. Laminar b. Transitional c. Turbulent d. Varies among individuals ANS: A
Low-velocity gas movement at the level of the terminal bronchiole and beyond is physiologically important for two reasons. First, laminar flow develops, which minimizes resistance in the small airways and decreases the work associated with inspiration. Second, low gas velocity facilitates rapid mixing of gases. DIF: Recall 106.
REF: p. 197
OBJ: 13
What is the most common cell type found in the mucosa of the larger airways? a. Pseudostratified ciliated columnar epithelium b. Pseudostratified ciliated cuboidal epithelium c. Stratified ciliated squamous epithelium d. Stratified unciliated serous endothelium ANS: A
The most common type of epithelia is the numerous pseudostratified, ciliated, columnar epithelia. DIF: Application
REF: p. 197
OBJ: 12
107.
What can the release of histamine and other chemical mediators from the mast cells in the airways cause? 1. Bronchoconstriction 2. Bronchodilation 3. Vasoconstriction 4. Vasodilation a. 2 and 4 only b. 1 and 3 only c. 2 and 3 only d. 1 and 4 only ANS: D
Mast cells are also found in the submucosa and release numerous and potent vasoactive and bronchoactive substances such as histamine. Histamine causes vasodilation and bronchoconstriction, acting directly on smooth muscle. DIF: Application 108.
REF: p. 199
OBJ: 12
What is the major source of respiratory tract secretions in the normal lung? a. Bronchial glands b. Clara cells c. Goblet cells d. Mast cells ANS: A
Normally, the respiratory tract produces approximately 100 ml of mucus per day. Most of the mucus formed in the larger airways is produced by the bronchial glands. DIF: Recall 109.
REF: p. 199
OBJ: 12
Identify functions of airway mucus in the normal lung. 1. Increased mucus production decreases bronchospasm. 2. Protect the airways from excessive water loss. 3. Shield the airway from toxic particles. 4. Trap inhaled contaminants. a. 1, 2, and 3 only b. 2, 3, and 4 only c. 1 and 4 only d. 3 and 4 only ANS: B
Mucus functions to protect the underlying tissue. It helps to prevent excessive amounts of water from moving into and out of the epithelia. It shields the epithelia from direct contact with potentially toxic materials and microorganisms. It acts like sticky flypaper to trap particles that make contact with it. This makes mucus an important part of the pulmonary defenses. DIF: Application 110.
REF: pp. 199-200 OBJ: 12
What is the name given to the action produced by the forward stroking of millions of cilia? a. Coughing
b. Mucociliary escalator c. Mucus stroking d. The wave ANS: B
The stroking action of millions of cilia propels the surrounding mucus at a speed approximately 2 cm/min. This action is commonly referred to as the mucociliary escalator. DIF: Recall 111.
REF: p. 200
OBJ: 12
Which of the following can impair or inhibit ciliary activity? 1. Drying of the respiratory tract mucosa 2. Exposure to smoke 3. Parasympatholytic drugs a. 1 and 2 only b. 1 only c. 1, 2, and 3 d. 2 and 3 only ANS: C
Ciliary beating can be effectively slowed or even stopped if the viscosity of the sol layer is increased by exposure to dry gas. Ciliary motion is also stopped following exposure to smoke, high concentrations of inhaled O 2 , and drugs like atropine. DIF: Application 112.
REF: p. 200
OBJ: 12
What is the common name given to classify the airway from the nares to the terminal bronchioles? a. Conducting airways b. Respiratory airways c. Transitional airways d. Upper airway ANS: A
The airways from the nares to and including the terminal bronchioles comprise the conducting zone airways, which do not participate in gas exchange. DIF: Application 113.
REF: p. 201
OBJ: 10
What is normal amount of anatomic dead space found in a healthy lung? a. 1 ml/kg predicted body weight b. 2 ml/kg predicted body weight c. 3 ml/kg predicted body weight d. 4 ml/kg predicted body weight ANS: B
These airways constitute the anatomic dead space of the respiratory system that is rebreathed with each breath. In the adult human, the volume filling the airways of the anatomic dead space is approximately 2 ml/kg of lean body weight, or approximately 150 ml in the typical adult. DIF: Recall
REF: p. 201
OBJ: 13
114.
Which of the following describes an acinus? a. Each acinus is comprised of five terminal respiratory units. b. It consists of all structures distal to a terminal bronchiole. c. It is composed of the smaller conducting airways. d. It is the transitional portion of the lung between conduction and respiration. ANS: B
A single terminal bronchiole supplies a cluster of respiratory bronchioles. Collectively, this unit is referred to as the acinus. DIF: Recall 115.
REF: p. 201
OBJ: 13
What is called the ―functional unit of the lungs‖? a. Only the alveoli b. Acinus c. Alveolar-capillary membranes d. Terminal bronchioles ANS: B
The primary lobule or acinus forms the functional unit of the lungs. DIF: Application 116.
REF: p. 201
OBJ: 13
Where are the largest alveoli found in the lung? a. Lingula b. Apexes c. Bases d. Middle ANS: B
Alveoli found in the apical regions of the vertical lung have greater diameters than those in the basal regions as a result of the gravitational effects. Those in the basal regions are partially collapsed as a result of the weight of the organ. DIF: Application 117.
REF: p. 201
OBJ: 13
What type of alveolar cells cover over 90% of the surface area of the alveolar-capillary membrane? a. Alveolar macrophages b. Granular pneumocytes c. Type I cells d. Type II cells ANS: C
The alveolar septa are covered with extremely flat squamous epithelia called type I pneumocytes (Figure 9-54). While they represent only about 8% of all the cells found in the alveolar region, the type I cells cover approximately 93% of the alveolar surface. DIF: Recall 118.
REF: p. 201
OBJ: 13
Which type of lung cells secretes pulmonary surfactant?
a. b. c. d.
Alveolar macrophages Type I cells (pneumocytes) Type II pneumocytes Type III pneumocytes
ANS: C
Type II cells do not function as gas-exchange membranes like the type I cells. They manufacture surfactant, store it in vesicles called lamellated bodies, and secrete it onto the alveolar surface. DIF: Recall 119.
REF: p. 202
OBJ: 13
Why is pulmonary surfactant such an important biologic substance? a. It clears out cellular debris. b. It is an alveolar macrophage. c. It promotes lung contraction aiding exhalation. d. It promotes lung stability. ANS: D
Surfactant functions to reduce the surface tension of the alveolus, which results in shedding water from the alveolar surface; helps to prevent alveolar surface tension-driven collapse; improves lung compliance; and reduces the work of breathing. DIF: Application 120.
REF: p. 202
OBJ: 13
What are the free-wandering phagocytic cells that ingest foreign material in the respiratory zone of the lungs? a. Alveolar macrophages b. Granular pneumocytes c. Type I cells d. Type II cells ANS: A
Macrophages are another common cell found in the alveolar region. They can move from the pulmonary capillary circulation by squeezing through openings in the alveolar septa and then move out onto the alveolar surface. They are defensive cells that patrol the alveolar region and phagocytize foreign particles and cells (e.g., bacteria). DIF: Recall 121.
REF: p. 202
OBJ: 13
What intercommunicating channels permit collateral ventilation between adjacent alveoli and primary lobules? 1. Bronchial anastomoses 2. Canals of Lambert 3. Pores of Kohn 4. Terminal bronchioles a. 1, 2, and 3 only b. 1 and 4 only c. 2 and 3 only d. 1, 2, 3, and 4 ANS: C
Small openings are located in the alveolar septa. Some of the openings allow gas to move from one alveolus to another. These are called the pores of Kohn. Other openings connect alveoli with secondary respiratory bronchioles. These passageways are called the canals of Lambert. All of these alveolar openings and passageways facilitate the collateral movement of gas and help maintain alveolar volume. DIF: Recall 122.
REF: p. 202
OBJ: 13
To what does the term ―faster-weaker‖ refer when discussing the alveolar-capillary membrane? a. Portion of the alveolar-capillary membrane that is average in thickness b. Shortest airways in the acinus, which allow fast gas exchange c. Thinnest portion of the alveolar-capillary membrane d. Thickest portion of the alveolar-capillary membrane ANS: C
On one side of the alveolar wall, the type I cell and capillary endothelial cells lie close together with a thin interstitial space. This part of the blood-gas barrier is, on average, 0.2 to 0.3 µm thick and it is where the alveolar capillary bulges into the alveolar space. On the other side, where there is a thicker interstitial space with greater fiber, matrix, and nuclear material content, the barrier can be more than 3 to 10 times thicker. This functionally results in ―faster-weaker‖ and ―slower-stronger‖ diffusion sides of the blood-gas barrier. DIF: Application 123.
REF: p. 205
OBJ: 14
Which of the following has/have been shown to injure the alveolar-capillary membrane? 1. Excessive pressures 2. Excessive tidal volumes 3. Increased intracranial pressures 4. Pulmonary hypertension a. 1, 2, and 4 only b. 2 and 3 only c. 4 only d. 1, 2, 3, and 4 ANS: A
Conditions of pulmonary hypertension (e.g., capillary pressure >30 mm Hg during congestive heart failure and high-altitude pulmonary edema) and excessive tidal volume and airway pressure during positive-pressure ventilation (e.g., tidal volume >6 ml/kg and airway pressures >30 cm H 2 O) can result in stress failure of the blood-gas membrane. Stress failure results in endothelial and/or type I cell stretching and shearing injuries. DIF: Application 124.
REF: p. 206
OBJ: 14
Identify the nonprimary function of the respiratory system. a. Filter out inhaled contaminants, various chemicals, and small blood clots. b. Exchange of gases between blood and tissues. c. Continuous absorption of O2 and excretion of carbon dioxide. d. Transport oxygenated blood to the tissues. ANS: A
The primary role of the respiratory system is breathing, external respiration (the continuous absorption of O 2 and the excretion of carbon dioxide), and the support of internal respiration, which is the exchange of gases between blood and tissues. The respiratory system is also equipped to filter out inhaled contaminants, while warming and humidifying inspired gas and simultaneously filter out various chemicals and small blood clots that are deposited or formed in the blood. DIF: Application 125.
REF: p. 159
OBJ: 1
What happens throughout fetal period? a. All major organs begin their development. b. Some of the major organs complete their development. c. Organs continue to develop and refine their structure and function. d. Gas exchange begins. ANS: C
The fetal period occurs during the remaining 32 weeks of gestation. During this period, the organs continue to develop and refine their structure and function. DIF: Application 126.
REF: p. 159
OBJ: 1
Which of following embryonic germinal tissue layers form all tissues and organs? 1. Endoderm 2. Mesoderm 3. Ectoderm 4. Mectoderm a. 2 only b. 2 and 3 only c. 1, 2, and 4 only d. 1, 2, and 3 only ANS: D
The three embryologically distinct germinal tissue layers form all tissues and organs: endoderm, mesoderm, and ectoderm. DIF: Recall 127.
REF: p. 159
OBJ: 1
Which phospholipid ratio would indicate a neonate with a low risk of developing respiratory distress syndrome (RDS)? a. L/S ratio of 1 b. L/S ratio of 2 or more c. L/S ratio of less than 1.5 d. L/S ratio of less than 1 ANS: B
An L/S ratio of 2 or more indicates a relatively low risk for the development of respiratory distress syndrome, while an L/S ratio of less than 1.5 is associated with a high risk. DIF: Application 128.
REF: p. 162
OBJ: 5
If premature delivery is anticipated, all of the following will help determine lung maturity, except:
a. b. c. d.
the presence of oligohydramnios. lecithin-sphingomyelin (L:S) ratio. phosphatidylglycerol (PG) concentration. body mass index (BMI).
ANS: D
Quantification of these phospholipids (the L/S ratio and PG concentration) provides a predictive index of the lung maturity in the fetus before birth and the risks of the development of respiratory distress. For example, an L/S ratio of 2 or more indicates a relatively low risk for the development of respiratory distress syndrome while an L/S ratio of less than 1.5 is associated with a high risk. Conditions that lead to reduced fetal breathing and amniotic fluid formation (oligohydramnios) are linked to incomplete inflation of the lung with fluid and poorly developed (hypoplastic) lungs. DIF: Application
REF: p. 162
OBJ: 5
TRUE/FALSE 1. Infants are more susceptible to profound hypoxemia than are adults. ANS: T
The combination of a reduced FRC and high O2 oxygen consumption in infants renders them more susceptible to profound hypoxemia in situations that further disturb ventilation, lung volume, and/or ventilation/perfusion matching. DIF: Application
REF: p. 164
OBJ: 5
Chapter 10 - The Cardiovascular System Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. The apex of the heart (tip of the left ventricle) lies just above the diaphragm at a level
corresponding to which intercostal space? a. Fourth b. Fifth c. Sixth d. Seventh ANS: B
The apex of the heart is formed by the tip of the left ventricle and lies just above the diaphragm at the level of the fifth intercostal space. DIF: Application
REF: p. 209
OBJ: 1
2. What is the loose membranous sac that encloses the heart? a. Endocardium b. Mesothelium c. Myocardium d. Pericardium ANS: D
The heart resides within a loose, membranous sac called the parietal pericardium. DIF: Recall
REF: p. 210
OBJ: 1
3. Tissue layers making up the heart wall include which of the following?
1. Endocardium 2. Epicardium 3. Myocardium a. 1, 2, and 3 b. 2 and 3 only c. 2 only d. 1 and 3 only ANS: A
The heart wall consists of three layers: (1) the outer epicardium, (2) the middle myocardium, and (3) the inner endocardium. DIF: Application
REF: p. 210
OBJ: 1
4. Most of the muscle mass of the heart is located in which chamber? a. Left atrium (LA) b. Left ventricle (LV) c. Right atrium (RA) d. Right ventricle (RV) ANS: B
The two lower heart chambers, or ventricles, makeup the bulk of the heart’s muscle mass and do most of the pumping that circulates the blood (Figure 9 -2). The mass of the left ventricle is approximately two-thirds larger than that of the right ventricle and has a spherical appearance when viewed in anteroposterior cross section. DIF: Recall
REF: p. 210
OBJ: 2
5. The mitral (bicuspid) valve does which of the following? a. Prevents atrial backflow during ventricular contraction. b. Separates the right atrium and the left atrium. c. Separates the right atrium and the right ventricle. d. Separates the right ventricle and the pulmonary artery. ANS: A
The valve between the left atrium and ventricle is the bicuspid, or mitral, valve. The AV valves close during systole (contraction of the ventricles), thereby preventing backflow of blood into the atria. DIF: Application
REF: p. 210
OBJ: 1
6. Narrowing of the mitral valve (mitral stenosis) results in which of the following? a. Increased afterload on left ventricle b. Increased preload on right ventricle c. Increased pulmonary congestion d. Systemic hypertension ANS: C
Stenosis is a pathologic narrowing or constriction of a valve outlet, which causes increased pressure in the affected chamber and vessels. Both conditions affect cardiac performance. For example, in mitral stenosis, high pressures in the left atrium back up into the pulmonary circulation. This can cause pulmonary edema. DIF: Application
REF: p. 211
OBJ: 1
7. The semilunar (pulmonary and aortic) valves do which of the following? a. Cause almost the entire afterload for the ventricles. b. Consist of two half-moon or crescent-shaped cusps. c. Prevent arterial backflow during ventricular relaxation. d. Separate the ventricles from their arterial outflow tracts. ANS: D
A set of semilunar valves separates the ventricles from their arterial outflow tracts (Figure 9-3). Consisting of three half-moon–shaped cusps attached to the arterial wall, these valves prevent backflow of blood into the ventricles during diastole (or when the heart’s chambers fill with blood). DIF: Application
REF: p. 211
OBJ: 1
8. What are the first arteries to branch off the ascending aorta? a. Brachiocephalic b. Carotid c. Coronary
d. Subclavian ANS: C
Two main coronary arteries, a left and a right, arise from the root of the aorta. DIF: Recall
REF: p. 212
OBJ: 1
9. What are the major branches of the left coronary artery?
1. Anterior descending 2. Circumflex 3. Coronary sinus 4. Posterior descending a. 1, 2, and 3 only b. 2 and 4 only c. 1 and 2 only d. 2 and 3 only ANS: C
An anterior descending branch courses down the anterior sulcus to the apex of the heart. A circumflex branch moves along the coronary sulcus toward the back and around the left atrial appendage. DIF: Recall
REF: p. 212
OBJ: 1
10. The branches of the left coronary artery DO NOT supply which area of the heart? a. Majority of the interventricular septum b. Majority of the left ventricle c. Majority of the left atrium d. Sinus node ANS: D
In combination, the branches of the left coronary artery normally supply most of the left ventricle, the left atrium, and the anterior two-thirds of the interventricular septum. DIF: Application
REF: p. 212
OBJ: 1
11. Before draining into the right atrium, where do the large veins of the coronary circulation
gather together? a. Coronary sinus b. Left posterior coronary vein c. Right coronary sulcus d. Thebesian veins ANS: A
These veins gather together into a large vessel called the coronary sinus, which passes left to right across the posterior surface of the heart. The coronary sinus empties into the right atrium. DIF: Application
REF: p. 212
OBJ: 1
12. Mixing of venous blood with arterial blood (a right-to-left shunt) occurs normally because of
which of the following?
1. Congenital cardiac defects 2. Bronchial venous drainage 3. Thebesian venous drainage in the heart a. 1, 2, and 3 b. 2 and 3 only c. 1 only d. 2 only ANS: B
Because the thebesian veins bypass, or shunt, around the pulmonary circulation, this phenomenon is called an anatomical shunt. When combined with a similar bypass in the bronchial circulation (see Chapter 7), these normal anatomical shunts account for approximately 2% to 3% of the total cardiac output. DIF: Application
REF: p. 212
OBJ: 1
13. What is the ability of myocardial tissue to propagate electrical impulses? a. Automaticity b. Conductivity c. Contractility d. Excitability ANS: A
Inherent rhythmicity or automaticity is the unique ability of the cardiac muscle to initiate a spontaneous electrical impulse. DIF: Application
REF: p. 213
OBJ: 2
14. What makes it impossible for the myocardium to go into tetany? a. Absolute refractory period b. Automaticity c. Cardiac myofibrils d. Intercalated discs ANS: A
Unlike those of other muscle tissues, however, cardiac contractions cannot be sustained or tetanized because myocardial tissue exhibits a prolonged period of inexcitability after contraction. The period during which the myocardium cannot be stimulated is called the refractory period. DIF: Application
REF: p. 213
OBJ: 2
15. Intercalated discs in the myocardium perform a very important function. Which of the
following describes that function? a. Absolute refractory period b. Automaticity c. Contractility d. Electrical conduction ANS: D
Cardiac fibers are separated by irregular transverse thickenings of the sarcolemma called intercalated discs. These discs provide structural support and aid in electrical conduction between fibers. DIF: Recall
REF: p. 213
OBJ: 2
16. What in essence is Frank-Starling’s law of the heart? a. The greater the stretch, the stronger the contraction. b. The less the afterload, the greater the ejection fraction. c. Describes the inverse relationship between diameter and resistance to flow. d. Curves show the hysteresis variations between systole and diastole. ANS: A
According to Frank-Starling’s law, the more a cardiac fiber is stretched, the greater the tension it generates when contracted. DIF: Recall
REF: p. 213
OBJ: 2
17. Which vessels in the body act like faucets, controlling the flow of blood into the capillary
beds? a. Arteries b. Arterioles c. Veins d. Venules ANS: B
Just as faucets control the flow of water into a sink, the smaller arterioles control blood flow into the capillaries. Arterioles provide this control by varying their flow resistance. For this reason, arterioles are often referred to as resistance vessels. DIF: Recall
REF: p. 214
OBJ: 1
18. Why are the vessels of the venous system, particularly the small venules and veins, termed
capacitance vessels? a. They transmit and maintain the head of perfusion pressure. b. They can alter their capacity to maintain adequate perfusion. c. They determine the afterload on the left ventricle. d. They maintain a constant environment for the body’s cells. ANS: B
By quickly changing its holding capacity, the venous system can match the volume of circulating blood to that needed to maintain adequate perfusion. Accordingly, the components of the venous system, especially the small, expandable venules and veins, are termed capacitance vessels. DIF: Application
REF: p. 214
OBJ: 1
19. Which of the following mechanisms facilitate venous return to the heart?
1. Sodium/potassium pump 2. Sympathetic venomotor tone 3. Cardiac suction 4. Skeletal muscle contraction
a. 1 and 2 only b. 2, 3, and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: B
The following four mechanisms combine to aid venous return to the heart: (1) sympathetic venous tone, (2) skeletal muscle pumping, or ―milking‖ (combined with venous one-way valves), (3) cardiac suction, and (4) thoracic pressure differences caused by respiratory efforts. DIF: Application
REF: p. 214
OBJ: 1
20. What circulatory system is referred to as a low-pressure, low-resistance system? a. Left heart b. Pulmonary vascular bed c. Right heart d. Systemic vascular bed ANS: B
The right side of the heart provides the pressures needed to drive blood through the low-resistance, low-pressure pulmonary circulation. DIF: Application
REF: p. 214
OBJ: 1
21. Which of the following equations would you use to compute systemic vascular resistance? a. (Mean aortic pressure right atrial pressure) ÷ CO b. (Mean aortic pressure/right atrial pressure) CO c. (Mean aortic pressure − right atrial pressure) ÷ CO d. (Right atrial pressure − mean aortic pressure) ÷ CO ANS: C
SVR = (mean aortic pressure – right atrial pressure)/CO. DIF: Recall
REF: p. 215
OBJ: 3
22. Which of the following statements is true? a. Pulmonary vascular resistance (PVR) is equal to systemic resistance. b. Pulmonary vasculature is a high-pressure, high-resistance circulation. c. Systemic vascular resistance (SVR) is less than PVR. d. SVR is normally approximately 10 times higher than PVR. ANS: D
DIF: Analysis
REF: p. 215
OBJ: 3
23. Which of the following equations best depicts the factors determining mean arterial blood
pressure? a. Mean arterial pressure = cardiac output ÷ vascular resistance b. Mean arterial pressure = cardiac output vascular resistance c. Mean arterial pressure = right atrial pressure − aortic pressure d. Mean arterial pressure = vascular resistance ÷ cardiac output ANS: B
Average blood pressure in the circulation is directly related to both cardiac output and flow resistance. Mean arterial pressure = cardiac output vascular resistance. DIF: Analysis
REF: p. 216
OBJ: 3
24. Mean arterial blood pressure can be regulated by changing which of the following?
1. Capacity of the circulatory system 2. Effective volume of circulating blood 3. Tone of the capacitance vessels (veins) a. 1 and 2 only b. 2 only c. 1, 2, and 3 d. 3 only ANS: C
All else being constant, mean arterial pressure is directly related to the volume of blood in the vascular system and inversely related to its capacity. A change in the tone of the capacitance vessels alters their capacity. Mean arterial pressure = volume/capacity. DIF: Application
REF: p. 216
OBJ: 4
25. During exercise, cardiac output increases dramatically, but mean arterial blood pressure rises
very little. Why is this so? a. Venules constrict, increasing vascular resistance. b. Arterioles dilate, decreasing vascular capacity. c. Arterioles constrict, increasing vascular resistance. d. Muscle vessels dilate, increasing vascular capacity. ANS: D
For example, when exercising, the circulating blood volume undergoes a relative increase, but blood pressure remains near normal. This is because the skeletal muscle vascular beds dilate, causing a large increase in system capacity. DIF: Application
REF: p. 216
OBJ: 4
26. During blood loss due to hemorrhage, perfusing pressures can be kept near normal until the
volume loss overwhelms the system. Why is this so? a. Arteries constrict, increasing vascular resistance. b. Arterioles dilate, decreasing vascular capacity. c. Muscle vessels dilate, increasing vascular capacity. d. Venules constrict, decreasing vascular capacity. ANS: D
When blood loss occurs, as with hemorrhage, system capacity is decreased by constricting the venous vessels. Thus, perfusing pressures can be kept near normal until the volume loss overwhelms the system. DIF: Application
REF: p. 216
OBJ: 4
27. The underlying goal of the body’s cardiovascular control mechanisms is to ensure that all
tissues receive which of the following? a. Blood flow according to their mass b. Blood flow according to their size c. Equivalent amounts of blood flow d. Perfusion according to their metabolic needs ANS: D
The goal is to maintain adequate perfusion to all tissues according to their needs. DIF: Application
REF: p. 216
OBJ: 4
28. The cardiovascular system regulates perfusion mainly by altering which of the following? a. Capacity and resistance of blood vessels b. Rate of cardiac contractions c. Strength of cardiac contractions d. Volume of cardiac contractions ANS: A
The cardiovascular system regulates blood flow mainly by altering the capacity of the vasculature and the volume of blood it holds. DIF: Application
REF: p. 216
OBJ: 4
29. What is the primary function of local or intrinsic cardiovascular control mechanisms? a. Alter local blood flow according to tissue needs. b. Alter the rate of cardiac contractions. c. Maintain a basal level of systemic vascular tone. d. Control the capacity of the venous reservoir. ANS: A
Local, or intrinsic, controls operate independently, without central nervous control. Intrinsic control alters perfusion under normal conditions to meet metabolic needs. DIF: Application
REF: p. 217
OBJ: 4
30. Central, or extrinsic, control of the cardiovascular system occurs through the action of which
of the following? 1. Autonomic nervous system 2. Circulating humoral agents 3. Local metabolites a. 1, 2, and 3 b. 2 and 3 only c. 3 only d. 1 and 2 only ANS: D
Central, or extrinsic, control involves both the central nervous system and circulating humoral agents. DIF: Application
REF: p. 217
OBJ: 4
31. Central control of vasomotor tone has its greatest impact on which of the following vessels?
1. Arterioles (resistance vessels) 2. Veins (capacitance vessels) 3. Microcirculation (exchange vessels) a. 2 and 3 only b. 1 and 2 only c. 3 only d. 1, 2, and 3 ANS: B
Central control mainly affects the high-resistance arterioles and capacitance veins. DIF: Application
REF: p. 217
OBJ: 4
32. Which of the following variations control blood flow to the brain? a. Central neural innervation b. Circulation of humoral agents c. Local metabolic control mechanisms d. Local myogenic control mechanisms ANS: C
Metabolic control involves the relationship between vascular smooth muscle tone and the level of local cellular metabolites. The vascular tone in the brain is the most sensitive to changes in the local metabolite levels, particularly those of CO2 and pH. DIF: Application
REF: p. 217
OBJ: 4
33. Which of the following variation(s) control(s) blood flow to the heart?
1. Local metabolic control mechanisms 2. Local myogenic control mechanisms 3. Central neural innervation a. 1, 2, and 3 b. 2 and 3 only c. 1 only d. 1 and 3 only ANS: B
The vasculature of the heart shows a strong response to both myogenic and metabolic factors. DIF: Recall
REF: p. 217
OBJ: 4
34. Which portion of the nervous system is mainly responsible for the central control of the blood
flow? a. Higher brain centers b. Parasympathetic nervous system c. Somatic (voluntary) nervous system d. Sympathetic nervous system ANS: D
Central control of blood flow is achieved primarily by the sympathetic division of the autonomic nervous system.
DIF: Application
REF: p. 217
OBJ: 4
35. Central mechanisms cause contraction and increased resistance to blood flow mainly through
which of the following? a. Adrenergic stimulation and the release of norepinephrine b. Cholinergic stimulation and the release of acetylcholine c. Cholinergic stimulation and the release of norepinephrine d. Stimulation of specialized alpha-adrenergic receptors ANS: A
Smooth muscle contraction and increased flow resistance are mostly caused by adrenergic stimulation and the release of norepinephrine. DIF: Application
REF: p. 217
OBJ: 4
36. Smooth muscle relaxation and vessel dilation are caused mainly by which of the following?
1. Action of local metabolites 2. Cholinergic stimulation 3. Stimulation of beta-adrenergic receptors a. 1 and 3 only b. 2 and 3 only c. 1 and 2 only d. 1, 2, and 3 ANS: B
Smooth muscle relaxation and vessel dilation occur as a result of stimulation of cholinergic or specialized beta-adrenergic receptors. DIF: Application
REF: p. 217
OBJ: 4
37. Which of the following formulas is used to calculate the total amount of blood pumped by the
heart per minute, or cardiac output? a. Blood pressure SV b. Rate SV c. SV ÷ rate d. SV vascular resistance ANS: B
Cardiac output = heart rate stroke volume. DIF: Recall
REF: p. 213
OBJ: 6
38. What is an approximate normal resting cardiac output for a healthy adult? a. 75 ml/min b. 500 ml/min c. 2000 ml/min d. 5000 ml/min ANS: D
A normal resting cardiac output of approximately 5 L/min can be calculated by substituting a normal heart rate (70 contractions/min) and stroke volume (75 ml, or 0.075 L, per contraction).
Cardiac output = 70 beats/min 0.075 L/beat = 5.25 L/min. DIF: Recall
REF: p. 217
OBJ: 6
39. Which of the following factors determine cardiac stroke volume?
1. Ventricular preload 2. Ventricular afterload 3. Ventricular contractility a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Stroke volume is affected chiefly by intrinsic control of three factors: (1) preload, (2) afterload, and (3) contractility. DIF: Application
REF: p. 214
OBJ: 5
40. Stroke volume can be calculated using which formula? a. Ejection fraction heart rate b. End-diastolic volume − end-systolic volume c. Ejection fraction end-systolic volume d. Cardiac output ÷ end-diastolic volume ANS: B
Stroke volume = EDV − ESV. DIF: Recall
REF: p. 217
OBJ: 7
41. Given a stroke volume of 40 ml and an end-diastolic volume (EDV) of 70 ml, what is the
patient’s ejection fraction (EF)? a. 0.57 b. 1.75 c. 67 d. 2800 ANS: A
Given a stroke volume of approximately 40 ml, and an EDV of 70 ml, the ejection fraction can be calculated as follows: EF = SV/EDV= 40 ml/70 ml = 0.57, or 57%. DIF: Application
REF: p. 218
OBJ: 7
42. What is a normal cardiac ejection fraction? a. 24% b. 44% c. 64% d. 84% ANS: C
Thus, on each contraction, the normal heart ejects approximately two-thirds of its stored volume. Decreases in ejection fraction are normally associated with a weakened myocardium and decreased contractility. DIF: Application
REF: p. 218
OBJ: 7
43. The heart’s ability to vary stroke volume based solely on changes in end-diastolic volume is
based on what mechanism? a. Automaticity b. Autoregulation c. Bohr equation d. Frank-Starling’s law ANS: D
The heart’s ability to change stroke volume solely according to the EDV is an intrinsic regulatory mechanism based on the Frank-Starling’s law. DIF: Application
REF: p. 218
OBJ: 5
44. Which of the following are true of the force against which the left ventricle must pump?
1. Referred to as left ventricular afterload. 2. Equivalent to systemic vascular resistance. 3. Helps to determine left ventricular stroke volume. a. 1 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 2 and 3 only ANS: C
A major factor affecting stroke volume is the force against which the heart must pump. This is called afterload. In clinical practice, left ventricular afterload equals the SVR. In other words, the greater the resistance to blood flow, the greater is the afterload. DIF: Application
REF: p. 218
OBJ: 8
45. Which of the following would have a negative impact on cardiac contractility?
1. Acidosis 2. Digitalis 3. Hypoxia 4. Norepinephrine a. 1, 2, and 3 b. 2 and 4 only c. 4 only d. 1 and 3 only ANS: D
Profound hypoxia and acidosis impair myocardial metabolism and decrease cardiac contractility. DIF: Application
REF: p. 220
OBJ: 5
46. Changes in the rate of cardiac contractions are affected primarily by changes in which of the
following? a. Sympathetic or parasympathetic tone b. Ventricular afterload c. Ventricular contractility d. Ventricular preload ANS: A
Those factors affecting heart rate are mainly of central origin (i.e., neural or hormonal). DIF: Application
REF: p. 220
OBJ: 4
47. Where are the central centers responsible for regulating the cardiovascular system located? a. Aortic bodies b. Brainstem c. Carotid arteries d. Cerebral hemispheres ANS: B
Central control of cardiovascular function occurs via interaction between the brainstem and selected peripheral receptors. DIF: Application
REF: p. 220
OBJ: 4
48. What is the affect on the cardiovascular medullary centers when the cerebral carbon dioxide is
low? a. Excitatory b. Inhibitory c. No affect d. Increased vascular tone ANS: B
The cardiovascular centers are also affected by local chemical changes in the surrounding blood and cerebrospinal fluid. For example, decreased levels of carbon dioxide tend to inhibit the medullary centers. DIF: Application
REF: p. 220
OBJ: 5
49. In order to function effectively, the central cardiovascular control center must receive signals
regarding changes in blood volume or pressure. From where do these signals come? a. Central chemoreceptors b. Hypothalamus c. Peripheral baroreceptors d. Skeletal muscles ANS: C
The greater the blood pressure, the greater is the stretch and the higher is the rate of neural discharge from the peripheral baroreceptors to the cardiovascular centers in the medulla. DIF: Application
REF: p. 222
OBJ: 4
50. Considering the negative feedback system for the control of blood pressure, when a blood
pressure rise is noted in the arterial receptors, what is the expected response? a. Arterial vasoconstriction b. Decreased inotropic state c. Increased heart rate d. Venoconstriction ANS: B
In the case of the arterial receptors, a rise in blood pressure increases aortic and carotid receptor stretch, and thus the discharge rate. The increased discharge rate causes an opposite response by the medullary centers (i.e., a depressor response). Venomotor tone decreases, blood vessels dilate, and heart rate and contractility both decrease. DIF: Application
REF: p. 222
OBJ: 5
51. Vascular low-pressure baroreceptors have their greatest impact on which system? a. Central chemoreceptors b. Endocrine c. Exocrine d. Renin-angiotensin ANS: D
The low-pressure atrial and venous baroreceptors regulate plasma volume mainly through their effects on the following: • Renal sympathetic nerve activity • Release of antidiuretic hormone (ADH), also called vasopressin • Release of atrial natriuretic factor (ANF) • Renin-angiotensin-aldosterone system DIF: Application
REF: p. 222
OBJ: 4
52. Which factor stimulates the carotid and aortic chemoreceptors? a. High carbon dioxide levels b. High oxygen (O2 ) levels c. High pH levels d. High 2,3-DPG levels ANS: A
They are strongly stimulated by decreased O2 tensions, although low pH or high levels of carbon dioxide also can increase their discharge rate. DIF: Application
REF: p. 223
OBJ: 4
53. What are the major effects of peripheral chemoreceptor stimulation? a. Decreased drive to breathe b. Decreased production of erythropoietin c. Vasoconstriction and increased heart rate d. Vasodilation and increased stroke volume ANS: C
It is important for the respiratory therapist to know that the major cardiovascular effects of chemoreceptor stimulation are vasoconstriction and increased heart rate.
DIF: Application
REF: p. 223
OBJ: 4
54. Significant loss of blood volume causes an increase in which of the following?
1. Vascular tone 2. Secretion of antidiuretic hormone (ADH) 3. Heart rate a. 1, 2, and 3 b. 2 and 3 only c. 1 and 3 only d. 1 and 2 only ANS: A
As the blood loss becomes more severe (20%), atrial receptor activity decreases further. This increases the intensity of sympathetic discharge from the cardiovascular centers. Plasma ADH and heart rate continue to climb, as does peripheral vasculature tone. DIF: Application
REF: p. 223
OBJ: 5
55. During the normal events of the cardiac cycle, which of the following statements is true? a. Electrical depolarization follows mechanical contraction. b. Electrical depolarization precedes mechanical contraction. c. Heart sounds precede electrical depolarization. d. Heart sounds precede cardiac valve opening or closing. ANS: B
The P wave signals atrial depolarization. Within 0.1 sec, the atria contract, causing a slight rise in both atrial and ventricular pressures (the A waves). DIF: Application
REF: p. 224
OBJ: 8
56. Immediately following the P wave of the electrocardiogram, an A wave appears on both the
left and right heart pressure graphs. This A wave corresponds to which of the following? a. Atrial contraction b. Atrioventricular valve closure c. Semilunar valve closure d. Ventricular contraction ANS: A
The P wave signals atrial depolarization. Within 0.1 sec, the atria contract, causing a slight rise in both atrial and ventricular pressures (the A waves). DIF: Analysis
REF: p. 224
OBJ: 8
57. The first heart sound is associated with what mechanical event of the cardiac cycle? a. Atrioventricular valve closure b. Atrioventricular valve opening c. Semilunar valve closure d. Semilunar valve opening ANS: A
As soon as ventricular pressures exceed those in the atria, the atrioventricular valves close. Closure of the mitral valve occurs first, followed immediately by closure of the tricuspid valve. This marks the end of ventricular diastole, producing the first heart sound on the phonocardiogram. DIF: Application
REF: p. 224
OBJ: 8
58. Opening of the semilunar valves occurs when which of the following occurs? a. The pressures in the arteries exceed those in the ventricles. b. The pressures in the atria exceed those in the ventricles. c. The pressures in the ventricles exceed those in the aorta and pulmonary artery. d. The pressures in the ventricles exceed those in the atria. ANS: C
Within 0.05 sec, ventricular pressures rise to exceed those in the aorta and pulmonary artery. This opens the semilunar valves. DIF: Application
REF: p. 224
OBJ: 8
59. Toward the end of systole, as repolarization starts (indicated by the T wave), the ventricles
begin to relax. Which of the following will occur next? a. Rapid rise in ventricular pressures. b. Arterial pressures exceed ventricular pressures. c. Closure of the atrioventricular valves. d. Opening of semilunar valves. ANS: B
Toward the end of systole, as repolarization starts (indicated by the T wave), the ventricles begin to relax. Consequently, ventricular pressures drop rapidly. When arterial pressures exceed those in the relaxing ventricles, the semilunar valves shut. DIF: Analysis
REF: p. 224
OBJ: 8
60. The semilunar valves close when which of the following occurs? a. The pressures in the arteries exceed those in the ventricles. b. The pressures in the ventricles and arteries become equal. c. The pressures in the atria exceed those in the ventricles. d. The pressures in the ventricles exceed those in the atria. ANS: A
Toward the end of systole, as repolarization starts (indicated by the T wave), the ventricles begin to relax. Consequently, ventricular pressures drop rapidly. When arterial pressures exceed those in the relaxing ventricles, the semilunar valves shut. DIF: Application
REF: p. 224
OBJ: 8
61. The second heart sound is associated with what mechanical event of the cardiac cycle? a. Atrioventricular valve closure b. Atrioventricular valve opening c. Semilunar valve closure d. Semilunar valve opening
ANS: C
Closure of the semilunar valves generates the second heart sound. DIF: Application
REF: p. 224
OBJ: 8
62. The dicrotic notch recorded in the aorta immediately follows what mechanical event of the
cardiac cycle? a. Closure of the aortic valve b. Closure of the atrioventricular valves c. Isovolume contraction d. Opening of the aortic valve ANS: A
Rather than immediately dropping off, aortic and pulmonary pressures rise again after the semilunar valves close. Note the feature termed the dicrotic notch, which is caused by the elastic recoil of the arteries. This recoil provides the extra ―push‖ that helps maintain the head of pressure created by the ventricles. DIF: Application
REF: p. 224
OBJ: 8
63. During the later stages of ventricular relaxation, the pressures in their chambers drop below
those in the atria. This results in which of the following? 1. Rapid drop in atrial pressures 2. Opening of the atrioventricular valves 3. Rapid ventricular filling 4. V pressure wave a. 2 and 3 only b. 1 and 2 only c. 1, 2, 3, and 4 d. 2, 3, and 4 only ANS: C
As the ventricles continue to relax, their pressures drop below the pressures in the atria. This drop reopens the atrioventricular valves. As soon as the atrioventricular valves open, the blood collected in the atria rushes to fill the ventricles, causing a rapid drop in atrial pressures (the V wave). DIF: Application
REF: p. 224
OBJ: 8
64. What is a potential cause of cardiac tamponade? a. A large pericardial effusion b. Blockage of the left ventricle c. Excessive amount of fluid the pleural space d. Clots in the superior vena cava ANS: A
A large pericardial effusion may affect the pumping function of the heart resulting in a cardiac tamponade. A cardiac tamponade will compress the heart muscle leading to a serious drop in blood flow to the body that may ultimately lead to shock and death. DIF: Application
REF: p. 210
OBJ: 1
65. What is the cause of a myocardial infarction? a. Decreased perfusion to the pulmonary artery b. Partial or complete obstruction of a coronary artery c. Blockage in one or more of the great vessels d. Narrowing of part of the aorta ANS: B
Partial obstruction of a coronary artery may lead to tissue ischemia (decreased O2 supply), a clinical condition called angina pectoris. Complete obstruction may cause tissue death or infarct, a condition called myocardial infarction (MI). DIF: Application
REF: p. 212
OBJ: 1
66. An abnormal amount of fluid can accumulate between the layers of the pericardium resulting
in which of the following? a. Pericardial effusion b. Pulmonary embolism c. Atrial fibrillation d. Premature ventricular contractions ANS: A
Abnormal amount of fluid can accumulate between the layers resulting in a pericardial effusion. DIF: Recall
REF: p. 210
OBJ: 1
67. What is the role of the left and right ventricles? a. Supply the body with blood. b. Increase the concentration of red blood cells in the blood. c. The forward movement of the blood. d. Draining of blood into the right atrium. ANS: C
The responsibility of the right and left ventricles is the forward movement of the blood. DIF: Application
REF: p. 210
OBJ: 2
68. What is the role of the dense connective tissue termed annulus fibrosi cordis in the function of
the heart? a. Provides an anchoring structure for the heart valves, and also electrically isolates the atria from the ventricle. b. Allows the blood to enter the left atrium from the right atrium before birth. c. Pulls in the right ventricular wall, aiding its contraction. d. Separate the right and left ventricles. ANS: A
It provides an anchoring structure for the heart valves; it also electrically isolates the atria from the ventricle. DIF: Application
REF: p. 210
OBJ: 2
Chapter 11 - Ventilation Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. What is the primary function of the lungs? a. Convert angiotensin I to angiotensin II. b. Filter pulmonary blood. c. Gas exchange. d. Remove carbon monoxide (CO). ANS: C
The primary functions of the lungs are to supply the body with oxygen (O 2 ) and to remove carbon dioxide (CO 2 ). DIF: Application
REF: p. 229
OBJ: 1
2. During each cycle of normal resting ventilation, a volume of gas is moved into and out of the
respiratory tract. This cyclical volume is called the: a. inspiratory reserve volume (IRV). b. vital capacity (VC). c. residual volume (RV). d. tidal volume (VT). ANS: D
During each cycle, a volume of gas moves in and out of the respiratory tract. This volume, measured during either inspiration or expiration, is called the tidal volume, or VT. DIF: Application
REF: p. 227
OBJ: 1
3. Which of the following pressures vary throughout the normal breathing cycle?
1. Alveolar pressure (Palv ) 2. Body surface pressure (Pbs ) 3. Mouth pressure (Pao ) 4. Pleural pressure (Ppl) a. 1, 2, 3, and 4 b. 2, 3, and 4 only c. 2 and 4 only d. 1 and 4 only ANS: D
Alveolar pressure (Palv ), often referred to as intrapulmonary pressure, varies during the breathing cycle. Ppl also varies during the breathing cycle. DIF: Application
REF: p. 228
OBJ: 2
4. Which of the following pressures normally remains negative (relative to atmospheric
pressure) during quiet breathing? a. Palv b. Ppl
c. Pao d. Pbs ANS: B
Pleural pressure (Ppl) is usually negative (i.e., sub-atmospheric) during quiet breathing. DIF: Recall
REF: p. 228
OBJ: 2
5. Which of the following pressure gradients is responsible for the actual flow of gas into and
out of the lungs during breathing? a. Transcanadian pressure gradient (Ppc – Pks ) b. Transpulmonary pressure gradient (Palv – Ppl) c. Transrespiratory pressure gradient (Palv – Pao ) d. Transthoracic pressure gradient (Ppl – Pbs ) ANS: C
The transrespiratory pressure gradient causes gas to flow into and out of the alveoli during breathing. DIF: Application
REF: p. 228
OBJ: 2
6. Which of the following pressure gradients is responsible for maintaining alveolar inflation? a. Transpulmonary pressure gradient (Palv – Ppl) b. Transthoracic pressure gradient (Ppl – Pbs ) c. Transcardiac pressure gradient (Pca – Palv ) d. Transrespiratory pressure gradient (Palv – Pao ) ANS: A
Transpulmonary or PL is the pressure difference that maintains alveolar inflation. DIF: Application
REF: p. 228
OBJ: 2
7. Which of the following statements about alveolar pressure (Palv ) during normal quiet breathing
is true? a. It is positive during inspiration and negative during expiration. b. It is the same as intrapleural pressure (Ppl). c. It is negative during inspiration and positive during expiration. d. It always remains less than atmospheric pressure. ANS: C
During inspiration the pleural pressure drops, the transpulmonary pressure gradient widens, causing the alveoli pressure to become sub-atmospheric and gas to enter the lung. During expiration the passive recoil of the lungs cause a supra-atmospheric pressure in the alveoli that causes gas to exit the lung. DIF: Application
REF: p. 228
OBJ: 2
8. What happens during normal inspiration?
1. The Ppl increases further below atmospheric pressure. 2. The transpulmonary pressure gradient widens. 3. Palv drops below that at the airway opening. a. 1 and 2 only
b. 2 and 3 only c. 1 only d. 1 and 3 only ANS: B
As the alveoli expand, their pressures fall below the pressure at the airway opening. This ―negative‖ (i.e., sub-atmospheric) transrespiratory pressure gradient causes air to flow from the airway opening to the alveoli, increasing their volume. DIF: Application
REF: p. 229
OBJ: 2
9. During normal tidal ventilation, the transpulmonary pressure gradient (Palv – Ppl) reaches its
maximum value at what point in the cycle? a. Midinspiration b. End-expiration c. End-inspiration d. Mid-expiration ANS: C
At this point, called end-inspiration, alveolar pressure has returned to 0 and the transpulmonary pressure gradient reaches its maximal value (for a normal breath) of approximately –10 cm H 2 O. DIF: Application
REF: p. 228
OBJ: 3
10. During expiration, why does gas flow out from the lungs to the atmosphere? a. Palv is less than at the airway opening. b. Palv is the same as at the airway opening. c. Palv is greater than at the airway opening. d. Airway pressure is greater than Palv . ANS: C
As expiration begins, the thorax recoils and Ppl starts to rise. As pleural pressure rises, alveolar pressure also increases. The transpulmonary pressure gradient narrows and alveoli begin to deflate. As the alveoli become smaller, alveolar pressure exceeds that at the airway opening. DIF: Application
REF: p. 229
OBJ: 2
11. What forces must be overcome to move air into the respiratory system?
1. Tissue movement 2. Elastic forces of lung tissue 3. Airway resistance 4. Surface tension forces a. 1, 2, and 3 only b. 2 and 4 only c. 4 only d. 1, 2, 3, and 4 ANS: D
Elastic forces involve the tissues of the lungs and thorax, along with surface tension in the alveoli. Frictional forces include resistance caused by gas flow and tissue movement during breathing.
DIF: Application
REF: p. 229
OBJ: 3
12. What term is used to note the difference between inspiratory lung volume and expiratory lung
volume at any given pressure? a. Alveolar aphasia b. Hysteresis c. Pleural pressure variance d. Transpulmonary pressures ANS: B
Deflation of the lung does not follow the inflation curve exactly. During deflation, lung volume at any given pressure is slightly greater than it is during inflation. This difference between the inflation and deflation curves is called hysteresis. DIF: Recall
REF: p. 231
OBJ: 3
13. Which of the following are effects of surface tension forces in the air-filled lung?
1. It increases the elastic recoil of the lung (promoting collapse). 2. It makes the lung harder to inflate than if it were filled with fluid. 3. It decreases the lung’s elasticity as volume increases. a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
Less pressure is needed to inflate a fluid-filled lung to a given volume. This phenomenon indicates that a gas-fluid interface in the air-filled lung changes its inflation-deflation characteristics. The recoil of the lung is therefore a combination of tissue elasticity and these surface tension forces in the alveoli. During inflation, additional pressure is needed to overcome surface tension forces. DIF: Application
REF: p. 231
OBJ: 4
14. The presence of surfactant in the alveoli tends to do which of the following? a. Decrease compliance b. Decrease surface tension c. Increase elastance d. Increase resistance ANS: B
A phospholipid called pulmonary surfactant lowers surface tension in the lung. DIF: Application
REF: p. 230
15. How is compliance calculated? a. Change in pressure/change in flow b. Change in pressure/change in volume c. Change in volume/change in flow d. Change in volume/change in pressure
OBJ: 4
ANS: D
Compliance of the lung (CL) is defined as volume change per unit of pressure change. DIF: Application
REF: p. 231
OBJ: 5
16. Normal lung compliance is approximately which of the following? a. 0.01 L/cm H2 O b. 0.20 L/cm H2 O c. 2.00 L/cm H2 O d. 10.00 L/cm H 2 O ANS: B
Compliance of a healthy adult lung averages 0.2 L/cm H2 O or 200 ml/cm H 2 O. DIF: Recall
REF: p. 231
OBJ: 5
17. A lung that loses elastic fibers would exhibit which of the following characteristics? a. Decreased airways resistance b. Decreased pulmonary vascular resistance c. Increased airway resistance d. Increased pulmonary compliance ANS: D
Increased compliance results primarily from loss of elastic fibers, which occurs in emphysema. DIF: Application
REF: p. 231
OBJ: 5
18. A fibrotic lung would exhibit which of the following characteristics? a. Decreased airway resistance b. Decreased lung compliance c. Decreased PVR d. Decreased surface tension ANS: B
The compliance curve of the patient with pulmonary fibrosis is flatter than the normal curve, shifted down and to the right. As a result, there is a smaller volume changes for any given pressure change (decreased compliance). DIF: Application
REF: p. 231
OBJ: 5
19. What occurs at a lung volume equivalent to the functional residual capacity (FRC)?
1. The forces of the chest wall and lungs are in balance. 2. Chest wall expansion is offset by lung contraction. 3. Opposing chest wall-lung forces generate negative Ppl. a. 1, 2, and 3 b. 1 and 2 only c. 1 and 3 only d. 2 and 3 only ANS: A
The lung-chest wall system may be compared with two springs pulling against each other. The chest wall spring tends to expand, whereas the lung spring tends to contract. At the resting level, the forces of the chest wall and lungs balance. The tendency of the chest wall to expand is offset by the contractile force of the lungs. This balance of forces determines the resting lung volume, or FRC. The opposing forces between the chest wall and lungs are partially responsible for the sub-atmospheric pressure in the intrapleural space. DIF: Application
REF: p. 228
OBJ: 4
20. At approximately what point during a maximum inspiration does the chest wall reach its
natural resting level? a. Approximately 30% of the VC b. Approximately 40% of the total lung capacity (TLC) c. Approximately 70% of the VC d. Approximately 90% of the VC ANS: C
When lung volume nears 70% of the VC, the chest wall reaches its natural resting level. DIF: Application
REF: p. 233
OBJ: 4
21. Exhalation below the resting level requires active muscular effort in order to overcome what
tendency? a. The airways to collapse b. The alveoli to expand c. The chest wall to expand d. The lungs to expand ANS: C
In order to exhale below the resting level (FRC) muscular effort is required to overcome the tendency of the chest wall to expand. DIF: Application
REF: p. 233
OBJ: 4
22. In order to inspire to a lung volume greater than approximately 70% of TLC, the inspiratory
muscles must overcome: a. the recoil of the lungs. b. the recoil of both the lungs and the chest wall. c. the recoil of both the chest walls. d. the recoil of the alveoli. ANS: B
At the beginning of the breath, the tendency of the chest wall to expand facilitates lung expansion. When lung volume nears 70% of the VC, the chest wall reaches its natural resting level. In order to inspire to a lung volume greater than approximately 70% of TLC, the inspiratory muscles must overcome the recoil of both the lungs and the chest wall (see Figure 11-7). DIF: Analysis
REF: pp. 232-233 OBJ: 5
23. Total lung-thorax compliance in normal subjects is about what level? a. 0.1 L/cm H2 O
b. 0.2 L/cm H2 O c. 1.0 L/cm H2 O d. 2.0 L/cm H2 O ANS: A
In healthy adults, the compliance of the lungs and chest wall are approximately equal at 0.2 L/cm H2 O. However, because the lungs are contained within the thorax, the two systems act as springs pulling against each other. This reduces the compliance of the system to approximately half that of the individual components, or 0.1 L/cm H2 O. Impedance to ventilation by the movement of gas through the airways is called airway resistance. DIF: Application
REF: pp. 232-233 OBJ: 5
24. What is the term for the impedance to ventilation caused by the movement of gas through the
conducting system of the lungs? a. Airway resistance b. Lung compliance c. Surface tension d. Tissue elastance ANS: A
DIF: Application
REF: p. 233
OBJ: 6
25. How is airway resistance (Raw) computed? a. Change in pressure/change in volume b. Change in pressure/flow c. Change in volume/change in pressure d. Change in volume/change in pressure ANS: B
Airway resistance (Raw) is the ratio of driving pressure responsible for gas movement to the flow of the gas. DIF: Application
REF: p. 233
OBJ: 6
26. Normal Raw is approximately which of the following? a. 0.1 to 0.2 cm H 2 O/L/sec b. 0.5 to 2.5 cm H 2 O/L/sec c. 15.0 to 20.0 cm H 2 O/L/sec d. 20.0 to 25.0 cm H 2 O/L/sec ANS: B
Airway resistance in healthy adults ranges from approximately 0.5 to 2.5 cm H 2 O/L/sec. DIF: Recall
REF: p. 233
OBJ: 6
27. Which of the following factors affects Raw?
1. Pattern of gas flow (e.g., laminar vs. turbulent) 2. Characteristics of the gas being breathed 3. Diameter and length of the airways 4. Variations in lung compliance a. 1, 2, and 3 only
b. 2 and 4 only c. 4 only d. 1, 2, 3, and 4 ANS: A
Laminar flow is affected by gas flow, viscosity of the gas, tube radius, and length. Turbulent flow is most affected by gas density and viscosity, linear velocity, and tube radius. DIF: Application
REF: p. 233
OBJ: 6
28. According to Poiseuille’s law, which of the following statements is true if we wish to
maintain a constant flow of gases? a. Alveolar recruitment has its greatest effect on flow. b. Halving the tube radius will require a 16-time increase in driving pressure. c. Large jumps in driving pressure are needed to overcome airway narrowing. d. The driving pressure varies directly with the airway circumference. ANS: B
For gas flow to remain constant, delivery pressure must vary inversely with the fourth power of the airway’s radius. Reducing the radius of a tube by half requires a 16-fold pressure increase to maintain a constant flow. To maintain ventilation in the presence of narrowing airways, large increases in driving pressure may be needed. The energy necessary to generate these pressures can markedly increase the work of breathing. DIF: Application
REF: p. 234
OBJ: 6
29. Most of the drop in pressure due to frictional resistance to gas flow occurs in what region? a. Nose, mouth, and large airways b. Respiratory bronchioles c. Terminal bronchioles d. Terminal respiratory unit ANS: A
Approximately 80% of the resistance to gas flow occurs in the nose, mouth, and large airways where flow is mainly turbulent. DIF: Application
REF: p. 234
OBJ: 6
30. Which of the following statements about Raw is true? a. The greater the lung volume, the greater is the Raw. b. The greater the lung volume, the less is the Raw. c. As lung volume decreases toward RV, the Raw drops. d. As lung volume increases toward TLC, the Raw rises. ANS: B
The increase in airway diameter with increasing lung volume decreases airway resistance. DIF: Application
REF: pp. 233-234 OBJ: 6
31. In healthy individuals, what may lead to airway collapse? a. Increased lung recoil b. Significantly decreased surfactant
c. Maximal inspiration to TLC d. Forced exhalation to RV ANS: D
In airways of healthy subjects, airway collapse occurs only with forced exhalation and at low lung volumes. DIF: Application
REF: p. 236
OBJ: 6
32. Which of the following statements about the equal pressure point (EPP) is true? a. As gas travels from the EPP to the mouth, greater expiratory effort increases flow. b. At the EPP, pressure inside the airway exceeds Ppl. c. The EPP normally occurs at volumes greatly below the FRC. d. Upstream from the EPP (toward the alveoli), Ppl exceeds pressure in the airway. ANS: C
At some point along the airway, the pressure inside equals the pressure outside in the pleural space. This point is referred to as the EPP. Downstream from this point, pleural pressure exceeds the airway pressure. The resulting positive transmural pressure gradient causes airwaycompression and can lead to actual collapse. Airway compression increases expiratory airway resistance and limits flow. At the EPP, greater expiratory effort only increases pleural pressure, further restricting flow. In airways of healthy subjects, the EPP occurs only with forced exhalation and at low lung volumes. DIF: Application
REF: p. 236
OBJ: 6
33. For healthy individuals at rest, which of the following statements about exhalation is true? a. Exhalation will be passive, due to inspiratory stored potential energy. b. Exhalation will only require 40% of the energy expended for inspiration. c. Exhalation will be the result of accessory respiratory muscle use. d. Exhalation will generally take half the time of inspiration. ANS: A
During normal quiet breathing, inhalation is active and exhalation is passive. The work of exhaling is recovered from potential energy ―stored ‖ in the expanded lung and thorax during inhalation. DIF: Application
REF: p. 237
OBJ: 7
34. In traditional physical terms, how is work defined? a. Force distance b. Force time c. Mass acceleration d. Mass force ANS: A
Work = force distance. DIF: Recall
REF: p. 237
OBJ: 7
35. Which of the following formulas is used to compute the mechanical work of breathing? a. Change in pressure/flow
b. Change in pressure change in flow c. Change in pressure change in volume d. Change in volume/change in pressure ANS: C
The mechanical work of breathing can be calculated as the product of the pressure across the respiratory system and the resulting change in volume. DIF: Application
REF: p. 237
OBJ: 7
36. Why is the total mechanical work of breathing difficult to assess during spontaneous
breathing? a. Most volunteer subjects cannot understand the procedure used. b. Respiratory muscle activity contributes to inflation resistance. c. The respiratory muscles (diaphragm, etc.) must be paralyzed. d. The subjects used to make the measurements must be unconscious. ANS: B
The mechanical work of breathing cannot be measured easily during spontaneous breathing. This is because the respiratory muscles contribute to the resistance offered by the chest wall. DIF: Application
REF: p. 238
OBJ: 7
37. On inspecting a volume-pressure curve of the lungs and thorax, an increase in the mechanical
work of breathing above normal would always be indicated by which of the following? a. Decrease in the area of the volume-pressure curve b. Decrease in the slope of the volume-pressure curve c. Increase in the area of the volume-pressure curve d. Increase in the slope of the volume-pressure curve ANS: C
The larger the area defined by the pressure and volume changes, the greater is the amount of work being done. DIF: Application
REF: p. 238
OBJ: 7
38. In health, approximately what proportion of the total work of breathing is attributable to
frictional resistance to tissue movement? a. 20% b. 30% c. 40% d. 50% ANS: A
Tissue resistance accounts for only approximately 20% of the total resistance to lung inflation. However, in conditions such as obesity, pleural fibrosis, and ascites, the tissue viscous resistance will increase the total impedance to ventilation. DIF: Application
REF: p. 233
OBJ: 7
39. On inspecting a volume-pressure curve for a patient with restrictive lung disease, which of the
following abnormalities would you expect to find?
1. Decrease in the slope of the volume-pressure curve 2. Increase in the area of the volume-pressure curve 3. Positive Ppl during exhalation a. 2 only b. 1, 2, and 3 c. 1 and 2 only d. 1 and 3 only ANS: C
In restrictive lung disease, the area of the volume-pressure curve is greater because the slope of the static component (compliance) is less than normal. DIF: Application
REF: p. 238
OBJ: 7
40. Which of the following factors would tend to increase the elastic component of the work of
breathing? 1. Decreased compliance of the lungs or thorax 2. High frequencies of breathing 3. Increased V T a. 1 and 3 only b. 1, 2, and 3 c. 2 and 3 only d. 1 and 2 only ANS: A
When changing from quiet breathing to exercise ventilation, healthy subjects adjust their tidal volumes and breathing frequencies to minimize the work of breathing. Similar adjustments occur in individuals who have lung disease (Figure 11-12). Patients with ―stiff lungs,‖ i.e., decreased compliance, have increased elastic work of breathing. Large tidal volumes also increase the elastic component of work. DIF: Application
REF: p. 237
OBJ: 7
41. Which of the following factors would tend to increase the frictional component of the work of
breathing? 1. Decreased compliance of the lungs or thorax 2. High frequencies of breathing 3. Increased Raw a. 1 and 2 only b. 1, 2, and 3 c. 1 and 3 only d. 2 and 3 only ANS: D
In healthy individuals, the mechanical work of breathing depends on the pattern of ventilation. High breathing rates (and hence, high flows) increase frictional work. Patients who have airwayobstruction (i.e., increased Raw) also experience increased frictional work of breathing. DIF: Application
REF: p. 238
OBJ: 7
42. In individuals with disorders characterized by an increased frictional work of breathing, such
as emphysema, which of the following breathing patterns results in the minimum work? a. Rapid and deep breathing b. Rapid and shallow breathing c. Slow and deep breathing d. Slow and shallow breathing ANS: C
Breathing slowly and using pursed-lip breathing during exhalation minimize airway resistance and thus work of breathing in patients with emphysema. DIF: Application
REF: p. 238
OBJ: 7
43. Which of the following will cause an increase in the pressure energy required for inspiration?
1. Increased compliance 2. Increased flow 3. Increased resistance 4. Increased volume a. 1 and 2 only b. 2 and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: C
High flows and increased R aw increase frictional work. Large tidal volumes increase the elastic component of work. Increased compliance will decrease the elastic component of work and thus is the one exception to an increased energy demand. DIF: Application
REF: p. 238
OBJ: 7
44. In a normal individual, what is the oxygen cost of breathing as a percentage of the body’s total
oxygen consumption? a.
5% b. 10% c. 20% d. 35% ANS: A
The oxygen cost of breathing in healthy individuals averages from 0.5 to 1.0 ml of oxygen per liter of ventilation. Given a normal minute ventilation of 5 L/min, the oxygen cost of breathing would be 2.5 to 5 ml out of a total oxygen consumption of 250 ml/min. This represents less than 5% of the oxygen consumption of the body. DIF: Application
REF: pp. 238-239 OBJ: 7
45. Compared to a normal individual, when a patient with a severe obstructive impairment such as
emphysema increases ventilation, which of the following occurs? a. Carbon dioxide production falls as anaerobic metabolism increases. b. Oxygen consumption increases at a faster rate than normal. c. Oxygen consumption rises faster than carbon dioxide production. d. The anaerobic threshold is reached later than normal.
ANS: B
In the presence of pulmonary disease (either obstructive or restrictive), the oxygen cost of breathing may increase dramatically with increasing ventilation (Figure 11-13). In an obstructive disease such as emphysema, increased ventilation causes the oxygen consumption of the respiratory muscles to increase rapidly. DIF: Application
REF: pp. 238-239 OBJ: 7
46. Regional factors affecting the distribution of gas in the normal lung result in which of the
following? a. More ventilation goes to the apexes and lung periphery. b. More ventilation goes to the apexes and lung core. c. More ventilation goes to the bases and lung core. d. More ventilation goes to the bases and lung periphery. ANS: D
In upright individuals, these factors direct more ventilation to the bases and periphery of the lungs. DIF: Application
REF: pp. 239-240 OBJ: 8
47. Which of the following statements are true about pressure differences in the upright lung?
1. Ppl increases from lung apex to base. 2. The apical alveoli resting volume is less than at the base. 3. The transpulmonary pressure gradient is greatest at the apex. a. 1 and 3 only b. 1, 2, and 3 c. 2 and 3 only d. 1 and 2 only ANS: A
In an adult-sized lung (approximately 30 cm from apex to base), pleural pressure at the apex is approximately –10 cm H 2 O. At the base, pleural pressure is only about –2.5 cm H 2 O. Because of these differences, the transpulmonary pressure gradient at the top of the upright lung is greater than it is at the bottom. DIF: Application
REF: pp. 239-240 OBJ: 8
48. Which of the following occurs during normal inspiration? a. Alveoli at the apexes expand less than those at the bases. b. Alveoli at the apexes expand more than those at the bases. c. Alveoli at the bases expand less than those at the apexes. d. Central alveoli expand more than those at the periphery. ANS: A
Despite their higher volume, alveoli at the apexes expand less during inspiration than alveoli at the bases or periphery. This is due to their respective positions on the pressure volume curves (Figure 11-14). The apical alveoli are on the flatter or less compliant portion of the curve and thus for any change in pressure there is only a small change in volume. The alveoli in the lung base are on the steep part of the curve, so even small changes in pressure result in comparatively large changes in volume.
DIF: Application
REF: pp. 239-240 OBJ: 8
49. In a normal individual lying on the right side (right side down), which of the following
conditions would be true? a. Both lungs would receive nearly equal ventilation. b. The left lung would receive the most ventilation. c. The right lung would receive the most ventilation. d. There is inadequate information to make a decision. ANS: C
Lying on the side causes more ventilation to go to whichever lung is lower. DIF: Analysis
REF: p. 241
OBJ: 8
50. Given a constant resistance, how will increasing the compliance of a lung unit alter gas
movement into and out of the alveolus? a. Both filling and emptying will be slower. b. The alveolus will fill and empty more quickly. c. The alveolus will fill more quickly but empty more slowly. d. The alveolus will fill more slowly but empty more quickly. ANS: A
Lung units with high compliance have less elastic recoil than normal. These units fill and empty more slowly than normal units. DIF: Application
REF: p. 241
OBJ: 8
51. Which of the following statements applies to a lung unit with higher resistance than normal? a. A given volume change will require less of a pressure change. b. It will fill and empty more rapidly than a normal lung unit. c. There will be less volume change for a given pressure change. d. Volume to this area will remain the same under all conditions. ANS: C
If the airway is obstructed, high resistance to gas flow can occur in a local area. The pressure drop across the obstruction may be substantial. Less driving pressure is available for alveolar inflation; thus there is less alveolar volume change. DIF: Application
REF: p. 241
OBJ: 8
52. Which of the following formulas are used to compute the time constant of a lung unit? a. Change in pressure flow b. Compliance/resistance c. Resistance/elastance d. Resistance compliance ANS: D
The time constant is simply the product of each unit’s compliance and resistance. DIF: Application
REF: p. 241
OBJ: 9
53. Which of the following lung units would empty and fill most slowly?
a. b. c. d.
A unit with high resistance and high compliance A unit with high resistance and low compliance A unit with low resistance and high compliance A unit with low resistance and low compliance
ANS: A
Lung units have a short time constant when resistance or compliance is low. Lung units with short time constants fill and empty more rapidly than those with normal compliance and resistance. The inverse also holds true. Those units with a high resistance and compliance will fill and empty the most slowly. DIF: Analysis
REF: p. 241
OBJ: 9
54. For a given transpulmonary pressure gradient and inflation time, which of the following lung
units would exhibit the greatest change in volume? a. A unit with high resistance and low compliance b. A unit with high resistance and normal compliance c. A unit with normal resistance and low compliance d. A unit with normal resistance and normal compliance ANS: D
The ventilation going to lung units with either long or short time constants is less than that received by units with normal compliance and resistance. DIF: Analysis
REF: p. 242
OBJ: 9
55. In patients with small-airway disease breathing at higher than normal frequencies, what is
likely to happen? 1. Dynamic compliance drops. 2. Oxygen consumption decreases. 3. The distribution of ventilation worsens. 4. The work of breathing increases. a. 1 and 2 only b. 1, 2, and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: B
Compliance of the lung appears to decrease as breathing frequency increases. This phenomenon is called frequency dependence of compliance. Compliance measured during breathing is dynamic as it includes pressure changes created by resistance to airflow. If dynamic compliance decreases as the respiratory rate increases, some lung units must have abnormal time constants. Any stimulus to increase ventilation, such as exercise, may redistribute inspired gas. Mismatching of ventilation and perfusion can result in hypoxemia, severely limiting an individual’s ability to perform daily activities. In addition the increased breathing frequency and decreased dynamic compliance may result in significant increases in oxygen consumption. DIF: Analysis
REF: p. 242
OBJ: 7
56. What is the gas that is wasted during normal ventilation called?
a. b. c. d.
Alveolar ventilation Bronchial ventilation Conducting ventilation Dead space ventilation
ANS: D
For each breath, the gas left in the conducting tubes does not participate in gas exchange and is, in effect, wasted. Similarly, regional differences in ventilation cause some gas that does reach the alveoli to be wasted. This occurs in alveoli that have little or no perfusion. Ventilation occurring without perfusion defines dead space. DIF: Recall
REF: p. 238
OBJ: 10
57. If a patient has a VT of 370 ml and a respiratory rate of 20 breaths/min, what is the minute
ventilation? a. 2.40 L/min b. 3.70 L/min c. 6.45 L/min d. 7.40 L/min ANS: D
Minute ventilation (exhaled) is denoted by E, which is calculated as the product of frequency of breathing (f B) times the expired tidal volume: For example, our patient is breathing 20 breaths/min and has a VT of 370 ml: = 20 370 ml = 7400 ml/min or 7.4 L/min DIF: Application
REF: p. 243
OBJ: 10
58. A patient has a V T of 625 ml and a physiological dead space of 275 ml and is breathing at a
frequency of 16/min. What is the alveolar ventilation (VA)? a. 3000 ml/min b. 4400 ml/min c. 5600 ml/min d. 7000 ml/min ANS: C
Alveolar ventilation depends on tidal volume, dead space, and breathing rate. For this patient the respiratory rate is 16, V T of 625 ml, and dead space (V D) of 275 ml. The alveolar ventilation is calculated as follows: V A = 16 (625 ml – 275 ml) = 16 350 = 5600 ml/min or 5.6 L/min DIF: Analysis
REF: p. 243
OBJ: 11
59. A normal 150-lb man is breathing at a rate of 17 with a tidal volume of 450 ml. By estimation,
what is his approximate alveolar ventilation? a. 7.65 L/min b. 5.10 L/min c. 3.85 L/min d. 2.60 L/min
ANS: B
V Danat averages approximately 1 ml/lb of ideal body weight (2.2 ml/kg). For a subject who weighs 150 lb (68 kg), V Danat is approximately 150 ml. For our patient the V T is 450, the RR is 17, and we will say his actual weight is his ideal body weight so 150-lb = 150 ml VD. V A = f(V T – VD) V A = 17(450 ml – 150 ml) V A = 17(300 ml) = 5100 ml or 5.1 L DIF: Analysis
REF: p. 243
OBJ: 11
60. Blockage of the pulmonary arterial circulation to a portion of the lung would cause which of
the following? a. Decrease in anatomical dead space b. Decrease in physiologic dead space c. Increase in alveolar dead space d. Increase in anatomical dead space ANS: C
A pulmonary embolus blocks a portion of the pulmonary circulation. This obstructs perfusion to ventilated alveoli, creating alveolar dead space. DIF: Application
REF: p. 244
OBJ: 10
61. In what portion of the lungs does alveolar dead space normally occur? a. Apexes b. Bases c. Middle portions of the lungs d. Terminal respiratory units ANS: A
In the normal upright subject at rest, alveoli at the apexes of the lungs have minimal or no perfusion, and thus contribute to the total volume of dead space ventilation. DIF: Application
REF: p. 244
OBJ: 10
62. Which is the correct formula to calculate the alveolar minute ventilation of a spontaneously
breathing subject? a. f V DS/V T b. f V T c. f (V T – VDSphys ) d. f (V T + VDSphys ) ANS: C
Physiologic dead space includes both the normal and abnormal components of wasted ventilation. V Dphy is the preferred clinical measure of ventilation efficiency. Measuring V Dphy more accurately assesses alveolar ventilation. DIF: Application
REF: p. 244
OBJ: 11
63. In clinical practice measuring the physiologic dead space ventilation is achieved by using
which formula?
a. b. c. d.
Bernoulli’s equation Modified Bohr equation Modified Shunt equation Reynold’s equation
ANS: B
The ratio is then calculated using a modified form of the Bohr equation, which assumes that there is no CO 2 in inspired gas. DIF: Application
REF: p. 244
OBJ: 11
64. In normal individuals, approximately what fraction of the VT is wasted ventilation (does not
participate in gas exchange)? a. One-third of the tidal volume b. Two-thirds of the tidal volume c. One-half the of tidal volume d. One-quarter of the tidal volume ANS: A
In the healthy adult, physiologic dead space is approximately one-third of the tidal volume. DIF: Recall
REF: p. 244
OBJ: 11
65. Which of the following diseases or disorders is most likely to result in an increased VD/VT
ratio? a. Atelectasis b. Pneumonia c. Pulmonary embolus d. Pulmonary fibrosis ANS: C
V D/V T increases with diseases that cause significant dead space, such as pulmonary embolism. DIF: Application
REF: p. 244
OBJ: 11
66. How can the body effectively compensate for an increased VDphy ? a. Decreased drive to breath b. Decreased respiratory rate c. Increased respiratory rate d. Increased tidal volume ANS: D
Effective compensation for increased VDphy requires an increased tidal volume. DIF: Application
REF: p. 245
OBJ: 10
67. Under resting metabolic conditions, how much carbon dioxide does a normal adult produce
per minute? a. 150 ml/min b. 200 ml/min c. 250 ml/min d. 300 ml/min
ANS: B
Under resting metabolic conditions, a normal adult produces approximately 200 ml of carbon dioxide per minute. DIF: Recall
REF: p. 245
OBJ: 10
68. For carbon dioxide levels to remain constant during exercise, which of the following factors
must be elevated? a. Alveolar ventilation b. Dead space ventilation c. Hemoglobin d. Bicarbonate ANS: A
The partial pressure of carbon dioxide in the alveoli and blood is directly proportional to its production (CO 2 ) and inversely proportional to its rate of removal by alveolar ventilation (V A). DIF: Application
REF: p. 245
OBJ: 10
69. Hypoventilation is defined as: a. decreased tidal volume. b. low-blood oxygen level. c. very slow respiratory rate. d. elevated blood carbon dioxide level. ANS: D
Ventilation that does not meet metabolic needs (resulting in respiratory acidosis) is termed ―hypoventilation.‖ Hypoventilation is indicated by the presence of an elevated PaCO2 . DIF: Application
REF: p. 245
OBJ: 10
70. What is ventilation that is insufficient to meet metabolic needs called? a. Hypoventilation b. Hyperventilation c. Hyperpnea d. Hypopnea ANS: A
Ventilation that does not meet metabolic needs (resulting in respiratory acidosis) is termed hypoventilation. Hypoventilation is indicated by the presence of an elevated PaCO 2 . DIF: Application
REF: p. 245
OBJ: 10
71. A patient has a PCO 2 of 56 mm Hg. Based on this information, what can be concluded? a. The patient is hyperventilating. b. The patient is hypoventilating. c. The patient’s breathing rate is fast. d. The patient’s VT is low. ANS: B
Ventilation that does not meet metabolic needs (resulting in respiratory acidosis) is termed hypoventilation. Hypoventilation is indicated by the presence of an elevated PaCO 2 . If alveolar ventilation increases, the lungs may remove carbon dioxide faster than it is being produced. In this case, PaCO 2 will fall below its normal value of 40 mm Hg, and pH will rise (i.e., respiratory alkalosis). DIF: Analysis
REF: p. 245
OBJ: 10
72. Given a constant carbon dioxide production, how will changing the level of V A affect the
PaCO 2 ? a. A decrease in A will decrease PaCO 2 b. An increase in A will decrease PaCO 2 c. An increase in A will increase PaCO 2 d. PaCO 2 is unaffected by changes in V A ANS: B
DIF: Analysis
REF: p. 245
OBJ: 11
73. What is ventilation in excess of metabolic needs called? a. Hyperpnea b. Hyperventilation c. Hypopnea d. Hypoventilation ANS: B
Ventilation in excess of metabolic needs is termed hyperventilation. DIF: Application
REF: p. 245
OBJ: 10
74. What is the normal increase in ventilation that occurs with increased metabolic rates called? a. Hyperpnea b. Hyperventilation c. Hypopnea d. Hypoventilation ANS: A
The increase in ventilation that occurs with increased metabolic rates is termed hyperpnea. DIF: Application
REF: p. 245
OBJ: 10
75. What is the single best indicator of the adequacy or effectiveness of alveolar ventilation? a. PaO 2 b. PAO 2 c. PaCO 2 d.
VT ANS: C
DIF: Application
REF: p. 245
76. Where is Raw highest in the airway of the human body? a. Terminal bronchioles b. Carina c. Left lower lobe d. Nose, mouth, and large airways
OBJ: 10
ANS: D
Approximately 80% of the resistance to gas flow occurs in the nose, mouth, and large airways, where flow is mainly turbulent. Only about 20% of the total resistance to flow is attributable to airways smaller than 2 mm in diameter, where flow is mainly laminar. DIF: Application
REF: p. 233
OBJ: 6
77. Which of the following causes gas to flow into and out of the alveoli during breathing? a. Transrespiratory system pressure (PTR) b. Intrapleural pressure (Ppl) c. Transpulmonary pressure (PTP) d. Transmural pressure (Ptm) ANS: A
Transrespiratory pressure (PTR) gradient causes gas to flow into and out of the alveoli during breathing. DIF: Application
REF: p. 228
OBJ: 2
78. What is used for setting optimal PEEP on a ventilator? a. Pressure-volume curve b. Flow-volume curve c. Patient’s height and weight d. The disease state the patient is in ANS: A
Pressure-volume curve is used for setting optimal PEEP. DIF: Application
REF: p. 237
OBJ: 7
Chapter 12 - Gas Exchange and Transport Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. On what does the movement of gases between the lungs and the body tissues mainly depend? a. Active transport b. Gaseous diffusion c. Membrane dialysis d. Membrane transport ANS: B
Gas movement between the lungs and tissues occurs by simple diffusion. DIF: Recall
REF: p. 248
OBJ: 1
2. The lowest PO 2 would normally be found in what location? a. Arterial blood b. Atmospheric air c. Cells d. Venous blood ANS: C
The intracellular PO 2 (approximately 5 mm Hg) provides the final gradient for oxygen (O 2 ) diffusion into the cell. DIF: Application
REF: p. 248
OBJ: 1
3. The highest PCO 2 levels are found in what location? a. Arterial blood b. Atmospheric air c. Cells d. Venous blood ANS: C
The partial pressure of carbon dioxide (PCO 2 ) is highest in the cells (approximately 60 mm Hg). DIF: Application
REF: p. 248
OBJ: 1
4. Which of the following is/are true regarding the PACO 2 ?
1. Directly proportional to whole-body carbon dioxide production 2. Directly proportional to alveolar ventilation (V A) 3. Normally maintained at approximately 35 to 45 mm Hg a. 2 and 3 only b. 3 only c. 1 and 2 only d. 1 and 3 only ANS: D
PACO2 varies directly with the body’s production of carbon dioxide (CO2 ) and inversely with alveolar ventilation (V A). Under normal conditions it is maintained at approximately 35 to 45 mm Hg. DIF: Application
REF: p. 248
OBJ: 2
5. What is the approximate normal level of carbon dioxide production (CO 2 ) for an adult? a. 200 ml/min b. 250 ml/min c. 4200 ml/min d. 6000 ml/min ANS: A
In a healthy individual the normal CO 2 of is approximately 200 ml/min. DIF: Recall
REF: p. 248
OBJ: 2
6. Under what conditions will the alveolar PACO 2 rise above normal? a. If both metabolic rate and ventilation increase (e.g., through exercise) b. If carbon dioxide production decreases relative to VA c. If VA decreases relative to carbon dioxide production d. When the patient is febrile ANS: C
The PACO 2 will increase above this level if carbon dioxide production increases while alveolar ventilation remains constant or when alveolar ventilation decreases while CO 2 remains constant. DIF: Application
REF: p. 248
OBJ: 2
7. A 70-kg male patient has a CO 2 of 200 ml/min and a V A of 9 L/min. From this information,
what can you infer? a. The patient’s carbon dioxide production is abnormally low. b. The patient’s A is abnormally low. c. The patient will have a lower than normal PACO 2 . d. The patient will have a higher than normal PACO 2 . ANS: C
When the CO 2 is normal while the A is elevated, the PACO 2 must be lower than normal. Likewise, the PACO 2 will fall if carbon dioxide production decreases or alveolar ventilation increases. DIF: Analysis
REF: p. 248
OBJ: 2
8. What is the primary determinant of the PAO 2 ? a. Body’s CO 2 b. Metabolic rate of the body tissues c. PaO 2 d. PO 2 in the inspired gas ANS: D
Many factors determine the alveolar partial pressure of oxygen (PAO 2 ). Most important is the inspired partial pressure of oxygen, or PIO 2 . DIF: Application
REF: p. 249
OBJ: 2
9. The PAO 2 depends on which of the following factors?
1. Ambient (atmospheric) pressure 2. Fractional concentration of inspired O2 3. Level of V A 4. Types of fuels burned (fat, protein, and carbohydrate) a. 1, 2, and 3 only b. 1 and 2 only c. 3 only d. 1, 2, 3, and 4 ANS: D
PAO 2 = FiO2 (PB – 47) – PACO 2 ÷ 0.8 where FiO 2 is fraction of inspired oxygen, PB is barometric pressure, 47 is water vapor tension (in mm Hg) at 37° C, PACO 2 is alveolar PCO 2 , and 0.8 is normal respiratory exchange ratio (R). As the A is the primary determinant of PACO 2 any changes in A will affect the PAO 2. Likewise the fuel source will determine the RQ which is normally 0.8. DIF: Analysis
REF: p. 249
OBJ: 3
10. Calculate the approximate PAO 2 given the following conditions (assume R = 0.8): FiO 2 = .40,
PB = 770 mm Hg, PACO 2 = 31 mm Hg a. 100 mm Hg b. 135 mm Hg c. 250 mm Hg d. 723 mm Hg ANS: C
PAO 2 = FiO2 (PB – 47) – PACO 2 ÷ 0.8 where FiO 2 is fraction of inspired oxygen, PB is barometric pressure, 47 is water vapor tension (in mm Hg) at 37° C, PACO 2 is alveolar PCO 2 , and 0.8 is normal respiratory exchange ratio (R). PAO 2 = 0.4(770 – 47) – (31/0.8) PAO 2 = 250.45 mm Hg DIF: Application
REF: p. 249
OBJ: 5
11. A healthy person breathing 100% O2 at sea level would have PAO 2 of approximately what
level? a. 149 mm Hg b. 670 mm Hg c. 713 mm Hg d. 760 mm Hg ANS: B
If the FiO 2 is 1.0, the PB is 760 mm Hg, and the PACO 2 is 40 mm Hg, the alveolar partial pressure of O 2 can be estimated as follows:
PAO2 = 1 (760 mm Hg – 47) – (40 mm Hg ÷ 0.8) = 663 mm Hg DIF: Analysis
REF: p. 249
OBJ: 3
12. Which of the following best represents the partial pressures of all gases in the normally
ventilated and perfused alveolus when breathing room air at sea level? a. PO 2 = 40 mm Hg; PCO 2 = 100 mm Hg; PN 2 = 573 mm Hg; PH 2 O = 47 mm Hg b. PO 2 = 100 mm Hg; PCO 2 = 40 mm Hg; PN 2 = 573 mm Hg; PH 2 O = 47 mm Hg c. PO 2 = 100 mm Hg; PCO 2 = 40 mm Hg; PN 2 = 713 mm Hg; PH 2 O = 47 mm Hg d. PO 2 = 149 mm Hg; PCO 2 = 40 mm Hg; PN 2 = 573 mm Hg; PH 2 O = 47 mm Hg ANS: B
Nitrogen is inert and plays no role in gas exchange. However, nitrogen does occupy space and exert pressure. According to Dalton’s law, the partial pressure of alveolar nitrogen must equal the pressure it would exert if it alone were present. Thus, to compute the partial pressure of alveolar nitrogen, subtract the pressures exerted by all the other alveolar gases, as follows: PAN 2 = PB – (PAO 2 + PACO 2 + PH 2 O) PAN 2 = 760 mm Hg – (100 mm Hg + 40 mm Hg + 47 mm Hg) PAN 2 = 760 mm Hg – 187 mm Hg PAN 2 = 573 mm Hg DIF: Analysis
REF: p. 250
OBJ: 2
13. In a person breathing room air (and with all else being normal), if the alveolar PCO 2 rises
from 40 to 70 mm Hg, what would you expect? a. PAO 2 to fall by approximately 30 mm Hg b. PAO 2 to fall by approximately 40 mm Hg c. PAO 2 to rise by approximately30 mm Hg d. PAO 2 to rise by approximately 40 mm Hg ANS: A
Based on the alveolar air equation, if the FiO 2 remains constant, then the PAO 2 must vary inversely with the PACO 2 . DIF: Analysis
REF: p. 249
OBJ: 3
14. Assuming a constant FiO 2 and carbon dioxide production, which of the following statements
is correct? a. An increased PACO 2 will result in and increased PAO 2 . b. Increased FIO 2 blows off carbon dioxide. c. Increases in alveolar ventilation (V A) decrease the PACO 2 and increase the PAO 2 . d. The PAO 2 varies proportionally with the PACO 2 . ANS: C
With a constant carbon dioxide production, a decrease in alveolar ventilation (V A) simultaneously raises the PACO 2 and lowers the PAO 2 . DIF: Application
REF: p. 250
OBJ: 4
15. What is the highest PAO 2 one could expect to observe in an individual breathing room air at
sea level?
a. b. c. d.
90 to 100 mm Hg 110 to 120 mm Hg 640 to 670 mm Hg 710 to 760 mm Hg
ANS: B
Neural control mechanisms and the increased of work breathing prevent decreases in PACO 2 much below 15 to 20 mm Hg. Thus, whenever a patient is breathing room air at sea level, the respiratory therapist should not expect to see a PaO 2 any higher than 120 mm Hg during hyperventilation. DIF: Application
REF: p. 249
OBJ: 2
16. Which of the following conditions must exist for gas to move between the alveolus and
pulmonary capillary? a. Adequate alveolar ventilation (VA) b. Difference in partial pressures (pressure gradient) c. Normal central nervous system (CNS) control mechanism d. Sufficient amount of blood hemoglobin (Hb) ANS: B
Diffusion is the process whereby gas molecules move from an area of high partial pressure to an area of low partial pressure. DIF: Application
REF: p. 250
OBJ: 1
17. Which of the following ―layers‖ must be traversed by gases moving across the
alveolar-capillary membrane? 1. Alveolar epithelial membrane 2. Capillary endothelial membrane 3. Interstitial space 4. Transbronchial radial tethering mechanisms a. 1, 2, and 3 only b. 1, 2, and 4 only c. 2 and 3 only d. 1, 2, 3, and 4 ANS: A
For carbon dioxide or O 2 to move between the alveoli and the pulmonary capillary blood, the following three barriers must be penetrated: (1) alveolar epithelium, (2) interstitial space, and capillary endothelium. DIF: Application
REF: p. 250
OBJ: 1
18. When is the rate of gaseous diffusion across a biological membrane decreased? a. The diffusion distance is small. b. The gas diffusion constant increases. c. The partial pressure gradient is low. d. The surface area is large. ANS: C
Given that the area of and distance across the alveolar-capillary membrane are relatively constant in healthy people, diffusion in the normal lung mainly depends on gas pressure gradients. DIF: Application REF: pp. 250-251 OBJ: 1 19. Which of the following values corresponds most closely to the normal PO 2 and PCO 2 in the
mixed venous blood returning to the lungs from the right side of the heart? a. PO 2 = 40 mm Hg; PCO 2 = 46 mm Hg b. PO 2 = 40 mm Hg; PCO 2 = 100 mm Hg c. PO 2 = 100 mm Hg; PCO 2 = 40 mm Hg d. PO 2 = 100 mm Hg; PCO 2 = 46 mm Hg ANS: A
Venous blood returning to the lungs has a lower PO 2 (40 mm Hg) than alveolar gas. Thus the pressure gradient for O 2 diffusion into the blood is approximately 60 mm Hg (100 mm Hg – 40 mm Hg). Therefore, as blood flows past the alveolus, it takes up O 2 , leaving the capillary with a PO 2 close to 100 mm Hg. Because venous blood has a higher PCO 2 than alveolar gas (46 mm Hg vs. 40 mm Hg), the pressure gradient for carbon dioxide causes diffusion of carbon dioxide in the opposite direction, from the blood into the alveolus. DIF: Application
REF: p. 251
OBJ: 6
20. Which of the following gases would diffuse fastest across the alveolar-capillary membrane? a. Air b. Carbon dioxide c. O 2 d. Nitrogen ANS: B
Carbon dioxide diffuses approximately 20 times faster across the alveolar-capillary membrane than does O2 , because of its much higher solubility in plasma. DIF: Application
REF: p. 251
OBJ: 1
21. Carbon dioxide diffuses across the alveolar-capillary membrane approximately how many
times faster than O2 ? a. b. c. d.
10 20 30 40
ANS: B
Carbon dioxide diffuses approximately 20 times faster across the alveolar-capillary membrane than does O2 , because of its much higher solubility in plasma. DIF: Application
REF: p. 251
OBJ: 1
22. The time available for diffusion in the lung is mainly a function of which of the following? a. Functional residual capacity (FRC) b. Inspired O 2 concentration c. Level of V A
d. Rate of pulmonary blood flow ANS: D
The diffusion time in the lung depends on the rate of pulmonary blood flow. DIF: Application
REF: p. 251
OBJ: 1
23. What is the minimum amount of time that blood must take for pulmonary capillary transit for
equilibration of O2 to occur across the alveolar-capillary membrane? a. 0.15 sec b. 0.25 sec c. 0.35 sec d. 0.45 sec ANS: B
If blood flow increases, such as during heavy exercise, capillary transit time can decrease to as low as 0.25 sec. Even this short timeframe is adequate to ensure that equilibration takes place, as long as no other factors impair diffusion. However, in the presence of a diffusion limitation, rapid blood flow through the pulmonary circulation can result in inadequate oxygenation. DIF: Recall
REF: p. 251
OBJ: 1
24. What is the primary factor that maintains the pressure gradient that drives O2 from the
capillaries into the interstitial spaces and into the cells? a. Bohr effect on the RBC b. Cellular consumption of O 2 c. Haldane effect on the RBC d. Increased carbon dioxide in blood decreasing Hb affinity for O 2 ANS: B
As cellular metabolism depletes its O 2 , the intracellular PO 2 drops below that of the blood entering the tissue capillary. This provides the diffusion gradient by which O 2 diffuses from the tissue capillary blood (PO 2 = 100 mm Hg) to the cells (PO 2 < 40 mm Hg). DIF: Analysis
REF: p. 252
OBJ: 2
25. In order to assess the events occurring at the tissue level, especially tissue oxygenation, what
parameter would you sample and measure? a. Coronary sinus blood b. Left-sided heart blood c. Systemic arterial blood d. Systemic mixed venous blood ANS: D
To assess tissue gas exchange, the respiratory therapist must consider mixed venous blood parameters. The use of mixed venous blood to assess tissue oxygenation also is discussed in Chapter 43. DIF: Application
REF: p. 252
OBJ: 6
26. What is the normal range of PAO 2 – PaO 2 for healthy young adults breathing room air?
a. b. c. d.
5 to 10 mm Hg 10 to 20 mm Hg 20 to 30 mm Hg 50 to 60 mm Hg
ANS: A
Rather than equaling the alveolar PO2 , the PaO 2 of healthy individuals breathing air at sea level is always approximately 5 to 10 mm Hg less than the calculated PAO 2 . DIF: Recall
REF: p. 252
OBJ: 4
27. Breathing room air, a normal PAO 2 – PaO 2 of 5 to 10 mm Hg exists due to which of the
following? 1. Anatomical shunts in the pulmonary and cardiac circulations 2. Normal limitations to O 2 diffusion in the lung 3. Regional differences in pulmonary ventilation and blood flow a. 1 and 3 only b. 2 and 4 only c. 1, 2, and 3 d. 1 and 2 only ANS: A
Two factors account for the normal PAO 2 – PaO 2 : (1) right-to-left shunts in the pulmonary and cardiac circulation and (2) regional differences in pulmonary ventilation and blood flow. DIF: Application
REF: p. 252
OBJ: 4
28. Which of the following would you expect to occur if ventilation to an area of the lung
remained constant but perfusion to this same area decreased? 1. The PACO 2 should fall. 2. The PAO 2 should fall. 3. The ratio should rise. a. 3 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
A decrease in pulmonary capillary blood flow will cause a fall in alveolar PCO 2 and a rise in alveolar PO2 assuming minute ventilation remains the same. This will result in an area of high . DIF: Analysis
REF: pp. 252-253 OBJ: 10
29. Which of the following would you expect to occur if perfusion to an area of the lung remained
constant, but V A to this same area decreased? a. The PACO 2 should fall. b. The HCO 3– will fall. c. The PAO 2 should fall. d. The ventilation/perfusion ratio ( ) should rise.
ANS: C
A low / indicates that ventilation is less than normal, perfusion is greater than normal, or both. In areas with a low /, the alveolar PO 2 is lower and the PCO 2 is higher than normal. DIF: Analysis
REF: p. 253
OBJ: 10
30. An area of the lung has no blood flow but is normally ventilated. Which of the following
statements are true about this area? 1. The alveolar gas is like air (PO 2 = 150; PCO 2 = 0). 2. The area represents alveolar dead space. 3. The / is elevated. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
At the extreme right of the graph, perfusion is 0 (/ = 0). Areas with ventilation but no blood flow represent alveolar dead space, as defined in Chapter 10. The makeup of gases in these areas is similar to that of inspired air (PO 2 = 150 mm Hg; PCO 2 = 0 mm Hg). DIF: Application
REF: p. 253
OBJ: 10
31. An area of the lung has no ventilation but is normally perfused by the pulmonary circulation.
Which of the following statement(s) is/are correct? 1. Blood exiting the pulmonary capillary will have a PO 2 = 40 and a PCO 2 = 46. 2. The area represents an alveolar shunt. 3. The is 0. a. 2 and 3 only b. 1 and 3 only c. 2 only d. 1, 2, and 3 ANS: D
With no ventilation to remove carbon dioxide and restore fresh O 2 , the makeup of gases in these areas is like that of mixed venous blood (PO 2 = 40 mm Hg; PCO 2 = 46 mm Hg). The / is 0. Venous blood entering areas with / ratios of 0 cannot pick up O2 or unload carbon dioxide and leave the lungs unchanged. For such areas to be distinguished from true anatomical shunts, exchange units with / values of 0 are called alveolar shunts. Although small anatomical shunts are normal, alveolar shunts are not. DIF: Analysis
REF: p. 253
OBJ: 4
32. Regarding pulmonary blood flow in the upright lung, which of the following statements is
true? a. The apexes receive approximately 20 times more blood flow than the bases. b. The bases receive approximately 20 times more blood flow than the apexes. c. The greatest blood flow is found at the apexes of the lungs. d. The pulmonary circulation is a high-pressure system. ANS: B
Farther down the lung, perfusion increases linearly in proportion to the hydrostatic pressure so the lung bases receive nearly 20 times as much blood flow as do the apexes. DIF: Application
REF: p. 253
OBJ: 4
33. During normal inspiration, which of the following occurs? a. Alveoli at the apexes expand less than those at the bases. b. Alveoli at the apexes expand more than those at the bases. c. Alveoli at the bases and apexes expand almost equally. d. Alveoli at the bases expand less than those at the apexes. ANS: A
Like perfusion, ventilation also is increased in the lung bases, with approximately four times as much ventilation going to the bases than to the apexes of the upright lung. DIF: Application
REF: p. 253
OBJ: 4
34. What occurs in the bases of the lung when a person is standing upright? a. The PAO 2 is higher than normal. b. The respiratory exchange ratio is elevated. c. There is significant dead space under normal conditions. d. The is lower than the average. ANS: D
At the bottom of the lung, blood flow is greater than ventilation, resulting in a low / (approximately 0.66), low PO 2 (89 mm Hg), and slightly higher PCO 2 (42 mm Hg). DIF: Application
REF: p. 253
OBJ: 4
35. Even in healthy young subjects, regional differences in pulmonary ventilation and blood flow
result in the PaO 2 being lower than the PAO 2 . Why is this so? a. Most blood flows through the apexes of the lung. b. Most blood flows through areas with high . c. Most blood flows through the bases of the lung. d. Most ventilation goes to the apexes of the lung. ANS: C
As shown in Table 12-1, because of gravity most blood flows to the lung bases, where the PO2 is lower and the PCO 2 is higher than normal. After leaving the lung, this relatively large volume of blood combines with the smaller volume coming from the middle and apical regions. The result is a mixture of blood with less O 2 and more carbon dioxide than would come from an ideal gas exchange unit. DIF: Application
REF: pp. 253-254 OBJ: 3
36. How is the vast majority of O 2 carried in the blood? a. As bicarbonate ion (HCO 3 ) b. As carbamino compounds c. Chemically combined with Hb d. In physical solution ANS: C
The majority of O2 is carried in a reversible chemical combination with hemoglobin inside the RBC. DIF: Recall
REF: p. 254
OBJ: 6
37. As the amount of O2 that dissolves in the plasma increases, what is it directly proportional to? a. Its partial pressure b. Its solubility coefficient c. Minute ventilation d. Temperature ANS: A
The relationship between partial pressure and dissolved O2 is direct and linear. By applying Henry’s law, the amount of dissolved O 2 in the blood (at 37° C) can be computed with the following simple formula: Dissolved oxygen (ml/dl) = PO 2 0.003. DIF: Application
REF: p. 254
OBJ: 6
38. At body temperature, how much O 2 will physically dissolve in plasma at a PO 2 of 40 mm Hg? a. 0.12 ml/dl b. 0.20 ml/dl c. 0.30 ml/dl d. 1.34 g/dl ANS: A
By applying Henry’s law, the amount of dissolved O2 in the blood (at 37° C) can be computed with the following simple formula: Dissolved oxygen (ml/dl) = PO 2 0.003 DIF: Recall
REF: p. 254
OBJ: 6
39. Under normal physiologic circumstances, how many milliliters of O2 are capable of
combining with 1 g of Hb? a. 0.003 ml b. 0.450 ml c. 0.820 ml d. 1.340 ml ANS: D
In whole blood, each gram of hemoglobin can carry approximately 1.34 ml of O2 . DIF: Recall
REF: p. 254
OBJ: 6
40. If the total hemoglobin content (Hb + HbO 2 ) of a sample of blood is 20 g/dl and the
oxyhemoglobin (HbO 2 ) content is 15 g/dl, what is the HbO 2 saturation? a. 17% b. 50% c. 75% d. 83% ANS: C
If there were a total of 20 g/dl Hb in the blood, of which 15 g was HbO 2 , the SaO 2 would be calculated as follows: SaO 2 (%) = [15 ÷ 20] 100 = 75% DIF: Analysis
REF: p. 255
OBJ: 6
41. At a PaO 2 of 65 mm Hg, what is the approximate saturation of Hb with O 2 ? a. 73% b. 80% c. 90% d. 97% ANS: C
If some abnormality reduced the PaO 2 to 65 mm Hg, the SaO 2 would still be approximately 90%. DIF: Application
REF: p. 255
OBJ: 7
42. Why is it necessary to keep the patient’s PaO 2 greater than 60 mm Hg? a. A level of 60 mm Hg marks the beginning of the steep part of O2 Hb dissociation
curve. b. Below the 60 mm Hg level, tissue hypoxia is ensured. c. Oxygen deprivation will cause severe cerebral vasoconstriction below 60 mm Hg. d. The PaCO 2 will start to rise precipitously if the PaO 2 falls further. ANS: A
With a PO 2 lower than 60 mm Hg, the curve steepens dramatically. Here, in the normal operating range of the tissues, even a small drop in PO 2 causes a large drop in SaO 2 , indicating a decreasing affinity for O2 . This normal decrease in the affinity of hemoglobin for O 2 helps release large amounts of O 2 to the tissue, where the PO 2 is low. This also explains why it is necessary to keep the PaO 2 higher than 60 mm Hg in clinical practice. DIF: Application
REF: p. 255
OBJ: 7
43. Given the following blood parameters, compute the total O 2 content (dissolved + HbO 2 ) of the
blood in ml/dl: Hb = 18; PO2 = 40 mm Hg; SO2 = 73%. a. 16.5 ml/dl b. 17.7 ml/dl c. 18.6 ml/dl d. 19.5 ml/dl ANS: B
Known values are (1) PO 2 , (2) total hemoglobin content (g/dl), and (3) hemoglobin saturation. Given these values, the following equation can be applied: CaO 2 = (0.003 PO2 ) + (Hbtot 1.34 SO2 ) DIF: Analysis
REF: p. 255
OBJ: 6
44. Given the following blood parameters, compute the total O 2 content (dissolved + HbO 2 ) of the
blood in ml/dl: Hb = 16; PO2 = 625 Hg; SO 2 = 100%. a. 17.8 ml/dl
b. 19.4 ml/dl c. 21.4 ml/dl d. 23.3 ml/dl ANS: D
The respiratory therapist obtains a sample of arterial blood from a patient breathing 100% O 2 . The PO 2 is 625 mm Hg, Hb is 16 g/dl, and the O 2 saturation is 100%. To compute the total O2 content, the respiratory therapist should apply the aforementioned equation as follows: CaO 2 = (0.003 PaO 2 ) + (Hbtot 1.34 SaO 2 ) CaO 2 = (0.003 ml 625 mm Hg) + (16 g/dl 1.34 1.0) CaO 2 = (1.875 ml) + (21.44 g/dl) CaO 2 = 23.3 ml/dl DIF: Analysis
REF: p. 255
OBJ: 6
45. What is the approximate normal CaO 2 – CO 2 in a healthy adult at rest? a. 5 ml/dl b. 15 ml/dl c. 20 ml/dl d. 250 ml/dl ANS: A
As indicated in Table 12-2, the difference between the normal arterial and venous O 2 contents is approximately 5 ml/dl. DIF: Recall
REF: p. 257
OBJ: 10
46. A patient has a whole-body O 2 consumption of 320 ml/min and a measured CaO 2 – CO 2 of 8
ml/dl. What is the cardiac output? a. 3.2 L/min b. 4.0 L/min c. 5.0 L/min d. 7.0 L/min ANS: B
Fick equation: t = O2 | C(a–v)O 2 10 In this equation, t is cardiac output (L/min), O 2 is the whole-body O 2 consumption (ml/min), and C(a–)O2 is the arteriovenous O 2 contents difference (ml/dl). The factor of 10 converts ml/dl to ml/L. Given a normal O 2 of 250 ml/min and a normal C(a–)O 2 of 5 ml/dl, a normal cardiac output is calculated as follows: t = 200 ml/min | 5 ml/dl 10 t = 250 ml/min | 5 ml/L t = 5.0 L/min DIF: Analysis
REF: p. 258
OBJ: 10
47. According to the Fick principle, if O2 consumption remains constant, an increase in cardiac
output will manifest itself as which of the following? a. Decrease in the CaO 2 – CO 2. b. Increase in the CaO 2.
c. Increase in the CaO 2 – CO 2. d. Decrease in the CO 2. ANS: A
If the cardiac output rises and O 2 consumption remains constant, the C(a–)O2 will fall proportionately. DIF: Analysis
REF: p. 258
OBJ: 10
48. According to the Bohr effect, when the pH drops, what happens?
1. The affinity of Hb for O2 decreases. 2. The Hb saturation for a given PO 2 falls. 3. The Hb saturation for a given PO2 rises. a. 1 and 2 only b. 2 only c. 2 and 3 only d. 1, 2, and 3 ANS: A
The impact of changes in blood pH on hemoglobin affinity for O2 is called the Bohr effect. As shown in Figure 12-10, the Bohr effect alters the position of the HbO 2 dissociation curve. A low pH (acidity) shifts the curve to the right, decreasing Hb affinity for O 2 and thus O 2 saturation. DIF: Application
REF: p. 259
OBJ: 10
49. Compared to normal levels, a shift in the HbO 2 curve to the right has which of the following
effects? 1. The affinity of Hb for O2 decreases. 2. The Hb saturation for a given PO 2 falls. 3. The Hb saturation for a given PO2 rises. a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3 ANS: B
As blood pH drops and the curve shifts to the right, the Hb saturation for a given PO 2 falls decreased Hb affinity for O 2 . DIF: Application
REF: p. 258
OBJ: 10
50. What role does the Bohr effect play in O2 transport? a. Describes the effect of varying enzyme levels on Hb and O 2 affinity. b. Diminishes tissue oxygenation due to electrolyte imbalances. c. Enhances O2 delivery to tissues and O 2 pickup at lungs. d. Explains the effect that O 2 levels have on carbon dioxide transport. ANS: C
The Bohr effect enhances O 2 loading in the lungs and O2 unloading in the tissues. DIF: Application
REF: p. 258
OBJ: 10
51. What happens when the temperature of the blood rises?
1. The Hb saturation for a given PO2 falls. 2. The HbO 2 curve shifts to the right. 3. The affinity of Hb for O2 increases. a. 1 and 2 only b. 1 and 3 only c. 2 only d. 1, 2, and 3 ANS: A
Conversely, as body temperature rises, the curve shifts to the right, and the affinity of Hb for O 2 decreases. DIF: Application
REF: pp. 258-259 OBJ: 10
52. What is the effect of an elevated intracellular 2,3-DPG concentration? a. Decreases the availability of O 2 to the tissues. b. Increases the affinity of Hb for O 2 . c. Increases the availability of O 2 to the tissues. d. Shifts the HbO 2 dissociation curve to the left. ANS: C
Increased 2,3-DPG concentrations shift the HbO 2 curve to the right, promoting O2 unloading. DIF: Application
REF: p. 259
OBJ: 10
53. In which of the following conditions will erythrocyte concentration of 2,3-DPG be decreased? a. Anemia b. Banked blood c. High pH d. Hypoxemia ANS: B
Erythrocyte concentrations of 2,3-DPG in banked blood decrease over time. After a week of storage, the 2,3-DPG level may be less than one-third of the normal value. DIF: Recall
REF: p. 259
OBJ: 10
54. The oxidation of the Hb molecule’s iron ions to the ferric state (Fe3+) results in which of the
following? 1. Form of anemia called sickle cell anemia 2. Formation of methemoglobin (metHb) 3. Inability of metHb to bind with O2 a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: C
metHb is an abnormal form of the molecule in which the heme-complex normal ferrous iron ion (Fe2+) loses an electron and is oxidized to its ferric state (Fe3+). In the ferric state, the iron ion cannot combine with O2 . DIF: Recall
REF: pp. 259-260 OBJ: 10
55. The affinity of Hb for carbon monoxide (CO) is approximately how many times greater than
its affinity for O2 ? a. 10 to 50 times greater b. 50 to 90 times greater c. 100 to 190 times greater d. 200 or greater ANS: D
Carboxyhemoglobin (HbCO) is the chemical combination of hemoglobin with CO. Hemoglobin’s affinity for CO is more than 200 times greater than it is for O2 . DIF: Application
REF: p. 260
OBJ: 10
56. Which of the following increases the affinity of Hb for O 2 ?
1. Decreased 2,3-DPG 2. Decreased PCO 2 3. Increased pH 4. Increased temperature a. 1, 2, and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 3 and 4 only ANS: B
An increased pH results in a right shift in the O2 -hemoglobin dissociation curve resulting in a decreased affinity. DIF: Application
REF: pp. 259-260 OBJ: 10
57. Which of the following is true regarding fetal hemoglobin (HbF)? a. It has a reduced level of 2,3-DPG. b. It is replaced in the first month of life. c. It delivers more O 2 to tissues at low PaO 2 than normal Hb. d. It has a higher P50 than normal Hb. ANS: C
HbF has a greater affinity for O 2 than does normal adult Hb, as manifested by a leftward shift of the HbO2 curve. Given the low PO 2 values available to the fetus in utero, this leftward shift aids O2 loading at the placenta. Because of the relatively low pH of the fetal environment, O 2 unloading at the cellular level is not greatly affected. DIF: Application
REF: p. 260
OBJ: 10
58. A patient has a P50 value of 29 mm Hg. What does this indicate? a. Decreased affinity of Hb for O2 b. Higher than normal Hb saturation for a given PO2
c. Increased affinity of Hb for O 2 d. Normal position in the HbO 2 ANS: A
Conditions that cause a decrease in Hb affinity for O2 (a shift of the HbO 2 curve to the right) increase the P50 to higher than normal. A normal P50 is 26 mm Hg. DIF: Application
REF: p. 260
OBJ: 10
59. In which of the following forms is/are carbon dioxide transported by the blood?
1. Chemically combined with proteins 2. Ionized as bicarbonate (HCO 3– ) 3. Simple physical solution a. 2 only b. 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Approximately 45 to 55 ml/dl of carbon dioxide is normally carried in the blood in the following three forms: (1) dissolved in physical solution, (2) chemically combined with protein, and (3) ionized as bicarbonate. DIF: Application REF: pp. 260-261 OBJ: 8 60. Which of these statements applies to the following reaction: Prot-NH 2 + CO 2 Prot-NHCOO – +
H +? a. Approximately 20% of the total blood carbon dioxide is carried in this form. b. It is second in importance to only the bicarbonate buffer system. c. It represents the formation of blood carbamino compounds. d. The resulting H+ ions are buffered by reduced HCO 3. ANS: C
A small amount of the carbon dioxide leaving the tissues combines with plasma proteins to form these carbamino compounds. DIF: Analysis
REF: p. 263
OBJ: 8
61. The largest percentage of carbon dioxide transported in the blood occurs as which of the
following? a. Carbamino-Hb b. Carbonic acid (H 2 CO 3 ) c. HCO 3 – d. Physically dissolved carbon dioxide ANS: C
Approximately 80% of the blood carbon dioxide is transported as bicarbonate. DIF: Recall
REF: p. 260
OBJ: 8
62. Why is the presence of carbonic anhydrase in RBCs so crucial for carbon dioxide transport? a. Forms H2 CO 3, which is the major buffer for carbon dioxide.
b. Drives the hydrolysis reaction that forms HCO -. 3 c. Forms H2 CO 3 , which is the way the majority of carbon dioxide is transported. d. Without its formation, carbon dioxide could not be excreted at the lungs. ANS: B
Hydrolysis of carbon dioxide initially forms carbonic acid, which quickly ionizes into hydrogen and bicarbonate ions: CO 2 + H2 O H2 CO 3 HCO3 − + H+ However, the rate of this plasma hydrolysis reaction is extremely slow, producing minimal amounts of H + and HCO 3−. This reaction is greatly enhanced by an enzyme catalyst called carbonic anhydrase. DIF: Application
REF: p. 260
OBJ: 8
63. When a Hb molecule accumulates excessive amounts of HCO –3 , it is expelled from the cell in
exchange for Cl– . What is this called? a. Bohr effect b. Haldane effect c. Hamburger phenomenon d. Hydrolysis phenomenon ANS: C
As the hydrolysis of carbon dioxide continues, HCO3 – ions begin to accumulate in the erythrocyte. To maintain a concentration equilibrium across the cell membrane, some of these anions diffuse outward into the plasma. Because the erythrocyte is not freely permeable by cations, electrolytic equilibrium must be maintained by way of an inward migration of anions. This is achieved by the shifting of chloride ions (Cl– ) from the plasma into the erythrocyte, a process called the chloride shift, or the Hamburger phenomenon. DIF: Recall
REF: p. 262
OBJ: 8
64. When Hb saturation with O2 is high, less carbon dioxide is carried in the blood. What is this
relationship called? a. Bohr effect b. Chloride shift c. Dissociation constant d. Haldane effect ANS: D
Figure 12-14 shows that oxyhemoglobin saturation also affects the position of the carbon dioxide dissociation curve. The influence of oxyhemoglobin saturation on carbon dioxide dissociation is called the Haldane effect. DIF: Application
REF: p. 262
OBJ: 9
65. The conversion of HbO 2 to deoxygenated Hb does which of the following?
1. Decreases blood carbon dioxide content. 2. Enhances carbon dioxide loading on Hb. 3. Helps buffer H+ ions. a. 2 and 3 only b. 1 and 2 only
c. 3 only d. 1, 2, and 3 ANS: A
Figure 12-14 shows that oxyhemoglobin saturation also affects the position of the CO 2 dissociation curve. The influence of oxyhemoglobin saturation on CO 2 dissociation is called the Haldane effect. As previously explained, this phenomenon is a result of changes in the affinity of hemoglobin for CO 2 , which occur as a result of its buffering of H+ ions. DIF: Analysis
REF: p. 262
OBJ: 9
66. Which of the following statements is true regarding the Haldane effect? a. At high SaO 2 levels, carbon dioxide more readily forms carbamino compounds. b. At high SaO 2 levels, the capacity of blood to hold carbon dioxide decreases. c. At high SaO 2 levels, the capacity of blood to hold carbon dioxide increases. d. At low SaO 2 levels, the capacity of blood to hold carbon dioxide decreases. ANS: B
At point ―a,‖ the high SaO2 decreases the blood’s capacity to hold carbon dioxide, thus helping unload this gas at the lungs. DIF: Application
REF: p. 262
OBJ: 9
67. Which of the following equations best describes O 2 delivery to the tissues? a. Arterial O 2 content ÷ cardiac output b. Arterial O 2 content cardiac output c. Cardiac output + arterial O 2 content d. Cardiac output vascular resistance ANS: B
Oxygen delivery (DO 2 ) to the tissues is a function of arterial oxygen content (CaO 2 ) times cardiac output (t): O 2 = CaO 2 t DIF: Analysis
REF: p. 263
OBJ: 10
68. In the presence of an acutely reduced arterial O 2 content (hypoxemia), normal O 2 delivery to
the tissues can be maintained by which of the following? a. Hyperventilation (increased V A) b. Increased RBC production c. Increasing the cardiac output d. Peripheral vasoconstriction ANS: C
Oxygen delivery (O2 ) to the tissues is a function of arterial O2 content (CaO 2 ) times cardiac output (t): O 2 = CaO 2 t If arterial O2 content falls an increased cardiac output will compensate. DIF: Analysis
REF: p. 263
OBJ: 10
69. Hypoxia is best defined as a condition in which what occurs?
a. b. c. d.
Blood Hb levels are less than normal (15 g/dl). The arterial PCO 2 is greater than normal (45 mm Hg). The arterial PO2 is greater than normal (100 mm Hg). Tissue O2 delivery is inadequate to meet cellular needs.
ANS: D
When O2 delivery falls short of cellular needs, hypoxia occurs. DIF: Application
REF: p. 263
OBJ: 10
70. Which of the following are potential causes of hypoxia?
1. Decrease in arterial PO 2 2. Decrease in available Hb 3. Decrease in cardiac output a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Hypoxia occurs if (1) the arterial blood O2 content is decreased (hypoxemia), or (2) cardiac output or perfusion is decreased (shock or ischemia). DIF: Application
REF: p. 263
OBJ: 10
71. An abnormal metabolic state in which the tissues are unable to utilize the O 2 made available
to them best describes which of the following? a. Diffusion hypoxia b. Dysoxia c. Hemic hypoxia d. Physiologic shunt ANS: B
Abnormal cellular function prevents proper uptake of O2 is called dysoxia. DIF: Application
REF: p. 266
OBJ: 10
72. A patient breathing room air at sea level has the following arterial blood gases: PaO 2 = 62 mm
Hg; PCO 2 = 75 mm Hg. When the FIO 2 is raised to 0.28, the PaO 2 rises to 95 mm Hg. What is the most likely cause of the hypoxemia? a. Hypoventilation b. Impaired diffusion c. Right-to-left shunt d. V/Q imbalance ANS: A
In the case of simple hypoventilation, a rise in the alveolar PCO 2 is always accompanied by a proportionate fall in alveolar PO 2 . The P(A–a)O 2 is normal in such cases. The hypoxemia will respond readily to O 2 therapy. DIF: Application
REF: p. 266
OBJ: 10
73. What is the most common cause of hypoxemia in patients with lung disease? a. Diffusion defect b. Hypoventilation c. Right-to-left shunt d. mismatch ANS: D
Ventilation-perfusion ( with lung disease. DIF: Application
) imbalances are the most common cause of hypoxemia in patients
REF: p. 264
OBJ: 9
74. A patient breathing 40% O 2 at sea level has a PaO 2 of 50 mm Hg, a PCO 2 of 30 mm Hg, and a
PAO 2 – PaO 2 of 250 mm Hg. When the FiO 2 is raised to 0.7, the PaO 2 rises to only 58 mm Hg. Hypoxemia is primarily due to which of the following? a. Hypoventilation b. Impaired diffusion c. Right-to-left shunt d. imbalance ANS: C
A of 0 represents a special type of imbalance. When the is 0, there is blood flow but no ventilation. The result is equivalent to a right-to-left anatomical shunt, shown at the bottom of Figure 12-15. Venous blood bypasses ventilated alveoli and mixes with freshly oxygenated arterial blood, resulting in what is called a venous admixture. Right-to-left physiologic shunting results in a more severe form of hypoxemia than does a simple . DIF: Analysis
REF: p. 264
OBJ: 9
75. The expected PaO 2 for an 80-year-old man who is otherwise in good health and breathing
room air is approximately what level? a. 50 mm Hg b. 75 mm Hg c. 80 mm Hg d. 90 mm Hg ANS: B
One may estimate the expected PaO 2 in older adults by using the following formula: Expected PaO 2 = 100.1 – (0.323 age in years) DIF: Analysis
REF: p. 264
OBJ: 9
76. A patient with a normal PaO 2 and cardiac output is exhibiting signs and symptoms of tissue
hypoxia. What is the most likely cause? a. Hemoglobin deficiency b. Low ambient PO 2 c. Right-to-left shunt d. Hypoventilation ANS: A
If the blood hemoglobin is low—even when the PaO 2 is normal—hypoxia can occur because of low O2 content in the arterial blood. DIF: Analysis
REF: p. 266
OBJ: 9
77. What is the most important component in the O2 transport system? a. Dissolved O2 in ml/dl b. HCO 3 – c. Hb d. PaO 2 ANS: C
Progressive falls in blood hemoglobin content cause large drops in arterial O 2 content (CaO 2 ). In fact, a 33% decrease in hemoglobin content (from 15 to 10 g/dl) reduces the CaO 2 as much as would a drop in PaO 2 from 100 to 40 mm Hg. DIF: Analysis
REF: p. 266
OBJ: 9
78. When O2 uptake by the tissues is abnormally low, as occurs in certain forms of dysoxia, what
would you expect to find? a. Decreased CaO 2 b. Decreased CvO 2 c. Decreased PaO 2 d. Increased CvO 2 ANS: D
Dysoxia is a form of hypoxia in which the cellular uptake of O 2 is abnormally decreased. The best example of dysoxia is cyanide poisoning. Cyanide disrupts the intracellular cytochrome oxidase system, thereby preventing cellular use of O2 . DIF: Analysis
REF: p. 267
OBJ: 9
79. Which of the following would you expect to find with ―O2 debt‖?
1. Accentuated in diseases such as sepsis. 2. O2 demand exceeds O 2 delivery. 3. O2 excess usage results in debt. a. 1, 2, and 3 b. 1 and 2 only c. 2 only d. 2 and 3 only ANS: B
Decreases in O2 delivery result in an O2 ―debt,‖ when O2 demand exceeds O2 delivery. Under conditions of O 2 debt, O 2 consumption becomes dependent on O 2 delivery (sloped line on Figure 12-19). This in turn leads to lactic acid accumulation and metabolic acidosis. In pathologic conditions such as septic shock and adult respiratory distress syndrome (dotted line in Figure 12-19), this critical point may occur at levels of O2 delivery considered normal. DIF: Application
REF: p. 267
OBJ: 10
80. Under which of the following conditions may carbon dioxide removal be impaired?
1. When a mismatch exists. 2. When the dead space ventilation/min is increased. 3. When the minute ventilation is inadequate. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Anything that decreases alveolar ventilation can impair carbon dioxide removal. A decrease in alveolar ventilation occurs when (1) the minute ventilation is inadequate, (2) the dead space ventilation per minute is increased, or (3) a imbalance exists. DIF: Application
REF: p. 267
OBJ: 11
81. What can you assume about a patient who has a mismatch and exhibits hypercapnia? a. The central nervous system is not responding to the increased PCO 2 . b. The patient cannot sustain the high E to overcome the high VD. c. The patient is compensating for an acute metabolic alkalosis. d. The patient is compensating for a chronic metabolic acidosis. ANS: B
An increase in dead space ventilation is caused by either (1) rapid, shallow breathing (an increase in anatomical dead space per minute) or (2) increased physiologic dead space (/ = 0). In either case, the proportion of wasted ventilation increases. Without compensation, this lowers alveolar ventilation per minute and impairs carbon dioxide removal. DIF: Application
REF: pp. 267-268 OBJ: 11
82. What does / mismatch have the biggest impact on? a. Carbon dioxide elimination b. Dissolved HCO 3– c. Oxygenation d. pH ANS: C
imbalances have a greater effect on oxygenation than on carbon dioxide removal. DIF: Application
REF: pp. 267-268 OBJ: 11
83. If blood from an area of the lung with a high / is mixed with blood perfusing an area with a
low a. b. c. d.
, what will be the result? CaO 2 higher than the average of the two CaO 2 lower than the average of the two PaO 2 equal to the average of the two PaO 2 lower than the average of the two
ANS: D
The final O 2 content, also arrived at by averaging the high and low / points, is shown as point X on the O2 curve (Figure 12-20). Whereas the averaged value for carbon dioxide was normal, the PaO 2 resulting from averaging the O 2 content of the high and low / units is well below normal (point ―a‖ on the O2 curve of Figure 12-20). DIF: Application
REF: pp. 267-268 OBJ: 10
84. Which of the following statements is NOT true about the effect of / imbalances on O 2 and
carbon dioxide exchange? a. Blood leaving high units has a high PO 2 and a low PCO 2 . b. Blood leaving low units has a low PO2 and a high PCO 2 . c. High units can compensate for high PCO 2 levels from low d. High units can compensate for low PO2 levels from low
units. units.
ANS: D
However, the shape of the dissociation curves dictates that a high / unit can reverse the high PCO 2 but not the low PO 2 . DIF: Analysis
REF: pp. 267-268 OBJ: 11
85. Under which of the following conditions can the alveolar partial pressure of carbon dioxide
(PACO 2 ) be increased? 1. When the body increases its production of CO2 (VCO 2 ) 2. When the dead space ventilation per minute is increased (VD) 3. When the minute ventilation is inadequate (VE) 4. When the alveolar ventilation is decreased (VA) a. 1 and 2 only b. 1 and 3 only c. 1, 2 and 3 d. 1, 2, 3, and 4 ANS: D
The alveolar partial pressure of carbon dioxide, or PACO 2 , varies directly with the body’s production of carbon dioxide (VCO 2 ) and inversely with alveolar ventilation (V A). A decrease in alveolar ventilation occurs when the minute ventilation is inadequate, the dead space ventilation per minute is increased, or a / imbalance exists. DIF: Analysis
REF: pp. 267-268 OBJ: 2
86. When using therapeutic agents that can cause methemoglobinemia (methHb), which of the
following is important to prevent adverse effects? a. Checking the frequency of ventilation b. Frequent monitoring for methHb to weigh the risk against the benefit c. Occasional monitoring for sickle cell anemia d. Frequent monitoring for abnormal body temperature (high or low) ANS: B
Methemoglobin (metHb) is an abnormal form of the molecule, in which the heme-complex normal ferrous iron ion (Fe2+) loses an electron and is oxidized to its ferric state (Fe 2+). In the ferric state, the iron ion cannot combine with O2 . The result is a special form of anemia called methemoglobinemia. As with HbCO, clinical abnormalities come from the associated increased affinity for O 2 and loss of oxygen-binding capacity. The most common cause of methemoglobinemia is the therapeutic use of oxidant medications such as nitric oxide, nitroglycerin, and lidocaine. When using these therapeutic agents, frequent monitoring for metHg is important to weigh the risk against the benefit. DIF: Application
REF: p. 259
OBJ: 7
87. The two major causes of dead space ventilation are:
1. a decreased tidal volume. 2. dysoxia. 3. impaired CO 2 removal. 4. increased physiologic dead space. a. 1 and 2 only b. 1 and 3 only c. 1 and 4 only d. 1, 2, and 3 only ANS: C
An increase in dead space ventilation, or V D/V T, is caused by either (1) a decreased tidal volume as with rapid, shallow breathing (an increase in anatomic dead space per minute) or (2) increased physiologic dead space as in pulmonary embolus. ( = 0). In either case, the proportion of wasted ventilation increases. DIF: Application
REF: p. 267
OBJ: 10
88. Disorders that can lead to alveolar dead space include:
1. pulmonary emboli. 2. partial obstruction of the pulmonary vasculature. 3. destroyed pulmonary vasculature. 4. reduced cardiac output. a. 1 and 2 only b. 1 and 3 only c. 1, 2, and 4 only d. 1, 2, 3, and 4 ANS: D
Alveolar dead space is that ventilation that enters into alveoli that are without any perfusion or without adequate perfusion. Disorders that can lead to alveolar dead space include pulmonary emboli, partial obstruction of the pulmonary vasculature, destroyed pulmonary vasculature (as can occur in COPD), and with reduced cardiac output. DIF: Application
REF: p. 267
OBJ: 10
Chapter 13 - Solutio ns, Body Fluids, and Electroly tes Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. What is a uniform distribution of large molecules that attract and hold water? a. Colloid b. Mixture c. Solution d. Suspension ANS: A
Colloids (sometimes called dispersions or gels) consist of large molecules that attract and hold water. DIF: Recall
REF: pp. 270-271 OBJ: 1
2. The combination of red blood cells in plasma is a good example of what? a. Colloid b. Mixture c. Solution d. Suspension ANS: D
Red blood cells in plasma are an example of a suspension. DIF: Application
REF: p. 271
OBJ: 1
3. What is a stable mixture of two or more evenly dispersed substances? a. Colloid b. Mixture c. Solution d. Suspension ANS: C
A solution is a stable mixture of two or more substances in a single phase. One substance is evenly dispersed throughout the other. DIF: Application
REF: p. 270
OBJ: 1
4. The ease with which a gas dissolves into a solvent is at least partially determined by which of
the following? a. Gas conductivity b. Gas temperature c. Level of 2,3-DPG d. Solvent conductivity ANS: B
The ease with which a solute dissolves in a solvent is its solubility, which is influenced by five factors:
1. Nature of the solute. The ease with which substances go into a solution in a given solvent depends on the forces of the solute-solute molecules and varies widely. 2. Nature of the solvent. A solvent’s ability to dissolve a solute depends on the bonds of the solvent-solvent molecules, and also varies widely. 3. Temperature. Solubility of most solids increases with increased temperature. However, the solubility of gases varies inversely with temperature. 4. Pressure. The solubility of solids and liquids is not greatly affected by pressure. The solubility of gases in liquids, however, varies directly with pressure. 5. Concentration. The concentration of a solute or available solvent will have an effect of how much of the substance goes into solution. DIF: Application
REF: p. 271
OBJ: 2
5. Which of the following is false regarding solubility? a. Gas solubility varies directly with pressure. b. Gas solubility varies directly with temperature. c. Solvents vary in their ability to dissolve substances. d. The solubility of solids increases with temperature. ANS: A
The ease with which a solute dissolves in a solvent is its solubility, which is influenced by five factors: 1. Nature of the solute. The ease with which substances go into a solution in a given solvent depends on the forces of the solute-solute molecules and varies widely. 2. Nature of the solvent. A solvent’s ability to dissolve a solute depends on the bonds of the solvent-solvent molecules, and also varies widely. 3. Temperature. Solubility of most solids increases with increased temperature. However, the solubility of gases varies inversely with temperature. 4. Pressure. The solubility of solids and liquids is not greatly affected by pressure. The solubility of gases in liquids, however, varies directly with pressure. 5. Concentration. The concentration of a solute or available solvent will have an effect of how much of the substance goes into solution. DIF: Application
REF: p. 271
OBJ: 2
6. Gas transport in the body is most affected by changes in which of the following variables? a. Ambient pressure b. Inspired gas temperature c. Oxygen’s solubility coefficient d. Water vapor pressure of inspired gases ANS: A
The partial pressure of the dissolved gas is the product of its coefficient of solubility and the partial pressure of the gas to which the liquid is exposed. Oxygen and carbon dioxide transport can change significantly with changes in body temperature or the pressure to which the body is exposed. DIF: Application
REF: p. 271
OBJ: 2
7. A solution holding the maximum amount of solute in a given volume at a constant
temperature is said to be what?
a. b. c. d.
Hypertonic Hypotonic Saturated Supersaturated
ANS: C
A saturated solution has the maximal amount of solute that can be held in a given volume of a solvent at a constant temperature. DIF: Application
REF: p. 271
OBJ: 2
8. Which of the following describes the most important physiological characteristic of solutions? a. Their ability to exert pressure b. Their ability to redistribute in blood c. Their ability to vary concentration inversely with tonicity d. Their ability to vary pressure inversely with temperature ANS: A
The most important physiologic characteristic of solutions is their ability to exert pressure. DIF: Application
REF: p. 272
OBJ: 1
9. What is the attractive force of solute particles in a concentrated solution? a. Diffusion pressure b. Gas pressure c. Hydrostatic pressure d. Osmotic pressure ANS: D
Osmotic pressure is the force produced by solvent particles under certain conditions. If a solution is placed on one side of a semipermeable membrane and pure solvent on the other, solvent molecules will move through the membrane into the solution. The force driving solvent molecules through the membrane is osmotic pressure (Figure 12-2, A). DIF: Recall
REF: p. 272
OBJ: 3
10. What is the effect of osmotic pressure on solutions of different solute concentrations,
separated by a semipermeable membrane? a. Causes a net loss of fluid. b. Equal distribution of solvent. c. Has no effect in this situation. d. Redistribution of the solute. ANS: B
Osmotic pressure tries to distribute solvent molecules so that the same concentration exists on both sides of the membrane. DIF: Application
REF: p. 272
OBJ: 3
11. If a 60% solution (A) were exposed to a 10% solution (B) across a semipermeable membrane,
what would be the strength of each solution following equilibrium? a. Solution A 10%/solution B 60%
b. Solution A 35%/solution B 35% c. Solution A 50%/solution B 20% d. Solution A 60%/solution B 10% ANS: B
Osmotic pressure can also be visualized as an attractive force of solute particles in a concentrated solution. If 100 ml of a 50% solution is placed on one side of a membrane and 100 ml of a 30% solution is placed on the other side, solvent molecules will move from the dilute to the concentrated side (Figure 13-2, D and E). The particles in the concentrated solution attract solvent molecules from the dilute solution until equilibrium occurs. Equilibrium exists when the concentrations (i.e., ratio of solute to solvent) in both compartments are equal (40% in Figure 13-2). DIF: Application
REF: p. 271
OBJ: 3
12. Which of the following is true regarding osmotic pressure? a. Osmotic pressure depends on the number of particles in solution. b. Osmotic pressure varies inversely with temperature. c. Osmotic pressure is highest in dilute solutions. d. Osmotic pressure varies inversely with tonicity. ANS: A
Osmotic pressure depends on the number of particles in solution but not on their charge or identity. A 2% solution has twice the osmotic pressure of a 1% solution under similar pressures. For a given amount of solute, osmotic pressure is inversely proportional to the volume of solvent. Osmotic pressure varies directly with temperature, increasing by 1/273 for each 1° C. DIF: Application
REF: p. 272
OBJ: 3
13. Which of the following is an isotonic solution? a. 0.09% NaCl b. 0.90% NaCl c. 9.00% NaCl d. 19.0% NaCl ANS: B
Average body cellular fluid has a tonicity equal to a 0.9% solution of sodium chloride (NaCl; sometimes referred to as physiologic saline). Solutions with similar tonicity are called isotonic. DIF: Recall
REF: p. 272
OBJ: 3
14. A 3% NaCl solution is referred to as: a. hypertonic. b. hypotonic. c. isotonic. d. normotonic. ANS: B
Those solutions with more tonicity are hypertonic, and those solutions with less tonicity are hypotonic.
DIF: Application
REF: p. 272
OBJ: 3
15. If your objective were to draw water out of cells or tissues, you would expose them to what
type of solution? a. Hypertonic b. Hypotonic c. Isotonic d. Normotonic ANS: A
Hypertonic solutions draw water out of cells. DIF: Application
REF: p. 272
OBJ: 3
16. What is the normal ratio of HCO 3– to carbonic acid in healthy individuals? a. 1:1 b. 2:1 c. 10:1 d. 20:1 ANS: D
The ratio of HCO 3– to carbonic acid in healthy individuals is maintained near 20:1; this results in a pH of close to 7.40. HCO 3– stores are evenly divided between intracellular and extracellular compartments. DIF: Recall
REF: p. 281
OBJ: 4
17. Positive ions are referred to as: a. anions. b. cations. c. covalents. d. electrolytes. ANS: B
If an electrode is placed in such a solution, positive ions migrate to the negative pole of the electrode. These ions are called cations. DIF: Recall
REF: p. 270
OBJ: 5
18. In which of the following solutions do the molecules of solute remain intact? a. Electrolytic b. Electrovalent c. Nonpolar covalent d. Polar covalent ANS: C
In nonpolar covalent solutions, molecules of solute remain intact and do not carry electrical charges; these solutions are referred to as nonelectrolytes. DIF: Application
REF: p. 270
OBJ: 5
19. How is the gram-equivalent (gEq) weight of a substance computed? a. Dividing its gram atomic weight by its valence b. Dividing its valence by its gram atomic weight c. Multiplying its atomic number times its atomic weight d. Multiplying its gram atomic weight times its valence ANS: A
Gram equivalent weight values. A gEq of a substance is calculated as its gram atomic (formula) weight divided by its valence. The valence signs (+ or –) are disregarded. DIF: Analysis
REF: p. 273
OBJ: 1
20. What is the gEq weight of an acid? a. Amount of the acid containing 1 mol of replaceable H + ions. b. Amount of the acid containing 1 mol of replaceable OH − ions. c. Gram atomic weight of the acid times its valence. d. Milligrams of acid per deciliter (dl) of normal solution. ANS: A
The gram equivalent weight of an acid may be calculated by dividing its gram formula weight by the number of hydrogen atoms in its formula, as shown in the following reaction: The single H + of hydrochloric acid (HCl) is replaced by Na+. One mole of HCl has 1 mol of replaceable hydrogen. By definition, the gEq of HCl must be the same as its gram formula weight, or 36.5 g. DIF: Application
REF: p. 273
OBJ: 1
21. A serum value of 140 mEq/L of Na is equivalent to how many mg/dl? a. 14 mg/dl b. 70 mg/dl c. 280 mg/dl d. 322 mg/dl ANS: D
For example, to convert a serum Na+ value of 322 mg/dl to mEq/L DIF: Analysis
REF: p. 273
OBJ: 1
22. In which of the following types of solutions is the relationship of solute to solvent expressed
as a proportion? a. Normal b. Percent c. Ratio d. Weight/volume ANS: C
Ratio solution. The amount of solute to solvent is expressed as a proportion. DIF: Application
REF: p. 274
OBJ: 4
23. You prepare a solution by dissolving 5 g of glucose in 100 ml of solution. What type of
solution are you making?
a. b. c. d.
Normal Percent Ratio Weight/volume
ANS: D
It is defined as weight of solute per volume of solution. This method is sometimes erroneously described as a percent solution. W/V solutions are commonly expressed in grams of solute per 100 ml of solution. For example, 5 g of glucose dissolved in 100 ml of solution is properly called a 5% solution. DIF: Application
REF: pp. 274-275 OBJ: 4
24. You prepare a solution by combining 5 g of glucose with 95 g of water. What type of solution
are you making? a. Normal b. Percent c. Ratio d. Weight/volume ANS: B
Percent solution. A percent solution is weight of solute per weight of solution. Five grams of glucose dissolved in 95 g of water is a true percent solution. The glucose is 5% of the total solution weight of 100 g. DIF: Application
REF: pp. 274-275 OBJ: 4
25. What type of solution could have 1 mol of solute per liter of solution? a. Molal b. Molar c. Normal d. Weight/volume ANS: B
Molar solution. A molar solution has 1 mol of solute per liter of solution, or 1 mmol/ml of solution. Solute is measured into a container and solvent is added to produce the solution volume desired. DIF: Application
REF: pp. 274-275 OBJ: 1
26. What type of solution could have 1 gEq of solute per liter of solution? a. Molal b. Molar c. Normal d. Weight/volume ANS: C
Normal solution. A normal solution has 1 gEq of solute per liter of solution, or 1 mEq/ml of solution. DIF: Application
REF: pp. 274-275 OBJ: 1
27. You add 50 ml of water to 150 ml of a 6% solution. What is the new concentration? a. 3.0% b. 4.5% c. 7.5% d. 12.0% ANS: B
If 50 ml of water is added to 150 ml of a 6% (0.03) solution, the new concentration is calculated by rearranging the dilution equation to find C2 . DIF: Analysis
REF: pp. 274-275 OBJ: 4
28. What is the characteristic of an acid? a. Absorbs H + ions. b. Accepts a proton. c. Is a proton donor. d. Produces OH − ions. ANS: C
Another definition of an acid is that of Brönsted-Lowry, in which an acid is any compound that is a proton (H +) donor. DIF: Recall
REF: p. 275
OBJ: 5
29. Identify the definition for a base substance. a. Compound that will donate a H+ ion b. Any compound that will accept a proton c. Only substances that contain a hydroxyl group d. Substances that contain Na+ ions ANS: B
The Brönsted-Lowry definition of a base is any compound that accepts a proton. DIF: Recall
REF: p. 275
OBJ: 5
30. Which of following are considered nonhydroxide bases?
1. Ammonia 2. Carbonates 3. Certain proteins 4. Ammonium a. 2 and 3 only b. 1, 2, and 3 only c. 1 and 4 only d. 1, 2, 3, and 4 ANS: B
Nonhydroxide bases. Ammonia and carbonates are good examples of nonhydroxide bases. Proteins, with their amino groups, also can serve as nonhydroxide bases. DIF: Recall
REF: pp. 275-276 OBJ: 5
31. Where does ammonia play its most important role as a base buffer?
a. b. c. d.
Kidney Liver Lung Vasculature
ANS: A
Ammonia plays an important role in renal excretion of acid. DIF: Recall
REF: p. 276
OBJ: 5
32. Which of the following is a facet of blood proteins? a. Blood proteins are composed of amino acids held together by fatty acids. b. Deoxygenated hemoglobin (Hb) is unable to accept H + ions. c. In an alkaline environment, blood proteins can act as bases. d. The imidazole group on amino acids is the key binding site for other amino acids. ANS: C
Protein bases. Proteins are composed of amino acids bound together by peptide links. Physiologic reactions in the body occur in a mildly alkaline environment. This allows proteins to act as H + receptors, or bases. Cellular and blood proteins acting as bases are transcribed as prot −. The imidazole group of the amino acid histidine is an example of an H + acceptor on a protein molecule (Figure 12-4). The ability of proteins to accept hydrogen ions limits H + activity in solution, which is called buffering. The ability of hemoglobin to accept (i.e., buffer) H + ions depends on its oxygenation state. Deoxygenated (reduced) hemoglobin is a stronger base (i.e., a better H+ acceptor) than oxygenated hemoglobin. DIF: Application
REF: p. 276
OBJ: 6
33. Pick the correct statement as it relates to hemoglobin and acid-base buffering. a. Deoxygenated hemoglobin acts as an acid at the tissue level. b. Deoxygenated hemoglobin is a fairly strong base. c. Hemoglobin contributes more H+ in the face of increased histidine. d. In an alkaline environment, hemoglobin becomes an ineffective base. ANS: B
The ability of proteins to accept hydrogen ions limits H + activity in solution, which is called buffering. The ability of hemoglobin to accept (i.e., buffer) H + ions depends on its oxygenation state. Deoxygenated (reduced) hemoglobin is a stronger base (i.e., a better H + acceptor) than oxygenated hemoglobin. DIF: Application
REF: p. 276
OBJ: 6
34. What is the relation between pure water and acid-base balance? a. A solution with an OH − concentration greater than that of water acts as an acid. b. Pure water is slightly acidic solution. c. The concentrations of both H + and OH − ions are equal. d. The H + concentration of water can be designated as 1 nmol/L. ANS: C
The concentration of both H+ and OH − in pure water is 10-7 mol/L. DIF: Application
REF: p. 277
OBJ: 7
35. How is pH defined? a. Log of the dissociation constant of the weak acid in a solution. b. Negative logarithm of the H+ ion concentration of a solution. c. Point at which an electrolyte solution is exactly 50% dissociated. d. Ratio of a solution’s weak acid concentration to its conjugate base pair. ANS: B
pH is the negative logarithm of the [H +] used as a positive number. DIF: Application
REF: p. 277
OBJ: 7
36. Which of the following describes an aspect of pH? a. Any solution with a pH of 7.0 is neutral. b. A pH of 7.0 describes an acidotic solution. c. A pH change from 7.0 to 8.0 equals a two-fold increase in H+ ion concentration. d. The pH is the log of the OH - ion concentration. ANS: A
In this scheme, any solution with a pH of 7.0 is neutral, corresponding to the [H +] of pure water. DIF: Application
REF: p. 277
OBJ: 7
37. If a patient’s pH were to drop from 7.40 to 7.10, the H + concentration will increase by how
much? a. 0.2 b. 0.3 c. 0.5 d. 0.10 ANS: A
Similarly, a change in pH of 0.3 units equals a two-fold change in [H+]. DIF: Analysis
REF: p. 277
OBJ: 7
38. Which of the following are true regarding water in the human body?
1. The more fatty tissue there is, the greater is the percentage of body water. 2. Total body water depends on an individual’s weight and sex. 3. Water constitutes approximately 45% to 80% of an individual’s body weight. 4. Water content is highest in the aged. a. 1 and 2 only b. 2 and 4 only c. 3 and 4 only d. 2 and 3 only ANS: D
Water is a major component of the body. It makes up 45% to 80% of an individual’s body weight, depending on that person’s weight, gender, and age. Leanness is associated with higher body water content. Obese individuals have a lower percentage of body water (as much as 30% less) than do normal-weight individuals. Men have a slightly higher percentage of total body water than women have. Total percentage of body water in infants and children is substantially greater than it is in adults. In the newborn, water accounts for 80% of the total body weight. DIF: Application
REF: p. 278
OBJ: 8
39. Intracellular water represents approximately what proportion of total body water? a. Approximately one-third of the total body water b. Approximately one-quarter of the total body water c. Approximately one-half of the total body water d. Approximately two-third of the total body water ANS: D
Intracellular water accounts for approximately two-thirds of the total body water, and extracellular water accounts for the remaining third. DIF: Recall
REF: p. 278
OBJ: 8
40. What is the smallest fluid subcompartment of extracellular water? a. Interstitial b. Intraorganelle c. Intravascular d. Transcellular ANS: D
Extracellular water is found in three subcompartments: (1) intravascular water (plasma), (2) interstitial water, and (3) transcellular fluid. Intravascular water makes up approximately 5% of the body weight. Interstitial water is water in the tissues between the cells. It makes up approximately 15% of the body weight. Transcellular fluid is quite small in proportion to plasma and interstitial fluid. DIF: Application
REF: p. 278
OBJ: 8
41. Which of the following are major extracellular electrolytes?
1. Cl– 2. HCO 3 – 3. K+ 4. Na+ a. 1, 2, and 3 only b. 2, 3, and 4 only c. 1, 3, and 4 only d. 1, 2, and 4 only ANS: D
Sodium (Na+), chloride (Cl−), and bicarbonate (HCO 3−) are the predominant extracellular electrolytes.
DIF: Recall
REF: p. 278
OBJ: 8
42. What are the main intracellular electrolytes?
1. K+ 2. Na+ 3. Phosphate 4. Sulfate a. 1, 3, and 4 only b. 2, 3, and 4 only c. 1 and 2 only d. 1, 2, 3, and 4 ANS: A
2+
+
3−
Potassium (K ), magnesium (Mg ), phosphate (PO
2−
), sulfate (SO 4
), and protein constitute 4
the main intracellular electrolytes.
DIF: Recall
REF: p. 278
OBJ: 8
43. Which of the following is false regarding body fluids and electrolytes? a. Interstitial fluid contains substantially more protein than does plasma. b. Intravascular and interstitial fluid have similar electrolyte compositions. c. Osmotic pressure helps to determine fluid distribution between compartments. d. Proteins account for the high colloid osmotic pressure of plasma. ANS: A
Intravascular and interstitial fluids have similar electrolyte compositions. However, plasma contains substantially more protein than interstitial fluid. Proteins, chiefly albumin, account for the high osmotic pressure of plasma. Osmotic pressure is an important determinant of fluid distribution between vascular and interstitial compartments. DIF: Application
REF: p. 278
OBJ: 8
44. What maintains the volume and composition of body fluids?
1. Filtration and reabsorption of sodium by the kidneys 2. Regulation of water balance by vasopressin (ADH) 3. Gastrointestinal filtration and excretion of chloride a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: A
The kidneys maintain the volume and composition of body fluids by two related mechanisms. First, filtration and reabsorption of sodium adjust urinary sodium excretion to match changes in dietary intake. Second, water excretion is regulated by secretion of antidiuretic hormone (ADH or vasopressin). DIF: Application
REF: p. 278
OBJ: 8
45. Water can be lost from the body through what organ systems?
1. Gastrointestinal tract
2. Liver 3. Lungs 4. Skin a. 1, 2, and 3 only b. 1, 3, and 4 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
Water may be lost from the body through the skin, lungs, kidneys, and gastrointestinal tract. DIF: Application
REF: p. 278
OBJ: 9
46. Insensible water loss occurs through what organs?
1. Gastrointestinal tract 2. Kidneys 3. Lungs 4. Skin a. 3 and 4 only b. 1, 2, and 4 only c. 2 and 3 only d. 2 and 4 only ANS: A
Water loss can be insensible, such as vaporization of water from the skin and lungs. DIF: Application
REF: p. 278
OBJ: 9
47. An adult’s insensible water loss averages what level? a. 300 ml/day b. 500 ml/day c. 700 ml/day d. 900 ml/day ANS: D
See Table 13-4. DIF: Recall
REF: p. 278
OBJ: 9
48. An adult’s insensible water through the lungs averages what level? a. 100 ml/day b. 200 ml/day c. 300 ml/day d. 400 ml/day ANS: B
See Table 13-4. DIF: Recall
REF: p. 278
OBJ: 9
49. What is the average urine output in a healthy adult? a. 600 to 800 ml/day
b. 800 to 1000 ml/day c. 1000 to 1200 ml/day d. 1200 to 1400 ml/day ANS: C
See Table 13-4. DIF: Recall
REF: p. 278
OBJ: 9
50. Hyponatremia can lead to which of the following problems?
1. Impaired cognitive function 2. Negative effects on gait stability 3. Renal insufficiency 4. Cerebral edema a. 1 and 3 only b. 2 and 3 only c. 1, 2, and 4 only d. 1, 2, 3, and 4 ANS: C
Once considered to be benign, mild hyponatremia has been shown in recent studies to have a significant impact on a patient’s cognitive function as well as his or her gait stability, it is thought to be a contributing factor in falls. Hyponatremia can lead to cerebral edema due to a change in osmotic pressure. DIF: Application
REF: p. 281
OBJ: 9
51. Patients with what condition are prone to evaporative water loss through the lungs?
1. Artificial airways 2. Hypothermia 3. Increased ventilation a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: B
Patients with increased ventilation also have increased water losses through increased evaporation from the respiratory tract. Patients with artificial airways are prone to evaporative water loss if inspired air is not adequately humidified. Artificial airways bypass the normal heat and water exchange processes of the nose. DIF: Application
REF: p. 279
OBJ: 9
52. Pick the statement that best describes the relationship between infants and their body fluids. a. Fluid loss or lack of intake depletes infants of water slower than it does adults. b. Infants have proportionately less body water than do adults. c. Infants’ higher metabolic rates necessitate greater urinary excretion compared with
adults. d. Under normal circumstances, infants’ water loses are three times those of adults. ANS: C
Infants have a greater proportion of body water than do adults, particularly in the extracellular compartments (Table 13-3). Water loss in infants may be twice that of adults. Infants also have a greater body surface area (in proportion to body volume) than adults, making their basal heat production twice as high. Higher metabolic rates in infants necessitate greater urinary excretion. Infants turn over approximately half of their extracellular fluid volume daily; adults turn over approximately one-seventh. Fluid loss or lack of intake can rapidly deplete an infant of water. DIF: Application
REF: p. 278
OBJ: 9
53. By what process is water replenished?
1. Absorption 2. Ingestion 3. Metabolism a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: C
Water is replenished in two major ways: ingestion and metabolism. DIF: Application
REF: p. 279
OBJ: 9
54. During recovery from a serious surgery or trauma, how much water is likely to be produced in
a 24-hr period by the catabolism of fat and proteins? a. 300 ml b. 500 ml c. 750 ml d. 1000 ml ANS: D
Recovery after surgery or trauma may be similar to starvation. Under such conditions, approximately 500 mg of protein and a similar amount of fat are metabolized. This yields approximately 1 L of water per day. DIF: Recall
REF: p. 279
OBJ: 9
55. What best describes an aspect of the movement of fluid and solutes between the capillaries
and the interstitial space? a. At the tissue level, osmotic pressure tends to draw water into the interstitial space. b. Electrolytes move freely across the capillary wall into the interstitium. c. The capillary and interstitial hydrostatic pressures are approximately equal. d. The interstitial fluid has a relatively high protein concentration. ANS: B
The first stage of homeostasis is fluid exchange between systemic capillaries and interstitial fluid by passive diffusion. Capillary walls are permeable to crystalline electrolytes. This allows equilibrium between the two extracellular compartments to occur quickly. DIF: Application
REF: p. 279
OBJ: 10
56. What is the net effect of the hydrostatic pressure gradient between the capillary and interstitial
space? a. It tends to push water into the capillaries. b. It tends to push water into the interstitial spaces. c. The pressure gradient is zero so fluid movement is due to osmosis. d. It tends to push water into the cells. ANS: B
Movement of fluid and solutes from capillary blood to interstitial spaces is enhanced by the difference in hydrostatic pressure between compartments. Hydrostatic pressure difference depends on blood pressure, blood volume, and the vertical distance of the capillary from the heart (i.e., the effects of gravity). Hydrostatic pressure tends to cause fluid to leak out of capillaries into the interstitial spaces. DIF: Application
REF: p. 279
OBJ: 10
57. What establishes the capillary colloidal osmotic pressure? a. Presence of electrolytes in plasma b. Presence of plasma proteins in blood c. Presence of RBCs in whole blood d. Presence of WBCs in whole blood ANS: B
Proteins such as albumin are too large to pass through the pores of the capillary. Instead, these proteins remain in the intravascular compartment and exert osmotic pressure, which draws water and small solute molecules back into the capillaries. This plasma colloid osmotic pressure is also sometimes called oncotic pressure. Because these large proteins are negatively charged, they attract (but do not bind) an equivalent amount of cations to the intravascular compartment. These cations have the effect of increasing osmotic pressure within the capillary (Donnan effect). DIF: Application
REF: p. 283
OBJ: 10
58. What does the Donnan effect describe? a. How Cl– exchanges for HCO 3– in RBCs at the tissue level. b. How proteins attract cations, which increase capillary osmotic pressure. c. Relationship between colloidal osmotic pressure and fluid movement at tissue. d. Relationship between osmotic and hydrostatic pressure at the capillary. ANS: B
DIF: Application
REF: p. 279
OBJ: 10
59. Describe the normal pressures or flows at the arterial end of the capillary. a. Electrolytes move from the interstitium into the capillary. b. Hydrostatic pressure is approximately 24 mm Hg. c. Osmotic pressure is approximately 30 mm Hg. d. Plasma minus the proteins flows into the interstitium. ANS: D
For example, in a typical capillary, blood pressure is approximately 30 mm Hg at the arterial end and approximately 20 mm Hg at the venous end (Figure 12-6). Colloid osmotic pressure of the intravascular fluid remains constant at approximately 25 mm Hg. Hydrostatic pressure along the capillary continually decreases. At the arterial end, hydrostatic pressure normally exceeds osmotic pressure and water flows out of the vascular space into the interstitial space. DIF: Application
REF: p. 279
OBJ: 10
60. Under normal circumstances, a small amount of fluid is filtered from the capillary in excess of
that which is absorbed. What prevents edema from occurring under these conditions? a. The lymphatic system absorbs it and returns it to the circulatory system. b. Tissue cells absorb this fluid and use it in the metabolic process. c. Wandering macrophages use this excess fluid in hydrolyzing invaders. d. Waste products dilute this, maintaining eutonic conditions. ANS: A
This slight outward excess is balanced by fluid return through the lymphatic circulation. DIF: Application
REF: p. 283
OBJ: 10
61. According to the Starling equilibrium equation, which of the following will facilitate fluid
filtration from the capillaries into the interstitial space? a. Low capillary hydrostatic pressure b. Low capillary permeability c. High capillary osmotic pressure d. High interstitial osmotic pressure ANS: D
These relationships may be expressed by the Starling equilibrium equation. DIF: Analysis
REF: p. 279
OBJ: 10
62. Which of the following factors contributes to reabsorption of tissue fluid in dependent regions
of the body? a. Hydrostatic pressure of 100 mm Hg b. Low capillary permeability c. Low interstitial osmotic pressure d. Pumping action of skeletal muscles ANS: D
Because of hydrostatic effects, capillary pressure in the feet can be as high as 100 mm Hg when an individual is standing. Reabsorption of tissue fluid can be accomplished although hydrostatic pressure greatly exceeds colloidal osmotic pressure. Three factors favor reabsorption under these circumstances. First, high intravascular hydrostatic pressure is somew hat balanced by a proportionally greater interstitial pressure. Second, the ―pumping‖ action of the skeletal muscles surrounding leg veins lowers venous pressures. Third, lymph flow back to the thorax is enhanced by a similar mechanism. This facilitates clearance of excess interstitial fluid. DIF: Application
REF: p. 279
OBJ: 10
63. The alveolar interstitial region of the lungs remains relatively ―dry‖ primarily because of
what? a. Low capillary hydrostatic pressure b. Low capillary osmotic pressure c. Low capillary permeability d. Low interstitial osmotic pressure ANS: A
To minimize interstitial fluid in the alveolar-capillary region, the hydrostatic pressure difference must be kept low. The pulmonary circulation is in fact a low-pressure system. The mean pulmonary vascular pressures are approximately one-sixth of those in the systemic circulation. Colloid osmotic pressure exceeds hydrostatic forces across the entire length of the pulmonary capillaries in healthy individuals. DIF: Application
REF: p. 279
OBJ: 10
64. What is a common cause for pulmonary edema due to increased hydrostatic pressure? a. Alveolar-capillary damage b. Chronic liver disease c. Failing left ventricle d. Failing right ventricle ANS: C
In the lungs, edema caused by increased hydrostatic pressure often is a result of back pressure from a failing left ventricle. DIF: Application
REF: p. 280
OBJ: 10
65. What is a normal range for serum sodium? a. 3.5 to 4.8 mEq/L b. 67.0 to 75.0 mEq/L c. 98.0 to 105.0 mEq/L d. 136.0 to 145.0 mEq/L ANS: D
The normal serum concentration of sodium ranges from 136 to 145 mEq/L. DIF: Recall
REF: p. 280
OBJ: 11
66. Na+ reabsorption in the kidneys is governed mainly by the level of what hormone? a. ADH b. Aldosterone c. Angiotensin d. Insulin ANS: B
Sodium reabsorption in the kidneys is governed mainly by the level of aldosterone, which is secreted by the adrenal cortex. DIF: Application
REF: p. 285
OBJ: 11
67. Which of the following would cause an abnormal loss of Na+ (hyponatremia)?
1. Ascites 2. Excessive sweating or fever 3. Use of certain diuretics 4. Steroid therapy a. 1 and 4 only b. 1, 2, and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
Abnormal losses of sodium can lead to hyponatremia and may occur for a number of reasons, as shown in Table 13-5. DIF: Application
REF: p. 285
OBJ: 11
68. What is the most prominent anion in the body? a. Chloride b. Bicarbonate c. Phosphate d. Sulfate ANS: A
Chloride is the most prominent anion in the body. DIF: Recall
REF: p. 286
OBJ: 11
69. What is a normal range for serum Cl– ? a. 3.5 to 4.8 mEq/L b. 98.0 to 106.0 mEq/L c. 137.0 to147.0 mEq/L d. 150.0 to 220.0 mEq/L ANS: B
Normal serum levels of chloride (Cl– ) range between 98 and 106 mEq/L. DIF: Recall
REF: p. 286
OBJ: 11
70. Which of the following correctly describes a facet of chloride? a. A loss of Cl– is equivalent to a gain in acid. b. Cl– is usually excreted with H + as HCl. c. Cl– levels vary inversely with HCO 3– levels. d. Cl– plays a key role in acid-base buffering. ANS: C
The concentration of extracellular chloride is inversely proportional to that of the other major anion, bicarbonate (HCO 3 – ). DIF: Recall
REF: p. 286
71. What can cause hypochloremia?
1. Diuretics 2. Gastrointestinal loss
OBJ: 11
3. Metabolic acidosis a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: A
Abnormal chloride levels may occur for a variety of reasons (see Table 13-5). DIF: Recall
REF: p. 285
OBJ: 11
72. Which of the following describe roles played by HCO 3 -?
1. HCO 3 – levels vary directly with Cl- levels. 2. It is the primary vehicle for blood carbon dioxide transport. 3. It plays a key role in acid-base homeostasis. a. 1, 2, and 3 b. 1 and 3 only c. 2 only d. 2 and 3 only ANS: D
HCO 3– plays an important role in acid-base homeostasis and is the strong base in the bicarbonate-carbonic acid buffer pair. HCO 3– is the primary means for transporting carbon dioxide from the tissues to the lungs. The ratio of HCO 3– to carbonic acid in healthy individuals is maintained near 20:1. DIF: Application
REF: p. 281
OBJ: 11
73. What is the role of kidneys when a patient experiences acute respiratory alkalosis? a. Cl– shift enhances the body’s compensatory mechanisms. b. HCO 3 – is eliminated in the urine. c. It dumps Cl– so as to retain HCO 3– . d. The Hamburger phenomenon occurs. ANS: B
In respiratory acidosis, the kidneys retain or produce HCO 3– to buffer the additional acid caused by CO 2 retention. In respiratory alkalosis, the opposite occurs. A reciprocal relationship exists between Cl– and HCO 3– concentrations. Bicarbonate retention is associated with chloride excretion. DIF: Application
REF: pp. 281-282 OBJ: 11
74. What cation is the most prominent in the intracellular compartment? a. Ca2+ b. K + c. Li+ d. Na+ ANS: B
Potassium is the main cation of the intracellular compartment. DIF: Recall
REF: p. 282
OBJ: 1
75. What is a normal K+ blood level? a. 3.5 to 5.0 mEq/L b. 7.8 to 10.2 mEq/L c. 22 to 26 mEq/L d. 35 to 42 mEq/L ANS: A
Serum K+ concentration normally ranges between only 3.5 and 5.0 mEq/L. DIF: Recall
REF: p. 286
OBJ: 1
76. Which patients are prone to K + depletion and hypokalemia?
1. Postsurgical patients 2. Those with renal disease 3. Trauma victims a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Patients who have undergone surgery have sustained trauma, or have renal disease often have greater K+ losses. DIF: Application
REF: p. 287
OBJ: 11
77. Which answer best describes the relationship between K+ movement and acid-base balance? a. Excess extracellular H + ions are exchanged for intracellular K+. b. Extracellular acidosis results in serum hypokalemia. c. Low-K+ diets are required following nasogastric suctioning. d. When the extracellular pH rises, K + moves out of the cells. ANS: A
Serum K+ concentration is determined primarily by the pH of extracellular fluid and the size of the intracellular K + pool. In extracellular acidosis, excess H + ions are exchanged for intracellular K +. Movement of K + from intracellular to extracellular spaces may produce dangerous levels of hyperkalemia. DIF: Application
REF: p. 287
OBJ: 11
78. What effect do metabolic acidosis and aldosterone have in common? +. a. They both result in renal3– loss of K b. There is a loss of HCO and Cl–– in the renal tubules. c.
There is retention of CO 2 and Cl . d. They both cause renal retention of HCO 3– . ANS: A
Renal excretion of K + is controlled by aldosterone levels. Aldosterone inhibits the enzyme responsible for K+ transport in the distal renal tubular cells of the kidney. Metabolic acidosis also inhibits the transport system.
DIF: Application
REF: p. 287
OBJ: 11
79. Hypokalemia disturbs cellular function in which of the following systems?
1. Gastrointestinal 2. Hepatic 3. Neuromuscular 4. Renal a. 1 and 2 only b. 2, 3, and 4 only c. 1, 3, and 4 only d. 2 and 4 only ANS: C
Hypokalemia (reduced serum potassium) disturbs cellular function in a number of organ systems. These include the gastrointestinal, neuromuscular, renal, and cardiovascular systems. DIF: Recall
REF: p. 285
OBJ: 11
80. What is the most common cause of hyperkalemia? a. Cardiac arrest b. Metabolic alkalosis c. Renal failure d. Respiratory acidosis ANS: C
Hyperkalemia (elevated serum potassium) is most common in renal insufficiency. DIF: Recall
REF: p. 285
OBJ: 11
81. Which of the following drugs can be used to temporarily lower K+ in severe hyperkalemia? a. Corticosteroids b. Insulin and glucose c. K-sparing diuretics d. Nonsteroidal antiinflammatory drugs ANS: B
Temporary measures for reducing serum K+ levels include administration of insulin, calcium gluconate, sodium salts, or large volumes of hypertonic glucose. DIF: Recall
REF: p. 287
OBJ: 11
82. What is the normal serum calcium concentration? a. 4.5 to 5.3 mg/dl b. 8.7 to 10.4 mg/dl c. 98.0 to 105.0 mg/dl d. 137 to 147 mg/dl ANS: B
The normal serum calcium is 8.7 to 10.4 mg/dl or approximately 4.5 to 5.25 mEq/L. DIF: Recall
REF: p. 287
OBJ: 11
83. Which of the following describes serum Ca2+? a. Approximately 30% of the serum Ca2+ is ionized and combined with plasma
anions. b. Acidemia decreases the serum levels of ionized Ca2+. c. More than half of the serum Ca2+ is nonionized and bound to plasma albumin. d. Serum Ca2+ is present in three forms: ionized, protein bound, and complex. ANS: D
Calcium is present in the blood in the following three forms: ionized, protein bound, and complex. Approximately 50% of serum calcium is ionized (Ca 2+) and is physiologically active. An additional 10% forms calcium anion complexes. The remaining 40% is bound to plasma proteins, primarily albumen. Ionized calcium is physiologically active in processes such as enzyme activity, blood clotting, neuromuscular irritability, and bone calcification. Acidemia increases, and alkalemia decreases, the concentration of Ca2+ in the serum. DIF: Application
REF: p. 283
OBJ: 11
84. Clinical symptoms of hyponatremia would include which of the following?
1. Headache 2. Bradycardia 3. Hypotension 4. Weakness a. 3 only b. 2 and 4 only c. 1, 3, and 4 only d. 1, 2, 3, and 4 ANS: C
Symptoms of hyponatremia include: weakness, lassitude, apathy, headache, orthostatic hypotension, and tachycardia. DIF: Application
REF: p. 281
OBJ: 11
85. Clinical signs of hypokalemia would include which of the following?
1. Cardiac arrest 2. Electrocardiogram abnormalities 3. Muscle weakness 4. Paralysis a. 1 and 2 only b. 2, 3 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: D
Symptoms of hypokalemia include: muscle weakness, paralysis, ECG abnormalities, supraventricular arrhythmias, circulatory failure, and cardiac arrest. DIF: Application
REF: p. 281
OBJ: 11
86. Signs and symptoms of hyperkalemia would include which of the following?
1. Cardiac arrest
2. Electrocardiogram abnormalities 3. Metabolic alkalosis 4. Ventricular arrhythmias a. 1, 2, and 4 only b. 2 and 3 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: A
Symptoms of hyperkalemia include: ECG changes, ventricular arrhythmias, and cardiac arrest. DIF: Application
REF: p. 281
OBJ: 11
87. Clinical manifestations of hypocalcemia would include which of the following?
1. Abdominal cramps 2. Depressed tendon reflexes 3. Electrocardiogram abnormalities 4. Muscular twitching and spasm a. 2 and 4 only b. 1 and 2 only c. 1, 3, and 4 only d. 3 only ANS: C
Symptoms of hypocalcemia include: hyperactive tendon reflexes, muscle twitching, spasm, abdominal cramps, ECG changes, and convulsions. DIF: Application
REF: p. 281
OBJ: 11
88. Symptoms of hypercalcemia would include which of the following? a. Depression b. Diarrhea c. Hyperactive tendon reflexes d. Muscle fasciculation ANS: A
Symptoms of hypercalcemia include: fatigue, depression, muscle weakness, anorexia, nausea, vomiting, and constipation. DIF: Application
REF: p. 281
OBJ: 11
89. What is hypercalcemia most often associated with? a. Hyperparathyroidism b. Kidney failure c. Pancreatitis d. Trauma ANS: A
Hypercalcemia (increased levels of calcium) can result from numerous disorders. The most common causes are hyperparathyroidism (increased intestinal calcium absorption) and in malignancies (e.g., multiple myeloma, lung cancer). Normal values for serum Mg 2+ range from 1.7 to 2.1 mg/dl (1.3 to 2.1 mEq/L) in healthy adults. DIF: Recall
REF: p. 283
OBJ: 11
90. What are normal values for serum Mg2+? a. 1.3 to 2.1 mEq/L b. 3.5 to 4.8 mEq/L c. 9.0 to 10.5 mEq/L d. 98.0 to 105.0 mEq/L ANS: A
Normal values for serum Mg++ range from 1.7 to 2.1 mg/dl (1.7 to 1.4 mEq/L) in healthy adults. DIF: Recall
REF: p. 283
OBJ: 11
91. Where is most of the Mg2+ found in the body? a. Bound to phosphate b. Bound to proteins c. In the cells d. Ionized ANS: C
Most (99%) of the magnesium in the body is intracellular. Of the small portion in extracellular spaces, 80% is ionized or bound to other ions (e.g., phosphate) with the remaining 20% bound to proteins. DIF: Recall
REF: p. 287
OBJ: 11
92. What is the normal range for serum phosphate? a. 1.2 to 2.3 mEq/L b. 3.5 to 5.8 mEq/L c. 9.0 to 10.5 mEq/L d. 98.0 to 106.0 mEq/L ANS: A
Only approximately 1% of the total-body phosphorus is available as free serum compounds, so the serum level (1.2 to 2.3 mEq/L) does not necessarily reflect total-body content. DIF: Recall
REF: p. 283
OBJ: 11
93. The ease with which a solute dissolves into a solvent is at least partially determined by which
of the following? a. Pressure of a solid b. Solute concentration c. Level of 2,3-DPG d. Solvent conductivity ANS: B
The ease with which a solute dissolves in a solvent is its solubility, which is influenced by five factors: 1. Nature of the solute. The ease with which substances go into a solution in a given solvent depends on the forces of the solute-solute molecules and varies widely. 2. Nature of the solvent. A solvent’s ability to dissolve a solute depends on the bonds of the solvent-solvent molecules, and also varies widely. 3. Temperature. Solubility of most solids increases with increased temperature. However, the solubility of gases varies inversely with temperature. 4. Pressure. The solubility of solids and liquids is not greatly affected by pressure. The solubility of gases in liquids, however, varies directly with pressure. 5. Concentration. The concentration of a solute or available solvent will have an effect of how much of the substance goes into solution. DIF: Application
REF: p. 271
OBJ: 2
94. Starling forces or fluid movement due to filtration across the wall of a capillary is dependent
upon: 1. hydrostatic and oncotic pressure gradients across the capillary. 2. hydraulic (hydrostatic) in the vessel. 3. colloid osmotic pressure (COP) in the vessel. 4. colloid osmotic pressure (COP) in the tissue space. a. 1 and 4 only b. 1, 2, and 4 c. 2 and 3 only d. 1, 2, 3, and 4 ANS: D
Ernst Starling was a nineteenth century British physiologist who studied fluid transport across membranes. His hypothesis states that the fluid movement due to filtration across the wall of a capillary is dependent upon both the hydrostatic and oncotic pressure gradients across the capillary. The driving force for fluid filtration across the wall of the capillary is determined by four separate pressures: hydraulic (hydrostatic), and colloid osmotic pressure (COP) both within the vessel and in the tissue space respectively. DIF: Application
REF: p. 280
OBJ: 1
95. The most common causes of acute hyponatremia include:
1. postoperative iatrogenic causes. 2. not drinking enough water. 3. self-induced due to water intoxication. 4. not eating enough foods containing sodium. a. 1 and 3 b. 2 and 3 c. 1, 2, and 4 d. 1, 2, 3, and 4 ANS: A
Hyponatremia can lead to cerebral edema due to a change in osmotic pressure. The two most common causes for acute hyponatremia are postoperative iatrogenic and self-induced due to water intoxication.
DIF: Application
REF: p. 281
OBJ: 11
Chapter 14 - Acid-Base Balance Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1.
The primary goal of acid-base homeostasis is to maintain which of the following? a. Normal HCO 3– b. Normal PCO 2 c. Normal pH d. Normal PO 2 ANS: C
Acid-base balance refers to physiological mechanisms that keep the H + ion concentration of body fluids in a range compatible with life. DIF: Recall 2.
REF: p. 286
OBJ: 1
What is the normal arterial blood pH range? a. 7.25 to 7.35 b. 7.35 to 7.45 c. 7.45 to 7.55 d. 7.55 to 7.65 ANS: B
To sustain life, the body must maintain the pH of fluids within a narrow range, from 7.35 to 7.45. DIF: Recall 3.
REF: p. 294
OBJ: 1
Which of the following is a volatile acid of physiologic significance? a. Hydrochloric b. Carbonic c. Phosphoric d. Lactic ANS: B
The only volatile acid of physiologic significance in the body is carbonic acid (H2 CO3 ), which is in equilibrium with dissolved CO 2 . DIF: Recall 4.
REF: p. 286
OBJ: 1
What are the major mechanisms responsible for maintaining a stable pH despite massive CO 2 production? 1. Isohydric buffering 2. Gastrointestinal secretion 3. Pulmonary ventilation a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only
ANS: D
Isohydric buffering and ventilation are the two major mechanisms responsible for maintaining a stable pH in the face of massive CO 2 production. DIF: Application 5.
REF: p. 286
OBJ: 1
Fixed acids are produced primarily from the catabolism of which of the following? a. Carbohydrates b. Fats c. Proteins d. Simple sugars ANS: C
Catabolism of proteins continually produces fixed (nonvolatile) acids such as sulfuric and phosphoric acids. DIF: Recall 6.
REF: p. 286
OBJ: 1
What is the primary buffer system for fixed acids? a. Cl– b. HCO 3 – c. Phosphate d. Plasma proteins ANS: B
The H + of fixed acids can be buffered by HCO –3 ions and converted to CO 2 and H2 O (see the previous reaction); the CO 2 thus formed is eliminated in exhaled gas. DIF: Recall 7.
REF: p. 289
OBJ: 1
By comparison, how much fixed acid is produced in any given period compared to the volatile acid CO2 ? a. Approximately the same amount b. Less fixed than volatile c. More fixed than volatile d. CO 2 is not a volatile acid ANS: B
Compared with daily CO 2 production, fixed acid production is small, averaging only about 50 to 70 mEq/day. DIF: Recall 8.
REF: p. 286
OBJ: 1
Which of the following statements about the equilibrium constant of an acid is true? a. The equilibrium constant of a weak acid is large. b. The equilibrium constant of a strong acid is small. c. The equilibrium constant of a weak acid is small. d. The more an acid ionizes, the smaller is the equilibrium constant. ANS: C
The KA is small because the H 2 CO3 concentration is quite large with respect to the numerator of reaction (3). The value of KA is always the same for H 2 CO3 at equilibrium, regardless of the initial concentration of H 2 CO3 . A strong acid, such as HCl, has a large KA because the denominator [HCl] is extremely small, compared with the numerator ([H +] [Cl−]). DIF: Recall 9.
REF: p. 286
OBJ: 2
A solution that resists large changes in pH upon addition of an acid or a base best describes which of the following? a. Acid-base excretor b. Buffer solution c. Catabolic regulator d. Homeostatic control ANS: B
A buffer solution resists changes in pH when an acid or a base is added to it. DIF: Recall 10.
REF: p. 287
OBJ: 3
When a strong acid is added to the bicarbonate buffer system, what is the result? a. Strong base and neutral salt b. Strong acid and neutral salt c. Weak acid and neutral salt d. Weak acid and basic salt ANS: C
If hydrogen chloride, a strong acid, is added to the H 2CO3 /NaHCO3 buffer solution, HCO3 – ions react with the added H+ ions to form weaker carbonic acid molecules and a neutral salt: HCl + H2 CO 3 /Na+HCO3 – 2H 2 CO3 + NaCl The strong acidity of HC l is converted to the relatively weak acidity of H2 CO3 , preventing a large decrease in pH. DIF: Recall 11.
REF: p. 287
OBJ: 3
Which of the following are components of the body’s nonbicarbonate buffer system? 1. Hemoglobin 2. Plasma proteins 3. Organic phosphates 4. Inorganic phosphates a. 1, 2, and 3 only b. 2 and 4 only c. 3 only d. 1, 2, 3, and 4 ANS: D
The nonbicarbonate buffer system consists mainly of phosphates and proteins, including hemoglobin. DIF: Recall 12.
REF: p. 287
OBJ: 3
What is the sum of all blood buffers in 1 L of blood? a. Buffer base
b. Base excess c. Standard bicarbonate d. Base deficit ANS: A
The blood buffer base is the sum of bicarbonate and nonbicarbonate bases measured in mmol/L of blood. DIF: Recall
REF: p. 287
OBJ: 3
Why is the bicarbonate buffer system considered an open buffer system? a. As the major blood and body buffer system, it is open by definition. b. It operates only in the extracellular fluid, avoiding cell closure. c. Its acid (carbonic acid) is converted to CO 2 and removed. d. Its chemical reactions occur very quickly. ANS: C
The bicarbonate system is called an open buffer system because H 2 CO 3 is in equilibrium with dissolved CO 2 , which is readily removed by ventilation. DIF: Recall 14.
REF: p. 287
OBJ: 4
Why is a buffer system such as phosphate considered a closed system? a. All the components remain in the system. b. It has limited utility in buffering acids. c. Its ability to buffer volatile acids is incomplete. d. Once its buffer level is established, it will never change. ANS: A
A nonbicarbonate buffer system is called a closed buffer system because all the components of acid-base reactions remain in the system. DIF: Recall 15.
REF: p. 287
OBJ: 4
What factor would limit the ability of the H2 CO3 /HCO 3– buffer system to perform efficiently? a. Temperature rise of more than 3° C b. Inadequate amount of 2,3-DPG in the blood c. Increased production of nonvolatile acids d. Lungs failing to excrete adequate levels of CO 2 ANS: D
For example, volatile acid (H 2 CO3 ) accumulates only if ventilation cannot eliminate CO 2 fast enough to keep up with the body’s CO 2 production. DIF: Recall 16.
REF: p. 287
OBJ: 4
Which buffer system has the greatest capacity? a. Bicarbonate b. Hemoglobin c. Phosphates d. Plasma proteins ANS: A
Bicarbonate buffers have the greatest buffering capacity because they function in an open system. DIF: Recall 17.
REF: p. 287
OBJ: 4
What effect does hyperventilation have on the closed buffer systems? a. It causes them to bind with more H+. b. It causes them to release more H+. c. It has no effect on them at all. d. It increases the affinity of the closed buffer system. ANS: B
Increased ventilation increases the CO2 removal rate, causing nonbicarbonate buffers to release H+ ions. Decreased ventilation ultimately causes nonbicarbonate buffers to accept more H+ ions. DIF: Recall 18.
REF: pp. 287-288 OBJ: 4
[H +] can be determined by the use of which factors? 1. HCO 3 – 2. H2 CO3 3. Inorganic phosphorus 4. PaO 2 a. 1, 2, and 3 only b. 2 and 3 only c. 4 only d. 1 and 2 only ANS: D
[H +] = (KA [H2 CO 3 ])/[HCO 3 –] Thus, [H+] is determined by the ratio between undissociated acid molecules [H 2 CO3 ] and base anions [HCO 3 –]. DIF: Recall 19.
REF: p. 288
OBJ: 4
A patient has a PCO 2 of 80 mm Hg. What is the concentration of dissolved CO 2 (in mmol/L) in the blood? a. 1.2 mmol/L b. 2.4 mmol/L c. 24 mmol/L d. 40 mmol/L ANS: B
Because dissolved CO2 (PCO 2 0.03) is in equilibrium with and directly proportional to blood [H 2 CO 3 ], and because blood PCO 2 is more easily measured than [H 2 CO 3 ], dissolved CO 2 is used in the denominator of the Henderson-Hasselbalch equation. DIF: Application 20.
REF: p. 288
OBJ: 4
Of what use is the Henderson-Hasselbalch equation for a clinician? a. It can guide therapeutic decision for critically ill patients.
b. It establishes the baseline values for buffer enhancement treatments. c. Given H2 CO 3 and CO 2 values, the pH can be computed. d. It allows validation of the reported values on a blood gas report. ANS: D
The Henderson-Hasselbalch−equation is useful for checking a clinical blood gas report to see if the pH, PCO , and [HCO ] values are compatible with one another. 2
DIF: Recall 21.
3
REF: pp. 288-289 OBJ: 5
What drives the bicarbonate buffer systems enormous ability to buffer acids? a. The fact that H2 CO 3 is a strong buffer b. The Henderson-Hasselbalch equation c. The large amounts of 2,3-DPG in red blood cells d. Ventilation continually removing CO2 from system ANS: D
This allows HCO 3– to continue buffering H + as long as ventilation continues. Hypothetically, this buffering activity can continue until all body sources of HCO 3– are used up in binding H + (i.e., the aforementioned reaction is continually pulled to the left because ventilation continually removes CO2 ). DIF: Recall 22.
REF: pp. 289-290 OBJ: 6
Of the nonbicarbonate buffer systems, which one is the most important? a. Hemoglobin b. Inorganic phosphates c. Organic phosphates d. Plasma proteins ANS: A
The nonbicarbonate buffers in the blood. Of these, hemoglobin (Hb) is the most important because it is the most abundant. DIF: Recall 23.
REF: p. 290
OBJ: 6
Which of the following systems is primarily responsible for the buffering of fixed acids? a. Ammonia b. HCO 3 – c. Hb d. Phosphate ANS: B
Most of the added fixed acid is buffered by HCO3 – because ventilation continually pulls the reaction to the left. DIF: Recall 24.
REF: p. 290
OBJ: 6
Which of the following acts as the ―first-line‖ or immediate defense against the accumulation of H + ions? a. Blood buffer system b. GI tract
c. Renal system d. Respiratory system ANS: A
Bicarbonate and nonbicarbonate buffer systems are the immediate defense against the accumulation of H + ions. DIF: Recall 25.
REF: p. 295
OBJ: 6
Which of the following organ systems assist in acid excretion? 1. Kidneys 2. Liver 3. Lungs a. 3 only b. 1 and 3 only c. 2 only d. 1, 2, and 3 ANS: B
The lungs and kidneys are the primary acid-excreting organs. DIF: Recall 26.
REF: p. 290
OBJ: 6
In regard to acid excretion by the body, which of the following statements are true? 1. If one system fails, the other can help compensate. 2. The kidneys can only remove fixed acids. 3. The kidneys can quickly remove acid. 4. The lungs can quickly remove acid. a. 1, 2, and 4 only b. 2 and 3 only c. 4 only d. 1 and 4 only ANS: A
Bicarbonate buffers effectively buffer the H + originating from fixed acid, converting it to H 2 CO 3 and, in turn, to CO 2 and H 2 O. By eliminating the CO 2 , the lungs can rapidly remove large quantities of fixed acid from the blood. The kidneys also remove fixed acids, but at a relatively slow pace. In healthy individuals, the acid excretion mechanisms of lungs and kidneys are delicately balanced. In diseased individuals, failure of one system can be partially offset by a compensatory response of the other. DIF: Recall 27.
REF: p. 289
OBJ: 6
The majority of the acid the body produces in a day is excreted through the lungs as CO2 . What happens to the H+ ions? a. They are bound to Hb. b. They bind to phosphate. c. They form carbamino compounds. d. They bind to an OH-forming H2 O. ANS: D
The CO 2 excretion of the lungs does not actually remove H + ions+from the body. Instead, the chemical reaction that breaks down H 2CO3 to form CO2 binds H ions in the harmless water molecule: H + + HCO3 – H2 CO3 H 2O + CO 2 DIF: Recall 28.
REF: p. 290
OBJ: 6
Which organ system actually excretes H+ from the body? a. Kidneys b. Liver c. Lungs d. Spleen ANS: A
The kidneys physically remove H+ from the body. DIF: Recall 29.
REF: p. 290
OBJ: 6
If the blood PCO 2 is high, the kidneys will do which of the following? a. Excrete more H+ and reabsorb more HCO 3– . b. Excrete less H + and reabsorb more HCO 3– . c. Excrete less H + and reabsorb less HCO 3– . d. Excrete more H+ and reabsorb less HCO 3– . ANS: A
If the blood PCO 2 is high, creating high levels of H2 CO 3 , then the kidneys excrete greater amounts of H + and reabsorb all of the tubule filtrate’s HCO 3 – back into the blood. DIF: Recall 30.
REF: pp. 290-291 OBJ: 6
Normally which of the following occur when the kidneys eliminate H +? 1. Sodium ions (and water) are reabsorbed. 2. HCO 3– is reabsorbed in proportion to the H + excreted. 3. Bicarbonate buffer capacity is restored. a. 1, 2, and 3 b. 1 and 3 only c. 2 only d. 2 and 3 only ANS: A
Both HCO 3– ions and Na+ ions are reabsorbed with water whenever H + ions are secreted into the tubular filtrate. DIF: Recall 31.
REF: pp. 291-292 OBJ: 6
What is the role of carbonic anhydrase in the kidneys? a. It drives the recovery of HCO 3– and excretion of H+. b. It is the catalyst for the hamburger phenomenon. c. It promotes the excretion of CO 2 in the urine. d. It promotes the loss of fluids in congestive heart failure. ANS: A
The HCO 3– ions in the filtrate react with the H + ions secreted by the tubular cells. The resulting carbonic acid breaks down into CO 2 and water. Because CO 2 is extremely diffusible through biological membranes, it diffuses instantly into the tubule cell. There, CO2 reacts rapidly– with water in the presence of carbonic anhydrase, rapidly forming HCO – and H +. The HCO ion diffuses back into the blood. Thus, the reabsorbed HCO ion is not the same HCO3– ion that existed in the tubular fluid. If the tubule cells secrete3 sufficient H+ , all HCO – 3
3
in the tubular fluid is reabsorbed in this manner. DIF: Recall 32.
REF: p. 292
OBJ: 6
What effect does hyperventilation have on HCO – recovery in the kidneys? 3
a. Less H+ excretion, greater HCO 3 – loss b. No effect as these involve two independent systems. c. Vicious cycle of worsening alkalemia as hyperventilation stimulates increased
HCO 3 – retention. d. Escalating retention of other buffer bases along with HCO 3– . ANS: A
If bloo– d CO 2 is low, as is the case in a state of hyperventilation (see Figure 14-3), the ratio of HCO ions to dissolved CO 2 molecules increases. Consequently, the renal filtrate has more HCO 3 – ions than H+ ions. Because HCO – cannot be reabsorbed without first reacting with H + , 3
3
the excess HCO 3– ions are excreted in the urine, carrying with them positive ions in the filtrate such as Na+ or K +. Therefore, the net effect of secreting fewer H + ions is to increase the quantity of HCO 3 – (base) lost in the urine. DIF: Recall 33.
REF: p. 292
OBJ: 6
What is the limiting factor for H+ excretion in the renal tubules? a. Excessive amounts of Cl– b. Excessive amounts of HCO 3– c. Insufficient buffers d. Insufficient sodium ANS: C
When filtrate pH falls to 4.5, H + secretion stops. Buffers in the tubular fluid are essential for the secretion and elimination of excess H + ions in acidotic states. DIF: Recall 34.
REF: p. 292
OBJ: 7
Which of the following mechanisms helps to eliminate excess H+ via the kidneys? 1. Reabsorption of HCO 3 – 2. Phosphate buffering 3. Ammonia buffering a. 2 and 3 only b. 1 and 3 only c. 2 only d. 1, 2, and 3 ANS: D
After all available HCO 3– ions react with H + ions, the remaining H + ions react with two other filtrate buffers, phosphate and ammonia, as illustrated in Figures 13-4 and 13-5.
DIF: Recall 35.
REF: p. 292
OBJ: 7
Which of the following is/are true about the relationship between chloride (Cl– ) and bicarbonate HCO 3– in acid-base balance? 1. For each Cl– ion excreted into the urine, the blood gains an HCO –3 ion. 2. Blood Cl– and HCO3 – ion levels are reciprocally related. – 3. People with chronically high CO2 tend to have low blood Cl levels. 4. Activation of the NH 3 buffer system enhances Cl– gain and HCO 3 loss. a. 2 and 3 only b. 1, 2, and 3 only c. 2 only d. 2, 3, and 4 only ANS: B
The net effect of ammonia buffer activity is to cause more bicarbonate to be reabsorbed into the blood, counteracting the acidic state of the blood. Figure 14-5 shows that when a Cl– ion is excreted in combination with an ammonium ion, the blood gains an HCO – ion. Thus, blood Cl– and HCO – ion concentrations are reciprocally related (i.e., when one is3 high, the other is 3
low). This explains why people with chronically high blood PCO 2 tend to have low blood Cl− concentrations. Activation of the ammonia buffer system enhances Cl– loss and HCO 3– gain. DIF: Recall 36.
REF: p. 294
OBJ: 7
Which organ system maintains the normal level of HCO 3 – at 24 mEq/L? a. Liver b. Lung c. Renal d. Spleen ANS: C
Normally, the kidneys maintain an arterial bicarbonate concentration of approximately 24 mEq/L, whereas lung ventilation maintains an arterial PCO 2 of approximately 40 mm Hg. DIF: Recall 37.
REF: p. 294
OBJ: 7
According to the Hen– derson-Hasselbalch equation, the pH of the blood will be normal as long as the ratio of HCO to dissolved CO is which of the following? 3
2
a. 10:1 b. 20:1 c. 24:1 d. 30:1 ANS: B
–
Note that the pH is determined by the ratio of [HCO ] to dissolved CO , rather than by the 3
2 – absolute values of these components. As long as the ratio of HCO 3 buffer to dissolved CO 2 is
20:1, the pH is normal, or 7.40. DIF: Recall 38.
REF: p. 294
OBJ: 7
The numerator of the Henderson-Hasselbalch (H-H) equation (HCO 3 – ) relates to which of the following?
a. b. c. d.
Blood concentration of nonbicarbonate buffers Excretion of volatile acid by the lungs Renal buffering and excretion of fixed acids Respiratory component of acid-base balance
ANS: C
Because the kidneys control blood [HCO 3– ] and the lungs control blood CO 2 levels, the H-H equation can be conceptually rewritten as follows: PH kidneys/lungs. DIF: Recall 39.
REF: p. 294
OBJ: 7
According to the Henderson-Hasselbalch equation, the blood pH will rise (alkalemia) under which of the following conditions? 1. The buffer capacity increases. 2. The volatile acid (CO 2 ) increases. 3. The volatile acid (CO 2 ) decreases. 4. The buffer capacity decreases. a. 1 only b. 3 only c. 1 and 3 only d. 2 and 4 only ANS: C
An increase in [HCO 3 – ] or a decrease in PCO 2 will raise the pH, leading to alkalemia. DIF: Recall 40.
REF: p. 294
OBJ: 7
When does a– state of alkalemia exist? 1. The HCO /CO ratio exceeds 20:1. 3
2
2. The blood pH exceeds 7.45. 3. The blood PCO 2 exceeds 54 mm Hg. a. 2 and 3 only b. 1, 2, and 3 c. 3 only d. 1 and
2
ANS: D
only A n increase in [HCO – ] or a decrease in PCO will raise the pH, leading to alkalemia. This 3
2
produces a [HCO – ]/( PCO 0.03) ratio greate r than 20:1 (e.g., 25:1). A decreased [HCO – ] or 3
2
3
an increased PCO 2 decreases the pH, leading to acidemia. This produces a [HCO – ]/(PCO 2 3
–
0.03) ratio less than 20:1 (e.g., 15:1). The normal ranges for arterial pH, PCO 2 , and [HCO 3 ] are as follows: pH = 7.35 to 7.45 PaCO 2 = 35 to 45 mm Hg [HCO 3– ] = 22 to 26 mEq/L Alkalemia is defined as a blood pH greater than 7.45. DIF: Recall 41.
REF: p. 294
OBJ: 7
What is the primary chemical event in respiratory acidosis?
a. b. c. d.
Decrease in blood CO 2 levels Decrease in blood HCO 3– levels Increase in blood CO 2 levels Increase in blood HCO 3– levels
ANS: C
A high PaCO 2 increases dissolved CO 2 , lowering the pH: pH HCO 3– /PaCO2 where means decreased, means no change, and means increased. Respiratory disturbances causing acidemia are called respiratory acidosis. DIF: Recall 42.
REF: p. 294
OBJ: 7
What is the primary chemical event in metabolic alkalosis? a. Decrease in blood CO 2 levels b. Decrease in blood HCO – levels 3 c. Increase in blood CO 2 levels d. Increase in blood HCO 3– levels ANS: D
Processes that increase arterial pH by losing fixed acid or gaining HCO –3 produce a condition called metabolic alkalosis. DIF: Recall 43.
REF: p. 294
OBJ: 7
What is a normal response of the body to a failure in one component of the acid-base regulatory mechanism? a. Autoregulation b. Compensation c. Correction d. Homeostasis ANS: B
When any primary acid-base defect occurs, the body immediately initiates a compensatory response. DIF: Recall 44.
REF: p. 294
OBJ: 7
Compensation for respiratory acidosis occurs through which of the following? a. Decrease in blood CO 2 levels b. Decrease in blood HCO 3– levels c. Increase in blood CO 2 levels d. Increase in blood HCO 3– levels ANS: D
For example, in hypoventilation (respiratory acidosis), the kidneys restore the pH toward normal by reabsorbing HCO 3 – into the blood. DIF: Recall 45.
REF: p. 295
OBJ: 7
Compensation for metabolic acidosis occurs through which of the following? a. Increase in blood CO 2 levels
b. Decrease in blood CO 2 levels c. Decrease in blood HCO 3– levels d. Increase in blood HCO 3– levels ANS: B
If a nonrespiratory (metabolic) process lowers or raises [HCO3– ], the lungs compensate by hyperventilating (eliminating CO 2 ) or hypoventilating (retaining CO 2 ), restoring the pH to near normal. DIF: Recall 46.
REF: p. 295
OBJ: 7
A patient has a bicarbonate concentration of 36 mEq and a PCO 2 of 60 mm Hg. What is the approximate pH? a. 7.2 b. 7.3 c. 7.4 d. 7.5 ANS: C
The kidneys compensate by retaining HCO – , returning the plasma HCO – /dissolved CO ratio 3
3
2
to almost 20:1. The conversion of PCO 2 to mEq is done by multiplying by 0.03. Thus 60 0.03 = 1.8. 36 to 1.8 is equal to a 20 to 1 ratio, thus the pH should be 7.40. DIF: Application 47.
REF: p. 295
OBJ: 7
Which of the following accurately describes compensation for acid-base disorders? a. Kidneys take hours to days to compensate for respiratory disorders. b. Lungs take hours to days to compensate for metabolic disorders. c. Renal compensation is always complete. d. Respiratory compensation is always complete. ANS: A
The lungs normally compensate quickly for metabolic acid -base defects because ventilation can change the PaCO 2 within seconds. The kidneys require more time to retain or excrete significant amounts of HCO 3 – , and thus compensate for respiratory defects at a much slower pace. DIF: Recall 48.
REF: p. 295
OBJ: 7
A patient with a measured plasma HCO 3 – concentration of 24 mmol/L has an episode of acute hypoventilation, with the PCO 2 rising from 40 to 70 mm Hg. What do you predict will happen acutely to the plasma HCO – concentration? 3 a. HCO 3– will remain unchanged. b. HCO 3 – will rise to approximately 27 to 28 mmol/L. c. HCO 3 – will fall to approximately 20 to 21 mmol/L. d. HCO 3 – will rise to approximately 54 to 55 mmol/L. ANS: B
In general, when the nonbicarbonate buffer concentration is normal and the PCO 2 rise is acute, the hydration reaction raises the plasma [HCO 3– ] approximately 1 mEq/L for every 10 mm Hg increase in PCO 2 higher than 40 mm Hg.
DIF: Application 49.
REF: p. 295
OBJ: 7
A patient has a pH of 7.49. How would you describe this? a. Acidemia b. Alkalemia c. Not sufficient information to determine d. Normal acid-base status ANS: B
Alkalemia is defined as a blood pH greater than 7.45. Acidemia is defined as a blood pH less than 7.35. DIF: Recall 50.
REF: p. 296
OBJ: 8
An increase in the H+ ion concentration [H+] of the blood due only to an increase in the arterial PCO 2 (hypercapnia) best describes which of the following? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis ANS: C
For example, if the pH was lower than 7.35 (denoting an acidosis) and the PaCO2 was higher than 45 mm Hg, according to the H-H equation, the high PaCO2 would indeed lower the pH (i.e., produce an acidosis). Therefore, the respiratory system is at least in part, if not entirely, responsible for the acidosis. DIF: Recall 51.
REF: p. 297
OBJ: 8
An ABG result shows the pH to be 7.56 and the HCO3 - to be 23 mEq/L. Which of the following is the most likely disorder? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis ANS: D
If HCO3 – is in the normal range in the presence of alkalosis, then the alkalosis probably is of respiratory origin. DIF: Recall 52.
REF: p. 297
OBJ: 8
An ABG result shows pH of 7.35, PaCO 2 of 30 mm Hg, and HCO 3 – of 18 mEq/L. Which of the following is the patient’s most likely primary disorder? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis ANS: A
In cases in which compensation has occurred, if the pH is on the acidic side of 7.40 (7.35 to 7.39), the component that would cause an acidosis (either increased PaCO 2 or decreased plasma HCO 3 – ) is generally the primary cause of the original acid-base imbalance. DIF: Application 53.
REF: p. 297
OBJ: 8
An ABG result shows pH of 7.35, PaCO 2 of 30 mm Hg, and HCO3 – of 18 mEq/L. What compensatory measure has the body taken to at least partially compensate for the acid-base disorder? a. Blown off CO 2 b. Retained HCO 3– c. Retained H+ d. Not enough information to determine ANS: A
The patient has a compensated metabolic acidosis. This is characterized by a low HCO 3– , a pH between 7.35 and 7.39, and a low PaCO 2 . The compensatory response (decreased PaCO 2 ) has restored the pH to the low normal range. DIF: 54.
Application
REF: p. 297
OBJ: 8
Which of the following clinical findings would you expect in a fully compensated respiratory acidosis? 1. Elevated HCO 3– 2. pH below 7.35 3. pH between 7.35 and 7.39 4. Elevated PO2 a. 1 and 3 only b. 2 and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: A
This completely compensated respiratory acidosis is characterized by the same originally observed high PaCO 2 , a pH that is now in the 7.35 to 7.39 range, and a plasma [HCO 3– ] that is greater than it was before complete compensation took place. DIF: Recall 55.
REF: p. 298
OBJ: 9
Causes of respiratory acidosis in patients with normal lungs include which of the following? 1. Neuromuscular disorders 2. Spinal cord trauma 3. Anesthesia 4. Use of incentive spirometry a. 1, 2, and 3 only b. 4 only c. 2, 3, and 4 only d. 1 and 3 only ANS: A
Any process in which alveolar ventilation fails to eliminate CO 2 as rapidly as the body produces it causes respiratory acidosis. This could occur in different ways. A person’s ventilation may be decreased from a drug-induced central nervous system depression. DIF: Recall 56.
REF: p. 298
OBJ: 9
In the face of uncompensated respiratory acidosis, which of the following blood gas abnormalities would you expect to encounter? 1. Decreased pH 2. Increased HCO 3 – 3. Increased PCO 2 4. Increased pH a. 1, 2, and 4 only b. 1 and 3 only c. 3 only d. 2, 3, and 4 only ANS: B
If hypercapnia is uncompensated, respiratory acidosis occurs with a low pH, a high PaCO 2 , and a normal or slightly high [HCO 3– ]. In this instance, the slightly high [HCO 3– ] is not a sign that the kidneys have started compensatory activity; it merely reflects the effect of CO 2 hydration reaction on [HCO 3– ]. DIF: Recall 57.
REF: p. 298
OBJ: 9
How is acute respiratory acidosis accomplished? a. By increasing HCO 3– reabsorption b. By increasing alveolar ventilation c. By decreasing HCO 3– reabsorption d. By decreasing alveolar ventilation ANS: B
The main goal in correcting respiratory acidosis is to improve alveolar ventilation. This may entail various respiratory care modalities ranging from bronchial hygiene and lung expansion techniques to endotracheal intubation and mechanical ventilation. DIF: Recall 58.
REF: p. 298
OBJ: 9
A decrease in the H+ ion concentration [H+] of the blood caused by a low PaCO 2 best describes which of the following? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis ANS: D
Any physiologic process that lowers the arterial PCO 2 (<35 mm Hg) and raises the arterial pH (>7.45) produces respiratory alkalosis. DIF: Recall 59.
REF: p. 298
OBJ: 9
What is the most common cause of respiratory alkalosis?
a. b. c. d.
Anxiety Central nervous system depression Hypoxemia Pain
ANS: C
The most common cause of hyperventilation in patients with pulmonary disease is probably a low arterial PO 2 (hypoxemia). DIF: Recall 60.
REF: p. 299
OBJ: 9
Which of the following are potential causes of respiratory alkalosis? 1. Anxiety 2. Central nervous system depression 3. Hypoxemia 4. Pain a. 1, 2, and 3 only b. 1, 3, and 4 only c. 1 and 4 only d. 1, 2, 3, and 4 ANS: B
Hypoxemia causes specialized neural structures to signal the brain, increasing ventilation (see Chapter 14). Anxiety, fever, stimulatory drugs, pain, and central nervous system injuries are possible causes of hyperventilation. DIF: Recall 61.
REF: p. 299
OBJ: 9
What condition or treatment could cause iatrogenic respiratory alkalosis? a. Central nervous system stimulation b. Mechanical hyperventilation c. Severe hypoxemia d. Vagal stimulation ANS: B
Hyperventilation and respiratory alkalosis also may be iatrogenically induced (induced by medical treatment). Such hyperventilation is most commonly associated with overly aggressive mechanical ventilation. DIF: Recall 62.
REF: p. 299
OBJ: 9
Which of the following are signs and symptoms of acute respiratory alkalosis? 1. Convulsions 2. Depressed reflexes 3. Dizziness 4. Paresthesia a. 1, 2, and 4 only b. 1, 3, and 4 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
An early sign of respiratory alkalosis is paresthesia (numbness or a tingling sensation in the extremities). Severe hyperventilation is associated with dizziness, hyperactive reflexes, and possibly tetanic convulsions. DIF: Recall 63.
REF: p. 300
OBJ: 9
Compensation for respiratory alkalosis occurs through which of the following? a. Renal excretion of H+ b. Renal excretion of HCO 3– c. Renal excretion of NH 4+ d. Renal reabsorption of HCO 3– ANS: B
The kidneys compensate for respiratory alkalosis by excreting HCO 3– in the urine (bicarbonate diuresis; see Figure 14-3). DIF: Recall 64.
REF: p. 300
OBJ: 9
In a patient with partially compensated respiratory alkalosis, which of the following blood gas abnormalities would you expect to encounter? 1. Decreased pH 2. Decreased HCO 3– 3. Decreased PCO 2 4. Increased pH a. 1, 2, and 4 b. 1 and 3 c. 3 only d. 2, 3, and 4 ANS: D
Partly compensated respiratory alkalosis is characterized by a low PaCO 2 , a low [HCO –3 ], and an alkaline pH—still not quite down in the normal range. DIF: Recall 65.
REF: p. 300
OBJ: 9
A patient who has fully compensated respiratory acidosis becomes severely hypoxic. If her lungs are not too severely compromised, what might her gases now appear to be? a. Fully compensated metabolic acidosis b. Fully compensated metabolic alkalosis c. Fully compensated respiratory alkalosis d. No change ANS: B
Consider a patient with a compensated respiratory acidosis who has an arterial pH of 7.38, a PaCO 2 of 58 mm Hg, and an HCO3 – of 33 mEq/L. If this patient becomes severely hypoxic, the hypoxia may stimulate increased alveolar ventilation if lung mechanics are not too severely deranged. This would acutely lower the PaCO 2 , possibly raising the pH to the alkalotic side of normal. For example, the patient’s blood gas values might now be as follows: pH of 7.44, PaCO 2 of 50 mm Hg, and HCO 3 – of 33 mEq/L. DIF: Application
REF: p. 300
OBJ: 9
66.
Metabolic acidosis may be caused by: 1. an increase in fixed (nonvolatile) acids. 2. an increase in blood carbon dioxide (CO 2 ). 3. excessive loss of bicarbonate (HCO 3– ). a. 1 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: D
Metabolic acidosis can occur in one of the following two ways: (1) fixed (nonvolatile) acid accumulation in the blood or (2) an excessive loss of HCO 3– from the body. DIF: Recall 67.
REF: p. 300
OBJ: 9
What is a normal anion gap range? a. 3 to 5 mEq/L b. 6 to 8 mEq/L c. 9 to 14 mEq/L d. 24 to 26 mEq/L ANS: C
A value of 140 mEq/L for Na+, 105 mEq/L for Cl−, and 24 mEq/L for HCO 3 – , yielding an anion gap of 11 mEq/L (140 mEq/L – [105 mEq/L + 24 mEq/L] = 11 mEq/L). The normal anion gap range is 9 to 14 mEq/L. DIF: Recall 68.
REF: p. 301
OBJ: 11
A patient has an anion gap of 21 mEq/L. Based on this information, what can you conclude? 1. There is an abnormal excess of unmeasured anions in the plasma. 2. The patient probably has metabolic acidosis. 3. The concentration of fixed acids is decreased. a. 2 only b. 1 and 2 only c. 1 and 3 only d. 3 only ANS: B
An increased anion gap (>14 mEq/L) is caused by metabolic acidosis in which fixed acids accumulate in the body. DIF: Application 69.
REF: p. 301
OBJ: 11
What explains the lack of an increased anion gap seen in metabolic acidosis caused by HCO –3 loss? a. For each HCO 3– ion lost, a Cl– ion is reabsorbed by the kidney. b. For each HCO 3– ion lost, the body produces another to replace it. c. HCO 3– is not a measured anion, so its loss does not affect the anion gap. d. Replacement of HCO 3 – occurs by ammonia ions which are also anions. ANS: A
A metabolic acidosis caused by HCO 3– loss from the body does not cause an increased anion gap. Bicarbonate loss is accompanied by Cl– ion gain, which keeps the anion gap within normal limits (Figure 14-7, C). DIF: Recall 70.
REF: p. 301
OBJ: 11
What are some causes of metabolic acidosis with an increased anion gap? 1. Diarrhea 2. Ketoacidosis 3. Lactic acidosis 4. Renal failure a. 2 and 3 only b. 2 and 4 only c. 2, 3, and 4 only d. 1, 3, and 4 only ANS: C
Box 14-5 summarizes causes of anion gap and nonanion gap metabolic acidosis. DIF: Recall 71.
REF: p. 301
OBJ: 10 | 11
Which of the following is/are cause(s) of hyperchloremic metabolic acidosis? 1. Hyperalimentation 2. Methanol intoxication 3. Severe diarrhea 4. NH 4 Cl administration a. 2 only b. 1 and 4 only c. 1, 3, and 4 only d. 1, 2, 3, and 4 ANS: B
Box 14-5 summarizes causes of anion gap and nonanion gap metabolic acidosis. DIF: Recall 72.
REF: p. 301
OBJ: 10 | 11
What is the main compensatory mechanism for metabolic acidosis? a. Excretion of HCO 3– b. Hyperventilation c. Hypoventilation d. Retention of CO2 ANS: B
Hyperventilation is the main compensatory mechanism for metabolic acidosis. The increased plasma [H+] of metabolic acidosis is buffered by plasma HCO 3– , reducing the plasma [HCO 3– ], and thus the pH. Uncompensated metabolic acidosis suggests that a ventilatory defect must exist. DIF: Recall 73.
REF: p. 302
OBJ: 9 | 10 | 11
In a patient with Kussmaul’s respirations, what acid-base disturbance would you expect to see?
a. b. c. d.
Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis
ANS: A
With severe diabetic ketoacidosis, a very deep, gasping type of breathing develops, called Kussmaul’s respiration. DIF: Recall 74.
REF: p. 302
OBJ: 9 | 11
What is the treatment for severe metabolic acidosis? a. Charcoal b. Insulin c. Glucose d. NaHCO3 – infusion ANS: D
In cases of severe metabolic acidosis, intravenous infusion of sodium bicarbonate (NaHCO 3– ) may be indicated. DIF: Recall 75.
REF: p. 302
OBJ: 9 | 11
Primary metabolic alkalosis is associated with which of the following? a. Gain of buffer base b. Gain in fixed acids c. Low blood CO 2 levels d. Diabetic crisis ANS: A
Metabolic alkalosis can occur in one of the following two ways: (1) loss of fixed acids or (2) gain of blood buffer base. DIF: Recall 76.
REF: p. 302
OBJ: 9 | 11
Which of the following is/are cause(s) of metabolic alkalosis? 1. Diuretics 2. Hyperkalemia 3. Hypochloremia 4. Vomiting a. 1, 3, and 4 only b. 2 and 3 only c. 1, 2, and 4 only d. 2 only ANS: A
The causes of metabolic alkalosis are summarized in Box 14-6. DIF: Recall 77.
REF: p. 303
OBJ: 9 | 11
What would be an example of an iatrogenic cause of metabolic alkalosis? a. Gastric suction
b. High-salt diet c. Discontinuing the patient’s diuretics d. Vomiting ANS: A
Often, metabolic alkalosis is iatrogenic, resulting from the use of diuretics, low-salt diets, and gastric drainage. DIF: Recall 78.
REF: p. 303
OBJ: 9 | 11
What is the kidneys’ most important function? a. Acid-base balance b. Chloride maintenance c. HCO 3– maintenance d. Sodium maintenance ANS: D
The kidneys’ main job is to reabsorb sodium, not excrete it. For this reason, and because sodium has a major role in maintaining fluid balance, the kidney places a greater priority on reabsorbing Na+ than on maintaining Cl– , K+, or acid-base balance. DIF: Recall 79.
REF: p. 303
OBJ: 9 | 11
What compensates for a metabolic alkalosis? a. Hyperventilation b. Hypoventilation c. Renal excretion of HCO 3– d. Renal retention of H+ ANS: B
The expected compensatory response to metabolic alkalosis is hypoventilation (CO 2 retention). DIF: Recall 80.
REF: p. 304
OBJ: 9 | 11
Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.43, PCO 2 = 39 mm Hg, HCO 3 – = 25.1 mEq/L a. Acid-base status within normal limits b. Fully compensated metabolic acidosis c. Fully compensated respiratory alkalosis d. Partially compensated metabolic acidosis ANS: A
As all the ABG values are within normal limits the gas must be normal. DIF: Recall 81.
REF: pp. 296-297 OBJ: 9 | 11
Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.62, PCO 2 = 41 mm Hg, HCO 3 – = 40.9 mEq/L a. Acute (uncompensated) metabolic alkalosis b. Acute (uncompensated) respiratory alkalosis c. Fully compensated metabolic alkalosis
d. Partially compensated metabolic alkalosis ANS: A
The patient is alkalotic (pH >7.35). This can be caused by an elevated HCO
– or a low PCO . 3
2
In this question the HCO 3– is elevated. If compensation were present the PCO 2 would have to be elevated. As it is normal, this is an uncompensated metabolic alkalosis. DIF: Application 82.
REF: p. 303
OBJ: 9 | 11
Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.43, PCO 2 = 20 mm Hg, HCO 3 – = 12.6 mEq/L a. Acute (uncompensated) respiratory alkalosis b. Fully compensated metabolic acidosis c. Fully compensated respiratory alkalosis d. Partially compensated respiratory alkalosis ANS: C
The patient’s pH is normal so either the gas is normal or fully compensated. As the PCO 2 and HCO 3– are both low, a fully compensated state exists. As the pH is on the high side of normal the fully compensated disorder would be alkalosis. This would be caused by a low PCO 2 or a high HCO 3– . In this case a low PCO 2. The low HCO 3– is compensating for this respiratory alkalosis. DIF: Application 83.
REF: p. 295
OBJ: 9 | 11
Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 6.89, PCO 2 = 24 mm Hg, HCO 3 – = 4.7 mEq/L a. Acute (uncompensated) metabolic acidosis b. Acute (uncompensated) respiratory acidosis c. Partially compensated metabolic acidosis d. Partially compensated respiratory acidosis ANS: C
The patient is acidotic (pH <7.35). This can be caused by an elevated PCO 2 or a low HCO – . 3
In this question the HCO 3- is low. Partial compensation is present as the PCO 2 is also low. DIF: Application 84.
REF: p. 297
OBJ: 9 | 11
Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.08, PCO 2 = 39 mm Hg, HCO 3 – = 11.8 mEq/L a. Acute metabolic acidosis b. Acute respiratory acidosis c. Partially compensated metabolic acidosis d. Partially compensated respiratory acidosis ANS: A
The patient is acidotic (pH <7.35). This can be caused by an elevated PCO 2 or a HCO 3 – low. In this question the HCO3 – is low. If compensation were present the PCO 2 would have to be decreased. As it is normal this is an uncompensated metabolic acidosis. Remember that when there is no compensation in this situation, it usually implies that there is a primary problem with the respiratory system as well.
DIF: Application 85.
REF: p. 297
OBJ: 9 | 11
Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.28, PCO 2 = 53 mm Hg, HCO 3 – = 25.8 mEq/L a. Acute metabolic acidosis b. Acute respiratory acidosis c. Partially compensated metabolic acidosis d. Partially compensated respiratory acidosis ANS: B
The patient is acidotic (pH <7.35). This can be caused by an elevated PCO2 or a HCO3 – low. In this question the PCO 2 is high. If compensation were present the HCO 3– would have to be increased. As it is normal this is an acute (uncompensated) respiratory acidosis. DIF: Application 86.
REF: p. 297
OBJ: 9 | 11
Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.38, PCO 2 = 21 mm Hg, HCO 3 – = 11.7 mEq/L a. Acute metabolic acidosis b. Fully compensated metabolic acidosis c. Partially compensated metabolic acidosis d. Fully compensated respiratory alkalosis ANS: B
The patient’s pH is normal so either the gas is normal or fully compensated. As the PCO 2 and HCO 3– are both low, a fully compensated state exists. As the pH is on the low side of normal the fully compensated disorder would be acidosis. This would be caused by a low HCO – or a high PCO . In this case a low HCO – . The low PCO is compensating for this metabolic 3 2
3
2
acidosis. DIF: Application 87.
REF: p. 297
OBJ: 9 | 11
Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.35, PCO 2 = 68 mm Hg, HCO 3 – = 34.3 mEq/L a. Acute respiratory acidosis b. Combined metabolic and respiratory acidosis c. Fully compensated respiratory acidosis d. Fully compensated metabolic alkalosis ANS: C
The patient’s pH is normal so either the gas is normal or fully compensated. As the PCO 2 and HCO 3 − are both high, a fully compensated state exists. As the pH is on the low side of normal the fully compensated disorder would be acidosis. This would be caused by a low HCO – or a high PCO – in this case a high PCO . The high HCO is compensating for this respiratory 2
2
3
acidosis. DIF: Application 88.
REF: p. 297
OBJ: 9 | 11
Correction of metabolic alkalosis may involve which of the following? 1. Restoring normal fluid volume 2. Administering acidifying agents
3. Restoring normal K+ and Cl− levels a. 3 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Correction of metabolic alkalosis is aimed at restoring normal fluid volume and electrolyte concentrations, especially K + and Cl− levels. Inadequate fluid volume, especially if coupled with hypochloremia, causes excessive secretion and loss of H + and K + ions because of the great need to reabsorb Na+ ions. Thus, in treating this type of alkalosis, it is important to supply adequate fluids containing Cl− ions. If hypokalemia is a primary factor, then KCl is the preferred corrective agent. In cases of severe metabolic alkalosis, acidifying agents, such as dilute hydrochloric acid or ammonium chloride may be infused directly into a large central vein. DIF: Recall 89.
REF: p. 297
OBJ: 9 | 11 | 12
In order to eliminate the influence of PCO 2 changes on plasma HCO – concentrations, what additional measures of the metabolic component of acid-base balance3 can be used? a. HCO 3 – b. Hemoglobin content c. Henderson-Hasselbalch equation d. Standard bicarbonate ANS: D
To eliminate the influence of the hydration reaction on plasma bicarbonate concentration, some laboratories report standard bicarbonate. DIF: Recall 90.
REF: p. 304
OBJ: 9 | 11 | 12
What is the normal range for BE? a. ±2 mEq/L b. ±4 mEq/L c. ±6 mEq/L d. ±24 mEq/L ANS: A
A normal BE is ±2 mEq/L. A ―positive BE‖ (>+2 mEq/L) indicates a gain of base or loss of acid from nonrespiratory causes. A ―negative BE‖ (<−2 mEq/L) indicates a loss of base or a gain of acid from nonrespiratory causes. DIF: Recall 91.
REF: p. 305
OBJ: 12
In acute respiratory acidosis, what would you expect the BE range to be? a. –4 to –6 mEq/L b. +2 to –2 mEq/L c. +4 to +6 mEq/L d. +22 to +26 mEq/L ANS: B
In cases of acute (uncompensated) respiratory acidosis, the BE commonly would be within the normal range, indicating correctly that the disturbance is purely respiratory in origin. DIF: Application 92.
REF: p. 305
OBJ: 12
Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.62, PCO 2 = 32 mm Hg, HCO 3 – = 29 mEq/L a. Acute (uncompensated) metabolic alkalosis b. Combined metabolic and respiratory alkalosis c. Partially compensated metabolic alkalosis d. Partially compensated respiratory acidosis ANS: B
A combined disturbance is one in which both respiratory and metabolic disturbances exist, which promote the same acid-base disturbance. For example, consider the following arterial blood gas results: a pH value of 7.62, a PaCO 2 value of 32 mm Hg, and an HCO 3– value of 29 mEq/L. The pH indicates alkalemia, consistent with both the low PaCO 2 and the elevated HCO 3– . This is a combined alkalosis, indicating that the patient has two primary acid -base problems (i.e., respiratory and metabolic alkalosis combined). Therefore, compensation is not possible. DIF: Application 93.
REF: p. 306
OBJ: 12 | 13
Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.01, PCO 2 = 71 mm Hg, HCO 3 – = 16.3 mEq/L a. Acute metabolic acidosis b. Acute respiratory acidosis c. Combined respiratory and metabolic acidosis d. Partially compensated respiratory acidosis ANS: C
A combined disturbance is one in which both respiratory and metabolic disturbances exist, which promote the same acid-base disturbance. For the follow – ing arterial blood gas results: a pH value of 7.01, a PaCO 2 value of 71 mm Hg, and an HCO value of 16.3 mEq/L. The pH 3
–
indicates acidemia, consistent with both the high PaCO 2 and the decreased HCO 3 . This is a combined acidosis, indicating that the patient has two primary acid -base problems (i.e., respiratory and metabolic alkalosis combined). Therefore, compensation is not possible. DIF: Application 94.
REF: p. 306
OBJ: 12
Using the Henderson-Hasselbalch equation, determine the accuracy of the gas below. To be considered accurate, it must be within 0.03 pH unit. pH = 7.35, PCO 2 = 77 mm Hg, HCO 3 – = 41 mEq/L a. This gas is completely accurate. b. This gas is accurate as the calculated pH is 7.32. c. This gas is accurate as the calculated pH is 7.38. d. This gas is inaccurate according to the H-H equation. ANS: A
DIF: Application
REF: p. 288
OBJ: 12
95.
Using the Henderson-Hasselbalch equation, determine the accuracy of the gas below. To be considered accurate, it must be within 0.03 pH unit. pH = 7.22, PCO 2 = 49 mm Hg, HCO 3 – = 20 mEq/L a. This gas is completely accurate. b. This gas is accurate as the calculated pH is 7.23. c. This gas is accurate as the calculated pH is 7.20. d. This gas is inaccurate according to the H-H equation. ANS: B
Plugging the ABG values supplied into the H-H equation results in a pH of 7.33 which indicate the gas is accurate as the value should be within 0.03 of the recorded pH. DIF: Application 96.
REF: p. 288
OBJ: 12
A patient has a blood gas result of: pH 7.29, PaCO 2 of 60 mm Hg, and a HCO 3 of 18 mEq/L. What is the blood gas indicating? 1. It is indicating a combined acidosis. 2. Patient has a primary respiratory and a primary metabolic disorder. 3. Compensation is not possible. a. 3 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
A mixed acid-base disorder has two primary acid-base problems, which is indicated by the low pH caused by a high PaCO 2 and a low HCO 3 . DIF: Application 97.
REF: p. 295
OBJ: 13
Approximately how much CO 2 is removed daily by the lungs? a. ~24,000 mmol/L of CO 2 b. ~14,000 mmol/L of CO 2 c. ~34,000 mmol/L of CO 2 d. ~4,000 mmol/L of CO 2 ANS: A
The lungs remove approximately 24,000 mmol/L of CO 2 daily. DIF: Recall 98.
REF: p. 286
OBJ: 6
A metabolic acidosis caused by HCO 3− loss: 1. can be a result of ammonium chloride ingestion. 2. will cause an increased anion gap. 3. may be referred to as hyperchloremic acidosis. 4. accompanied by Cl– gain. a. 1, 3, and 4 only b. 1 and 3 only c. 3 only d. 2, 3, and 4 only ANS: A
Metabolic acidosis caused by a loss of bicarbonate can be caused by ammonium chloride ingestion or severe diarrhea. As the body is losing the bicarbonate, the kidneys increase their reabsorption of chloride ions which keeps the anion gap within normal limits. This type of metabolic acidosis is sometimes referred to as hyperchloremic acidosis. DIF: Application 99.
REF: p. 302
OBJ: 10
A 21-year-old woman in the emergency room is displaying rapid and deep, labored breathing. Her room ABG reveals a pH of 7.25, PaCO 2 of 28, HCO –3 of 14 mEq/L, and a base excess of –14 mEq/L. How would the respiratory therapist assess her acid-base condition? 1. Severe hyperventilation 2. Partially compensated metabolic acidosis 3. Compensatory response to the metabolic acidosis 4. Severe hypoventilation a. 1, 2, and 3 only b. 1 and 3 only c. 3 only d. 2, 3, and 4 only ANS: A
First, the patient’s pH must be categorized. The patient’s pH is below the range of 7.35 to 7.45, which indicates acidemia. Second, respiratory involvement must be determined. The PaCO 2 is well below the normal range of 35 to 45 mm Hg, indicating severe hyperventilation. By itself, this would cause alkalosis, but the presence of a low pH indicating acidemia, this rules out the cause as primary respiratory alkalosis. The low PaCO 2 is probably a compensatory response to primary metabolic acidosis, although the response is insufficient to restore pH to its normal range. Third, a determination of metabolic involvement must be analyzed. The HCO 3– is severely reduced below the normal range of 22 to 26 mEq/L. This result is consistent with the low pH. In the presence of low pH and low PaCO 2 and a low HCO 3– low indicates primary metabolic acidosis. This is also confirmed by the large BE value. Finally, a confirmation of compensation must be made. The severe hyperventilation represents a compensatory response to the primary metabolic acidosis, although compensation is far from complete. Nevertheless, the pH level would be even lower if the PaCO 2 were normal. DIF: Analysis 100.
REF: p. 302
OBJ: 9 | 10 | 11
A 31-year-old man suffering from food poisoning is having severe vomiting for the last 2 days. His blood gas and serum electrolyte analyses revealed the following: pH of 7.60, PaCO 2 of 49 mm Hg, an HCO 3- of 47 mEq/L, a base excess (BE) of +20 mEq/L, a serum K + of 2.5 mEq/L, and a serum of Cl– of 92 mEq/L. How would the respiratory therapist assess his acid-base condition? 1. Severe hyperventilation 2. Metabolic alkalosis 3. Adequate compensatory response 4. Minimal hypoventilation a. 1, 2, and 3 only b. 2 and 4 only c. 3 only d. 2, 3, and 4 only
ANS: B
The patient’s pH is well above the normal range of 7.35 to 7.45, so the pH is indicating alkalemia. Respiratory involvement shows the PaCO 2 is slightly above normal range of 35 to 45 mm Hg, indicating mild hypoventilation. But, the pH does not represent respiratory acidosis, and then the elevated PaCO 2 may be a compensatory response to a primary metabolic problem. The HCO 3– is extremely higher than the normal range of 22 to 26 mEq/L. Given the pH is indicating alkalemia, this elevated HCO 3− represents metabolic alkalosis. Another indication of metabolic alkalosis is confirmed by the large BE value. Plus, the low serum K + and Cl– values indicate hypokalemic and hypochloremic metabolic alkalosis. Even though, PaCO 2 is slightly elevated, compensation for metabolic alkalosis is minimal. This lack of compensation is consistent with the presence of hypokalemic metabolic alkalosis. DIF: Analysis
REF: p. 306
OBJ: 9 | 11
Chapter 15 - Regulation of Breathing Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Where are the inspiratory and expiratory centers in the brain found? a. Broca’s area b. Neurons in the cerebellum c. Pons d. No such centers exist ANS: D
Recent evidence shows that inspiratory and expiratory neurons are anatomically intermingled and do not necessarily inhibit one another. No clearly separate inspiratory and expiratory centers exist. DIF: Recall
REF: p. 309
OBJ: 1
2. The medulla oblongata contains which of the following areas?
1. Apneustic center 2. Dorsal respiratory group neurons (DRGs) 3. Pneumotaxic center 4. Ventral respiratory group neurons (VRGs) a. 1, 2, and 3 only b. 2 and 4 only c. 3 only d. 1, 3, and 4 only ANS: B
Instead, the medulla contains several widely dispersed respiratory-related neurons, as shown in Figure 15-1. The DRGs contain mainly inspiratory neurons, whereas the VRGs contain both inspiratory and expiratory neurons. DIF: Recall
REF: p. 309
OBJ: 1
3. Sensory input to the dorsal respiratory neurons from the lungs, airways, and peripheral
chemoreceptors is provided via which nerves? 1. Glossopharyngeal 2. Phrenic 3. Vagus 4. Trigeminal a. 1 and 2 only b. 1, 2, and 4 only c. 1 and 3 only d. 2 and 3 only ANS: C
The vagus and glossopharyngeal nerves transmit many sensory impulses to the DRGs from the lungs, airways, peripheral chemoreceptors, and joint proprioceptors. These impulses modify the basic breathing pattern generated in the medulla.
DIF: Recall
REF: p. 309
OBJ: 1
4. To which anatomic structures do the ventral respiratory centers send motor signals during
inspiration? 1. Diaphragm 2. Larynx 3. Pharynx 4. Sternocleidomastoids a. 1, 2, and 3 only b. 2 and 4 only c. 1 only d. 1, 2, and 4 ANS: A
Some inspiratory VRG neurons send motor impulses through the vagus nerve to the laryngeal and pharyngeal muscles, abducting the vocal cords and increasing the diameter of the glottis. Other VRG inspiratory neurons transmit impulses to the diaphragm and external intercostal muscles. DIF: Recall
REF: p. 309
OBJ: 1
5. Which of the following control the inhibitory neurons that switch off the inspiratory ramp
signal? 1. Apneustic center 2. Pneumotaxic center 3. Pulmonary stretch receptors a. 1, 2, and 3 b. 1 and 2 only c. 3 only d. 2 and 3 only ANS: D
The inhibitory neurons that switch off the inspiratory ramp signal are controlled by the pneumotaxic center and pulmonary stretch receptors. DIF: Recall
REF: p. 310
OBJ: 2
6. What centers are located in the pons of the brainstem?
1. Apneustic center 2. Dorsal respiratory neurons 3. Pneumotaxic center a. 1, 2, and 3 b. 2 and 3 only c. 1 and 3 only d. 1 and 2 only ANS: C
Figure 15-1 shows two groups of neurons in the pons: (1) the apneustic center and (2) the pneumotaxic center.
DIF: Recall
REF: p. 310
OBJ: 1
7. Failure to switch off the brainstem inspiratory neurons can result in which of the following? a. Apnea b. Apneustic breathing c. Biot’s breathing d. Cheyne-Stokes breathing ANS: B
Under such circumstances, the DRG inspiratory neurons fail to switch off, causing prolonged inspiratory gasps interrupted by occasional expirations (apneustic breathing). DIF: Recall
REF: p. 310
OBJ: 2
8. The pneumotaxic center controls which of the following? a. Response to changes in blood pH and PCO 2 b. Rhythm of the full breathing cycle c. When inspiration switches off (the inspiratory time) d. When inspiration switches on (the expiratory time) ANS: C
The pneumotaxic center controls the ―switch-off‖ point of the inspiratory ramp, thus controlling inspiratory time. DIF: Recall
REF: p. 310
OBJ: 2 | 3
9. What stimulates the Hering-Breuer inflation reflex? a. The DRG when it is time to end inspiratory efforts. b. The stretch of receptors at high lung volumes. c. The VRG when it is time for inspiration. d. Very low lung volumes stimulate inspiration. ANS: B
In adults, the Hering-Breuer reflex is activated only at large tidal volumes (800 to 1000 ml or more) and, apparently, it is not an important control mechanism in quiet breathing. DIF: Recall
REF: p. 310
OBJ: 4
10. Which statement(s) describe aspects of the Hering-Breuer reflex?
1. It affects the rate and depth of breathing during exercise. 2. It is only activated at large tidal volumes in normal adults. 3. Its impulses travel via the vagus nerve to the dorsal respiratory groups (DRGs). 4. Its receptors are located in the large and small airways. a. 1 only b. 1 and 2 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: D
The Hering-Breuer inflation reflex, described by H. E. Hering and Josef Breuer in 1868, is generated by stretch receptors located in the smooth muscle of both large and small airways. When lung inflation stretches these receptors, they send inhibitory impulses through the vagus nerve to the DRG neurons, stopping further inspiration. In this way, the Hering-Breuer reflex has an effect similar to that of the pneumotaxic center. In adults, the Hering-Breuer reflex is activated only at large tidal volumes (800 to 1000 ml or more) and, apparently, it is not an important control mechanism in quiet breathing. However, this reflex is important in regulating respiratory rate and depth during moderate to strenuous exercise. DIF: Recall
REF: p. 310
OBJ: 4
11. What is the effect when the deflation reflex is stimulated? a. A strong inspiratory effort b. Expiration is initiated c. Cuts off all inspiratory signals d. Stimulates the termination of expiration ANS: A
Sudden collapse of the lung stimulates strong inspiratory efforts (deflation reflex). DIF: Recall
REF: p. 310
OBJ: 4
12. What reflex is associated with the sensory stimulation of the pulmonary stretch receptors that
stimulate a deeper breath upon inspiration? a. Carotid b. Head’s paradoxical c. Hering-Breuer d. J receptor ANS: B
If the Hering-Breuer reflex is blocked by cooling the vagus nerve, lung hyperinflation causes a further increase in inspiratory effort, the opposite of the Hering-Breuer reflex. The receptors for this reflex are called rapidly adapting receptors, because they stop firing promptly after a volume change occurs. Head’s reflex may help maintain large tidal volumes during exercise and may be involved in periodic deep sighs during quiet breathing. DIF: Recall
REF: p. 311
OBJ: 4
13. What receptors are associated with causing coughing, sneezing, and tachypnea when
stimulated? a. Irritant receptors b. J receptors c. Muscle spindles d. Peripheral proprioceptors ANS: A
Rapidly adapting irritant receptors in the epithelium of the larger conducting airways have vagal sensory nerve fibers. Their stimulation, whether by inhaled irritants or by mechanical factors, causes reflex bronchoconstriction, coughing, sneezing, tachypnea, and narrowing of the glottis.
DIF: Recall
REF: p. 311
OBJ: 4
14. What negative responses can be elicited by suctioning a patient’s airway?
1. Tachycardia 2. Coughing 3. Laryngospasm 4. Severe bronchospasm a. 1, 2, and 3 only b. 2 and 4 only c. 1 and 3 only d. 2, 3, and 4 only ANS: D
Suctioning may result in laryngospasm, coughing, and slowing of the heartbeat. Endotracheal intubation, airway suctioning, and bronchoscopy readily elicit vagovagal reflexes. Physical stimulation of the conducting airways, as with suctioning or bronchoscopy, may cause a severe case of bronchospasm, coughing, and laryngospasm. DIF: Recall
REF: p. 311
OBJ: 4
15. Stimulation of the irritant receptors in the lung can result in which of the following?
1. Bronchoconstriction 2. Coughing 3. Narrowing of the glottis a. 1 only b. 1 and 3 only c. 1, 2, and 3 d. 1 and 3 only ANS: C
Irritant receptors are responsible for laryngospasm, coughing, and slowing of the heartbeat. Endotracheal intubation, airway suctioning, and bronchoscopy readily elicit vagovagal reflexes. Physical stimulation of the conducting airways, as with suctioning or bronchoscopy, may cause a severe case of bronchospasm, coughing, and laryngospasm. DIF: Recall
REF: p. 311
OBJ: 4
16. Which of the following can cause laryngospasm and bradycardia through a vagovagal reflex?
1. Bronchoscopy 2. Endotracheal intubation 3. Tracheal suctioning a. 1 only b. 1 and 3 only c. 1, 2, and 3 d. 1 and 2 only ANS: C
Such reflexes are responsible for laryngospasm, coughing, and slowing of the heartbeat. Endotracheal intubation, airway suctioning, and bronchoscopy readily elicit vagovagal reflexes. Physical stimulation of the conducting airways, as with suctioning or bronchoscopy, may cause a severe case of bronchospasm, coughing, and laryngospasm.
DIF: Recall
REF: p. 311
OBJ: 4
17. What receptors cause a rapid shallow breathing pattern when stimulated by pulmonary
disease? a. Irritant receptors b. J receptors c. Muscle spindles d. Peripheral proprioceptors ANS: B
C fibers in the lung parenchyma near the pulmonary capillaries are called juxtacapillary receptors or J receptors. Alveolar inflammatory processes (pneumonia), pulmonary vascular congestion (congestive heart failure), and pulmonary edema stimulate these receptors. This stimulation causes rapid, shallow breathing; a sensation of dyspnea; and expiratory narrowing of the glottis. DIF: Recall
REF: p. 311
OBJ: 4
18. Which of the following can be stimulated by pulmonary J receptors?
1. Edema 2. Inflammatory processes 3. Pulmonary vascular congestion a. 1 and 3 only b. 1 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
C fibers in the lung parenchyma near the pulmonary capillaries are called juxtacapillary receptors or J receptors. Alveolar inflammatory processes (pneumonia), pulmonary vascular congestion (congestive heart failure), and pulmonary edema stimulate these receptors. This stimulation causes rapid, shallow breathing; a sensation of dyspnea; and expiratory narrowing of the glottis. DIF: Recall
REF: p. 311
OBJ: 4
19. What receptors are known to cause an increase in ventilation when the patient’s limbs are
moved or cold water is splashed on the patient’s face? a. Irritant receptors b. J receptors c. Muscle spindles d. Peripheral proprioceptors ANS: D
Proprioceptors in muscles, tendons, and joints, as well as pain receptors in muscles and skin, send stimulatory signals to the medullary respiratory center. Such stimuli increase medullary inspiratory activity and cause hyperpnea. For this reason, moving the limbs, slapping or splashing cold water on the skin, and other painful stimuli stimulate ventilation in patients with respiratory depression.
DIF: Recall
REF: p. 311
OBJ: 4
20. Which receptors are primarily responsible for the initial increase in ventilation that occurs at
the beginning of exercise? a. Carotid chemoreceptors b. Irritant receptors c. J receptors d. Proprioceptors ANS: D
Proprioceptors in joints and tendons may be important in initiating and maintaining increased ventilation at the beginning of exercise. DIF: Recall
REF: p. 311
OBJ: 4
21. Adjustment of respiratory muscle contractions to accommodate varying loads is regulated by
which of the following? a. Medullary respiratory centers b. Muscle spindle fiber feedback c. Pontine apneustic center d. Pontine pneumotaxic center ANS: B
Muscle spindles in the diaphragm and intercostal muscles are part of a reflex arc that helps the muscles adjust to an increased load. DIF: Recall
REF: p. 311
OBJ: 4
22. What group of nerve cells senses and responds to changes in the chemical composition of its
fluid environment? a. Chemoreceptors b. Gamma-efferent system c. Muscle spindle fibers d. Proprioceptors ANS: A
Hypercapnia, acidemia, and hypoxemia stimulate specialized nerve structures called chemoreceptors. DIF: Recall
REF: p. 311
OBJ: 5
23. Where are the peripheral chemoreceptors located?
1. In the arch of the aorta 2. In the bifurcations of carotid arteries 3. On the ventrolateral surfaces of the medulla a. 1 and 2 only b. 2 only c. 2 and 3 only d. 1 and 3 only ANS: A
Peripherally located chemoreceptors are found in the fork of the common carotid arteries and the aortic arch. DIF: Recall
REF: p. 311
OBJ: 5
24. What has the primary responsibility for sensing and responding to changes in blood levels of
CO 2 ? a. Apneustic centers b. Central chemoreceptors c. Peripheral chemoreceptors d. Pneumotaxic center ANS: B
Hydrogen ions stimulate highly responsive chemosensitive nerve cells, located bilaterally in the medulla. Nevertheless, these central chemoreceptors are extremely sensitive to CO 2 in an indirect fashion. Through the hydrolysis reaction, as CO 2 increases there is a greater release of hydrogen ions to which the chemoreceptors respond. DIF: Recall
REF: p. 312
OBJ: 5
25. Which of the following is indirectly responsible for minute-to-minute control of breathing? a. CO 2 levels b. HCO − levels 3 c. Lactate levels d. Oxygen (O 2 ) levels ANS: A
As the H+ ions in the CSF are generated in direct relation to the level of arterial PCO 2 , it is really the arterial PCO 2 that (indirectly) controls primary minute-to-minute ventilation. DIF: Recall
REF: p. 312
OBJ: 5
26. In the face of chronically elevated levels of CO 2 , what happens to the response mediated by
the central chemoreceptors? a. It is accentuated or increased. b. It is muted or decreased. c. There is no change in the response. d. There is no way to predict the body’s response. ANS: B
The stimulatory effect of chronically high CO2 on the central chemoreceptors gradually declines over 1 or 2 days, because the kidneys retain bicarbonate ions in response to respiratory acidosis, bringing the blood pH level back toward normal. DIF: Recall
REF: p. 312
OBJ: 5
27. Which of the following causes hypoxic stimulation of the carotid bodies?
1. Large decrease in arterial PO 2 2. Large decrease in O 2 content 3. CO poisoning a. 1 only b. 1 and 2 only
c. 1, 2, and 3 d. 1 and 3 only ANS: A
When the PaO 2 is low carotid body sensitivity to a given [H +] increases; in this way hypoxemia increases ventilation for any given pH. DIF: Recall
REF: p. 312
OBJ: 6
28. Both anemia and carbon monoxide (CO) poisoning can cause severe hypoxia, yet neither
condition results in a major stimulation of breathing. Why is this so? a. The peripheral chemoreceptors do not respond to low O2 content. b. Anemia and CO poisoning depresses the peripheral chemoreceptors. c. Anemia and CO poisoning depresses the central chemoreceptors. d. Anemia and CO cause stagnant hypoxia, not hypoxemia. ANS: A
Because of their extremely high blood-flow rates, the carotid bodies respond to decreased arterial partial pressure of O2 rather than to an actual decrease in arterial O2 content. DIF: Recall
REF: p. 312
OBJ: 6
29. Stimulation to increase ventilation does not occur until the PaO 2 falls below what level? a. 90 mm Hg b. 80 mm Hg c. 70 mm Hg d. 60 mm Hg ANS: D
When pH and PaCO2 are normal (pH = 7.40 and PaCO2 = 40 mm Hg), the carotid bodies’ nerve-impulse transmission rate does not increase significantly until the PaO 2 decreases to approximately 60 mm Hg. DIF: Recall
REF: p. 313
OBJ: 6
30. Why does it take approximately 24 hr for a full ventilatory response to develop to acute
hypoxemia? a. Initial cerebrospinal fluid alkalemia blunts the hypoxic ventilatory stimulus. b. Peripheral chemoreceptors are slow to respond to decreased blood O2 levels. c. Renal compensation for respiratory alkalosis increases chemoreceptor sensitivity. d. A full ventilatory response is not possible until after the muscles become fatigued. ANS: A
High altitude causes a healthy person’s ventilation to increase because low barometric pressure decreases the inspired PO 2 , and thus the arterial PO 2, which in turn raises the sensitivity of peripheral chemoreceptors to hydrogen ions. The resulting increase in ventilation is less than expected though, because hyperventilation lowers the PaCO 2 and raises arterial pH. The increased pH depresses the medullary respiratory center, counteracting the excitatory effect of a low PaO 2 on peripheral chemoreceptors. DIF: Recall
REF: p. 313
OBJ: 6
31. Which of the following centers responds more strongly to high levels of CO 2 ? a. Aortic chemoreceptors b. Carotid chemoreceptors c. Central chemoreceptors d. Ventral respiratory centers ANS: C
For a given increase in PaCO 2 or hydrogen ion concentration, the carotid bodies are less responsive than the central chemoreceptors. The peripheral chemoreceptors account for only 20% to 30% of the ventilatory response to hypercapnia. DIF: Recall
REF: p. 313
OBJ: 6
32. Which respond more rapidly to high levels of CO 2 ? a. Aortic chemoreceptors b. Carotid chemoreceptors c. Central chemoreceptors d. Ventral respiratory centers ANS: B
The carotid chemoreceptors respond to increased arterial hydrogen ion concentration more rapidly than do the central chemoreceptors. DIF: Recall
REF: p. 312
OBJ: 6
33. In the face of hyperoxia, what is the response of the peripheral chemoreceptors to
hypercapnia? a. There is a decreased drive to breathe. b. There is an increased drive to breathe. c. There is insufficient information. d. There is virtually no response. ANS: D
High arterial PO 2 (hyperoxia) decreases the peripheral chemoreceptors’ PCO 2 sensitivity to almost zero. DIF: Recall
REF: p. 312
OBJ: 6
34. Coexisting arterial hypoxemia, acidemia, and high PaCO 2 (i.e., asphyxia) will have what
effect on the peripheral chemoreceptors? a. There is a decreased drive to breathe. b. There is a maximally increased drive to breathe. c. There is insufficient information to make a determination. d. There is virtually no response. ANS: B
Coexisting arterial hypoxemia, acidemia, and high PaCO 2 (i.e., asphyxia) maximally stimulate the peripheral chemoreceptors. DIF: Recall
REF: p. 312
35. What happens in chronic hypercapnia?
OBJ: 6
1. The central chemoreceptive response to CO2 is decreased. 2. The cerebrospinal fluid pH is restored to normal. 3. Responsiveness to increased CO2 is decreased. a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
If PaCO 2 rises gradually over time, as might occur in severe COPD because of steadily deteriorating lung mechanics, the kidneys compensate by increasing the plasma bicarbonate concentration, keeping the arterial pH within normal limits. As plasma bicarbonate levels increase, these ions slowly diffuse across the blood-brain barrier, keeping cerebrospinal fluid pH in its normal range. The central chemoreceptors respond to hydrogen ion concentration, not the CO 2 molecule; thus, they sense a normal pH environment, even though the PaCO 2 is abnormally high. DIF: Recall
REF: p. 314
OBJ: 6
36. When given high concentrations of O 2 , a patient with chronic hypercapnia may develop a
more serious respiratory acidosis. Which of the following might be contributing to the patient’s increased PCO 2 ? 1. Worsening ventilation-perfusion (VV/QQ) balance 2. Desensitization of the carotid bodies 3. Removal of the hypoxic stimulus a. 1 and 2 only b. 1 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
Nevertheless, the reduction in minute ventilation following O 2 breathing in advanced COPD is not always severe enough to account for the increased PaCO 2 . Some investigators suggest that O 2 breathing worsens the VV/QQ relationships in the lungs and is responsible for the increase in PaCO 2 . Other investigators have suggested that O2 -induced hypercapnia is caused by the combined effects of hypoxic stimulus removal and redistribution of lungs. DIF: Recall
REF: p. 314
relationships in the
OBJ: 7 | 8
37. In what manner would O 2 therapy induce worsening
mismatch and thus a further elevation in CO 2 in a chronically hypercapnic patient? a. By improving blood flow to poorly ventilated alveoli b. By decreasing blood flow to poorly ventilated alveoli c. Causing bronchoconstriction, which worsens gas flow to low areas d. Causing bronchodilation, which improves gas flow to poorly ventilated alveoli ANS: A
Oxygen breathing causes more blood flow to be directed to poorly ventilated alveoli, which takes blood flow away from well-ventilated alveoli. The key point is that when already under-ventilated alveoli receive additional blood flow, blood PCO 2 rises further. These events can occur without a fall in overall minute ventilation. DIF: Recall
REF: p. 314
OBJ: 7 | 8
38. How should O2 therapy be administered to chronically hypercapnic patients? a. Avoid giving any supplemental O 2 . b. Give as much O 2 as possible (60% to 100%). c. Withhold O2 until the patient is intubated. d. Give as much O2 as required to maintain adequate oxygenation. ANS: D
Oxygen should never be withheld from acutely hypoxemic COPD patients for fear of inducing hypoventilation and hypercapnia. Tissue oxygenation is an overriding priority; O 2 must never be withheld from exacerbated, hypoxemic COPD patients for any reason. This means the clinician must be prepared to mechanically support ventilation if O 2 administration induces severe hypoventilation. DIF: Recall
REF: p. 314
OBJ: 8
39. What is the response of a patient with chronic hypercapnia to a sudden acute rise in carbon
dioxide? a. In almost all of these patients, there will be no response. b. The patient’s drive to breathe will be increased. c. This will further depress his or her respiratory centers. d. This will induce apnea and sudden death. ANS: B
Chronic hypercapnia does not mean that the medullary chemoreceptors cannot respond to further acute rises in PaCO 2 . A sudden elevation in PaCO 2 immediately crosses the blood-brain barrier into the cerebrospinal fluid, generating H+ ions that subsequently stimulate the medullary chemoreceptors. This will increase the drive to breathe. DIF: Recall
REF: p. 314
OBJ: 8
40. Which of the following will occur during even strenuous exercise in a normal healthy
individual? a. Blood gases remain stable. b. The arterial PCO 2 rises. c. The arterial pH falls. d. The arterial PO 2 falls. ANS: A
Strenuous exercise increases carbon dioxide production and O 2 consumption by as much as 20-fold. Ventilation normally keeps pace with CO 2 production, keeping PaCO 2 , PaO 2 , and arterial pH constant. Because arterial blood gases do not change, elevated carbon dioxide or hypoxia does not stimulate ventilation in healthy individuals during exertion. DIF: Recall
REF: p. 315
OBJ: 11
41. While observing a patient’s breathing, you note that the depth and rate first increase, then
decrease, followed by a period of apnea. Which of the following terms would you use in charting this observation? a. Apneustic breathing b. Biot’s breathing c. Cheyne-Stokes breathing d. Paradoxical breathing ANS: C
In Cheyne-Stokes respiration, respiratory rate, and tidal volume gradually increase and then gradually decrease to complete apnea (absence of ventilation), which may last several seconds. Then tidal volume and breathing frequency gradually increase again, repeating the cycle. DIF: Recall
REF: p. 315
OBJ: 11
42. Which of the following can cause Cheyne-Stokes breathing?
1. Brain injuries 2. Congestive heart failure 3. Metabolic acidosis a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
Cheyne-Stokes breathing occurs when cardiac output is low, as in congestive heart failure, delaying the blood transit time between the lungs and the brain. In this instance, changes in respiratory center PCO 2 lag behind changes in arterial PCO 2 . For example, when an increased PaCO 2 from the lungs reaches the respiratory neurons, ventilation is stimulated; this then lowers the arterial PCO 2 level. By the time the reduced PaCO 2 reaches the medulla to inhibit ventilation, hyperventilation has been in progress for an inappropriately long time. When blood from the lung finally does reach the medullary centers, the low PaCO 2 greatly depresses ventilation to the point of apnea. Arterial PCO 2 then rises, but a rise in respiratory center PCO 2 is delayed because of low blood flow rate. The brain eventually does receive the high PaCO 2 signal and the cycle is repeated. Cheyne-Stokes respiration may also be caused by brain injuries in which the respiratory centers overrespond to changes in the PCO 2 level. DIF: Recall
REF: p. 315
OBJ: 11
43. You observe a patient’s breathing pattern as very irregular, with periods of breathing
interspersed with long periods of apnea. Which of the following terms would you use in charting this observation? a. Apneustic breathing b. Biot’s respiration c. Cheyne-Stokes breathing d. Kussmaul’s breathing ANS: B
Biot’s respiration is similar to Cheyne-Stokes respiration, except that tidal volumes are of identical depth.
DIF: Recall
REF: p. 315
OBJ: 11
44. Biot’s respiration is most frequently observed in patients with which of the following? a. Congestive heart failure b. Increased intracranial pressure c. Metabolic acidosis d. Peripheral nerve disorders ANS: B
Biot’s breathing occurs in patients with increased intracranial pressure, but the mechanism for this pattern is unclear. DIF: Recall
REF: p. 315
OBJ: 11
45. What does apneustic breathing indicate? a. Damage to the cerebrum b. Damage to the pons c. Spinal cord transaction d. Vagal nerve damage ANS: B
Apneustic breathing indicates damage to the pons. DIF: Recall
REF: p. 315
OBJ: 11
46. Which of the following are causes of central neurogenic hyperventilation?
1. Head trauma 2. Inadequate brain blood flow 3. Severe brain hypoxia 4. Hypothermia a. 2 and 3 only b. 1 and 4 only c. 2 and 3 only d. 1, 2, and 3 only ANS: D
Central neurogenic hyperventilation is characterized by persistent hyperventilation driven by abnormal neural stimuli. It is related to midbrain and upper pons damage associated with head trauma, severe brain hypoxia, or lack of blood flow to the brain. DIF: Recall
REF: p. 316
OBJ: 11
47. In patients with closed-head injuries, what may happen in the presence of hypercapnia? a. High CO 2 increases the risk of psychotic events. b. High CO 2 levels cause cerebral vasodilation and improved oxygenation. c. Severe cerebral vasoconstriction results in anoxia and stroke. d. Vasodilation causes increased intracranial pressure and possibly stops blood flow. ANS: D
Increased PCO 2 dilates cerebral vessels, raising cerebral blood flow, whereas decreased PCO 2 constricts cerebral vessels and reduces cerebral blood flow. In patients with traumatic brain injury, the brain swells acutely; this raises the intracranial pressure in the rigid skull to such high levels that blood supply to the brain might be cutoff, causing cerebral hypoxia (ischemia). That is, high intracranial pressure may exceed cerebral arterial pressure and stop blood flow. DIF: Recall
REF: p. 316
OBJ: 10 | 11
48. A patient in the emergency room is displaying prolong inspiratory gasps interrupted by
occasional expirations, what serious injury should be suspected on this patient? 1. Pneumotaxic center has been severed. 2. Vagus nerve has been severed. 3. Glossopharyngeal nerve has been severed. a. 2 and 3 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
If a situation occurs where the higher pneumotaxic center and vagus nerves were severed, the DRG inspiratory neurons would fail to switch off, causing prolonged inspiratory gasps interrupted by occasional expirations (apneustic breathing). Vagal and pneumotaxic center impulses hold the apneustic center’s stimulatory effect on DRG neurons in check. DIF: Application
REF: pp. 309-310 OBJ: 3
49. A healthy 33-year-old woman relocates to an area approximately 8000 ft above sea level. On
her first day, she begins to hyperventilate, but in 24 hr she shows signs of recovery. What is the probable cause of her condition? a. Hypoxemia-mediated hyperventilation b. Hypercapnia c. Hyperoxia-mediated hyperventilation d. Increased H+ ANS: A
High altitude causes a healthy person’s ventilation to increase because low barometric pressure decreases the inspired PO 2 , and thus the arterial PO 2, which in turn raises the sensitivity of peripheral chemoreceptors to H+. The resulting increase in ventilation is less than expected, though, because hyperventilation lowers the PaCO 2 and raises arterial pH. DIF: Application
REF: p. 313
OBJ: 6
50. Why does splashing cold water on the skin stimulate ventilation? a. It decreases medullary inspiratory activity causing hyperpnea. b. Hering-Breuer inflation reflex. c. It increases medullary inspiratory activity causing hyperpnea. d. J receptor. ANS: C
Proprioceptors in muscles, tendons, and joints, as well as pain receptors in muscles and skin, send stimulatory signals to the medullary respiratory center. Such stimuli increase medullary inspiratory activity and cause hyperpnea. For this reason, moving the limbs, slapping or splashing cold water on the skin, and other painful stimuli stimulate ventilation in patients with respiratory depression. DIF: Recall
REF: p. 311
OBJ: 4
Chapter 16 - Bedside Assessment of the Patient Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following can be considered a purpose of the interview the RT performs?
1. To collect diagnostic information 2. To establish a rapport with the patient 3. To identify plans for payment 4. To identify the effect of therapy a. 1 and 4 only b. 2 and 3 only c. 1, 2, and 4 only d. 1, 2, 3, and 4 ANS: C
Interviewing furnishes unique information because it provides the patient’s perspective. It serves the following three related purposes: (1) to establish a rapport between clinician and patient, (2) to obtain essential diagnostic information, and (3) to help monitor changes in the patient’s symptoms and response to therapy. DIF: Recall
REF: p. 321
OBJ: 1
2. The patient interview conducted by the clinician is done in which space? a. Social space b. Personal space c. Intimate space d. Critical space ANS: B
Move to the personal space (2 to 4 ft from the patient) to begin the interview. DIF: Recall
REF: p. 322
OBJ: 1
3. Which of the following is an example of a leading question? a. Is your breathing better now? b. How is your breathing now? c. When did your breathing change? d. Where is your pain located? ANS: A
Asking the patient, ―Is your breathing better now?‖ leads the patient toward a desired response and may elicit false information. DIF: Recall
REF: pp. 322-323 OBJ: 1
4. Which of the following are common causes of an increase in the drive to breathe, which
would increase the sensation of dyspnea? 1. Hypoxemia 2. Acidosis
3. High fever 4. Hypocapnia a. 1 and 4 only b. 2 and 4 only c. 1, 2, and 3 only d. 2, 3, and 4 only ANS: D
Increases in the drive to breathe occur with hypoxemia, acidosis, fever, exercise, or anxiety. DIF: Recall
REF: p. 323
OBJ: 2
5. What term is used to describe difficult breathing in the reclining position? a. Orthopnea b. Platypnea c. Eupnea d. Apnea ANS: A
Dyspnea may be present only when the patient assumes the reclining position, in which case it is referred to as orthopnea. DIF: Recall
REF: p. 323
OBJ: 2
6. What term is used to describe shortness of breath in the upright position? a. Orthopnea b. Platypnea c. Eupnea d. Apnea ANS: B
Shortness of breath in the upright position is known as platypnea. DIF: Recall
REF: p. 323
OBJ: 2
7. Which of the following factors has minimal or no impact on the effectiveness of the patient’s
cough? a. Lung recoil b. Airways resistance c. Lung volume d. Pulmonary vascular resistance ANS: D
The effectiveness of a cough depends on the individual’s ability to take a deep breath, his or her lung recoil, the strength of his or her expiratory muscles, and the level of airway resistance. DIF: Recall
REF: p. 325
OBJ: 2
8. Which of the following conditions is most likely to cause a dry, nonproductive cough? a. Chronic bronchitis b. Cystic fibrosis
c. Pulmonary fibrosis d. Chronic obstructive pulmonary disease ANS: C
For example, a dry, nonproductive cough is typical for restrictive lung diseases such as congestive heart failure or pulmonary fibrosis. DIF: Recall
REF: p. 325
OBJ: 2
9. What is the technical term for secretions from the tracheobronchial tree that have not been
contaminated by the mouth? a. Sputum b. Phlegm c. Mucus d. Pus ANS: B
Technically, mucus from the tracheobronchial tree that has not been contaminated by oral secretions is called phlegm. DIF: Recall
REF: p. 325
OBJ: 2
10. What term is used to describe sputum that has pus in it? a. Fetid b. Mucoid c. Purulent d. Tenacious ANS: C
Sputum that contains pus cells is said to be purulent, suggesting a bacterial infection. DIF: Recall
REF: p. 326
OBJ: 2
11. Which of the following terms is used to describe coughing up blood-streaked sputum? a. Hematemesis b. Hemoptysis c. Hemolysis d. Hemostasis ANS: B
Coughing up blood or blood-streaked sputum from the lungs is referred to as hemoptysis. DIF: Recall
REF: p. 326
OBJ: 2
12. Which of the following characteristics are typical for pleuritic chest pain?
1. Located laterally. 2. Sharp and stabbing in nature. 3. Increases with breathing. 4. Radiates to the arm. a. 3 and 4 only b. 1 and 3 only c. 1, 2, and 3 only
d. 1, 2, and 4 only ANS: C
Pleuritic chest pain usually is located laterally or posteriorly. It worsens when the patient takes a deep breath and is described as a sharp, stabbing type of pain. DIF: Recall
REF: p. 326
OBJ: 2
13. What term is used to describe the chest pain associated with blockage of the coronary arteries? a. Angina b. Myocarditis c. Myalgia d. Infarction ANS: A
A common cause of nonpleuritic chest pain is angina, which classically is a pressure sensation with exertion or stress and results from coronary artery occlusion. DIF: Recall
REF: p. 326
OBJ: 2
14. What change in the patient’s respiratory breathing pattern is commonly seen with significant
fever? a. Slower rate b. More rapid rate c. More prolonged expiratory time d. More prolonged inspiratory time ANS: B
The increased need for oxygen intake and carbon dioxide removal may cause tachypnea. DIF: Recall
REF: p. 326
OBJ: 2
15. What is the most common cause of pedal edema? a. Liver failure b. Kidney failure c. Heart failure d. Electrolyte imbalances ANS: C
Swelling of the lower extremities is known as pedal edema. It most often occurs with heart failure, which causes an increase in the hydrostatic pressure of the blood vessels in the lower extremities. DIF: Recall
REF: p. 326
OBJ: 2
16. Which of the following are critical elements of a patient’s past medical history?
1. Childhood diseases 2. Prior major illnesses or surgery 3. Marital status 4. Drugs and immunizations a. 1 and 2 only b. 1 and 3 only
c. 1, 2, and 3 only d. 1, 2, and 4 only ANS: C
The next step is to review the patient’s past medical history, which describes all past major illnesses, injuries, surgeries, hospitalizations, allergies, and health-related habits. DIF: Recall
REF: p. 327
OBJ: 2
17. Which of the following are elements of a patient’s social and environmental history?
1. Occupation and employment history 2. Drugs and medications 3. Recent travel 4. Living arrangements a. 1, 3, and 4 only b. 1 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: A
Review the family and social/environmental history. This part of the medical history focuses on potential genetic or occupational links to disease and the patient’s current life situation. Pulmonary disorders such as asthma, lung cancer, cystic fibrosis, and chronic obstructive pulmonary disease are believed to have a genetic link in many cases. DIF: Recall
REF: p. 327
OBJ: 2
18. Which of the following are associated with diaphoresis?
1. Fever 2. Severe stress 3. Acute anxiety 4. Hemoptysis a. 2 and 3 only b. 1 and 4 only c. 1, 2, and 3 only d. 2, 3, and 4 only ANS: C
Diaphoresis (sweating) can indicate fever, pain, severe stress, increased metabolism, or acute anxiety. DIF: Recall
REF: p. 327
OBJ: 2
19. Which of the following is most commonly associated with tripodding? a. Severe pulmonary hyperinflation b. Congestive heart disease c. Pneumonia d. Pulmonary fibrosis ANS: A
The patient with severe pulmonary hyperinflation tends to sit upright while bracing his or her elbows on a table. This helps the accessory muscles gain a mechanical advantage for breathing and is called tripodding. DIF: Recall
REF: p. 328
OBJ: 2
20. Your patient has an abnormal sensorium. Which of the following is most likely true? a. The patient knows his or her name. b. The patient is confused about where he or she is. c. The patient is aware of the correct day. d. The patient knows the name of the hospital he or she has been taken to. ANS: B
This often is called evaluating the sensorium. The alert patient who is well oriented to time, place, person, and situation is said to be ―oriented 4,‖ and sensorium is considered normal. DIF: Recall
REF: p. 328
OBJ: 2
21. What structure in the body is responsible for regulating the body temperature? a. Pituitary gland b. Thyroid gland c. Hypothalamus d. Thymus gland ANS: C
The hypothalamus plays an important role in regulating heat loss. DIF: Recall
REF: p. 329
OBJ: 2
22. What is the most common cause of hypothermia? a. Exposure to cold environment b. Head injury c. Stroke d. Thyroid gland dysfunction ANS: A
The most common cause of hypothermia is prolonged exposure to cold. DIF: Recall
REF: p. 326
OBJ: 2
23. Which of the following sites is closest to core body temperature? a. Axillary b. Oral c. Rectal d. Forehead ANS: C
Rectal temperatures are closest to actual core body temperature. DIF: Recall
REF: p. 326
OBJ: 2
24. Which of the following is least likely to cause tachycardia?
a. b. c. d.
Fever Severe pain Hypotension Hypothermia
ANS: D
Common causes of tachycardia are exercise, fear, anxiety, low blood pressure, anemia, fever, reduced arterial blood oxygen levels, and certain medications. DIF: Recall
REF: pp. 329-330 OBJ: 2
25. What two factors determine cardiac output? a. Ventricular filling and heart rate b. Stroke volume and heart rate c. Stroke volume and respiratory rate d. Heart rate and tidal volume ANS: B
The amount of blood circulated per minute (cardiac output) is a function of heart rate and stroke volume. DIF: Recall
REF: p. 330
OBJ: 2
26. Which of the following is a common cause of pulsus paradoxus? a. Acute asthma attack b. Severe pneumonia c. Congestive heart failure d. Myocardial infarction ANS: A
Pulsus paradoxus can be quantified with a blood pressure cuff and is common in patients with acute obstructive pulmonary disease, especially those suffering from an asthma attack. DIF: Recall
REF: p. 330
OBJ: 2
27. Which of the following are common causes of tachypnea?
1. Hypoxemia 2. Exercise 3. Narcotic overdose 4. Metabolic acidosis a. 2, 3, and 4 only b. 1, 2, and 4 only c. 2 and 3 only d. 1 and 4 only ANS: B
Rapid respiratory rates are associated with exertion, fever, arterial hypoxemia, metabolic acidosis, anxiety, atelectasis, and pain. DIF: Recall
REF: pp. 329-330 OBJ: 2
28. What is the normal range for systolic blood pressure in the adult patient?
a. b. c. d.
90 to 140 mm Hg 80 to 100 mm Hg 75 to 100 mm Hg 60 to 100 mm Hg
ANS: A
In general, the normal range for systolic blood pressure in the adult is 90 to 140 mm Hg. DIF: Recall
REF: p. 330
OBJ: 2
29. What is the normal range for diastolic blood pressure in the adult patient? a. 40 to 80 mm Hg b. 60 to 90 mm Hg c. 80 to 110 mm Hg d. 60 to 110 mm Hg ANS: B
Diastolic pressure is the force in the major arteries remaining after relaxation of the ventricles; it is normally 60 to 90 mm Hg. DIF: Recall
REF: p. 330
OBJ: 2
30. What is the normal range for pulse pressure? a. 20 to 35 mm Hg b. 30 to 60 mm Hg c. 30 to 40 mm Hg d. 30 to 60 mm Hg ANS: C
A normal pulse pressure is 30 to 40 mm Hg. DIF: Recall
REF: p. 330
OBJ: 2
31. Which of the following is a true statement about the cause of systemic hypertension in adult
patients? a. The cause is often unknown. b. The cause is often related to poor diet. c. The cause is often related to a lack of exercise. d. The cause is often related to sleep apnea. ANS: A
Hypertension is a common medical problem in adults, and the cause is often unknown. DIF: Recall
REF: p. 330
OBJ: 2
32. Which of the following are causes of hypotension?
1. Heart failure 2. Hypovolemia 3. Mild tachycardia 4. Peripheral vasoconstriction a. 2 and 4 only b. 1, 2, and 4 only
c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
The usual causes are left ventricular failure, low blood volume, and peripheral vasodilation. DIF: Recall
REF: p. 331
OBJ: 2
33. What artery is most often used to assess arterial blood pressure? a. Femoral b. Radial c. Ulnar d. Brachial ANS: D
When the cuff is applied to the upper arm and pressurized to exceed systolic blood pressure, the brachial artery blood flow stops. DIF: Recall
REF: p. 331
OBJ: 2
34. Why should the respiratory therapist perform a blood pressure assessment fairly quickly? a. The procedure is expensive. b. The procedure cuts off blood flow to the forearm temporarily. c. The respiratory therapist has other procedures to do. d. The procedure is billed by the time involved. ANS: B
The clinician must perform the procedure rapidly, because the pressurized cuff impairs circulation to the forearm and hand. DIF: Recall
REF: p. 331
OBJ: 2
35. Which of the following is/are advantages of the digital blood pressure measurement devices? a. They reduce the risk of human error. b. They reduce the cost. c. They have an alarm. d. They measure blood pressure and stroke volume. ANS: A
These devices do not require the health care provider to listen for the Korotkoff sounds and eliminate variances in recorded blood pressures based on human perception. They are considered to be very accurate and simply require the clinician to apply the blood pressure cuff correctly and press the start button. Subsequently, the device takes over and inflates and deflates the cuff automatically. The blood pressure and pulse rate are then displayed on a digital screen. DIF: Recall
REF: p. 332
OBJ: 2
36. What is indicated by the presence of central cyanosis? a. Respiratory failure b. Circulatory failure c. Anemia
d. Hypotension ANS: A
When respiratory disease reduces arterial oxygen content, cyanosis (a bluish discoloration of the tissues) may be detected, especially around the lips and in the oral mucosa of the mouth (central cyanosis). DIF: Recall
REF: p. 332
OBJ: 2
37. What is the advantage of COPD patients breathing through pursed lips during exhalation? a. Helps the patient focus on breathing. b. Promotes more complete emptying of the lungs. c. Reduces the patient’s anxiety level. d. Improves arterial pH levels. ANS: B
Breathing through pursed lips during exhalation creates resistance to flow. The increased resistance causes development of a slight backpressure in the small airways during exhalation, which prevents their premature collapse and allows more complete emptying of the lung. DIF: Recall
REF: p. 332
OBJ: 2
38. Which of the following may cause the trachea to shift to the right? a. Right-sided tension pneumothorax b. Right-sided large pleural effusion c. Right upper lobe atelectasis d. Left lower lobe pneumonia ANS: C
The trachea shifts away from areas with increased air, fluid, or tissue (e.g., in tension pneumothorax or large pleural effusion) and toward atelectasis. In general, abnormalities in the lung bases do not shift the trachea. DIF: Application
REF: p. 332
OBJ: 2
39. What is the most common cause of jugular venous distention (JVD)? a. Right-sided heart failure b. Arterial hypoxemia c. Tension pneumothorax d. Acute systemic hypertension ANS: A
The most common cause of JVD is the failure of the right side of the heart. DIF: Recall
REF: p. 332
OBJ: 3
40. Which of the following is the least likely cause of lymphadenopathy in the neck? a. Lymphoma b. Pulmonary infection c. Congestive heart failure d. Lung cancer ANS: C
Lymphadenopathy occurs with a variety of medical disorders including infection, malignancy, and sarcoidosis. Tender lymph nodes in the neck are suggestive of a nearby infection. The lymph nodes are not tender when malignancy is the cause. DIF: Recall
REF: p. 332
OBJ: 3
41. What disease is associated with a barrel chest? a. Emphysema b. Heart failure c. Pneumonia d. Pleural effusions ANS: A
This abnormal increase in anteroposterior diameter is called barrel chest and is associated with emphysema. DIF: Recall
REF: p. 332
OBJ: 3
42. What term is used to describe an abnormal anteroposterior curvature of the spine? a. Scoliosis b. Pectus excavatum c. Kyphosis d. Pectus carinatum ANS: C
Kyphosis is a spinal deformity in which the spine has an abnormal anteroposterior curvature. DIF: Recall
REF: p. 333
OBJ: 3
43. You observe a patient’s breathing pattern as very irregular and interspersed with long periods
of apnea. Which of the following is the most likely cause of this problem? a. Central nervous system disorder b. Congestive heart failure c. Metabolic acidosis d. Increased intracranial pressure ANS: D
Table 16-2 describes some of the common abnormal patterns of breathing and their causes. DIF: Application
REF: p. 334
OBJ: 3
44. While observing a patient’s breathing, you note that the depth and rate first increase, then
decrease, followed by a period of apnea. Which of the following terms would you use in charting this observation? a. Apneustic breathing b. Cheyne-Stokes breathing c. Biot’s breathing d. Paradoxical breathing ANS: B
Table 16-2 describes some of the common abnormal patterns of breathing.
DIF: Recall
REF: p. 334
OBJ: 3
45. While observing a patient’s breathing, you note that the depth and rate first increase, then
decrease, followed by a period of apnea. Which of the following are potential causes of this abnormality? 1. Central nervous system disorder 2. Congestive heart failure 3. Metabolic acidosis a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
Table 16-2 describes some of the common abnormal patterns of breathing and their causes. DIF: Recall
REF: p. 334
OBJ: 3
46. What is indicated by retractions? a. An increase in PaCO 2 b. An increase in the work of breathing c. A decrease in blood flow to the lungs d. Reduction in lung volumes ANS: B
Increased work of breathing also can result in retractions. DIF: Recall
REF: p. 335
OBJ: 3
47. What breathing pattern is associated with severe atelectasis? a. Rapid and deep b. Rapid and shallow c. Slow and shallow d. Slow and deep ANS: B
A significant reduction in lung volume, such as that which occurs with atelectasis, usually results in rapid, shallow breathing. DIF: Recall
REF: p. 335
OBJ: 3
48. A patient with asthma would tend to exhibit which of the following? a. Prolonged inhalation b. Slow and shallow breathing c. Prolonged exhalation d. Deep and fast breathing ANS: C
Obstruction of the intrathoracic airways (as occurs with asthma) results in a prolonged exhalation time because airways within the chest tend to narrow more on exhalation. DIF: Recall
REF: p. 335
OBJ: 3
49. What breathing pattern is associated with diabetic ketoacidosis? a. Kussmaul breathing b. Apneustic breathing c. Biot’s breathing d. Apnea ANS: A
Patients with diabetic ketoacidosis often breathe with a deep and rapid pattern, which is called Kussmaul breathing. DIF: Recall
REF: p. 335
OBJ: 3
50. What term is used to describe the breathing pattern seen in COPD patients in whom the lower
costal margins of the chest wall draw inward with each inspiration? a. Hoover’s sign b. Kussmaul’s sign c. Abdominal paradox sign d. Respiratory alternans sign ANS: A
Contraction of a flat diaphragm tends to draw in the lateral costal margins, instead of expanding them (Hoover’s sign), and does little to help move air into the thorax. DIF: Recall
REF: p. 335
OBJ: 3
51. What is indicated by the breathing pattern known as abdominal paradox? a. Obstructive lung disease b. Restrictive lung disease c. Heart failure d. Diaphragm fatigue ANS: D
This is recognized by inward movement of the anterior abdominal wall during inspiratory efforts and is seen best with the patient in the supine position. This sign is called abdominal paradox. DIF: Recall
REF: p. 335
OBJ: 3
52. Which of the following would cause an increase in tactile fremitus? a. Pleural effusion b. Pneumonia c. Emphysema d. Pneumothorax ANS: B
Any condition that increases the density of the lung, such as the consolidation (or alveolar filling) that occurs in pneumonia, increases the intensity of fremitus. DIF: Recall
REF: p. 336
OBJ: 3
53. While palpating the chest of a patient who repeats the word s ―ninety-nine,‖ you note an area
of increased tactile fremitus over the left lower lobe. Which of the following could explain this finding? 1. Pneumothorax 2. Emphysema 3. Pneumonia 4. Pleural effusions a. 2 only b. 1 and 4 only c. 1, 2, and 4 d. 3 only ANS: D
Tactile fremitus is increased when the lung becomes consolidated as with pneumonia because sound vibrations travel better through a more solid medium. DIF: Application
REF: p. 336
OBJ: 3
54. While palpating the thorax of a patient who repeats the words ―ninety-nine,‖ you note a
localized area of decreased tactile fremitus on the lower right side. Which of the following could explain this finding? 1. Atelectasis on the right 2. Right-sided lower pneumothorax 3. Right-sided lower pleural effusion 4. Obstruction of a bronchus in the right lung a. 2, 3, and 4 only b. 1 and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: A
Tactile fremitus is reduced most often in patients who are obese or overly muscular. In addition, when the pleural space lining the lung becomes filled with air (pneumothorax) or fluid (pleural effusion), fremitus is significantly reduced or absent. DIF: Application
REF: p. 336
OBJ: 3
55. On palpating the neck region of a patient on a mechanical ventilator, you notice a crackling
sound and sensation. What is the most likely cause of this observation? a. Subcutaneous emphysema b. Upper bronchial obstruction c. Pneumonia of the upper lobes d. Atelectasis of the upper lobes ANS: A
Subcutaneous emphysema is caused by air trapped in the subcutaneous tissues and is usually due to an air leak from the lung. DIF: Recall
REF: p. 336
OBJ: 3
56. The vibration created by percussion penetrates the lung to approximately what depth?
a. b. c. d.
1 to 2 cm 3 to 5 cm 5 to 7 cm 8 to 10 cm
ANS: C
The vibration created by percussion penetrates the lung to a depth of 5 to 7 cm below the chest wall. DIF: Recall
REF: p. 336
OBJ: 3
57. To minimize bony interference with percussion on the posterior chest wall, the practitioner
should have the patient do which of the following? a. Lean forward at a 45-degree angle. b. Keep his or her arms at the sides of the body. c. Raise his or her arms above the shoulders. d. Place his or her hands on the hips. ANS: C
Asking patients to raise their arms above their shoulders will help move the scapulae laterally and minimize their interference with percussion on the posterior chest wall. DIF: Recall
REF: p. 336
OBJ: 3
58. While percussing a patient’s chest wall, you encounter an area that produces a decreased
resonance to percussion. Which of the following are potential causes of this finding? 1. Pneumothorax 2. Pleural effusion 3. Pneumonia 4. Atelectasis a. 2 and 3 only b. 2 and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: C
Any abnormality that increases lung tissue density, such as pneumonia, tumor, or atelectasis, results in a loss of resonance and decreased resonance to percussion over the affected area. Pleural spaces filled with fluid, such as blood or water, also produce decreased resonance to percussion. DIF: Application
REF: p. 336
OBJ: 3
59. While percussing a patient’s chest wall, you detect an abnormal increase in resonance. Which
of the following are possible causes of this finding? 1. Asthma 2. Pneumothorax 3. Emphysema 4. Pneumonia a. 1, 2, and 3 only b. 2 and 4 only
c. 1, 3, and 4 only d. 1, 2, 3, and 4 ANS: A
Increased resonance can be detected in patients with hyperinflated lungs. Hyperinflation can result from acute or chronic bronchial obstruction, such as asthma or emphysema. DIF: Application
REF: p. 336
OBJ: 3
60. Which of the following represent proper chest auscultation technique?
1. The practitioner should begin auscultation at the lung bases. 2. The patient should be instructed to breathe through an open mouth. 3. The patient should be placed in a comfortable upright position. 4. The patient should avoid deeply inhaling because it can mask certain lung sounds. a. 1 and 4 only b. 1, 2, and 3 only c. 3 only d. 1, 2, and 4 only ANS: B
When possible, the patient should be sitting upright in a relaxed position. Instruct the patient to breathe a little more deeply than normal through an open mouth. Inhalation should be active, with exhalation passive. Place the bell or diaphragm directly against the chest wall when possible, because clothing may produce distortion. The tubing must not be allowed to rub against any objects, because this may produce extraneous sounds, which could be mistaken for adventitious lung sounds. DIF: Recall
REF: p. 337
OBJ: 3
61. Soft, muffled sounds heard mainly during inspiration over the peripheral lung parenchyma
best describe which of the following breath sounds? a. Vesicular b. Bronchovesicular c. Bronchial d. Tracheal ANS: A
When auscultating over the lung parenchyma of a healthy individual, soft, muffled sounds are heard. These normal breath sounds, referred to as vesicular breath sounds, are lower in pitch and intensity than bronchovesicular breath sounds. Vesicular sounds are heard primarily during inhalation, with only a minimal exhalation component (Table 16-2). DIF: Recall
REF: pp. 337-338 OBJ: 5
62. Loud, tubular breath sounds with an expiratory component equal to the inspiratory component
best describes which of the following breath sounds? a. Adventitious b. Bronchial c. Vesicular d. Bronchovesicular ANS: B
When the expiratory component of harsh breath sounds equals the inspiratory component, they are described as bronchial breath sounds. DIF: Recall
REF: pp. 337-338 OBJ: 5
63. During auscultation of a patient’s chest, you hear abnormal discontinuous ―bubbling‖ sounds
at the lung bases. Which of the following chart entries best describes this finding? a. ―Bronchial sounds heard at lung bases.‖ b. ―Wheezes heard at lung bases.‖ c. ―Crackles heard at lung bases.‖ d. ―Rhonchi heard at lung bases.‖ ANS: C
Discontinuous adventitious lung sound types are described as crackles. DIF: Recall
REF: pp. 337-338 OBJ: 5
64. What term best describes a loud, high-pitched continuous sound heard (often with the unaided
ear) primarily over the larynx or trachea during inhalation in patients with upper airway obstruction? a. Stridor b. Rhonchi c. Crackles d. Wheeze ANS: A
Another continuous type of adventitious lung sounds heard in certain situations, primarily over the larynx and trachea during inhalation, is stridor. Stridor is a loud, high-pitched sound, which sometimes can be heard without a stethoscope. Most common in infants and small children, stridor is a sign of obstruction in the trachea or larynx. Stridor is most often heard during inspiration. DIF: Recall
REF: p. 338
OBJ: 5
65. What does the presence of stridor indicate? a. Lower airway obstruction b. Increased secretions in the large airways c. Upper airway obstruction d. Bronchial spasm ANS: C
Another continuous type of adventitious lung sounds heard in certain situations, primarily over the larynx and trachea during inhalation, is stridor. Stridor is a loud, high-pitched sound, which sometimes can be heard without a stethoscope. Most common in infants and small children, stridor is a sign of obstruction in the trachea or larynx. Stridor is most often heard during inspiration. DIF: Recall
REF: pp. 338-339 OBJ: 5
66. Which of the following can cause decreased breath sounds?
1. Air or fluid in the pleural space 2. Hyperinflation of lung tissue
3. Mucus plugging of the airways 4. Shallow or slow breathing a. 2 and 4 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 2, 3, and 4 only ANS: C
Airways plugged with mucus and hyperinflated lung tissue attenuate sounds through the lungs. Air or fluid in the pleural space and obesity also reduce sound transmission through the chest wall. DIF: Application
REF: p. 338
OBJ: 6
67. Which of the following changes in the characteristics of wheezing indicate improvement in
airway obstruction following bronchodilator therapy? a. Lower pitch, shorter duration b. Higher pitch, shorter duration c. Lower pitch, longer duration d. Higher pitch, longer duration ANS: A
It is useful to monitor the pitch and duration of wheezing. Improved expiratory flow is associated with a decrease in the pitch and length of the wheezing. For example, if high-pitched wheezing is present during the entire expiratory time before treatment but becomes lower pitched and occurs only late in exhalation after therapy, the pitch and duration of the wheeze have diminished. This suggests that the degree of airway obstruction has decreased. DIF: Recall
REF: p. 338
OBJ: 6
68. During auscultation of a patient’s chest, you hear coarse crackles throughout both inspiration
and expiration. These sounds clear when the patient coughs. Which of the following is the most likely cause of these adventitious sounds? a. Opening of closed smaller airways or alveoli b. Opening of collapsed large, proximal airways c. Variable obstruction to flow in the upper airway d. Movement of excessive secretions in the airways ANS: D
Excessive mucus in the airways causes crackles that are usually coarse (low pitched) and heard during inspiration and expiration. These crackles often clear when the patient coughs or when the upper airway is suctioned. DIF: Recall
REF: p. 339
OBJ: 6
69. Inspiratory crackles in patients without excess secretions are most commonly associated with
which of the following? a. Reduced chest-wall sound transmission b. Airways popping open during inspiration c. Complete obstruction of the upper airway
d. Mucosal edema or inflammation ANS: B
Crackles also may be heard in patients without excess secretions. These crackles occur when collapsed airways pop open during inspiration. Airway collapse or closure can occur in peripheral bronchioles or in larger, more proximal bronchi. DIF: Recall
REF: p. 339
OBJ: 6
70. Which of the following are true of early inspiratory crackles?
1. They most often occur in COPD patients. 2. They generally indicate severe airway obstruction. 3. They are affected by coughing or positional change. 4. They are usually scant (few in number). a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, and 4 only ANS: D
Early inspiratory crackles are usually scanty but may be loud or faint. They often are transmitted to the mouth and are not silenced by a cough or a change in position. They most often occur in patients with COPD, such as chronic bronchitis, emphysema, or asthma, and usually indicate a severe airway obstruction. DIF: Recall
REF: p. 339
OBJ: 6
71. In which of the following conditions would late-inspiratory crackles be most likely to occur?
1. Emphysema 2. Pulmonary fibrosis 3. Pneumonia 4. Pulmonary edema a. 2, 3, and 4 only b. 1, 3, and 4 only c. 3 and 4 only d. 1 and 2 only ANS: A
Late-inspiratory crackles are most common in patients with respiratory disorders that reduce lung volume. These disorders include atelectasis, pneumonia, pulmonary edema, and pulmonary fibrosis (Table 16-4). DIF: Recall
REF: p. 339
OBJ: 6
72. A creaking or grating sound that increases in intensity with deep breathing and is similar to
coarse crackles, but is not affected by coughing, best describes which of the following? a. Rhonchi b. Friction rub c. Rales d. Wheezing ANS: B
A pleural friction rub is a creaking or grating sound that occurs when the pleural surfaces become inflamed and the roughened edges rub together during breathing, as in pleurisy. It may be heard only during inhalation but often is identified during both phases of breathing. DIF: Recall
REF: p. 340
OBJ: 6
73. An increase in intensity and clarity of vocal resonance because of enhanced transmission of
sound is referred to as which of the following? a. Bronchophony b. Vesicularity c. Pectoriloquy d. Egophony ANS: A
An increase in the intensity and clarity of vocal resonance produced by enhanced transmission of vocal vibrations is called bronchophony. DIF: Recall
REF: p. 340
OBJ: 6
74. What is the area of the anterior chest wall overlying the heart called? a. Epigastrium b. Precordium c. Pericardium d. Axillary ANS: B
The techniques for physical examination of the chest wall overlying the heart (precordium) include inspection, palpation, and auscultation. DIF: Recall
REF: p. 340
OBJ: 7
75. Where is the normal apical impulse (point of maximal impulse [PMI]) usually identified? a. Third right intercostal space, left sternal border b. Fifth left intercostal space, midclavicular line c. Third left intercostal space, anterior axillary line d. Fifth right intercostal space, midclavicular line ANS: B
In healthy individuals who are not obese or overly muscular, the PMI can be felt and visualized near the left midclavicular line in the fifth intercostal space. DIF: Recall
REF: p. 340
OBJ: 7
76. Right ventricular hypertrophy often produces a systolic thrust that can be felt and seen near
which of the following? a. Lower left border of the sternum b. Upper right border of the sternum c. Left fifth intercostal space, midclavicular line d. Lower right border of the sternum ANS: A
Right ventricular hypertrophy, a common manifestation of chronic lung disease, often produces a systolic thrust called a heave that is felt and possibly visualized near the lower left sternal border. DIF: Recall
REF: p. 340
OBJ: 7
77. In which of the following patient categories would the intensity of the point of maximal
impulse (PMI) be most difficult to palpate? a. Chronic pulmonary hyperinflation b. Mitral (bicuspid) stenosis c. Left ventricular hypertrophy d. Right ventricular hypertrophy ANS: A
In patients with chronic pulmonary hyperinflation (emphysema), the PMI may be difficult to locate. Because of the increase in anteroposterior diameter and the changes in lung tissue, systolic vibrations are not well transmitted to the chest wall. DIF: Recall
REF: p. 340
OBJ: 7
78. Which of the following conditions would tend to shift the point of maximal impulse (PMI)
farther to the left? 1. Pulmonary emphysema 2. Collapse of the left lower lobe 3. Collapse of the right lower lobe 4. Right-sided tension pneumothorax a. 1, 2, and 3 only b. 2 and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: B
The PMI may shift either left or right, following deviations in the position of the lower mediastinum, which may be caused by pneumothorax or lobar collapse. Typically, the PMI shifts toward lobar collapse but away from a tension pneumothorax. The PMI in patients with emphysema and low flat diaphragms may be shifted centrally to the epigastric area. DIF: Recall
REF: p. 340
OBJ: 7
79. Normal heart sounds are created primarily by which of the following? a. Opening of the heart valves b. Rush of blood during systole c. Closing of the heart valves d. Electrical conduction in the heart ANS: C
Normal heart sounds are created by closure of the heart valves. DIF: Recall
REF: p. 340
OBJ: 7
80. The first heart sound (S1 ) is created primarily by which of the following? a. Closure of the semilunar valves
b. Opening of the semilunar valves c. Opening of the atrioventricular valves d. Closure of the atrioventricular valves ANS: D
The first heart sound (S1 ) is produced by closure of the mitral and tricuspid (atrioventricular [AV]) valves during contraction of the ventricles. DIF: Recall
REF: p. 340
OBJ: 7
81. The second heart sound (S2 ) is created primarily by which of the following? a. Closure of the semilunar valves b. Opening of the atrioventricular valves c. Closure of the atrioventricular valves d. Opening of the semilunar valves ANS: A
When systole ends, the ventricles relax, and the pulmonic and aortic (semilunar) valves close, creating the second heart sound (S2 ). DIF: Recall
REF: p. 340
OBJ: 7
82. Splitting of the second heart sound (S2 ) is normally most pronounced during which of the
following? a. Exhalation b. Breath holding c. Inhalation d. Forced exhalation ANS: C
The normal splitting of S2 is increased during inhalation because of the decrease in intrathoracic pressure, which improves venous return to the right side of the heart and further delays pulmonic valve closure. DIF: Recall
REF: p. 340
OBJ: 7
83. In which of the following conditions might the intensity of the heart sounds be reduced?
1. Heart failure 2. Severe cachexia 3. Pneumothorax 4. Pleural effusion a. 1, 3, and 4 only b. 2 and 4 only c. 2, 3, and 4 only d. 1, 2, and 3 only ANS: A
Pulmonary hyperinflation, pleural effusion, pneumothorax, and obesity make identification of both S1 and S2 difficult. The intensity of S1 and S2 also decreases when the force of ventricular contraction is poor, as in heart failure, or when valvular abnormalities exist. DIF: Recall
REF: p. 340
OBJ: 7
84. In auscultating the heart sounds of a patient with chronic hypoxemia, you notice a marked
increase in the intensity of the second heart sound (S2 ) and no splitting during inhalation. This finding is most consistent with which of the following? a. Mitral insufficiency b. Left ventricular hypertrophy c. Tricuspid valve stenosis d. Pulmonary hypertension ANS: D
Pulmonary hypertension produces an increased intensity of S2 . This sound is referred to as a loud P2 and is a result of more forceful closure of the pulmonic valve. DIF: Recall
REF: p. 340
OBJ: 7
85. In auscultating the precordium of a patient, you hear a high-pitched ―whooshing‖ noise
occurring simultaneously with S 1 . This finding is most consistent with which of the following? a. Incompetent mitral valve b. Stenotic tricuspid valve c. Incompetent pulmonic valve d. Stenotic mitral valve ANS: A
Systolic murmurs are produced by an incompetent atrioventricular (AV) valve or a stenotic semilunar valve. An incompetent AV valve allows a backflow of blood into the atrium, usually producing a high-pitched ―whooshing‖ noise simultaneously with S 1 . DIF: Recall
REF: p. 340
OBJ: 7
86. Diastolic murmurs are generally associated with which of the following?
1. Stenotic semilunar valve 2. Incompetent atrioventricular (AV) valve 3. Incompetent semilunar valve 4. Stenotic atrioventricular valve a. 1, 2, and 3 only b. 2 and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: C
Diastolic murmurs are created by an incompetent semilunar valve or a stenotic AV valve. DIF: Recall
REF: p. 340
OBJ: 7
87. Which of the following are potential causes of cardiac murmurs?
1. Backflow of blood through an incompetent valve 2. Forward flow through a stenotic valve 3. Rapid flow through a normal valve a. 2 and 3 only b. 1 and 2 only
c. 1, 2, and 3 d. 1 and 3 only ANS: C
Murmurs are created by the following: (1) a backflow of blood through an incompetent valve, (2) a forward flow of blood through a stenotic valve, and (3) a rapid flow of blood through a normal valve. DIF: Recall
REF: p. 340
OBJ: 7
88. Which of the following pulmonary disorders is most likely to result in hepatomegaly? a. Pulmonary atelectasis b. Acute viral infections c. Cor pulmonale d. Acute asthma ANS: C
An enlarged liver is called hepatomegaly and may be caused by right-sided heart failure from chronic hypoxemia (cor pulmonale), although many other causes exist. DIF: Recall
REF: p. 341
OBJ: 7
89. Which of the following abnormalities should the practitioner be on the lookout for during
inspection of the extremities? 1. Digital clubbing 2. Peripheral cyanosis 3. Ascites 4. Impaired capillary refill a. 1 and 2 only b. 1, 2, and 4 only c. 3 and 4 only d. 2 only ANS: B
Respiratory disease may cause several abnormalities of the extremities, including digital clubbing, cyanosis, and pedal edema. DIF: Recall
REF: pp. 341-342 OBJ: 7
90. In which of the following disorders is digital clubbing a common physical sign?
1. Congenital heart disease 2. Lung cancer 3. Chronic obstructive pulmonary disease 4. Pancreatic cancer a. 3 only b. 1, 3 and 4 only c. 1, 2, and 4 only d. 1, 2, and 3 only ANS: D
Many causes of clubbing exist, including infiltrative or interstitial lung disease, bronchiectasis, various cancers (including lung cancer), congenital heart problems that cause cyanosis, chronic liver disease, and inflammatory bowel disease. DIF: Recall
REF: p. 341
OBJ: 7
91. Which of the following is true of peripheral cyanosis? a. Reliable indicator of tissue hypoxia. b. Develops early in patients with anemia. c. Develops late in patients with polycythemia. d. Sign of inadequate tissue perfusion. ANS: D
Cyanosis of the digits is referred to as peripheral cyanosis and is mainly the result of poor blood flow, especially in the extremities. DIF: Recall
REF: p. 341
OBJ: 7
92. In patients with chronic respiratory disease, what does pedal edema indicate? a. Right ventricular failure b. Impaired pulmonary diffusion c. Systemic hypertension d. Left ventricular hypertrophy ANS: A
Pedal edema most often results from heart failure, which causes an increase in the hydrostatic pressure of the venous system and leaking of fluid from the vessels into the surrounding tissues. DIF: Recall
REF: p. 326
OBJ: 7
93. During examination of a patient’s extremities, you press firmly for a brief period on a
fingernail. You observe that it takes approximately 5 sec for the color to return to the nail bed. This finding is most consistent with which of the following? a. Reduction in cardiac output or poor peripheral perfusion b. Presence of a disorder causing chronic hypoxemia c. Reduction in venous return to the right side of the heart d. Presence of a disorder causing systemic hypertension ANS: A
When cardiac output is reduced and digital perfusion is poor, capillary refill is slow, taking several seconds to complete. In healthy individuals with good cardiac output and digital perfusion, capillary refill time is less than 3 sec. DIF: Recall
REF: p. 342
OBJ: 7
94. In palpating a patient’s feet and hands, you note extreme coolness to the touch. This finding is
most consistent with which of the following? a. Presence of a disorder causing chronic hypoxemia b. Reduction in venous return to the right side of the heart c. Peripheral vasoconstriction due to inadequate perfusion d. Presence of a disorder causing systemic hypertension
ANS: C
When perfusion is poor (as in heart failure or shock), the compensatory vasoconstriction in the extremities helps shunt blood to the vital organs. This reduction in peripheral perfusion causes the extremities to become cool to the touch. The extent to which the coolness to touch extends toward the body is an indication of the degree of circulatory failure. DIF: Recall
REF: p. 342
OBJ: 7
95. An RT is examining a patient suspected to have a left-sided tension pneumothorax. During
inspection and palpation, the RT notices the patient’s trachea has shifted to the left. Is the patient’s diagnosis correct? a. Yes, the patient may have left-sided tension pneumothorax. b. No, the patient may have left upper lobe atelectasis. c. No, the patient may have right lower lobe pneumonia. d. No, patient may have left-sided large pleural effusion. ANS: B
The trachea shifts away from areas with increased air, fluid, or tissue (e.g., in tension pneumothorax or large pleural effusion) and toward atelectasis. In general, abnormalities in the lung bases do not shift the trachea. DIF: Analysis
REF: p. 332
OBJ: 2
96. An emergency room patient is lying on his bed with his head elevated at a 45-degree angle.
An RT, who is coming to examine the patient, notices that the patient’s jugular vein extends approximately 7 cm above his sternal angle. What can the RT assume about this patient’s condition? a. Cor pulmonale b. Pneumonia c. Kussmaul’s sign d. Pneumothorax ANS: A
When lying in a supine position, a healthy individual has neck veins that are full. When the head of the bed is elevated gradually to a 45-degree angle, the level of the blood column descends to a point no more than a few centimeters above the clavicle. With elevated venous pressure, the neck veins may be distended as high as the angle of the jaw, even when the patient is sitting upright. Jugular venous distention (JVD) is present when the jugular vein is enlarged and it can be seen more than 3 to 4 cm above the sternal angle. The most common cause of JVD is heart failure (cor pulmonale). Heart failure frequently occurs with advanced COPD because of hypoxemia. This causes chronic pulmonary vasoconstriction and hypertension which leads to right heart failure from the excessive workload. Other conditions associated with JVD include left heart failure, cardiac tamponade, tension pneumothoraces, and mediastinal tumors. DIF: Analysis
REF: p. 332
OBJ: 2
97. A clinician unsuccessfully tried to take the pulse of a patient who is suffering from an asthma
attack in the ER. The patient’s breath sounds are diminished to absent bilaterally with a BP of 110 mm Hg systolic and 90 mm Hg diastolic. What can be concluded about this patient’s condition? 1. Abdominal paradox is present. 2. Lung hyperinflation is present. 3. Pulsus paradoxus is present. 4. Pulse pressure is greater than 30 mm Hg. a. 2 and 3 only b. 1 and 2 only c. 2 only d. 1, 3, and 4 only ANS: A
When the pulse pressure is less than 30 mm Hg during spontaneous inhalation, the peripheral pulse is difficult to detect, which is called pulsus paradoxus, or paradoxical pulse. Pulsus paradoxus is the consequence of lung hyperinflation experienced during a severe asthma attack or status asthmaticus. DIF: Analysis
REF: p. 335
OBJ: 2
98. A 55-year-old patient has been smoking a pack and a half of cigarettes (30 cigarettes) per day
for 30 years. What is the patient’s smoking history? a. 30 pack-years b. 35 pack-years c. 40 pack-years d. 45 pack-years ANS: D
If a patient describes his or her smoking in terms of the number of cigarettes, or fractions of a pack, the calculation is as follows: there are 20 cigarettes per pack. If a patient states he or she has smoked a pack and a half of cigarettes per day for 30 years, then the smoking history is calculated as follows: 30 cigarettes/20 cigarettes-per-pack = 1.5 packs 30 years = 45 pack-year smoking history. DIF: Application
REF: p. 327
OBJ: 2
99. A 23-year-old patient enters the emergency room complaining of dyspnea. The RT places the
patient on oxygen as per hospital protocol and begins to interview the patient about her symptoms. She states that she is having difficulty taking a breath with chest tightness. Patient has a respiratory rate of 28 breaths/min with a loose productive cough. During auscultation, the RT hears bilateral wheezing in the lungs. What is the most likely cause of the patient’s symptoms? a. Asthma b. Bronchitis c. Congestive heart failure d. Emphysema ANS: A
A patient with asthma would suffer from dyspnea caused by the airway obstruction. Usually a patient with asthma will complain of chest tightness and difficulty to take a breath. Bilateral wheezing and a loose, productive cough are also signs of an asthma attack. DIF: Analysis
REF: p. 324
OBJ: 2 | 3 | 4 | 5| 6
100. What term is used to describe the absence of breathing? a. Orthopnea b. Platypnea c. Eupnea d. Apnea ANS: D
Apnea is the term used to describe no breathing and is typically caused by cardiac arrest, narcotic overdose, and severe brain trauma. DIF: Recall
REF: p. 334
OBJ: 2
Chapter 17 - Interpreting Clinical and Laboratory Data Kacmarek et al.: Egan’s Funda mentals of Respiratory Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following are formed elements in the blood?
1. Leukocytes 2. Erythrocytes 3. Thrombocytes 4. Electrolytes a. 1 and 2 only b. 1, 2, and 3 only c. 2, 3, and 4 only d. 1, 2, and 4 only ANS: C
The complete blood count (CBC) is routinely performed from a venous blood sample and examines the formed elements in the blood. It provides a detailed description of the number of circulating white blood cells (WBCs), called leukocytes, red blood cells (RBCs), called erythrocytes, and platelets, called thrombocytes. DIF: Recall
REF: p. 346
OBJ: 2
2. What term is used to describe a white blood cell (WBC) count that is above normal values? a. Leukocytosis b. Leukopenia c. Neutropenia d. Polycythemia ANS: A
Elevation of the WBC count is known as leukocytosis. DIF: Recall
REF: p. 346
OBJ: 2
3. What term is used to describe a white blood cell (WBC) count that is below normal values? a. Anemia b. Thrombocytopenia c. Leukopenia d. Hypoleukemia ANS: C
A WBC count that is below normal is known as leukopenia. DIF: Recall
REF: p. 346
OBJ: 2
4. Which of the following are causes of leukopenia?
1. Chemotherapy 2. Bone marrow disease 3. Radiation therapy 4. Antibiotics
a. b. c. d.
1 and 4 only 1, 2, and 3 only 2 and 3 only 1, 2, and 4 only
ANS: B
Diseases of the bone marrow (e.g., leukemia, lymphoma) and chemotherapy and radiation therapy for cancer are common causes of leukopenia. DIF: Recall
REF: p. 346
OBJ: 2
5. What type of white blood cell increases in response to allergic reactions? a. Neutrophils b. Eosinophils c. Lymphocytes d. Monocytes ANS: B
See Table 17-2 for a list of the normal differential counts in the adult patient and common causes for elevation of each cell type. DIF: Recall
REF: p. 347
OBJ: 2
6. What type of white blood cell increases in response to viral infections? a. Neutrophils b. Eosinophils c. Lymphocytes d. Monocytes ANS: C
See Table 17-2 for a list of the normal differential counts in the adult patient and common causes for elevation of each cell type. DIF: Recall
REF: p. 347
OBJ: 1
7. What is the name used for immature neutrophils? a. Segs b. Bands c. Polys d. Neutros ANS: B
Immature neutrophils are known as bands due to the banded shape of the nucleus. DIF: Recall
REF: p. 347
OBJ: 2
8. What term is used to describe a result significantly outside the reference range that may
represent a pathophysiologic condition? a. Reference range b. Biological reference intervals c. Expected value d. Critical test value
ANS: D
A critical test value is a result significantly outside the reference range and represents a pathophysiologic condition. A critical value may be potentially life threatening unless corrective action is taken promptly. DIF: Recall
REF: p. 346
OBJ: 1
9. What term is used to describe a red blood cell (RBC) count that is below normal values? a. Leukocytosis b. Leukopenia c. Anemia d. Polycythemia ANS: C
An abnormally low RBC count is referred to as anemia and suggests that either RBC production by the bone marrow is inadequate or excessive loss of blood has occurred. DIF: Recall
REF: p. 348
OBJ: 2
10. What term is used to describe a red blood cell (RBC) count that is above normal values? a. Leukocytosis b. Leukopenia c. Anemia d. Polycythemia ANS: D
An abnormally elevated RBC count is known as polycythemia. DIF: Recall
REF: p. 348
OBJ: 2
11. What abnormality in the complete blood count is often seen in a patient with significant
hypoxemia caused by chronic lung disease? a. Leukocytosis b. Anemia c. Polycythemia d. Leukopenia ANS: C
Polycythemia helps prevent the negative side effects of reduced PO 2 in the blood by increasing the oxygen-carrying capacity of the blood. DIF: Recall
REF: p. 348
OBJ: 2
12. The mean cell hemoglobin concentration of your patient is reduced. What type of anemia is
this? a. Microcytic b. Macrocytic c. Hypochromic d. Hypotrophic ANS: C
Patients with an inadequate hemoglobin concentration will have red blood cells that are smaller than normal (microcytic) and lack normal color (hypochromic). DIF: Recall
REF: p. 348
OBJ: 2
13. What test is useful for evaluating the blood-clotting ability of your patient? a. Red blood cell count b. Platelet count c. Neutrophil count d. Hematocrit ANS: B
The complete blood cell count also reports the number of circulating platelets (thrombocytes), which are the smallest formed elements in the blood and are important for coagulation. DIF: Recall
REF: p. 352
OBJ: 1
14. What term is used to describe a platelet count below normal? a. Anemia b. Leukopenia c. Thrombocytopenia d. Thrombocytosis ANS: C
A significant reduction in the platelet count (known as thrombocytopenia) occurs with bone marrow diseases or with disseminated intravascular coagulation. DIF: Recall
REF: p. 348
OBJ: 2
15. Which of the following values represents a normal serum potassium level? a. 137 to 147 mEq/L b. 98 to 105 mEq/L c. 7 to 20 mEq/L d. 3.5 to 5.0 mEq/L ANS: D
The normal values for these electrolytes are listed in Table 17-3. DIF: Recall
REF: pp. 349-350 OBJ: 3
16. What term is used to describe a sodium concentration that is below normal in the blood
serum? a. Hypokalemia b. Hyponatremia c. Hypocalcemia d. Hypochloremia ANS: B
A low sodium level is referred to as hyponatremia, and it may occur with diuretic therapy, diarrhea, or certain kidney problems. DIF: Recall
REF: p. 350
OBJ: 3
17. What term is used to describe a potassium concentration that is below normal in the blood
serum? a. Hypokalemia b. Hyponatremia c. Hypocalcemia d. Hypochloremia ANS: A
An abnormally low serum potassium level is known as hypokalemia. DIF: Recall
REF: p. 350
OBJ: 3
18. In which of the following clinical settings would hypokalemia be a significant problem? a. During weaning from mechanical ventilation b. In a patient with pleural effusion c. In a patient with kyphoscoliosis d. During a bronchial challenge test ANS: A
The potassium level is of particular interest in the patient being weaned from mechanical ventilation, because both hyperkalemia and hypokalemia may render the diaphragm weak and less effective. DIF: Application
REF: p. 350
OBJ: 3
19. The total carbon dioxide (CO 2 ) value is linked to what electrolyte in the blood serum? a. Sodium b. Potassium c. Bicarbonate d. Chloride ANS: C
The total CO 2 represents the level of HCO 3− in venous blood. DIF: Recall
REF: p. 350
OBJ: 3
20. The sweat chloride level is used to diagnose which of the following disorders? a. Asthma b. Cystic fibrosis c. Hyperthyroidism d. Hepatitis ANS: B
Patients with cystic fibrosis have increased levels of chloride in their sweat because of their inability to reabsorb it. DIF: Recall
REF: p. 354
21. What is the normal anion gap? a. 5 to 10 mEq/L b. 8 to 14 mEq/L
OBJ: 3
c. 25 to 32 mEq/L d. 35 to 45 mEq/L ANS: B
The normal anion gap is 8 to 14 mEq/L. DIF: Recall
REF: p. 351
OBJ: 3
22. What is indicated by an elevation of the anion gap? a. Respiratory failure b. Metabolic alkalosis c. Metabolic acidosis d. Renal failure ANS: C
Elevation of the anion gap suggests that a metabolic acidosis is present, and further evaluation of the patient’s acid-base status is necessary. DIF: Recall
REF: p. 351
OBJ: 3
23. Which of the following tests is used to evaluate renal function? a. Creatinine b. Protein level c. Serum enzymes d. Sweat chloride ANS: A
The most common tests performed to evaluate kidney function are blood urea nitrogen and creatinine. DIF: Recall
REF: p. 350
OBJ: 3
24. Your patient has an elevated aspartate aminotransferase (AST). What two organs are most
likely diseased? a. Heart and brain b. Liver and kidney c. Brain and kidney d. Heart and liver ANS: D
The highest concentrations of AST are found in patients with liver disease, such as hepatitis, and during the second day after a myocardial infarction. DIF: Recall
REF: p. 351
OBJ: 4
25. A patient receiving heparin has a prothrombin time (PT) of 19 sec and an International
Standardized Ratio (INR) of approximately 5.0, what does this indicate? a. High likelihood of excessive bleeding. b. Patient’s results are normal. c. High likelihood of increased clotting. d. Possible embolism. ANS: A
Prothrombin time (PT) is defined as the time in seconds required by plasma to form a fibrin clot following exposure to tissue factors. Clinically, abnormal increases in PT and PTT are found in patients with vitamin K deficiencies, and patients on anticoagulation therapy such as warfarin or heparin. PT is accompanied by an additional measurement known as the International Standardized Ratio (INR). The INR expresses PT relative to an established sample value. A normal INR value is 0.9 to 1.3. INR values of approximately 5.0 indicate a high likelihood for bleeding. Values of 0.5 are associated with a tendency toward increased clotting. DIF: Application
REF: p. 352
OBJ: 4
26. What is the upper limit of normal for the fasting blood glucose level? a. 50 mg/dl b. 85 mg/dl c. 120 mg/dl d. 140 mg/dl ANS: D
A blood glucose level above 140 mg/dl on two occasions indicates diabetes is present in most cases. DIF: Recall
REF: pp. 349-350 OBJ: 2
27. A patient is brought into the ER with chest pain. The physician is having difficulty confirming
the patient’s diagnosis through an ECG. Blood results show an elevated level of CPK-2. What can the physician suspect after reviewing the blood work? a. Pulmonary embolism b. Gastroesophageal reflux c. Myocardial infarction d. Valvular stenosis ANS: C
The most common CPK enzyme test is CPK-2 (CPK-MB) which is released from the heart following myocardial infarction. Peak levels occur sometime between 12 and 24 hr following injury. Serial CPK-2 measurements are monitored in patients with suspected myocardial infarction, as well as patients with cardiac contusion from chest trauma, open-heart surgery, or myocarditis. DIF: Analysis
REF: p. 352
OBJ: 4
28. An 80-year-old patient arrives in the emergency room complaining of difficulty breathing
with signs of pulmonary edema. The clinician orders a B-type Natriuretic Peptide (BNP) test to be performed on the patient. The test result shows 800 pg/ml. What is the patient’s possible condition? a. Severe heart failure b. Respiratory distress syndrome c. Severe sepsis d. Mild heart failure ANS: A
B-type Natriuretic Peptide (BNP) is a substance secreted by the heart in response to increased stretch in the cardiac muscle. The BNP test is used primarily to evaluate patients for heart failure, particularly those who present to the emergency department with dyspnea and pulmonary edema.4 In general, values greater than 300 pg/ml are indicative of mild heart failure whereas values in excess of 600 and 900 pg/ml are found in patients with moderate and severe heart failures, respectively. DIF: Application
REF: p. 352
OBJ: 4
29. Which of the following Gram stain results suggests the most legitimate sputum sample in a
patient with pneumonia? a. Many epithelial cells and many pus cells b. Few pus cells and many epithelial cells c. Few pus cells and few epithelial cells d. Few epithelial cells and many pus cells ANS: D
In such cases, the Gram stain will demonstrate few (<25 per low-power field) or no pus cells and numerous epithelial cells. DIF: Recall
REF: p. 353
OBJ: 6
30. What should be done in response to a sputum sample that has many epithelial cells in it? a. Repeat Gram stain. b. Sputum culture. c. Sputum sensitivity. d. Obtain new sputum sample. ANS: D
Many epithelial cells indicate that the sample is merely saliva and should be discarded because it will not reflect the type of infection occurring in the lung. DIF: Recall
REF: p. 353
OBJ: 6
31. An RT receives a doctor’s order to perform an ABG on a 71-year-old woman. Upon
reviewing the patient’s chart, the RT notices that the patient has a platelet count of 110 103 mcl. What should the RT do? 1. Perform ABG as normal. 2. Refuse to perform the ABG. 3. After ABG is performed, compress the puncture site for a longer time. 4. Recommend that an ABG should be performed on the patient only when it is absolutely necessary. a. 2 and 4 only b. 1 only c. 3 and 4 only d. 2 only ANS: C
In patients requiring arterial blood gas (ABG) testing, or who need nasotracheal suctioning, RTs must evaluate the clotting characteristics of the blood. For ABG testing, patients with an abnormally low platelet count, or an elevated PT and INR, will need to have the puncture site compressed for a longer time after the arterial sample is obtained to prevent bleeding and hematoma development. Patients with an extremely low platelet count should have an arterial puncture performed (or undergo nasotracheal suctioning) only when it is essential because of the extraordinary high risk of bleeding. Normal platelet count is 150 to 400 103 mcl. DIF: Analysis
REF: pp. 353-354 OBJ: 5
32. An ICU patient in septic shock shows the following electrolyte panel results: a serum Na + of
150 mmol/L, a total CO 2 of 18 mmol/L, lactate of 4 mmol/L, and a serum Cl– level of 110 mmol/L. The patient is hypotensive and the RT is unable to obtain an ABG for analysis. What conclusion(s) can be drawn regarding this patient’s acid-base status? 1. The anion gap is decreased. 2. Metabolic acidosis is present. 3. Anion gap is increased. 4. Lactic acidosis is present. a. 1, 2, and 4 only b. 1 only c. 2 and 4 only d. 2, 3, and 4 only ANS: D
The anion gap is calculated by subtracting the sum of CO2 and Cl– from the Na+ (150 – [110 + 18]). In this case the anion gap is elevated (22 mmol/L) and is consistent with a metabolic acidosis. Normal anion gap is 8-14 mmol/L. The increased lactate values reveal the presence of lactic acidosis due to anaerobic metabolism as a cause of the metabolic acidosis in this patient. Normal lactate range is 0.7 to 2.1 mmol/L. DIF: Analysis
REF: pp. 350-351 OBJ: 3
33. What term is used to describe a chloride concentration that is below normal in the blood
serum? a. Hypokalemia b. Hyponatremia c. Hypocalcemia d. Hypochloremia ANS: D
An abnormally low serum chloride level is known as hypochloremia. DIF: Recall
REF: p. 350
OBJ: 3
34. Which of the following values represents a normal serum sodium level? a. 136 to 145 mEq/L b. 98 to 105 mEq/L c. 7 to 20 mEq/L d. 3.5 to 5.0 mEq/L ANS: A
The normal values for these electrolytes are listed in Table 17-3. DIF: Recall
REF: p. 349
OBJ: 3
35. Which of the following values represents a normal serum chloride level? a. 136 to 145 mEq/L b. 98 to 106 mEq/L c. 7 to 20 mEq/L d. 3.5 to 5.0 mEq/L ANS: B
The normal values for these electrolytes are listed in Table 17-3. DIF: Recall
REF: p. 349
OBJ: 3
36. Which of the following values represents a normal serum lactate level? a. 0.7 to 2.1 mEq/L b. 1.2 to 2.3 mEq/L c. 1.7 to 2.1 mEq/L d. 3.5 to 5.0 mEq/L ANS: A
The normal values for these electrolytes are listed in Table 17-3. DIF: Recall
REF: p. 349
OBJ: 3
37. What is the name used for mature neutrophils? a. Segs b. Bands c. Polys d. Neutros ANS: A
Mature neutrophils are known as segs because of the segmented shape of their nucleus. DIF: Recall
REF: p. 347
OBJ: 2
Chapter 19 - Analysis and Monitoring of Gas Exchange Kacmarek et al.: Egan’s Fundamentals of Respiratory Care, 12th Edition
MULTIPLE CHOICE
1. Which of the following are true about invasive versus noninvasive monitoring? 1. Invasive procedures require insertion of a device into the body. 2. Laboratory analysis of gas exchange is usually noninvasive in nature. 3. Physiologic monitoring can be either invasive or noninvasive. 4. Invasive procedures provide more accurate data but carry greater risks. a.
2 and 4 only
b.
1, 3, and 4 only
c.
2 only
d.
1, 2, 3, and 4
ANS: B Invasive procedures require the insertion of a sensor or collection device into the body, whereas noninvasive monitoring is a means of gathering data externally. Because laboratory analysis of gas exchange requires blood samples, it is usually considered invasive. On the other hand, monitoring can be either invasive or noninvasive. In general, invasive procedures tend to provide more accurate data than do noninvasive methods but carry greater risk. DIF:
Recall
REF:
p. 370
OBJ:
1
2. Under ideal conditions, electrochemical oxygen (O2) analyzers have approximately what degree of accuracy? a.
1%
b.
2%
c.
3%
d.
4%
ANS: B There are two common types of electrochemical oxygen analyzers: (1) the polarographic (Clark) electrode and (2) the galvanic fuel cell. Under ideal conditions of temperature, pressure, and relative humidity, both types are accurate to within ±2% of the actual concentration. DIF:
Recall
REF:
p. 370
OBJ:
2
3. How does the Clark polarographic O2 electrode function? a.
It measures the magnetic properties of O2 versus N2.
b.
It measures the electrical potential across a Wheatstone bridge.
c.
It uses O2 to produce a reduction-oxidation reaction.
d.
It measures the comparative cooling effect on a heated wire.
ANS: C This system typically consists of a platinum cathode and a silver-silver chloride anode (Figure 19-1). Oxygen molecules diffuse through the sensor membrane into the electrolyte, where a polarizing voltage causes electron flow between the anode and cathode. While silver is oxidized at the anode, the flow of electrons reduces oxygen (and water) to hydroxyl ions (OH−) at the cathode. The more O2 molecules that are reduced, the greater is the electron flow across the poles (current). The resulting change in current is proportional to the PO2, with its value displayed on a galvanometer, calibrated in percent oxygen. DIF:
Recall
REF:
p. 370
OBJ:
2
4. Which of the following is false about the galvanic fuel cell O2 analyzer? a.
It actually measures the PO2 and not the O2 concentration.
b.
It requires an external power source (alternating current line or batteries).
c.
It has a slower response time than the Clark
electrode. d.
Its fuel cells deplete and must be periodically replaced.
ANS: B Most galvanic fuel cells use a gold anode and a lead cathode. Unlike the Clark electrode, current flow across these poles is generated by the chemical reaction itself. Thus, unless accessories such as alarms are included, a galvanic cell needs no external power. Unfortunately, this means that galvanic cells re spond more slowly than do Clark electrodes, sometimes taking as long as 60 sec. DIF:
Recall
REF:
p. 370
OBJ:
2
5. While checking a polarographic (Clark) electrode, you determine that the device fails to read 100% when exposed to pure O2. Which of the following actions would be the proper first step? a.
Check the silica crystals.
b.
Send the device out for repair.
c.
Replace the analyzer’s batteries.
d.
Change the analyzer’s fuel cell.
ANS: C Because a low battery condition is so common with Clark electrode systems, the first step in troubleshooting is to replace the batteries. DIF:
Recall
REF:
p. 371
OBJ:
3
6. During calibration of a Clark polarographic O 2 analyzer, you cannot get the sensor to read 100% when exposed to 100% O2, even after adjusting its calibration control. The unit has new batteries. Which of the following actions would be correct? a.
Use it only with low FiO2 values.
b.
Send the device out for repair.
c.
Replace the unit’s batteries.
d.
Change the sensor or electrode.
ANS: D If the analyzer still does not calibrate on fresh batteries, the problem is probably a depleted sensor. With most analyzers, a depleted sensor must be replaced (some Clark electrodes can be recharged). DIF:
Recall
REF:
p. 371
OBJ:
3
7. You are asked to provide continuous monitoring of the FiO 2 provided by a humidified O 2 delivery system using a galvanic cell analyzer. Where would you install the analyzer’s sensor? a.
Proximal to the heated humidifier
b.
On the expiratory side of the circuit
c.
Distal to the heated humidifier
d.
As close to the patient as possible
ANS: A To avoid this problem during continuous use in humidified circuits, the clinician should place the analyz er sensor proximal to any humidification device. DIF:
Recall
REF:
p. 371
OBJ:
3
8. Which of the following sites are used for arterial blood sampling by percutaneous needle puncture? 1. Femoral 2. Radial 3. Brachial 4. Carotid a.
2 and 3 only
b.
1 and 4 only
c.
1, 2, and 3 only
d.
1, 2, 3, and 4
ANS: C
Arterial puncture involves drawing blood from a peripheral artery (radial, brachial, femoral, or dorsalis pedis) through a single percutaneous needle puncture. DIF:
Recall
REF:
p. 371
OBJ:
4
9. Why is the radial artery the preferred site for arterial blood sampling? 1. It is near the surface and easy to palpate and stabilize. 2. The ulnar artery normally provides good collateral circulation. 3. The radial artery is not near any large veins. 4. It is the largest artery located in the upper extremities. a.
1 and 4 only
b.
3 only
c.
2 and 4 only
d.
1, 2, and 3 only
ANS: D The radial artery is the preferred site for arterial blood sampling for the following reasons: • It is near the surface and relatively easy to palpate and stabilize. • Effective collateral circulation normally exists in the ulnar artery. • The artery is not near any large veins. • The procedure is relatively pain free. DIF:
Recall
REF:
pp. 371-372
OBJ:
4
10. Clinical indications for arterial blood analysis include which of the following? 1. Sudden, unexplained dyspnea 2. Cardiopulmonary resuscitation 3. Changes in ventilator settings 4. Chest pain
a.
1 and 3 only
b.
2 and 4 only
c.
1, 2, and 4 only
d.
1, 2, and 3 only
ANS: D Box 19-3 lists the clinical indications for arterial blood gas analysis. DIF:
Recall
REF:
p. 373
OBJ:
4
11. Which of the following are reasons for finding an alternative site for arterial puncture? 1. Failed Allen test 2. History of peripheral vascular disease 3. Anticoagulation therapy 4. Presence of a surgical shunt a.
1, 2, and 4 only
b.
2 and 4 only
c.
1, 2, and 3 only
d.
1, 3, and 4
ANS: A To guide practitioners in providing quality care, the American Association for Respiratory Care (AARC) has published Clinical Practice Guideline: Sampling for Arterial Blood Gas Analysis. Modified excerpts from the AARC guideline appear on p. 373. DIF:
Recall
REF:
p. 373
OBJ:
4
12. Precautions and/or possible complications of arterial puncture include which of the following? 1. Arteriospasm 2. Embolization
3. Infection 4. Hemorrhage a.
1, 2, and 3 only
b.
2 and 3 only
c.
2 and 4 only
d.
1, 2, 3, and 4
ANS: D To guide practitioners in providing quality care, the American Association for Respiratory Care (AARC) has published Clinical Practice Guideline: Sampling for Arterial Blood Gas Analysis. Modified excerpts from the AARC guideline appear on p. 373. DIF:
Recall
REF:
p. 373
OBJ:
4
13. Which of the following should be monitored during the sampling of arterial blood? 1. Blood pressure proximal to puncture site 2. Presence of pulsatile blood return 3. Presence of air bubbles or clots in sample 4. Appearance of puncture site a.
1, 2, and 3 only
b.
2, 3, and 4 only
c.
1, 2, 3, and 4
d.
2 and 3 only
ANS: B To guide practitioners in providing quality care, the American Association for Respiratory Care (AARC) has published Clinical Practice Guideline: Sampling for Arterial Blood Gas Analysis. Modified excerpts from the AARC guideline appear on p. 373. DIF:
Recall
REF:
p. 373
OBJ:
4
14. Which of the following patient parameters does not need to be assessed as part of arterial blood sampling? a.
Blood pressure
b.
Temperature
c.
Position or activity level
d.
Clinical appearance
ANS: A To guide practitioners in providing quality care, the American Association for Respiratory Care (AARC) has published Clinical Practice Guideline: Sampling for Arterial Blood Gas Analysis. Modified excerpts from the AARC guideline appear on p. 373. DIF:
Recall
REF:
p. 373
OBJ:
4
15. Purposes of a needle-capping device include which of the following? 1. To isolate the sample from air exposure 2. To help prevent needlestick injuries 3. To hold the excess anticoagulant a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: A If provided, the needle-capping device serves two purposes. First, it isolates the sample from air exposure (to ensure accurate results). Second, it helps prevent inadvertent needlestick injuries. DIF:
Recall
REF:
p. 372
OBJ:
4
16. After obtaining an arterial blood sample through percutaneous puncture using a syringe that does not have a capping safety device, what should you do?
a.
Remove the needle with a Kelly clamp, then plug the syringe.
b.
“Scoop” the needle cap up with one hand, then plug the syringe.
c.
Force the needle into a rubber cork or plastic stopper.
d.
Manually remove and bend the needle, then plug the syringe.
ANS: B If a capping safety device is not provided, the clinician should use the single-handed “scoop” method to cap the needle before removing it and plugging the syringe. DIF:
Recall
REF:
p. 374
OBJ:
4
17. Which of the following Centers for Disease Control and Prevention (CDC) barrier precautions would you use when obtaining an arterial blood gas (ABG) through percutaneous puncture? 1. Gloves 2. Protective eyewear 3. Gown or apron a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: A See Box 19-1. DIF:
Recall
REF:
p. 372
OBJ:
4
18. What size needle would you recommend to obtain an ABG sample through percutaneous puncture of an infant?
a.
18 gauge
b.
20 gauge
c.
22 gauge
d.
25 gauge
ANS: D See Box 19-1. DIF:
Recall
REF:
p. 372
OBJ:
4
19. Required equipment and supplies for percutaneous arterial blood sampling of an adult include all of the following except: a.
antiseptic (alcohol or Betadine).
b.
patient or sample label.
c.
20- to 22-gauge needle.
d.
local anesthetic.
ANS: D See Box 19-1. DIF:
Recall
REF:
p. 372
OBJ:
4
20. What chart information should be checked before performing artery puncture? 1. Patient’s primary diagnosis and history 2. Presence of bleeding disorders or blood-borne infections 3. Anticoagulant or thrombolytic drug prescriptions 4. Respiratory care orders (e.g., O2 therapy) a.
1, 2, and 3 only
b.
2 and 3 only
c.
2, 3, and 4 only
d.
1, 2, 3, and 4
ANS: D Box 19-2 outlines the basic procedure for radial artery puncture of adults. DIF:
Recall
REF:
p. 374
OBJ:
4
21. Which of the following describes the correct procedure for an Allen test? a.
Compress both the radial and ulnar arteries, and then release the radial artery.
b.
Compress both the radial and ulnar arteries, and then release the ulnar artery.
c.
Compress both the radial and ulnar arteries, and then release both arteries at once.
d.
Compress the brachial artery only and observe circulation to the hand.
ANS: B Box 19-2 outlines the basic procedure for radial artery puncture of adults. DIF:
Recall
REF:
p. 374
OBJ:
4
22. After obtaining an arterial blood sample, what should you do? 1. Apply pressure to the puncture site until bleeding stops. 2. Place the sample in a transport container with ice slush. 3. Check to see if the patient is getting anticoagulant therapy. 4. Mix the sample by rolling and inverting the syringe. a.
1 and 2 only
b.
1, 2, and 4 only
c.
3 and 4 only
d.
1, 2, 3, and 4
ANS: B Box 19-2 outlines the basic procedure for radial artery puncture of adults. DIF:
Recall
REF:
p. 374
OBJ:
4
23. How long should you wait before drawing an ABG on a chronic obstructive pulmonary disease (COPD) patient whose FiO2 has just been changed? a.
5 to 10 min
b.
10 to 15 min
c.
15 to 20 min
d.
20 to 30 min
ANS: D Box 19-2 outlines the basic procedure for radial artery puncture of adults. DIF:
Recall
REF:
p. 375
OBJ:
4
24. Before performing puncture or cannulation of the radial artery, what should you do? a.
Fix and tighten a tourniquet above the antecubital fossa.
b.
Perform the Allen test to ensure collateral circulation.
c.
Inject heparin into the adjoining subcutaneous tissues.
d.
Apply firm pressure to the arterial site for 5 min.
ANS: B
Box 19-2 outlines the basic procedure for radial artery puncture of adults. DIF:
Recall
REF:
p. 375
OBJ:
4
25. You return to a patient’s room 20 min after drawing an ABG. Which of the following should you check at this time? 1. Puncture site for hematoma 2. Adequacy of distal circulation 3. Prothrombin or partial thromboplastin times a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: A Box 19-2 outlines the basic procedure for radial artery puncture of adults. DIF:
Recall
REF:
p. 374
OBJ:
4
26. When performing an Allen test on the left hand of a patient, you notice that the palm, fingers, and thumb remain blanched for more than 15 sec after pressure on the ulnar artery is released. What should you do? a.
Use the brachial site for sampling.
b.
Sample from the contralateral radial artery.
c.
Use the femoral site for sampling.
d.
Perform the Allen test on the right hand.
ANS: D Box 19-2 outlines the basic procedure for radial artery puncture of adults. DIF:
Recall
REF:
p. 374
OBJ:
4
27. You are asked to calibrate an O2 analyzer. Which of the following gases would you use for this procedure? 1. 100% oxygen 2. 50% oxygen 3. 21% oxygen (room air) a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: B To obtain accurate results with an O 2 analyzer, the clinician first must calibrate it according to manufacturer’s recommendations. Although procedures differ according to the manufacturer, the basic steps are similar, requiring exposure of the sensor to two gases with different O 2 concentrations, usually 100% O2 and room air (21% O2 ). In one common procedure, the sensor is first exposed to 100% O 2. If the analyzer fails to read 100%, the device’s calibration, or balance control, must be adjusted until it reads 100%. Then, the clinician exposes the sensor to room air and confirms a second reading of 21% ( ±2%). The clinician should use the analyzer to measure a patient’s FiO2 only after confirming both readings. DIF:
Recall
REF:
p. 371
OBJ:
3
28. A patient suffering from traumatic brain injury in the ICU has a PtO2 (tissue oxygen) value of 10 to 15 mm Hg, what does this indicate? a.
Normal intracranial pressure
b.
Ischemic brain damage
c.
Normal cerebral perfusion
d.
Cerebral hyperperfusion
ANS: B In patients with traumatic brain injury, brain tissue oxygen (PtO2 ) values when intracranial pressure and cerebral perfusion are normal are between 25 and 30 mm Hg. The critical threshold for ischemic brain damage and poor outcome is suspected to be around a brain PtO2 of 10 to 15 mm Hg.
DIF:
Recall
REF:
p. 386
OBJ:
7
29. When performing a percutaneous needle puncture of the radial artery, you get only a small spurt of blood. Which of the following is the best action at this time? a.
Slowly withdraw the needle until a pulsatile flow fills the syringe.
b.
Pull out entirely, use a different angle and then reinsert it.
c.
Slowly advance the needle until a pulsatile flow fills the syringe.
d.
Repeat the procedure with a fresh blood gas kit.
ANS: A If you get only a small spurt of blood, the needle has probably passed through the artery. In this situa tion, slowly withdraw the needle until a pulsatile flow fills the syringe. DIF:
Recall
REF:
p. 373
OBJ:
4
30. Which of the following indicates venous admixture during arterial puncture? 1. Need to use syringe suction. 2. Dark-colored blood. 3. Small sample volumes. a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: B Small sample volumes or the need to apply syringe suction also may indicate that venous blood has been obtained.
DIF:
Recall
REF:
p. 373
OBJ:
4
31. If patient pain or anxiety occurs during arterial puncture, which of the following will probably occur? a.
Hypoventilation
b.
Hyperventilation
c.
Respiratory acidosis
d.
Hypoxemia
ANS: B If you suspect that pain or anxiety during the procedure may have altered the results (most typically causing hyperventilation), consider using a local anesthetic for subsequent sampling attempts. DIF:
Recall
REF:
p. 374
OBJ:
4
32. Most pre-analytical ABG errors can be avoided by ensuring that the sample is which of the following? 1. Properly anticoagulated. 2. Obtained anaerobically. 3. Analyzed within 15 to 30 min. a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: D Clinicians can avoid most pre-analytical errors by ensuring that the sample is obtained anaerobically, is properly anticoagulated (with immediate expulsion of air bubbles), and is analyzed within 15 min. DIF:
Recall
REF:
p. 375
OBJ:
4
33. Which of the following would you expect to occur if too much heparin was used in gathering an ABG
sample from a patient breathing room air? –
a.
Increase in HCO3
b.
Decrease in PCO2
c.
Decrease in pH
d.
Decrease in PO2
ANS: B See Table 19-1. DIF:
Recall
REF:
p. 375
OBJ:
4
34. To avoid the dilution effects caused by too much sodium heparin during ABG sampling of an adult, what should you do? 1. Ensure a sample volume greater than 2 ml. 2. Use dry heparin instead. 3. Fill the needle dead space only. 4. Use saline if dry heparin is not available. a.
1 and 4 only
b.
1 and 3 only
c.
2 and 4 only
d.
1, 2, and 3 only
ANS: D See Table 19-1. DIF:
Recall
REF:
p. 375
OBJ:
4
35. A practitioner forgets to ice an ABG sample and leaves it at room temperature for 45 min. Which of the following parameters can you predict will increase in this sample during that period? 1. PCO2
2. pH 3. PO2 a.
1 only
b.
1 and 2 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: A See Table 19-1. DIF:
Recall
REF:
p. 375
OBJ:
4
36. When analyzing an ABG sample from a patient with acute respiratory distress syndrome and refractory hypoxemia, you notice a PaO 2 of 141 mm Hg and a PaCO2 of 14 mm Hg. Which of the following analytic errors should you suspect? a.
Excessive time since sample collection
b.
Exposure of the blood sample to air
c.
Excessive heparin in the sample
d.
Sample admixture with venous blood
ANS: B See Table 19-1. DIF:
Application
REF:
p. 375
OBJ:
4
37. Which of the following changes would occur if an arterial blood sample of a patient breathing room air were exposed to a large air bubble? 1. Decreased PCO2 2. Decreased pH 3. Increased PO2
a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: B See Table 19-1. DIF:
Recall
REF:
p. 375
OBJ:
4
38. Which of the following can help avoid the problem of arterial blood sample contamination with air? 1. Discarding frothy samples 2. Fully expelling any bubbles 3. Mixing before expelling air 4. Capping syringe quickly a.
2 and 3 only
b.
1, 2, and 4 only
c.
1 and 4 only
d.
1, 2, 3, and 4
ANS: B See Table 19-1. DIF:
Recall
REF:
p. 375
OBJ:
4
39. Analysis of an arterial blood sample taken from a healthy athlete reveals a pH of 7.36, a PCO2 of 45 mm Hg, and a PO2 of 43 mm Hg. Which of the following analytic errors should you suspect? a.
Excessive time since sample collection
b.
Exposure of the blood sample to air
c.
Excessive heparin in the sample
d.
Sample admixture with venous blood
ANS: D See Table 19-1. DIF:
Application
REF:
p. 375
OBJ:
4
40. Because of an extremely low PO 2 , you suspect that an arterial blood sample taken from a patient’s brachial artery might have been contaminated with venous blood. Which of the following might help to confirm your suspicion? a.
Call the laboratory resources/staff to get the latest chemistry report.
b.
Inspect the sample for color and consistency.
c.
Cross-check the sample with an SpO2 reading.
d.
Measure the sample’s actual hemoglobin saturation.
ANS: C See Table 19-1. DIF:
Recall
REF:
p. 375
OBJ:
4
41. You determine that a blood gas sample that requires analysis has been sitting in ice slush for 90 min. What should you do? a.
Go ahead and analyze the sample (because it was on ice).
b.
Warm the sample to room temperature before analysis.
c.
Readjust the blood gas analyzer temperature to 0° C.
d.
Discard the sample and notify the appropri-
ate clinician.
ANS: D Even chilled samples should be discarded if they are not analyzed within 60 min. DIF:
Recall
REF:
p. 375
OBJ:
4
42. An outpatient scheduled for an arterial blood sample enters the pulmonary lab 20 min late and out of breath, having run up four flights of stairs. What should you do? a.
Postpone the blood sample until tomorrow.
b.
Scold the patient for being so late.
c.
Wait 5 min before taking the sample.
d.
Scold the patient for using the stairs.
ANS: C Patients with healthy lungs achieve a steady state in only 5 min after changes, whereas those with chronic obstructive pulmonary disease may require as long as 20 to 30 min. DIF:
Recall
REF:
p. 375
OBJ:
4
43. A PaO2 below what value would be considered moderate hypoxemia? a.
75 mm Hg
b.
65 mm Hg
c.
55 mm Hg
d.
Depends on the FiO2
ANS: C A PaO2 of less than 40 mm Hg is called severe hypoxemia, a PaO2 of 40 to 59 mm Hg is called moderate hypoxemia, and a PaO2 of 60 mm Hg to the predicted normal is called mild hypoxemia. DIF:
Recall
REF:
p. 376
OBJ:
4
44. What is a normal level for CaO2? a.
12 to 15 ml/100 ml
b.
14 to 16 ml/100 ml
c.
18 to 20 ml/100 ml
d.
16 to 22 ml/100 ml
ANS: C A normal CaO2 is 18 to 20 ml of oxygen per 100 ml of arterial blood. DIF:
Recall
REF:
p. 376
OBJ:
4
45. To assess gas exchange at the tissues, you would obtain a blood sample from which of the following? a.
Pulmonary artery (balloon-deflated)
b.
Peripheral artery (radial, brachial)
c.
Central vein (superior or inferior vena cava)
d.
Pulmonary artery (balloon-inflated)
ANS: D Table 19-2 summarizes the usefulness of these various sites in providing relevant clinical information. DIF:
Recall
REF:
p. 376
OBJ:
4
46. Before connecting the sample syringe to an adult’s arterial line stopcock, what would you do? a.
Flush the line and stopcock with the heparinized intravenous solution.
b.
Aspirate 1 to 2 ml of fluid or blood using a waste syringe.
c.
Align the stopcock off to the patient and on to the flush solution.
d.
Increase the flush-solution bag pressure by 20 to 30 mm Hg.
ANS: B Box 19-4 outlines the proper procedure for taking an arterial blood sample from a three-way stopcock system. DIF:
Recall
REF:
p. 376
OBJ:
4
47. After obtaining an arterial blood sample from an arterial line, you would do all of the following except: a.
flush the line and stopcock with the heparinized intravenous solution.
b.
aspirate at least 5 ml of fluid or blood (dead space or waste).
c.
confirm stopcock port open to intravenous bag solution and catheter.
d.
confirm undamped pulse pressure waveform on monitor.
ANS: B Box 19-4 outlines the proper procedure for taking an arterial blood sample from a three-way stopcock system. DIF:
Recall
REF:
p. 378
OBJ:
4
48. A physician requests that you obtain and set up an arterial line system for invasive monitoring of blood pressure. Which of the following equipment would you gather? 1. Pressurized intravenous bag 2. Continuous flush device 3. Arterial catheter 4. Volume transducer a.
1, 3, and 4 only
b.
2 and 3 only
c.
2, 3, and 4 only
d.
1, 2, and 3 only
ANS: D See Figure 19-5. DIF:
Recall
REF:
p. 377
OBJ:
4
49. Through which pulmonary artery catheter port would you obtain a mixed venous blood sample? a.
Proximal (right atrium) port
b.
Catheter thermistor connector
c.
Distal (catheter tip) port
d.
Balloon inflation port
ANS: C First, ensure that the balloon is deflated and prepare to draw the sample directly from the catheter’s distal port (no three-way stopcock). DIF:
Recall
REF:
p. 376
OBJ:
4
50. A mixed venous blood sample obtained from a pulmonary artery catheter sample has a PO2 of 85 mm Hg and a hemoglobin saturation of 95%. Which of the following is likely? 1. The pulmonary artery catheter balloon was not deflated. 2. The sample was drawn from the proximal, not distal port. 3. The blood sample was withdrawn too quickly. a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: B If one fails to deflate the balloon before sampling or withdraw the sample too quickly, the venous blood may be “contaminated” with that from the pulmonary capillaries. The result is always a falsely high oxygen level. DIF:
Analysis
REF:
pp. 376-377
OBJ:
4
51. All of the following are true about capillary blood gas sampling except: a.
capillary sampling can be used in lieu of direct arterial access in some infants and small children.
b.
a capillary sample PO2 provides a fairly close estimate of actual arterial oxygenation.
c.
clinicians should exercise caution when using capillary samples to guide decisions.
d.
properly obtained capillary blood can provide estimates of arterial pH and PCO2 levels.
ANS: B Sometimes capillary blood gas sampling is used as an alternative to direct arterial access in infants and small children. Properly obtained capillary blood from a well-perfused patient can provide rough estimates of arterial pH and PCO 2 levels. However, the capillary PO 2 is of no value in estimating arterial oxygenation. For this reason, direct arterial access is still the preferred approach for assessing gas exchange in infants and small children. Respiratory therapists must exercise extreme caution when using capillary blood gases to guide clinical decisions. DIF:
Recall
REF:
p. 377
OBJ:
4
52. Warming a capillary bed to 42° C has which of the following effects? 1. It constricts the underlying blood vessels. 2. It increases blood flow well above tissue needs. 3. It “arterializes” the capillary blood. a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: C Warming the skin (to approximately 42° C) causes dilation of the underlying blood vessels, which in creases capillary flow well above tissue needs. Blood gas values resemble those in the arterial circulation. This is why a sample obtained from a warmed capillary site is often referred to as arterialized blood. DIF:
Recall
REF:
p. 377
OBJ:
4
53. When is capillary blood gas sampling indicated? a.
There is a need for direct analysis of blood oxygenation.
b.
Normal noninvasive monitor readings need to be checked.
c.
ABG analysis is needed, but arterial access is not available.
d.
Continuous data on patient ventilation status are needed.
ANS: C To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Capillary Blood Gas Sampling for Neonatal and Pediatric Patients. Modified excerpts from the AARC guideline appear on p. 379. DIF:
Recall
REF:
p. 379
OBJ:
4
54. What is the best site for capillary puncture in an infant? a.
Lateral aspect of the heel’s plantar surface
b.
Anterior curvature of the heel
c.
Medial aspect of the heel’s plantar surface
d.
Posterior curvature of the heel
ANS: A The most common site for sampling is the heel, specifically the lateral aspect of the plantar surface. DIF:
Recall
REF:
p. 377
OBJ:
4
55. Capillary puncture should be performed at or through what location? 1. Edematous tissue 2. Areas with new signs of infection 3. The heal of neonates 4. Previous puncture sites a.
2 and 3
b.
4 only
c.
1, 2, and 4
d.
1, 2, 3, and 4
ANS: A To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Capillary Blood Gas Sampling for Neonatal and Pediatric Patients. Modified excerpts from the AARC guideline appear on p. 379. DIF:
Recall
REF:
p. 379
OBJ:
4
56. Possible complications of capillary blood gas sampling include which of the following? 1. Infection 2. Hematoma 3. Hemorrhage 4. Hypotension
a.
3 and 4 only
b.
2 and 4 only
c.
1, 3, and 4 only
d.
1, 2, and 3 only
ANS: D To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Capillary Blood Gas Sampling for Neonatal and Pediatric Patients. Modified excerpts from the AARC guideline appear on p. 379. DIF:
Recall
REF:
p. 379
OBJ:
4
57. Before a sample of capillary blood is taken, what should you do to the site? 1. Warmed to 42° C for 10 min. 2. Squeezed lightly until blanched. 3. Cleaned with an antiseptic solution. a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: B The most common site for sampling is the heel, specifically the lateral aspect of the plantar surface. Before any puncture is done the site should be properly warmed to “arterialize” the skin and clean with an antiseptic solution to prevent infections. DIF:
Recall
REF:
p. 378
OBJ:
4
58. A blood gas analyzer measures which of the following? 1. HCO3 – 2. PCO2
3. PO2 4. pH a.
2 and 3 only
b.
2, 3, and 4 only
c.
2 and 4 only
d.
1, 2, 3, and 4
ANS: B The primary parameters of pH, PCO2, and PO2 in a blood sample are measured with a blood gas analyzer. DIF:
Recall
REF:
p. 378
OBJ:
4
59. Components of a laboratory blood gas analyzer include which of the following? 1. Two-electrode measuring chamber 2. Reagent containers 3. Calibrating gas tanks 4. Waste container a.
1, 2, and 3 only
b.
1 and 4 only
c.
2 and 4 only
d.
2, 3, and 4 only
ANS: D Many instrumentation companies manufacture laboratory blood gas analyzers. Although available in a range of designs, these devices typically share the following key components: • An operator interface (e.g., operating controls, light-emitting diode [LED] or cathode ray tube [CRT] displays, keypads, software) • A measuring chamber incorporating the typical three-electrode system • Calibrating gas tanks • Reagent containers (buffers used for calibration, rinse solutions)
• A waste container • A results display, storage, and transmittal system (e.g., screen, printer, disk storage device, network interface) DIF:
Recall
REF:
p. 379
OBJ:
5
60. Which blood gas analyzer electrode uses a separate reference electrode? a.
O2
b.
pH
c.
Clark
d.
HCO3
–
ANS: B The reference half-cell produces a constant potential, regardless of sample pH. The difference in potential between the two electrodes is proportional to the H + concentration of the sample, which is displayed on a voltmeter calibrated in pH units. DIF:
Recall
REF:
p. 379
OBJ:
5
61. To measure PCO2, blood gas analyzers use what electrode? a.
Severinghaus
b.
Clark
c.
Sahn
d.
White
ANS: A To measure PCO2, blood gas analyzers use the Severinghaus electrode, which is essentially a pH electrode exposed to an electrolyte solution that is in equilibrium with the sample through a carbon dioxide–permeable membrane. DIF:
Recall
REF:
p. 380
OBJ:
5
62. Which of the following are true about a blood gas analyzer’s waste fluids? 1. A strong disinfectant should be added to waste fluid containers. 2. Waste fluids should be handled as if they were blood samples. 3. Waste fluids should be treated as potentially infectious. a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: D Remember that waste fluids are potentially infectious and should be handled as if they were blood samples. In addition, the National Committee for Clinical Laboratory Standards recommends adding a strong disinfectant, such as 2% glutaraldehyde or a 1:4 solution of sodium hypochlorite, to the instrument’s waste container either during use or before disposal. DIF:
Recall
REF:
p. 381
OBJ:
5
63. What is the process of testing a new blood gas analyzer to confirm a manufacturer’s claims? a.
Automated calibration
b.
Performance validation
c.
Proficiency testing
d.
Preventive maintenance
ANS: B Performance validation is the process of testing a new instrument to confirm a manufacturer’s claims. DIF:
Recall
REF:
p. 381
OBJ:
5
64. How is the accuracy of a blood gas analyzer determined? a.
Examining the repeatability of the analyzer’s
results b.
Comparing the analyzer’s measurements to known values
c.
Adjusting the offset (or balance) of the instrument
d.
Adjusting the gain (or slope) of the instrument
ANS: B Typically, this involves using samples with known values to assess both the accuracy (comparing the value from the tested instrument with a known value) and the precision (examining the repeatability of results) of the instrument. DIF:
Recall
REF:
p. 381
OBJ:
5
65. What media are used to calibrate a blood gas analyzer’s gas electrodes? a.
Standard pH buffer solutions
b.
Bloodlike control media
c.
Precision mixtures of O2 and CO2
d.
Tonometered human blood samples
ANS: C In most units, the media used to calibrate the gas electrodes are precision mixtures of oxygen and carbon dioxide. DIF:
Recall
REF:
p. 381
OBJ:
5
66. To ensure that the output of a blood gas analyzer is both accurate and linear across the range of measured values, a calibration procedure must measure what? a.
Two different parameters at the same time
b.
Parameters with known input values at one point
c.
Two different parameters at different times
d.
Parameters with known input values at two points
ANS: D Calibration is performed to ensure that the output of the analyzer is both accurate and linear across the range of measured values. Parameters must be measured with known input values representing at least two points, usually a low and a high values. DIF:
Recall
REF:
p. 382
OBJ:
5
67. How often should blood gas calibration verification by control media take place? a.
At least one level of control media should be analyzed every 8 hr.
b.
At least two levels of control media should be analyzed every day.
c.
At least two levels of control media should be analyzed every 8 hr.
d.
At least two levels of control media should be analyzed every hour.
ANS: C As a general recommendation, at least two levels of control media should be analyzed during every 8-hr shift. DIF:
Recall
REF:
p. 382
OBJ:
5
68. Statistically derived limits for internal quality control of blood gas samples are usually set at what appropriate level? a.
1 standard deviation from the mean
b.
2 standard deviations from the mean
c.
3 standard deviations from the mean
d.
5 standard deviations from the mean
ANS: B In one common approach, the results of control media analyses are plotted on a graph and compared with statistically derived limits, usually ±2 standard deviation (SD) ranges (see Figure 19-9). DIF:
Recall
REF:
p. 397
OBJ:
5
69. When inspecting an internal quality-control plot for a blood gas analyzer, you notice several data points sporadically appearing outside the 2 standard deviation (SD) range. This represents what type of analytic error? 1. Random error 2. Bias 3. Imprecision 4. Systematic error a.
1 and 3 only
b.
2 and 4 only
c.
1, 2, and 4 only
d.
1, 2, 3, and 4
ANS: A There are two categories of analytical error: (1) random and (2) systematic. Random error is observed when sporadic, out-of-range data points occur (see Figure 19-9, point A). Random errors are errors of precision or, more precisely, imprecision. DIF:
Recall
REF:
p. 382
OBJ:
5
70. The total instrument error (inaccuracy) of a blood gas analyzer equals which of the following? a.
Bias + imprecision
b.
Imprecision + random error
c.
Bias + systematic error
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d.
Trend error + bias
ANS: A Bias plus imprecision equals total instrument error, or inaccuracy. DIF:
Recall
REF:
p. 382
OBJ:
5
71. Which of the following factors contributing to imprecision (random) errors during blood gas analysis? a.
Sample contamination
b.
Contaminated buffers
c.
Statistical probability
d.
Sample mishandling
ANS: B Table 19-3 outlines the major factors causing these two types of error and suggests some common corrective actions. DIF:
Recall
REF:
p. 382
OBJ:
5
72. When analyzing a blood gas control sample, you notice that the result falls outside the 2 SD range. How could you verify that this was a random error (error of imprecision)? 1. Repeat the analysis on a different analyzer. 2. Compare the control to an actual patient sample. 3. Rerun the control sample a second time. a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: B
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Table 19-3 outlines the major factors causing these two types of error and suggests some common corrective actions. DIF:
Recall
REF:
p. 382
OBJ:
5
73. Which of the following factors does not contributing to bias (systematic) errors during blood gas analysis? a.
Incorrect procedures
b.
Statistical probability
c.
Contaminated buffers
d.
Component failure
ANS: B Table 19-3 outlines the major factors causing these two types of error and suggests some common corrective actions. DIF:
Recall
REF:
p. 382
OBJ:
5
74. While analyzing a blood gas control sample, you notice a trending of several PCO2 values above the 2 SD range over the last six control samples run. What corrective action would you consider at this time? 1. Check the function of the PCO2 electrode. 2. Rerun the control sample a second time. 3. Repair or replace any failed components. a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: B Table 19-3 outlines the major factors causing these two types of error and suggests some common corrective actions.
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DIF:
Recall
REF:
p. 382
OBJ:
5
75. What is the quality control procedure of analysis and reporting on externally provided control media with unknown values? a.
Automated calibration
b.
Performance validation
c.
Proficiency testing
d.
Preventive maintenance
ANS: C Proficiency testing requires analysis and reporting on externally provided control media with unknown values, usually three times per year, with five samples per test. DIF:
Recall
REF:
p. 382
OBJ:
5
76. The advantage that point-of-care testing has over traditional laboratory testing is that point-of-care testing: a.
reduces turnaround time.
b.
utilizes equipment that is less expensive.
c.
does not require trained personnel to run the tests.
d.
is more accurate than traditional laboratory testing.
ANS: A This reduces turnaround time, which should improve care and lower costs. DIF:
Recall
REF:
p. 383
OBJ:
6
77. Which of the following is false about transcutaneous blood gas monitoring?
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a.
Transcutaneous blood gas monitoring provides a reasonable estimate of PaO2 and PaCO2.
b.
Transcutaneous blood gas monitoring is most accurate when used with older adults.
c.
Accurate estimates of transcutaneous blood gases are difficult in patients with shock.
d.
Transcutaneous blood gas monitors use heated skin electrodes to arterialize the blood.
ANS: B In terms of age, the younger the patient, the better the agreement between the PaO 2 and PtcO2. DIF:
Recall
REF:
p. 384
OBJ:
7
78. In which of the following patients would transcutaneous blood gas monitoring most likely provide inaccurate or erroneous results? a.
Newborn infant with respiratory distress syndrome (RDS)
b.
Patient with hypoxemia
c.
Patient with a hyperpyrexia
d.
Patient in hypovolemic shock
ANS: D This is because accurate transcutaneous measures require adequate skin perfusion. Low cardiac output, shock, and dehydration all cause peripheral vasoconstriction and impair capillary flow, which lowers the PtcO2 level. DIF:
Recall
REF:
p. 384
OBJ:
7
79. Transcutaneous blood gas monitoring is indicated when what need exists? 1. To continuously analyze gas exchange in infants or children
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2. To quantify the real-time responses to bedside interventions 3. To continuously monitor for hyperoxia in newborn infants 4. To monitor CO levels following hyperbaric oxygen treatment a.
3 and 4 only
b.
1 and 3 only
c.
2 and 4 only
d.
1, 2, and 3 only
ANS: D Based on these factors, transcutaneous monitoring is a reasonable choice when there is a need for continuous, noninvasive analysis of gas exchange in hemodynamically stable infants or children. In these patients, the PaO2 can be “calibrated” against the P tcO2, thus decreasing the need for repeated arterial samples. Because pulse oximetry cannot provide accurate estimates of excessive blood oxygen, the transcutaneous monitor also is useful for monitoring hyperoxia in neonates. DIF:
Recall
REF:
p. 384
OBJ:
7
80. Which of the following is not a common tissue injury to be on guard for at the site of transcutaneous blood gas electrode placement? a.
Erythema
b.
Hematomas
c.
Burns or blisters
d.
Skin tears
ANS: B To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Tran scutaneous Blood Gas Monitoring for Neonatal and Pediatric Patients. Modified excerpts from the AARC guideline appear on p. 385. DIF:
Recall
REF:
p. 385
OBJ:
7
81. The transcutaneous blood gas electrode should not be placed on the:
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a.
chest.
b.
abdomen.
c.
lower back.
d.
thigh.
ANS: D The most common sites for electrode placement are the abdomen, chest, and lower back. DIF:
Recall
REF:
p. 399
OBJ:
7
82. To validate patient readings obtained from a transcutaneous blood gas monitor, what should you do? a.
Measure and compare the P tcO2 and PtcCO2 at three or more different sites.
b.
Compare the monitor’s readings to a concurrent pulse oximetry reading.
c.
Compare the monitor’s readings to those obtained with a concurrent ABG sample.
d.
Compare the patient reading to those obtained when calibrating the sensor.
ANS: C Once the electrodes are properly set up, the clinician should compare the monitor readings with those obtained with a concurrent ABG. DIF:
Recall
REF:
p. 386
OBJ:
7
83. Before attaching a transcutaneous blood gas monitor sensor to a patient, what should you do? 1. Provide a specified warm-up time and set the probe temperature. 2. Check the membrane and prepare a sensor with an adhesive ring and gel. 3. Prepare the monitoring site (remove excess hair and clean the skin). a.
1 and 2 only
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b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: D See Box 19-7. DIF:
Recall
REF:
p. 486
OBJ:
7
84. What is the appropriate interval for changing the site for a transcutaneous blood gas monitor sensor? a.
1 to 2 hr
b.
2 to 6 hr
c.
6 to 8 hr
d.
8 to 12 hr
ANS: B See Box 19-7. DIF:
Recall
REF:
p. 401
OBJ:
7
85. You must immediately begin monitoring the oxygenation status of an infant admitted to the emergency department in severe respiratory distress. Which of the following approaches would you select? a.
Pulse oximetry (SpO2)
b.
Transcutaneous monitoring (PtcO2 )
c.
Arterial puncture (PaO2 )
d.
Intraarterial optode monitoring
ANS: A In terms of technical limitations, the lengthy stabilization time needed by transcutaneous monitors precludes their use during short procedures or in emergencies. In such cases, the pulse oximeter is a better choice.
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DIF:
Application
REF:
p. 387
OBJ:
7
86. To avoid thermal injury with transcutaneous blood gas monitor sensors, what should you do? 1. Carefully monitor the sensor temperature. 2. Apply hydrocortisone cream under the sensor. 3. Regularly rotate the sensor site. a.
1 and 2 only
b.
1 and 3 only
c.
2 and 3 only
d.
1, 2, and 3
ANS: B Because the sensor is heated, clinicians must take care to avoid thermal injury to the patient’s skin. This is accomplished by (1) careful monitoring of sensor temperature (the safe upper limit is approximately 42° C) and (2) regularly rotating the sensor site. DIF:
Recall
REF:
p. 386
OBJ:
7
87. While monitoring an active infant through a transcutaneous blood gas system, you notice a rapid rise in PtcO2 from 63 to 145 mm Hg. At that same time, the (P tcCO2 ) drops from 35 to 7 mm Hg. What is the most appropriate action in this case? a.
Perform a quick assessment of the infant’s airway.
b.
Stabilize the infant and call for emergency assistance.
c.
Check the sensor for air leaks or dislodgment.
d.
Remove the sensor and recalibrate the instrument.
ANS: C Proper sensor-electrolyte contact is essential, as is proper application to the skin surface. A loosely ap-
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plied sensor may have air leaks or may become dislodged. In either case, the resulting measurements will approach those in room air: PO2 = 159 mm Hg PCO2 = 0 mm Hg DIF:
Recall
REF:
p. 386
OBJ:
7
88. Oximetry is the measurement of blood hemoglobin saturations using what technique? a.
Electrochemical dissociation
b.
Photoplethysmography
c.
Photochemical reactions
d.
Spectrophotometry
ANS: D Oximetry is the measurement of blood hemoglobin saturations using spectrophotometry. DIF:
Recall
REF:
p. 387
OBJ:
8
89. Which of the following will result in falsely low HbO2 readings with a pulse oximeter? a.
Presence of HbCO
b.
Vascular dyes
c.
Dark skin pigmentation
d.
Presence of fetal hemoglobin
ANS: B Table 19-6 outlines some of the potential problems and resulting errors that can occur with hemoximetry. DIF:
Recall
REF:
p. 388
OBJ:
8
90. Indications for pulse oximetry include which of the following?
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1. To assess changes in HbO2 during certain procedures 2. To measure abnormal Hb 3. To comply with external regulations or recommendations 4. To monitor the adequacy of HbO2 saturation a.
1 and 4 only
b.
1, 2, and 4 only
c.
1, 3, and 4 only
d.
1, 2, 3, and 4
ANS: C To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Pulse Oximetry. Modified excerpts from the AARC guideline appear on p. 406. DIF:
Recall
REF:
p. 388
OBJ:
8
91. What is the greatest hazard of pulse oximetry? a.
False results leading to incorrect decisions
b.
Pressure sores at the measuring site
c.
Skin burns due to using incompatible probes
d.
Electrical shock at the measuring site
ANS: A To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Pulse Oximetry. Modified excerpts from the AARC guideline appear on p. 389. DIF:
Recall
REF:
p. 389
OBJ:
8
92. Pulse oximeter readings are generally unreliable at saturations below what level? a.
70%
b.
80%
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c.
90%
d.
95%
ANS: B Most clinicians consider pulse oximeter readings unreliable at saturations below 80%. DIF:
Recall
REF:
p. 390
OBJ:
8
93. Under ideal conditions, pulse oximeter readings patients usually fall in what range of those obtained with invasive hemoximetry? a.
1% to 2%
b.
2% to 3%
c.
3% to 5%
d.
5% to 7%
ANS: C In terms of accuracy, the pulse oximetry readings of sick patients usually fall within ±3% to 5% of those obtained with invasive hemoximetry. DIF:
Recall
REF:
p. 390
OBJ:
9
94. You are monitoring a nurse acquiring a capillary blood sample from an infant. The nurse immediately punctures the infant’s heel with a lancet and then squeezes the puncture site to increase the flow of blood. What mistakes has the nurse made while obtaining the capillary blood sample? 1. Inadequate warming of the capillary bed 2. Squeezing of the puncture site 3. Puncture of the infant’s heel 4. Use of a lancet. a.
1 and 2 only
b.
3 and 4 only
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c.
1, 2, and 3 only
d.
1, 3, and 4 only
ANS: A The most common technical errors in capillary sampling are inadequate warming of the capillary bed and squeezing of the puncture site. Squeezing the puncture site may result in venous and lymphatic contamination of the sample. DIF:
Application
REF:
p. 378
OBJ:
4
95. Which of the following guidelines should you adhere to when performing pulse oximetry? 1. Mix different sensors among different devices to ensure accuracy. 2. Make sure that the sensors are the correct size and are properly applied. 3. Avoid using pulse oximetry to monitor hyperoxia in neonates. 4. Whenever possible, validate the initial SpO2 against the actual SaO2. a.
1 and 3 only
b.
1, 2, and 3 only
c.
3 and 4 only
d.
2, 3, and 4 only
ANS: D Box 19-8 lists key points to be considered when performing pulse oximetry. DIF:
Recall
REF:
p. 391
OBJ:
9
96. For continuous monitoring of adults and children, you should set a pulse oximeter’s low alarm in what range? a.
80% to 85%
b.
85% to 88%
c.
88% to 92%
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d.
93% to 97%
ANS: C Box 19-8 lists key points to be considered when performing pulse oximetry. DIF:
Recall
REF:
p. 391
OBJ:
9
97. Which of the following can cause false high readings when using a pulse oximeter? a.
Fetal hemoglobin
b.
Intravascular dyes
c.
Carboxyhemoglobin
d.
Presence of metHb
ANS: C See Table 19-6. DIF:
Recall
REF:
p. 391
OBJ:
10
98. What is the most common source of error and false alarms with pulse oximetry? a.
Presence of HbCO
b.
Patient motion artifact
c.
Presence of vascular dyes
d.
Ambient light detection
ANS: B Patient motion artifact probably is the most common source of error and false alarms. DIF:
Recall
REF:
p. 392
OBJ:
10
99. During continuous monitoring of an active 5-year-old patient with a finger pulse oximetry probe, you
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obtain frequent and repeated false low HbO2 alarms (<90%). Which of the following would be the best action to take in this situation? a.
Sedate the patient and restrain the arms.
b.
Reset the low alarm limit to the 80% to 85% range.
c.
Use a spot check instead of continuous monitoring.
d.
Relocate the sensor to a more stable location.
ANS: D Although new technologies promise to reduce this, relocation of the sensor to the earlobe, toe, or forehead can minimize the problem. DIF:
Application
REF:
p. 391
OBJ:
10
100. You obtain an SpO2 reading of 90% using an oximeter with an approximate accuracy of 5%. This could indicate a PO2 as low as what level? a.
55 mm Hg
b.
60 mm Hg
c.
65 mm Hg
d.
70 mm Hg
ANS: A However, with the accuracy of some oximeters being only ±4%, an SpO2 reading of 90% could mean an actual SaO2 reading as low as 86%, corresponding to a PO2 level of 55 mm Hg or less! DIF:
Application
REF:
p. 392
OBJ:
10
101. You obtain an SpO2 reading of 100% on a patient receiving O2 through a nonrebreathing mask. What range of PaO2 levels is possible in this patient? a.
60 to 90 mm Hg
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b.
90 to 100 mm Hg
c.
100 to 200 mm Hg
d.
100 to 600 mm Hg
ANS: D At the high end, oximetry data can be even less meaningful. Because of the characteristics of the oxy hemoglobin dissociation curve (see Chapter 11), a patient with an SpO2 reading of 100% could represent a PaO2 level anywhere between 100 and 600 mm Hg. DIF:
Application
REF:
p. 392
OBJ:
10
102. An alert outpatient awaiting bronchoscopy has an SpO 2 reading of 81% breathing room air. The patient appears in no distress and exhibits no signs of hypoxemia. Which of the following would be the best initial action to take in this situation? a.
Switch sites or replace the sensor probe.
b.
Immediately start O2 therapy.
c.
Obtain an ABG.
d.
Cancel the bronchoscopy procedure.
ANS: A Often, discrepancies can be reduced by switching sites or replacing the sensor probe. DIF:
Application
REF:
p. 392
OBJ:
10
103. What is the measurement of CO2 in respiratory gases called? a.
Oximetry
b.
Capnometry
c.
Optometry
d.
Barometry
ANS: B
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Capnometry is the measurement of CO2 in respiratory gases. DIF:
Recall
REF:
p. 393
OBJ:
11
104. What is the most common technique used to measure CO2 in respiratory gases? a.
Infrared absorption
b.
Mass spectroscopy
c.
Photoacoustics
d.
Raman scattering
ANS: A The infrared capnometer is the most common. DIF:
Recall
REF:
p. 394
OBJ:
11
105. Which of the following are indications for capnography? 1. Evaluating the response to therapies affecting ventilation/perfusion ratio () relationships 2. Determining the position of an artificial airway (trachea vs. esophagus) 3. Assessing a patient’s readiness for weaning from ventilatory support 4. Monitoring the integrity of the ventilatory circuit and artificial airway a.
1 and 3 only
b.
2, 3, and 4 only
c.
1, 2, and 4 only
d.
1, 2, 3, and 4
ANS: C See CPG 19-6. DIF:
Recall
REF:
p. 394
OBJ:
11
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106. At the very beginning of exhalation, the PETCO2 normally should be at what level? a.
0 mm Hg
b.
15 mm Hg
c.
25 mm Hg
d.
40 mm Hg
ANS: A Initially, the expired PCO2 is 0 mm Hg, indicating exhalation of pure dead space gas. DIF:
Recall
REF:
p. 396
OBJ:
11
107. During a single-breath capnogram, what does the occurrence of a plateau indicate? a.
Exhalation of mainly dead space gas
b.
Inspiration of fresh respiratory gas
c.
Exhalation of mixed alveolar and dead space gas
d.
Exhalation of mainly alveolar gas
ANS: D This plateau indicates exhalation of gas coming mainly from ventilated alveoli. DIF:
Recall
REF:
p. 396
OBJ:
11
108. What is a normal end-tidal PETCO2 range? a.
30 to 38 mm Hg
b.
35 to 43 mm Hg
c.
38 to 46 mm Hg
d.
42 to 50 mm Hg
ANS: B
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In healthy individuals, the PETCO 2 averages 1 to 5 mm Hg less than the PaCO 2 , or between 35 and 43 mm Hg (approximately 5% to 6% CO2). DIF:
Recall
REF:
p. 396
OBJ:
11
109. What is the normal gradient between PaCO2 and PETCO2? a.
3 to 5 mm Hg
b.
5 to 10 mm Hg
c.
10 to 15 mm Hg
d.
15 to 20 mm Hg
ANS: A In healthy individuals, the PETCO 2 averages 3 to 5 mm Hg less than the PaCO 2 , or between 35 and 43 mm Hg (approximately 5% to 6% CO2). DIF:
Recall
REF:
p. 396
OBJ:
11
110. What is the normal range for end-tidal CO2 as measured by capnography? a.
0% to 5%
b.
5% to 6%
c.
6% to 8%
d.
35% to 45%
ANS: B In healthy individuals, the PETCO 2 averages 1 to 5 mm Hg less than the PaCO 2 , or between 35 and 43 mm Hg (approximately 5% to 6% CO2). DIF:
Recall
REF:
p. 396
OBJ:
11
111. During a single-breath capnogram, the sharp downstroke and return to baseline that normally occurs after the end-tidal point indicates what?
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a.
Exhalation of mainly dead space gas
b.
Inspiration of fresh respiratory gas
c.
Exhalation of mixed alveolar and dead space gas
d.
Exhalation of mainly alveolar gas
ANS: B The sharp downstroke and return to baseline that normally occurs after the end-tidal point indicates inhalation of fresh gas with 0 CO2 . DIF:
Recall
REF:
p. 396
OBJ:
11
112. A patient being monitored by capnography exhibits a sudden rise in end-tidal CO2 levels. Which of the following are possible causes? 1. Sudden release of a tourniquet 2. Massive pulmonary embolism 3. Sudden increase in cardiac output 4. Injection of NaHCO3 a.
2 and 3 only
b.
1, 3, and 4 only
c.
2, 3, and 4 only
d.
1, 2, 3, and 4
ANS: B Table 19-8 differentiates between the causes of high and low PETCO2 readings by the suddenness of the change. DIF:
Recall
REF:
p. 396
OBJ:
11
113. During capnography monitoring of a mechanically ventilated patient, you note that the PETCO2 has dropped to 0 mm Hg. Which of the following is the most likely problem?
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a.
Ventilator disconnection
b.
Tracheal intubation
c.
Increased cardiac output
d.
Hypoventilation
ANS: A Table 19-7 differentiates between the causes of high and low PETCO2 readings by the suddenness of the change. DIF:
Recall
REF:
p. 396
OBJ:
11
114. The shape of the expired CO2 tracing of a patient is normal but instead of being zero, the baseline is elevated to approximately 12 mm Hg. Which of the following is the most likely problem? a.
Patient disconnected from the system
b.
Obstruction of the sampling tube
c.
Rebreathing
d.
Presence of N2 O
ANS: C An elevated baseline (higher than 0 mm Hg) indicates rebreathing. DIF:
Recall
REF:
p. 396
OBJ:
11
115. After changing the FiO2 of a patient with emphysema, how long should you wait to draw an ABG to monitor the patient’s respiratory status? a.
5 to 10 min
b.
10 to 20 min
c.
20 to 30 min
d.
30 to 40 min
ANS: C
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Patients with healthy lungs achieve a steady state in only 5 min after changes, whereas those with chronic obstructive pulmonary disease (COPD) may require as long as 20 to 30 min. For example, if the patient’s FiO2 is changed, the measured PaO 2 will accurately reflect the patient’s gas exchange status within 5 min in healthy people but may require 20 to 30 min in patients with COPD. DIF:
Recall
REF:
p. 375
OBJ:
4
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Chapter 20 - Pulmonary Function Testing Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following are indications for assessing pulmonary function?
1. Screen for pulmonary disease. 2. Evaluate patients for surgical risk. 3. Assess the progression of disease. 4. Assist in diagnosing cardiac disability. a. 1, 2, and 3 only b. 2 and 4 only c. 1 and 3 only d. 2, 3, and 4 only ANS: A
The indications for pulmonary function testing are: • To identify and quantify changes in pulmonary function. The most common purposes of pulmonary function testing are to detect the presence or absence of pulmonary disease, to classify the type of disease as either obstructive or restrictive, and to quantify the severity of pulmonary impairment as mild, moderate, severe, or very severe. Over time pulmonary function tests help quantify the progress or the reversibility of the disease. • To evaluate need and quantify therapeutic effectiveness. Pulmonary function tests may aid clinicians in selecting or modifying a specific therapeutic regimen or technique (e.g., bronchodilator medication, airway clearance therapy, rehabilitation exercise protocol). Clinicians and researchers use pulmonary function tests to objectively measure changes in lung function before and after treatments. • To perform epidemiologic surveillance for pulmonary disease. Screening programs may detect pulmonary abnormalities caused by disease or environmental factors in general populations, occupational settings, smokers, or other high-risk groups. In addition, researchers have determined what normal pulmonary function is by measuring the pulmonary function of the healthy population. • To assess patients for risk of postoperative pulmonary complications. Preoperative testing can identify those patients who may have an increased risk of pulmonary complications after surgery. Sometimes the risk of complications can be reduced by preoperative respiratory care, and sometimes the risk may be so significant to rule out surgery. • To determine pulmonary disability. Pulmonary function tests can also determine the degree of disability caused by lung diseases, including occupational diseases such as pneumoconiosis of coal workers. Some federal entitlement programs and insurance policies rely on pulmonary function tests to confirm claims for financial compensation. DIF: Recall
REF: p. 401
OBJ: 2
2. What do relative contraindications for lung volume determinations include?
1. Recent cataract removal surgery 2. Unstable cardiovascular status 3. Treated pneumothorax 4. Hemoptysis of unknown origin a. 1, 2, and 3 only
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b. 2 and 4 only c. 3 and 4 only d. 1, 2, and 4 only ANS: D
Patients with acute, unstable cardiopulmonary problems such as hemoptysis, pneumothorax, myocardial infarction, and pulmonary embolism and patients with acute chest or abdominal pain should not be tested. Testing could be harmful, if needed treatment would be delayed. Patients who have nausea and who are vomiting should not be tested; there is a risk of aspiration. Testing for patients who have had recent cataract removal surgery should be delayed; changes in ocular pressure may be harmful to the eye. DIF: Recall
REF: p. 402
OBJ: 2
3. What is the primary problem in obstructive lung disease? a. Increased airway resistance b. Low lung volumes c. Increased pulmonary capillary pressure d. Reduced lung diffusion ANS: A
The primary problem in obstructive pulmonary disease is an increased airway resistance. DIF: Recall
REF: p. 402
OBJ: 3
4. Which of the following measure is typically increased in patients with restrictive lung
disease? a. Lung compliance b. Lung volumes c. Pressure needed to expand the lung d. Airway resistance ANS: C
The primary problem in restrictive lung disease is reduced lung compliance, thoracic compliance, or both lung and thoracic compliances. Compliance is the volume of gas inspired per the amount of inspiratory effort; effort is measured as the amount of pressure created in the lung or in the pleural space when the inspiratory muscles contract. Compliance is calculated according to the following formula: C = V/P. DIF: Recall
REF: p. 402
OBJ: 3
5. You perform a series of pulmonary function tests on a patient with a potentially infectious
disease carried via the airborne route. Which of the following infection-control procedures should you implement? 1. Wear a respirator or close-fitting surgical mask. 2. Dispose of, sterilize, or disinfect the tubing circuit after testing. 3. Clean the interior surface of the spirometer before the next test. a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3
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ANS: B
When performing procedures on patients with potentially infectious airborne diseases, practitioners should wear a personal respirator or a close-fitting surgical mask, especially if the testing induces coughing. Practitioners should always wash their hands between testing patients and after contact with testing equipment. Although it is unnecessary to routinely clean the interior surfaces of the testing instruments between patients, the mouthpiece, nose clips, tubing, and any parts of the instrument that come into direct contact with a patient should be disposed, sterilized, or disinfected between patients. DIF: Application
REF: p. 403
OBJ: 3
6. Which of the following pulmonary function devices directly collect and measure gas
volumes? 1. Water-sealed spirometer 2. Dry rolling-seal spirometer 3. Bellows spirometer 4. Pneumotachometer a. 3 and 4 only b. 1 and 2 only c. 1, 2, and 3 only d. 2, 3, and 4 only ANS: C
Flow measuring devices are commonly called pneumotachometers. DIF: Recall
REF: p. 403
OBJ: 4
7. To what does the range or limit of a device’s measuring ability refer? a. Capacity b. Accuracy c. Error d. Precision ANS: A
The capacity of an instrument refers to the range or limits of how much it can measure. DIF: Recall
REF: p. 404
OBJ: 4
8. How closely a device measures a certain reference value refers to what quality? a. Capacity b. Accuracy c. Linearity d. Precision ANS: B
The accuracy of a measuring instrument is how well it measures a known reference value. DIF: Recall
REF: p. 404
OBJ: 4
9. What would you use to determine the accuracy of a water-sealed spirometer in measuring
lung volumes? a. Calibrated high-flow flowmeter
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b. Computer-generated flow patterns c. Calibrated 3-L syringe d. Standard subject with known volumes ANS: C
For volume measurements, standard reference values are provided by a graduated 3.0-L calibration syringe. DIF: Recall
REF: p. 404
OBJ: 4
10. While checking the accuracy of a portable spirometer for volumetric measures with a
calibrated super syringe, you obtain a mean measured value of 2.7 L. What is the percent error of this instrument? a. 1% b. 10% c. 30% d. 90% ANS: B
or
DIF: Application
REF: p. 404
OBJ: 4
11. What is the ability of a measuring device to consistently provide the same measure of the
same quantity? a. Capacity b. Accuracy c. Linearity d. Precision ANS: D
Precision is synonymous with reliability of measurements and the opposite of variability. DIF: Recall
REF: p. 404
OBJ: 4
12. What do we measure to determine the precision of an instrument? a. Mean measured reference value b. Difference between the mean measured and actual reference value c. Range of the mean measured reference value d. Standard deviation (SD) of the mean measured reference value ANS: D
A small SD indicates low variability and high precision. DIF: Recall
REF: p. 404
OBJ: 4
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13. What is the American Thoracic Society standard for volumetric accuracy of spirometers? a. ±1% error, or within 10 ml of the reference value b. ±3% error, or within 50 ml of the reference value c. ±5% error, or within 100 ml of the reference value d. ±10% error, or within 500 ml of the reference value ANS: B
When measuring the vital capacity, forced vital capacity, and forced expiratory volumes, a volume-measuring spirometer should have a capacity of at least 8 L and should measure volumes with less than a 3% error or within 50 ml of a reference value, whichever is greater. DIF: Recall
REF: p. 404
OBJ: 4
14. What is the American Thoracic Society standard for accuracy when measuring flows during
pulmonary function testing? a. 90% accuracy or within 0.30 L/sec, whichever is greater b. 95% accuracy or within 0.20 L/sec, whichever is greater c. 97% accuracy or within 0.10 L/sec, whichever is greater d. 99% accuracy or within 0.05 L/sec, whichever is greater ANS: B
A diagnostic spirometer that measures flow should be at least 95% accurate (or within 0.2 L/sec, whichever is greater) over the entire 0 to 14 L/sec range of gas flow. DIF: Recall
REF: p. 404
OBJ: 4
15. How often should a spirometer in continual use undergo volumetric calibration? a. Every 4 hr b. Every shift c. At least daily d. Weekly ANS: C
For quality control, the standards include verifying volume accuracy with a 3.0-L calibration syringe at least daily. DIF: Recall
REF: p. 404
OBJ: 4
16. Tests of pulmonary mechanics include:
1. maximum voluntary ventilation. 2. functional residual capacity. 3. forced expiratory flows. 4. forced expiratory volumes. a. 3 and 4 only b. 1 and 2 only c. 1, 2, and 3 only d. 1, 3, and 4 only ANS: D
Spirometry includes the tests of pulmonary mechanics, the measurements of forced vital capacity, FEV 1 , several FEF values, forced inspiratory flow (FIF) rates, and the MVV.
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DIF: Recall
REF: p. 405
OBJ: 6
17. Which of the following adverse reactions is not typically seen with pulmonary function
testing? a. Syncope b. Cough c. Hemoptysis d. Chest pain ANS: C
Possible complications include pneumothorax, syncope, chest pain, paroxysmal coughing, and bronchospasm associated with exercise-induced asthma. Hemoptysis (cough up bloody sputum) is not a side effect of spirometry. DIF: Recall
REF: p. 406
OBJ: 6
18. What is the most common measurement of pulmonary mechanics during pulmonary function
testing? a. Tidal volume b. Forced vital capacity c. Residual volume d. Inspiratory reserve volume ANS: B
The forced vital capacity is the most commonly performed test of pulmonary mechanics. DIF: Recall
REF: p. 405
OBJ: 6
19. Which of the following statements is false regarding measurement of the patient’s forced vital
capacity (FVC)? a. The patient can be sitting or standing. b. Nose clips are not required. c. It is an effort-dependent test. d. Accurate results can be obtained without patient cooperation. ANS: D
The FVC is an effort-dependent maneuver that requires careful patient instruction, understanding, coordination, and cooperation. Spirometry standards for FVC specify that patients must be instructed in the FVC maneuver, that the appropriate technique be demonstrated, and that enthusiastic coaching occurs. When measuring the FVC, the therapist needs to coach the preceding inspiratory capacity as enthusiastically as the FVC. According to the standards, nose clips are encouraged, but not required, and patients may be tested in the sitting or standing position. Although standing usually produces a larger FVC compared with sitting, sitting is considered safer in case of lightheadedness. It is recommended that the position be consistent for repeat testing of the same patient. FVC should be converted to body temperature conditions and reported as liters under body temperature, ambient pressure, saturated (BTPS) conditions. DIF: Recall
REF: p. 407
OBJ: 6
20. To ensure validity of the forced vital capacity (FVC) measurement, how many attempts
should the patient perform?
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a. b. c. d.
Just one good one Two that are nearly the same Three that are acceptable At least four
ANS: C
To ensure validity, each patient must perform a minimum of three acceptable FVC maneuvers. DIF: Recall
REF: p. 407
OBJ: 6
21. What is the minimum objective standard for the volume exhaled during the final 1 sec of an
acceptable forced vital capacity effort? a. 0.10 L b. 0.05 L c. 0.025 L d. 0.001 L ANS: C
An end-expiratory plateau must be obvious in the volume-time curve; the objective standard is less than 0.025 L exhaled during the final second of exhalation. DIF: Recall
REF: p. 407
OBJ: 6
22. Which of the following statements is false about the FEV 1 measurement? a. It is a volume measurement. b. The recorded FEV 1 must come from the same forced vital capacity (FVC) effort. c. It is often compared to the size of the FVC. d. It is a popular test. ANS: B
The FEV 1 is a measurement of the volume exhaled in the first second of the FVC (Figure 20-2, A). To ensure validity of the FEV 1 , the measurement must originate from a set of three acceptable FVC trials. The first second of forced exhalation begins at the zero time point (Figure 20-3). To ensure reliability of the FEV 1 , the largest FEV 1 and second largest FEV 1 from the acceptable trials should not vary by more than 0.150 L. Consistent with its definition, the largest FEV 1 (body temperature, ambient pressure, saturated [BTPS]) measured is the patient’s FEV 1 . The largest FEV 1 sometimes comes from a different trial than the largest FVC. DIF: Recall
REF: pp. 407-408 OBJ: 6
23. What pulmonary function test presents the highest risk for fainting? a. Slow vital capacity b. Tidal volume per minute c. Maximum voluntary ventilation d. Total lung capacity ANS: C
Because of the potential for acute hyperventilation and fainting or coughing during maximum voluntary ventilation testing, the patient should be seated.
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DIF: Recall
REF: p. 409
OBJ: 6
24. What is the predicted normal forced vital capacity (FVC) for the average 20-year-old man? a. 4.5 L b. 5.6 L c. 6.2 L d. 7.0 L ANS: B
The predicted normal FVC for a 20-year-old, 180-cm man approaches 5.60 L. DIF: Recall
REF: p. 407
OBJ: 6
25. What is the predicted normal FEV 1 for the average 20-year-old man? a. 3.3 L b. 4.0 L c. 4.7 L d. 5.2 L ANS: C
The predicted normal FEV 1 for a 20-year-old, 180-cm man approaches 4.70 L. DIF: Recall
REF: p. 408|p. 411
OBJ: 6
26. Normal healthy people can exhale what percentage of the forced vital capacity in 1 sec? a. 50% b. 60% c. 70% d. 80% ANS: C
In general, individuals without airway obstruction will be able to exhale at least 70% of their vital capacity in the first second. DIF: Recall
REF: p. 411
OBJ: 6
27. You are examining the expiratory flow tracing during the patient’s forced vital capacity
(FVC) maneuver. At what point during the exhalation can you generally begin to see flow from the bronchioles? a. Beyond 30% b. Beyond 50% c. Beyond 70% d. Beyond 90% ANS: B
Any flow measured in the first half of the FVC reflects on the bronchi; any flow measured beyond 50% of the vital capacity reflects on the bronchioles. DIF: Recall
REF: p. 407
OBJ: 6
28. What is the predicted normal for the peak expiratory flow (PEF) in the average man? a. 5.5 L/sec
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b. 6.5 L/sec c. 8.0 L/sec d. 9.5 L/sec ANS: D
Typical normal values for the adult male: PEF is 9.5 L/sec. DIF: Recall
REF: p. 411
OBJ: 6
29. What shape of the flow-volume loop is typical for the patient with a fixed upper airway
obstruction? a. Circular b. Box c. Elliptical d. Ramp ANS: B
Compared with the normal flow-volume loop, a fixed upper airway obstruction produces a curve that appears box-shaped. DIF: Recall
REF: p. 413
OBJ: 6
30. When evaluating a forced vital capacity maneuver postbronchodilator use to determine the
reversibility of any airway obstruction, what percent increase in FEV 1 is needed to be able to say the treatment was effective? a. 5% b. 10% c. 15% d. 20% ANS: C
Although improvements in other measurements of pulmonary function are sometimes used, reversibility is defined as a 15% or greater improvement in FEV 1 . DIF: Recall
REF: p. 414
OBJ: 6
31. You have just given your patient a 0.03 mg/ml dose of methacholine to assess for asthma. The
subsequent forced vital capacity (FVC) shows no change. What should you do next? a. Report to the physician that the patient does not have asthma. b. Wait 1 hr and repeat the test at the same dose. c. Have the patient return tomorrow to repeat the test. d. Double the dose and repeat the FVC maneuver. ANS: D
If a positive response does not occur, the methacholine dosage is doubled to 0.06 mg/ml, and then the FVC maneuver is repeated. DIF: Recall
REF: p. 414
OBJ: 7
32. Which of the following volumes or capacities cannot be measured by simple spirometry?
1. Functional residual capacity (FRC) 2. Expiratory reserve volume (ERV)
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3. Residual volume (RV) 4. Inspiratory reserve volume (IRV) a. 1, 3, and 4 only b. 1, 2, 3, and 4 c. 1 and 3 only d. 1 and 4 only ANS: C
The four lung capacities are TLC, inspiratory capacity (IC), FRC, and the VC. These volumes and capacities are shown in Figure 20-10. The lung volumes that can be measured directly with a spirometer or pneumotachometer include V T, IC, IRV, ERV, and VC. DIF: Recall
REF: p. 414
OBJ: 8
33. After a resting expiration, air still remains in the lungs. What is this volume called? a. Functional residual capacity (FRC) b. Vital capacity (VC) c. Residual volume (RV) d. Expiratory reserve volume (ERV) ANS: A
The four lung capacities are TLC, inspiratory capacity (IC), FRC, and the VC. These volumes and capacities are shown in Figure 20-10. The lung volumes that can be measured directly with a spirometer or pneumotachometer include V T, IC, IRV, ERV, and VC. DIF: Recall
REF: p. 414
OBJ: 8
34. Which of the following is equal to total lung capacity (TLC)? a. V T + ERV + IRV + RV b. IC + VT + ERV c. VC + ERV d. FRC + IRV ANS: A
See Figure 20-10. DIF: Recall
REF: p. 415
OBJ: 8
35. Which of the following is a true statement? a. VC = FRC + VT b. VC = IRV + VT + ERV c. VC = VT + IRV + RV d. FRC = V T + ERV ANS: B
See Figure 20-10. DIF: Application
REF: p. 415
OBJ: 8
36. A patient has an expired minute ventilation of 14.2 L and a ventilatory rate of 25/min. What is
the average V T? a. 568 ml
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b. 635 ml c. 725 ml d. 410 ml ANS: A
An alternate approach is to measure the total volume of air exhaled for 1 min (E) and then divide by the breathing frequency (f) counted during the same period. The following formula can be used to calculate the tidal volume: VT = E/f. DIF: Application
REF: p. 415
OBJ: 8
37. How can you ensure reliability when measuring the expiratory reserve volume (ERV)? a. Have the patient perform the maneuver twice, ensure consistency, and then take
the best value. b. Have the patient perform the maneuver three times, and then take the last value. c. Have the patient perform the maneuver twice, ensure consistency, and then take the mean value. d. Have the patient perform the maneuver until he or she becomes fatigued, and then take the last value. ANS: A
To ensure reliability, the ERV should be measured at least twice and the two largest measurements should agree within 5%. DIF: Recall
REF: p. 415
OBJ: 8
38. What is the most common lung volume measured during spirometry? a. Tidal volume b. Vital capacity c. Total lung capacity d. Expiratory reserve volume ANS: B
The vital capacity is the most commonly measured lung volume. DIF: Recall
REF: p. 415
OBJ: 8
39. Which of the following techniques are used to measure residual volume?
1. Helium dilution 2. Body plethysmography 3. Nitrogen washout 4. Flow-volume loops a. 2 and 4 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 1, 3, and 4 only ANS: B
There are three indirect techniques to measure residual volume and FRC. They are helium dilution, nitrogen washout, and body plethysmography. DIF: Recall
REF: pp. 417-419 OBJ: 8
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40. In both the helium dilution test and nitrogen washout functional residual capacity (FRC)
determinations, at what point should the patient normally be connected to the system to begin the test? a. Resting expiration b. Full forced inspiration c. Resting inspiration d. Full forced expiration ANS: A
The valve is turned to connect the patient to the breathing circuit usually at the resting expiratory level of the FRC. DIF: Recall
REF: pp. 417-420 OBJ: 8
41. During a helium dilution test for functional residual capacity, you notice that it takes 19 min
for equilibration between the gas concentrations in the spirometer and the patient’s lungs. Based on this information, what can you conclude? a. The patient has restrictive lung disease. b. The spirometer is leaking helium. c. The patient has obstructive lung disease. d. Insufficient oxygen was added to the system. ANS: C
Patients with obstructive lung disease may require up to 20 min to equilibrate because of slow gas mixing in the lungs. DIF: Application
REF: p. 417
OBJ: 8
42. During a helium (He) dilution functional residual capacity (FRC) measurement, the
technologist first bleeds in 500 ml of He (He Vol) and obtains an initial reading of 4.0% (FiHe). After equilibration, the second He reading is 3.2% (FfHe). What is the patient’s FRC? a. 4450 ml b. 3125 ml c. 2680 ml d. 3670 ml ANS: B
If the patient is connected to the circuit at the resting level, the FRC can be calculated with the following equation: FRC = (vol He ÷ FiHe) [(FiHe – FfHe) ÷ FfHe]. DIF: Application
REF: p. 417
OBJ: 8
43. To what should all spirometric values obtained under ambient conditions be converted? a. Ambient temperature and pressure, saturated (ATPS) b. Standard temperature and pressure, dry (STPD) c. Body temperature, ambient pressure, saturated (BTPS) d. Ambient temperature and pressure, dry (ATPD) ANS: C
All lung volumes and capacities must be reported under BTPS conditions.
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DIF: Recall
REF: p. 417
OBJ: 8
44. A patient has a vital capacity of 4200 ml, a functional residual capacity (FRC) of 3300 ml, and
an expiratory reserve volume (ERV) of 1500 ml. What is the residual volume (RV)? a. 5700 ml b. 2700 ml c. 1800 ml d. 7500 ml ANS: C
Once these corrections are made, the RV can be calculated by subtracting the ERV from the FRC according to the following equation: RV = FRC – ERV. DIF: Application
REF: p. 415
OBJ: 8
45. Toward the end of a nitrogen washout test for functional residual capacity, the expired
concentration of N2 begins rising. What does this probably indicate? a. The patient is trying too hard. b. There is a leak in the system. c. The test is nearing completion. d. N 2 is being trapped in the lungs. ANS: B
The test must occur in a leak proof circuit because the presence of any air increases the measured nitrogen percentages and results in grossly elevated measurements of lung volume. DIF: Application
REF: p. 418
OBJ: 8
46. Which of the following are true statements regarding the volume of tissue nitrogen excreted
during the N2 washout test for measuring functional residual capacity (FRC)? 1. It is not a factor. 2. It varies with the length of the test. 3. It varies with the weight of the patient. 4. It cannot be correct. a. 1 only b. 2 and 3 only c. 2, 3, and 4 only d. 4 only ANS: B
The volume of tissue nitrogen excreted (V tis in milliliters) is directly related to the duration (t in minutes) of the test and weight (W in kilograms) of the patient. A correction for this extra nitrogen should be made according to the following formula: V tis (ml) = (0.1209 – 0.0665) (W/70). V tis (ml) is subtracted from the BTPS-corrected lung volume. The residual volume is the difference between the expiratory reserve volume and the FRC. DIF: Recall
REF: p. 418
OBJ: 8
47. When used to determine functional residual capacity, the body plethysmograph operates on
which of the following physical principles?
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a. b. c. d.
Dalton’s law Charles’ law Boyle’s law Gay-Lussac’s law
ANS: C
The plethysmography technique applies Boyle’s law and uses measurements of volume and pressure changes to determine lung volume, assuming temperature is constant. DIF: Recall
REF: p. 418
OBJ: 8
48. What is the predicted normal tidal volume in the adult patient? a. 300 to 450 ml b. 400 to 500 ml c. 500 to 700 ml d. 450 to 750 ml ANS: C
The normal V T is approximately 500 to 700 ml for the average healthy adult. DIF: Recall
REF: p. 419
OBJ: 8
49. How reliable is the tidal volume measurement in predicting the type of lung disease present? a. Very reliable b. Somewhat reliable c. Not reliable d. Reliable but only in certain age groups ANS: C
Normal tidal volumes are often observed in both restrictive and obstructive lung diseases. Therefore, the V T alone is not a valid indicator of the type of lung disease. DIF: Recall
REF: p. 419
OBJ: 8
50. What is the normal average inspiratory capacity (IC)? a. 1200 ml b. 2400 ml c. 3600 ml d. 4800 ml ANS: C
The normal IC is approximately 3600 ml, with a significant variation in the normal population. DIF: Recall
REF: p. 419
OBJ: 8
51. Which of the following statements is true about inspiratory capacity (IC)?
1. It is reduced in restrictive lung diseases. 2. It may be reduced in obstructive lung diseases. 3. It may help determine the type of lung expansion therapy to apply. a. 1 and 3 only b. 2 and 3 only
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c. 1 and 2 only d. 2 only ANS: A
The IC may be normal or reduced in restrictive and obstructive lung diseases. A reduction of IC occurs in restrictive lung diseases because the patient’s inhaled volume is reduced, and there is a reduction in total lung capacity. In mild obstructive lung diseases, the IC is usually normal. In moderate and severe obstructive diseases, the IC can be reduced because the resting expiratory level of the functional residual capacity has increased because of hyperinflation of the lungs. An increase in IC may occur when the patient inhales from below the resting expiratory level when the measurement is performed; athletes and musicians who play wind instruments may also have increased inspiratory capacities. Therapists use the measurement of IC in clinical protocols to decide between methods of lung expansion therapy. DIF: Recall
REF: p. 419
OBJ: 8
52. What is the normal predicted vital capacity (VC) measurement in the adult patient? a. 3600 ml b. 4800 ml c. 5400 ml d. 6000 ml ANS: B
The normal value of the VC is 4.80 L and represents approximately 80% of the total lung capacity. DIF: Recall
REF: p. 419
OBJ: 8
53. Which of the following statements is true when comparing the pulmonary function test results
of men versus women? a. Females have larger predicted volumes when corrected for height. b. Females have the same predicted values when corrected for weight. c. Males and females have the same predicted values when corrected for age. d. Males have larger predicted volumes when corrected for height. ANS: D
Male values are larger than female values when height and age are equal. DIF: Recall
REF: p. 420
OBJ: 8
54. What is the normal predicted total lung capacity (TLC) for adults? a. Approximately 6 L b. Approximately 7 L c. Approximately 8 L d. Approximately 9 L ANS: A
The typical normal TLC is 6.00 L. The normal residual volume is approximately 1.20 L and represents approximately 20% of the TLC. DIF: Recall
REF: p. 420
OBJ: 8
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55. What percent of the total lung capacity (TLC) does the residual volume (RV) normally
represent? a. 10% b. 20% c. 30% d. 40% ANS: B
The typical normal TLC is 6.00 L. The normal RV is approximately 1.20 L and represents approximately 20% of the TLC. DIF: Recall
REF: p. 420
OBJ: 8
56. What causes the residual volume (RV) and functional residual capacity (FRC) to increase? a. Atelectasis b. Chronic obstructive lung disease c. Pneumonia d. Pneumothorax ANS: B
The RV and FRC are usually enlarged in acute and chronic obstructive lung diseases because of hyperinflation and air trapping. DIF: Recall
REF: p. 420
OBJ: 8
57. In which of the following conditions is total lung capacity (TLC) always reduced? a. Restrictive lung disease b. Obstructive lung disease c. Combined restrictive and obstructive disease d. Acute airways obstruction ANS: A
The TLC is always reduced in restrictive lung diseases because of a loss of lung volume; the RV and functional residual capacity are often reduced proportionately. Carbon monoxide (CO) is the gas normally used to measure the DL. DIF: Recall
REF: p. 420
OBJ: 8
58. Which gas normally used to measure the diffusing capacity of the lung? a. O 2 b. CO c. CO 2 d. He ANS: B
Carbon monoxide (CO) is the gas normally used to measure the diffusion capacity (DL) of the lung. The diffusing capacity of the lung for carbon monoxide (DLCO) is expressed in ml/min/mm Hg under standard temperature and pressure and dry conditions. DIF: Recall
REF: p. 421
OBJ: 9
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59. Under which of the following conditions would you postpone a diffusing capacity test?
1. Just before the test, the patient smoked two cigarettes. 2. Just before the test, the patient had an episode of severe coughing. 3. Just before the test, the patient had a long wait at a busy bus stop. a. 1 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: B
Performing the diffusing capacity on patients who have recently smoked a cigarette or who have been exposed to environmental carbon monoxide may hinder test validity. DIF: Recall
REF: p. 421
OBJ: 9
60. Which of the following are necessary to ensure a valid single-breath diffusing capacity of the
lungs (DLCO) test result? 1. Two or more acceptable tests should be averaged. 2. Breath-hold time should be between 3 and 5 sec. 3. Corrections for hemoglobin (Hb) and COHb should be included. 4. The maneuvers should be reproducible to within 10%. a. 1, 2, and 3 only b. 2 and 4 only c. 1, 3, and 4 only d. 1, 2, 3, and 4 ANS: C
The mean of two acceptable tests is the DLCO that meet the repeatability requirement of either being within 3 ml of CO (STPD)/min/mm Hg of each other or within 10% of the highest value. DIF: Recall
REF: p. 421
OBJ: 9
61. What is a normal single-breath diffusing capacity for carbon monoxide for a young, healthy
man of average size? a. 10 ml/min/mm Hg b. 20 ml/min/mm Hg c. 30 ml/min/mm Hg d. 40 ml/min/mm Hg ANS: D
A typical normal value for a 20-year-old healthy man is 40 ml/min/mm Hg. DIF: Recall
REF: p. 421
OBJ: 10
62. In which of the following conditions will you see an increase in the DLCO? a. Pulmonary emphysema b. Secondary polycythemia c. Severe anemia d. Pulmonary fibrosis ANS: B
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The DLCO may be increased in patients with polycythemia, congestive heart failure (resulting from an increase in pulmonary vascular blood volume), and elevated cardiac output. Factors that can alter the DLCO above or below the normal value are summarized in Table 20-7. DIF: Recall
REF: p. 423
OBJ: 10
63. A patient has a decreased DLCO but a normal DLCO/V A ratio. The patient most likely has: a. emphysema. b. pulmonary fibrosis. c. a small lung (low total lung capacity). d. secondary polycythemia. ANS: C
The diffusing capacity of the lung to effective total lung capacity ratio (DLCO/V A) differentiates between diffusion abnormalities caused by having a small lung volume compared with diffusion abnormalities caused by alveolar-capillary membrane pathologies. Patients whose only problem is small lungs will have a decreased DLCO, but their DLCO/V A ratio will be normal. Patients with pulmonary emphysema or fibrosis will have a decreased DLCO and a decreased DLCO/V A ratio. DIF: Recall
REF: p. 423
OBJ: 10
64. What conclusions can you draw from the following data, obtained on a 32-year-old 53-kg
woman admitted for elective surgery?
TLC FRC RV VC
a. b. c. d.
ACTUAL .93 41 1.29 3.64
PRED 5.27 2.43 1.35 3.86
%PRED 94% 99% 96% 94%
FVC %FEV 1 FEF200–1200 FEF25%–75%
ACTUAL 3.67 84% 5.66 3.53
PRED 3.86 78% 5.74 3.49
%PRED 95% 99% 101%
Results indicate a mild restrictive lung disorder. Results indicate normal pulmonary function. Results indicate a combined disease process. Results indicate generalized airway obstruction.
ANS: B
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Interpretation of the pulmonary function report: Interpretive strategies for pulmonary function testing abound. Most computer-based pulmonary function testing systems have algorithms in their software programs for computer-assisted interpretations of the pulmonary function report. A consensus for interpreting test results is growing. Table 20-8 summarizes pulmonary function changes that may occur in advanced obstructive and restrictive patterns of lung diseases, and Figure 20-16 presents a simple algorithm to assess pulmonary function test results in clinical practice. When considering a pulmonary function report, the %FEV 1 /VC ratio is a good place to start, because it provides an initial focus as normal, restrictive, or obstructive impairment. When the %FEV 1 /FVC is less than the limit of normal (LLN), there is airway obstruction. When the %FEV 1 /FVC is greater than the LLN, there is no airway obstruction. The LLN %FEV 1 /FVC can be determined directly for various population using regression equations in Table 20-9 or simply estimated at 70%. If the %FEV 1 /FVC ratio is greater than the LLN or 70% and if the TLC is less than the LLN, often defined as less than 80% predicted normal, the patient has a restrictive impairment, according to this algorithm. The severity of the restriction is based on the percent predicted or on the number of standard deviations below the LLN TLC according to Table 20-2. If the %FEV 1 /FVC ratio is less than 70%, the patient likely has an obstructive impairment; the severity of the obstruction is based on the percent predicted normal FEV 1 according to Table 20-2. If the percent predicted normal DLCO is less than 80%, the patient has a diffusion impairment. Some laboratories also report the DLCO/V A ratio, which indexes the DLCO for lung volume measured during the single breath test. If the DLCO/V A ratio is also less than 80% of the indexed value, the cause of the diffusion impairment is considered within the lung, and if the DLCO/V A ratio is greater than 80% of the indexed value, the cause of the diffusion impairment is considered due to small lung volume. DIF: Analysis
REF: p. 424
OBJ: 10
65. What conclusions can you draw from the following data, obtained on a 67-year-old, 76-kg
man admitted for pulmonary complications arising from silicosis? ACTUAL TLC .34 FRC 73 RV 1.45 VC 2.89
a. b. c. d.
PRED 7.73 4.36 2.63 4.74
% PRED 56% 40% 55% 61%
FVC %FEV 1 FEF200-1200 FEF25%-75%
ACTUAL 2.86 96% 6.89 2.78
PRED 4.74 83% 6.71 2.88
% PRED 60% 103% 96%
Results indicate generalized airway obstruction. Results indicate normal pulmonary function. Results indicate a combined disease process. Results indicate a restrictive lung disorder.
ANS: D
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Interpretation of the pulmonary function report: Interpretive strategies for pulmonary function testing abound. Most computer-based pulmonary function testing systems have algorithms in their software programs for computer-assisted interpretations of the pulmonary function report. A consensus for interpreting test results is growing. Table 20-8 summarizes pulmonary function changes that may occur in advanced obstructive and restrictive patterns of lung diseases, and Figure 20-16 presents a simple algorithm to assess pulmonary function test results in clinical practice. When considering a pulmonary function report, the %FEV 1 /VC ratio is a good place to start, because it provides an initial focus as normal, restrictive, or obstructive impairment. When the %FEV 1 /FVC is less than the limit of normal (LLN), there is airway obstruction. When the %FEV 1 /FVC is greater than the LLN, there is no airway obstruction. The LLN %FEV 1 /FVC can be determined directly for various population using regression equations in Table 20-9 or simply estimated at 70%. If the %FEV 1 /FVC ratio is greater than the LLN or 70% and if the TLC is less than the LLN, often defined as less than 80% predicted normal, the patient has a restrictive impairment, according to this algorithm. The severity of the restriction is based on the percent predicted or on the number of standard deviations below the LLN TLC according to Table 20-2. If the %FEV 1 /FVC ratio is less than 70%, the patient likely has an obstructive impairment; the severity of the obstruction is based on the percent predicted normal FEV 1 according to Table 20-2. If the percent predicted normal DLCO is less than 80%, the patient has a diffusion impairment. Some laboratories also report the DLCO/V A ratio, which indexes the DLCO for lung volume measured during the single breath test. If the DLCO/V A ratio is also less than 80% of the indexed value, the cause of the diffusion impairment is considered within the lung, and if the DLCO/V A ratio is greater than 80% of the indexed value, the cause of the diffusion impairment is considered due to small lung volume. DIF: Analysis
REF: p. 424
OBJ: 10
66. What conclusions can you draw from the following data, obtained from a 41-year-old man
who admits to ―occasional smoking‖ but otherwise reveals no past history of pulmonary problems?
TLC FRC RV VC
a. b. c. d.
ACTUAL 4.75 2.31 1.28 3.48
PRED 4.90 2.21 1.20 3.63
% PRED 97% FVC %FEV 1 105% FEF200-1200 106% FEF25%-75% 96%
ACTUAL 2.96 82% 4.33 1.95
PRED 3.63 78% 5.45 3.37
% PRED 82% 79% 58%
Results indicate small airway obstruction. Results indicate generalized airway obstruction. Results indicate a restrictive lung disorder. Results indicate a combined disease process.
ANS: A
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Interpretation of the pulmonary function report: Interpretive strategies for pulmonary function testing abound. Most computer-based pulmonary function testing systems have algorithms in their software programs for computer-assisted interpretations of the pulmonary function report. A consensus for interpreting test results is growing. Table 20-8 summarizes pulmonary function changes that may occur in advanced obstructive and restrictive patterns of lung diseases, and Figure 20-16 presents a simple algorithm to assess pulmonary function test results in clinical practice. When considering a pulmonary function report, the %FEV 1 /VC ratio is a good place to start, because it provides an initial focus as normal, restrictive, or obstructive impairment. When the %FEV 1 /FVC is less than the limit of normal (LLN), there is airway obstruction. When the %FEV 1 /FVC is greater than the LLN, there is no airway obstruction. The LLN %FEV 1 /FVC can be determined directly for various population using regression equations in Table 20-9 or simply estimated at 70%. If the %FEV 1 /FVC ratio is greater than the LLN or 70% and if the TLC is less than the LLN, often defined as less than 80% predicted normal, the patient has a restrictive impairment, according to this algorithm. The severity of the restriction is based on the percent predicted or on the number of standard deviations below the LLN TLC according to Table 20-2. If the %FEV 1 /FVC ratio is less than 70%, the patient likely has an obstructive impairment; the severity of the obstruction is based on the percent predicted normal FEV 1 according to Table 20-2. If the percent predicted normal DLCO is less than 80%, the patient has a diffusion impairment. Some laboratories also report the DLCO/V A ratio, which indexes the DLCO for lung volume measured during the single breath test. If the DLCO/V A ratio is also less than 80% of the indexed value, the cause of the diffusion impairment is considered within the lung, and if the DLCO/V A ratio is greater than 80% of the indexed value, the cause of the diffusion impairment is considered due to small lung volume. DIF: Analysis
REF: p. 424
OBJ: 10
67. Which of the following is necessary to assure comprehensive quality for helium dilution and
nitrogen washout testing? 1. The accuracy and precision of the volume or flow-measuring device must be assured. 2. The accuracy and linearity of the gas analyzer must be verified. 3. Leak test must be acceptable while monitoring change in volume and gas concentrations over at least a minute. 4. Corrections for hemoglobin (Hb) and COHb must be included. a. 2, 3, and 4 only b. 2 and 3 only c. 1, 3, and 4 only d. 1, 2, and 3 only ANS: D
Comprehensive quality assurance for helium dilution and nitrogen washout testing requires accuracy and precision of the volume or flow measuring device, accuracy, and linearity of the gas analyzer and leak test must be acceptable levels. DIF: Application
REF: p. 422
OBJ: 8
68. Comprehensive quality assurance of pulmonary function testing consists of which of the
following: 1. The accuracy and precision of the measured instrument. 2. Patient must be able to do a breath-hold between 3 and 5 sec.
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3. The performance of the technologist. 4. Test results when measuring a standard. a. 2, 3, and 4 only b. 2 and 3 only c. 1, 3, and 4 only d. 1, 2, and 3 only ANS: C
Quality assurance of pulmonary function testing requires accuracy and precision of instruments, monitoring of the performance of the technologist and test results being compared to a measured standard. A patient breath hold is not required. DIF: Recall
REF: p. 422
OBJ: 4
69. Airway resistance (Raw) is usually defined as: a. the pressure difference between the ends of the airway divided by the flow rate of
gas moving through the airway. b. the sum of the pressures between the ends of the airway divided by the flow rate of gas moving through the airway. c. the pressure difference between the ends of the airway multiplied by the flow rate of gas moving through the airway. d. the sum of the pressures between the ends of the airway multiplied by the flow rate of gas moving through the airway. ANS: A
Airway resistance is computed as the change in pressure divided by the flow. DIF: Recall
REF: p. 402
OBJ: 3
70. Which of the following precautions must be considered when performing pulmonary function
procedures on patients with potentially infectious airborne disease? 1. Practitioners should wear sterile gloves. 2. Practitioner should wear a personal respirator or a close-fitting surgical mask. 3. Practitioners should wash their hands between testing patients and after contact with testing equipment. 4. The mouthpiece, nose clips, tubing, and any parts of the instrument that come into direct contact with a patient should be disposed, sterilized, or disinfected between patients. a. 2, 3, and 4 only b. 2 and 3 only c. 1, 3, and 4 only d. 1, 2, and 3 only ANS: A
A respiratory therapist must always wash their hands and wear gloves when dealing with patients. Additional precautions are required when a patient may have an infectious disease. Therapist should put on a respirator or close-fitting surgical mask, washing hands constantly between testing patients and touching equipment, and dispose, sterilize, or disinfect any area or instrument that the patient may have contacted. DIF: Recall
REF: pp. 403-404 OBJ: 3
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Chapter 21 - Review of Thoracic Imaging Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. What lung problem is ventilation/perfusion ( a. Asthma b. Pulmonary embolism c. Pneumonia d. Lung cancer
) scanning used to detect?
ANS: B
Ventilation/perfusion scanning (also known as pulmonary embolism. DIF: Recall
REF: p. 428
scanning) is often used in evaluating for
OBJ: 7
2. Which of the following structures will result in the most radiopaque shadow on the chest
radiograph? a. Aorta b. Heart c. Lungs d. Ribs ANS: D
Bone absorbs a large amount of the x-ray beam and is seen as a nearly white (radiopaque) shadow. DIF: Recall
REF: p. 429
OBJ: 2
3. The right heart shadow is not visible on your patient’s chest radiograph. Which of the
following pathologies may explain this? a. Right middle lobe pneumonia b. Right lung pneumothorax c. Bilateral emphysema d. Bleb in the right lower lobe ANS: A
The structures visible on a chest radiograph are seen only when tissue of one density is next to tissue of another density. For example, the heart is visible as a soft tissue density in the middle of the chest because the lungs, which are primarily air density, normally surround it. If the chest on either side of the heart was filled with water (pulmonary consolidation or pleural effusion), the normal heart shadow would not be visible on the radiograph. DIF: Recall
REF: p. 429
OBJ: 5
4. In which of the following situations is obtaining a chest radiograph least useful? a. Following intubation b. Following placement of a central venous pressure line c. When the static pressure drops by 2 cm H 2 O during CMV
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d. When the patient’s oxygenation status deteriorates for no known reason ANS: C
The respiratory therapist needs to be familiar with the common clinical indications for obtaining a chest radiograph (Table 21-1). DIF: Recall
REF: p. 430
OBJ: 1
5. In what pulmonary condition does the chest radiograph often ―lag behind‖ the clinical status
of the patient? a. Pulmonary embolism b. Emphysema c. Pneumonia d. Congestive heart failure ANS: C
The chest radiograph often lags behind the clinical condition of the patient. This is common in pneumonia where the patient may come in with high fever and cough typical for pneumonia but an infiltrate on the chest film may not appear for 12 to 24 hr. DIF: Recall
REF: p. 429
OBJ: 3
6. Which radiographic view of the chest allows the physician to read the best quality film? a. Anteroposterior b. Posteroanterior c. Lateral d. Lordotic ANS: B
The posteroanterior view is usually performed in the radiology department with equipment that standardizes the distance from the x-ray source to the film and where the x-ray technician can maximize the quality of each film. In addition, taking the film with the anterior chest closest to the film minimizes magnification of the heart. DIF: Recall
REF: p. 431
OBJ: 4
7. Your patient just had an anteroposterior chest film taken. When you view the film, what may
be a consideration? a. The lungs may appear smaller than they really are. b. The heart may appear less dense then it really is. c. The ribs may appear more horizontal than normal. d. The heart may appear larger than it really is. ANS: D
The closer x-ray source and the position of the patient both lead to a slight magnification of the heart shadow. DIF: Recall
REF: p. 431
OBJ: 4
8. What abnormality may appear to be present on the chest x-ray but is simply due to abnormal
rotation of the patient during production of the film? a. Enlarged lungs
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b. Enlarged heart c. Widened mediastinum d. Thickened pleura ANS: C
Patient’s rotation will make the mediastinum appear unusually wide. DIF: Recall
REF: p. 431
OBJ: 3
9. What problem exists when interpreting an overexposed chest film? a. There is difficulty in seeing the peripheral blood vessels. b. The ribs appear wider than normal. c. The heart shadow is blurred. d. The lymph nodes in the mediastinum cannot be seen. ANS: A
An overpenetrated x-ray overexposes the film, leaving the lung parenchyma black and no ability to visualize the peripheral blood vessels. This overpenetration will make evaluation of the lung parenchyma far more difficult. DIF: Recall
REF: p. 431
OBJ: 2
10. In the standard posteroanterior chest film, the heart shadow should be less than what
proportion of the chest width? a. 33% b. 40% c. 50% d. 65% ANS: C
In the posteroanterior projection, the diameter of the heart shadow should not exceed one-half the diameter of the chest. DIF: Recall
REF: p. 433
OBJ: 4
11. Computed tomography (CT) scanning of the chest would be least useful for which of the
following? a. To evaluate the large vessels of the mediastinum b. To evaluate the pleura c. To evaluate lung masses d. To evaluate patients with asthma ANS: D
Conventional CT scanning of the chest is commonly used to evaluate lung nodules and masses, the great vessels of the chest, mediastinum, and pleural disease. DIF: Recall
REF: p. 434
OBJ: 7
12. Which of the following diseases are typically evaluated using high-resolution CT?
1. Emphysema 2. Asthma 3. Bronchiectasis
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4. Interstitial lung disease a. 1 and 3 only b. 1, 3, and 4 only c. 2 and 3 only d. 1, 2, 3, and 4 ANS: B
HRCT is ideally suited to evaluating diffuse parenchymal lung disease like interstitial lung disease, emphysema, and bronchiectasis. DIF: Recall
REF: p. 434
OBJ: 7
13. CT angiography is most often used to evaluate the patient for which of the following
conditions? a. Pulmonary emboli b. Chronic obstructive pulmonary disease c. Congestive heart failure d. Bilateral pneumonia ANS: A
In the chest, CT angiography has been used for years to identify pulmonary thromboemboli. DIF: Recall
REF: p. 434
OBJ: 7
14. Which of the following is a major limitation of magnetic resonance imaging (MRI) of the
chest? a. Cannot visualize large vessels. b. Cannot be used in patients with pacemakers. c. Cannot be used to examine hilar structures. d. Interpretation is difficult. ANS: B
It is critically important to avoid taking conventional metal objects near the MRI machine, because the powerful magnet will pull the metallic object into the magnet with great force, exposing patients and health care providers in its path to life-threatening risk. DIF: Recall
REF: p. 436
OBJ: 7
15. Which of the following structures in the chest is typically examined using MRI?
1. Lung parenchyma 2. Hilar structures 3. Large vessels in the lung 4. Structures in the mediastinum a. 2, 3, and 4 only b. 2 and 3 only c. 4 only d. 1, 2, 3, and 4 ANS: A
The most common uses for MRI in the chest are for imaging the mediastinum, large vessels in the lung, and hilar regions of the lungs.
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DIF: Recall
REF: p. 436
OBJ: 7
16. Which of the following statements is false regarding the use of ultrasound to image the chest? a. It is useful to image the heart. b. It is useful to image pleural abnormalities. c. It is useful to image lung tissue. d. It uses sound waves that echo back to the sensor. ANS: C
Ultrasound of the chest is excellent for evaluating the heart or pleural fluid. Ultrasonic evaluation of the lung itself is rarely useful because of the poor ability of ultrasound to transmit through the air-filled lungs. DIF: Recall
REF: p. 436
OBJ: 7
17. Blunting of the costophrenic angles seen on the posteroanterior or lateral chest film typically
indicates: a. emphysema. b. excess pleural fluid. c. obesity. d. rib fractures. ANS: B
If the point of the costophrenic angle is rounded rather than sharp, it usually indicates a hydrothorax is present. DIF: Recall
REF: p. 438
OBJ: 5
18. Which chest x-ray view is best used to identify excess pleural fluid? a. Posteroanterior b. Anteroposterior c. Lateral decubitus d. Apical lordotic ANS: C
The best film for detecting small amounts of pleural fluid is the lateral decubitus view, which is a frontal view taken as the patient is lying on the side of the suspected effusion. DIF: Recall
REF: p. 438
OBJ: 5
19. What is the earliest sign of a left-sided pleural effusion on an upright chest radiograph? a. An increased distance between the inferior margin of the left lung and the stomach
gas bubble b. Inability to see small pulmonary blood vessels over the left lower lung c. A widened mediastinum d. Elevation of the right hemidiaphragm ANS: A
The earliest sign of a left-sided pleural effusion on an upright chest radiograph is an increased distance between the inferior margin of the left lung and the stomach gas bubble. DIF: Recall
REF: p. 438
OBJ: 5
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20. An air-fluid level in the pleural space typically indicates: a. tension pneumothorax. b. hydropneumothorax. c. pleural effusion. d. an aerobic infection. ANS: B
An air-fluid level in the pleural space indicates a hydropneumothorax. DIF: Recall
REF: p. 438
OBJ: 8
21. In which of the following would loculation of pleural fluid be as likely to occur?
1. Empyema 2. Exudative fluid 3. Hemothorax 4. Congestive heart failure a. 4 only b. 2 and 3 only c. 1, 2, and 4 only d. 1, 2, and 3 only ANS: D
Loculation of pleural fluid (or trapping so the fluid does not move freely with changing positions) is more commonly seen in exudative effusions, hemothorax (blood in the pleural space), and empyema (infection of the pleural fluid). DIF: Application
REF: p. 438
OBJ: 8
22. What is indicated by the presence of gas bubbles within the pleural fluid without prior surgery
or needle insertion? a. Hemothorax b. Pneumothorax c. Empyema d. CHF ANS: C
The presence of gas bubbles within the fluid without prior surgery or needle insertion (which can introduce air) establishes the diagnosis of empyema. DIF: Recall
REF: p. 439
OBJ: 8
23. Which of the following statements is false regarding the use of the chest x-ray to detect a
pneumothorax? a. An expiratory film may be best for a small pneumothorax. b. The standard chest film is of limited use in detecting a pneumothorax. c. The film will show a lack of vascular markings in the affected region. d. The lung margin is often visible with a pneumothorax. ANS: B
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The clinician can easily detect a pneumothorax on the standard chest film in most cases by seeing the lung margin and noting absence of bronchovascular markings between the lung margin and the inner aspect of the chest wall. Visualizing a small pneumothorax may be assisted by taking the chest radiograph when the patient exhales. DIF: Recall
REF: p. 440
OBJ: 6
24. Which of the following statements is false regarding the recognition and treatment of a
tension pneumothorax as seen on the chest radiograph? a. The hemidiaphragm on the affected side will be pushed downward. b. The mediastinum will be pushed toward the unaffected side. c. It requires immediate insertion of a chest tube. d. The patient should be intubated. ANS: D
A tension pneumothorax is suggested on chest films when the hemidiaphragm is pushed down inferiorly or when the mediastinum is shifted toward the opposite lung. A tension pneumothorax requires immediate decompression with a chest tube or Heimlich valve. DIF: Recall
REF: pp. 440-441 OBJ: 8
25. What term is used to describe the shadows seen on the chest film when the alveoli fill with
pus, fluid, or blood? a. Consolidates b. Infiltrates c. Alveolar lesions d. Densities ANS: B
Both pneumonia and a bleeding lung can cause identical-appearing patchy increased density shadows of that tend to coalesce over time on the chest radiograph. These shadows are often referred to as infiltrates. DIF: Recall
REF: p. 441
OBJ: 8
26. Which of the following is false regarding the visualization of air bronchograms on the chest
film? a. They indicate fluid in the pleura. b. They are caused by air-filled airways surrounded by consolidation. c. They are the hallmark of alveolar consolidation. d. They signify airspace disease. ANS: B
These shadows or opacities often have lucent tubular visible structures running through them that represent air bronchograms. Normally, patent airways are not visible in the outer two thirds of the lung on the chest radiograph. There is no contrast between air in the airway and air in the lung. However, the increased contrast produced by filling of the surrounding alveoli with fluid makes the airways more visible and causes the air bronchogram sign. Air bronchograms are the hallmark of infiltrates that fill alveoli (the so-called airspace disease). DIF: Recall
REF: p. 442
OBJ: 8
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27. Which of the following are typical causes of pulmonary edema as seen on the chest
radiograph? 1. Left heart failure 2. Renal failure 3. Cor pulmonale 4. Fluid overload a. 2 only b. 1 and 3 only c. 1, 2, and 4 only d. 1, 2, 3, and 4 ANS: C
Edema from vascular congestion can be caused by failure of the left heart (cardiogenic pulmonary edema), renal failure, or fluid overload. DIF: Recall
REF: p. 442
OBJ: 8
28. What is the most common cause of cephalization as seen on the upright chest film? a. Renal failure b. Left heart failure c. Hypoxemia d. Empyema ANS: B
Cephalization of the pulmonary blood flow is often caused by left heart failure. DIF: Recall
REF: p. 442
OBJ: 8
29. What term is used to describe the predominance of edema in the hilar regions of both lungs
with progressively less edema in the more peripheral areas of the lungs as seen on the chest film? a. Bat’s wing b. Hilar wings c. Butterfly wings d. Heart wings ANS: A
The term ―bat’s wing‖ appearance is applied to the predominance of edema in the hilar regions of both lungs with progressively less edema in the more peripheral areas of the lungs. DIF: Recall
REF: p. 443
OBJ: 8
30. Which of the following statements best describe the typical findings on a chest radiograph for
a patient with interstitial lung disease? a. Unilateral upper lobe infiltrates b. Diffuse bilateral infiltrates c. Diffuse pulmonary hyperinflation d. Diffuse pleural inflammation ANS: B
The chest radiograph of a patient with interstitial lung disease usually has diffuse, bilateral infiltrates.
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DIF: Recall
REF: p. 443
OBJ: 8
31. Which of the following is the most common type of interstitial lung disease? a. Asbestosis b. Silicosis c. Sarcoidosis d. Scleroderma ANS: C
The two most common interstitial lung diseases are sarcoidosis and idiopathic pulmonary fibrosis. DIF: Recall
REF: p. 443
OBJ: 7
32. What is the most common cause of pulmonary fibrosis? a. A virus b. Inhaled dusts c. Drug reaction d. Unknown ANS: D
The two most common interstitial lung diseases, sarcoidosis and idiopathic pulmonary fibrosis, have no known cause. DIF: Recall
REF: p. 443
OBJ: 8
33. What type of imaging is most useful for diagnosing idiopathic pulmonary fibrosis? a. Conventional chest radiography b. CT angiography c. HRCT d. MRI ANS: C
HRCT is particularly helpful in diagnosing idiopathic pulmonary fibrosis. DIF: Recall
REF: p. 443
OBJ: 8
34. Which of the following is not a typical cause of atelectasis? a. Abdominal surgery b. Rib fracture c. Hepatomegaly d. Pleurisy ANS: C
Atelectasis commonly occurs after abdominal or thoracic surgery, with pleurisy, or following pleural irritation from rib fracture or pulmonary infarction. DIF: Recall
REF: p. 444
OBJ: 8
35. What is the most common cause of lobar atelectasis? a. Bronchial obstruction
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b. Loss of surfactant c. Viral pneumonia d. Pleurisy ANS: A
Volume loss involving a whole lobe is usually caused by central airway obstruction. DIF: Recall
REF: p. 444
OBJ: 8
36. Which of the following are common radiographic findings seen in patients with volume loss
due to atelectasis? 1. Elevation of the hemidiaphragm 2. Narrowing of the space between the ribs 3. Increase in the retrosternal airspace 4. Shift of the mediastinum a. 1 only b. 3 only c. 1, 2, and 4 only d. 3 and 4 only ANS: C
This can be seen by elevation of the diaphragm on the side of the atelectasis, a shift of the mediastinum toward the atelectasis, and poor expansion of the chest causing narrowing of the space between the ribs. If the collapsed segment of the lung is in the upper lobe, the hilum will be displaced upward and the minor fissure on the right will be displaced upward. DIF: Recall
REF: p. 444
OBJ: 8
37. Which of the following findings on the chest radiograph is considered a secondary sign of
emphysema? a. Flattening of the diaphragm b. Widening of the cardiac shadow c. Narrowing of the space between the ribs d. Blunting of the costophrenic angle ANS: A
In patients with chronic obstructive pulmonary disease, there may also be an increase in the anteroposterior diameter of the chest, with associated enlargement of the retrosternal and retrocardiac airspaces and flattening of the hemidiaphragms. DIF: Recall
REF: p. 446
OBJ: 8
38. What imaging technique would be most useful to determine which patients with emphysema
may benefit from lung volume reduction surgery? a. Chest HRCT b. CT angiography c. MRI d. Ultrasound ANS: A
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HRCT is far more sensitive and may show evidence of emphysema even when pulmonary function test results are normal. For example, Figure 21-24 demonstrates a case of upper lobe paraseptal emphysema, characterized by cysts on the pleural surface. Chest CT may prove useful to define which patients may benefit from treatments such as lung volume reduction surgery. DIF: Recall
REF: p. 443
OBJ: 8
39. How many solitary pulmonary nodules (SPNs) would be encountered for every 1000 routine
chest radiographs? a. 1 or 2 b. 10 to 15 c. 30 to 40 d. 80 to 100 ANS: A
One or two SPNs are encountered in every 1000 chest radiographs. DIF: Recall
REF: p. 448
OBJ: 8
40. Radiographically, into how many compartments is the mediastinum divided? a. Two b. Three c. Four d. Five ANS: B
The mediastinum is divided into three compartments: anterior, middle, and posterior mediastinum. DIF: Recall
REF: p. 449
OBJ: 5
41. What is the best imaging technique for examining mediastinal masses? a. Conventional lateral chest radiography b. Chest CT c. MRI d. Ultrasound ANS: B
CT is the best type of imaging for assessing most mediastinal masses. DIF: Recall
REF: p. 452
OBJ: 8
42. Which of the following is least likely to cause pneumomediastinum? a. Chest trauma b. Esophageal rupture c. Thyroid surgery d. Pericarditis ANS: D
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Pneumomediastinum, is a form of barotrauma, may result from movement of air into the mediastinum, as may also be seen in cases of esophageal rupture (Figure 21-30). This usually occurs in the distal portion of the esophagus in patients who undergo procedures to stretch or dilate the esophagus. Chest trauma may cause rupture of a main bronchus, also allowing movement of air into the mediastinum. Rarely, air dissects down from the soft tissues of the neck after thyroid, parathyroid, or tonsillar surgery. Gas associated with a retrotonsillar abscess may also move down to the mediastinum through the fascial planes of the neck. Air that accumulates in the retroperitoneum may enter the mediastinum via openings in the diaphragm for the aorta or esophagus. DIF: Application
REF: p. 452
OBJ: 8
43. What is the optimal position of the endotracheal tube following intubation as seen on the chest
radiograph? a. 1 to 2 cm above the carina b. 3 to 4 cm above the carina c. 5 to 7 cm above the carina d. In the upper third of the carina ANS: C
Goodman and Putman suggest that when the head and neck are in the neutral position, the endotracheal tube should be midtrachea (5 to 7 cm from the carina). DIF: Recall
REF: p. 452
OBJ: 6
44. What is the optimal position of the tip of an intra-aortic balloon pump? a. 2 cm above the carina b. 4 cm above the carina c. 7 cm above the carina d. In the upper third of the carina ANS: A
The balloon inflates during diastole and deflates during systole to enhance perfusion of the coronary arteries and cardiac output. The radiopaque tip should reside just beyond the origin of the left subclavian artery within the proximal descending thoracic aorta. The carina can be used as a landmark with the tip of the IABP approximately 2 cm above the carina. DIF: Recall
REF: p. 453
OBJ: 6
45. What are the two most common reasons for placing a chest tube? a. Pneumothorax and pleural effusion b. Pneumothorax and empyema c. Hemothorax and hydrothorax d. To place medicine in the pleural space and to withdraw excess fluid ANS: B
The most common indications for a chest tube are pneumothorax (air in the pleural space) and empyema (pus in the pleural space), although chest tubes may also be used to drain blood (hemothorax) or fluid (hydrothorax) or to install a sealant (e.g., the antibiotic doxycycline) to achieve closure of the pleural space, thereby preventing recurrent pneumothorax or hydrothorax.
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DIF: Recall
REF: p. 452
OBJ: 8
46. A 49-year-old COPD patient arrives to the ER complaining of shortness of breath (SOB) and
difficulty breathing. The physical examination reveals bilateral coarse crackles throughout the lung fields, pedal edema, and hepatomegaly. The chest x-ray shows bilateral fluffy infiltrates with a ―bat’s wing‖ configuration. What clinical condition you may suspect on this patient? a. Acute coronary syndrome b. COPD exacerbation c. Hypertensive crisis d. Left heart failure ANS: D
The term ―bat’s wing‖ appearance is applied to the predominance of edema in the hilar regions of both lungs with progressively less edema in the more peripheral areas of the lungs. Left heart failure and CHF will cause congestion of the pulmonary vessels leading to pulmonary edema throughout the lung fields. DIF: Analysis
REF: p. 443
OBJ: 8
47. A high-resolution CAT scan of a 62-year-old smoker has revealed several nodules on the right
lung. Which of the following procedures would you suggest to assess the ―malignancy‖ of these nodules? a. Ultrasound tomography b. Positron emission tomography c. Magnetic resonance imaging d. CAT scan angiography ANS: B
Positron emission tomography (PET) is often very helpful in evaluating solitary pulmonary nodules. Nodules with greater than 1 cm diameter that are avid for the isotope used in PET (5 fluorodeoxyglucose) and therefore ―light up‖ on the scan generally are more likely to be malignant than nodules without uptake. DIF: Application
REF: p. 449
OBJ: 6
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Chapter 22 - Flexible Bronchoscopy and the Respiratory Therapist Kacmarek et al.: Egan’s Funda menta ls of Respiratory Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following are divisions of imaging systems used during flexible bronchoscopy?
1. Fiberoptic 2. Video 3. Hybrid 4. Fusion a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
The flexible bronchoscope uses fiberoptic bundles to illuminate the endobronchial tree. Based on its imaging system, FBs are divided into fiberoptic, video, or hybrid. DIF: Recall
REF: p. 457
OBJ: 1
2. What two directions can the distal tip of a flexible bronchoscope be flexed? a. Up to 90 degree in ante-flexion and up to 30 degree in retro-flexion positions b. Up to 270 degree in ante-flexion and up to 220 degree in retro-flexion positions c. Up to 180 degree in ante-flexion and up to 90 degree in retro-flexion positions d. Up to 180 degree in ante-flexion and up to 130 degree in retro-flexion positions ANS: D
The distal tip of flexible bronchoscope can be flexed in two directions up to 180 degree in ante-flexion and up to 130 degree in retro-flexion positions. DIF: Recall
REF: p. 457
OBJ: 1
3. Which of the following are considered indications for flexible bronchoscopy?
1. Unexplained lung collapse 2. Need for large size tissue specimen 3. Evaluate endotracheal tube-related injury 4. Bronchogenic carcinoma a. 1 and 3 only b. 1, 2, and 3 only c. 1, 3, and 4 only d. 1, 2, 3, and 4 ANS: C
Table 22-1 presents the indications to performing FB. DIF: Recall
REF: p. 458
OBJ: 2
4. Which of the following are considered contraindications for flexible bronchoscopy?
1. Severe hypercapnia
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2. Impaired neck mobility 3. Hemoptysis 4. Recent myocardial infarction a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Table 22-2 presents the contraindications to performing FB. DIF: Recall
REF: p. 458
OBJ: 2
5. Your patient is being scheduled for a flexible bronchoscopy and is inquiring about when to
stop taking her warfarin. After consulting the physician, what would you tell her? a. 1 to 2 days prior to the procedure. b. 3 to 5 days prior to the procedure. c. 1 week prior to the procedure. d. She does not need to discontinue her warfarin. ANS: B
Table 22-5 details antithrombotic therapies and recommended interval between last dose and procedure. DIF: Application
REF: p. 462
OBJ: 1
6. Which of the following are considered indications for rigid bronchoscopy?
1. Large foreign body extraction 2. Management of massive hemoptysis 3. Self-expandable stent placement 4. Mediastinal and hilar lymphadenopathy a. 3 only b. 2 and 3 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
Box 22-4 presents the indications to performing rigid bronchoscopy. DIF: Recall
REF: p. 464
OBJ: 2
7. Metallic stents are placed during: a. flexible bronchoscopy. b. rigid bronchoscopy. c. either flexible or rigid bronchoscopy. d. mediastinal surgery. ANS: C
Table 22-3 presents the comparison of silicone and metallic stent properties. DIF: Recall
REF: pp. 464, 466 OBJ: 4
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8. For patient safety, to help avoid methemoglobinemia, the total dose of lidocaine should not
exceed: a. 2 mg/kg. b. 5 mg/kg. c. 7 mg/kg. d. 10 mg/kg. ANS: C
For patient safety, to help avoid methemoglobinemia, the total dose of lidocaine should not exceed 7 mg/kg of body weight during a routine (<45 min) FB procedure. DIF: Analysis
REF: p. 458
OBJ: 1
9. The assessment of the upper airway prior to a flexible bronchoscopy procedure to help
identify patients in whom it may be difficult to secure an airway is referred to as: a. the Glasgow Coma Scale. b. the Mallampati classification. c. the APACHE scale. d. the Borg scale. ANS: B
The assessment of the upper airway prior to the procedure helps to identify those patients in whom it may be difficult to secure an airway in case of hypoventilation. The Mallampati classification is one of the most commonly used methods to identify individuals who may pose difficulty during intubation. The Mallampati score is assessed by having the patient open his/her mount and protrude the tongue as much as possible without phonation. DIF: Recall
REF: p. 459
OBJ: 1
10. What is the most difficult parameter to monitor during FB? a. Depth of sedation b. Airway pressure c. Chest movement d. Pulse oximetry ANS: A
One of the most difficult parameters to monitor during FB is the depth of sedation. Intermittent boluses of sedation may be needed to ensure the adequate depth of sedation during the procedure. However, the depth of sedation must be balanced with the side effects of over-sedation during and after the procedure. DIF: Application
REF: pp. 457-458 OBJ: 1
11. Which of the following must be continuously monitored during a bronchoscopy?
1. Cardiac monitoring 2. Blood pressure 3. Oximetry 4. MetHb levels a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only
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d. 1, 2, 3, and 4 only ANS: B
Continuous cardiac, blood pressure, and oximetry monitoring must be carried out during the procedure of bronchoscopy. Capnography is highly recommended. DIF: Recall
REF: pp. 457-458 OBJ: 6
12. To obtain lavage fluid, the bronchoscope is wedged at which of the following locations? a. The level of the carina b. The level of second or third generation bronchus c. The level of fourth or fifth generation bronchus d. At least at the level of the sixth generation bronchus ANS: C
To obtain the lavage fluid, the bronchoscope is wedged at the level of fourth or fifth generation bronchus. A ―good wedge‖ position means that the bronchoscope is advanced as far as possible while the distal lumen is still visible. DIF: Recall
REF: p. 460
OBJ: 2
13. Where should a bronchoalveolar lavage be obtained? a. The nondependent part of the lung b. The dependent part of the lung c. The largest lobe of the lung affected d. The smallest lobe of the lung affected ANS: A
BAL should be obtained from the nondependent part of the lung to optimize the fluid return. DIF: Recall
REF: p. 460
OBJ: 2
14. What portion of the airway are bronchial washings generally obtained? a. The large airways b. Either of the upper lobes c. Either of the lower lobes d. The lowest portion of the airways possible ANS: A
Unlike BAL, bronchial washings are obtained from the large airways. DIF: Recall
REF: p. 461
OBJ: 2
15. When is endobronchial biopsy performed? a. To obtain a sputum sample from a visible endobronchial lesion. b. To obtain a tissue sample from a visible endobronchial lesion. c. It is used with transbronchial needle aspiration. d. It is used during bronchial stent placement. ANS: B
Endobronchial biopsy (EBBx) is a technique whereby flexible forceps are used to obtain a tissue sample from a visible endobronchial lesion. It provides specimens for histological examination.
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DIF: Application
REF: p. 461
OBJ: 5
16. A technique of obtaining a specimen of the lung parenchyma by using flexible forceps
positioned distally through the working channel of the bronchoscope is referred to as: a. an endobronchial biopsy. b. bronchial brushing. c. transbronchial needle aspiration. d. a transbronchial biopsy. ANS: D
Transbronchial biopsy (TBBx) is a technique of obtaining a specimen of the lung parenchyma by using flexible forceps positioned distally through the working channel of the bronchoscope. DIF: Recall
REF: p. 461
OBJ: 5
17. In a patient with suspected bronchogenic carcinoma, how many biopsy specimens need to be
collected during an endobronchial biopsy? a. 1 b. 2 c. 3 d. 4 ANS: C
The number of biopsy specimens that should be obtained depends upon the diagnosis suspected. In patients suspected to have bronchogenic carcinoma, three biopsy specimens are often able to successfully diagnose almost all such cases. DIF: Recall
REF: p. 461
OBJ: 6
18. What are the two major complications of transbronchial biopsy? a. Uncontrollable coughing and bleeding b. Pneumothorax and bleeding c. Pneumothorax and coughing d. Cardiac arrest and pneumothorax ANS: B
There are two major complications of TBBx, pneumothorax and bleeding. Adequate sedation and cough suppression are important to reduce the risk of pneumothorax arising from cough-induced barotrauma. DIF: Recall
REF: p. 462
OBJ: 2
19. What is the major challenge of ultrathin bronchoscopy? a. Bronchoscopy kinking during procedure b. The equipment is expensive c. Issues with CT guidance equipment d. Maintaining proper anatomical orientation in the peripheral airways ANS: D
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The major technical challenge of performing ultrathin bronchoscopy is maintaining proper anatomic orientation in the peripheral airways. The instrument is seldom used without a real-time CT guidance, virtual bronchoscopy, or a specially designed peripheral EBUS system. DIF: Recall
REF: p. 464
OBJ: 5
20. During thermal ablation, how are endobronchial ignitions prevented? a. The FiO 2 should always be maintained at 21%. b. The FiO 2 should always be maintained below 40%. c. The procedure is only performed for 3 sec at a time. d. The patient’s airway is cooled with cryotherapy prior to the procedure. ANS: B
During the application of ―hot therapies‖ (thermal ablation) like laser, electrosurgery, or argon plasma coagulation, the FiO 2 should always be maintained below 40% to prevent endobronchial ignition. DIF: Recall
REF: p. 465
OBJ: 3
21. Which of the following is an advantage of brachytherapy? a. It is a treatment option for all lung cancer types. b. It does not require the use of a bronchoscope. c. A lower dose of radiation can be delivered to the tumor cells while minimizing
radiation to the normal tissue. d. A higher dose of radiation can be delivered to the tumor cells while minimizing radiation to the normal tissue. ANS: D
The main advantage of brachytherapy is that a higher dose of radiation can be delivered to the tumor cells while minimizing radiation to the normal tissue, thereby reducing complications. Brachytherapy is indicated in patients with inoperable lung cancer or cancer metastatic to the airways. DIF: Recall
REF: p. 465
OBJ: 3
22. Which of the following are indications for self-expanding metallic stent placement?
1. Extrinsic compression of central airways 2. Stabilizing airway patency after endoscopic removal of an intrinsic tumor 3. Sealing fistula between the lung and the gastrointestinal tract 4. Managing benign central airway obstruction a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
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The indications for SEMS placement include (1) extrinsic compression of central airways; (2) stabilizing airway patency after endoscopic removal of an intrinsic tumor; (3) sealing fistula between the lung and the gastrointestinal tract; and (4) managing of post-lung transplant anastomotic complications. SEMS is rarely used in benign central airway obstruction because there is high risk for stent-related granulation tissue formation. DIF: Recall
REF: p. 466
OBJ: 4
23. Which of the following are roles of the RT during bronchoscopic procedures?
1. Collaborates with other members of the patient care team to determine if the procedure is indicated. 2. Ensures that all documentation is in place before the procedure. 3. Helps to recognize the patient’s oxygen requirement and anticipates appropriate oxygen supplement during the procedure. 4. Assists the physician in operating the bronchoscopic accessories. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
RT roles are summarized in Table 22-8. DIF: Application
REF: p. 467
OBJ: 6
24. During bronchoscopy of an intubated patient receiving mechanical ventilation, what should
the RT be aware of? a. Risks are minimal since the patient already has a secured airway. b. The resistance imposed by the bronchoscope may cause tracheal pressures to increase noticeably. c. Albuterol should be available to address and airway resistance changes. d. Inspiratory and expiratory effort (measured by tracheal pressure) appears minimally affected in most patients. ANS: B
The external diameter of a standard fiberoptic bronchoscope is 5.7 mm, but in some situations a smaller (5 mm or less) or larger (6.4 mm) diameter scope may be used. The narrowest point in the upper airway (and point of maximal resistance) is the cricoid space, the diameter of which averages 14 mm in women and 18 mm in men. Thus, in nonintubated, spontaneously breathing patients inspiratory and expiratory effort (measured by tracheal pressure) appears minimally affected in most patients (−5 and +3.5 cm H 2 O, respectively). However, in intubated, spontaneously breathing patients, the resistance imposed by the bronchoscope may cause tracheal pressures to increase noticeably (−10 and +9 cm H 2 O) and may reach clinically unacceptable levels (−20 and +20 cm H 2 O) in some patients.68 Therefore, the minimum appropriately sized endotracheal tube for a standard 5.7-mm bronchoscope is an 8.0-mm inner diameter. DIF: Application
REF: p. 468
OBJ: 7
25. Hypoxemia during FB on a mechanically ventilated patient is typically due to: a. inappropriately set alarms.
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b. equipment failure. c. loss of lung volume. d. bronchospasm. ANS: C
Hypoxemia during FB on mechanically ventilated patients is related to several factors, including loss of lung volume during suctioning, particularly if tidal volume delivery also is compromised. It occurs more frequently in those with acute respiratory distress syndrome and in those insufficiently sedated. DIF: Application
REF: p. 468
OBJ: 7
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Chapter 23 - Nutrition Assessment Kacmarek et al.: Egan’s Funda menta ls of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. What is the primary purpose of nutrition assessment? a. To identify how much weight the patient needs to lose b. To identify the patient’s ideal body weight c. To develop a nutrition care plan d. To identify the proper caloric intake for the patient ANS: C
The purpose of nutrition assessment is to gather data to develop a nutrition care plan that will ensure adequate nutrition for health and well-being when implemented. DIF: Recall
REF: p. 475
OBJ: 1
2. Which of the following is not considered part of the anthropometric assessment? a. Body mass index b. Activity level c. History of weight loss d. Triceps skin fold ANS: B
Box 23-1 gives an overview of the information to incorporate into a nutrition assessment. DIF: Recall
REF: p. 475
OBJ: 1
3. If your patient is 2 m in height and weighs 80 kg, what is his body mass index (BMI)? a. 40 kg/m2 b. 30 kg/m2 c. 20 kg/m2 d. 15 kg/m2 ANS: C
The formula used to calculate BMI for measurements in kilograms and meters is as follows: . DIF: Application
REF: p. 476
OBJ: 2
4. What is the normal BMI for adults? a. 15.5 to 20.6 kg/m2 b. 18.5 to 24.9 kg/m2 c. 20.6 to 25.9 kg/m2 d. 22.5 to 26.0 kg/m2 ANS: B
A healthy weight may be confirmed by a BMI of between 18.5 and 24.9 kg/m 2 for adults or a BMI-for-age between the tenth and eighty-fifth percentiles for children.
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DIF: Recall
REF: p. 476
OBJ: 2
5. Obesity is defined as a BMI over what value? a. 20 kg/m2 b. 25 kg/m2 c. 30 kg/m2 d. 35 kg/m2 ANS: C
Obesity is defined as a BMI greater than 30 kg/m2 in the adult and greater than the ninety-fifth percentile in boys and girls aged 2 to 20 years. DIF: Recall
REF: p. 476
OBJ: 2
6. Which of the following statements is true regarding kwashiorkor?
1. Occurs with a long-term loss of protein. 2. Often causes facial and limb edema. 3. Child often has a pot belly. 4. May occur in combination with marasmus. a. 1, 2, and 3 only b. 2 and 3 only c. 2, 3, and 4 only d. 1 and 4 only ANS: C
Kwashiorkor results from the more sudden lack of protein and calories, as in the first-born infant weaned suddenly on the arrival of a new sibling, when a diet of nutrient-rich breast milk is traded for a nutrient-poor cereal-based diet. The protruding belly and edematous face and limbs, characteristics of kwashiorkor, result from a lack of circulating proteins needed to maintain fluid balance and to transport fat out of the liver. DIF: Application
REF: p. 476
OBJ: 2
7. Protein-energy malnutrition may be reflected in reduced values for which of the following?
1. Albumin levels 2. Lymphocyte count 3. Transferrin 4. Red blood cell count a. 1, 2, and 3 only b. 1 and 2 only c. 2 and 4 only d. 3 and 4 only ANS: A
Protein-energy malnutrition may be reflected in low values for albumin, transferrin, transthyretin, retinol-binding protein, and total lymphocyte count. DIF: Recall
REF: p. 477
OBJ: 3
8. Which of the following blood tests is most useful for day-to-day monitoring of long-term
trends in the nutrition status of the patient? a. Albumin levels
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b. Total white blood cell count c. Hematocrit d. Serum potassium levels ANS: A
The general availability and stability of albumin levels from day to day make it one of the most useful tests for assessing long-term trends (Table 23-2). DIF: Recall
REF: p. 477
OBJ: 4
9. Your male patient has a creatinine excretion level of 8 mg/kg body weight/day. What does
this indicate? a. It is normal. b. There is mild muscle wasting. c. There is moderate muscle wasting. d. There is severe muscle wasting. ANS: D
Predicted values are based on gender and height, with reference values of approximately 18 mg/kg body weight/day for women to approximately 23 mg/kg body weight/day for men. Values of 60% to 80% of predicted indicate a mild deficit of muscle mass; 40% to 60% indicate a moderate deficit, and less than 40% of predicted suggest a severe depletion of muscle mass. DIF: Application
REF: p. 478
OBJ: 4
10. Which of the following complications is least likely to influence creatinine excretion? a. Sepsis b. Trauma c. Hypoxemia d. Diet ANS: C
Factors that influence creatinine excretion, and thus complicate interpretation of this index, include age, diet, exercise, stress, trauma, fever, and sepsis. DIF: Recall
REF: p. 478
OBJ: 4
11. What is the recommended measurement for nitrogen balance? a. Blood urea nitrogen b. Serum urea nitrogen c. Urinary nitrogen d. Urinary urea nitrogen ANS: C
Urinary nitrogen is the recommended value to use in determining nitrogen balance. DIF: Recall
REF: p. 478
OBJ: 4
12. What changes in lung function are associated with malnutrition? a. Reduced VC b. Increased TLC
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c. Increased RV d. Decreased FRC ANS: A
Weakness of the diaphragm and other muscles of inspiration can lead to a reduced vital capacity and peak inspiratory pressures. DIF: Recall
REF: p. 478
OBJ: 4
13. Your patient is reported to be cachexic. Which of the following physical findings would
support this statement? a. The patient’s belly is swollen. b. The patient has facial edema. c. The patient’s ribs protrude. d. The patient’s hair falls out easily. ANS: C
Patients with persistent malnutrition will often appear very thin to the point that their ribs and bony structures of the chest are very visible. The patient is said to be cachexic in such cases. DIF: Recall
REF: p. 478
OBJ: 5
14. What is the classic measure of energy expenditure? a. Basal oxygen consumption b. Basal metabolic rate (BMR) c. Resting caloric uptake d. Resting carbon dioxide production ANS: B
The classic measure of energy expenditure is the BMR. DIF: Recall
REF: p. 479
OBJ: 5
15. When is the basal metabolic rate (BMR) best obtained? a. After 10 hr of fasting b. While walking on a treadmill c. On rising in the morning d. 1 hr after lunch ANS: A
Obtained after 10 hr of fasting, the BMR measures the number of calories (kcal) expended at rest per square meter of body surface per hour (kcal/m2 /hr). DIF: Recall
REF: p. 479
OBJ: 5
16. What procedure is used to overcome the limitations associated with estimating resting energy
expenditures? a. Measuring blood glucose before and after exercise b. Monitoring body temperature during heavy exercise c. Indirect calorimetry d. The Douglas procedure ANS: C
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To overcome the limitations of estimating formulas, energy needs can be measured at the bedside. To do so, a procedure called indirect calorimetry is used. DIF: Recall
REF: p. 479
OBJ: 5
17. Which of the following statements is false regarding energy needs? a. They vary with state of health. b. They vary with activity level. c. They are increased with obese patients. d. They increase with sepsis. ANS: C
Of course, energy needs vary according to activity level and state of health. Energy needs of sick patients can be significantly higher than predicted normal values. Energy needs for obese individuals are less because adipose tissue uses less energy than does muscle. Energy needs should be reevaluated and adjusted whenever weight changes more than 5 to 10 lb. DIF: Recall
REF: p. 479
OBJ: 5
18. In which of the following patients would indirect calorimetry be indicated?
1. Patients who are difficult to wean from mechanical ventilation 2. Patients with morbid obesity 3. Patients with a high level of stress a. 1 only b. 1 and 2 only c. 1 and 3 only d. 3 only ANS: C
Specific clinical conditions supporting the need for indirect calorimetry as a tool in nutrition assessment are listed in Box 23-4. DIF: Application
REF: p. 480
OBJ: 8
19. Which of the following pieces of equipment is not needed to perform indirect calorimetry? a. Oxygen analyzer b. Tissot spirometer c. Douglas bag d. Nitrogen analyzer ANS: D
Indirect calorimetry can be performed with a Douglas bag, a Tissot spirometer, and CO 2 and O 2 gas analyzers. DIF: Recall
REF: p. 480
OBJ: 8
20. What probably represents the most significant problem while performing calorimetry on a
patient being mechanically ventilated? a. Compensating for mechanical dead space b. Leaks in the circuit c. Volume compression during inspiration d. High PEEP levels
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ANS: B
Perhaps the most significant problem in performing indirect calorimetry on mechanically ventilated patients is the presence of leaks (circuit, tracheal tube cuff, and chest tubes). DIF: Recall
REF: p. 480
OBJ: 8
21. What does the RQ represent? a. Matching of respiration to perfusion b. Ratio of the moles of CO 2 produced to O2 consumed c. Ratio of O 2 consumed to kilograms of ideal body weight d. Ratio of calories consumed to CO 2 produced ANS: B
The second step in metabolic assessment is to interpret the RQ. The RQ is the ratio of moles of CO 2 expired to moles of O 2 consumed. DIF: Recall
REF: p. 480
OBJ: 10
22. Which of the following has an RQ of 1.0? a. Fat b. Carbohydrates c. Protein d. Soy ANS: B
Carbohydrates have an RQ of 1.0, protein has an RQ of 0.82, and fat has an RQ of 0.7. DIF: Recall
REF: p. 483
OBJ: 10
23. Which of the following is associated with primary protein-energy malnutrition (PEM)? a. Poor diet due to living in a developing country b. Anorexia c. Malabsorption d. Severe infection ANS: A
PEM has adverse effects on respiratory musculature and the immune response. PEM may be either primary or secondary. Primary PEM results from inadequate intake of calories and/or protein and is typically seen only in developing countries. Secondary PEM is due to underlying illness. Illness may cause (1) decreased caloric or protein intake (e.g., anorexia, dysphagia); (2) increased nutrient losses (e.g., malabsorption or diarrhea); and/or (3) increased nutrient demands (e.g., injury or infection). As many as 50% of hospital patients may have secondary PEM. DIF: Recall
REF: p. 484
OBJ: 3
24. Which of the following diseases is/are associated with protein-energy malnutrition (PEM)?
1. Asthma 2. Emphysema 3. Cancer a. 1 only
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b. 1 and 2 only c. 2 and 3 only d. 3 only ANS: C
This type of PEM usually manifests itself as a gradual wasting process, as seen in chronic diseases such as cancer and emphysema. The primary clinical sign is progressive weight loss. DIF: Recall
REF: p. 484
OBJ: 12
25. Which of the following illnesses are associated with acute catabolic disease?
1. Trauma 2. Sepsis 3. Burns 4. Pulmonary embolism a. 3 only b. 1, 2, and 3 only c. 2, 3, and 4 only d. 3 and 4 only ANS: B
This type of protein-energy malnutrition typically occurs with acute catabolic disease, such as in sepsis, burns, or trauma. DIF: Recall
REF: p. 484
OBJ: 12
26. Which of the following is not associated with zinc deficiencies? a. Poor blood clotting b. Impaired wound healing c. Bronchospasm d. Reduced immunity ANS: C
Zinc deficiencies can impair clotting, slow wound healing, and impair immunity. DIF: Recall
REF: p. 484
OBJ: 13
27. Which of the following is not associated with magnesium deficiencies? a. Reduced diaphragm strength b. Neurologic abnormalities c. Cardiac abnormalities d. Liver enlargement ANS: C
Magnesium deficiencies can result in cardiac, vascular, neurologic, and electrolyte abnormalities (hypocalcemia, hypokalemia), as well as in decreases in respiratory muscle strength. DIF: Recall
REF: p. 484
OBJ: 13
28. Which of the following is associated with acute cardiac muscle weakness and potential
cardiopulmonary failure?
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a. b. c. d.
Hyperkalemia Hypophosphatemia Hypernatremia Low folic acid levels
ANS: B
Severe hypophosphatemia can result in decreased muscle strength and contractility and acute cardiopulmonary failure. DIF: Recall
REF: p. 484
OBJ: 13
29. Which of the following abnormalities in the respiratory system is/are associated with
malnutrition? 1. Reduced hypoxic drive 2. Increased airway clearance 3. Loss of lung surfactant a. 1 only b. 1 and 3 only c. 2 and 3 only d. 2 only ANS: B
Specific effects of malnutrition on the respiratory system are listed in Box 23-9. DIF: Recall
REF: p. 485
OBJ: 12
30. Which of the following statements is false regarding malnutrition in patients with chronic
obstructive pulmonary disease (COPD)? a. Use of a nasal cannula may contribute to the problem. b. Depression is common and may reduce appetite. c. A high work of breathing increases caloric needs. d. Vitamin deficiencies increased the need for oxygen. ANS: D
Box 23-10 summarizes the factors contributing to malnutrition in COPD patients. DIF: Application
REF: p. 485
OBJ: 17
31. Ideally, approximately what percent of a patient’s estimated calorie needs should be provided
by protein? a. 20% b. 40% c. 50% d. 60% ANS: A
Ideally, approximately 20% of a patient’s estimated calorie needs should be provided by protein. DIF: Recall
REF: p. 485
OBJ: 14
32. What effect does high carbohydrate intake have on metabolism?
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a. b. c. d.
Increases CO2 production. Reduces oxygen consumption. Increases caloric needs. Reduces protein catabolism.
ANS: A
For the patient with pulmonary disease or those requiring mechanical ventilation, high carbohydrate loads can cause problems. High carbohydrate loads increase CO 2 production and the RQ, resulting in increased ventilatory demand, O2 consumption, and work of breathing. DIF: Recall
REF: p. 486
OBJ: 14
33. What percent of the patient’s caloric intake should come from fat in most circumstances? a. 10% to 15% b. 20% to 30% c. 30% to 40% d. 40% to 50% ANS: B
Ideally, approximately 20% of a patient’s estimated calorie needs should be provided by proteins. For critically ill patients, 50% to 60% of the total daily calories can be in the form of simple carbohydrate, and the remaining calories (20% to 30%) should be provided from fat. DIF: Recall
REF: p. 486
OBJ: 14
34. Which of the following situations is not an indication for enteral nutritional support? a. Burns over 30% of the body surface area b. Persistent inability to eat orally c. Severe pancreatitis d. Renal failure ANS: D
Box 23-12 provides guidelines for initiating nutrition support as recommended by the American Society for Parenteral and Enteral Nutrition (ASPEN). DIF: Recall
REF: p. 486
OBJ: 15
35. Which of the following are reasons to use enteral feeding over parenteral?
1. Reduced incidence of stress ulcers. 2. Enteral route may avoid intestinal atrophy. 3. Enteral causes less hypoglycemia. 4. Enteral is safer and cheaper. a. 1 and 3 only b. 1, 2, and 4 only c. 2 and 3 only d. 3 and 4 only ANS: B
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Enteral feedings are the route of choice: ―If the gut works, use it.‖ The enteral route is safer and cheaper to use than the parenteral route. Enteral feeding stimulates gut hormones, subjects nutrients to the absorptive and metabolic controls of the intestinal tract and liver, and produces less hyperglycemia (providing for better immune function) than the parenteral route. In addition, the buffering capacity of enteral feeding can improve resistance against stress ulcers. Finally, enteral feeding maintains a more normal intestinal mucosa than the parenteral route (the intestinal mucosa may undergo atrophy during parenteral nutrition). DIF: Application
REF: p. 486
OBJ: 15
36. What tube feeding method is associated with an increased risk of aspiration? a. Bolus b. Intermittent c. Continuous drip d. Pressurized ANS: A
There is an increased risk of aspiration associated with bolus feedings because of the rapid infusion of formula into the stomach. DIF: Recall
REF: p. 487
OBJ: 16
37. What tube feeding method must be used when the food substance is delivered beyond the
pylorus? a. Bolus b. Intermittent c. Continuous drip d. Pressurized ANS: C
Because the small bowel lacks storage capacity, feedings delivered beyond the pylorus must be provided by the continuous drip method. DIF: Recall
REF: p. 487
OBJ: 15
38. Why raise the head of the bed during tube feedings? a. It reduces the time needed. b. It improves absorption. c. It reduces the risk of aspiration. d. It is easier for the caregiver. ANS: C
The two most important ways to minimize the likelihood of aspiration are (1) to raise the head of the bed at least 45 degrees and (2) to deliver the feeding beyond the pylorus using the continuous drip method. DIF: Recall
REF: p. 487
OBJ: 14
39. Which of the following metabolism issues is not associated with systemic inflammatory
response syndrome (SIRS)? a. Hypoglycemia b. Protein catabolism
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c. Increased macronutrient requirement d. Triglyceride intolerance ANS: A
Metabolism in SIRS is characterized by increased total caloric requirements, hyperglycemia, triglyceride intolerance, increased net protein catabolism, and increased macronutrient and micronutrient requirements. DIF: Recall
REF: p. 488
OBJ: 17
40. What are the primary goals of nutritional support during mechanical ventilation?
1. Avoid loss of lean body mass. 2. Avoid lung infection. 3. Keep muscles of breathing strong enough for weaning. a. 1 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
During acute illness, proper nutrition helps prevent the loss of lean body mass. After the resolution of the acute phase of illness, good nutrition helps the muscles regain strength and improves the likelihood of successful ventilator weaning. DIF: Recall
REF: p. 488
OBJ: 17
41. Which of the following statements is false with regard to nutritional support of the patient
with advanced chronic obstructive pulmonary disease? a. Provide low-calorie options. b. Provide high-protein nutrition. c. Provide small, frequent meals. d. Provide good patient education. ANS: A
Given the positive link between dietary intake and knowledge of diet and health, good patient education is critical. Patients should be taught to select easy to consume calorically dense foods (Box 23-13). Emphasis should be placed on small, frequent feedings with the use of high-calorie, high-protein nutritional supplements encouraged. DIF: Recall
REF: p. 490
OBJ: 17
42. Which of the following pulmonary diseases is similar to chronic obstructive pulmonary
disease with regard to metabolic abnormalities? a. Asthma b. Cystic fibrosis c. Pulmonary fibrosis d. Acute respiratory distress syndrome ANS: B
The same disturbance may cause pancreatic insufficiency. Metabolic problems in cystic fibrosis are similar to those in the patient with chronic obstructive pulmonary disease, with reduced intake and increased metabolic needs.
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DIF: Application
REF: p. 490
OBJ: 17
43. Which of the following instructions must be followed to prepare a patient for indirect
calorimetry? 1. Suction the patient 30 min before the test. 2. Fasting 10 hr before test. 3. Avoid physical activity 4 hr before the test. 4. 24-hr urine urea nitrogen collection. a. 1 and 2 only b. 2, 3, and 4 only c. 4 only d. 3 and 4 only ANS: B
Fasting in required because if feeding in continued result will reflect the patient’s energy expenditure in response to feeding and may be high if patient is being overfed. It may also register high if there has been recent physical activity. The UUN collection is used if determination of carbohydrate, fat, and protein utilization is desired. DIF: Recall
REF: p. 480
OBJ: 9
44. Which of the following tools for nutritional assessment requires the patient to maintain a daily
record of food intake for a 3- or 7-day period? a. The 24-hr recall b. Usual intake recall c. Food frequency questionnaire d. Food diary ANS: D
Keeping a dietary history allows the patient to arrive with a history already recorded so the patient interview can reveal other dietary practices. DIF: Recall
REF: p. 475
OBJ: 6
45. Which of the following is not a nutritional goal for the management of a cystic fibrosis
patient? a. Maximize nutritional intake. b. Meet clinical and psychological needs. c. Avoid caloric dense foods. d. Encourage mineral and vitamin supplementation. ANS: C
All of the following are nutritional goals for the management of a cystic fibrosis patient, except: Use of calorically dense nutritional supplements consumed throughout the day have proved useful in achieving weight gain. DIF: Recall
REF: p. 490
OBJ: 17
46. Morbid obesity is defined as a BMI over what value? a. 20 kg/m2 b. 25 kg/m2
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c. 30 kg/m2 d. 35 kg/m2 ANS: D
Morbid obesity is defined as a BMI greater than 35 kg/m2 in the adult and greater than the ninety-ninth percentile in boys and girls aged 2 to 20 years. DIF: Recall
REF: p. 476
OBJ: 2
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Chapter 24 - Pulmo nary Infections Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following is true concerning pneumonia? a. Patients with community-acquired pneumonia most often require hospitalization. b. Community-acquired pneumonias are most often antibiotic-resistant strains. c. Pneumonia is the number one cause of death in the United States. d. Pneumonia is the sixth leading cause of death in the United States. ANS: D
Pneumonia is the sixth leading cause of death in the United States and the most common cause of infection-related mortality. DIF: Application
REF: p. 495
OBJ: 1
2. A patient comes into the emergency department presenting with signs and symptoms of
pneumonia. While taking the patient’s history, it is determined that 2 months ago the patient spent 3 days in the hospital for acute angina. Since then the patient has been stable on medication. What type of pneumonia is this patient most likely to have? a. CAP b. HAP c. HCAP d. VAP ANS: C
HCAP is defined as pneumonia occurring in any patient hospitalized for 2 or more days in the past 90 days in an acute care setting or who, in the past 30 days, has resided in a long-term care or nursing facility, attended a hospital or hemodialysis clinic, or who has received intravenous antibiotics, chemotherapy, or wound care. DIF: Application
REF: p. 495
OBJ: 2
3. Which of the following types of pneumonia suggests that the patient acquired it through
inhalation of infectious particles? a. Cytomegalovirus b. Haemophilus influenzae c. Histoplasmosis d. Staphylococcus ANS: C
Six pathogenetic mechanisms may contribute to the development of pneumonia (Table 24-2). Histoplasmosis is one of those caused by inhalation of infectious particles. DIF: Recall
REF: p. 496
OBJ: 2
4. Via what route is tuberculosis spread? a. Direct contact b. Fecal-oral route
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c. Fomite d. Inhaled particles ANS: D
Tuberculosis is acquired by inhalation of infectious particles is the basis for a policy whereby patients with suspected or proven tuberculosis who are coughing are placed in respiratory isolation, thereby minimizing the risk of disease transmission within the hospital setting. DIF: Recall
REF: p. 496
OBJ: 2
5. Which group of patients is most likely to develop pneumonia subsequent to large-volume
aspiration? a. Acute respiratory distress syndrome b. Alcohol toxicity c. Diabetes mellitus d. Obstructive sleep apnea ANS: B
Certain patient populations are at risk of large-volume aspiration, such as those with impaired gag reflexes from narcotic use, alcohol intoxication, or prior stroke. DIF: Recall
REF: p. 496
OBJ: 3
6. What mechanism has been found to be useful in minimizing the development of pneumonia
associated with intubated patients? a. Elevation of the head of the bed b. Frequent suctioning through the endotracheal tube c. Maintaining the patient on severe fluid restriction d. Use of tracheal gas insufflation ANS: A
In intubated patients, chronic aspiration of colonized secretions through a tracheal cuff has been linked to the subsequent occurrence of pneumonia, which has led to the development of novel strategies to prevent hospital-acquired pneumonia, such as continuous suctioning of subglottic secretions in mechanically ventilated patients and elevation of the head of the bed. DIF: Recall
REF: p. 496
OBJ: 3
7. Which of the following mechanisms is an uncommon route for the spread of pneumonia? a. Aspiration of infectious particles b. Inhalation of infectious particles c. Through the bloodstream d. Direct contact ANS: C
The spread of infection through the bloodstream from a remote site is called hematogenous dissemination. This is an uncommon cause of pneumonia, which may occur in patients with right-sided bacterial endocarditis in whom fragments of an infected heart valve break off, embolize through the pulmonary arteries to the lungs, and produce either pneumonia or septic pulmonary infarcts. DIF: Recall
REF: p. 496
OBJ: 3
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8. Which of the following types of pneumonia suggests that the patient acquired it because of the
reactivation of a latent infection, often in the setting of immunosuppression? a. Cytomegalovirus b. Haemophilus influenzae c. Histoplasmosis d. Staphylococcus ANS: A
Cytomegalovirus pneumonia is an example of a latent infection that can reactivate during chronic immunosuppression, especially in solid organ and bone marrow transplant recipients. DIF: Recall
REF: p. 496
OBJ: 3
9. What is the most common identified cause of community-acquired pneumonia? a. Haemophilus influenzae b. Legionella pneumophila c. Staphylococcus aureus d. Streptococcus pneumoniae ANS: D
In most studies, S. pneumoniae, also called pneumococcus, has been the most commonly identified cause of community-acquired pneumonia, accounting for 20% to 75% of cases (Table 24-3). DIF: Recall
REF: p. 497
OBJ: 4
10. Which of the following represents an example of atypical community-acquired pneumonia? a. Haemophilus influenzae b. Legionella pneumophila c. Staphylococcus aureus d. Streptococcus pneumoniae ANS: B
Legionella species, Chlamydophilia pneumoniae, and Mycoplasma pneumoniae together account for 10% to 20% of cases. These latter organisms, called atypical pathogens, vary in frequency in recent reports, depending on the age of the patient population, the season of the year, and geographical locale. DIF: Recall
REF: p. 497
OBJ: 4
11. What has been found to be a common cause of pneumonia in HIV-positive patients? a. Klebsiella b. Pneumocystis jiroveci c. Staphylococcus d. Streptococcus pneumoniae ANS: B
In urban settings that have a high incidence of endemic HIV infection, P. jiroveci may be a more common cause of community-acquired pneumonia and, according to one report, may account for up to 13% of cases.
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DIF: Recall
REF: p. 497
OBJ: 4
12. In what percentage of patients with pneumonia has no microbial agent been isolated? a. Up to 40% b. Up to 50% c. Up to 60% d. Up to 70% ANS: B
In most published series, no microbiological diagnosis is established in up to 50% of patients. DIF: Recall
REF: p. 497
OBJ: 4
13. Which of the following would be the more common route for nosocomial pathogens to be
transmitted? a. Directly patient to patient b. Fecal-oral route c. Aerosol route d. Via the health care worker ANS: D
Nosocomial pathogens capable of producing hospital-acquired pneumonia can be transmitted directly from one patient to another, as in the case of tuberculosis. However, transmission from health care workers (including respiratory therapists (RTs)), contaminated equipment, or fomites (objects capable of transmitting infection through physical contact with them) is more common, especially for gram-negative bacilli, S. aureus, and viruses. DIF: Recall
REF: p. 498
OBJ: 4
14. What term is used to describe objects capable of transmitting infection through physical
contact with them? a. Consolidates b. Contaminants c. Fomites d. Vectors ANS: C
Fomites are objects capable of transmitting infection through physical contact with them. DIF: Recall
REF: p. 498
OBJ: 4
15. In what type of pneumonia is diarrhea a common symptom? a. Cytomegalovirus b. Klebsiella c. Pneumococcal d. Staphylococcal ANS: C
The occurrence of concomitant diarrhea, once considered indicative of legionellosis, is now known to be common in pneumococcal and Mycoplasma pneumonia. DIF: Recall
REF: p. 498
OBJ: 5
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16. A patient presents with high fever, teeth-chattering chills, pleuritic pain, and a cough
producing rust-colored sputum. What pathogen should be suspected? a. Chlamydia pneumoniae b. Legionella pneumoniae c. Mycoplasma pneumoniae d. Pneumococcal pneumoniae ANS: D
In patients presenting with high fever, teeth-chattering chills, pleuritic pain, and a cough producing rust-colored sputum, pneumococcal pneumonia is the most likely diagnosis. DIF: Recall
REF: p. 498
OBJ: 5
17. Which of the following symptoms is typical for pneumococcal pneumonia? a. Foul-smelling sputum b. Low-grade fever c. Minimal sputum production d. Pleuritic chest pain ANS: D
In patients presenting with high fever, teeth-chattering chills, pleuritic pain, and a cough-producing rust-colored sputum, pneumococcal pneumonia is the most likely diagnosis. DIF: Recall
REF: p. 498
OBJ: 5
18. Your patient has community-acquired bacterial pneumonia. Which of the following symptoms
are common with this type of pneumonia? 1. Cough with purulent sputum 2. Diarrhea 3. Low fever 4. Shaking chills a. 1 and 3 only b. 2 and 4 only c. 3 only d. 1, 2, and 4 only ANS: D
In patients presenting with high fever, teeth-chattering chills, pleuritic pain, and a cough-producing rust-colored sputum, pneumococcal pneumonia is the most likely diagnosis. Diarrhea is also a common finding. DIF: Application
REF: p. 498
OBJ: 5
19. A patient presents with pneumonia accompanied by foul-smelling breath, absent gag reflex, or
recent loss of consciousness. What should be suspected? a. Aspiration pneumonia b. Chlamydia pneumonia c. Pneumococcal pneumonia d. Tuberculosis ANS: A
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Patients with pneumonia accompanied by foul-smelling breath, absent gag reflex, or recent loss of consciousness are most likely to have a mixed aerobic and anaerobic infection as a consequence of aspiration. DIF: Application
REF: p. 498
OBJ: 5
20. What organism is likely to be responsible for pneumonia that is community acquired and
produces a hoarse voice in the patient? a. Chlamydia pneumoniae b. Haemophilus influenzae c. Legionella d. Mycoplasma ANS: A
Community-acquired pneumonia accompanied by hoarseness suggests that the culprit is C. pneumoniae. DIF: Recall
REF: p. 498
OBJ: 5
21. An elderly patient comes in with failure to thrive, shortness of breath, confusion, and
worsening congestive heart failure. What is most likely the patient’s primary problem? a. An atypical pneumonia b. Aspiration pneumonia c. Community-acquired pneumonia d. Tuberculosis ANS: C
The clinical presentation of community-acquired pneumonia in elderly patients deserves special mention because it may be subtle. Older individuals with pneumonia may not have a fever or cough and may simply present with shortness of breath, confusion, worsening congestive heart failure (CHF), or failure to thrive. DIF: Application
REF: p. 498
OBJ: 5
22. What clinical finding should raise your suspicion that a patient has developed
hospital-acquired pneumonia? a. A new fever b. Digital clubbing c. Diplopia d. Pedal edema ANS: A
HCAP, HAP, and VAP usually present with a new onset of fever in hospitalized or institutionalized patients. DIF: Recall
REF: p. 499
OBJ: 3
23. What finding is usually used to confirm the diagnosis of pneumonia? a. Development of central cyanosis b. New cough or new characteristic to the cough c. New fever d. New infiltrate on chest radiograph
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ANS: D
In patients with a compatible clinical syndrome, the diagnosis of community-acquired pneumonia is established by the presence of a new pulmonary infiltrate on the chest radiograph. DIF: Recall
REF: p. 499
OBJ: 5
24. Which of the following clinical conditions are often associated with a normal chest radiograph
in the patient with pneumonia? 1. Dehydration 2. Early infection 3. Klebsiella pneumonia 4. Pneumocystis jiroveci infection a. 1, 2, and 4 only b. 2 and 3 only c. 1 only d. 3 and 4 only ANS: A
A normal chest x-ray film does not exclude the diagnosis of pneumonia. The chest radiograph may be normal in patients with early infection, dehydration, or P. jiroveci infection. DIF: Recall
REF: p. 499
OBJ: 6
25. What finding on the chest radiograph is typical for a viral pneumonia? a. Interstitial infiltrates b. Lobar consolidation c. Patchy infiltrate surrounding one bronchus or several bronchi d. Pleural effusion ANS: A
Interstitial infiltrates, especially if diffuse, suggest viral disease, P. jiroveci, or miliary tuberculosis in patients with community-acquired pneumonia. DIF: Recall
REF: p. 499
OBJ: 6
26. What type of lung infection is most commonly associated with cavitating lesions on the chest
radiograph? a. Community-acquired pneumonia b. Reactivation tuberculosis c. Staphylococcus aureus d. Viral pneumonias ANS: B
Cavitary infiltrates are seen in reactivation pulmonary tuberculosis; fungal pneumonias, such as histoplasmosis and blastomycosis; nocardiosis; pyogenic lung abscess; and rarely, P. jiroveci pneumonia. DIF: Recall
REF: p. 499
OBJ: 6
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27. What type of severe lung infection may result in the development of small lung cavities called
pneumatoceles? a. Community-acquired pneumonia b. Legionella pneumoniae c. Staphylococcus aureus d. Viral pneumonia ANS: C
Patients with severe staphylococcal or gram-negative pneumonias may develop small cavities called pneumatoceles. DIF: Recall
REF: p. 499
OBJ: 6
28. Rapidly spreading multilobar consolidation is typical for what type of pneumonia? a. Klebsiella b. Legionella c. Pneumocystis jiroveci d. Viral ANS: B
Table 24-4 lists the radiographic patterns produced by pathogens in CAP. DIF: Recall
REF: p. 499
OBJ: 6
29. What organism is associated with the highest mortality rate for patients with pneumonia? a. Klebsiella b. Legionella c. Pseudomonas aeruginosa d. Staphylococcus aureus ANS: C
Mortality varies according to the infecting agent and was highest for P. aeruginosa (61.1%), Klebsiella species (35.7%), Escherichia coli (35.3%), and S. aureus (31.8%). Mortality rates for more common pathogens were lower but still substantial and included Legionella species (14.7%), S. pneumoniae (12.3%), C. pneumoniae (9.8%), and M. pneumoniae (1.4%). DIF: Recall
REF: p. 500
OBJ: 7
30. Which of the following clinical findings is not associated with an increased risk of death in
the patient with pneumonia? a. Kidney disease b. Heart rate of 130 beats/min c. Respiratory alkalosis d. Systolic blood pressure of 85 mm Hg ANS: C
Points are assigned for the presence of a number of variables, and cumulative point scores are used to stratify patients into one of five different risk groups with predictable mortality rates (Table 24-5). Of the above only respiratory alkalosis is NOT associated with increased risk of death. DIF: Recall
REF: p. 501
OBJ: 7
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31. Which of the following would be associated with a fatal outcome in a patient with pneumonia
who is mechanically ventilated? a. Heart rate of 110 beats/min b. Multisystem organ failure c. Presence of purulent sputum d. Respiratory alkalosis ANS: B
In mechanically ventilated patients, factors associated with fatal outcome include the following: • Infection with high-risk organisms such as P. aeruginosa, Acinetobacter species, and Stenotrophomonas maltophilia • Multisystem organ failure • Nonsurgical diagnosis • Therapy with antacids or H 2 -receptor antagonists • Transfer from another hospital or ward • Renal failure • Prolonged mechanical ventilation • Coma or shock • Inappropriate antibiotic therapy • Hospitalization in a noncardiac ICU DIF: Recall
REF: p. 502
OBJ: 7
32. Which of the following would interfere with the collection of a good sputum sample for Gram
stain? 1. Contamination of the sample with oral secretions 2. Lack of productive cough 3. Prior antibiotic therapy 4. Rinsing with mouthwash prior to sputum collection a. 1, 2, and 3 only b. 2 and 4 only c. 3 only d. 1 and 4 only ANS: A
Factors that contribute to a poor Gram stain specimen include: lack of productive cough, prior antibiotic therapy, and contamination by oral secretions as specimens contaminated with oropharyngeal epithelial cells are unsatisfactory for analysis. DIF: Recall
REF: p. 502
OBJ: 8
33. What would be important to perform in order to obtain a good sputum sample that is to be
used to detect the pathogen causing community-acquired pneumonia? a. Ensure that antibiotic treatment was instituted at least 24 hr earlier. b. Have patient sit in the semirecumbent position to obtain sample. c. Have patient spit into sample container. d. Patient should rinse mouth prior to sample collection. ANS: D
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The RT has an important role in the collection of an appropriate specimen of expectorated sputum. Patients should be advised to rid the mouth of contaminating saliva, either by rinsing with water or by spitting, and then to expectorate a specimen from deep within the tracheobronchial tree into a collection container. Prompt transportation to the laboratory is essential and improves the diagnostic yield from culture. DIF: Recall
REF: p. 502
OBJ: 8
34. Which of the following organisms have been found to colonize the oropharynx of healthy
individuals? a. Coccidioides immitis b. Haemophilus influenzae c. Histoplasma capsulatum d. Mycobacterium ANS: B
In routine sputum culture, the isolation of bacteria, such as S. pneumoniae and H. influenzae, must be interpreted within the context of the Gram stain because these organisms can colonize the oropharynx, and their presence in culture may not signify true lower respiratory tract infection. DIF: Recall
REF: p. 503
OBJ: 8
35. In the patient suspected of having tuberculosis, what finding on Gram stain would result in the
initiation of antituberculosis medications? a. Acid-fast bacilli b. Gram-negative rods c. Pleomorphic cocci d. Presence of gram-negative cocci ANS: A
In patients with suspected tuberculosis, the finding of acid-fact bacilli in stained specimens of sputum often prompts initiation of antituberculous therapy, because culture isolation of M. tuberculosis may take up to 6 weeks. DIF: Recall
REF: p. 503
OBJ: 8
36. Which of the following organisms that cause pneumonia is most likely to result in a positive
blood culture? a. Chlamydia pneumoniae b. Haemophilus influenzae c. Mycoplasma pneumoniae d. Pneumocystis jiroveci ANS: B
Blood cultures should be obtained in hospitalized patients with community-acquired pneumonia and may be helpful in establishing the diagnosis in patients with typical bacterial pathogens. Blood cultures are positive in approximately 30% of patients with pneumococcal pneumonia and in up to 70% of those with H. influenzae pneumonia. DIF: Recall
REF: p. 503
OBJ: 9
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37. What percent of patients with community-acquired pneumonia have a parapneumonic pleural
effusion? a. 5% to 10% b. 20% to 35% c. 30% to 50% d. 50% to 75% ANS: C
Parapneumonic pleural effusions are common and occur in 30% to 50% of cases of community-acquired pneumonia. DIF: Recall
REF: p. 503
OBJ: 9
38. A 35-year-old man is admitted to the hospital and has been confirmed to have pneumococcal
pneumonia. What test would it be wise to order at this time? a. Bronchial biopsy b. CBC and electrolytes c. HIV d. Sputum culture and sensitivity ANS: C
Because pneumococcal and H. influenzae pneumonia occur with higher frequency in patients with HIV than they do in the average population, an HIV test is recommended for patients with community-acquired pneumonia who are between the ages of 15 and 54 years. HIV testing is also recommended for other individuals who engage in behaviors that put them at risk for HIV. DIF: Application
REF: p. 504
OBJ: 9
39. An intubated, mechanically ventilated patient is suspected of developing nosocomial
pneumonia. The pulmonologist decides to perform a bronchoscopy. Which bronchoscopy findings would be consistent with pneumonia? 1. Alveolar collapse 2. Distal purulent secretions 3. Persistent secretions surging from distal bronchi during exhalation 4. P/F ratio less than 50 a. 2, 3, and 4 only b. 1 and 3 only c. 2 only d. 3 and 4 only ANS: A
Direct visualization by bronchoscopy of the lower airway in ventilated patients is sometimes helpful in supporting the diagnosis of VAP. In one recent study, the presence of distal, purulent secretions; persistence of secretions surging from distal bronchi during exhalation; and a decrease in the PaO 2 /FiO 2 ratio of less than 50 were independently associated with the presence of pneumonia. DIF: Application
REF: p. 505
OBJ: 9
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40. In order to determine the presence of ventilator-associated pneumonia, what diagnostic
procedure might be done by a respiratory therapist? a. Bronchial biopsy b. Mini bronchoalveolar lavage c. Protected specimen brush d. Transthoracic ultrathin needle aspiration ANS: B
Recently, mini-BAL performed by RTs has been advocated for diagnosing VAP. In one study, results obtained using this technique were comparable with those obtained by bronchoscopy using PSB. DIF: Recall
REF: p. 505
OBJ: 9
41. What time line has been established to initiate antibiotic treatment in patients with pneumonia
who are admitted to the hospital that will result in improved survival? a. 2 hr or less b. 4 hr or less c. 6 hr or less d. 8 hr or less ANS: B
Therapy initiated within 4 hr of hospital admission has been associated with improved survival. DIF: Recall
REF: pp. 505-506 OBJ: 10
42. For a patient with pneumonia with coexisting cardiopulmonary disease, according to the ATS
guidelines, what single antibiotic could be given as empiric treatment? a. Intravenous beta-lactam b. Intravenous doxycycline c. Intravenous fluoroquinolone d. Intravenous macrolide ANS: C
For higher risk patients with these comorbidities, acceptable alternatives include an IV beta-lactam plus an IV or oral macrolide or doxycycline; alternatively, a parenteral fluoroquinolone may be used alone. DIF: Recall
REF: pp. 505-506 OBJ: 10
43. ATS guidelines suggest using which of the following antibiotics if methicillin-resistant S.
aureus is a concern? a. Cefazolin b. Doxycycline c. Penicillin d. Vancomycin ANS: D
Vancomycin is another alternative, although the ATS guidelines suggest avoiding vancomycin unless methicillin-resistant S. aureus is a concern.
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DIF: Recall
REF: pp. 505-506 OBJ: 10
44. What antibiotic is the drug of choice for the patient with nonresistant S. pneumoniae? a. Ampicillin b. Azithromycin c. Penicillin d. Vancomycin ANS: C
For isolates of S. pneumoniae susceptible to penicillin, penicillin remains the preferred agent. DIF: Recall
REF: pp. 505-506 OBJ: 10
45. What is the drug of choice for the patient with Pneumocystis jiroveci pneumonia? a. Ampicillin b. Doxycycline c. Erythromycin d. Trimethoprim-sulfamethoxazole ANS: D
Trimethoprim-sulfamethoxazole (TMP-SMX) is the drug of choice for P. jiroveci pneumonia. DIF: Recall
REF: pp. 505-506 OBJ: 10
46. If an HIV-infected patient has an adverse reaction to the treatment of choice for Pneumocystis
jiroveci pneumonia, what treatment should be instituted? a. Amphotericin B b. Pentamidine c. Trimethoprim-sulfamethoxazole d. Vancomycin ANS: B
Up to 50% of HIV-infected patients will develop fever or a rash while taking TMP-SMX. Pentamidine is an acceptable alternative. DIF: Application
REF: pp. 505-506 OBJ: 10
47. What might be indicated by failure of the patient’s temperature to normalize 4 or 5 days after
the start of antibiotic therapy? 1. A closed-space infection 2. Drug fever 3. A missed pathogen a. 1 and 2 only b. 2 and 3 only c. 1 only d. 1, 2, and 3 ANS: D
Failure of the patient’s temperature to normalize within 4 or 5 days suggests the following possibilities: a missed pathogen, a metastatic or closed-space infection (e.g., empyema), drug fever, or the presence of an obstructing endobronchial lesion.
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DIF: Application
REF: p. 507
OBJ: 10
48. A 45-year-old patient diagnosed with pneumonia has received appropriate antibiotic therapy.
Radiographic resolution is most often seen within what time period? a. 1 week b. 1 month c. 6 months d. 1 year ANS: B
Within 1 month, radiographic resolution occurs in 90% of individuals younger than the age of 50 years. DIF: Recall
REF: p. 507
OBJ: 6
49. Which of the following organisms is associated with a poor prognosis in the patient with
ventilator-related pneumonia despite optimal therapy? a. C. pneumoniae b. Klebsiella c. P. aeruginosa d. S. pneumoniae ANS: C
Some organisms, such as P. aeruginosa and Acinetobacter species, are associated with a poor prognosis in ventilator-associated pneumonia, despite optimal therapy. The mortality rate for these organisms may approach 90%, despite appropriate treatment. DIF: Recall
REF: p. 508
OBJ: 4
50. Which of the following individuals should be immunized against influenza?
1. 65-year-old individual 2. Respiratory therapist 3. Individual with chronic heart disease 4. Individual with glaucoma a. 1, 2, and 3 only b. 2 and 4 only c. 1 and 3 only d. 1, 2, 3, and 4 ANS: A
Immunization for community-acquired pneumonia is indicated for individuals: older than the age of 60 years, with chronic lung or heart disease, or for whom the morbidity of influenza may be substantial. Health care workers, including RTs, should be immunized annually to prevent transmission of influenza to patients. DIF: Recall
REF: p. 508
OBJ: 11
51. Pneumococcal vaccines are indicated for which of the following individuals?
1. 65-year-old individual 2. Respiratory therapist 3. Individual with chronic heart disease 4. Individual with glaucoma
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a. b. c. d.
1, 2, and 3 only 2 and 4 only 1 and 2 only 3 and 4 only
ANS: C
Pneumococcal vaccination is indicated for all individuals older than the age of 65 years and for those older than the age of 2 years who have functional or anatomical asplenia. Vaccination is also indicated in patients with chronic illnesses such as CHF, chronic lung disease, chronic liver disease, alcoholism, cerebrospinal fluid leaks, or conditions characterized by impaired immunity. Routine pneumococcal vaccination of all health care workers is not currently recommended, unless they possess one of the specific indications for vaccination outlined previously. DIF: Recall
REF: p. 508
OBJ: 11
52. What is an often-neglected but very important component of preventing transmission of
pathogens between patients, particularly those who are ventilated? a. Adequate antibiotic therapy b. Brushing of teeth c. Handwashing d. Use of negative-pressure rooms ANS: C
Handwashing is an important but frequently neglected measure that can reduce transmission of nosocomial bacteria from one patient to another. It is especially important for RTs who may be caring for several ventilated patients in the ICU. DIF: Recall
REF: p. 509
OBJ: 11
53. Which of the following are common laboratory findings found in adults with suspected
community-acquired pneumonia? 1. Acidemia 2. Proteinuria 3. Azotemia 4. Hyponatremia a. 1, 2, and 3 only b. 2 and 4 only c. 1 and 3 only d. 1, 3, and 4 only ANS: D
Table 24--5 lists some of the laboratory and radiographic findings to help in the diagnosis of community-acquired pneumonia. Some of these findings are acidemia (arterial pH > 7.35), azotemia (BUN < 30 mg/dl), hyponatremia (sodium < 130 mmol/L), hypoxia (PaO 2 < 60 mm Hg), hyperglycemia (glucose > 250 mg/dl), anemia (hematocrit < 30%), and pleural effusion. Proteinuria is not common in CAP. DIF: Recall
REF: p. 512
OBJ: 5
54. All of the following are extra-pulmonary manifestations for TB, except:
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a. b. c. d.
hectic fever. hepatomegaly. bronchioectasis. weight loss.
ANS: C
Complications of pulmonary tuberculosis include tuberculous empyema, bronchiectasis, extensive pulmonary parenchymal destruction, spontaneous pneumothorax, and massive hemoptysis from rupture of a Rasmussen aneurysm in the wall of a cavity. Extra-pulmonary complications may include hectic fever, wasting, and hepatosplenomegaly (enlargement of the liver and spleen). Laboratory testing may demonstrate pancytopenia (decreased cell counts in white blood cells, red blood cells, and platelets) and advanced immunodeficiency. DIF: Recall
REF: p. 501
OBJ: 10
55. A 26 year-old seasonal worker from South America came to the ER with a history of a dry,
hacking blood-tinged cough, fever, chills, and loss of appetite. The chest x-ray showed cavitary lesion in the right upper lobe. After a week in the hospital, the sputum culture shows the present of acid-fast stained organisms. Which of the following medications would you recommend for this patient at this time? 1. Ceftizoxime 2. Isoniazid 3. Rifampin 4. Ethambutol a. 1 only b. 2 and 4 only c. 1, 2, and 3 only d. 2, 3, and 4 only ANS: D
Isoniazid, rifampin, pyrazinamide, and ethambutol are first-line antituberculous medications. Pending antimicrobial susceptibility results; treatment with four drugs at the outset is recommended. In those with drug-susceptible pulmonary tuberculosis, a number of 6- to 9-month treatment regimens have been shown to be effective as outlined in the ATS/CDC/IDSA guidelines. DIF: Analysis
REF: p. 511
OBJ: 10
TRUE/FALSE 1. The chest radiograph is often of little help in the diagnosis of nosocomial pneumonia in
mechanically ventilated patients in the ICU because these individuals often have other reasons for radiographic abnormalities. ANS: T
The chest radiograph is often less helpful in the diagnosis of VAP because mechanically ventilated patients often have other reasons for radiographic abnormalities, such as ARDS, CHF, pulmonary thromboembolism, alveolar hemorrhage, or atelectasis. DIF: Recall
REF: p. 511
OBJ: 6
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Chapter 25 - Obstructive Lung Disease: Chronic Obstructiv e Pulmonary Disease (COPD), Asthma, and Related Diseases Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE
1. Which of the following are typically found in a patient with COPD? 1. Airway inflammation 2. Partially reversible airway obstruction 3. Progressive airway obstruction 4. Restrictive disease a. 2 and 3 only b. 1 and 4 only c. 1, 2, and 3 only d. 2, 3, and 4 only
ANS: C Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. DIF: Recall
REF: p. 515
OBJ: 1
2. Emphysema is defined as: a. chronic productive cough. b. conducting airway enlargement. c. destruction of alveolar walls without fibrosis. d. hemoptysis associated with productive cough and alveolar-capillary membrane destruction.
ANS: C
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Emphysema is defined in anatomical terms as a condition characterized by abnormal, permanent enlargement of the airspaces beyond the terminal bronchiole, accompanied by destruction of the walls of the airspaces without fibrosis. DIF: Recall
REF: p. 515
OBJ: 1
3. Which complaint is most closely associated with the diagnosis of chronic bronchitis? a. Airway enlargement b. Chronic productive cough c. Dyspnea on exertion d. Hemoptysis
ANS: B Chronic bronchitis is defined in clinical terms as a condition in which chronic productive cough is present for at least 3 months per year for at least 2 consecutive years. DIF: Recall
REF: p. 515
OBJ: 1
4. Approximately how many Americans are affected by COPD? a. 8 million b. 16 million c. 24 million d. 32 million
ANS: C COPD is common, with recent estimates suggesting that 24 million Americans are affected. It is the third leading cause of death in the United States, responsible for 145,075 deaths in 2008. DIF: Recall
REF: p. 516
OBJ: 2
5. The mechanisms of airway obstruction in COPD include which of the following? 1. Airway remodeling 2. Inflammation and obstruction of small airway 3. Loss of elasticity 4. Active bronchospasm
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a. 1 and 2 only b. 1 and 4 only c. 2, 3, and 4 only d. 3 and 4 only
ANS: C The mechanisms of airflow obstruction in COPD include inflammation and obstruction of small airways (<2 mm in diameter); loss of elasticity, which keeps small airways open when elastin is destroyed in emphysema; and active bronchospasm. DIF: Recall
REF: p. 517
OBJ: 1
6. Where does COPD rank among the leading causes of death in the United States? a. First b. Second c. Third d. Fourth
ANS: C COPD is now the third leading cause of death in the United States. DIF: Recall
REF: p. 516
OBJ: 2
7. Approximately how many individuals died of COPD in the United States in 2008? a. 145,000 b. 210,000 c. 550,000 d. 1,000,000
ANS: A COPD is now the third leading cause of death in the United States, accounting for an estimated 145,075 (or approximately 4% of all) deaths in 2008. DIF: Recall
REF: p. 516
OBJ: 2
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8. What is the approximate cost of COPD to the U.S. health system? a. $20 billion b. $30 billion c. $40 billion d. $50 billion
ANS: D In 2010, COPD caused 715,000 hospitalizations (which accounted for 1.9% of all hospitalizations in the United States), and, in 2010, COPD resulted in a total health expenditure of $49.9 billion. In this regard, COPD is a problem that is a frequent challenge for the respiratory clinician. DIF: Recall
REF: p. 516
OBJ: 2
9. What is the leading risk factor for the development of COPD? a. Air pollution b. Alpha 1 -antitrypsin deficiency c. Cigarette smoking d. Secondhand smoke
ANS: C Although many risk factors exist for COPD (Box 25-1), the two most common are cigarette smoking (which has been estimated to account for 80% to 90% of all COPD-related deaths) and alpha 1 -antitrypsin deficiency. DIF: Recall
REF: p. 516
OBJ: 3
10. What percentage of all cases of COPD is caused by alpha1 -antitrypsin deficiency? a. 2% to 3% b. 10% to 15% c. 25% to 40% d. 50% to 75%
ANS: A
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Accounting for 2% to 3% of all cases of COPD, alpha1 -antitrypsin deficiency is severely underrecognized by health care providers, but it affects an estimated 100,000 Americans. DIF: Recall
REF: p. 516
OBJ: 3
11. What is the critical alpha1 -antitrypsin level below which lung elastin is attacked and broken down? a. 57 mg/dl b. 84 mg/dl c. 100 mg/dl d. 150 mg/dl
ANS: A In the face of a severe deficiency of alpha 1 -antitrypsin (i.e., when serum levels fall below a ―protective threshold‖ value of 11 µmol/L, or 57 mg/dl), neutrophil elastase may go unchecked, causing breakdown of elastin and resulting dissolution of alveolar walls. DIF: Recall
REF: p. 517
OBJ: 3
12. Which airways are most susceptible to airway obstruction in patients with COPD? a. Small b. Medium c. Large d. Central
ANS: A The mechanisms of airflow obstruction in COPD include inflammation and obstruction of small airways (<2 mm in diameter). DIF: Recall
REF: p. 517
OBJ: 3
13. Which of the following signs associated with COPD is considered a late manifestation? a. Accessory muscle usage b. Frequent coughing c. Shortness of breath
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d. Wheezing
ANS: A Late signs of COPD may include use of accessory muscles of respiration (e.g., sternocleidomastoid). DIF: Recall
REF: p. 518
OBJ: 4
14. Which of the following signs and symptoms is most closely associated with respiratory failure in a COPD patient? a. Bilateral wheezing b. Changes in mental status c. Dyspnea on exertion d. Excessive sputum production
ANS: B Late signs of COPD may include use of accessory muscles of respiration (e.g., sternocleidomastoid), edema from cor pulmonale, mental status changes caused by hypoxia or hypercapnia (especially in acute exacerbations of chronic, severe disease), or asterixis (i.e., involuntary flapping of the hands when held in an extended position, as in ―stopping traffic‖). DIF: Recall
REF: p. 518
OBJ: 1
15. It is not clear whether your patient has COPD or asthma. Which of the following characteristics is most closely associated with the diagnosis of asthma? a. Daily phlegm production b. Diminished vascularity on the chest radiograph c. Low diffusion capacity d. Reversal of the FEV1 after use of a bronchodilator ANS: D The diagnosis of asthma is favored if the diminished FEV1 obtained on spirometry can be normalized after use of an inhaled bronchodilator (reversible airway obstruction). DIF: Recall
REF: p. 518
OBJ: 4
16. Which of the following medications is indicated for regular use in patients with stable COPD?
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a. Antibiotics b. Beta-2 agonists c. Corticosteroids d. Methylxanthines
ANS: B Although the airflow obstruction from emphysema itself is irreversible, most (up to two -thirds) patients with stable COPD will demonstrate a reversible component of airflow obstruction, defined as a 12% and 200-ml rise in the post-bronchodilator FEV1 and/or FVC. For this reason, as indicated in an algorithm developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), bronchodilator therapy is recommended for patients with COPD. DIF: Recall
REF: pp. 519-520 OBJ: 4
17. Which of the following medications is generally only used if the patient still has debilitating symptoms from stable COPD, despite inhaled bronchodilator therapy? a. Antibiotics b. Beta-2 agonists c. Corticosteroids d. Methylxanthines
ANS: D Treatment with methylxanthines offers little additional bronchodilation in patients on inhaled bronchodilators, and generally it is reserved for patients with debilitating symptoms from stable COPD, despite optimal inhaled bronchodilator therapy. DIF: Recall
REF: pp. 519-520 OBJ: 5
18. During an acute exacerbation of COPD, what is the role of IV methylprednisolone? a. It accelerates recovery as noted in FEV1 . b. It causes pulmonary edema due to retention of water. c. It causes severe immunosuppression and worsens outcomes. d. It has been shown to have no effect.
ANS: A
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An early randomized controlled trial of IV methylprednisolone for patients with acute exacerbations has shown accelerated improvement in FEV1 within 72 hr. DIF: Recall
REF: p. 520
OBJ: 5
19. A patient is experiencing an exacerbation of COPD. He is 65 years old, slim, and in notable distress with tachypnea, tachycardia, and an arterial blood pH of 7.29. Which of the following therapies would be most indicated? a. Intrapulmonary percussive ventilation b. Intubation and mechanical ventilation c. Nasal CPAP d. Noninvasive ventilation
ANS: D Criteria defining candidacy for noninvasive ventilation include acute respiratory acidosis (without frank respiratory arrest), hemodynamic stability, ability to tolerate the interface needed for noninvasive ventilation, ability to protect the airway, and lack of craniofacial trauma or burns, copious secretions, or massive obesity. DIF: Application
REF: p. 520
OBJ: 5
20. What is the benefit of pulmonary rehabilitation in patients with moderate to severe COPD? a. Improves exercise tolerance. b. Improves FEV1 . c. Improves lung function. d. Improves survival.
ANS: A Comprehensive pulmonary rehabilitation is an additional important strategy for improving functional status. Indeed, randomized controlled trials show that a pulmonary rehabilitation program including education and a progressive exercise program can enhance exercise capacity, even though lung function and survival are not improved. DIF: Recall
REF: p. 520
OBJ: 5
21. What treatment for patients with COPD has been shown to improve long-term survival?
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a. Bronchodilators b. Corticosteroids c. Mechanical ventilation d. Oxygen
ANS: D Among the available treatments for COPD, supplemental oxygen is important because, like smoking cessation and lung-volume reduction surgery in selected individuals (see below), it can prolong survival. Box 23-2 reviews the indications for supplemental oxygen, and Figure 23-6 shows the results of the American Nocturnal Oxygen Therapy Trialand the British Medical Research Council Trial of Domiciliary Oxygen, 1980-1981. Survival was improved when eligible patients used supplemental oxygen for as close to 24 hr as possible and that survival improved less for those using oxygen only 15 hr/day. DIF: Recall
REF: p. 520
OBJ: 5
22. What lung disease is the most common current indication for lung transplantation? a. Adult respiratory distress syndrome b. COPD c. Pneumoconiosis d. Pulmonary fibrosis
ANS: B COPD is the most common current indication for lung transplantation. DIF: Recall
REF: p. 524
OBJ: 5
23. Which of the following pulmonary function improvements have been associated with lung volume-reduction surgery (LVRS) in patients with emphysema? 1. Improved exercise endurance 2. Improved FEV1 3. Improved quality-of-life 4. Improved survival a. 1, 3, and 4 only b. 2 and 4 only
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c. 3 only d. 2, 3, and 4 only
ANS: A LVRS can prolong survival, improve quality-of-life, and increase exercise capacity. DIF: Recall
REF: p. 524
OBJ: 5
24. Which of the following problems is associated with intravenous augmentation of synthetic alpha 1 -antitrypsin for the patient with genetic emphysema? a. Bronchospasm b. Expense c. Headache d. Nausea
ANS: B Difficulties with intravenous augmentation therapy include the substantial expense (approximately $100,000 per year), the inconvenience of frequent intravenous infusions for life, and the infusion itself, which confers a theoretical risk of transmitting a blood-borne infection. DIF: Recall
REF: p. 525
OBJ: 5
25. What pathophysiologic characteristic of asthma has been most recently emphasized in the description and subsequent treatment of this disease? a. Hyperactivity of the airways b. Hyperinflation of the lung parenchyma c. Inflammation of the airways d. Mucus plugging of the airways
ANS: C Past definitions of asthma emphasized airway hyperresponsiveness and reversible obstruction; newer and more accurate definitions of asthma focus on asthma as a primary inflammatory disease of the airways, with clinical manifestations of increased bronchial hyperreactivity and airflow obstruction secondary to the inflammation. DIF: Recall
REF: p. 525
OBJ: 6
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26. Which of the following statements are true about the incidence of asthma? 1. The prevalence has increased significantly over the past 20 years in the United States. 2. The mortality has remained the same over the past 20 years in the United States. 3. Researchers have determined the causes of asthma and are working on a vaccine. 4. Diagnosis of asthma is done in a physician’s office following an extensive clinical assessment. a. 1 and 3 only b. 1 only c. 1 and 2 only d. 1, 2, and 4 only
ANS: B Asthma is a chronic illness that has been increasing in prevalence in the United States since 1980. In 2007, asthma accounted for 3447 deaths, approximately 456,000 hospitalizations, and approximately 13.3 million emergency room or physician office visits among persons of all ages. Approximately 7.7% of U.S. adults, or 17.5 million Americans, have asthma currently. DIF: Recall
REF: p. 525
OBJ: 6
27. What causes the degranulation of mast cells in asthma patients? a. Antigens attaching to IgE molecules on the mast cell surface. b. Antigens attaching to proteins receptors on mast cell surface. c. Irritant receptors on the mast cells are stimulated by antigens. d. Infectious particles attacking the mast cells.
ANS: A When a patient with asthma inhales an allergen to which he or she is sensitized, the antigen cross-links to specific IgE molecules attached to the surface of mast cells in the bronchial mucosa and submucosa. The mast cells degranulate rapidly (within 30 min), releasing multiple mediators including leukotrienes (previously known as slow-reacting substance of anaphylaxis [SRS-A]), histamine, prostaglandins, platelet-activating factor, and other mediators. DIF: Recall
REF: p. 526
OBJ: 6
28. Which of the following symptoms is not a typical symptom of asthma?
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a. Cough b. Shortness of breath c. Chest tightness d. Chest pain
ANS: D The classic symptoms of asthma are episodic wheezing, shortness of breath, chest tightness, or cough. DIF: Recall
REF: p. 526
OBJ: 7
29. How much improvement is needed in the FEV1 after bronchodilator therapy before reversibility can be considered present in the patient with obstructive lung disease? a. 50 ml b. 200 ml c. 350 ml d. 500 ml
ANS: B By convention, improvement in the FEV 1 by at least 12% and 200 ml following administration of a bronchodilator is considered evidence of reversibility. DIF: Recall
REF: p. 537
OBJ: 6
30. What test is most useful for the diagnosis of asthma in the symptom-free patient? a. Arterial blood gases b. Bronchoprovocation testing with pulmonary function tests c. Chest radiograph d. Ventilation-perfusion ratio (
) scans
ANS: B Asthmatics evaluated in a symptom-free period may have a normal chest x-ray examination and normal pulmonary function tests. Under these circumstances, provocative testing can be used to induce airway obstruction. Bronchoprovocation is a well-established method to detect and quantify airway hyperresponsiveness.
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DIF: Recall
REF: p. 527
OBJ: 6
31. What stimulus is most commonly used in bronchoprovocation testing in the patient suspected to have asthma? a. Acetylcysteine b. Leukotriene inhibitors c. Methacholine d. Methylprednisolone
ANS: C The most commonly used bronchoprovocative stimulus is methacholine. DIF: Recall
REF: p. 527
OBJ: 6
32. A patient is admitted to the emergency department with an acute asthma exacerbation. Based on the following blood gas results, how severe was the asthma attack? pH 7.35, PaO 58 mm Hg, PaCO 46 mm Hg, HCO − 18 mEq/L, SaO 89% 2
2
3
2
a. Mild b. Moderate c. Severe d. Normalized
ANS: C A patient suffering an acute asthma attack usually has a low PaCO 2 level as a result of hyperventilation. A normal PaCO2 level in such a situation indicates a severe attack and impending respiratory failure. DIF: Recall
REF: p. 527
OBJ: 7
33. Which of the following tests is recommended as part of the initial assessment of asthma? a. Arterial blood gas b. Chest radiograph c. Spirometry d.
scan
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ANS: C It is recommended that spirometry be performed as part of the initial assessment of all patients being evaluated for asthma, and periodically thereafter as needed. DIF: Recall
REF: p. 528
OBJ: 7
34. What does the National Asthma Education Project recommend be measured at home in patients with moderate to severe asthma? a. Pulse oximeter b. Degree of pulmonary shunt c. DLCO d. Peak expiratory flow
ANS: D National Asthma Education Project guidelines also recommend that home PEFR measurement be used for patients with moderate to severe asthma. DIF: Recall
REF: p. 528
OBJ: 7
35. An asthma patient’s best effort produces a PEFR of 55% of personal best. What is indicated at this time? a. Patient should lie down and try to relax. b. Patient should probably seek medical attention now. c. Patient should retry the PEFR maneuver. d. Patient should take his or her controller medications.
ANS: B A PEFR below 60% of the personal best is in the red zone and signals a medical alert, requiring immediate medical attention if the patient does not return to the yellow or green zone with bronchodilator use. DIF: Recall
REF: p. 528
OBJ: 7
36. What medication is currently the most effective for the treatment of asthma?
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a. Corticosteroids b. Fast-acting beta-2 agonists c. Long-acting beta-2 agonists d. Nonsteroidal antiinflammatory drugs
ANS: A Corticosteroids are the most effective medication currently available for the treatment of asthma. DIF: Recall
REF: p. 529
OBJ: 8
37. Which of the following side effects is associated with the use of inhaled corticosteroids? a. Bronchospasm b. Frequent cough c. Nausea d. Oral candidiasis
ANS: D Oropharyngeal candidiasis and dysphonia are controllable with spacer use and by rinsing the mouth after each treatment. DIF: Recall
REF: p. 529
OBJ: 8
38. What classification of drug would the leukotriene inhibitors fall under? a. Antiinflammatory b. Corticosteroid c. Long-acting bronchodilator d. Short-acting bronchodilator
ANS: A Leukotrienes are mediators of inflammation and bronchoconstriction and are thought to play a role in the pathogenesis of asthma. Three leukotriene antagonists are currently available for the treatment of asthma. DIF: Recall
REF: p. 529
OBJ: 8
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39. Identify the drug whose regular use in the treatment of asthma may worsen control or even increase the risk of death by asthma. a. Anticholinergic b. Antiinflammatory c. Beta-2 agonists d. Corticosteroid
ANS: C The effectiveness of beta-2 agonists as bronchodilators is not disputed, and they remain the drug of choice for acute emergency management of asthma. However, there is concern that they may worsen asthma control if used regularly and that excessive use may increase the risk of death from asthma, which makes their role in long-term maintenance therapy questionable DIF: Recall
REF: p. 529
OBJ: 8
40. According to the National Asthma Education Project guidelines, what should be considered if the patient with asthma requires more than 3 or 4 puffs of beta-2 agonists per day? a. Add or increase the dose of anticholinergic. b. Add or increase the dose of antiinflammatory. c. Add or increase the dose of magnesium sulfite. d. Increase dose of beta-2 agonists.
ANS: B The National Asthma Education Project guidelines recommend that inhaled beta-2 agonists be used as needed. If a patient needs more than 3 or 4 puffs a day of a beta-2 agonist, additional antiinflammatory therapy should be considered. DIF: Recall
REF: p. 531
OBJ: 8
41. What beta-2 agonist is associated with 12 to 24 hr of bronchodilation? a. Albuterol b. Metaproterenol c. Salmeterol d. Aclinidium
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ANS: C Newer, longer acting (12 to 24 hr) beta-2 agonists, such as salmeterol and formoterol, are now available in the United States. DIF: Recall
REF: p. 531
OBJ: 8
42. Which factor is associated with a decrease in the plasma levels of theophylline in an asthmatic patient? a. Cigarette smoking b. Heart failure c. Hepatic disease d. Viral infections
ANS: A Conditions that tend to decrease plasma levels of theophylline include cigarette smoking and the use of medications that increase hepatic clearance, such as phenobarbital. DIF: Recall
REF: p. 532
OBJ: 8
43. Which medication is an anticholinergic bronchodilator? a. Ipratropium bromide b. Vilanterol c. Salmeterol d. Terbutaline
ANS: A Inhaled anticholinergic agents, such as ipratropium bromide, are effective dilators of airway smooth muscles. DIF: Recall
REF: pp. 530-531 OBJ: 8
44. Which medication is a once-daily combination of a beta-2 agonist and an inhaled corticosteroid? a. Combivent Respimat b. Advair
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c. Flovent d. Breo Ellipta
ANS: D Breo Ellipta is a once-daily combination medication that includes fluticasone and vilanteral. It is currently only approved for patients with COPD. DIF: Recall
REF: pp. 530-531 OBJ: 8
45. Which bronchodilator is commonly used in the hospital management of acute asthma exacerbation but is not considered the first-line bronchodilator? a. Albuterol b. Ipratropium bromide c. Salmeterol d. Arformoterol
ANS: B Ipratropium also can be used in treating acute asthma when first-line bronchodilators are ineffective. DIF: Recall
REF: pp. 530-531 OBJ: 8
46. What medication would likely be the least often ordered during the emergency department management of an acute asthma attack? a. Beta-2 agonists b. Corticosteroids c. Methylxanthines d. Oxygen
ANS: C Hospital and ICU care for patients with asthma should be aggressive. The goals are to decrease mortality and morbidity and to return the patient to preadmission stability and function as quickly as possible. Management includes oxygen supplementation, frequent administration of high doses of aerosolized beta-2 agonists (limited only by tachycardia or tremor), high-dose parenteral corticosteroids (more than 0.5 to 1.0 mg/kg/day), and antibiotics if there is evidence of infection. DIF: Recall
REF: pp. 530-531 OBJ: 8
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47. Which of the following strategies is useful in the mechanical ventilation of a patient in status asthmaticus? 1. Allow peak inspiratory pressures to go as high as required. 2. Permissive hypercapnia. 3. Prolonged inspiratory time. 4. Small tidal volumes. a. 1, 2, and 3 only b. 2 and 4 only c. 3 only d. 2, 3, and 4 only
ANS: B Patients with severe asthma and respiratory failure (hypoxia, hypercapnia, and increased work of breathing) need ventilatory support and present special challenges. Mortality rates for these patients can be as high as 22%, and complications are common, especially barotrauma. These complications can be minimized by limiting peak inspiratory pressure to less than 50 cm H 2 O and by the use of small tidal volumes, allowing ―permissive hypercapnia‖ if necessary. DIF: Recall
REF: p. 532
OBJ: 8
48. What treatment strategy is most controversial for a patient with asthma? a. Antibiotic therapy b. Anticholinergic therapy c. Environmental control d. Immunotherapy
ANS: D Although immunotherapy is acceptable in the treatment of allergic rhinitis, its use in the treatment of asthma is not standardized and remains controversial. The role of immunotherapy in asthma is currently limited to patients with allergic asthma who are unable to achieve substantial relief of symptoms with avoidance measures and pharmacotherapy. It is hoped that future studies will define its role and efficacy more clearly. DIF: Recall
REF: p. 532
OBJ: 8
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49. What step must be taken to gain control of asthma in a patient that is experiencing frequent emergency department visits? a. Regular antibiotic therapy b. Regular anticholinergic therapy c. Environmental control d. Regular immunotherapy
ANS: C To prevent allergic reactions in asthma patients, environmental control measures to reduce exposure to indoor and outdoor allergens and irritants are essential. DIF: Recall
REF: p. 533
OBJ: 8
50. Of the following common causes of asthma, which is the least likely to cause exercise-induced asthma? a. Long distance cycling b. Running cross country c. Skiing and snowboarding d. Swimming indoors
ANS: C Exercise-induced asthma (EIA) is common in asthmatics, especially after participation in outdoor activities in cold weather. The causes are not fully understood, but heat loss from the airways appears to be one of them. DIF: Recall
REF: p. 533
OBJ: 8
51. Which of the following has been identified as the most common cause of occupational asthma? a. Alpha 1 -antitrypsin deficiency b. IgE abnormality c. Nitric oxide deficiency d. Toluene diisocyanate
ANS: D Toluene diisocyanate is the most common cause of occupational asthma and is the best studied.
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DIF: Recall
REF: p. 534
OBJ: 8
52. What etiologic factor is associated with the onset of nocturnal asthma? a. Aspiration of gastric acid at night b. Supine position c. Variation in acetylcholine secretion at night d. Variation in the secretion of insulin at night
ANS: A It probably is due to the known physiologic decrease in the airway tone during sleep, which has been attributed to variation in catecholamine and cortisol secretion. Aspiration of gastric acid also may play a role in some patients with increased symptoms at night. DIF: Recall
REF: p. 534
OBJ: 8
53. Which of the following asthma medications is not typically administered during pregnancy? a. Albuterol b. Cromalyn c. Ipratropium bromide d. Theophylline
ANS: C Theophyllines, beta-2 agonists, inhaled or oral corticosteroids, or cromolyn can be used during pregnancy without significant risk of fetal abnormalities. DIF: Recall
REF: p. 534
OBJ: 8
54. Identify the hallmark symptom of bronchiectasis. a. Evidence of cystic spaces and tram tracks on the chest radiograph b. Hemoptysis c. Large amounts of purulent sputum d. Variable dyspnea
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ANS: C The hallmark of bronchiectasis is the chronic production of large quantities of purulent sputum. DIF: Recall
REF: p. 535
OBJ: 9
55. Your patient has bronchiectasis. Which of the following therapies is most needed? a. Antibiotics b. Bronchodilators c. Incentive spirometry d. Oxygen
ANS: A Antibiotics and bronchopulmonary hygiene are the mainstays of bronchiectasis management. Antibiotics can be given as needed or following a regularly scheduled regimen. Sputum cultures may be helpful in guiding antibiotic choice. DIF: Recall
REF: p. 535
OBJ: 9
56. Bronchiectasis characterized by progressive, distal enlargement of the airways, resulting in sac -like dilatations is classified as: a. cylindrical bronchiectasis. b. varicose bronchiectasis. c. cystic bronchiectasis. d. obstructive bronchiectasis.
ANS: C Bronchiectasis refers to the abnormal, irreversible dilatation of the bronchi caused by destructive and inflammatory changes in the airway walls. Bronchiectasis characterized by progressive, distal enlargement of the airways, resulting in sac-like dilatations is classified as Cystic bronchiectasis. DIF: Recall
REF: p. 535
OBJ: 9
57. You are called to the ER to assess a 25-year-old female patient in status asthmaticus. Her PEFR results of pre- and post-bronchodilator therapy are given below: Pre-bronchodilator
Post-bronchodilator
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1st attempt
216
334
2nd attempt 3rd attempt
224
330
210
340
You should suggest to the ER physician to: a. stop the bronchodilators. b. repeat the PEF measurement. c. increase the medication dosage. d. continue current therapy.
ANS: D When assessing PEFR results, the highest measurement pre and post should be used to calculate the percentage improvement (pre-post/pre 100). Any improvement of 12 percentage in the PEFR or 200 ml in the FEV1 represent a significant improvement for the bronchodilator. In this case, the patient had an improvement of 52 percentage; hence the therapy should be continued. DIF: Application
REF: p. 535
OBJ: 9
58. What medical problems are suggested by Mr. Jones’ medical history? a. Chronic bronchitis b. Emphysema c. Occupational asthma d. Obstructive bronchiectasis
ANS: A Mr. Jones’ medical history suggests chronic bronchitis exacerbated by a respiratory infection such as acute bronchitis, flu, or pneumonia. Chronic bronchitis is defined in clinical terms as a condition in which chronic productive cough is present for at least 3 months per year for at least 2 consecutive years. DIF: Analysis
REF: p. 515
OBJ: 4
59. Which of the following procedures would you recommend to further assess Mr. Jones’ condition? 1. Pre-post PFT 2. Exercise testing 3. Chest x-ray
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4. Room air ABG a. 1 and 4 only b. 1, 2, and 3 only c. 2, 3 and 4 only d. 1, 3, and 4 only
ANS: D Mr. Jones’ dyspnea at rest and chronic sputum production requires further evaluation. A pre-post PFT study is indicated at this time to (1) differentiate his COPD diagnosis between emphysema, chronic bronchitis and asthma and (2) assess possible airway obstruction and its reversibility level. A chest x-ray and arterial blood gas analysis are also indicated in the presence of dyspnea and due to this patient’s occupational history. DIF: Application
REF: p. 519
OBJ: 3
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Chapter 26 - Interstitial Lung Disease Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Which group of disorders is categorized together because of similarities in their clinical
presentations, plain chest radiographic appearance, and physiologic features? a. Congestive heart failure b. Infant respiratory distress syndrome c. Interstitial lung diseases d. Sudden acute respiratory syndrome ANS: C
The term interstitial lung disease (ILD) refers to a broad category of lung diseases rather than to a specific disease entity. It includes a variety of illnesses with diverse causes, treatments, and prognoses. These disorders are grouped together because of similarities in their clinical presentations, plain chest radiographic appearance, and physiologic features. DIF: Recall
REF: p. 540
OBJ: 1
2. Which of the following interstitial lung diseases (ILDs) is not occupationally related? a. Asbestosis b. Berylliosis c. Sarcoidosis d. Silicosis ANS: C
Sarcoidosis is not an occupationally related ILD (see Figure 26-1). DIF: Recall
REF: p. 551
OBJ: 1
3. What is the primary pathologic change that occurs in interstitial lung disease? a. Alveolar-capillary membrane structures replaced by fibrotic tissue b. Bronchial submucosal gland hypertrophy c. Bronchoconstriction of medium to small airways d. Increased sputum production ANS: A
The lung must respond to the damage and repair itself. If the exposure to the causative agent persists or if the repair process is imperfect, the lung may be permanently damaged with increased interstitial tissue replacing the normal capillaries, alveoli, and healthy interstitium. DIF: Recall
REF: p. 540
OBJ: 2
4. In interstitial lung disease, which of the following mechanisms contributes to impaired gas
exchange? 1. Depression of respiratory drive 2. Diffusion defect 3. Shunt 4. Ventilation/perfusion mismatch
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a. b. c. d.
1 and 4 only 2 and 3 only 2, 3, and 4 only 1, 2, and 4
ANS: C
Gas exchange is impaired owing to ventilation/perfusion mismatching, shunt, and decreased diffusion across the abnormal interstitium. DIF: Recall
REF: p. 542
OBJ: 1
5. What symptoms are most common in the patient with interstitial lung disease? a. Exertional dyspnea and nonproductive cough b. Exertional dyspnea and wheezing c. Nonproductive cough and wheezing d. Productive cough and increased sputum production ANS: A
An exertional breathlessness (dyspnea) and a nonproductive cough are the most common reasons patients seek medical attention. DIF: Recall
REF: p. 542
OBJ: 2
6. For what reason do patients with interstitial lung disease most commonly seek medical care? a. Excessive mucus production b. Hacking cough resulting in chest cage pain c. Progressive exertional dyspnea d. Severe wheezing and sense of breathlessness ANS: C
An exertional breathlessness (dyspnea) and a nonproductive cough are the most common reasons patients seek medical attention. DIF: Recall
REF: p. 542
OBJ: 2
7. Among smokers with IPF, normal spirometry and lung volumes with reduced DLCO suggest
the presence of coexisting: a. emphysema. b. asthma. c. chronic bronchitis. d. lung carcinoma. ANS: A
Among smokers with IPF, normal spirometry and lung volumes with reduced DLCO suggest the presence of coexisting emphysema. DIF: Recall
REF: pp. 543-544 OBJ: 3
8. What auscultatory finding is most consistent with the diagnosis of interstitial lung disease
(ILD)? a. Coarse inspiratory and expiratory crackles b. Fine bilateral inspiratory crackles
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c. Monophonic expiratory wheezes d. Polyphonic expiratory wheezes ANS: B
Most patients with ILD have bilateral inspiratory, fine crackles, which usually are most prominent at the lung bases. DIF: Recall
REF: p. 542
OBJ: 2
9. Which of the following physical examination findings could be considered a late
manifestation of interstitial lung disease (ILD)? a. Bronchial wheezing b. Increased wedge pressure c. Peripheral cyanosis d. Pulmonary hypertension ANS: D
Signs of pulmonary arterial hypertension with right ventricular dysfunction, such as lower extremity edema or jugular venous distention, may occur late in the course of any ILD and are not helpful in the diagnosis of a specific ILD. DIF: Recall
REF: p. 542
OBJ: 2
10. What radiographic technique has the ability to better define the specific parenchymal
characteristics associated with specific types of interstitial lung disease? a. Bronchograms b. High-resolution CT c. MRI d. Scans ANS: B
The ready availability of high-resolution CT (HRCT) has highlighted significant radiographic differences between diseases that have similar plain chest radiographic patterns. DIF: Recall
REF: p. 543
OBJ: 2
11. What is the most common cause of interstitial lung disease (ILD)? a. Asbestosis b. Berylliosis c. Pulmonary fibrosis (IPF) d. Sarcoidosis ANS: C
The plain chest radiographic and HRCT features of IPF often are considered the classic ILD pattern, primarily because, next to sarcoidosis, IPF is the most common ILD and because several other ILDs have a similar appearance. DIF: Recall
REF: p. 543
OBJ: 3
12. The classic chest radiographic findings in which of the following interstitial lung disease
(ILD) is calcification along the pleura? a. Asbestosis
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b. Berylliosis c. Idiopathic pulmonary fibrosis (IPF) d. Sarcoidosis ANS: C
Calcification along the pleura on a chest radiograph suggests previous exposure to asbestos. Although such calcified areas (called plaques) do not cause symptoms or physiologic abnormality, they can provide a clue that the cause of ILD is asbestos exposure. DIF: Recall
REF: p. 543
OBJ: 3
13. What is the classic radiographic finding present in many end-stage interstitial lung diseases
(ILDs)? a. Cystic pattern called honeycombing b. Pleural disease uncommon c. Prominent bibasilar infiltrates d. Severe hyperinflation ANS: A
This cystic pattern, called honeycombing, reflects end-stage fibrosis and is a feature of many end-stage ILDs. DIF: Recall
REF: p. 543
OBJ: 1
14. The disease seen in interstitial lung disease is primarily a/an a. airway constrictive b. obstructive c. restrictive d. supralaryngeal
process.
ANS: C
A restrictive physiologic impairment is the common finding in ILD. DIF: Recall
REF: p. 543
OBJ: 2
15. What are the typical pulmonary function test results in a patient with interstitial lung disease?
1. Decreased airway resistance 2. Decreased forced expiratory volumes 3. Increased airway resistance 4. Normal to elevated FEV 1 /FVC a. 1, 2, and 4 only b. 2 and 4 only c. 3 only d. 2, 3, and 4 only ANS: B
In ILD, both forced expiratory volume in 1 second (FEV 1 ) and forced vital capacity (FVC) are diminished, while the FEV 1 /FVC ratio is preserved or even supranormal. DIF: Recall
REF: p. 543
OBJ: 2
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16. Which of the following pulmonary function tests is most likely to be normal in the patient
with interstitial pulmonary fibrosis? a. Diffusing capacity of the lungs (DLCO) b. FEV 1 (forced expiratory volume in 1 second) c. FEV 1 /FVC d. FVC (forced vital capacity) ANS: C
In ILDs, the FEV 1 /FVC ratio is preserved or even supranormal. DIF: Recall
REF: p. 543
OBJ: 2
17. Which of the following is found almost universally in patients with interstitial lung disease
(ILD)? a. Airway dilation b. Bronchoconstriction c. Compensatory cytokine release d. Decreased compliance ANS: D
In almost all of the ILDs, the lungs have reduced compliance and require supranormal transpleural pressures to ventilate (Figure 26-4). This lack of compliance results in small lung volumes and increased work of breathing. DIF: Recall
REF: p. 544
OBJ: 2
18. The term ―asbestos-related pulmonary disease‖ may be used to encompass which of the
following? 1. Asbestosis 2. Coal worker’s pneumoconiosis 3. Sarcoidosis 4. Silicosis a. 1, 2, and 4 only b. 1 and 4 only c. 2 only d. 2, 3, and 4 only ANS: A
The three most common types of occupational interstitial lung disease are asbestosis, chronic silicosis, and coal worker’s pneumoconiosis. Predictable clinical and radiographic abnormalities occur in susceptible patients who have been exposed to asbestos. These abnormalities include pleural changes (plaques, fibrosis, effusions, atelectasis, and mesothelioma) as well as parenchymal scarring and lung cancer. The term ―asbestos-related pulmonary disease‖ may be used to encompass all of these entities. DIF: Recall
REF: pp. 546-547 OBJ: 3
19. The presence of pleural calcification on the chest film is consistent with what type of
interstitial lung disease (ILD)? a. Asbestosis b. Coal worker’s pneumoconiosis
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c. Sarcoidosis d. Silicosis ANS: A
With an appropriate exposure history, the presence of radiographic pleural plaques or rounded atelectasis may indicate that asbestos as the cause of the ILD. DIF: Recall
REF: pp. 546-547 OBJ: 3
20. It is determined that a patient has silicosis. What profession is he most likely to have worked
at? a. b. c. d.
Foundry worker Talc manufacturer employee Carpenter Miller
ANS: A
Occupations that commonly involve exposure to silica include mining, tunneling, sandblasting, and foundry work. DIF: Recall
REF: pp. 546-547 OBJ: 3
21. Which of the following indicates the typical chest radiographic findings of a patient with
silicosis? a. Apical nodules b. Bibasilar reticulogranular appearance c. Lymphadenopathy d. Pleural plaque ANS: A
The chest radiograph commonly shows upper-lung-zone predominant abnormalities characterized by multiple small nodular opacities in the central lung tissue. DIF: Recall
REF: p. 547
OBJ: 3
22. What disease process is associated with much higher risk of tuberculosis? a. Asbestosis b. Coal worker’s pneumoconiosis c. Sarcoidosis d. Silicosis ANS: D
It is important to recognize the association of silicosis with lung cancer and active tuberculosis. Silicosis patients develop active tuberculosis 2- to 30-fold more frequently than do coal workers’s pneumoconiosis without silicosis. DIF: Recall
REF: p. 547
OBJ: 3
23. In simple coal worker’s pneumoconiosis, a chest radiograph that is characterized by multiple
small nodular opacities on the chest x-ray film is most likely to be associated with what clinical presentation? a. Asymptomatic
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b. Cough c. Crackles d. Shortness of breath ANS: A
Simple coal worker’s pneumoconiosis, characterized by multiple small nodular opacities on the chest x-ray film, is asymptomatic. DIF: Recall
REF: p. 547
OBJ: 3
24. Exacerbations of silicosis are most often treated with what medication? a. Aerosolized steroids b. Antibiotics c. Diuretics d. Positive inotropes ANS: B
Exacerbations can be frequent and are treated with antibiotics and systemic corticosteroids. DIF: Recall
REF: p. 547
OBJ: 4
25. Which of the following categories of medications is most closely associated with the onset of
interstitial pulmonary fibrosis? a. Antiarrhythmic drugs b. Anticoagulants c. Bronchodilators d. Vasodilators ANS: A
Drugs from many different therapeutic classes can cause interstitial lung disease, including chemotherapeutic agents, antibiotics, antiarrhythmic drugs, and immunosuppressive agents (see Box 26-1). DIF: Recall
REF: p. 545
OBJ: 3
26. A patient is exposed a second time to an antigen and subsequently seeks medical attention
with sudden shortness of breath, chest pain, fever, chills, malaise, and a cough that may be productive of purulent sputum. What is the most likely cause of this pathology? a. Acute anaphylactic shock b. Acute hypersensitivity pneumonitis c. Allergic congestive heart failure d. Bronchial asthma ANS: B
Initial exposure to the antigen ramps up the immune system. Subsequent exposure to the antigen results in the hypersensitivity response. Patients with acute hypersensitivity pneumonitis usually present to medical attention with sudden shortness of breath, chest pain, fever, chills, malaise, and a cough that may be productive of purulent sputum. DIF: Application
REF: pp. 545-546 OBJ: 3
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27. A patient is exposed a second time to an antigen and subsequently seeks medical attention
with sudden shortness of breath, chest pain, fever, chills, malaise, and a cough that may be productive of purulent sputum. Which of the following is the most likely source for the antigen? a. Bed b. Foundry c. Hay field d. Mine ANS: C
Common organic antigens known to cause hypersensitivity pneumonitis include bacteria and fungi, which may be found in moldy hay (farmer’s lung) or in the home environment, particularly in association with central humidification systems (humidifier lung), indoor hot tubs, and animal proteins (e.g., bird breeder’s lung). DIF: Application
REF: p. 546
OBJ: 3
28. Scleroderma, rheumatoid arthritis, and systemic lupus erythematosus are all examples of what
type of disease group? a. Asbestos-associated illnesses b. Connective tissue diseases c. Hypersensitivity pneumonitis d. Pneumoconiosis ANS: B
Interstitial lung disease is a well-known complication of various connective tissue diseases. The most commonly implicated disorders are scleroderma, rheumatoid arthritis, Sjögren’s syndrome, polymyositis/dermatomyositis, and systemic lupus erythematosus. DIF: Recall
REF: p. 547
OBJ: 3
29. What disease process is the most common cause of interstitial lung disease (ILD) in the
United States? a. Asbestosis b. Coal worker’s pneumoconiosis c. Idiopathic pulmonary fibrosis d. Sarcoidosis ANS: D
Sarcoidosis is an idiopathic multisystem inflammatory disorder that commonly involves the lung. In fact, it is the most common cause of the ILD in the United States. DIF: Recall
REF: p. 548
OBJ: 3
30. What is the most common radiographic finding in the chest film of a patient with sarcoidosis? a. Bibasilar parenchymal opacities b. Bilateral hilar lymphadenopathy c. Pleural plaque with calcification d. Upper-lobe distribution of fibrotic cysts ANS: B
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The most common manifestation of sarcoidosis is asymptomatic hilar adenopathy. Less frequently, the chest radiograph demonstrates parenchymal opacities in the mid-lung zone, which may be nodular, reticulonodular, or alveolar. DIF: Recall
REF: p. 548
OBJ: 3
31. A 65-year-old patient with a history of exposure to metal dust comes in to the emergency
department with chronic cough and exertional dyspnea. HRCT shows bibasilar, peripheral reticular abnormalities with focal honeycomb cystic changes. What is the most likely diagnosis? a. Asbestosis b. Coal worker’s pneumoconiosis c. Idiopathic pulmonary fibrosis d. Sarcoidosis ANS: C
Risk factors for development of idiopathic pulmonary fibrosis include exposure to smoke, metal dust, farming dust, and hairdressing chemicals. Patients present with chronic cough and exertional dyspnea with HRCT demonstrating bibasilar, peripheral reticular abnormalities with focal honeycomb cystic change. DIF: Application
REF: p. 549
OBJ: 3
32. What is the life expectancy of a patient diagnosed with progressive idiopathic pulmonary
fibrosis? a. Less than 2 years b. Less than 4 years c. Less than 6 years d. Less than 7 years ANS: B
Most patients die of progressive fibrotic lung disease within 4 years of diagnosis. DIF: Recall
REF: p. 549
OBJ: 3
33. What is the most common treatment for patients with idiopathic pulmonary fibrosis (IPF)? a. Hyperbaric oxygen treatments b. Lung transplantation c. Penicillin d. Prednisone ANS: D
No medical therapy has proven beneficial for IPF. Immunosuppression with oral corticosteroids and cytotoxic agents such as azathioprine are most commonly used, although they appear to benefit only a minority of patients. DIF: Recall
REF: p. 549
OBJ: 4
34. A patient with which of the following diseases will have the longest life expectancy? a. Alveolar proteinosis b. Idiopathic pulmonary fibrosis c. Nonspecific interstitial pneumonitis
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d. Sarcoidosis ANS: D
Although the prognosis for NSIP is better than IPF, the life expectancy is still only 7 to 10 years. Sarcoidosis often follows a benign course without symptoms or long-term consequences and may spontaneously resolve. DIF: Recall
REF: pp. 548-549 OBJ: 3
35. Which of the interstitial lung diseases will in one-third of patients cause a chylothorax? a. Alveolar proteinosis b. Idiopathic pulmonary fibrosis c. Lymphangioleiomyomatosis d. Nonspecific interstitial pneumonitis ANS: C
Lymphangioleiomyomatosis (LAM) is a rare disorder of abnormal smooth muscle tissue proliferating around small airways leading to severe obstruction and destruction of alveoli with resultant thin-walled cyst formation. Unilateral or less commonly bilateral chylothorax is seen in approximately one-third of patients. This results from lymphatic obstruction by abnormal smooth muscle tissue. DIF: Recall
REF: pp. 548-549 OBJ: 3
36. Which of the interstitial lung diseases is directly tied to exposure to first- and secondhand
tobacco smoke? a. Alveolar proteinosis b. Idiopathic pulmonary fibrosis c. Nonspecific interstitial pneumonitis d. Pulmonary Langerhans cell histiocytosis (PLCH) ANS: D
PLCH is an interstitial lung disease found in adult smokers. Patients usually have a significant smoking history and develop cough and progressive dyspnea on exertion. DIF: Recall
REF: p. 544
OBJ: 3
37. Which of the following medications has been shown to be useful in the treatment of almost all
interstitial lung diseases? a. Acetaminophen b. Aspirin c. Oxytocin d. Oxygen ANS: D
Although studies are limited, supplemental oxygen delivered via nasal cannula can prevent resting hypoxemia and allow greater exertion before desaturation. These benefits may improve quality-of-life and potentially ward off development of pulmonary arterial hypertension, although further studies are needed. DIF: Recall
REF: p. 550
OBJ: 4
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38. What treatment is most useful in preventing subsequent right-sided heart failure in a patient
with interstitial lung disease? a. Bronchodilator b. Digoxin c. Oxygen d. Caffeine ANS: C
Although studies are limited, supplemental oxygen delivered via nasal cannula can prevent resting hypoxemia and allow greater exertion before desaturation. These benefits may improve quality-of-life and potentially ward off development of pulmonary arterial hypertension, although further studies are needed. DIF: Recall
REF: p. 550
OBJ: 4
39. What treatment is recommended by the Centers for Disease Control and Prevention (CDC)
guidelines for patients with interstitial lung disease (ILD)? a. Measles vaccine b. Mumps vaccine c. Pneumococcal vaccine d. Varicella vaccine ANS: C
Patients with ILD should receive a pneumococcal vaccine per CDC guidelines and a yearly influenza virus vaccine. DIF: Recall
REF: p. 551
OBJ: 4
40. What is the only therapy shown to prolong life in patients with end-stage, particularly fibrotic
interstitial lung disease (ILD)? a. Corticosteroids b. Lung transplantation c. Oxygen therapy d. Pulmonary rehabilitation ANS: B
The only therapy shown to prolong life in patients with end-stage, particularly fibrotic ILD, is lung transplantation. DIF: Recall
REF: p. 551
OBJ: 4
41. What use, other than prognostic value, can serial pulmonary function tests provide for the
management of interstitial lung disease patients? a. Determine the degree of refractory hypoxemia. b. Establish the need for lung transplantation. c. Guide the type of oxygen therapy delivered. d. Guide the type of medication therapy delivered. ANS: B
Changes in lung function over time help determine whether to continue therapy or to refer eligible patients for lung transplantation.
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DIF: Recall
REF: p. 551
OBJ: 4
42. A 45 year-old patient with sarcoidosis complaints of being unable to perform his daily house
chores due to shortness of breaths despite continued oxygen therapy of 2 L/min via a nasal cannula. You would recommend which of the following to the patient? a. Increase O 2 to 5 L/min. b. Nebulized budesonide BID. c. Pulmonary rehabilitation. d. Lung transplantation. ANS: C
Pulmonary rehabilitation, a very important part of treating obstructive lung disease, also has proved beneficial in the management of ILD. Pulmonary rehabilitation is important in building aerobic fitness, maintaining physical activity, and improving quality of life. DIF: Application
REF: p. 551
OBJ: 4
43. You are called to attend to an ER patient complaining of shortness of breath and severe
dyspnea on exertion. Patient history is significant for a 30-year-pack smoking history, dry nonproductive cough, and occasional pedal edema. CXR findings are not remarkable except for mild cardiomegaly. You want to rule out ILD versus obstructive lung disease. Which of the following tests may help you to differentiate the diagnosis on this patient? 1. Sputum culture and sensitivity 2. High-resolution CT 3. Pulmonary function testing 4. Arterial blood gas analysis a. 2, 3, and 4 only b. 1, 3, and 4 only c. 1 and 4 only d. 3 and 4 only ANS: A
Obtaining HRCT images allows noninvasive evaluation of the ILDs and is a key element in making a confident diagnosis in the management of ILD. An ABG is useful to assess gas exchange. The presence of significant mismatching, shunt, and decreased diffusion across the abnormal interstitium is a hallmark of IDLs. Both FEV 1 and FVC are diminished, and the FEV 1 /FVC ratio is preserved or even supranormal. Lung volumes are reduced, as is the diffusing capacity of the lung for carbon monoxide (DLCO). This reduction in diffusing capacity reflects a pathological disturbance of the alveolus-capillary interface. DIF: Application REF: pp. 542-543 OBJ: 3 44. You are called to attend to an ER patient complaining of shortness of breath and severe
dyspnea on exertion. Patient history is significant for a 30-year-pack smoking history, dry nonproductive cough, and occasional pedal edema. CXR findings are not remarkable except for mild cardiomegaly. You want to rule out ILD versus obstructive lung disease. Results for pulmonary function testing are shown below. Spirometry Value %Predicted FVC (L) 2.79 63 SVC (L) 2.61 59
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FEV 1 (L) 2.12 FEV 1 /FVC (%) FEF 25% to 75% (L/min) 4.11 Lung volume RV (L) 1.20 TLC (L) 3.99 DLCO (ml/min/mm Hg) 11.35 These results are consistent with: a. small airway disease. b. air trapping. c. severe obstructive disease. d. loss of alveolar capillary surface.
67 80 98 100 60 28
ANS: D
The DLCO indicates a loss of alveolar capillary surface area and strongly suggests that lung destruction is occurring at the level of the alveolar-capillary membrane. DIF: Analysis
REF: p. 554
OBJ: 3
45. You are called to attend to an ER patient complaining of shortness of breath and severe
dyspnea on exertion. Patient history is significant for a 30-year-pack smoking history, dry nonproductive cough, and occasional pedal edema. CXR findings are not remarkable except for mild cardiomegaly. You want to rule out ILD versus obstructive lung disease. HRCT shows a diffused ground glass appearance with the presence of centrilobular nodules. Together with the PFT results, HRCT finding indicates the presence of: a. respiratory bronchiolitis ILD. b. chronic bronchitis. c. emphysema. d. sarcoidosis. ANS: A
The presence of diffused ground glass appearance with the presence of centrilobular nodules in the HRTC is consistent with respiratory bronchiolitis ILD caused by tobacco exposure. Moreover, PFT results support this conclusion by showing a restrictive process with loss of alveolar-capillary surface area. DIF: Analysis
REF: p. 543
OBJ: 3
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Chapter 27: Pleural Diseases Test Bank MULTIPLE CHOICE 1. How much pleural fluid does a normal healthy adult have in each hemithorax? a. 5 mL b. 8 mL c. 12 mL d. 16 mL ANS: B
The average person has approximately 8 mL of pleural fluid per hemithorax. DIFF: Recall DIF: Recall
REF: p. 563
OBJ: 1
2. Which of the following statements about pleural fluid is FALSE? a. Fluid can move easily between each hemithorax. b. Normal protein concentration is between 1.3 and 1.4 g/dL. c. The total volume is approximately 16 mL. d. Total protein concentration is similar to that of interstitial fluid elsewhere in the
body. ANS: A
The average person has approximately 8 mL of pleural fluid per hemithorax. It is estimated that this pleural fluid has a total protein concentration similar to that of interstitial fluid elsewhere in the body: between 1.3 and 1.4 g/dL. In human beings, the pleural spaces surrounding each lung are completely independent, being separated by the mediastinum. DIF: Recall
REF: p. 563
OBJ: 1
3. At what point is intrapleural pressure most negative? a. end exhalation b. FRC c. inspiration d. maximal expiration ANS: C
The pleural space is under negative pressure except during forced expiration. The intact thoracic rib cage provides elastic recoil pressure outward, whereas the intrinsic recoil pressure of the lung is inward toward the lung hilum. The diaphragm further decreases the intrapleural pressure below the atmospheric pressure to allow inspiration to occur. DIF: Recall
REF: p. 563
OBJ: 1
4. Pleural fluid with a total protein concentration of less than 50% of the serum total protein
level is one of the indications of transudative pleural effusion. a. True b. False
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ANS: A
A pleural fluid total protein concentration less than 50% of the serum total protein level and lactate dehydrogenase (LDH) values in the pleural fluid less than 60% of the serum value indicate the presence of a transudative pleural effusion. DIF: Recall
REF: p. 564
OBJ: 2
5. What is the most common cause of pleural effusion in the clinical setting? a. acute renal failure b. congestive heart failure c. liver disease d. lung cancer ANS: B
Congestive heart failure is the most common cause of clinical pleural effusions. DIF: Recall
REF: p. 565
OBJ: 2
6. The pleural effusions associated with heart failure are rarely drained. a. True b. False ANS: A
The effusions are rarely drained because outcome is heavily influenced by successful management of the underlying heart failure, which also clears the effusions. DIF: Recall
REF: p. 565
OBJ: 3
7. Nephrotic syndrome causes pleural effusion by increasing oncotic pressure in the blood as a
result of a protein leak into the urine. a. True b. False ANS: B
In nephrotic syndrome (also known as nephrosis), the kidneys leak more than 3 grams of protein per day into the urine. Because patients become protein depleted, there is insufficient oncotic pressure within the blood to hold appropriate amounts of fluid within the blood vessels. These patients become edematous, and fluid leaks into the lung interstitium and pleural space. Pleural effusions are common but usually are small. DIF: Recall
REF: p. 565
OBJ: 3
8. A patient with nephritic syndrome is noted to have a large right-sided pleural effusion and a
small to medium-sized left-sided pleural effusion. What would explain this finding? a. The nephrosis is complicated by CHF. b. The nephrosis is complicated by pulmonary emboli. c. This is a common finding in patients with nephrosis. d. This just a complicated case of nephrosis. ANS: B
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Patients with nephrosis are at increased risk of deep venous thrombosis and pulmonary emboli. In nephrosis, protein S, which keeps blood from clotting, becomes deficient from leaking into the urine. Therefore, the presence of large or asymmetrical pleural effusions should raise the possibility of the presence of pulmonary emboli. Pleural effusions associated with pulmonary emboli usually are exudates and contain large numbers of red blood cells. DIF: Application
REF: p. 566
OBJ: 3
9. Pleural effusion is a complication of ascites in fewer than 10% of the cases. a. True b. False ANS: A
Excessive pleural fluid is present in approximately 6% of patients with ascites, and 70% of these fluid collections are on the right side. DIF: Recall
REF: p. 566
OBJ: 3
10. What is the most common cause of pleural effusion that occurs due to lymphatic obstruction
within the mediastinum? a. cancer that has metastasized to the mediastinum b. hepatic hydrothorax c. malignant pleural effusion d. tuberculous pleurisy ANS: A
Lymphatic obstruction within the mediastinum causes poor pleural fluid egress from the pleural space, although the pleural space is otherwise normal. The most common condition that causes this abnormality is cancer that metastasizes to the mediastinum. DIF: Recall
REF: p. 566
OBJ: 3
11. Exudative pleural effusions have more protein and inflammatory cells present compared to
transudative effusions. a. True b. False ANS: A
An exudative pleural effusion is caused by inflammation in the lung or pleura. This type of pleural effusion has more protein and inflammatory cells present than does a transudative effusion. DIF: Recall
REF: p. 566
OBJ: 2
12. Most pleural effusions are transudative. a. True b. False ANS: B
Box 25-1 lists the common causes of exudative pleural effusion. They account for approximately 70% of all pleural effusions.
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DIF: Recall
REF: p. 566
OBJ: 2
13. What is a common cause of persistent fever in intensive care unit (ICU) patients with
pneumonia? a. congestive heart failure b. most exudative effusions c. parapneumonic effusions d. transudative effusions ANS: C
Parapneumonic effusions are common causes of persistent fever among ICU patients with pneumonia. Sampling by thoracentesis is commonly performed to exclude empyema. Pleural fluid drainage can improve ventilation if the fluid volume is large. DIF: Recall
REF: p. 566
OBJ: 3
14. What is a common complication of pleurodynia (pleural pain)? a. atelectasis b. insomnia c. pneumonia d. pneumothorax ANS: A
The typical patient with pleurodynia has shallow respirations; deeper breaths are limited by pain. The subsequent atelectasis can cause oxygenation difficulty caused by shunting. DIF: Recall
REF: p. 566
OBJ: 3
15. Which of the following conditions is most closely associated with exudative pleural effusion? a. cirrhosis of the liver b. congestive heart failure c. nephrotic syndrome d. tuberculosis ANS: D
In many parts of the world, any lymphocyte-predominant exudative effusion is considered tuberculosis until proved otherwise. DIF: Recall
REF: p. 566
OBJ: 3
16. What is the most likely cause of a large unilateral pleural effusion in a 70 year old patient? a. congestive heart failure b. malignancy c. pneumonia d. tuberculosis ANS: B
Malignant disease is the most common cause of large unilateral pleural effusions among persons older than 60 years. DIF: Recall
REF: p. 567
OBJ: 3
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17. What type of pleural problem is most likely to develop from rupture of the thoracic duct? a. chylothorax b. hemothorax c. hydrothorax d. pneumothorax ANS: A
The thoracic duct is a lymphatic channel that runs from the abdomen through the mediastinum to enter the left subclavian vein. Disruption of the thoracic duct anywhere along its course can cause leakage of chyle into the mediastinum, which then may rupture into the pleural space and cause a chylothorax. DIF: Recall
REF: p. 567
OBJ: 4
18. What is the most common cause of a chylothorax? a. chest trauma b. malignancy c. pulmonary embolism d. surgery ANS: B
The most common causes of rupture are malignancy (50%), surgery (20%), and trauma (5%). DIF: Recall
REF: p. 567
OBJ: 4
19. What is the most common cause of hemothorax? a. chest trauma b. malignancy c. pulmonary embolism d. surgery ANS: A
Although hemothorax is seen most commonly after blunt or penetrating chest trauma, a number of medical conditions can give rise to blood in the pleural space. DIF: Recall
REF: p. 567
OBJ: 4
20. What is a common clinical finding even with small pleural effusions? a. air bronchograms b. arrhythmias c. dyspnea d. tachycardia ANS: C
Dyspnea is common with small pleural effusions, even when lung mechanics are relatively preserved. DIF: Recall
REF: p. 568
OBJ: 5
21. What diagnostic procedure or technique is most commonly used to diagnose the presence of a
pleural effusion? a. chest radiography
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b. pleuroscopy c. thoracentesis d. thoracoscopy ANS: A
The chest radiograph is the most common method of detecting a pleural effusion. DIF: Recall
REF: p. 568
OBJ: 6
22. What anatomical position is most likely to show the presence of a small pleural effusion in the
upright chest radiograph? a. apical regions b. costophrenic angles c. fissures d. subdiaphragmatic region ANS: B
It is important that, if possible, the chest radiograph be obtained with the patient in an upright position to show a pleural fluid meniscus at the costophrenic angles. DIF: Recall
REF: p. 568
OBJ: 6
23. What diagnostic procedure or technique is most sensitive for the identification of pleural
effusion? a. chest radiography b. computed tomography c. pleurodesis d. thoracoscopy ANS: B
Computed tomography of the chest is the most sensitive study for identification of pleural effusion. DIF: Recall
REF: p. 568
OBJ: 6
24. Which of the following is NOT a typical complication of thoracentesis? a. infection b. intercostal artery laceration c. rib fracture d. pneumothorax ANS: C
Thoracentesis involves the following three major risks: (1) intercostal artery laceration, (2) infection, and (3) pneumothorax. DIF: Recall
REF: p. 569
OBJ: 7
25. What agent has proved to be the most successful in pleurodesis? a. mixture of saline and Mucomyst b. acetaminophen in suspension c. saline solution mixed with heparin d. talc suspended in saline
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ANS: D
The success of talc pleurodesis, approximately 90%, is higher than that of all alternatives except surgical abrasion. DIF: Recall
REF: p. 569
OBJ: 6
26. Pleural effusions that occur secondarily to a. ascites b. congestive heart failure c. malignancy d. nephrotic syndrome
are most often treated with pleurodesis.
ANS: C
Although pleurodesis of benign effusions, such as those occurring with CHF, nephrotic syndrome, and idiopathic chylothorax, have been performed successfully, the procedure is discouraged for pleural effusions that are not malignant. DIF: Recall
REF: p. 569
OBJ: 7
27. Primary spontaneous pneumothorax occurs in a patient with no previous underlying lung
disease. a. True b. False ANS: A
Spontaneous pneumothoraces are of two types: (1) primary spontaneous pneumothorax, in which there is no underlying lung disease, and (2) secondary spontaneous pneumothorax, in which lung disease is present. DIF: Recall
REF: p. 570
OBJ: 8
28. Describe a secondary spontaneous pneumothorax. a. pneumothorax that occurs secondary to cardiac complications b. pneumothorax that occurs without trauma or any underlying disease c. pneumothorax that results from nonpenetrating chest trauma d. pneumothorax that results from underlying lung disease ANS: D
Spontaneous pneumothoraces are of two types: (1) primary spontaneous pneumothorax, in which there is no underlying lung disease, and (2) secondary spontaneous pneumothorax, in which lung disease is present. DIF: Recall
REF: p. 570
OBJ: 8
29. Chest pain occurs in only a small percentage of patients with a pneumothorax. a. True b. False ANS: B
Chest pain, which is typically sharp and abrupt, occurs in nearly every patient with pneumothorax.
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DIF: Recall
REF: p. 570
OBJ: 8
30. Dyspnea occurs in the majority of patients with a pneumothorax. a. True b. False ANS: A
Dyspnea occurs in approximately two thirds of patients when decreases in vital capacity and PO 2 , probably due to airway closure at low lung volumes, cause ventilation-perfusion defects and shunting. DIF: Recall
REF: p. 570
OBJ: 8
31. What are the functions of a chest tube in a patient with chest trauma that causes bleeding and
pneumothorax? 1. to measure the rate of bleeding 2. to improve ventilation 3. to allow lung reexpansion a. 1 and 2 b. 2 and 3 c. 3 d. 1, 2, and 3 ANS: D
The chest tube is multifunctional to allow measurement of the rate of bleeding, to allow the lung to be pulled to the parietal pleural surface to tamponade bleeding, and to allow maximum ventilation. DIF: Recall
REF: p. 570
OBJ: 9
32. What size of chest tube would you use in the management of trauma related pneumothoraces? a. large b. medium c. small d. size is immaterial ANS: A
Large-caliber chest tubes are placed for trauma-related pneumothoraces to allow exit of blood and blood clots, which can be difficult to remove through small-bore catheters. DIF: Recall
REF: p. 570
OBJ: 9
33. Chest tubes should be directed toward the base of the lung to evacuate a pneumothorax. a. True b. False ANS: B
When bleeding is a major component of pleural injury, two chest tubes are used: a posterior chest tube to drain blood that is gravity dependent and an anterior and apical chest tube to drain air that moves to the lung apex in the absence of pleural disease. DIF: Recall
REF: p. 570
OBJ: 9
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34. Iatrogenic pneumothorax is the most common type of traumatic pneumothorax. a. True b. False ANS: A
Iatrogenic pneumothorax is the most common type of traumatic pneumothorax. DIF: Recall
REF: p. 570
OBJ: 8
35. In what age group is a primary spontaneous pneumothorax most commonly seen? a. under 15 years b. 18 to 25 years c. 35 to 45 years d. over 60 years ANS: B
Primary spontaneous pneumothorax usually occurs in patients in their late teenage years or early 20s. DIF: Recall
REF: p. 571
OBJ: 8
36. What is the primary risk factor associated with spontaneous pneumothoraces? a. cigarette smoking b. heavy exercise c. obesity d. urban living ANS: A
Results of some studies suggest that cigarette smoking is a risk factor in more than 90% of cases of primary spontaneous pneumothorax. The smoking history is typically short and smoking cessation is recommended. DIF: Recall
REF: p. 571
OBJ: 8
37. What underlying lung disease is most often present in a patient with secondary spontaneous
pneumothorax? a. asthma b. chronic obstructive pulmonary disease (COPD) c. interstitial pulmonary fibrosis d. pneumonia ANS: B
In most cases, the underlying lung disease is COPD with some component of emphysema. DIF: Recall
REF: p. 571
OBJ: 8
38. Which of the following findings on a radiologic report would indicate the presence of a
tension pneumothorax? a. bilateral inversion of diaphragm, long narrow heart, flattened ribs b. blunting of costophrenic angles, marked interstitial infiltrates, apical free air c. contralateral mediastinal shift, diaphragmatic depression, flattening of ribs
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d. ipsilateral mediastinal shift, sail-shape noted right hemithorax, marked interstitial
infiltrates right sided ANS: C
Tension pneumothorax occurs when air in the pleural space exceeds atmospheric pressure. The radiographic appearance includes mediastinal shift to the contralateral side, diaphragmatic depression, and expansion of the ribs. DIF: Recall
REF: p. 572
OBJ: 9
39. At what anatomic position should an 18-gauge IV catheter be placed to relieve a tension
pneumothorax? a. just inferior to the second rib b. just inferior to the third rib c. just superior to the second rib d. just superior to the fourth rib ANS: C
This procedure usually is done with an 18-gauge intravenous (e.g., Jelco) catheter inserted just over the second rib on the anterior aspect of the chest in the midclavicular line. DIF: Recall
REF: p. 572
OBJ: 9
40. A quick diagnosis based on clinical presentation can significantly improve the survival rates
in patients with tension pneumothorax. a. True b. False ANS: A
In one case series of 74 patients with tension pneumothorax, a clinical diagnosis was made for 45 patients; the associated mortality rate was 7%. In the other cases, the diagnosis was delayed from the onset of clinical signs by 30 minutes to 8 hours, resulting in a 31% mortality rate. DIF: Recall
REF: p. 572
OBJ: 9
41. What complication often occurs following rapid lung reexpansion due to the evacuation of air
or fluid from the pleural space? a. arrhythmias b. pulmonary edema c. pulmonary emboli d. systemic hypotension ANS: B
Reexpansion pulmonary edema occurs in a lung that has been rapidLy reinflated from low lung volumes, particularly when the pneumothorax has been longstanding or when the pressure gradient across the lung has become high, as might occur when there is endobronchial obstruction from cancer, mucus, or blood. DIF: Recall
REF: p. 572
OBJ: 9
42. What is the primary tool used to diagnosis a pneumothorax?
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a. b. c. d.
chest radiography computed tomography PET scan ultrasonography
ANS: A
The diagnosis of pneumothorax is established with chest radiography. DIF: Recall
REF: p. 572
OBJ: 9
43. If accurate sizing on a pneumothorax is desired, what diagnostic technique would be most
appropriate? a. chest radiography b. computed tomography c. PET scan d. ultrasonography ANS: B
Pneumothoraces are most accurately sized by the use of chest CT. DIF: Recall
REF: p. 572
OBJ: 9
44. The administration of oxygen to a patient with a pneumothorax will speed the rate at which
resolution occurs once the leak has stopped. a. True b. False ANS: A
Oxygen should be administered to all patients who have a pneumothorax. Most of the air in a pneumothorax is nitrogen because oxygen is readily absorbed. If an air leak is continuing, supplemental oxygen rather than nitrogen leaks into the pleural space. After an air leak has been stopped, administration of oxygen decreases the blood and tissue partial pressure and nitrogen surrounding the pleural space. Pneumothorax resolution is normally 1.25% of the air per day. Oxygen speeds recovery by increasing the gradient of nitrogen from the pleural space to the pleural tissues. DIF: Recall
REF: p. 573
OBJ: 9
45. Which of the following could be early warning signs that a pneumothorax is enlarging?
1. decreased pulse oximetry reading 2. development of a fever 3. increased respiratory rate 4. mental confusion a. 1, 2, and 3 b. 1 and 3 c. 2 d. 1, 2, 3, and 4 ANS: B
During observation, it is important to record the respiratory rate and any signs of deteriorating respiratory function. An oximetry decrease can be an early warning of pneumothorax enlargement. Any deterioration indicates that the pneumothorax must be drained.
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DIF: Application
REF: p. 573
OBJ: 9
46. When using a small-bore catheter with a one-way valve such as a HeimLich valve, how can
you determine definitively that there is or is not a small air leak? a. Connect to an underwater seal. b. Increase the FIO 2 and note clinical changes. c. Listen for air movement. d. Watch the valve to see if it moves. ANS: A
It is difficult to determine whether a Heimlich valve has an ongoing leak unless it is placed to underwater seal. This procedure can be done in the emergency department by placing the Heimlich valve into a cup of water or by placing it in-line with a water-seal chamber to see whether an air leak is continuing after lung expansion. DIF: Recall
REF: p. 573
OBJ: 9
47. What method of chest tube removal has been associated with the lowest level of
pneumothorax recurrence? a. Clamp the chest tube for 4 hours; if chest radiograph is good, remove the tube. b. Clamp chest tube for 24 hours; if clinically stable, remove the tube. c. Remove the chest tube as soon as the air leak resolves. d. Remove the chest tube 48 hours after the air leak resolves. ANS: D
The recurrence rate is near zero when chest tubes are removed 48 hours after the air leak no longer is seen in the water-seal chamber. DIF: Recall
REF: p. 574
OBJ: 9
48. For which type of pneumothorax is pleurodesis most commonly indicated? a. iatrogenic b. bronchopleural fistula c. spontaneous d. traumatic ANS: C
Patients who have had one pneumothorax are more likely than the general population to have a second. The recurrence rate is greater than 30% among patients with primary spontaneous pneumothorax and approximately 40% among patients with secondary spontaneous pneumothorax. These high recurrence rates indicate that prevention of recurrence of pneumothorax should be undertaken, particularly for patients in whom pneumothorax may be life threatening. Preventing recurrence involves production of adhesions between the parietal and the visceral pleura in the involved area and is termed pleurodesis. DIF: Recall
REF: p. 574
OBJ: 9
Read the following scenario and answer the questions about Ms. Paul:
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Fifteen hours after open heart surgery, Ms. Paul remains on mechanical ventilation. During assessment you note decreased chest movement on the right-side with decreased breath sounds and dull sound to percussion. Decreased lung compliance is also noted. 49. Which of the following procedures would you recommend to assess her situation at this time? a. chest x-ray b. auto-peep maneuver c. measure her compliance manually d. CT scan of the chest ANS: A
Considering that the patient is stable, a chest x-ray would be the most indicated procedure to determine the cause of the clinical changes in Ms. Paul. DIF: Analysis
REF: p. 574
OBJ: 2
50. The chest radiograph showed the presence a meniscus in the right chest together with a
blunted right costophrenic angle. Which of the following procedures would you recommend at this point to treat Ms. Paul? a. anterior chest tube thoracotomy b. chest needle decompression c. video-assisted thoracoscopy (VAT) d. posterior chest tube thoracotomy ANS: D
The presence of a meniscus in the chest radiograph is indicative of a large pleural effusion. Large pleural effusions need to be drained either by needle aspiration during a thoracentesis for spontaneously-breathing patients or by the insertion of a posterior chest tube. Anterior chest tubes are used for a pneumothorax. DIF: Application
REF: p. 564
OBJ: 2
51. Forty-eight hours after the chest tube insertion Ms. Paul remains on mechanical ventilation.
While assessing the chest tube system you note small bubbles in the water seal chamber generated during peak inspiration. This is an indication of which of the following: a. normal functioning of the water seal chamber b. bronchopleural fistula c. low water level in the chamber d. high suction pressure from the suction chamber ANS: B
Bubbling in the water seal chamber is an indication of a leak in the chest tube collection system. The leak can be generated by 1) cracked or broken collection system, 2) improperly positioned chest tubes and 3) a persistent bronchopulmonary fistula. To rule out 1) versus 2) and 3) the chest tube should be clamped by the chest level. If the leak continues the collection system is cracked or defective. If the leak stops the chest tube is malposition or there is a bronchopulmonary fistula generating the leak. DIF: Analysis
REF: p. 574
OBJ: 8
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Chapter 28: Pulmo nary Vascular Disease Test Bank MULTIPLE CHOICE 1. Venous thromboembolism is a major national health issue in the United States. a. True b. False ANS: A
Venous thromboembolism is a major national health problem DIF: Recall
REF: p. 581
OBJ: 1
2. Approximately what percentage of patients who die from pulmonary embolism are NOT
suspected before death? a. b. c. d.
5% 20% 40% 70%
ANS: D
More than 70% of patients who die of pulmonary embolism are not suspected before death. DIF: Recall
REF: p. 581
OBJ: 1
3. Which of the following risk factors is NOT associated with an increase in the incidence of
pulmonary embolism? a. advanced age b. immobilization c. multiple injuries from trauma d. positive smoking history ANS: D
Several conditions enhance the intravascular coagulability of the blood and predispose to venous thromboembolic disease (Box 26-1). The most frequent causes of an inherited hypercoagulable state are the factor V Leiden mutation and the prothrombin gene mutation, which together account for 50-60% of cases. The major acquired risk factors for VTE include recent major surgery, trauma, immobilization, antiphospoholipid antibody syndrome, malignancy, pregnancy, oral contraceptives, and myeloproliferative disorders. DIF: Recall
REF: p. 582
OBJ: 1
4. Where do most pulmonary emboli originate? a. deep veins of the arms b. deep veins of the legs c. thrombi from the right side of the heart d. veins of the thorax ANS: B
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Pulmonary emboli arise from detached portions of venous thrombi that form, in most cases, in deep veins of the lower extremities or pelvis (86%). DIF: Recall
REF: p. 581
OBJ: 2
5. Which of the following conditions predispose a patient to venous thromboembolic disease?
1. carcinoma 2. COPD 3. trauma 4. thrombocytosis a. 1, 2, and 3 b. 1 and 4 c. 2 d. 1, 3, and 4 ANS: D
Several conditions enhance the intravascular coagulability of the blood and predispose to venous thromboembolic disease (Box 26-1). The most frequent causes of an inherited hypercoagulable state are the factor V Leiden mutation and the prothrombin gene mutation, which together account for 50-60% of cases. The major acquired risk factors for VTE include recent major surgery, trauma, immobilization, antiphospoholipid antibody syndrome, malignancy, pregnancy, oral contraceptives, and myeloproliferative disorders. Vessel wall abnormalities are found most often in patients who have sustained trauma or have undergone major surgery. DIF: Recall
REF: p. 581
OBJ: 2
6. What percentage of patients with pulmonary embolism have pulmonary infarction as a
complication? a. less than 10% b. about 25% c. about 40% d. about 65% ANS: A
Embolism to the pulmonary circulation produces pulmonary hemorrhage in the ischemic area and infarction (or tissue death from deprivation of blood flow) in fewer than 10% of cases of pulmonary embolism. Infarction is less common than thromboembolism because the lung has two blood supplies: the pulmonary arterial circulation and the bronchial circulation. DIF: Recall
REF: p. 582
OBJ: 4
7. Most pulmonary infarctions occur in the lung apexes. a. True b. False ANS: B
In general, infarcts occur at the lung bases, are pleural based, and may be accompanied by pleural effusion. DIF: Recall
REF: p. 582
OBJ: 3
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8. Death from massive pulmonary embolism is the result of cardiovascular collapse rather than
respiratory failure. a. True b. False ANS: A
Death from massive pulmonary embolism is the result of cardiovascular collapse rather than of respiratory failure. DIF: Recall
REF: p. 582
OBJ: 3
9. Which of the following pathophysiologic changes in the lung is not typically associated with
pulmonary embolism? a. bronchoconstriction b. decreased ciliary mobility c. increased dead space ventilation d. reduced surfactant production ANS: B
Embolic obstruction of the pulmonary artery increases the alveolar dead space, causes bronchoconstriction, and decreases the production of alveolar surfactant. DIF: Recall
REF: p. 582
OBJ: 3
10. Which of the following conditions contribute to the development of hypoxemia in a patient
with pulmonary emboli? 1. cardiogenic shock 2. destruction of lung parenchyma 3. intrapulm onary shunt 4. a. b. c. d.
mismatch 1, 2, and 3 1 and 4 2 only 1, 3, and 4
ANS: D
Hypoxemia develops because of mismatch, intrapulmonary shunt, and cardiogenic shock. Shock is caused by obstruction of the pulmonary vasculature by massive emboli or by numerous small emboli in the presence of cardiopulmonary disease. Cardiac output decreases and oxygen delivery falls. With the decrease in oxygen delivery, the peripheral tissues increase oxygen extraction causing venous oxygen desaturation. In patients with significantly increased right heart pressures, intracardiac right-to-left shunt may develop when blood flows through a patent foramen ovale. DIF: Recall
REF: p. 582
OBJ: 4
11. What is the main hemodynamic consequence of pulmonary emboli? a. increased pulmonary vascular resistance b. increased systemic vascular resistance c. pulmonary instability d. pulmonary vasodilation
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ANS: A
The main hemodynamic consequence of pulmonary embolism is increased resistance to blood flow caused by obstruction of the pulmonary arterial bed. DIF: Application
REF: p. 582
OBJ: 6
12. What percentage of the pulmonary vascular bed must be occluded by emboli before
pulmonary hypertension occurs? a. 25% b. 33% c. 50% d. 75% ANS: C
Pulmonary hypertension occurs when 50% of the pulmonary vascular bed has been occluded. DIF: Recall
REF: p. 583
OBJ: 6
13. What is the critical value for mean pulmonary arterial pressure, above which the right
ventricle fails and death may ensue? a. 30 mm Hg b. 40 mm Hg c. 50 mm Hg d. 60 mm Hg ANS: B
When the mean pulmonary arterial pressure increases to greater than 40 mm Hg during an acute first pulmonary embolism, the right ventricle fails, and hemodynamic collapse and death occur. DIF: Recall
REF: p. 583
OBJ: 6
14. What treatment is initiated in patients suspected of pulmonary emboli, and continued until
pulmonary emboli is ruled out? a. antiarrhythmia b. anticoagulation c. corticosteroids d. diuretics ANS: B
Unless there is a contraindication to anticoagulation of the patient (e.g., recent bleeding, head trauma, etc.), anticoagulation is often begun when the diagnosis of pulmonary embolism is first suspected and continued until pulmonary embolism is ruled out by tests. DIF: Recall
REF: p. 583
OBJ: 5
15. What is the most frequent symptom found in patients with confirmed pulmonary emboli? a. cough b. dyspnea c. leg swelling d. pleuritic pain
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ANS: B
The most frequent symptom in patients with angiographically confirmed pulmonary embolism is dyspnea. DIF: Recall
REF: p. 583
OBJ: 5
16. Which of the following are the main components of Virchow’s triad?
1. hypercoagulable states 2. vessel wall abnormalities 3. fibrinogen abnormalities 4. venous stasis a. 2. b. 1, 2, and 3. c. 1, 2, and 4. d. 1, 2, 3, and 4. ANS: C
Conditions that favor thrombus formation include blood stasis, the presences of hypercoagulable states, and vessel wall abnormalities (factors known as Virchow’s triad). DIF: Recall
REF: p. 581
OBJ: 1
17. Which of the following physical examination findings are consistent with the diagnosis of
pulmonary embolism? 1. congestive heart failure 2. inspiratory crackles on auscultation 3. loud P2 4. tachypnea a. 2, 3, and 4 b. 1 and 4 c. 3 d. 1, 2, 3, and 4 ANS: A
The most frequent physical findings include tachypnea, rales on chest examination, and tachycardia. These signs, like dyspnea, may be short-lived. Other common physical findings include an accentuated pulmonary component of the second heart sound (loud P2 ) consistent with pulmonary hypertension. Fever may be present in as many as 54% of patients. DIF: Recall
REF: p. 583
OBJ: 5
18. Which of the following findings on a chest radiograph is NOT consistent with pulmonary
embolism? a. diffuse hyperinflation b. elevation of the diaphragm c. enlargement of the heart shadow d. pleural effusion ANS: A
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The chest radiograph is abnormal in more than 80% of cases. Some of the abnormalities include enlargement of the right descending pulmonary artery (66%), elevation of the diaphragm (61%), enlargement of the heart shadow (55%), and a small pleural effusion (50%). DIF: Recall
REF: p. 583
OBJ: 4
19. Approximately what percentage of patients with pulmonary embolism have a normal ECG? a. 10% to 15% b. 25% to 30% c. 40% to 60% d. 70% to 75% ANS: A
The ECG is frequently abnormal in patients with pulmonary embolism (87% of the time). DIF: Recall
REF: p. 584
OBJ: 4
20. What are the two most common findings on the electrocardiogram (ECG) in the patient with
pulmonary embolism? a. bradycardia and elevated ST segment b. inverted T waves and depressed ST segment c. large P waves and inverted T waves d. tachycardia and depressed ST segment ANS: D
The ECG is frequently abnormal in patients with pulmonary embolism (87% of the time), but the ECG abnormalities accompanying pulmonary embolism are nonspecific in most (70% to 75%) cases; tachycardia and ST-segment depression are most common. DIF: Recall
REF: p. 584
OBJ: 4
21. Which of the following arterial blood gas findings is seen in most patients with pulmonary
embolism? a. hypercapnia b. hypoxemia c. low pH d. normal SaO 2 ANS: B
Most patients with acute pulmonary embolism have hypoxemia and hypocapnia. DIF: Recall
REF: p. 584
OBJ: 4
22. A D-dimer test is performed in a patient in whom a pulmonary embolism is suspected. The
value comes back at 379 mg/L. What does this suggest? a. almost completely establishes the presence of pulmonary embolism b. almost completely rules out pulmonary embolism c. establishes roughly a 50/50 chance of pulmonary embolism d. is indeterminate but highly suggestive of pulmonary embolism ANS: B
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The specificity D-dimer enzyme-linked immunosorbent assay (ELISA) can exclude all but 5% to 10% of patients with acute pulmonary embolism, so this test has been used as an important early assessment. The specificity of the test is only 39%, but a value less than 500 mg/L has been shown to rule out venous thromboembolic disease in 98% of patients. DIF: Analysis
REF: p. 584
OBJ: 5
23. Why is the D-dimer test not routinely performed on hospital inpatients suspected of having
pulmonary emboli? a. A high D-dimer only suggests the presence of comorbidities. b. A low D-dimer is associated with immunodepression. c. It loses sensitivity if numerous blood tests have been performed. d. The cost is prohibitive. ANS: A
Inpatients should undergo an imaging study as the initial test for pulmonary emboli because most will already have elevated D-dimer levels due to comorbid conditions. DIF: Application
REF: p. 584
OBJ: 5
24. How does impedance plethysmography determine the presence or absence of deep vein
thrombosis? a. notes resistance to electrical current associated with blood flow b. radioactive isotopes target clots and show ―hot‖ on gamma cameras c. uses ultrasonic waves to delineate the presence of clot or clots d. uses radiographic technique to spot the clots ANS: A
Impedance plethysmography, a noninvasive method, measures electrical impedance to blood flow, which changes with inflation and deflation of a lower-extremity cuff. DIF: Recall
REF: p. 584
OBJ: 5
25. The presence of previous chronic obstructive pulmonary disease (COPD) reduces the
diagnostic usefulness of a. True b. False
scans in acute pulmonary embolism.
ANS: B
The presence of concomitant cardiopulmonary disease even if severe (e.g., hypoxemia with or without ventilatory support, a condition that necessitates intensive care), or COPD does not diminish the diagnostic usefulness of scans in the diagnosis of acute pulmonary embolism. DIF: Recall
REF: p. 586
OBJ: 5
26. In patients suspected of having pulmonary emboli in whom noninvasive studies do not give a
definite diagnosis, what diagnostic procedure is the test of choice? a. CT b. MRI c. pulmonary angiography
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d. ANS: C
For the one third of patients who do not receive a definitive diagnosis on the basis of the results of noninvasive studies, pulmonary angiography is the test of choice. DIF: Recall
REF: p. 586
OBJ: 5
27. Which of the following is true regarding the use of CT with contrast for diagnosing
pulmonary embolism (PE)? a. limited due to availability of CT equipment b. most sensitive of the diagnostic techniques c. can only identify the medium to large PE d. high risk of mortality limits its use ANS: C
; Chest CT with intravenous contrast has become the principal diagnostic imaging modality to evaluate suspected PE. The reported sensitivity of helical computed tomography ranges from 53% to 100% and the specificity ranges from 81% to 100%. Studies indicate that helical CT scanning detects large PEs involving main and lobar emboli. However, this test is generally is unable to detect smaller PEs. DIF: Recall
REF: p. 586
OBJ: 5
28. Which of the diagnostic tests for pulmonary embolism is probably the safest and the most
consistently accurate? a. impedance plethysmography b. MRI c. pulmonary angiogram d. helical CTA ANS: B
The sensitivity, specificity, and accuracy of MRI are approximately 97%. MRI with radial pulse acquisition appears accurate in the diagnosis of acute deep venous thrombosis. Because of its limited availability, MRI may not be useful in the acute setting. DIF: Recall
REF: p. 588
OBJ: 5
29. Prophylactic deep venous thrombosis (DVT) therapy would be most important in which of the
following patient groups? a. general surgery patients b. general ward patients c. ICU patients d. patients with hip replacements ANS: D
The frequency of proximal DVT varies from 2% to 4% among general surgical patients undergoing minor surgery to 40% to 80% among patients at the highest risk, such as those who have undergone hip or knee surgery. DIF: Recall
REF: p. 588
OBJ: 5
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30. Which of the following medications should be used in the hospital for prophylactic deep
venous thrombosis therapy? a. acetylcholine esterase b. albuterol c. aspirin d. heparin ANS: D
Pharmacologic choices for prophylaxis include low-dose subcutaneous heparin, low-molecular-weight heparin, and fondaparinux. DIF: Recall
REF: p. 588
OBJ: 5
31. Most hospitalized patients who are immobile need prophylaxis for venous thromboembolism. a. True b. False ANS: A
Most hospitalized patients who are immobile need prophylaxis for venous thromboembolism. DIF: Recall
REF: p. 588
OBJ: 5
32. Which of the following medications would be standard therapy to treat acute deep venous
thrombi? a. acetylcholine esterase b. heparin c. streptokinase d. warfarin ANS: B
Heparin is the standard therapy for venous thromboembolic disease. DIF: Recall
REF: p. 588
OBJ: 5
33. What is the fastest way to achieve therapeutic levels of heparin in the treatment of acute deep
venous thrombi? a. continuous drip system b. follow established nomogram c. large bolus at 10 µg/kg d. IV injections while tracking blood levels ANS: B
The fastest way to achieve a therapeutic heparin effect is to follow an established nomogram. Several nomograms are currently available, and one is shown in Table 26-6. These nomograms have been well accepted by clinicians and have led to aggressive heparin dosing and improvement in intermediate outcome. The use of nomograms has been associated with decreasing time to achieve therapeutic activated thromboplastin time (85% to 90% of patients achieve a therapeutic level within 24 hours) and a decrease in the variance of these parameters without any changes in bleeding rate. DIF: Recall
REF: p. 589
OBJ: 5
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34. What is the most commonly used oral anticoagulant? a. acetylcholine esterase b. heparin c. streptokinase d. warfarin ANS: D
The coumarin derivative, warfarin sodium, is the most commonly used oral anticoagulant. It must be given for 6 to 7 consecutive days to achieve a full antithrombotic effect. Warfarin should not be used solely for the initial management of venous thromboembolism because the peak effect is delayed for at least 72 to 96 hours. DIF: Recall
REF: p. 589
OBJ: 5
35. What drug would be the treatment of choice for pulmonary emboli? a. heparin b. streptokinase c. urokinase d. warfarin ANS: A
Therapy with heparin, whether unfractionated or low molecular weight, followed by oral coumarin in a regimen similar to that for acute deep venous thrombosis is the treatment of choice. DIF: Recall
REF: p. 590
OBJ: 5
36. A patient with pulmonary emboli has severe hypoxemia, acute right-sided heart failure, and
shock. What treatment should be given at this time? a. acetylcholine esterase b. heparin c. streptokinase d. warfarin ANS: C
In the care of patients with severe hypoxemia, acute right-sided heart failure, or shock, thrombolytic therapy may be administered for lysis of the emboli. However, for patients with no evidence of hypotension, thrombolytic administration has to be individualized. When thrombolytic therapy with streptokinase and urokinase is used, heparin should not be infused concurrently. DIF: Application
REF: p. 590
OBJ: 5
37. At rest, what level does the mean pulmonary artery pressure need to reach before it is
considered pulmonary hypertension? a. >10 mm Hg b. >15 mm Hg c. >20 mm Hg d. >25 mm Hg ANS: D
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Pulmonary hypertension is defined by an elevation in mean pulmonary arterial pressure greater than 25 mm Hg at rest. DIF: Recall
REF: p. 590
OBJ: 6
38. Pulmonary artery hypertension (PAH) is NOT associated with which of the following
conditions? a. amyotrophic lateral sclerosis b. cirrhosis of the liver c. congenital heart disease d. human immunodeficiency virus infection ANS: A
PAH may be associated with several conditions, including congenital heart disease, collagen vascular disease, cirrhosis of the liver, viral infections (e.g., human immunodeficiency virus infection), and drugs and toxins (diet pills or anorexigens), to name a few. DIF: Recall
REF: p. 590
OBJ: 8
39. What is the initial event in the pathogenesis of idiopathic pulmonary artery hypertension
(IPAH)? a. insult to the pulmonary endothelium b. elevated level of serotonin c. monoclonal proliferation of endothelial cells d. vascular remodeling ANS: A
The initial event of IPAH is probably an insult to the pulmonary endothelium (the cells that line the blood vessel). DIF: Recall
REF: p. 590
OBJ: 7
40. Primary pulmonary hypertension is more common in males than in females. a. True b. False ANS: B
Idiopathic pulmonary artery hypertension is more common among women than among men, with a ratio of 3:1. DIF: Recall
REF: p. 591
OBJ: 9
41. On average, how long does the diagnosis of idiopathic pulmonary artery hypertension (IPAH)
follow the onset of the disease? a. 6 months b. 1 year c. 18 months d. 2 years ANS: D
On average, the diagnosis of IPAH is delayed for 2 years after the onset of IPAH.
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DIF: Recall
REF: p. 591
OBJ: 9
42. What are the two most common symptoms associated with primary pulmonary hypertension? a. dry cough and dyspnea b. dyspnea and angina c. hemoptysis and dyspnea d. syncope and chest pain ANS: B
The most common initial symptom is dyspnea (60% of patients). Angina, probably due to underperfusion of the right ventricle or stretching of the large pulmonary arteries, is present in approximately 50% of patients. DIF: Recall
REF: p. 591
OBJ: 9
43. Which of the following physical examination findings is NOT found in patients with primary
pulmonary hypertension? a. cyanosis b. diastolic heart murmur c. digital clubbing d. loud second heart sound (P2 ) ANS: C
Physical findings associated with idiopathic pulmonary artery hypertension (IPAH) include a loud second heart sound and a right-sided third or fourth heart sound. Other common signs are a palpable right ventricular heave and impulse of the pulmonary artery and both pulmonary ejection and pulmonary tricuspid regurgitation murmurs. Signs of right ventricular failure are common. Cyanosis often is present as a result of low cardiac output or the presence of an intracardiac right-to-left shunt that occurs as cor pulmonale develops. Clubbing does not occur in IPAH. DIF: Recall
REF: p. 591
OBJ: 9
44. Which of the following radiographic findings is NOT typical for patients with primary
pulmonary hypertension? a. enlargement of the pulmonary artery b. enlargement of the right ventricle c. narrowing of the peripheral arteries d. pleural effusion ANS: D
The chest radiographic findings include enlargement of the main and hilar pulmonary arteries, ―pruning‖ (or narrowing) of the peripheral arteries, and enlargement of the right ventricle and atrium though the chest radiograph may remain normal in 6% of patients. Pleural effusions are not present. DIF: Recall
REF: p. 591
OBJ: 9
45. What ECG findings are typically seen in patients with idiopathic pulmonary artery
hypertension? 1. frequent premature ventricular complexes 2. right-axis deviation
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3. right ventricular hypertrophy 4. left bundle-branch block a. 1, 2, and 4 b. 2 and 3 c. 4 d. 1, 2, 3, and 4 ANS: B
Electrocardiographic findings usually include right-axis deviation, right ventricular hypertrophy, and strain. The echocardiogram may show dilatation of the right ventricle and right atrium and tricuspid regurgitation. DIF: Recall
REF: p. 591
OBJ: 9
46. What ECG finding is most often associated with right-sided heart failure and pulmonary
hypertension? a. elevated ST segment b. inverted P wave in lead I c. prolonged PR interval d. right-axis deviation ANS: D
ECG findings usually include right-axis deviation, right ventricular hypertrophy, and strain. The echocardiogram may show dilatation of the right ventricle and right atrium and tricuspid regurgitation. DIF: Recall
REF: p. 591
OBJ: 9
47. What is the most important noninvasive diagnostic test for evaluation of a patient with
idiopathic pulmonary artery hypertension (IPAH)? a. posteroanterior chest radiograph b. physical examination c. pulmonary function testing d. scan ANS: D
The most important noninvasive test for IPAH is the scan lung scan, which helps to rule out the possibility of chronic thromboembolic pulmonary hypertension (a mimic of IPAH). DIF: Recall
REF: p. 591
OBJ: 9
48. What is the most common pulmonary function abnormality found in patients with idiopathic
pulmonary artery hypertension (IPAH)? a. reduced diffusing capacity of the lungs (DLCO) b. reduced forced vital capacity (FVC) c. reduced forced expiratory flow (FEF25%-75%) d. reduced lung compliance (CL) ANS: A
Pulmonary function tests are useful to rule out the presence of significant restrictive or obstructive airway disease. The most common abnormality at pulmonary function testing of patients with IPAH is a low carbon monoxide diffusing capacity (DLCO).
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DIF: Recall
REF: p. 591
OBJ: 8
49. What is the 5-year survival rate for patients with untreated idiopathic pulmonary artery
hypertension (IPAH)? a. 33% b. 44% c. 55% d. 66% ANS: A
IPAH can be life-threatening and carries a poor prognosis. Without therapy, only 33% of patients are alive 5 years after the onset of the disorder. DIF: Recall
REF: p. 592
OBJ: 9
50. Idiopathic pulmonary artery hypertension (IPAH) is often a fatal disease. a. True b. False ANS: A
IPAH can be life threatening and carries a poor prognosis. Without therapy, only 33% of patients are alive 5 years after the onset of the disorder. DIF: Recall
REF: p. 591
OBJ: 1
51. Unless there are contraindications, what treatment is given universally to all patients with
idiopathic pulmonary artery hypertension (IPAH)? a. oral anticoagulation b. oxygen c. steroids d. vasodilators ANS: A
Oral anticoagulation improves survival in IPAH and is recommended in all these patients unless there is a contraindication to anticoagulation. DIF: Recall
REF: p. 592
OBJ: 10
52. Why is the use of oxygen to maintain oxygen saturations greater than 90% particularly
important in the management of idiopathic pulmonary artery hypertension? a. These patients have a low cardiopulmonary reserve. b. Low alveolar oxygen causes vasoconstriction. c. Many patients have central cyanosis. d. These patients are especially susceptible to tissue hypoxia. ANS: B
Supplemental oxygen should be used to maintain oxygen saturation greater than 90%, especially because hypoxemia is a major cause of pulmonary vasoconstriction. DIF: Application
REF: p. 592
OBJ: 10
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53. Why are calcium channel blockers NOT used in all patients with idiopathic pulmonary artery
hypertension? a. It causes severe side effects. b. Many of these patients have systemic hypotension. c. Only a small percentage of IPAH patients respond. d. There is a high incidence of anaphylaxis. ANS: C
Patients with IPAH who respond to vasodilators in the short term have improved survival with long-term use of calcium-channel blockers. Thus, these agents should be considered in all patients who have significant and definite response to a short-acting vasodilator. Unfortunately, only a small fraction of IPAH patients qualify for and benefit from long-term therapy with oral calcium-channel blockers. DIF: Recall
REF: p. 592
OBJ: 10
54. What IV infusion has been found to improve exercise capacity, hemodynamic variables, and
survival in patients with severe IPAH? a. bosentan b. epoprostenol c. methylprednisolone d. sildenafil ANS: B
Epoprostenol delivered by continuous intravenous infusion, improves exercise capacity, hemodynamic variables, and survival in IPAH patients and is the treatment of choice for severely ill patients. DIF: Recall
REF: p. 592
OBJ: 10
55. What type of drug is Bosentan? a. corticosteroid b. endothelin antagonists c. phosphodiesterase inhibitors d. prostanoids ANS: B
Endothelin antagonists represent another class of medications that are newly available for treating pulmonary hypertension. Bosentan, an orally administered endothelin receptor antagonist, improves walking distance, hemodynamic variables, and functional class in patients with PAH. DIF: Recall
REF: p. 593
OBJ: 10
56. Lung transplantation is an option in the management of idiopathic pulmonary artery
hypertension. a. True b. False ANS: A
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Single or double lung transplantation has been used successfully in the treatment of patients with IPAH. Patients who undergo lung transplantation have an immediate decrease in pulmonary artery pressure at the time of surgery and rapid improvement in right heart function despite severe preoperative cor pulmonale. Lung transplantation is indicated in the care of patients who do not respond to vasodilators and have significant cardiac impairment. DIF: Recall
REF: p. 594
OBJ: 10
57. In what type of IPAH patient is lung transplantation indicated? a. all pulmonary artery hypertension patients with clinically significant disease b. patients not responding to vasodilators with significant cardiac dysfunction c. patients with class II, class III, or class IV disease d. patients with refractory hypoxemia ANS: B
Single or double lung transplantation has been used successfully in the treatment of patients with IPAH. Lung transplantation is indicated in the care of patients who do not respond to vasodilators and have significant cardiac impairment. DIF: Recall
REF: p. 594
OBJ: 10
58. What is the most important factor contributing to the onset of pulmonary hypertension in the
patient with COPD? a. alveolar hypoxia b. compression of pulmonary vasculature c. left ventricular failure d. loss of vascular surface ANS: A
Alveolar hypoxia, because of its potent pulmonary vasoconstrictive effect, is probably the most important factor contributing to pulmonary hypertension in patients with COPD. Sustained alveolar hypoxia causes pulmonary vasoconstriction and eventually medial hypertrophy, fibrosis of the intima, and narrowing of the lumen of the pulmonary blood vessels. DIF: Recall
REF: p. 594
OBJ: 11
59. What therapy has been proven to improve survival in patients with COPD and pulmonary
hypertension? a. bronchodilators b. oral vasodilators c. oxygen d. prostanoids ANS: C
Oxygen therapy is the main treatment that improves survival among patients with COPD and pulmonary hypertension, though smoking cessation and lung volume reduction (in selected individuals) may also confer survival benefits in patients with COPD. DIF: Recall
REF: p. 594
OBJ: 11
60. What drug is NOT classified as a prostanoid?
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a. b. c. d.
epoprostenol iloprost treprostinil sildenafil
ANS: D
Several prostanoids are currently available for treating patients with pulmonary hypertension, especially IPAD: epoprostenol, treprostinil, and iloprost. DIF: Recall
REF: p. 592
OBJ: 10
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Chapter 29: Acute Respirato ry Distress Syndro me Test Bank
MULTIPLE CHOICE
1. On the basis of the Berlin definition of Acute Respiratory Distress Syndrome (ARDS), the definition of moderate acute respiratory distress syndrome comprises which of the following components?
I. PaO2 /FiO2 200 mm Hg II. Onset of respiratory symptoms within 1 week of clinical insult III. Pulmonary capillary wedge pressure greater than 18 mm Hg IV. Chest radiograph with bilateral infiltrates not fully explained by effusions or collapse a. I and II only b. I and III only c. II and IV only d. I, II, and IV only
ANS: C Within 1 week of known clinical insult or new/worsening respiratory symptoms; Bilateral opacities that are not fully explained by effusions, lobar/lung collapse, or nodules. Can be either on CXR or CT scan; With PEEP 5, mild ARDS: PaO 2 /FiO2 201-300, moderate ARDS: PaO 2 /FiO2 200, severe ARDS: PaO2 /FiO2 00; Risk factors for ARDS must be present. Respiratory failure that is not fully explained by cardiac failure or fluid overload. If no risk factors are present, objective assessment (e.g., echocardiography) is required to exclude hydrostatic edema. REF: p. 562
2. A therapist is evaluating the progress of a patient with ARDS. The arterial blood gas reveals a PaO 2 of 55 mm Hg and a PaCO2 of 65 mm Hg. The PEEP is set at 12 cm H 2O, and the mean airway pressure is 18 on an FiO2 of 0.60. What is the OI in this patient? a. 20.7 b. 13.1 c. 1.31 d. 200
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ANS: A OI = (
FiO2 )/PaO2 100
REF: p. 562
3. Which of the following indirect insults can cause ARDS? a. Pneumonia b. Chest trauma c. Closed head injury d. Cor pulmonale
ANS: C ARDS can be caused by numerous insults (risk factors) that both directly and indirectly affect the lung via the generation of inflammatory mediators. Direct pulmonary insults include pneumonia, aspiration, chest trauma, and smoke inhalation. Indirect lung injury may be the result of generalized systemic conditions, such as sepsis, closed head injury, multiple trauma, transfusion reactions, and hemorrhagic shock. REF: p. 563
4. What acid-base abnormality does a patient generally display when experiencing stage 2 of ARDS? a. Mixed acidosis b. Respiratory alkalosis c. Respiratory acidosis d. Metabolic acidosis
ANS: B The clinical course of ARDS is characterized by distinct clinical, radiographic, and pathologic manifestations. The first stage consists of direct or indirect acute injury to the lung tissue. Clinically, patients may display mild tachypnea and dyspnea and tend to have normal radiographic findings. The second stage, or latent period, lasts a variable period of time after the onset of acute injury. During this time the patient may appear clinically stable but begins to develop early signs of pulmonary injury or insufficiency manifested by hyperventilation with hypocarbia and a respiratory alkalosis. REF: p. 563
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5. Which of the following clinical signs characterizes the onset of the third stage of ARDS? a. Refractory hypoxemia b. Hypocarbia c. Increased anatomic dead space d. Decreased cardiac output
ANS: A The third stage, acute respiratory failure, is heralded by the rapid onset of respiratory failure with hypoxemia refractory to supplemental oxygen. Diffuse pulmonary edema and worsening compliance cause significant atelectasis and intrapulmonary shunting. Clinically, patients develop rapid, shallow tachypnea with increased work of breathing. REF: p. 563
6. What are some of the physical signs of respiratory failure among children?
I. Head bobbing II. Nasal flaring III. Crying IV. Grunting a. I and II only b. I, II, and IV only c. I, III, and IV only d. II, III, and IV only
ANS: B The physical signs of respiratory failure will vary with age and include subcostal and supraclavicular retractions, grunting (i.e., an attempt to generate increased intrinsic positive end -expiratory pressure, PEEP), nasal flaring, and head bobbing. REF: p. 563
7. The therapist is auscultating a 2-year-old patient with ARDS. Which of the following is a common auscultatory finding in ARDS? a. Wheezing
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b. Stridor c. Crackles d. Pleural rub
ANS: C Lung examination usually reveals diffuse crackles on auscultation. REF: p. 563
8. Radiographically, what features are typically seen in ARDS?
a. Horizontal ribs b. Bilateral consolidations c. Flattened diaphragms d. Pleural effusions
ANS: C Radiographically, there are bilateral areas of consolidation with air bronchograms that reflect alveolar filling and atelectasis.
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REF: p. 564
9. Which of the following interventions should the therapist implement to decrease mortality in patients with ARDS? a. High PEEP b. Alveolar recruitment maneuvers c. Low tidal volume d. High respiratory rate
ANS: D Except for low tidal volume ventilation, no single intervention for adult ARDS has been clearly shown to decrease mortality. This highlights the pressing need for development of effective management strategies for ARDS. REF: p. 565
10. Which of the following pathophysiologic conditions contribute to the decreased pulmonary compliance associated with ARDS? a. Destruction of alveolar type II cells b. Inactivation of pulmonary surfactant c. Fluid accumulation in the pleural spaces d. Rapid removal of fluid by the pulmonary lymphatics
ANS: B Pulmonary compliance is significantly worsened by the presence of edema and can result in widespread atelectasis. Pulmonary compliance is further impacted by the inactivation of surfactant that results from the presence of plasma protein, such as fibrin, and inflammatory mediators, such as proteinases, in the alveolar space. REF: p. 564
11. Which of the following pathophysiologic changes seen in ARDS is responsible for the decrease in available surface area for gas exchange? a. Hyperinflation of the lungs b. Decreased right ventricular cardiac output
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c. Pulmonary hypertension d. Obliteration of small precapillary vessels
ANS: D Vascular changes occur throughout the later stages of ARDS with obliteration of small precapillary vessels and an increase in the medial thickness of intra-acinar pulmonary arteries. Overall, these changes markedly decrease the available surface area for gas exchange and result in intractable respiratory failure or chronic lung disease, potentially requiring prolonged ventilator support. REF: pp. 564-565
12. What pathophysiologic change accounts for the alteration of the hysteresis curve during ARDS? a. High transpulmonary pressures b. High transairway pressures c. Hyperinflated lungs d. Refractory hypoxemia
ANS: A During ARDS, marked hysteresis of the pressure–volume loop occurs, making significantly higher transpulmonary pressures during inspiration than during expiration necessary to achieve a given lung volume. REF: p. 565
13. How should the therapist use the point on the pressure–volume loop where the shape changes from concave to exponential? a. To set PEEP b. To set VT c. To set Ti d. To set PIP
ANS: A The point on the pressure–volume loop where the shape changes from concave to exponential is known as the lower inflection point. It reflects the pressure point at which alveoli begin to open and is located above functional residual capacity (see Figure 35-2 in the textbook). This suggests that many gas exchange units will collapse at normal transpulmonary pressures in acutely injured lungs and may need significant PEEP to maintain patency during expiration.
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REF: p. 565
14. Which of the following regions of the lungs is most likely to be unaffected by pathophysiology associated with ARDS? a. The dependent regions of the lung b. The nondependent regions of the lung c. The middle zone of the lung d. Depends on the etiology
ANS: B Lung injury and areas of involvement in ARDS are heterogeneous and not uniform through all lung units. Some areas of the lung, typically in the dependent regions, are grossly affected. Other regions of the lung, typically in the nondependent regions, may be relatively unaffected. This creates varying areas of compliance within the lung itself. Dependent regions are generally fluid filled, atelectatic, and noncompliant. Nondependent areas are relatively normal and, thus, at risk for overdistention (i.e., volutrauma) and/or barotrauma during mechanical ventilation. REF: p. 565
15. What level of FiO2 should the therapist avoid using long term in patients with ARDS? a. 40% b. 50% c. 60% d. Any level above 30%
ANS: C Every patient with ARDS is hypoxemic by definition. Prolonged administration of high concentrations of oxygen can damage the lungs, owing to the formation of highly reactive oxygen free radicals. Human and animal studies suggest that a prolonged FiO 2 greater than 0.60 should be avoided to prevent oxygen-induced pulmonary damage. REF: p. 566
16. The therapist was titrating PEEP levels to maintain an SaO 2 of 85% and found that 13 cm H 2O were required to achieve this goal. What should the most important concern with this level of PEEP?
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a. Risk of pneumothorax b. Decreased cardiac output c. Auto-PEEP d. Overdistention
ANS: B PEEP is typically increased to a level that allows adequate oxygenation as defined by an arterial oxygen saturation (SaO 2) of 85% or greater at an acceptable FiO 2 of 0.60 or less. It should be noted that the minimal acceptable arterial oxygen saturation remains very controversial. A PEEP level of 10 to 15 cm H2 O, or even higher, may be required to achieve adequate oxygenation. However, as PEEP levels exceed 12 to 15 cm H 2 O, the increase in intrathoracic pressure may adversely affect cardiac output, primarily by decreasing systemic venous return. As PEEP is increased, the ARDS patient should be monitored for a decrease in cardiac output with a decrease in peripheral perfusion. REF: p. 566
17. Which of the following ventilatory strategies is appropriate when mechanically ventilating a patient with ARDS? a. PEEP less than 15 cm H2 O and tidal volume (VT) between 8 and 10 mL/kg b. Peak inspiratory pressure (PIP) less than 40 cm H2 O and Pplateau less than 30 cm H2 O c. VT less than 6 mL/kg and Pplateau less than 30 cm H2 O d. A high or low level of PEEP and a VT between 8 and 10 mL/kg
ANS: C The ARDS Network investigated the optimal PEEP-FiO2 strategy for adults with ARDS. The results of this prospective, randomized, multicenter study indicate that in adult ARDS patients who are ventilated with 6 mL/kg tidal volumes and an end-inspiratory plateau pressure of less than 30 cm H 2 O, a "moderately high" or "very high" PEEP strategy produced similar survival rates. It must be noted that this study investigated two relatively aggressive PEEP strategies. Subsequent studies performed outside the United States also showed similar results. In a study involving 30 ICUs and 983 adult patients with ARDS, there was no difference in hospital mortality despite the reduction in the need of rescue therapies in the ―high‖ PEEP group. A recent systematic review on the effect of PEEP in ARDS showed that the subgroup of ARDS patients who may stand to benefit most from a ―high‖ PEEP strategy are those with the worst degree of hypoxemia. REF: p. 566
18. What level of Pplateau should the therapist target to improve outcomes in patients with ARDS?
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a. 35 cm H2 O b. 32 cm H2 O c. 25 cm H2 O d. 20 cm H2 O
ANS: B The data support the conclusion that for adult patients with ARDS, the P plateau should be limited to < approximately 32 cm H 2 O to improve outcome. The applicability of this conclusion to pediatric ARDS patients requires investigation. It is very possible that the "critical" limit on plateau pressure for infants and children will be < 32 cm H2 O and may vary with patient age and size. REF: p. 567
19. During the implementation of permissive hypercapnia, which of the following concepts is the most critical to prevent complications of this strategy? a. The PaCO2 should never reach 100 mm Hg. b. The pH should never remain below 7.30. c. The rate at which the CO2 rises may be more important than the actual PaCO2. d. The target PaCO2 should be reached in 48 hours.
ANS: B Recent data from a laboratory model of ischemia-reperfusion acute lung injury indicate that hypercapnic acidosis is protective and that buffering of the hypercapnic acidosis attenuates its protective effects. In allowing permissive hypercapnia, the rate at which carbon dioxide rises may be more important than the actual value itself. A rapid regression to normocapnia may be more deleterious to the cardiac system than hypercapnia itself. REF: p. 569
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 30 - Trauma, Burns and Near Drowning Kacmarek et al.: Egan’s Funda menta ls of Respiratory Care,12th Editio n MULTIPLE CHOICE 1.
Which of the following are considered basic respiratory interventions in the bedridden trauma patient? 1. Sedation 2. Incentive spirometry 3. Pain control 4. Humidification a. 1 and 2 only b. 2 and 3 only c. 3 only d. 2, 3, and 4 only ANS: D
See Box 30-1. Basic respiratory interventions in the bedridden trauma patients • Mobilization • Humidification • Pain control • Incentive Spirometry • Non-invasive CPAP or BiPAP DIF:
Recall
R N
REF:
S
I
I M
OBJ:
p. 619
.
N N C
U G O
G K
2
2. Survival in burn patients is associated with which of the following? a. Pharmacological treatment to improve hemodynamic stability b. Conservative surgical treatments c. Development of multidisciplinary teams d. Delayed fluid resuscitation ANS: C
See Box 30-8. Survival in burn patients has been associated with: • Early fluid resuscitation •P
This study resource was
revention of post burn sep-
sis • Aggressive surgical treatment
https://www.coursehero.com/file/69019800/30pdf/
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
shared via Course-
•• IDemprovvelopmed
pe
Hero.com
ent of mulrioperatitivediscipl care inary teams
REF:
p. 627
OBJ:
DIF:
Recall
1
3. Your patient is in the burn unit of the hospital with burns that have destroyed the epidermis
and dermis above the fascia. What degree of burn would this be categorized as? a. First degree b. Second degree c. Third degree d. Fourth degree ANS: C
See Box 30-9. DIF:
Recall
REF:
p. 628
OBJ:
1
4. Which of the following are early clinical features of carbon monoxide poisoning?
1. Anxiety 2. Bradycardia 3. Headache 4. Confusion a. 1 and 3 only b. 2 and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
See Box 30-9 DIF:
Recall
REF:
p. 629
OBJ:
2
5. Which of the following precautions should be immediately taken in a patient with blunt
trauma? a. Securing the airway with an endotracheal tube b. Immobilization of the cervical spine c. IV placement and aggressive fluid replacement therapy d. CT scanning to determine N
N N G
I S
C
K R
U
. M I
G O
occult internal bleeding
ANS: B
If blunt injury is present, cervical spine injury should always be suspected and immobilization of the cervical spine must be instituted immediately.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application REF: p. 616 OBJ: 3 6. Which of the following patients is most likely to require endotracheal intubation? a. COPD patient with acute exacerbation b. An obese asthma patient with wheezing c. A patient with a head injury and a GCS score of 7 d. A patient with suspected carbon monoxide poisoning and an SpO 2 of 100% ANS: C
This study resource was shared via CourseHero.com Trendotraaum a
vicche
atil ims wintubation ath traund gematic brneraain illy hanjury
ave poornd Ger CpostS sc injoreury qs of leuass tlity of lihan 8 rfee aquirend gr
eater
disability. DIF:
Analysis
REF:
p. 616
OBJ:
1
7. Two classifications of chest trauma are: a. blunt or penetrating. b. bronchial or tracheal. c. unifocal or multifocal. d. sharp or dull. ANS: A
Chest trauma is usually classified either as penetrating trauma (i.e., high force applied to a small surface area of the body, such as with a gunshot) or blunt trauma (i.e., high force applied over a larger body surface, such as the case of a head on end motor vehicle accident). DIF: Recall REF: p. 617 OBJ: 1 8. You are taking care of a trauma patient in the ICU. Following placement of a chest tube, there is
a large amount of air that continues to exit the chest tube in a synchronized pattern with positive pressure ventilation. What do you suspect? a. Inappropriate ventilator settings b. Bronchial injury c. Correct placement of the chest tube d. Endotracheal tube cuff leak ANS: B
The presence of bronchial injury should be suspected when, after the placement of a chest tube for pleural drainage, large amounts of air continue to exit the chest tube in a synchronized pattern with positive pressure ventilation. DIF: Analysis REF: p. 617 OBJ: 8 9. Mechanical ventilation of the obese patient often includes which of the following?
1. Pressure or volume ventilation 2. Tidal volume: average 10 ml/kg PBW, range 8 to 12 ml/kg PBW
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
O
3. Position head of the bed gre
C G
. N
G I
M
U
K
N I
N S
R
ater than or equal to 30 degrees elevation 4. NIV for 24- to 48-hr postextubation a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
See Box 30-5.
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10.
aD 2. My1. Dessocia I
F:
cocrRted weecaardiaseal
d pl itl hypeh obereloadrtrsit R opy cEFhy:ould be a p. 624
n ex-
planOBatiJ:on? 8 While discussing the care of a morbidly obese patient with hemodynamic instability, the physician expresses concern regarding aggressive IV fluid therapy. Which patient pathologies
3. Decreased heart-wall compliance 4. Reduces heart chamber volumes a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Myocardial hypertrophy and diastolic dysfunction are the results of these alterations, eventually leading to heart failure, arrhythmias, or sudden cardiac arrest. Myocardial hypertrophy and the consequently reduced heart-wall compliance, as well as reduced heart chamber volumes, are responsible for poor tolerance of IV fluids in these patients. DIF:
Application
REF:
p. 621
OBJ:
3
11. Over two-thirds of obese patients also suffer from what pathology? a. Diabetes b. Sleep apnea c. Myocardial infarction d. Peripheral vascular disease ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Over two-thirds of obese patients have sleep apnea. All obese patients on admission should be evaluated for sleep apnea if not already being treated for their sleep apnea. DIF:
Recall
REF:
p. 622
OBJ:
6
12. Which of the following decreases as body mass index increases?
1. Airway resistance 2. Functional residual capacity 3. Forced vital capacity 4. Forced expiratory volume in 1 second a. 2 only b. 1, 2, and 3 only c. 3 and 4 only
N
d. 2, 3, and 4 only
I
U O
N M
G
R
K
G
.
C
S I N
ANS: D
Lung volumes progressively decrease as BMI increases. Total lung capacity and residual volume decrease linearly as BMI increases, while functional residual capacity is exponentially reduced at higher BMI values, especially in patients with a central fat distribution (high waist circumference). Furthermore, forced vital capacity, forced expiratory volume in 1 second, maximum voluntary ventilation, and forced mid-expiratory flow are significantly reduced in obese subjects, with airway closure occurring during tidal breathing in the extreme range of obesity. DIF:
Recall
REF:
p. 622
OBJ:
3
This study resource was 13.
When assessing an obese patient, an approach to noninvasive ventilation includes: 1. obtain an arterial blood gas analysis to assess baseline gas exchange. 2. monitor vit
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al
signs, gas exchange, respiratory rate, tidal volume, and comfort of the patient. 3. explain the indications of noninvasive ventilation to the patient and the possible outcomes. 4. suggested initial settings are 5 cm H2 O of pressure support and 5 cm H2 O of PEEP. a. 1 and 2 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, and 4 only ANS: B
Approach to noninvasive ventilation: 1. Explain the indications of noninvasive ventilation to the patient and the possible outcomes (requirement of intubation or prolonged use of noninvasive ventilation). Explain to the patient
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
that he or she is not allowed to drink or eat anything by mouth until he or she is able to avoid the risk of aspiration during noninvasive ventilation. 2. Obtain an arterial blood gas analysis to assess baseline gas exchange. 3. Fit the mask appropriately. If more than one model is available, quickly check with the patient which one is most comfortable to him or her. 4. Suggested initial settings are 10 cm H2 O of pressure support and 10 cm H2 O of PEEP. 5. Monitor vital signs, gas exchange, respiratory rate, tidal volume, and comfort of the patient. 6. Gradually increase PEEP in 2 cm H 2 O increments to improve airway patency and oxygenation (SpO 2 > 90%). Check hemodynamics carefully. 7. Gradually increase pressure support in 2 cm H 2 O increments to improve tidal volume (until 6 to 8 ml/kg of ideal body weight), reduce the respiratory rate (below 25), reduce ventilatory distress, and improve CO2 clearance. 8. Check gas exchange at 60 min. If noticeable improvement has been observed and there is no clinical deterioration, noninvasive ventilation can be continued. If noninvasive ventilation did not improve oxygenation or hypercapnia, the patient should be intubated and mechanically ventilated. DIF: Recall REF: p. 623 OBJ: 7
14. How should tidal volume be determined for an obese patient? a. Based on actual body weight b. Based on predicted body weight c. Based on chest rise d. Based on arterial blood ga R G
S N
N G
N
I
. C
O
U I M
K
s results ANS: B
Tidal volume in obese patients should always be determined based on predicted, NOT actual, body weight since lung size is not based on weight, it is based on height and gender. DIF: Application REF: p. 623 OBJ: 6 15. Which of the following is a true statement? a. It has not been demonstrated that recruitment maneuvers in obese, mechanically
ventilated patients are effective at improving respiratory system compliance and oxygenation without affecting hemodynamics. b.
This study resource was
It is not advisable to per-
form a recruitment maneuver whenever PEEP is increased
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or after temporary PEEP discontinuation.
Hero.co
c. reand respiraductory syisntg PEEP reem complquireiancments fore, oxyge optina-
timal veon, redunticlation iing expirn obeatory fse palow litients.mitation, It has been shown that the elevation of the head of bed is effective at improving
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. PEEP should be weaned before FiO 2 and pressure support level is decreased. ANS: C
It has been demonstrated in intraoperative settings that recruitment maneuvers in obese, mechanically ventilated patients are effective at improving respiratory system compliance and oxygenation without affecting hemodynamics. This effect is due to the reversal of atelectasis which forms during induction and which persists without adequate levels of PEEP during mechanical ventilation. It is advisable to perform a recruitment maneuver whenever PEEP is increased or after temporary PEEP discontinuation. It has been shown that the elevation of the head of bed is effective at improving respiratory system compliance, oxygenation, reducing expiratory flow limitation, and reducing PEEP requirements for optimal ventilation in obese patients. FiO 2 and pressure support level should always be weaned before PEEP level is decreased. DIF:
Application
REF:
p. 624
OBJ:
7
16. From 2005 to 2009 in the United States, approximately how many deaths were due to
drowning? a. 4000 b. 6000 c. 8000 d. 10000 ANS: A
From 2005 to 2009 in the United States, there were approximately 4000 deaths due to drowning. DIF:
Recall
REF:
p. 625
OBJ:
17. inhalaWhich oftion of the f frolleshwowing aater? re re
1
N
C
. G N I K I G R M U O spiratory and blood chemistry dysfunctions associated with the
S
1. Rapid depletion of alveolar surfactant 2. Direct damage to the alveolar-capillary membrane 3. Acute neurogenic pulmonary edema 4. Rapid loss of circulating volume into the alveolar space across the injured alveolar capillary membrane may cause hemoconcentration, hypernatremia, and hypoalbuminemia a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
aA 1. I. N
tion of f
This study resource was
InhalatiS:nh aA la-
on of frereshwashwatteerr and i
ts effects on the respiratory system. Inhala-
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N
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
tion of freshwater rapidly depletes alveolar surfactant, leading to ventilation/perfusion mis-
match. Inhaled water
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is quickly absor
bed
into the vascular system from the alveolar space by osmosis, causing alveolar collapse and worsening shunt and hypoxia. Additionally, in the setting of inhaled freshwater, acute neurogenic pulmonary edema due to cerebral hypoxia has been shown to worsen alveolar flooding. However, if hypoxia is reversed, normal pulmonary function can be quickly restored. b. The effects of inhalation of freshwater on other organs. If a large volume of freshwater is inhaled, it is rapidly absorbed into the circulation, leading to electrolyte imbalance. Hyponatrem ia can lead to seizures, especially in pediatric patients. Additionally, diluted plasma causes water to rapidly enter into erythrocytes by osmosis, causing hemolysis. The resulting hyperkalemia and hyponatremia can cause ventricular fibrillation, and the liberation of hemoglobin into the plasma can precipitate acute renal failure. DIF: 18.
Analysis
REF:
p. 626
OBJ:
5
Which of the following are mechanical ventilation strategies for the trauma patient? 1. Pressure or volume ventilation 2. Tidal volume: 6 to 8 ml/kg PBW 3. Plateau pressure: less than 28 cm H 2 O 4. Minute volume to maintain PaCO 2 between 25 and35 mm Hg a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
See Box 30-2. DIF:
Recall
REF:
p. 620
OBJ:
6
19. The most common aspirated material in near-drowning events is: a. sand or mud/dirt. b. emesis.
N
c. blood.
I N M
U O
G
K .
R G C
S I N
d. leaves. ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
The aspiration of foreign matter occurs relatively common in drowning or near-drowning events, particularly those events involving drowning in shallow water. The most common aspirated material is sand or mud/dirt. DIF:
Recall
REF:
20. adiffaYour.sks for
p. 626
OBJ: 5
This study resource was
iculty bre
pa atie trnt ieaas brought in by EMStmthieng, hant sugs gburnt naestion resaga al hairrding hefter bes, sooting pulr re in tspiled fheratory ne orarom al phare houseds.ynx, Wha firand stt
woule. Srihedor. Td you sugge is complhe physiainist?ng ofc ian
b.c.
HypeRNon-
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racemierbabr
ceric
eapinephthi oxygeng mask arinen therat 15 L/mpy d.
in
Intubations and mechanical ventilation
ANS: D
Inhalation injury can complicate 20% of burn patients; these patients often present with facial burns. Patient presenting with facial burns, burnt nasal hairs, soot in the oral and nasal pharynx, and any signs of upper airway burns should be immediately intubated since the probability of serious airway obstruction developing over time is nearly 100%.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF:
Analysis
REF:
p. 629
OBJ:
6
21. Respiratory assessment of the burn patient should focus on which of the following?
1. Predicted body weight for tidal volume setting during mechanical ventilation 2. Extension and depth of external burns 3. Degree of involvement of lung tissue 4. Inhalation of toxic cases a. 2, 3, and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: A
Respiratory assessment of burn patients should focus on: 1. Extension (total-body surface area, TBSA) and depth of external burns. 2. Degree of involvement of lung tissue. 3. Inhalation of toxic gases (carbon monoxide and cyanide). DIF:
Recall
REF:
p. 628
OBJ:
1
N I I C
U N N O
R G G M
S K .
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
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TCPDF (www.tcpdf.org)
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 31 - Lung Cancer Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE
1. What is the number one cause of cancer-related death in the United States? a. Leukemia b. Lung cancer c. Breast cancer d. Brain cancer
ANS: B Lung cancer is the number one cause of cancer-related death in men and women; it surpassed colon cancer in the early 1950s in men and breast cancer in the late 1980s in women. There are more deaths from lung cancer than breast, colon, and prostate cancer combined. DIF: Recall
REF: p. 635
OBJ: 1
2. Which of the following comments regarding lung cancer is true? a. The incidence has risen over the past few decades. b. It is the third leading cause of cancer deaths in the United States. c. The peak incidence occurred in the mid-1970s. d. Incidence has increased in women 40 to 58 years of age.
ANS: A The frequency of lung cancer deaths peaked in 1984 and declined until the end of the 1990s and has leveled off since. In 2010, there were 187,000 cancer deaths. DIF: Recall
REF: p. 635
OBJ: 1
3. Approximately what percentage of all lung cancer is linked to smoking?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. 50% to 55% b. 70% to 75% c. 85% to 90% d. 100%
ANS: C Direct exposure to tobacco has occurred in 85% to 90% of individuals with lung cancer. DIF: Recall
REF: p. 635
OBJ: 2
4. In what age group has smoking increased recently? a. 18 to 24 years b. 25 to 40 years c. 45 to 60 years d. Older than 70 years
ANS: A A decrease in smoking has not been observed among adults 18 to 24 years of age. DIF: Recall
REF: p. 635
OBJ: 2
5. Which of the following are being targeted as a primary source of new customers by tobacco companies? a. Young people and developing countries b. Women aged 21 to 35 years c. Men aged 21 to 35 years d. Men and women over 50 years of age
ANS: A In the context that a person who has not started smoking as a teenager is unlikely to ever become a smoker, the tobacco industry has focused on young people and developing countries as the primary sources of new customers.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 635 OBJ: 2
6. Other causes of lung cancer include: 1. asbestos. 2. arsenic. 3. chromium. 4. microwave radiation. a. 2, 3, and 4 only b. 2 and 3 only c. 1 and 4 only d. 1, 2, and 3 only
ANS: D Arsenic, asbestos, and chromium confer the highest risks. DIF: Recall
REF: p. 636
OBJ: 2
7. Which of the following are major histopathologic types of lung cancer? 1. Adenocarcinoma 2. Squamous cell carcinoma 3. Small-cell carcinoma 4. Ciliated cell carcinoma a. 2, 3, and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1 and 2 only
ANS: B The non–small-cell cancer category consists of adenocarcinoma (including bronchoalveolar cell carcinoma), squamous cell carcinoma, large-cell carcinoma, and variants (Figure 31-4). DIF: Recall
REF: p. 636
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 8. What composition of adenocarcinoma best describes its histopathology? a. Stratified epithelial cells b. Pleomorphic cells c. Polygonal cells d. Glandular structures
ANS: D See Table 31-1. DIF: Recall
REF: p. 637
OBJ: 3
9. Squamous cell carcinoma is composed of which of the following? a. Glandular structures from lung scars b. Common pulmonary stem cells c. Flattened stratified epithelial cells d. Multicentric stratified cells
ANS: C See Table 31-1. DIF: Recall
REF: p. 637
OBJ: 4
10. Which of the following best describes the cell characteristics in small-cell carcinoma? a. Larger than lymphocyte nucleus b. Enlarged nuclei-differentiated cells c. Keratin structures throughout lung tissue d. Develops from a common pulmonary stem cell
ANS: D See Table 31-1.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application REF: p. 637 OBJ: 4
11. What type of histopathologic cells is associated with large-cell carcinoma? a. Pleomorphic cells b. Glandular structures c. Stratified epithelial cells d. Pulmonary stem cells
ANS: A See Table 31-1. DIF: Recall
REF: p. 637
OBJ: 4
12. Which of the following is the most common type of lung cancer? a. Large cell b. Adenocarcinoma c. Squamous cell d. Small cell
ANS: B See Table 31-1. DIF: Recall
REF: p. 637
OBJ: 5
13. Which of the following is not associated with the clinical features of lung cancer? a. Local growth of tumor b. Metastasis extrathoracic or intrathoracic c. Associated pain or discomfort d. Paraneoplastic syndrome
ANS: C
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK The clinical features of lung cancer result from the effects of local growth of the tumor, regional growth or spread through the lymphatic system, hematogenous (blood-borne) distant metastatic spread, and remote paraneoplastic effects from tumor products or immune cross-reaction with tumor antigens. DIF: Recall
REF: p. 638
OBJ: 5
14. Which of the following is typically not associated with local tumor growth in the central airways? a. Large airway obstruction b. Cough c. Hemoptysis d. Fine crackles
ANS: D Local growth in a central location (e.g., in a main stem bronchus) can cause cough, hemoptysis, or features of large-airway obstruction. DIF: Recall
REF: p. 638
OBJ: 5
15. What type of lung cancer usually is seen as a central lesion that may obstruct airways and lead to atelectasis? a. Adenocarcinoma b. Squamous cell c. Large cell d. Bronchogenic carcinoma
ANS: B Squamous cell carcinoma and small-cell carcinoma are more likely to grow in a central location than other cell types. DIF: Recall
REF: p. 636
OBJ: 5
16. On a chest radiograph, large-cell carcinoma is commonly seen as what type of lesion? a. Central lesion
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK b. Well-defined mass c. Bilateral nodules d. Unilateral nodules
ANS: D These will show a small spot (<3 cm in diameter) termed a nodule. DIF: Recall
REF: p. 636
OBJ: 5
17. Apical growth may be associated with which of the following syndromes? a. Good pasture b. Pancoast c. Miller d. Granulomatosis
ANS: B Apical growth may lead to Pancoast syndrome. DIF: Recall
REF: p. 637
OBJ: 5
18. Which of the following organs is not commonly compromised in metastatic lung cancer? a. Brain b. Liver c. Bone d. Stomach
ANS: D The brain, bones, liver, and adrenal glands are most commonly involved. DIF: Recall
REF: p. 638
OBJ: 5
19. What is the most effective way to prevent lung cancer?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. Vitamin E b. Beta-carotene c. Smoking prevention d. Avoidance of atmospheric pollution
ANS: C The most effective way to prevent lung cancer is to prevent smoking. DIF: Recall
REF: p. 648
OBJ: 8
20. What minimum size does a lesion in the lung need to be in order to be called a nodule? a. 1 cm b. 2 cm c. 3 cm d. 4 cm
ANS: C These will show a small spot (<3 cm in diameter) termed a nodule. DIF: Recall
REF: p. 639
OBJ: 5
21. What is the most commonly used additional imaging technique to confirm lung cancer? a. Gammagraphy b. Videoscintigraphy c. Positron emission tomography d. Enhanced computed tomography
ANS: C The most commonly used additional imaging technique is positron emission tomography (PET) utilizing [18 F]fluorodeoxyglucose.
DIF: Recall
REF: p. 640
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 22. Which of the following are common purposes for staging a case of lung cancer? 1. Selection of therapy 2. Assessment of extent of the disease 3. Prognosis 4. Etiology a. 2, 3, and 4 only b. 1, 2, and 4 only c. 3 and 4 only d. 1 and 2 only
ANS: B One of the major factors that determines the prognosis of lung cancer and guides the proper selection of treatment is the extent to which the cancer has spread in the lungs and throughout the body. DIF: Recall
REF: p. 640
OBJ: 7
23. What does the acronym TNM mean? a. Tumor, number, mass b. Tumor, non-small, metastases c. Tracheal, number, metastases d. Tumor, lymph node, metastases
ANS: D Non–small-cell lung cancer is staged using the TNM system (―T‖ for extent of primary tumor, ―N‖ for regional lymph node involvement, and ―M‖ for metastases). DIF: Recall
REF: p. 640
OBJ: 7
24. Which of the following pulmonary function tests are frequently used to determine tolerance to resectional surgery? 1. FEV1 2. FEF25% to 75%
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 3. FVC 4. DLCO a. 1 only b. 1 and 4 only c. 2 and 4 only d. 2, 3, and 4 only
ANS: B To determine if an individual will tolerate lung resection surgery, reports of activity tolerance and pulmonary function testing are used. Although no one pulmonary function study or absolute cutoff has proven ideal, the FEV 1 and diffusing capacity for carbon monoxide (DLCO) are the most frequently used measures. DIF: Recall
REF: p. 643
OBJ: 7
25. Which of the following PFT values are indications a patient can safely undergo surgical resection for lung cancer? a. An FEV1 greater than 80% predicted value or 2 L b. An FEV1 between 30% and 60% predicted value or 1.75 L c. An FEV1 greater than 70% predicted value or 1.75 L d. An FEV1 between 30% and 60% predicted value or 2 L ANS: A Patients with an FEV 1 greater than 80% predicted value or 2 L can safely undergo surgical resection for lung cancer, even if pneumonectomy is needed. DIF: Recall
REF: p. 643
OBJ: 8
26. Which of the following is not a therapeutic option for patients with lung cancer? a. Surgical resection b. Radiotherapy c. Laser d. Chemotherapy
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: C Three classes of treatment are used to treat non–small-cell lung cancer—surgical resection, radiotherapy, and chemotherapy. DIF: Recall
REF: p. 644
OBJ: 8
27. What treatment is the best initial modality for patients with non–small-cell lung cancer because it offers the best prospect of long-term survival? a. Chemotherapy b. Surgical resection c. Radiation therapy d. Endobronchial laser therapy
ANS: B Surgical resection offers the best chance of cure for early-stage non–small-cell lung cancer (stages I and II). DIF: Application
REF: p. 645
OBJ: 8
28. What is the treatment of choice for limited-stage small-cell lung cancer? a. Surgical resection b. Chemoradiotherapy c. Radiation therapy only d. Chemotherapy only
ANS: B In limited-stage disease, combination chemotherapy with concurrent hyperfractionated radiotherapy is recommended. DIF: Recall
REF: p. 645
OBJ: 8
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 32 - Neuromuscular and Other Diseases of the Chest Wall Kacmarek et al.: Egan’s Funda menta ls of Respira tory Care, 12th Editio n
MULTIPLE CHOICE
1. Which of the following would not be considered a common pulmonary consequence of neuromuscular disease? a. Sleep apnea b. Aspiration c. Cor pulmonale d. Pneumothorax
ANS: D The pulmonary consequences of neuromuscular disease can include the following: hyperventilation or hypoventilation, sleep apnea, aspiration, atelectasis with resulting hypoxemia, pulmonary hypertension, and cor pulmonale. DIF: Recall
REF: p. 651
OBJ: 2
2. To effectively document and assess the need for endotracheal intubation in a patient with neuromuscular disease, which of the following would be most appropriate? a. Spirometry every 4 to 6 hr b. Chest x-ray every shift c. Polysomnograpy testing d. Monitoring SpO2 with pulse oximeter ANS: A Patients with dyspnea, orthopnea, or impaired ability to maintain a patent airway should receive spirometry every 4 to 6 hr for documentation of function and assessment of the need for endotracheal intubation.
DIF: Analysis
REF: p. 660
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 3. Respiratory muscle weakness is associated with which of the following abnormalities? 1. Pulmonary embolism 2. Ventilatory insufficiency 3. Hypoxemia 4. Atelectasis a. 4 only b. 2, 3, and 4 only c. 1 and 3 only d. 1, 3, and 4 only
ANS: B Of the many neuromuscular problems causing pulmonary dysfunction, respiratory muscle weakness that leads to atelectasis, hypoxemia, and ventilatory insufficiency is among the best recognized. DIF: Recall
REF: p. 651
OBJ: 1
4. Patients with respiratory muscle weakness due to neuromuscular disease may initially report with which of the following symptoms? 1. Exertional dyspnea 2. Fatigue 3. Oliguria 4. Orthopnea a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2 and 4 only
ANS: B Patients with respiratory muscle weakness due to neuromuscular disease may initially report exertional dyspnea, fatigue, orthopnea, or symptoms of cor pulmonale.
DIF: Recall
REF: p. 653
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 5. Which of the following is a clinical condition that typically does not precipitate rapid respiratory failure in patients with significant neuromuscular weakness? a. Pulmonary edema b. Pneumonia c. Mucous plugging d. Lung cancer
ANS: D Pulmonary edema, pneumonia, and mucous plugging are examples of clinical conditions that can precipitate respiratory failure rapidly in patients with significant neuromuscular weakness. Such patients may need observation of their respiratory status when they are in the hospital with these conditions. DIF: Recall
REF: p. 654
OBJ: 3
6. Cobb angles are used to measure the severity in which disorder of the thoracic cage? a. Ankylosing spondylitis b. Flail chest c. Scoliosis d. Pectus excavatum
ANS: C The degree of scoliosis is measured by the Cobb angle. DIF: Recall
REF: p. 665
OBJ: 3
7. Which of the following is not a pulmonary complication frequently associated with flail chest? a. Pneumothorax b. Hemothorax c. Pulmonary contusion d. Aspiration pneumonia
ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK Pulmonary contusion, hemothorax, and pneumothorax are frequently associated with flail chest and often necessitate urgent or emergency treatment of the trauma patient. DIF: Recall
REF: p. 666
OBJ: 6
8. Pulmonary function testing in patients with neuromuscular weakness would show normal values for which of the following? a. Diffusing capacity of the lungs (DLCO) b. Vital capacity c. Forced expiratory volume in 1 second d. Total lung capacity
ANS: A Residual volume is normal or increased, and diffusing capacity corrected for alveolar volume is normal or near normal but has been reported to be decreased. DIF: Application
REF: p. 652
OBJ: 1
9. A decrease in forced expiratory volume in 1 second (FEV1 ) and vital capacity (VC) of greater than 20% when a patient moves from the seated to the supine position is suggestive of which of the following? a. Diaphragmatic muscle weakness b. Scalene muscle weakness c. Brainstem injury d. Internal intercostal weakness
ANS: A A decrease in FEV 1 and VC of greater than 20% when a patient moves from the seated to the supine position suggests diaphragmatic muscle weakness. DIF: Recall
REF: p. 652
OBJ: 1
10. Which of the following is not a clinical condition that precipitates respiratory failure rapidly in patients with significant neuromuscular weakness?
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. Pulmonary edema b. Pneumonia c. Mucus plugging d. Pulmonary fibrosis
ANS: D Pulmonary edema, pneumonia, and mucus plugging are examples of clinical conditions that can precipitate respiratory failure rapidly in patients with significant neuromuscular weakness. DIF: Recall
REF: p. 654
OBJ: 2
11. What finding is associated with Duchenne muscular dystrophy? a. Lordosis b. Drooping eyelids c. Pedal edema d. Hepatomegaly
ANS: A Duchenne muscular dystrophy manifests early in life with proximal muscle weakness that leads to a waddling gait, exaggerated lumbar curvature (lordosis), and frequent falls. DIF: Recall
REF: p. 656
OBJ: 6
12. By what age do most patients with Duchenne muscular dystrophy die? a. 10 years b. 20 years c. 35 years d. 50 years
ANS: B Death generally occurs by 20 years of age, as a result of complications of declining respiratory muscle strength and subsequent infection.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 656 OBJ: 6
13. What respiratory dysfunction is commonly seen in myotonic dystrophy? a. Sleep-related disorders b. Pulmonary fibrosis c. Obstructive pulmonary disease d. Pulmonary edema
ANS: A Sleep-related disorders are particularly common, even at an early age. DIF: Recall
REF: p. 656
OBJ: 6
14. Disorders of the neuromuscular junction include which of the following? 1. Lambert-Eaton syndrome 2. Myasthenia gravis 3. Dermatomyositis 4. Tetanus, botulism a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: B Disorders of the neuromuscular junction include myasthenia gravis, Lambert-Eaton syndrome, and poisoning (organophosphate, tetanus, and botulism). DIF: Recall
REF: p. 658
OBJ: 6
15. In what group of patients is myasthenia gravis most common? a. Older males
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK b. Younger males c. Younger females d. Older females
ANS: C Myasthenia gravis typically occurs in younger patients, with a female predominance (female-to-male ratios typically are 3:1 to 4.5:1). DIF: Recall
REF: p. 658
OBJ: 6
16. In myasthenia gravis, which two pulmonary function values are the most sensitive in detecting respiratory muscle weakness? 1. TLC and VC 2. PImax and PEmax 3. VC and expired volume per unit time (VE ) 4. VC and tidal volume (VT) a. 1 and 4 only b. 1 and 2 only c. 3 and 4 only d. 2 and 3 only
ANS: B PImax and PEmax are more sensitive markers of early respiratory muscle weakness. DIF: Recall
REF: p. 658
OBJ: 1
17. Lambert-Eaton syndrome is characterized by which of the following? a. It affects mainly the limbs and eyes. b. Patients have a mean age of 40 years. c. Large-cell carcinoma is most common. d. It is commonly associated with small-cell lung cancer.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D More than 66% of cases of Lambert-Eaton syndrome are associated with cancer. Of these cancer-related cases, 50% are associated with small-cell carcinoma of the lung. DIF: Application
REF: p. 660
OBJ: 6
18. Nerve conduction studies are most helpful in the clinical diagnosis of which of the following? a. Myasthenia gravis b. Lambert-Eaton syndrome c. Myotonic dystrophy d. Amyotrophic lateral sclerosis
ANS: B The clinical diagnosis of Lambert-Eaton syndrome is supported by the results of nerve conduction studies. DIF: Recall
REF: p. 660
OBJ: 6
19. Which of the following peripheral nerve disorders can cause respiratory muscle dysfunction? a. Inflammatory processes b. Vascular disorders c. Metabolic imbalances d. Fluid imbalances a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: B The peripheral nerves may be affected by toxic agents, inflammatory processes, vascular disorders, malignant diseases, and metabolic or nutritional imbalances. DIF: Recall
REF: p. 660
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 20. What is the most common peripheral neuropathy causing respiratory insufficiency? a. Lambert-Eaton syndrome b. Amyotrophic lateral sclerosis c. Guillain-Barré syndrome d. Myasthenia gravis
ANS: C Guillain-Barré syndrome is the most common peripheral neuropathy causing respiratory insufficiency. DIF: Recall
REF: p. 660
OBJ: 6
21. What is the mortality rate for Guillain-Barré syndrome? a. 0% b. Low, less than 10% c. Moderate, 40% to 60 % d. High, greater than 80%
ANS: B Guillain-Barré syndrome is typically a self-limited disease, but overall mortality ranges from 3% to 6%. DIF: Recall
REF: p. 660
OBJ: 6
22. Which of the following is often preceded by a history of upper respiratory or flulike symptoms? a. Myotonic dystrophy b. Polymyositis c. Guillain-Barré syndrome d. Amyotrophic lateral sclerosis
ANS: C
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK Patients with Guillain-Barré syndrome often have a history of upper respiratory infections or a flulike illness that precedes the onset of symptoms and is thought to be related. DIF: Recall
REF: p. 660
OBJ: 6
23. What treatment strategies have improved the outcome in Guillain-Barré syndrome? a. Plasmapheresis b. Corticosteroids c. Radiation therapy d. Antibiotics
ANS: A Treatment strategies that have improved outcome in Guillain-Barré syndrome include intravenous immunoglobulin infusions and plasmapheresis. DIF: Recall
REF: p. 660
OBJ: 7
24. What percentage of patients with Guillain-Barré syndrome has respiratory muscle compromise? a. 10% b. 33% c. 60% d. 100%
ANS: B Approximately one-third of all patients with Guillain-Barré syndrome have respiratory muscle compromise. DIF: Recall
REF: p. 660
OBJ: 6
25. Which of the following criteria for weaning a patient with Guillain-Barré syndrome from mechanical ventilation have shown to be predictive of weaning success? 1. VC greater than 18 ml/kg 2. Transdiaphragmatic pressures greater than 31 cm H2 O
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 3. PImax greater than 30 cm H2 O 4. Cardiac output above 2.0 L/min a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4
ANS: B Weaning of patients with Guillain-Barré syndrome from mechanical ventilation is predicted by VC greater than 18 ml/kg, transdiaphragmatic pressure greater than 31 cm H2 O, or a PImax greater than 30 cm H2 O. DIF: Application
REF: p. 661
OBJ: 1
26. How is diaphragmatic paralysis most often diagnosed? a. Chest radiography b. Pulmonary function testing c. Arterial blood gases d. Physical examination
ANS: A Patients with unilateral diaphragmatic paralysis may have a 15% to 20% reduction in vital capacity and total lung capacity in the upright position and a further reduction while supine. DIF: Recall
REF: p. 661
OBJ: 1
27. What percentage of amyotrophic lateral sclerosis patients die within 5 years of diagnosis? a. 10% b. 25% c. 50% d. 80%
ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK The prognosis of amyotrophic lateral sclerosis is poor, with 80% of patients dying within 5 years of the onset of the disease. DIF: Recall
REF: p. 662
OBJ: 6
28. At what level do the nerves that innervate the diaphragm exit the spine? a. C1-3 b. C3-5 c. C6-7 d. T1-3
ANS: B The diaphragm receives its innervation from nerve roots exiting the spinal cord at levels C3-5. DIF: Recall
REF: p. 663
OBJ: 2
29. What is the hallmark finding of diaphragm paralysis? a. Rapid and shallow breathing b. Weak cough c. Abdominal paradox d. Retractions
ANS: C Abdominal paradox (inward movement of the abdomen while the thorax expands) is the hallmark of significant bilateral diaphragmatic weakness. DIF: Recall
REF: p. 663
OBJ: 3
30. What alteration in respiration is typically associated with stroke involving the cerebral cortex? a. Severe hypoxemia b. Respiratory acidosis c. Mild hyperventilation
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Sleep apnea ANS: D Stroke in these regions of the motor cortex can lead to obstructive sleep apnea or aspiration pneumonia as a result of the loss of bulbar muscle function. DIF: Recall
REF: p. 664
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 33 - Disorders of Sleep Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE
1. What percent of the adult population is believed to have obstructive sleep apnea? a. Less than 1% b. 2% to 4% c. 5% to 10% d. Unknown
ANS: B It is estimated that approximately 2% to 4% of the adult population has OSA. DIF: Recall
REF: p. 670
OBJ: 1
2. The definition of sleep apnea uses what criteria for defining an episode of apnea? a. 5 sec b. 10 sec c. 15 sec d. 20 sec
ANS: B Sleep apnea can be defined as repeated episodes of complete cessation of airflow for 10 sec or longer. DIF: Recall
REF: p. 670
OBJ: 2
3. Which of the following conditions are associated with central apnea? 1. Congestive heart failure 2. Primary central nervous system lesions 3. High-altitude hypoxemia
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 4.
Obesity a. 1 and 4 only b. 2 and 3 only c. 1, 2, and 3 only d. 1, 2, 3, and 4
ANS: C Primary central nervous system lesions, stroke, congestive heart failure, and high-altitude hypoxemia can diminish respiratory control and cause central apnea events. DIF: Recall
REF: pp. 670-671 OBJ: 2
4. What term is used to describe a significant decrease in airflow during sleep but not a complete cessation of breathing? a. Apnea b. Minor apnea c. Hypopnea d. Dyspnea
ANS: C Hypopnea is a significant decrease in airflow without complete cessation of airflow. DIF: Recall
REF: p. 671
OBJ: 2
5. What are the criteria to define hypopnea? a. 20% decrease in airflow and 4% oxygen desaturation b. 20% decrease in airflow and 2% oxygen desaturation c. 30% decrease in airflow and 4% oxygen desaturation d. 30% decrease in airflow and 2% oxygen desaturation
ANS: C Hypopnea is defined as a 30% decrease in airflow in conjunction with 4% oxygen desaturation.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 671
OBJ: 2
6. What is the primary cause of obstructive sleep apnea? a. Small or unstable pharyngeal airway b. Deviated septum c. Unstable larynx d. Large tongue
ANS: A The primary cause of obstructive sleep apnea is a small or unstable pharyngeal airway. DIF: Recall
REF: p. 672
OBJ: 3
7. Which of the following conditions are associated with untreated obstructive sleep apnea? 1. Systemic hypotension 2. Pulmonary hypertension 3. Heart failure 4. Myocardial infarction a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: D Patients with untreated obstructive sleep apnea, compared with the general population, have an increased risk of systemic and pulmonary hypertension, stroke, nocturnal arrhythmia, heart failure, and myocardial infarction. DIF: Application
REF: p. 672
OBJ: 3
8. What is believed to be the cause of systemic hypertension in patients with sleep apnea?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. Hypervolemia b. Increased sympathetic tone c. Elevated CO2 d. Tachycardia
ANS: B Over time, increased sympathetic tone may result in systemic and modest pulmonary hypertension. DIF: Recall
REF: p. 672
OBJ: 3
9. Which of the following factors has been shown to positively correlate with obstructive sleep apnea? a. Age b. Height c. Obesity of the upper body d. Blood pressure at rest
ANS: C Obesity, especially of the upper body, has been found to correlate positively with the presence of obstructive sleep apnea. DIF: Recall
REF: p. 673
OBJ: 3
10. What is the name of the respiratory pattern where a crescendo-decrescendo pattern of hyperpnea alternates with periods of apnea? a. Cheyne-Stokes b. Kussmaul c. Agonal d. Biot’s
ANS: A Cheyne-Stokes respiration, which often occurs in patients with congestive heart failure or stroke, is a severe type of periodic breathing characterized by a crescendo-decrescendo pattern of hyperpnea alternating with apnea.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 673
OBJ: 3
11. Which of the following characteristics are typically associated with sleep apnea? 1. Male patient 2. Over the age of 40 years 3. Hypotensive 4. Loud snoring during sleep a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: B Patients with sleep apnea more commonly are men (three times greater frequency than among women), are older than 40 years, and have hypertension (Box 33-2). DIF: Application
REF: p. 673
OBJ: 3
12. Which of the following complaints is frequently seen in a patient with obstructive sleep apnea? a. Dizziness b. Chest pain c. Shortness of breath with exertion d. Excessive daytime sleepiness
ANS: D Patients who have an increased frequency of awakenings and microarousals have more daytime sleepiness and greater difficulty with daytime functioning than does the general population. DIF: Recall
REF: p. 673
OBJ: 3
13. Which of the following physical exam findings are associated with obstructive sleep apnea? 1. Large tonsils
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 2. Microcephaly 3. Macroglossia 4. Deviated nasal septum a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: D Although tonsillar hypertrophy is common in children with sleep apnea, it is seldom found in adults. Large palatine tonsils may increase the risk of airway closure during sleep. DIF: Recall
REF: p. 674
OBJ: 3
14. Which of the following are parameters used to confirm the metabolic syndrome associated with obstructive sleep apnea? 1. Low triglycerides 2. Insulin resistance 3. Hypertension 4. Impaired glucose intolerance a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: D The metabolic syndrome includes three of the following: waist circumference greater than 102 cm, hypertension, impaired glucose tolerance, insulin resistance, and elevated triglyceride levels. DIF: Application
REF: p. 674
OBJ: 3
15. Which of the following parameters is not typically monitored with a polysomnogram?
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a. SaO2
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
b. Electroencephalogram (EEG) c. Breathing effort d. Exhaled PCO2 ANS: D In a laboratory sleep study, several physiologic signals are recorded to determine whether airway closure occurs during sleep and to what extent the closure disturbs sleep continuity and cardiopulmonary function. An electroencephalogram (EEG), electrooculogram (EOG), and chin electromyogram (EMG) are obtained for assessment of sleep stage and documentation of sleep disruption due to sleep-related breathing disturbance. Airflow (measured at nose and mouth), ventilatory effort (using inductive plethysmography or piezo belts), cardiac rhythm (with a modified lead II electrocardiogram), and oxygen saturation (measured with pulse oximetry) are included in the standard testing montage. DIF: Application
REF: p. 674
OBJ: 4
16. What value for the apnea-hypopnea index (AHI) is consistent with moderate obstructive sleep apnea? a. 5 to 15 b. 15 to 30 c. Above 30 d. Below 5
ANS: B The AASM has operationally defined the severity of obstructive sleep apnea as follows: mild, AHI 5 to 15; moderate, AHI 15 to 30; and severe, AHI greater than 30. DIF: Recall
REF: p. 675
OBJ: 4
17. Which of the following behavioral interventions is least useful for the treatment of sleep apnea? a. Weight loss b. Avoidance of alcohol c. Avoidance of sedatives d. Avoidance of daytime naps
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D Several behavioral interventions can be beneficial, including weight loss in obese patients; avoidance of alcohol, sedatives, and hypnotics; and avoidance of sleep deprivation. DIF: Recall
REF: p. 675
OBJ: 5
18. Why should the patient with obstructive sleep apnea not use alcohol? a. Alcohol decreases the arousal threshold. b. Alcohol increases upper airway muscle tone. c. Alcohol increases the arousal threshold. d. Alcohol reduces the cardiovascular compensatory mechanisms.
ANS: A Alcohol decreases the arousal threshold and as a result can increase the duration of apnea. Alcohol also reduces upper airway muscle tone, causing the airway to be more compliant and thus more prone to complete or partial closure. DIF: Recall
REF: p. 677
OBJ: 5
19. Which of the following medical therapies is considered first-line treatment for obstructive sleep apnea (OSA)? a. Continuous positive airway pressure (CPAP) b. Surgery c. Oxygen therapy d. Antibiotics
ANS: A CPAP therapy was introduced for management of OSA in 1981. It has become the first-line medical therapy for OSA. DIF: Recall
REF: p. 677
OBJ: 6
20. What is the amount of CPAP that is typically required to abolish upper airway obstruction in patients with OSA?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. 3 to 5 cm H2 O b. 10 to 20 cm H2 O c. 2.5 to 7.5 cm H2 O d. 7.5 to 12.5 cm H2 O ANS: D For most patients, obstruction of the upper airway is abolished by CPAP between 7.5 and 12.5 cm H2 O. DIF: Recall
REF: p. 677
OBJ: 6
21. How does CPAP improve breathing in the patient with OSA? a. Stimulation of the phrenic nerve b. Pneumatic splinting of the upper airway c. Stimulation of upper airway muscles d. Repositioning of the epiglottis
ANS: B CPAP therapy is believed to work by splinting the upper airway open, thus raising the intraluminal pressure of the upper airway above a critical transmural pressure of the pharynx and hypopharynx that is associated with airway closure. DIF: Recall
REF: pp. 677-678 OBJ: 7
22. When differentiating between central and obstructive sleep apnea, which of the following ―channels‖ or parameters would reflect vastly different results during an apneic episode or event? a. SpO2 b. Heart rate c. Chest wall and abdominal effort d. Nasal airflow
ANS: C
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK In central sleep apnea, there is essentially no chest wall or abdominal effort detected during episodes/events due to a problem with the signal from the brain, while such effort is present and may increase in obstructive sleep apnea. DIF: Analysis
REF: p. 675
OBJ: 10
23. What is considered to be the major problem with the use of CPAP in patients with obstructive sleep apnea? a. Patient compliance b. Frequent pneumothorax c. Cardiovascular complications d. Expense
ANS: A Approximately 80% of patients accept CPAP, although long-term objective compliance is frequently less than optimal. DIF: Recall
REF: p. 678
OBJ: 8
24. In what way do BiPAP units differ from CPAP units? a. BiPAP applies different pressure levels on inspiration and exhalation. b. BiPAP units cost significantly more that CPAP units. c. BiPAP operates on electricity. d. BiPAP simulates spontaneous breathing.
ANS: A Unlike conventional CPAP, BiPAP is titrated by increasing inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP) separately in response to apnea, hypopnea, and desaturation. DIF: Recall
REF: p. 679
OBJ: 9
25. What term is used to describe CPAP units that use a computer to adjust CPAP levels as needed by the patient during sleep?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. Min-CPAP b. Max-CPAP c. Retro-CPAP d. Auto-CPAP
ANS: D These devices are referred to as ―auto-CPAP,‖ ―intelligent CPAP,‖ or ―smart CPAP.‖ These devices use a computer algorithm for adjusting the level of CPAP in response to dynamic changes in airflow and/or vibration secondary to snoring. DIF: Recall
REF: p. 679
OBJ: 10
26. Which of the following are common side effects of positive-pressure therapy? 1. Dry nasal mucosa 2. Claustrophobia 3. Skin irritation 4. Headache a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: B These effects include feelings of claustrophobia, nasal congestion, rhinorrhea, skin irritation, and nasal dryness (Figure 33-4). DIF: Recall
REF: pp. 679-680 OBJ: 1
27. Which of the following are true about obstructive sleep apnea (OSA)? 1. It is overdiagnosed in the United States. 2. It has an equivalent prevalence to asthma in the general population. 3. It has an equivalent prevalence to diabetes in the general population. 4. The spectrum of the disease includes sleep disruption related to increased airway resistance.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. 1 and 2 only b. 2 and 3 only c. 1, 2, and 4 only d. 2, 3, and 4 only
ANS: D Obstructive sleep apnea syndrome is a common clinical problem that continues to be underdiagnosed. The prevalence is equivalent to that of asthma and diabetes in the general population. The spectrum of the disease ranges from sleep disruption related to increased airway resistance to profound daytime sleepiness in conjunction with severe oxyhemoglobin desaturation, pulmonary hypertension, and right heart failure. DIF: Recall
REF: p. 670
OBJ: 1
28. Which of the following are interventions used in the management of obstructive sleep apnea? 1. Group therapy 2. Behavioral 3. Medical 4. Surgical a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: D Management of OSA should be individualized but generally can be divided into three options: behavioral, medical, and surgical interventions. DIF: Recall
REF: p. 676
OBJ: 6
TRUE/FALSE
1. Central sleep apnea occurs more often than obstructive sleep apnea.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: F Central sleep apnea is not as common as obstructive sleep apnea. DIF: Recall
REF: p. 661
OBJ: 2
2. Available evidence has shown that bilevel pressure is associated with better patient compliance than the conventional CPAP. ANS: F Although patient acceptance may be slightly better with bilevel pressure, the published data have shown no difference in compliance between conventional CPAP and BiPAP. DIF: Recall
REF: p. 669
OBJ: 9
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 34 - Neonatal and Pediatric Respiratory Disorders Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE
1. Another name for respiratory distress syndrome (RDS) is: a. hyaline membrane disease. b. transient tachypnea of the newborn. c. type II RDS. d. persistent pulmonary hypertension.
ANS: A Respiratory distress syndrome, or hyaline membrane disease, is a disease of prematurity. DIF: Recall
REF: p. 689
OBJ: 1
2. What are the major factors in the pathophysiology of RDS? 1. Qualitative surfactant deficiency 2. Increased alveolar surface area 3. Increased small airways compliance 4. Presence of the ductus arteriosus a. 1 and 2 only b. 1 and 3 only c. 1, 3, and 4 only d. 1, 2, 3, and 4
ANS: C The major factors in the pathophysiology of RDS are qualitative surfactant deficiency, decreased alveolar surface area, increased small airways compliance, and the presence of the ductus arteriosus. DIF: Recall
REF: p. 689
OBJ: 1
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 3. Which of the following factors is associated with an increase in the incidence of RDS? a. Maternal heart disease b. Maternal diabetes c. Maternal asthma d. Long labor
ANS: B Maternal factors that impair fetal blood flow, such as abruptio placentae and maternal diabetes, also may lead to RDS. DIF: Recall
REF: p. 689
OBJ: 1
4. What is the first clinical sign of RDS in the newborn infant? a. Cyanosis b. Wheezing c. Hypertension d. Tachypnea
ANS: D Tachypnea usually occurs first. DIF: Recall
REF: p. 690
OBJ: 1
5. Which of the following clinical signs is not consistent with the onset of RDS? a. Grunting b. Retractions c. Nasal flaring d. Cyanosis
ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK After tachypnea, worsening retractions, paradoxical breathing, and audible grunting are observed. Nasal flaring also may be seen. DIF: Recall
REF: p. 690
OBJ: 1
6. What diagnostic parameter is most often used to confirm the diagnosis of RDS? a. Arterial blood gases b. Chest radiograph c. Pulmonary function test d. Serum enzymes
ANS: B Definitive diagnosis of RDS usually is made with chest radiography. DIF: Recall
REF: p. 690
OBJ: 1
7. Which of the following findings on the chest radiograph are typical for RDS? 1. Hyperinflation 2. Air bronchograms 3. Diffuse hazy infiltrates 4. Bilateral reticulogranular densities a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: D Diffuse, hazy, reticulogranular densities with the presence of air bronchograms with low lung volumes are typical of RDS. The reticulogranular pattern is caused by aeration of respiratory bronchioles and collapse of the alveoli. Air bronchograms appear as aerated, dark, major bronchi surrounded by the collapsed or consolidated lung tissue. DIF: Recall
REF: p. 690
OBJ: 1
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 8. Which of the following treatments is the least useful for the treatment of RDS? a. CPAP b. Surfactant replacement therapy c. High-frequency ventilation d. Bronchial hygiene techniques
ANS: D Continuous positive airway pressure (CPAP) and positive end expiratory pressure (PEEP) are the traditional support modes used to manage RDS. Surfactant replacement therapy and high-frequency ventilation (HFV) have been added to these traditional approaches. DIF: Recall
REF: p. 690
OBJ: 1
9. You are caring for an infant with RDS. Nasal CPAP has been used; however, the infant suddenly deteriorates and is demonstrating severe hypoxemia on an FiO2 of 0.60. What should be done next? a. Increase the CPAP. b. Intubate the infant and begin mechanical ventilation. c. Switch to nasal CPAP. d. Increase the FiO2 . ANS: B Mechanical ventilation with PEEP should be initiated if oxygenation does not improve with CPAP or if the patient is apneic or acidotic. DIF: Application
REF: p. 690
OBJ: 1
10. What is the maximum PIP that should be used with mechanical ventilation of larger premature infants to prevent volutrauma? a. 25 cm H2 O b. 30 cm H2 O c. 40 cm H2 O d. 50 cm H2 O
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: B For minimization of the potential for volutrauma, the PIP should be kept at less than 30 cm H 2O for larger premature infants and even lower PIP for more immature infants. DIF: Recall
REF: p. 691
OBJ: 1
11. In which infants is the surfactant administered as rescue? a. Infants delivered prematurely b. Infants with failure on CPAP trial c. Infants with diagnosis of RDS d. Infants with congenital heart disease
ANS: C Surfactant replacement therapy also is used as both prophylactic and rescue treatment (of infants who already have RDS). DIF: Recall
REF: p. 691
OBJ: 1
12. What is believed to be the cause of transient tachypnea of the newborn (TTN)? a. Persistent hypoxemia b. Immature surfactant c. Delayed clearance of fetal lung fluid d. Persistent fetal circulation
ANS: C The cause of TTN is unclear, but it is most likely related to delayed clearance of fetal lung liquid. DIF: Recall
REF: p. 691
OBJ: 2
13. What radiographic finding is common in infants with transient tachypnea? a. Low lung volumes b. Bilateral perihilar lymphadenopathy
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. Hyperinflation d. Mucus plugging
ANS: C The chest radiographic findings, which may initially be indistinguishable from those of pneumonia, are hyperinflation, which is secondary to air trapping and perihilar streaking. DIF: Recall
REF: p. 692
OBJ: 2
14. What treatment usually causes improvement in the initial treatment of transient tachypnea of the newborn? a. Mechanical ventilation with PEEP b. Oxygen with low FiO2 c. Bronchodilators d. Mucolytics
ANS: B Infants with TTN usually respond readily to a low FiO2 by infant oxygen hood or nasal cannula. DIF: Recall
REF: p. 692
OBJ: 2
15. What treatment is indicated for infants with transient tachypnea requiring higher FiO2 ? a. Frequent turning of the infant b. Oxygen c. Mechanical ventilation d. CPAP
ANS: D Infants requiring a higher FiO 2 may benefit from CPAP. DIF: Recall
REF: p. 692
OBJ: 2
16. What treatment may improve lung fluid clearance in the infant with transient tachypnea?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. CPAP b. Oxygen c. Mechanical ventilation d. Frequent turning of the infant
ANS: D Because the retention of lung fluid may be gravity dependent, frequent changes in the infant’s position may help to speed lung fluid clearance. DIF: Recall
REF: p. 692
OBJ: 2
17. Which statements about TTN are true? 1. TTN and neonatal pneumonia have different clinical signs. 2. The need for mechanical ventilation in TTN is rare. 3. A small number of infants with TTN eventually have persistent pulmonary hypertension. 4. Intravenous administration of antibiotics should be considered. a. 2 only b. 3 only c. 1, 2, and 3 only d. 2, 3, and 4 only
ANS: D Because TTN and neonatal pneumonia have similar clinical signs, intravenous administration of antibiotics should be considered for at least 3 days after appropriate culture samples are obtained. The need for mechanical ventilation is rare and probably indicates a complication. Clearing of the lungs evident on both a chest radiograph and with clinical improvement usually occurs within 24 to 48 hr. A small number of infants with TTN eventually have persistent pulmonary hypertension. DIF: Recall
REF: p. 692
OBJ: 2
18. What percentage of births will present with meconium-stained amniotic fluid? a. 2% b. 12%
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c. 25%
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
d. 50%
ANS: B Amniotic fluid stained with meconium is found in approximately 12% of all births. DIF: Recall
REF: p. 692
OBJ: 3
19. Which of the following is not a problem with the typical case of meconium aspiration syndrome? a. Lung tissue damage b. Pulmonary obstruction c. Hypovolemia d. Pulmonary hypertension
ANS: C Meconium aspiration syndrome involves three primary problems: pulmonary obstruction, lung tissue damage, and pulmonary hypertension. DIF: Recall
REF: p. 692
OBJ: 3
20. What is associated with ball-valve obstruction in meconium aspiration syndrome? a. Volutrauma b. Atelectrauma c. Hypertension d. Hypotension
ANS: A Ball-valve obstruction causes air trapping and can lead to volutrauma. DIF: Recall
REF: p. 692
OBJ: 3
21. Which of the following clinical findings are usually seen in meconium aspiration syndrome?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 1. Tachypnea and grunting 2. Irregular pulmonary densities on the chest film 3. Metabolic acidosis 4. Respiratory alkalosis a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: B Infants with MAS typically have gasping respirations, tachypnea, grunting, and retractions. The chest radiograph usually shows irregular pulmonary densities, which represent areas of atelectasis, and hyperlucent areas, which represent hyperinflation due to air trapping. DIF: Recall
REF: p. 693
OBJ: 3
22. Which of the following blood gas alteration is usually seen in meconium aspiration syndrome? a. Hypoxemia and respiratory acidosis b. Hypoxemia and mixed respiratory and metabolic alkalosis c. Hypoxemia and normal acid-base balance d. Hypoxemia and mixed respiratory and metabolic acidosis
ANS: A Arterial blood gases typically show hypoxemia with mixed respiratory and metabolic acidosis. DIF: Recall
REF: p. 693
OBJ: 3
23. Which of the following should be done early in the treatment of the nonvigorous infant with meconium aspiration syndrome? a. Suctioning b. Mask CPAP c. Antibiotics
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Vasopressors ANS: A In the presence of meconium-stained amniotic fluid, once delivery is complete and if the infant is depressed and requires intubation for resuscitation, an endotracheal (ET) tube should be inserted immediately, and suction should be applied directly to the ET tube. DIF: Recall
REF: p. 693
OBJ: 3
24. Which of the following ventilatory modalities have been associated with a lesser rate of air leak in meconium aspiration syndrome? 1. IMV 2. HFV 3. CPAP a. 1 only b. 1 and 2 only c. 2 and 3 only d. 3 only
ANS: B Evidence suggests that both HFV and intermittent mechanical ventilation decrease the risk of air leak. DIF: Recall
REF: p. 693
OBJ: 3
25. Which of the following have been implicated in the origin of bronchopulmonary dysplasia (BPD)? 1. Oxygen toxicity 2. Malnutrition 3. Mechanical ventilation a. 1 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D Immaturity, genetics, malnutrition, oxygen toxicity, and mechanical ventilation all have been implicated in the origin of BPD. DIF: Recall
REF: p. 693
OBJ: 4
26. What clinical finding is typically seen with BPD infants? a. Areas of air trapping on the chest film b. Areas of consolidation on the chest film c. Hypoxemia and hypercapnia d. Hypocapnia
ANS: C Progressive vascular leakage and areas of atelectasis and emphysema develop in the lungs, and progressive pulmonary damage occurs. The chest radiograph for severe disease will show areas of atelectasis, emphysema, and fibrosis diffusely intermixed throughout the lung (Figure 34 -5). Arterial blood gas measurements reveal varying degrees of hypoxemia and hypercapnia secondary to airway obstruction, air trapping, pulmonary fibrosis, and atelectasis. DIF: Recall
REF: p. 694
OBJ: 4
27. What is the best strategy in the management of BPD? a. Adequate fluid management b. Prevention c. Aggressive mechanical ventilation d. PEEP
ANS: B The best management of BPD is prevention. DIF: Recall
REF: p. 694
OBJ: 4
28. Which of the following therapies has little effect on long-term outcome such as mortality and duration of oxygen therapy in infants with BPD?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. Diuretics b. Steroids c. Antibiotics d. Bronchodilators
ANS: B Steroid therapy has little effect on long-term outcome such as mortality and duration of oxygen therapy. DIF: Recall
REF: p. 694
OBJ: 4
29. Which of the following is not associated with apnea episodes in premature infants? a. Apnea lasts longer than 15 sec. b. Apnea is associated with cyanosis. c. Apnea is associated with bradycardia. d. Apnea lasts longer than 1 min.
ANS: D Apneic spells are abnormal if (1) they last longer than 15 sec or (2) they are associated with cyanosis, pallor, hypotonia, or bradycardia. DIF: Recall
REF: p. 695
OBJ: 5
30. Which of the following are associated with causing apnea in premature infants? 1. Gender 2. Intracranial lesion 3. Gastroesophageal reflux 4. Impaired oxygenation a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D See Table 34-2. DIF: Recall
REF: p. 695
OBJ: 5
31. Treatment of the premature infant with apnea includes which of the following? a. Tactile stimulation b. Caffeine citrate c. Transfusion d. Manage underlying cause a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 1, 2, 3, and 4
ANS: D Table 34-3 outlines current treatment strategies for infants with apnea. DIF: Recall
REF: p. 695
OBJ: 5
32. What physiologic abnormality is believed to be the cause of persistent pulmonary hypertension of the newborn (PPHN)? a. Right-to-left shunting b. High cardiac output c. High pulmonary vascular resistance d. Metabolic acidosis
ANS: C The common denominator in PPHN is a return to fetal circulatory pathways, usually because of high PVR. DIF: Recall
REF: p. 696
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 33. What are the fundamental pathophysiologic events that explain PPHN? 1. Vascular spasm 2. Hypoxemia 3. Increased muscle wall thickness 4. Decreased cross-sectional area a. 1 and 2 only b. 2, 3, and 4 only c. 1 and 3 only d. 1, 3, and 4 only
ANS: D There are fundamental types of PPHN: vascular spasm, increased muscle wall thickness, and decreased cross-sectional area of pulmonary vessels. DIF: Recall
REF: p. 696
OBJ: 6
34. Which of the following factors may stimulate pulmonary vascular spasm and cause persistent pulmonary hypertension of the newborn? 1. Hypoxemia 2. Hypoglycemia 3. Hypotension 4. Pain a. 1 only b. 1 and 2 only c. 1, 2, 3, and 4 d. 4 only
ANS: C Vascular spasm is an acute event that can be triggered by many different conditions, including hypoxemia, hypoglycemia, hypotension, and pain. DIF: Recall
REF: p. 696
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 35. Treatment of the infant with persistent pulmonary hypertension may include which of the following? 1. ECMO 2. High-frequency ventilation 3. Nitric oxide 4. Caffeine citrate a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: B Initial therapy for PPHN is removal of the underlying cause, such as administration of oxygen for hypoxemia, surfactant for RDS, glucose for hypoglycemia, and inotropic agents for low cardiac output and systemic hypotension. If correction of the underlying problem does not correct the hypoxemia, the infant needs intubation and mechanical ventilation. Because pain and anxiety may contribute to PPHN, the infant may need sedation and, frequently, paralysis. If these measures do not improve oxygenation, the next step is HFV. This mode of ventilation allows a higher FRC without a large tidal volume. Inhaled nitric oxide is now considered the next intervention. Should all of these modalities fail to improve oxygenation, the infant may be a candidate for extracorporeal membrane oxygenation (ECMO). DIF: Recall
REF: p. 696
OBJ: 6
36. Which of the following is an example of an internal obstruction to the infant’s airway? a. Hemangiomas b. Neck mass c. Tracheoesophageal fistula d. Laryngomalacia
ANS: D Internal obstruction includes common problems, such as laryngomalacia, that cause obstructive apnea. DIF: Recall
REF: p. 696
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 37. Which of the following is the most common type of esophageal atresia? a. Esophageal atresia with a proximal fistula b. Esophageal atresia with a distal fistula c. Intact esophagus with an H fistula d. Esophageal atresia without either fistula
ANS: B The most common of these malformations is esophageal atresia with a distal fistula, which comprises 85% to 90% of all tracheoesophageal fistulas. DIF: Recall
REF: p. 697
OBJ: 6
38. The pathophysiologic abnormalities associated with congenital diaphragmatic hernia include which of the following? 1. Malformation of the left ventricle 2. Lung hypoplasia 3. Pulmonary hypertension 4. Unusual anatomy of the inferior vena cava a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: D The pathophysiologic mechanism is a complex combination of lung hypoplasia, including decreased alveolar count and decreased pulmonary vasculature, pulmonary hypertension, and unusual anatomy of the inferior vena cava. DIF: Recall
REF: p. 697
OBJ: 7
39. Clinical findings associated with congenital diaphragmatic hernia include which of the following? 1. Severe cyanosis
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 2. Decreased breath sounds 3. Displaced heart sounds 4. Hepatomegaly a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: B Physical examination may yield the following findings: scaphoid abdomen (because the abdominal contents are in the thorax), decreased breath sounds, displaced heart sounds (because the heart is pushed away from the hernia), and severe cyanosis (from lung hypoplasia and pulmonary hypertension). DIF: Recall
REF: p. 697
OBJ: 7
40. Which of the following diagnostic tools serves to confirm the diagnosis of congenital heart disease? a. Sweat test b. Fluoroscopy c. Chest radiography d. Ultrasound
ANS: C The diagnosis is established with chest radiography. DIF: Recall
REF: p. 697
OBJ: 7
41. Which of the following is the most common defect of the abdominal wall? a. Inguinal hernia b. Omphalocele c. Gastroschisis d. Agenesis of abdominal muscles
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: B Large defects in the abdominal wall can cause severe respiratory compromise. The most common of these defects is omphalocele. DIF: Recall
REF: p. 698
OBJ: 8
42. Which of the following are common neuromuscular defect that affect infants? 1. Spinal muscular atrophy 2. Congenital myasthenia gravis 3. Myotonic dystrophy 4. Poliomyelitis a. 1 only b. 1, 2, and 3 only c. 1 and 3 only d. 1, 2, and 4 only
ANS: B Many diseases of poor neuromuscular control affect newborns. These include spinal muscular atrophy, congenital myasthenia gravis, myotonic dystrophy, and many others. DIF: Recall
REF: p. 698
OBJ: 8
43. Which of the following defects is not associated with tetralogy of Fallot? a. Ventricular septal defect b. Right ventricular hypoplasia c. Pulmonary stenosis d. Dextroposition of the aorta
ANS: B Tetralogy of Fallot is a defect that includes (1) obstruction of right ventricular outflow (pulmonary stenosis), (2) ventricular septal defect (a hole between the right and left ventricles), (3) dextroposition of the aorta, and (4) right ventricular hypertrophy.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 698 OBJ: 8
44. Which of the following is the most likely diagnosis in the newborn with severe cyanosis at birth? a. Persistent pulmonary hypertension b. Tetralogy of Fallot c. Transposition of the great vessels d. Ventricular septal defect
ANS: C Transposition of the great arteries is the heart disease that most frequently causes severe cyanosis. DIF: Recall
REF: p. 700
OBJ: 9
45. Which of the following is false regarding ventricular septal defects in infants? a. Are quite common. b. Usually cause right-to-left shunting. c. May cause congestive heart failure. d. Usually do not appear immediately after birth.
ANS: B A simple ventricular septal defect usually causes left-to-right shunting and congestive heart failure. DIF: Recall
REF: p. 700
OBJ: 9
46. How soon after birth does the ductus typically close? a. 1 to 2 days b. 3 to 4 days c. 5 to 7 days d. 10 days
ANS: C Closure of the ductus normally occurs 5 to 7 days after the birth of term infants.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 700
OBJ: 9
47. In which of the following defects is heart transplantation an accepted option for treatment? a. Interrupted aortic arch b. Coarctation of the aorta c. Hypoplastic left heart syndrome d. Tetralogy of Fallot
ANS: C Hypoplastic left heart syndrome has three accepted treatments: comfort care (allowing the infant to die), a palliative surgical procedure (Norwood), and transplantation. DIF: Recall
REF: p. 701
OBJ: 9
48. Which of the following maternal characteristics are associated with an increased frequency of SIDS? 1. Younger than 20 years 2. Low socioeconomic status 3. Cigarette smoking 4. History of asthma a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: B Factors associated with increased frequency of SIDS are presented in Box 34-1. DIF: Recall
REF: p. 701
OBJ: 10
49. Which of the following infant characteristics is associated with an increased risk of SIDS? a. Female gender
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK b. Preterm birth c. High Apgar score d. Full-term birth
ANS: B An infant who dies of SIDS typically is a preterm African-American boy born to a poor mother younger than 20 years who received inadequate prenatal care. DIF: Recall
REF: p. 701
OBJ: 10
50. Which of the following findings is not associated with gastroesophageal reflux (GER) disease? a. Stridor b. Apnea c. Reactive airways disease d. Syncope
ANS: D Respiratory problems caused by gastroesophageal reflux include reactive airways disease, aspiration pneumonia, laryngospasm, stridor, chronic cough, choking spells, and apnea. DIF: Recall
REF: p. 702
OBJ: 11
51. Which of the following are used to diagnose GER? 1. Esophageal pH testing 2. Chest radiograph 3. Upper GI contrast studies 4. Gastric scintiscanning a. 1 only b. 1, 2, and 3 only c. 1 and 3 only d. 1, 3, and 4 only
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ANS: D
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
GER disease can be diagnosed with esophageal pH testing, upper gastrointestinal contrast studies, and gastric scintiscanning. DIF: Recall
REF: p. 702
OBJ: 11
52. Which of the following disease is not commonly associated with bronchiolitis and least likely to result in respiratory failure? a. Infant with congenital heart failure b. Infant with BPD c. Child with cystic fibrosis d. Pneumonia
ANS: D Those most prone to respiratory failure as a consequence of bronchiolitis are very young and immunodeficient and have comorbidity, such as congenital heart disease, bronchopulmonary dysplasia, cystic fibrosis, or childhood asthma. DIF: Recall
REF: p. 702
OBJ: 12
53. Which of the following findings are typical for infants with bronchiolitis? 1. Stridor 2. Wheezing 3. Dyspnea 4. Tachypnea a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: D After a few days, signs of respiratory distress develop, particularly dyspnea and tachypnea. Progressive inflammation and narrowing of the airways cause inspiratory and expiratory wheezing and increase airway resistance.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 702
OBJ: 12
54. Which of the following groups of infants should receive passive immunization for RSV? 1. Chronic lung disease 2. Infants born less than 32 weeks’ gestational age 3. Infants with congenital heart disease 4. Infants with retinopathy of prematurity a. 1 only b. 1, 2, and 3 only c. 1 and 3 only d. 1, 3, and 4 only
ANS: B Passive immunization is now recommended for infants younger than 2 years of age who are requiring medical therapy for chronic lung disease, infants born less than 32 weeks’ gestational age, and infants with congenital heart disease who have cardiovascular compromise. DIF: Recall
REF: p. 702
OBJ: 12
55. Which of the following therapies is considered controversial in the management of the infant with severe bronchiolitis? a. Hydration b. Oxygen c. Bronchodilator therapy d. CPAP
ANS: C Because bronchiolitis and childhood asthma have similar symptoms, a trial course of bronchodilator therapy with a beta agonist may be useful if airway obstruction is relieved after administration. This practice is controversial, and practitioners should assess the efficacy of all bronchodilator therapy before continuing.
DIF: Recall
REF: p. 703
OBJ: 12
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 56. Which of the following statements are true about croup? 1. Caused by viral organism 2. Most common form of airway obstruction in children aged 6 months to 6 years 3. Causes subglottic swelling and obstruction 4. Most often caused by parainfluenza virus a. 1 and 3 only b. 2, 3, and 4 only c. 3 and 4 only d. 1, 2, 3, and 4
ANS: D Croup is a viral disorder of the upper airway that normally results in subglottic swelling and obstruction. Termed laryngotracheobronchitis, viral croup is usually caused by the parainfluenza virus and is the most common form of airway obstruction in children between 6 months and 6 years of age. DIF: Recall
REF: p. 703
OBJ: 13
57. Which of the following clinical signs are common with croup? 1. Stridor 2. Murmur 3. Coughing 4. Cyanosis a. 1 and 3 only b. 2 and 3 only c. 1, 3, and 4 only d. 1, 2, 3, and 4
ANS: C The child typically has slow, progressive inspiratory and expiratory stridor and a barking cough. As the disease progresses, dyspnea, cyanosis, exhaustion, and agitation occur.
DIF: Recall
REF: p. 703
OBJ: 13
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 58. Which of the following is the most common radiographic finding that suggests the presence of croup? a. Thumb sign b. Flail chest c. Sail sign d. Steeple sign
ANS: D Classic croup manifests on an anteroposterior radiograph as characteristic subglottic narrowing of the trachea, called the steeple sign. DIF: Recall
REF: p. 703
OBJ: 13
59. Which of the following clinical findings suggest the child with croup should be hospitalized? 1. Stridor at rest 2. Suprasternal retractions 3. Cyanosis on room air 4. Harsh breath sounds a. 1 only b. 1 and 2 only c. 1, 3, and 4 only d. 1, 2, 3, and 4
ANS: D If there is stridor at rest (accompanied by harsh breath sounds, suprasternal retractions, and cyanosis with breathing of room air), hospitalization is indicated. DIF: Recall
REF: p. 704
OBJ: 13
60. Which of the following treatments is least likely to be needed in the treatment of the child with croup? a. Oxygen b. Mechanical ventilation
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. Aerosolized racemic epinephrine d. Budesonide
ANS: B Progressive worsening of the clinical signs despite treatment indicates the need for intubation and mechanical ventilation. DIF: Recall
REF: p. 704
OBJ: 13
61. What modality is believed to be the cause of a decrease in the reported incidence of epiglottitis over the past decade? a. Vaccine b. Better diet c. Improved epidemiology reporting d. Better quality of air
ANS: A Evidence suggests that the incidence of epiglottitis is decreasing among children, probably because of the use of vaccines. DIF: Recall
REF: p. 704
OBJ: 13
62. Which of the following clinical findings is not typically seen in patients with epiglottitis? a. High fever b. Stridor c. Barking cough d. Drooling
ANS: C The patient does not have a croupy bark but instead has a muffled voice. DIF: Recall
REF: p. 704
OBJ: 13
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 63. Which of the following is the most common radiographic finding that suggests the presence of epiglottitis? a. Thumb sign b. Flail chest c. Sail sign d. Steeple sign
ANS: A Lateral neck radiographic results (Figure 34-9) indicate the epiglottis is markedly thickened and flattened (thumb sign). DIF: Recall
REF: p. 704
OBJ: 13
64. Which of the following therapies is least likely to be needed in the child with epiglottitis? a. Tracheostomy b. Pressure support with low-level CPAP c. High FiO2 d. Humidity therapy
ANS: A Tracheostomy may be needed if the patient’s condition warrants it; however, this procedure is rarely used. DIF: Recall
REF: p. 705
OBJ: 13
65. A 2-year-old boy is in severe respiratory distress. The child is drooling and has labored breathing. Stridor is heard. RR is 42 breaths/min and HR is 148 beats/min. What should be done next? a. Intubate. b. Provide 100% oxygen on nonrebreather mask. c. Administer racemic epinephrine. d. Place on CPAP with low PSV.
ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK The clinical picture, particularly the age, level of distress, stridor, and drooling, suggests that this patient apparently has epiglottitis, a severe swelling of the tissue around the glottis. Given the potential for additional swelling and complete airway closure, this patient should be intubated for airway protection. DIF: Analysis
REF: p. 705
OBJ: 13
66. What is the likely diagnosis of an 18-month-old patient in moderate respiratory distress with a 1-week history of a low-grade fever and chills, barking cough, and an AP chest radiograph which shows a steeple sign? a. Pulmonary interstitial emphysema b. Bronchopulmonary dysplasia c. Epiglottis d. Croup
ANS: D A child typically has slow, progressive inspiratory and expiratory stridor and a barking coup. As the disease progresses, dyspnea, cyanosis, exhaustion, and agitation occur. DIF: Analysis
REF: p. 704
OBJ: 13
67. What is the leading cause of death among patients with cystic fibrosis? a. Pancreatic disease b. Lung disease c. Gastrointestinal disease d. Diabetes
ANS: B Complications of lung disease are the leading cause of death among patients with cystic fibrosis. DIF: Recall
REF: p. 705
OBJ: 14
68. Which test is commonly used to confirm the diagnosis of cystic fibrosis? a. Sweat chloride
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK b. Chest radiograph c. Lung diffusion capacity d. Serum enzyme levels
ANS: A In evaluation of a child, a sweat chloride level greater than 60 mEq/L confirms the diagnosis of cystic fibrosis. DIF: Recall
REF: p. 706
OBJ: 14
69. What therapy has been shown to reduce the incidence of bronchiectatic exacerbations in the patient with cystic fibrosis? a. Autogenic lung drainage b. Inhaled tobramycin c. Chest physical therapy d. Bronchodilator therapy
ANS: B When inhaled tobramycin is used twice daily every other month, there is a marked reduction in the number of bronchiectatic exacerbations. DIF: Recall
REF: p. 706
OBJ: 14
70. What therapy has been shown to reduce the rate of loss of lung function in patients with cystic fibrosis? a. High doses of ibuprofen b. Continuous oxygen therapy c. Corticosteroids d. Inhaled DNase
ANS: A High doses of the anti-inflammatory drug ibuprofen reduce the rate of lung function loss in patients younger than 13 years.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 706 OBJ: 14
71. Which of the following are indications for RSV prophylactic therapy? 1. Infants less than 32 weeks and requiring FiO2 greater than 0.21 for at least the first 28 days of life 2. Cyanotic heart defects in the first year of life 3. Severely immunocompromised children less than 24 months of age 4. Children with cystic fibrosis a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: C See Box 34-5—American Academy of Pediatrics Recommendations for Respiratory Syncytial Virus Prophylaxis. DIF: Recall
REF: p. 704
OBJ: 13
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 35 - Airway Pharmacology Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following phases constitute the course of drug action from dose to effect?
1. Drug administration 2. Pharmacognosy 3. Pharmacokinetic 4. Pharmacodynamic a. 1, 2, and 3 only b. 1, 3, and 4 only c. 2, 3, and 4 only d. 2 and 4 only ANS: B
Three phases constitute the course of drug action from dose to effect: the drug administration, pharmacokinetic, and pharmacodynamic phases. DIF: Recall
REF: p. 717
OBJ: 1
2. Which of the following devices are most commonly used to deliver aerosols by the inhalation
route? 1. Small particle aerosol generator 2. Metered dose inhaler 3. Small volume nebulizer 4. Soft-mist inhaler a. 1 and 3 only b. 2 and 4 only c. 1, 2, and 3 only d. 2, 3, and 4 only ANS: D
The most commonly used devices to administer orally or nasally inhaled aerosols are the metered dose inhaler, the small volume nebulizer, the dry powder inhaler, and the soft-mist inhaler. DIF: Recall
REF: p. 717
OBJ: 1
3. Which one or more of the following devices are used in combination with metered dose
inhaler (MDI) therapy to reduce the need for hand-breathing coordination and oropharyngeal impaction of aerosolized drugs? 1. Reservoir devices 2. One-way spacers 3. Valved holding chambers 4. Drying chambers a. 1 and 3 only b. 1, 2, and 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Reservoir devices, including both holding chambers with one-way inspiratory valves and simple, nonvalved spacer devices, are often added to an MDI to reduce the need for complex hand-breathing coordination and to reduce oropharyngeal impaction of the aerosol drug. DIF: Recall
REF: p. 717
OBJ: 1
4. Which of the following are advantages for the treatment of the respiratory tract with inhaled
aerosols? 1. Doses are usually smaller. 2. Onset of drug action is rapid. 3. Delivered dose is consistent with each administration. 4. Systemic side effects are often fewer and less severe. a. 1 and 3 only b. 1, 2, and 4 only c. 4 only d. 2 and 4 only ANS: B
The advantages for treatment of the respiratory tract with inhaled aerosols are as follows: • Aerosol doses are usually smaller than doses for systemic administration. • Onset of drug action is rapid. • Delivery is targeted to the organ requiring treatment. • Systemic side effects are often fewer and less severe. DIF: Recall
REF: p. 717
OBJ: 1
5. Which phase describes the time course and disposition of a drug in the body based on its
absorption, distribution, metabolism, and elimination? a. Pharmaceutical b. Pharmacognosy c. Pharmacokinetic d. Pharmacodynamic ANS: C
The pharmacokinetic phase of drug action describes the time course and disposition of a drug in the body based on its absorption, distribution, metabolism, and elimination. DIF: Recall
REF: p. 717
OBJ: 1
6. Which of the following methods limits the systemic distribution of an inhaled aerosolized
drug? a. Use of a fully ionized drug b. Use of a partially ionized drug c. Use of metabolites d. Use of the generic form of the drug
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ANS: A
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
One method of limiting distribution of inhaled aerosols is use of a fully ionized drug rather than a nonionized agent. DIF: Recall
REF: p. 708
OBJ: 1
7. Which of the following anticholinergics is poorly ionized? a. Atropine b. Ipratropium bromide c. Tiotropium bromide d. Aclidinium bromide ANS: A
Atropine is poorly ionized and diffuses well, distributing throughout the body. DIF: Recall
REF: p. 708
OBJ: 1
8. Which of the following lung availability/total systemic availability (L/T) ratios is consistent
with an efficient aerosol delivery? a. 0.46 b. 0.23 c. 0.1 d. 0.6 ANS: D
The L/T ratio quantifies the efficiency of aerosol delivery to the lung. DIF: Application
REF: p. 717
OBJ: 1
9. Which phase describes the mechanism of drug action by which a drug causes its effects within
the body through drug-receptor interactions? a. Pharmaceutical b. Pharmacognosy c. Pharmacokinetic d. Pharmacodynamic ANS: D
The pharmacodynamic phase describes the mechanisms of drug action by which a drug molecule causes its effects in the body. DIF: Recall
REF: p. 717
OBJ: 1
10. Pharmacologic control of the airway is mediated by receptors found on which of the following
structures? 1. Smooth muscle 2. Secretory cells 3. Blood vessels 4. Alveolar epithelium a. 1 and 3 only b. 1, 2, and 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Pharmacologic control of the airway is mediated by receptors found on airway smooth muscle, secretory cells, bronchial epithelium, and pulmonary and bronchial blood vessels. DIF: Recall
REF: p. 717
OBJ: 1
11. Which of the following is the usual neurotransmitter in the sympathetic system? a. Atropine b. Acetylcholine c. Norepinephrine d. Dopamine ANS: C
The usual neurotransmitter in the sympathetic system is norepinephrine, which is similar to epinephrine, also known as adrenaline. DIF: Recall
REF: p. 717
OBJ: 1
12. Which of the following terms is used to describe a drug that stimulates a receptor responding
to norepinephrine? a. Sympatholytic b. Anticholinergic c. Cholinergic d. Adrenergic ANS: D
Adrenergic (adrenomimetic) refers to a drug that stimulates a receptor responding to norepinephrine or epinephrine. DIF: Recall
REF: p. 717
OBJ: 1
13. When stimulated, which of the following receptors causes bronchoconstriction? a. M3 b. M2 c. 1 d. 2
ANS: A
See Table 35-1. DIF: Recall
REF: p. 718
OBJ: 1
14. Which of the following comprises the largest single group of drugs among aerosolized agents
used for inhalation? a. Inhaled corticosteroids b. Adrenergic bronchodilators c. Mucus-controlling agents
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Anticholinergic bronchodilators ANS: B
The adrenergic bronchodilators represent the largest single group of drugs among the aerosolized agents used for oral inhalation. DIF: Recall
REF: p. 718
OBJ: 2
15. Proventil and Ventolin are brand names for which of the following beta-adrenergic
bronchodilators? a. Albuterol b. Levalbuterol c. Vilanterol d. Arformoterol ANS: A
See Table 35-2. DIF: Recall
REF: p. 719
OBJ: 4
16. Foradil is a brand name for which of the following beta-adrenergic bronchodilators? a. Albuterol b. Levalbuterol c. Arformoterol d. Formoterol ANS: D
See Table 35-2. DIF: Recall
REF: p. 719
OBJ: 4
17. A metered dose inhaler of salmeterol delivers which of the following? a. 131 mcg/puff b. 90 mcg/puff c. 65 mcg/puff d. 25 mcg/puff ANS: D
See Table 35-2. DIF: Recall
REF: p. 719
OBJ: 4
18. What is the dosage for salmeterol MDI? a. 2 puffs every 4 to 6 hr b. 1 to 2 puffs four times daily c. 2 puffs three times daily d. 2 puffs every 12 hr ANS: D
See Table 35-2.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 719 OBJ: 4 19. Which of the following is an indication for use of an adrenergic bronchodilator? a. Treatment of excessive, viscous mucus secretions b. Antiinflammatory treatment of mild to moderate persistent asthma c. Treatment of reversible airflow obstruction d. Prophylactic management of asthma ANS: C
The general indication for use of an adrenergic bronchodilator is the presence of reversible airflow obstruction. DIF: Recall
REF: p. 718
OBJ: 3
20. Adrenergic bronchodilators improve flow rates for which of the following diseases?
1. Asthma 2. Acute bronchitis 3. Chronic bronchitis 4. Pulmonary fibrosis a. 1 only b. 1, 2, and 3 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: B
The most common use of these agents clinically is to improve flow rates in asthma (including exercise-induced asthma), acute and chronic bronchitis, emphysema, bronchiectasis, cystic fibrosis, and other obstructive airway states. DIF: Recall
REF: p. 718
OBJ: 5
21. Short-acting adrenergic bronchodilators are considered what type of agent according to the
National Asthma Education and Prevention Program? a. Antiinflammatory b. Rescue c. Controller d. Mucolytic ANS: B
Short-acting agents are termed ―rescue‖ agents in the 2007 National Asthma Education and Prevention Program Expert Panel II (NAEPP EPR II) guidelines. DIF: Recall
REF: p. 718
OBJ: 2
22. What is the name of the enzyme responsible for the short duration of action of catecholamine
bronchodilators? a. Catechol O-methyltransferase (COMT) b. Epinephrine dismutase c. EDTA d. Hyaluronidase
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: A
Catecholamines are metabolized rapidly by the enzyme COMT, which causes a short duration of action. DIF: Recall
REF: p. 720
OBJ: 2
23. Which of the following short-acting catecholamines is used for their strong
alpha-1-vasoconstricting effects to reduce swelling in the nose and larynx and to control bleeding during bronchoscopic biopsy? a. Levophed b. Dopamine c. Dobutamine d. Racemic epinephrine ANS: D
Because of their strong alpha-1 activity and vasoconstricting effect, epinephrine and the synthetic racemic epinephrine are used to reduce swelling in the nose (nasal decongestant) and larynx (croup, epiglottitis) and to control bleeding during bronchoscopic biopsy. DIF: Recall
REF: p. 719
OBJ: 2
24. What is the average duration of action of the short-acting noncatecholamine agents? a. 1 to 2 hr b. 2 to 4 hr c. 4 to 6 hr d. 6 to 8 hr ANS: C
Because their duration of action is approximately 4 to 6 hr, these drugs were more suited to maintain therapy than catecholamines and could be taken on a four-times-daily schedule. DIF: Recall
REF: p. 720
OBJ: 3
25. Which of the following are LABA bronchodilators?
1. Indacaterol 2. Olodaterol 3. Albuterol 4. Salmeterol a. 1 and 3 only b. 1, 2, and 3 only c. 1, 2, and 4 only d. 1, 2, 3, and 4 ANS: C
Long-acting beta agonists (LABAs), such as salmeterol, formoterol, arformoterol, indacaterol, and olodaterol, are indicated for maintaining bronchodilation and control of bronchospasm and nocturnal symptoms in asthma or other obstructive diseases, such as chronic obstructive pulmonary disease (COPD).
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 721 OBJ: 2 26. Which of the following is the generic name for Arcapta Neohaler? a. Indacaterol b. Olodaterol c. Formoterol d. Umeclidinium bromide ANS: A
See Table 35-2. DIF: Recall
REF: p. 719
OBJ: 4
27. What is the brand name of the (R)-isomer of formoterol? a. Foradil b. Survanta c. Brovana d. Performist ANS: C
Arformoterol (Brovana), the single (R)-isomer of formoterol, is the newest long-acting beta agonist on the market. DIF: Recall
REF: p. 721
OBJ: 4
28. Which of the following are side effects of beta-2-selective bronchodilators?
1. Bradycardia 2. Tremor 3. Insomnia 4. Headache a. 1 only b. 1 and 2 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
The newer, more beta-2-selective agents are safe and typically cause tremor as the main side effect. Other common side effects with the inhaled agents include headache, insomnia, and nervousness. DIF: Recall
REF: pp. 721-722 OBJ: 3
29. What are some potential adverse effects with use of adrenergic bronchodilators?
1. Hypokalemia 2. Dizziness 3. Worsening ventilation/perfusion ratio ( 4. Bradycardia a. 1 and 4 only b. 2 and 3 only
)
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
Potential adverse effects with use of adrenergic bronchodilators include the following: • Chlorofluorocarbon (CFC) propellant-induced bronchospasm • Dizziness • Hypokalemia • Loss of bronchoprotection • Nausea • Tolerance (tachyphylaxis) • Worsening ventilation/perfusion ratio (decrease in PaO 2 ) DIF: Recall
REF: pp. 721-722 OBJ: 3
30. Which of the following are indications for the use of acetylcysteine (Mucomyst)?
1. Treatment of acetaminophen overdose 2. Treatment of excessive, viscous mucus secretions 3. Treatment of aspirin overdose 4. Treatment of purulent mucus secretions by breaking up DNA a. 1 and 2 only b. 2 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: A
Acetylcysteine is indicated for treatment to reduce accumulation of airway secretions. It is also used to treat or prevent the liver damage that can occur when a patient takes an overdose of acetaminophen. DIF: Recall
REF: p. 725
OBJ: 3
31. What amount of ipratropium bromide (Atrovent) is delivered by metered dose inhaler? a. 10 mcg/puff b. 15 mcg/puff c. 17 mcg/puff d. 90 mcg/puff ANS: C
See Table 35-3. DIF: Recall
REF: p. 723
OBJ: 4
32. What is the dosage for ipratropium bromide (Atrovent)? a. 2 puffs four times daily b. 2 puffs three times daily c. 2 puffs twice daily d. 2 puffs every 12 hr
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: A
See Table 35-3. DIF: Recall
REF: p. 723
OBJ: 4
33. What is the duration of action for ipratropium bromide? a. 4 to 6 hr b. 6 to 8 hr c. 8 to 10 hr d. 12 hr ANS: A
See Table 35-3. DIF: Recall
REF: p. 723
OBJ: 3
34. What is the duration of action for the formulation of ipratropium bromide plus albuterol
sulfate (DuoNeb)? a. 4 to 6 hr b. 6 to 8 hr c. 8 to 10 hr d. 12 hr ANS: A
See Table 35-3. DIF: Recall
REF: p. 723
OBJ: 4
35. Which of the following nebulizers is used to nebulize iloprost? a. Hudson b. Pari c. I-neb d. Respirgard ANS: C
Iloprost inhalation is administered with the I-neb. DIF: Recall
REF: p. 736
OBJ: 5
36. What are some common side effects seen with ipratropium bromide (Atrovent)? a. Tachycardia b. Blood pressure increase c. Cough and dry mouth d. Tolerance ANS: C
See Box 35-2. DIF: Recall
REF: p. 724
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 37. Ipratropium bromide should be used with precaution in which of the following
diseases/conditions? 1. Prostatic hypertrophy 2. Urinary retention 3. Kidney stones 4. Glaucoma a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Although ipratropium is not contraindicated in subjects with prostatic hypertrophy, urinary retention, or glaucoma, the drug should be used with precaution and adequate evaluation for possible systemic side effects in these subjects. DIF: Recall
REF: p. 724
OBJ: 3
38. Which of the following are mucoactive agents currently approved for inhalation in the United
States? 1. Tryptase alfa 2. Dornase alfa 3. Hyperosmolar saline 4. Mucomyst a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
See Table 35-4. DIF: Recall
REF: p. 725
OBJ: 2
39. Acetylcysteine (Mucomyst) is indicated in which of the following diseases?
1. Acute tracheobronchitis 2. Bronchiectasis 3. Chronic obstructive pulmonary disease (COPD) 4. Asthma a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Diseases of excessive viscous mucus secretions and poor airway clearance include COPD, acute tracheobronchitis, and bronchiectasis. DIF: Recall
REF: p. 725
OBJ: 3
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 40. A 45-year-old man has a history of heart failure and is diagnosed with pulmonary arterial
hypertension. Initially, he is prescribed treprostinil (Tyvaso) 3 breathes (18 mcg) per treatment session via the Tyvaso Inhalation System. Upon first administration, the patient feels nauseated, throat irritation, muscle pain, and experiences flushing. What is the best next course of action? a. Continue medication administration with the addition of pain relievers. b. Stop medication administration and continue to the next treatment session. c. Reduce dose to 1 to 2 breaths per session and then gradually increase to 3. d. Change medication administration. ANS: C
The initial dose for Tyvaso is 3 breathes (18 mcg) per treatment session. If not tolerated, the dose may be reduced to 1 to 2 breathes per session and then increased to 3. Tyvaso should be increased by 3 breathes every 1 to 2 weeks until 9 breathes (54 mcg) per treatment session is reached. DIF: Analysis
REF: p. 736
OBJ: 6
41. Which of the following explains how acetylcysteine (Mucomyst) lowers the viscosity of
mucus? a. Breaking down DNA b. Increasing the osmolarity of the mucus and pulling water into it c. Changing the pH of the mucus, causing it to break down d. Substituting its sulfhydryl group for disulfide bonds and breaking a portion of the bond forming the gel structure ANS: D
Acetylcysteine acts as a classic mucolytic to reduce the viscosity of mucus by substituting its own sulfhydryl group for the disulfide group in mucus, thereby breaking a portion of the bond forming the gel structure. DIF: Recall
REF: p. 725
OBJ: 3
42. Which of the following prophylactic therapies is recommended to reduce the irritant effect of
acetylcysteine? a. Administration of anticholinergics b. Administration of dornase alfa c. Administration of corticosteroids d. Administration of adrenergic bronchodilator ANS: D
Pretreatment with an adrenergic bronchodilator, allowing adequate time for a bronchodilatory effect to be produced, can prevent or reduce airway resistance with acetylcysteine. DIF: Recall
REF: p. 725
OBJ: 3
43. When administering acetylcysteine (Mucomyst), the respiratory therapist should be
particularly focused on which of the following potential adverse effects?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1. Incompatibility with certain antibiotics when administered together 2. Blurred vision 3. Bronchospasm 4. Airway obstruction due to rapid liquefaction of mucus a. 3 only b. 1, 2, and 3 only c. 2, 3, and 4 only d. 1, 3, and 4 only ANS: D
Other side effects that can occur include the following: • Airway obstruction due to rapid liquefaction of secretions • Disagreeable odor due to hydrogen sulfide • Incompatibility with certain antibiotics (sodium ampicillin, amphotericin B, erythromycin, tetracyclines, and aminoglycosides) if mixed in solution • Increased concentration and toxicity of nebulizer solution toward end of treatment • Nausea and rhinorrhea • Stomatitis • Reactivity of acetylcysteine with rubber, copper, iron, and cork DIF: Application
REF: pp. 725-726 OBJ: 3
44. Which of the following is a contraindication for the use of nitric oxide? a. Neonates older than 34 weeks b. Hypoxic respiratory failure c. Right-to-left shunt dependence d. Pulmonary hypertension ANS: C
Nitric oxide is contraindicated in neonates with dependent right-to-left shunts. DIF: Recall
REF: p. 736
OBJ: 3
45. Which of the following are side effects of dornase alfa administration?
1. Allergic reactions due to antibody production in the patient against dornase alfa 2. Chest pain 3. Rash 4. Laryngitis a. 1, 2, and 3 only b. 1, 3, and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: C
Common side effects associated with dornase alfa have included pharyngitis and voice alteration, laryngitis, rash, chest pain, and conjunctivitis. DIF: Recall
REF: p. 726
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 46. Bland aerosols are best classified as: a. mucolytics. b. bronchodilators. c. expectorants. d. mucoactive therapy. ANS: C
Bland aerosols are therefore more properly considered expectorants rather than mucolytic agents. DIF: Recall
REF: p. 726
OBJ: 2
47. Which of the following should be assessed during the administration of mucolytic agents?
1. Breathing pattern and rate 2. Monitoring peak flow changes 3. Patient’s reaction to treatment 4. Monitoring for presence of hydrogen sulfide (a rotten egg odor), which means that the acetylcysteine (Mucomyst) is no longer active a. 1 and 3 only b. 1, 2, and 3 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: B
During treatment and short term: • Instruct and then verify correct use of aerosol nebulization system, including cleaning. • Assess therapy based on indication for drug: mucolysis and improved clearance of secretions. • Monitor airflow changes or adverse effects such as a decrease in FEV 1 . • Assess breathing pattern and rate. • Assess patient’s subjective reaction to treatment (changes in breathing effort or pattern). • Discontinue therapy if patient experiences adverse reactions. DIF: Application
REF: p. 727
OBJ: 6
48. Which of the following FEV 1 values indicates severe compromise of expiratory airflow that
may contraindicate the use of mucoactive therapy? a. Less than 65% b. Less than 55% c. Less than 35% d. Less than 25% ANS: D
Generally, if the FEV 1 is less than 25% of predicted, it becomes difficult to mobilize and expectorate secretions. DIF: Recall
REF: p. 727
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 49. The National Asthma Education and Prevention Program guidelines advocate the use of oral
corticosteroids for which of the following? a. Acute asthma exacerbations b. Maintenance of severe persistent asthma c. Maintenance of moderate to severe persistent asthma d. Maintenance of mild to moderate persistent asthma ANS: D
The primary use of orally inhaled corticosteroids is for antiinflammatory maintenance therapy of persistent asthma. DIF: Recall
REF: p. 727
OBJ: 5
50. Which of the following is not an available formulation strength for fluticasone propionate
(Flovent) by metered dose inhaler? a. 44 mcg/puff b. 110 mcg/puff c. 220 mcg/puff d. 250 mcg/puff ANS: D
See Table 35-5. DIF: Recall
REF: p. 728
OBJ: 4
51. Which of the following are true regarding glucocorticoids?
1. Theywork through activation of intracellular receptors. 2. Relief is immediate. 3. Daily compliance is essential to controlling inflammation in asthma. 4. They work in a similar fashion to adrenergic bronchodilators. a. 1 and 3 only b. 1, 3, and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: A
Because steroid action involves modification of cell transcription, full antiinflammatory effects require hours to days. It is important for patients to understand that inhalation of an aerosolized steroid will not provide immediate relief as with an adrenergic bronchodilator. However, daily compliance with the inhaled medication is essential to controlling the inflammation of asthma. DIF: Recall
REF: p. 727
OBJ: 3
52. Aerosolized delivery of corticosteroids usually does not manifest in adrenal suppression
compared to systemic use as long as the daily dose in adults is kept below what level? a. 800 mcg b. 1000 mcg c. 1200 mcg
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. 1400 mcg ANS: A
The systemic effect of adrenal suppression is not usually seen with inhaled doses less than 800 mcg/day in adults or less than 400 mcg/day in children. DIF: Recall
REF: p. 727
OBJ: 4
53. Which of the following inhaled corticosteroids is a prodrug? a. Ciclesonide b. Flunisolide c. Budesonide d. Triamcinolone ANS: A
Ciclesonide, a prodrug, is given as an inactive compound and is converted to an active metabolite, desisobutyryl-ciclesonide (des-CIC), by intracellular enzymes. DIF: Recall
REF: p. 727
OBJ: 2
54. Which of the following is NOT considered part of the assessment of severity of symptoms
recommended by the NAEPP and GOLD guidelines to modify level or dosage of corticosteroids? a. Number of exacerbations b. Missed work or school days c. Pulmonary function d. Use of anticholinergics ANS: D
Assess severity of symptoms (coughing, wheezing, nocturnal awakenings, symptoms during exertion; use of rescue bronchodilator; number of exacerbations, missed work/school days; and pulmonary function), and modify level or dosage as recommended by NAEPP and GOLD guidelines. DIF: Recall
REF: p. 729
OBJ: 3
55. Which of the following are considered nonsteroidal antiasthma drugs?
1. Cromolyn-like agents 2. Leukotriene modifiers 3. Anti-IgE agents 4. Anti-IgA agents a. 1 and 3 only b. 1, 2, and 3 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: B
Nonsteroidal antiinflammatory agents include the cromolyn-like agents (cromolyn sodium); the antileukotrienes, also termed leukotriene modifiers (zafirlukast, zileuton, and montelukast); and a new class, monoclonal antibodies or anti-IgE agents (omalizumab).
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 729
OBJ: 2
56. How does cromolyn sodium work? a. Produces antiinflammatory enzymes within cells. b. Inhibits degranulation of mast cells. c. Prevents arachidonic acid formation from activation of mast cell membrane
phospholipase A2 . d. Provides leukotriene inhibition. ANS: B
Cromolyn sodium acts by inhibiting the degranulation of mast cells in response to allergic and nonallergic stimuli. DIF: Recall
REF: p. 730
OBJ: 3
57. Which of the following are medications contain fluticasone furoate?
1. Arnuity Ellipta 2. Breo Ellipta 3. Combivent Respimat 4. Advair Diskus a. 1 and 2 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: A
See Table 35-5. DIF: Recall
REF: p. 728
OBJ: 3
58. Zileuton belongs to which of the following categories? a. Cromolyn-like agents b. Leukotriene modifiers c. Anti-IgE agents d. Anti-IgA agents ANS: B
Zileuton inhibits the 5-lipoxygenase enzyme that catalyzes the formation of leukotrienes from arachidonic acid, as also shown in Figure 35-8. DIF: Recall
REF: p. 729
OBJ: 2
59. Which of the following are considered an aerosolized antiinfective agent?
1. Pentamidine 2. Ribavirin 3. Tobramycin 4. Amikacin a. 1 and 3 only b. 1, 2, and 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Pentamidine, ribavirin, inhaled tobramycin, and zanamivir are antiinfective agents. They are briefly outlined in the chapter text. DIF: Recall
REF: p. 732
OBJ: 2
60. Pentamidine is indicated for the treatment of which of the following diseases? a. Pneumocystis jiroveci b. Tuberculosis c. HIV infection d. Pneumococcal pneumonia ANS: A
Pentamidine isethionate is an antiprotozoal agent that has been used in the treatment of opportunistic pneumonia caused by Pneumocystis carinii (PCP). DIF: Recall
REF: p. 732
OBJ: 3
61. When administering aerosolized pentamidine, what should the respiratory care practitioner
do? 1. Use a nebulizer that produces particles in the 1- to 2-µm mean mass aerodynamic diameter (MMAD) range. 2. Use a nebulizer system with one-way valves and scavenging expiratory filters. 3. Provide isolation and an environmental containment system. 4. Screen patients for human immunodeficiency virus (HIV). a. 1 and 2 only b. 2 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
When administering aerosolized pentamidine, isolation, an environmental containment system (e.g., a booth or negative pressure room), and personnel barrier protection should be provided. Subjects should be screened for tuberculosis. The drug is given using a nebulizer system with one-way valves and scavenging expiratory filters (e.g., the Respirgard). This reduces environmental contamination. Nebulizer systems capable of producing an MMAD of 1 to 2 µm for peripheral lung deposition may reduce coughing. DIF: Application
REF: p. 732
OBJ: 5
62. Which of the following is true about the use of ribavirin?
1. It is used as an antiviral agent against respiratory syncytial virus. 2. It is delivered via a Respirgard unit. 3. Adverse effects include skin rash, conjunctivitis, and eyelid erythema. 4. It can occlude endotracheal tube and ventilator exhalation valves. a. 1 and 2 only
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
b. 3 and 4 only c. 1, 3, and 4 only d. 1, 2, 3, and 4 ANS: C
Administration of the aerosol requires use of a special large-reservoir nebulizer called the small particle aerosol generator (SPAG). DIF: Recall
REF: p. 733
OBJ: 5
63. Which of the following is true about the use of tobramycin?
1. It is primarily used by patients with cystic fibrosis. 2. It is intended to manage chronic infections with Pseudomonas aeruginosa. 3. It prevents deterioration of lung function due to recurrent infections. 4. It has very good lung bioavailability. 5. It is associated with a high rate of bacterial resistance. a. 1 and 2 only b. 3 and 5 only c. 1, 2, 3, and 5 only d. 1, 2, 4, and 5 only ANS: C
Patients with cystic fibrosis (CF) have chronic respiratory infection with Pseudomonas aeruginosa, as well as other microorganisms. Such chronic infection causes recurrent acute respiratory infections and deterioration of lung function. With the exception of the quinoline derivatives such as ciprofloxacin, antibiotics such as the aminoglycosides (e.g., tobramycin), which are effective against Pseudomonas organisms, have poor lung bioavailability when taken orally. Consequently, such antibiotics must be given either intravenously or by inhalation. The aminoglycoside, tobramycin, has been approved for inhaled administration and is intended to manage chronic infection with P. aeruginosa in CF. Goals of therapy are to treat or prevent early colonization with P. aeruginosa and maintain present lung function or reduce the rate of deterioration. The emergence of bacterial resistance was not seen in clinical trials with inhaled tobramycin. DIF: Recall
REF: p. 733
OBJ: 5
64. Side effects associated with parenteral administration of aminoglycosides include which of the
following? 1. Ototoxicity 2. Voice alteration 3. Nephrotoxicity 4. Deafness a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: D
See Box 35-5.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 733
OBJ: 3
65. Inhaled zanamivir is indicated for which of the following treatment of uncomplicated
respiratory illness? a. Pharyngitis b. Croup c. Epiglottitis d. Influenza ANS: D
Inhaled zanamivir is indicated for the treatment of uncomplicated acute illness due to influenza virus in adults and children 5 years of age or older, who have been symptomatic for no longer than 2 days. DIF: Recall
REF: p. 734
OBJ: 5
66. What is the mechanism behind nitric oxide (INO max )? a. It dilates pulmonary arterial vascular beds and affects platelet aggregation. b. It inhibits the degranulation of mast cells. c. It inhibits the 5-lipoxygenase enzyme that catalyzes the formation of leukotrienes
from arachidonic acid. d. It relaxes vascular smooth muscle by binding to the heme group of cystolic guanylate, activating guanylate cyclase, increasing cyclic GMP. ANS: D
When inhaled, nitric oxide produces pulmonary vasodilation, reducing pulmonary artery pressure and improving mismatching. DIF: Recall
REF: pp. 735-736 OBJ: 3
67. In addition to nitric oxide, which of the following inhalational agents have been approved by
the U.S. Food and Drug Administration for the treatment of pulmonary hypertension? 1. Treprostenil 2. Epoprostenol 3. Iloprost 4. Alprostadil a. 2 only b. 1 and 3 only c. 1, 2, 3, and 4 d. 2 and 4 only ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
The use of nitric oxide gas to treat neonates with persistent pulmonary hypertension is approved by the FDA and is discussed in detail in Chapter 41. In addition to this medical gas, inhaled medications are being tested and used to treat pulmonary hypertension. Several such agents are being studied, including epoprostenol (Flolan) and alprostadil (Prostin VR Pediatric); however, only two, iloprost and treprostenil, are approved by the FDA for widespread use. DIF: Recall
REF: p. 735
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 36 - Airway Management Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. What is the primary indication for tracheal suctioning? a. Presence of pneumonia b. Presence of atelectasis c. Ineffective coughing d. Retention of secretions ANS: D
Excerpts from the AARC guideline (CPG 36-1) include indications, contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring. DIF: Recall
REF: p. 741
OBJ: 1
2. What is the most common complication of suctioning? a. Hypoxemia b. Hypotension c. Arrhythmias d. Infection ANS: A
Excerpts from the AARC guideline (CPG 36-1) include indications, contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring. DIF: Recall
REF: p. 741
OBJ: 1
3. Complications of tracheal suctioning include which of the following?
1. Bronchospasm 2. Hyperinflation 3. Mucosal trauma 4. Elevated intracranial pressure a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
Complications of tracheal suctioning include bronchospasm, mucosal trauma, and elevated intracranial pressures. DIF: Recall 4.
REF: p. 741
OBJ: 1
How often should patients be suctioned? a. At least once every 2 to 3 hr b. Whenever they are moved or ambulated
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. When physical findings support the need d. Whenever the charge nurse requests it ANS: C
A patient should never be suctioned according to a preset schedule. DIF: Recall 5.
REF: p. 742
OBJ: 1
What is the normal range of negative pressure to use when suctioning an adult patient? a. –100 to –120 mm Hg b. –80 to –100 mm Hg c. –60 to –80 mm Hg d. –20 to –30 mm Hg ANS: A
The suction pressure should be set at the lowest effective level. Negative pressures of 80 to 100 mm Hg in neonates and less than 150 mm Hg in adults are generally recommended DIF: Recall 6.
REF: p. 742
OBJ: 1
What is the normal range of negative pressure to use when suctioning children? a. –60 to –80 mm Hg b. –80 to –100 mm Hg c. –100 to –120 mm Hg d. –120 to –150 mm Hg ANS: C
The suction pressure should be set at the lowest effective level. Negative pressures of 80 to 100 mm Hg in neonates and less than 150 mm Hg in adults are generally recommended. DIF: Recall 7.
REF: p. 742
OBJ: 1
You are about to suction a 10-year-old patient who has a 6-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter that you would use in this case? a. 6 Fr b. 8 Fr c. 10 Fr d. 14 Fr ANS: C
See Rule of Thumb 36-1. DIF: Application 8.
REF: p. 742
OBJ: 1
You are about to suction a female patient who has an 8-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter you would use in this case? a. 8 Fr b. 10 Fr c. 12 Fr
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. 14 Fr ANS: D
See Rule of Thumb 36-1. DIF: Application 9.
REF: p. 742
OBJ: 1
To prevent hypoxemia when suctioning a patient, the respiratory care practitioner should initially do which of the following? a. Manually ventilate the patient with a resuscitator. b. Preoxygenate the patient with 100% oxygen. c. Give the patient a bronchodilator treatment. d. Have the patient hyperventilate for 2 min. ANS: B
First, preoxygenation helps minimize the incidence of hypoxemia during suctioning. DIF: Application 10.
REF: p. 743
OBJ: 1
To maintain positive end expiratory pressure (PEEP) and high FiO 2 when suctioning a mechanically ventilated patient, what would you recommend? a. Limit suction time to no more than 5 sec. b. Use a closed-system multiuse suction catheter. c. Limit suctioning to once an hour. d. Use the smallest possible catheter. ANS: B
Basic indications for the use of closed suction catheters can be found in Box 36-2. DIF: Application 11.
REF: p. 743
OBJ: 1
Total application time for endotracheal suction in adults should not exceed which of the following? a. 20 to 25 sec b. 15 to 20 sec c. 10 to 15 sec d. 3 to 5 sec ANS: C
Keep total suction time to less than 10 to 15 sec. DIF: Recall 12.
REF: p. 743
OBJ: 1
While suctioning a patient, you observe an abrupt change in the electrocardiogram waveform being displayed on the cardiac monitor. Which of the following actions would be most appropriate? a. Change to a smaller catheter and repeat the procedure. b. Stop suctioning and immediately administer oxygen. c. Stop suctioning and report your findings to the nurse. d. Decrease the amount of negative pressure being used.
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ANS: B
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
If any major change is seen in the heart rate or rhythm, immediately stop suctioning and administer oxygen to the patient, providing manual ventilation as needed. DIF: Analysis 13.
REF: p. 744
OBJ: 1
Which of the following methods can help to reduce the likelihood of atelectasis due to tracheal suctioning? 1. Limit the amount of negative pressure used. 2. Hyperinflate the patient before and after the procedure. 3. Suction for as short a period of time as possible. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Atelectasis can be caused by removal of too much air from the lungs. You can avoid this complication by (1) limiting the amount of negative pressure used, (2) keeping the duration of suctioning as short as possible, and (3) providing hyperinflation before and after the procedure. DIF: Recall 14.
REF: p. 744
OBJ: 1
Which of the following can help to minimize the likelihood of mucosal trauma during suctioning? 1. Use as large a catheter as possible. 2. Rotate the catheter while withdrawing. 3. Use as rigid a catheter as possible. 4. Limit the amount of negative pressure. a. 1 and 2 only b. 2 and 4 only c. 3 and 4 only d. 1, 2, and 4 only ANS: B
To avoid this problem, limit the amount of negative pressure used and always rotate the catheter while withdrawing. DIF: Recall 15.
REF: p. 744
OBJ: 1
Absolute contraindication for nasotracheal suctioning includes which of the following? 1. Epiglottitis 2. Croup 3. Irritable airway a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: A
Excerpts from the AARC guideline (CPG 36-2) include indications, contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring. DIF: Recall 16.
REF: p. 741
OBJ: 1
Which of the following equipment is needed to perform nasotracheal suctioning? 1. Suction kit (catheter, gloves, basin, etc.) 2. Laryngoscope with MacIntosh and Miller blades 3. Oxygen delivery system (mask and manual resuscitator) 4. Bottle of sterile water or saline solution a. 1 and 3 only b. 1, 3, and 4 only c. 2 and 4 only d. 2, 3, and 4 only ANS: B
See Box 36-1. DIF: Recall 17.
REF: p. 742
OBJ: 1
After repeated nasotracheal suctioning over 2 days, a patient with retained secretions develops minor bleeding through the nose. Which of the following actions would you recommend? a. Perform a tracheotomy for better access to the lower airway. b. Discontinue nasotracheal suctioning for 48 hr and reassess. c. Stop the bleeding and use a nasopharyngeal airway for access. d. Orally intubate the patient for better access to the lower airway. ANS: C
Placement of a nasopharyngeal airway can help minimize nasal trauma when repeated access is needed. DIF: Application 18.
REF: p. 744
OBJ: 1
Before the suctioning of a patient, auscultation reveals coarse breath sounds during both inspiration and expiration. After suctioning, the coarseness disappears, but expiratory wheezing is heard over both lung fields. What is most likely the problem? a. Secretions are still present and the patient should be suctioned again. b. The patient has hyperactive airways and has developed bronchospasm. c. A pneumothorax has developed and the patient needs a chest tube. d. The patient has developed a mucous plug and should undergo bronchoscopy. ANS: B
The bronchospastic response may be particularly strong in patients with hyperactive airway disease. These patients should be assessed for the development of wheezes associated with suctioning. DIF: Analysis
REF: p. 746
OBJ: 1
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 19.
What general condition requires airway management? 1. Airway compromise 2. Respiratory failure 3. Need to protect the airway a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Excerpts from the AARC guideline (CPG 36-3) include indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring. DIF: Recall 20.
REF: pp. 747-748 OBJ: 3
Which of the following conditions require emergency tracheal intubation? 1. Upper airwayor laryngeal edema 2. Loss of protective reflexes 3. Cardiopulmonary arrest 4. Traumatic upper airway obstruction a. 1 and 4 only b. 3 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: D
Excerpts from the AARC guideline (CPG 36-3) include indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring. DIF: Recall 21.
REF: pp. 747-748 OBJ: 3
Which of the following autonomic or protective neural responses represent potential hazards of emergency airway management? 1. Hypotension 2. Bradycardia 3. Cardiac arrhythmias 4. Laryngospasm a. 1, 2, and 3 only b. 1 and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
Excerpts from the AARC guideline (CPG 36-3) include indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: pp. 747-748 OBJ: 4 22.
Which of the following indicate an inability to adequately protect the airway? 1. Wheezing 2. Coma 3. Lack of gag reflex 4. Inability to cough a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Excerpts from the AARC guideline (CPG 36-3) include indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring. DIF: Recall 23.
REF: pp. 747-748 OBJ: 4
Which of the following types of artificial airways are inserted through the larynx? 1. Pharyngeal airways 2. Tracheostomy tubes 3. Nasotracheal tubes 4. Orotracheal tubes a. 1 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: C
The two basic types of tracheal airways are endotracheal (translaryngeal) tubes and tracheostomy tubes. Endotracheal tubes are inserted through either the mouth or nose (orotracheal or nasotracheal), through the larynx, and into the trachea. DIF: Recall 24.
REF: p. 749
OBJ: 3
Compared with the nasal route, the advantages of oral intubation include which of the following? 1. Reduced risk of kinking 2. Less retching and gagging 3. Easier suctioning 4. Less traumatic insertion a. 1 and 3 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 1, 3, and 4 only ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
A summary of the advantages and disadvantages of each of these three approaches appears in Table 36-1. DIF: Recall 25.
REF: p. 750
OBJ: 3
Compared with the oral route, the advantages of nasal intubation include which of the following? 1. Reduced risk of kinking 2. Less retching and gagging 3. Less accidental extubation 4. Greater long-term comfort a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
A summary of the advantages and disadvantages of each of these three approaches appears in Table 36-1. DIF: Recall 26.
REF: p. 750
OBJ: 3
Compared with translaryngeal intubation, the advantages of tracheostomy include which of the following? 1. Greater patient comfort 2. Reduced risk of bronchial intubation 3. No upper airway complications 4. Decreased frequency of aspiration a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
A summary of the advantages and disadvantages of each of these three approaches appears in Table 36-1. DIF: Recall 27.
REF: p. 750
OBJ: 3
What is the standard size for endotracheal or tracheostomy tube adapters? a. 22-mm external diameter b. 15-mm external diameter c. 15-mm internal diameter d. 22-mm internal diameter ANS: B
The proximal end of the tube is attached to a standard adapter with a 15-mm external diameter. DIF: Recall
REF: p. 749
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 28.
What is the purpose of the additional side port (Murphy eye) on most modern endotracheal tubes? a. Protect the airway against aspiration. b. Help ascertain proper tube position. c. Minimize mucosal trauma during insertion. d. Ensure gas flow if the main port is blocked. ANS: D
In addition to the beveled opening at the tip, there should be an additional side port or ―Murphy eye,‖ which ensures gas flow if the main port should become obstructed. The tube cuff is permanently bonded to the tube body. Inflation of the cuff seals off the lower airway, either for protection from aspiration or to provide positive pressure ventilation. DIF: Recall 29.
OBJ: 3
What is the purpose of a cuff on an artificial tracheal airway? a. To seal off and protect the lower airway b. To stabilize the tube and prevent its movement c. To provide a means to determine tube position via radiograph d. To help clinicians determine the depth of tube insertion ANS: A
30.
REF: p. 749
DIF: Recall
REF: p. 749
OBJ: 7
What is the purpose of the pilot balloon on an endotracheal or a tracheostomy tube? a. To help ascertain proper tube position b. To minimize mucosal trauma during insertion c. To monitor cuff status and pressure d. To protect the airway against aspiration ANS: C
A small filling tube leads from the cuff to a pilot balloon, used to monitor cuff status and pressure once the tube is in place. DIF: Recall 31.
REF: p. 749
OBJ: 6
Which of the following features incorporated into most modern endotracheal tubes assist in verifying proper tube placement? 1. Length markings on the curved body of the tube 2. Imbedded radiopaque indicator near the tube tip 3. Additional side port (Murphy eye) near the tube tip a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: A
Not shown, but included with most modern endotracheal tubes, is a radiopaque indicator that is embedded in the distal end of the tube body. This indicator allows for easy identification of tube position on radiograph.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall 32.
REF: p. 749
OBJ: 6
The removable inner cannula commonly incorporated into modern tracheostomy tubes serves which of the following purposes? 1. Aid in routine tube cleaning and tracheostomy care 2. Prevent the tube from slipping into the trachea 3. Provide a patent airway should it become obstructed a. 1 and 3 only b. 2 and 3 only c. 3 only d. 1, 2, and 3 ANS: A
A removable inner cannula with a standard 15-mm adapter is normally kept in place within the outer cannula but can be removed for routine cleaning or if it becomes obstructed. DIF: Recall 33.
REF: p. 751
OBJ: 7
What is the purpose of a tracheostomy tube obturator? a. To minimize trauma to the tracheal mucosal during insertion b. To provide a patent airway should the tube become obstructed c. To help ascertain the proper tube position by radiograph d. To provide a means to inflate and deflate the tube cuff ANS: A
An obturator with a rounded tip is used for tube insertion. Prior to insertion, the obturator is placed within the outer cannula, with its tip extending just beyond the far end of the tube. This minimizes mucosal trauma during insertion. DIF: Recall 34.
REF: p. 751
OBJ: 7
In the absence of neck or facial injuries, what is the procedure of choice to establish a patent tracheal airway in an emergency? a. Surgical tracheotomy b. Orotracheal intubation c. Nasotracheal intubation d. Cricothyrotomy ANS: B
Orotracheal intubation is the preferred route for establishing an emergency tracheal airway. DIF: Application 35.
REF: p. 753
OBJ: 5
While checking a crash cart for intubation equipment, you find the following: suction equipment, oxygen apparatus, two laryngoscopes and assorted blades, five tubes, Magill forceps, tape, lubricating gel, and local anesthetic. What is missing? 1. Obturator 2. Syringe(s) 3. Resuscitator bag and mask
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
4. Tube stylet a. 1, 2, and 3 only b. 2 and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: C
Box 36-3 lists the equipment necessary for intubation. DIF: Application 36.
REF: p. 753
OBJ: 5
Before beginning an intubation procedure, the practitioner should check and confirm the operation of which of the following? 1. Laryngoscope light source 2. Endotracheal tube cuff 3. Suction equipment 4. Cardiac defibrillator a. 1, 2, and 3 only b. 2 and 4 only c. 3 and 4 only d. 1, 3, and 4 only ANS: A
Before beginning an intubation procedure, the practitioner should confirm the operation of suction equipment, oxygen, airway equipment, monitors, and esophageal detectors and check position of the patient. DIF: Recall 37.
REF: p. 753
OBJ: 5
While checking a Miller and a MacIntosh blade on an intubation tray during an emergency intubation, you find that the Miller blade ―lights‖ but the MacIntosh blade does not. What should you do now? a. Swap the defective MacIntosh for the good Miller blade. b. Check and replace the bulb in the MacIntosh blade. c. Replace the batteries in the laryngoscope handle. d. Check and clean the laryngoscope handle electrical contact. ANS: B
If the light does not function, first check that the bulb is tight. If the scope still does not light, check the batteries or replace the bulb. DIF: Analysis 38.
REF: p. 753
OBJ: 5
What size endotracheal tube would you select to intubate a 3-year-old child? a. 3.0 to 4.0 mm b. 4.5 to 5.0 mm c. 5.5 to 6.0 mm d. 6.0 to 7.0 mm ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Table 36-4 lists recommended orotracheal tube sizes according to patient weight or age. DIF: Application 39.
REF: p. 753
OBJ: 5
What size endotracheal tube would you select to intubate a 1500-g newborn infant? a. 2.5 mm b. 3.0 mm c. 3.5 mm d. 4.0 mm ANS: B
Table 36-4 lists recommended orotracheal tube sizes according to patient weight or age. DIF: Application 40.
REF: p. 753
OBJ: 5
What size endotracheal tube would you select to intubate an adult female? a. 6 mm b. 7 mm c. 8 mm d. 9 mm ANS: C
Table 36-4 lists recommended orotracheal tube sizes according to patient weight or age. DIF: Application 41.
REF: p. 753
OBJ: 5
What is the purpose of an endotracheal tube stylet? a. It helps ascertain proper tube position. b. It adds rigidity and shape to ease insertion. c. It minimizes mucosal trauma during insertion. d. It protects the airway against aspiration. ANS: B
Some clinicians insert a stylet into the tube to add rigidity and maintain shape during insertion. DIF: Recall 42.
REF: p. 753
OBJ: 5
To make oral intubation easier, how should the patient’s head and neck be positioned? a. Neck extended over the edge of the bed, with head dangling down b. Neck extended, with head supported by towel and flexed forward c. Both the neck and head fully extended, with neck supported by towel d. Neck flexed, with head supported by towel and tilted back ANS: D
You achieve this alignment by combining moderate cervical flexion with extension of the atlantooccipital joint. Placement of one or more rolled towels under the patient’s head helps. You then flex the neck and tilt the head backward with your hand (Figure 36-14). DIF: Recall
REF: p. 753
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 43.
What should be the maximum time devoted to any intubation attempt? a. 30 sec b. 60 sec c. 90 sec d. 2 min ANS: A
Do not devote more than 30 sec to any intubation attempt. DIF: Recall 44.
REF: p. 754
OBJ: 5
Which of the following statements are true about methods used to displace the epiglottis during oral intubation? a. Regardless of the blade used, the laryngoscope is lifted up and forward. b. The curved (MacIntosh) blade lifts the epiglottis indirectly. c. The straight (Miller) blade lifts the epiglottis directly. d. Levering the laryngoscope against the teeth can aid displacement. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
In lifting the tip of the blade, you should avoid levering the laryngoscope against the teeth, as this can damage the teeth and gums. DIF: Recall 45.
REF: p. 754
OBJ: 5
During oral intubation of an adult, the endotracheal tube should be advanced into the trachea about how far? a. Until its cuff has passed the cords b. Just far enough so that the tube cuff is no longer visible c. Until its cuff has passed the cords by 2 to 3 in d. Until its tip has passed the cords by 2 to 3 cm ANS: A
Once you see the tube tip pass through the glottis, advance it until the cuff has passed the vocal cords. DIF: Recall 46.
REF: p. 754
OBJ: 5
Immediately after insertion of an oral endotracheal tube on an adult, what should you do? 1. Stabilize it with your right hand. 2. Inflate the tube cuff. 3. Provide ventilation or oxygenation. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. 1, 2, and 3 ANS: D
Once the tube is in place, stabilize it with the right hand, and use the left hand to remove the laryngoscope and stylet. Then inflate the cuff to seal the airway and immediately provide ventilation and oxygenation. DIF: Application 47.
REF: p. 755
OBJ: 5
Ideally, the distal tip of a properly positioned endotracheal tube (in an adult man) should be positioned approximately how far above the carina? a. 1 to 3 cm b. 3 to 6 cm c. 7 to 9 cm d. 4 to 6 in ANS: B
Ideally, the tip of an endotracheal tube should be positioned in the trachea approximately 5 cm above the carina. DIF: Recall 48.
REF: p. 755
OBJ: 6
Which of the following bedside methods can absolutely confirm proper endotracheal tube position in the trachea? a. Auscultation b. Observation of chest movement c. Tube length (cm to teeth) d. Fiberoptic laryngoscopy ANS: D
With the exception of fiberoptic laryngoscopy, none of these methods can absolutely confirm proper tube placement. DIF: Recall 49.
REF: pp. 755-756 OBJ: 6
What is the average distance from the tip of a properly positioned oral endotracheal tube to the incisors of an adult man? a. 16 to 18 cm b. 19 to 21 cm c. 21 to 23 cm d. 24 to 26 cm ANS: C
As indicated in Table 36-2 the average length from the teeth (incisors) to the tip of a properly positioned oral endotracheal tube in males is between 21 and 23 cm. DIF: Recall 50.
REF: p. 755
OBJ: 6
When using a bulb-type esophageal detection device (EDD) during an intubation attempt, how do you know that the endotracheal tube is in the esophagus?
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a. b. c. d.
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
The bulb fails to reexpand upon release. The bulb quickly reexpands upon release. The bulb cannot be completely squeezed closed. The bulb cannot be attached to the endotracheal tube.
ANS: A
If the tube is in the esophagus, it will not reinflate because the esophagus collapses around the endotracheal tube. DIF: Recall 51.
REF: p. 755
OBJ: 6
After an intubation attempt, an expired capnogram indicates a CO 2 level near zero. What does this finding probably indicate? a. Abnormally high ventilation/perfusion ratio ( ) b. Placement of the endotracheal tube in the esophagus c. Placement of the endotracheal tube in the trachea d. Failure of the cuff to properly seal the airway ANS: B
If the tube is in the esophagus, CO2 levels remain near zero. DIF: Recall 52.
REF: p. 756
OBJ: 6
When using capnometry or colorimetry to differentiate esophageal from tracheal placement of an endotracheal tube, which of the following conditions can result in a false -negative finding (i.e., no CO 2 present even when the tube is in the trachea)? a. Cardiac arrest b. Gastric CO 2 diffusion c. Right main stem intubation d. Delivery of a high FiO 2 ANS: A
In cardiac arrest victims, however, expired CO 2 levels may be near zero because of poor pulmonary blood flow, yielding a false-negative result. DIF: Recall 53.
REF: p. 756
OBJ: 6
After intubation of a cardiac arrest victim, you observe a slow but steady rise in the expired CO 2 levels as measured by a bedside capnometer. Which of the following best explains this observation? a. Return of spontaneous circulation b. Abnormally high c. Placement of the endotracheal tube in the esophagus d. Failure of the cuff to properly seal the airway ANS: A
Generally, expired CO2 levels increase with the return of spontaneous circulation. DIF: Application
REF: p. 756
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 54.
Serious complications of oral intubation include which of the following? 1. Cardiac arrest 2. Acute hypoxemia 3. Bradycardia 4. Tongue lacerations a. 2 and 4 only b. 1, 2, and 3 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: B
The most common complication of emergency airway management is tissue trauma. The most serious complications are acute hypoxemia, hypercapnia, bradycardia, and cardiac arrest. Examples include intubation of patients when the oral route is unavailable, such as maxillofacial injuries or oral surgery. DIF: Recall 55.
REF: p. 758
OBJ: 8
You are assisting a physician in the emergency care of a patient with a maxillofacial injury who will require short-term ventilatory support. Which of the following airway approaches would you recommend? a. Intubate via the oral route. b. Insert an oropharyngeal airway. c. Perform an emergency tracheotomy. d. Intubate via the nasal route. ANS: D
With the maxillofacial injury, the oral cavity will not be accessible. Intubation via the nasal route may be required. It is a short term need so a tracheotomy will not be necessary. DIF: Application 56.
REF: p. 758
OBJ: 3
To provide local anesthesia and vasoconstriction during nasal intubation, what would you recommend? a. Nasal spray of 0.25% phenylephrine b. SVN aerosol delivery of 2% lidocaine for 10 min c. Mixture of 0.25% phenylephrine and 3% lidocaine d. SVN aerosol delivery of 0.25% phenylephrine for 10 min ANS: C
A mixture of 0.25% phenylephrine and 3% lidocaine may be applied to the nasal mucosa with a long cotton tip swab to provide local anesthesia and vasoconstriction of the nasal passage. DIF: Application 57.
REF: p. 758
OBJ: 5
Successful tube passage through the larynx during blind nasotracheal intubation is indicated by which of the following? 1. Louder breath sounds 2. Harsh cough
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. Vocal silence a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: C
Successful passage of the tube through the larynx usually is indicated by a harsh cough, followed by vocal silence. DIF: Recall 58.
REF: p. 759
OBJ: 6
What is the primary indication for tracheostomy? a. When a patient loses pharyngeal or laryngeal reflexes b. When a patient has a long-term need for an artificial airway c. When a patient has been orally intubated for more than 24 hr d. When a patient has upper airway obstruction due to secretions ANS: B
Tracheotomy is the preferred, primary route for overcoming upper airway obstruction or trauma and for long-term care of patients with neuromuscular disease. DIF: Recall 59.
REF: p. 759
OBJ: 7
Which of the following factors should be considered when deciding to change from an endotracheal tube to a tracheostomy tube? 1. Patient’s tolerance of the endotracheal tube 2. Relative risks of continued intubation versus tracheostomy 3. Patient’s severity of illness and overall condition 4. Length of time that the patient will need an artificial airway 5. Patient’s ability to tolerate a surgical procedure a. 1, 3, and 4 only b. 3, 4, and 5 only c. 2, 3, 4, and 5 only d. 1, 2, 3, 4, and 5 ANS: D
Pertinent factors that should be considered in making this decision are summarized in Box 36-5. DIF: Recall 60.
REF: p. 759
OBJ: 7
In a properly performed traditional surgical tracheotomy, entrance to the trachea is made through an incision in what area? a. Through or between the first and second tracheal rings b. Through the ligament between the thyroid and cricoid cartilages c. Through or between the second and third tracheal rings d. Between the cricoid cartilage and the first tracheal ring ANS: C
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
In the traditional surgical tracheotomy, the surgeon makes an incision in the neck over the second or third tracheal ring. DIF: Recall 61.
REF: p. 759
OBJ: 7
A surgical resident has asked that you assist in an elective tracheotomy procedure on an orally intubated patient. Which of the following would be an appropriate action? a. Remove the oral tube just before tracheostomy tube insertion. b. Remove the oral tube before the tracheotomy is performed. c. Pull the oral tube only after the tracheostomy tube is placed. d. Withdraw the oral tube 2 to 3 in while the incision is made. ANS: D
After dissection to the anterior tracheal wall, the endotracheal tube is retracted to keep the tip of the tube inside the larynx. DIF: Application 62.
REF: p. 759
OBJ: 7
Compared with traditional surgical tracheostomy, which of the following are true about percutaneous dilatational tracheostomy? 1. Percutaneous dilatational tracheostomy has a lower incidence of complications. 2. Percutaneous dilatational tracheostomy is faster than traditional tracheostomy. 3. Percutaneous dilatational tracheostomy can be performed at the bedside. 4. Percutaneous dilatational tracheostomy does not require anterior neck dissection. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Compared with the traditional surgical procedure, percutaneous dilatational tracheotomy is rapid with fewer complications from the surgical site and has a better cosmetic appearance after decannulation. DIF: Recall 63.
REF: pp. 760-761 OBJ: 7
Which of the following techniques may be used to diagnose injury associated with artificial airways? 1. Laryngoscopy or bronchoscopy 2. Physical examination 3. Air tomography 4. Pulmonary function studies a. 1 and 2 only b. 1 and 3 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Techniques commonly used to diagnose airway damage include physical examination, air tomography, fluoroscopy, laryngoscopy, bronchoscopy, magnetic resonance imaging, and pulmonary function studies. DIF: Recall 64.
REF: p. 763
OBJ: 8
What is the most common sign associated with the transient glottic edema or vocal cord inflammation that follows extubation? a. Difficulty in swallowing b. Wheezing c. Orthopnea d. Hoarseness ANS: D
The primary symptoms of glottic edema and vocal cord inflammation are hoarseness and stridor. DIF: Recall 65.
REF: p. 763
OBJ: 8
Soon after endotracheal tube extubation, an adult patient exhibits a high-pitched inspiratory noise, heard without a stethoscope. Which of the following actions would you recommend? a. STAT-heated aerosol treatment with saline b. STAT racemic epinephrine aerosol treatment c. Careful observation of the patient for 6 hr d. Immediate reintubation via the nasal route ANS: B
Stridor is often treated with epinephrine (2.25% racemic solution or levoepinephrine 1:1000) via aerosol. DIF: Application 66.
REF: p. 763
OBJ: 8
After removal of an oral endotracheal tube, a patient exhibits hoarseness and stridor that do not resolve with racemic epinephrine treatments. What is most likely the problem? a. Vocal cord paralysis b. Tracheoesophageal fistula c. Glottic edema or cord inflammation d. Tracheomalacia ANS: A
Vocal cord paralysis is likely in extubated patients with hoarseness and stridor that does not resolve with treatment or time. DIF: Recall 67.
REF: p. 763
OBJ: 8
Which of the following injuries are seen with tracheostomy tubes? 1. Tracheomalacia 2. Tracheal stenosis 3. Glottic edema 4. Vocal cord granulomas
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a. b. c. d.
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1 and 2 only 2 and 4 only 3 and 4 only 1, 2, and 3 only
ANS: A
Whereas laryngeal lesions occur only with oral or nasal endotracheal tubes, tracheal lesions can occur with any tracheal airway. These tracheal lesions are granulomas, tracheomalacia, and tracheal stenosis. DIF: Recall 68.
REF: p. 763
OBJ: 8
Tracheal stenosis occurs in as many as 1 in 10 patients after prolonged tracheostomy. At what sites does this stenosis usually occur? 1. Cuff site 2. Tip of the tube 3. Stoma site a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
In patients with tracheostomy tubes, stenosis may occur at the cuff, tube tip, or stoma sites, with the stoma site being the most common. DIF: Recall 69.
REF: p. 763
OBJ: 8
A patient is being evaluated for tracheal damage sustained while having undergone prolonged tracheostomy intubation approximately 3 months earlier. The flow-volume loop demonstrates a fixed obstructive pattern. What is the most likely cause of the problem? a. Tracheomalacia b. Laryngeal web c. Cord paralysis d. Tracheal stenosis ANS: D
Tracheal stenosis will appear as a fixed obstructive pattern, with flattening of both the inspiratory and expiratory limbs of the flow-volume loop (Figure 36-25). DIF: Recall 70.
REF: p. 763
OBJ: 8
A patient has been receiving positive-pressure ventilation through a tracheostomy tube for 4 days. In the past 2 days, there is evidence of both recurrent aspiration and abdominal distention but minimal air leakage around the tube cuff. What is most likely cause of the problem? a. Paralysis of the vocal cords b. Underinflated tube cuff c. Tracheoesophageal fistula
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Tracheoinnominate fistula ANS: C
Diagnosis can be made by a history of recurrent aspiration and abdominal distention as air is forced into the esophagus during positive-pressure ventilation. DIF: Recall 71.
REF: p. 763
OBJ: 8
A physician is concerned about the potential for tracheal damage due to tube movement in a patient who recently underwent tracheotomy and is now receiving 40% oxygen through a T tube (Briggs adapter). Which of the following would be the best way to limit tube movement in this patient? a. Give a neuromuscular blocker to prevent patient movement. b. Secure the T tube delivery tubing to the bed rail. c. Tape the T tube to the tracheostomy tube connector. d. Switch from the T tube to a tracheostomy collar. ANS: D
If the tracheostomy patient requires oxygen therapy, tracheostomy collars are preferred to T tubes or Briggs adapters. DIF: Recall 72.
REF: p. 767
OBJ: 8
Which of the following techniques or procedures should be used to help minimize infection of a tracheotomy stoma? 1. Regular aseptic stoma cleaning 2. Adherence to sterile techniques 3. Regular change of tracheostomy dressings a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Good tracheostomy care, including aseptic cleaning of the stoma with sterile normal saline or half strength hydrogen peroxide, should be carried out routinely. DIF: Recall 73.
REF: p. 768
OBJ: 8
When checking for proper placement of an endotracheal tube or a tracheostomy tube on a chest radiograph, how far above the carina should the distal tip of the tube be positioned? a. 1 to 2 cm b. 2 to 4 cm c. 3 to 6 cm d. 6 to 8 cm ANS: C
The tube tip should be approximately 3 to 6 cm above the carina in adults, or between the second and fourth tracheal rings.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 765 OBJ: 6 74.
When checking for proper placement of an endotracheal tube in an adult patient on chest radiograph, it is noted that the distal tip of the tube is 2 cm above the carina. Which of the following actions would you recommend? a. Withdraw the tube by 2 to 3 cm (using tube markings as a guide). b. Withdraw the tube by 7 to 8 cm (using tube markings as a guide). c. Advance the tube by 2 to 3 cm (using tube markings as a guide). d. Advance the tube by 7 to 8 cm (using tube markings as a guide). ANS: A
If the tube is malpositioned, you should remove the old tape and reposition the tube, using the centimeter markings as a guide. DIF: Application 75.
REF: p. 765
OBJ: 6
An alert patient with a long-term need for a tracheostomy tube (because of recurrent aspiration) is having difficulty communicating with the intensive care unit staff. Which of the following would you recommend to help this patient communicate better? 1. Use a letter, phrase, or picture board. 2. Consider switching to a fenestrated tracheostomy tube. 3. Consider a ―talking‖ tracheostomy tube. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: B
A better solution is a letter, phrase, or picture board. These devices allow patients to communicate by simple pointing. Large and simple drawings are particularly important for patients who cannot clearly see print. For conscious patients with a long-term tracheostomy and ventilator dependent, communication can be enhanced with a ―talking‖ tracheostomy tube (Figure 36-29). DIF: Application 76.
REF: pp. 766-767 OBJ: 9
To ensure adequate humidification for a patient with an artificial airway, inspired gas at the proximal airway should be 100% saturated with water vapor and at which of the following temperatures? a. 32° to 35° C b. 37° to 40° C c. 30° to 32° C d. 40° to 42° C ANS: A
These devices can provide saturated gas to the airway at temperatures between 32° and 35° C. DIF: Recall
REF: p. 767
OBJ: 9
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 77.
Tracheal airways increase the incidence of pulmonary infections for which of the following reasons? 1. Lower levels of humidification 2. Increased aspiration of pharyngeal material 3. Contaminated equipment or solutions 4. Ineffective clearance through cough a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
As indicated in Box 36-7, there are several reasons why tracheal tubes increase the incidence of pulmonary infection. DIF: Recall 78.
REF: p. 768
OBJ: 8
Which of the following is likely to increase the likelihood of damage to the tracheal mucosa? a. Maintaining cuff pressures below 20 to 25 mm Hg b. Using the minimal leak technique for inflation c. Using a low-residual-volume, low-compliance cuff d. Monitoring intracuff pressures every 1 to 2 hr ANS: C
In the past, high-pressure tracheal tube cuffs were a major cause of airway damage. Since the 1970s, high-residual-volume, low-pressure cuffs have become the norm (see Figure 36-34). DIF: Application 79.
REF: p. 768
OBJ: 10
What is the maximum recommended range for tracheal tube cuff pressures? a. 15 to 20 mm Hg b. 20 to 25 mm Hg c. 25 to 30 mm Hg d. 30 to 35 mm Hg ANS: B
The goal is to keep cuff pressures below the tracheal mucosal capillary perfusion pressure, estimated to range between 20 and 25 mm Hg to help minimize aspiration. DIF: Recall 80.
REF: p. 768
OBJ: 10
Repeated connecting and disconnecting of a cuff pressure manometer to the pilot tube of a cuffed tracheal airway will do which of the following? a. Increase cuff pressure. b. Not affect cuff pressure. c. Decrease cuff pressure. d. Rupture the cuff. ANS: C
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Attaching the measurement system to the pilot tube evacuates some volume from the cuff (and lowers its pressure). For this reason, you should always adjust the pressure to the desired level, never just measure it. DIF: Recall 81.
REF: p. 769
OBJ: 10
An adult man on ventilatory support has just been intubated with a 7-mm oral endotracheal tube equipped with a high-residual-volume, low-pressure cuff. When sealing the cuff to achieve a minimal occluding volume, you note a cuff pressure of 45 cm H2 O. What is most likely the problem? a. The tube chosen is too small for the patient. b. The cuff pilot balloon and line are obstructed. c. The tube is in the right main stem bronchus. d. The cuff has herniated over the tube tip. ANS: A
High pressures may be caused by the need to overinflate the cuff to seal the airway. This problem is common if the tube chosen is too small for the patient’s trachea, positioned too high in the trachea or if the patient has developed tracheomalacia which is softening of the tracheal tissue. DIF: Recall 82.
REF: p. 774
OBJ: 10
Which of the following is false about cuff inflation techniques (MOV = minimal occluding volume; MLT = minimal leak technique)? a. The MLT approach negates the need for pressure monitoring. b. The MLT allows a small leak at peak or end of inspiration. c. At MOV, air leakage around the tube cuff should cease. d. With MLT, secretions tend to be blown upward during inflation. ANS: A
Cuff pressure measurements should be done regularly to maintain the cuff pressure in the safe range to avoid tracheal wall injury and minimize risk of aspiration of oral secretions. DIF: Application 83.
REF: p. 766
OBJ: 12
120. What is the normal range of negative pressure to use when suctioning infants? a. –60 to –80 mm Hg b. –80 to –100 mm Hg c. –100 to –120 mm Hg d. –150 to –200 mm Hg ANS: B
The suction pressure should be set at the lowest effective level. Negative pressures of 80 to 100 mm Hg in neonates and less than 150 mm Hg in adults are generally recommended. DIF: Recall 84.
REF: p. 742
OBJ: 1
Which of the following statements are true about the potential for aspiration in patients with cuffed tracheal tubes?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1. Periodic oropharyngeal suctioning can help to minimize aspiration. 2. Aspiration is least likely in spontaneously breathing patients. 3. The methylene blue test can help detect leakage-type aspiration. 4. Aspiration is more likely with tracheostomy tubes than with endotracheal tubes. a. 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: D
Aspiration is reported to be more common in spontaneously breathing patients than in those patients receiving positive-pressure ventilation. This may be due to the movement of pharyngeal secretions around the cuff during the negative-pressure phase of a spontaneous inspiration. DIF: Application 85.
REF: p. 770
OBJ: 9
To minimize the problems associated with pharyngeal aspiration in intubated patients, which of the following could you recommend? 1. Position patients in semi-recumbent position. 2. Insert the feeding tube into the duodenum. 3. Suction above the tracheal tube cuff. 4. Provide continuous aspiration of subglottic secretions. a. 1 only b. 1 and 2 only c. 1, 2, 3, and 4 d. 2, 3, and 4 only ANS: C
Ideally, the patient should be switched to a tube that continually aspirates subglottic secretions. If this is not possible, oropharyngeal suctioning (above the tube cuff) should be performed as needed. To decrease the possibility of aspiration with feedings, the head of the bed should be elevated 30 degrees when possible. Also, the feeding tube can be inserted into the duodenum, with its position confirmed by radiograph. The use of slightly higher cuff pressure during and after feedings may also minimize aspiration. DIF: Recall 86.
REF: p. 770
OBJ: 9
A patient with a tracheal airway exhibits signs of tube obstruction. Which of the following are possible causes of this obstruction? 1. The tube cuff has herniated over the tip of the tube. 2. The tube is obstructed by a mucus plug or secretions. 3. The tube is kinked, or the patient is biting the tube. 4. The tube orifice is impinging on the tracheal wall. a. 2 and 4 only b. 3 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4
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ANS: D
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Obstruction of the tube is one of the most common causes of airway emergencies. Tube obstruction can be caused by (1) the kinking of the tube or the patient biting on the tube, (2) herniation of the cuff over the tube tip, (3) obstruction of the tube orifice against the tracheal wall, and (4) mucus plugging (Figure 36-36). DIF: Recall 87.
REF: p. 772
OBJ: 9
A patient with a tracheostomy tube is receiving positive-pressure ventilation through a volume ventilator. Over the past 5 min, the peak inspiratory pressure has risen, and the pressure limit alarm is now sounding. On quick examination, you notice a generalized decreased in breath sounds. Which of the following problems is most likely? a. Partial obstruction of the tracheostomy tube b. Complete obstruction of the tracheostomy tube c. Development of a left-sided pneumothorax d. Obstruction of the left bronchus by a mucus plug ANS: A
A spontaneously breathing patient with partial airway obstruction will exhibit decreased breath sounds and decreased airflow through the tube. If the patient is receiving volume-controlled ventilation, peak inspiratory pressures will rise, often causing the high-pressure alarm to sound; during pressure-controlled ventilation, delivered tidal volumes will fall. DIF: Analysis 88.
REF: p. 772
OBJ: 9
A patient with a tracheal airway exhibits severe respiratory distress. On quick examination, you notice the complete absence of breath sounds and no gas flowing through the airway. What is most likely the problem? a. Partial tube obstruction b. Right-sided pneumothorax c. Complete tube obstruction d. Vocal cord paralysis ANS: C
With complete tube obstruction, the patient will exhibit severe distress, no breath sounds will be heard, and there will be no gas flow through the tube. DIF: Application 89.
REF: p. 772
OBJ: 9
After determining a patient has a complete obstruction of an oral endotracheal tube, your efforts to relieve the obstruction by moving the patient’s head and neck and deflating the cuff both fail. What should be your next step? a. Immediately extubate the patient. b. Try to pass a suction catheter. c. Call for an emergency tracheotomy. d. Apply manual positive pressure. ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
If you cannot clear the obstruction by using the above techniques, you must remove the airway and replace it. DIF: Application 90.
REF: p. 772
OBJ: 11
A patient receiving mechanical ventilatory support accidentally displaces the endotracheal tube out of the trachea. What would be the most appropriate action at this time? a. Remove the tube and provide manual ventilation or oxygenation as necessary. b. Push the tube back into the trachea by moving the patient’s neck up and down. c. Suction the oropharynx with a Yankauer (tonsillar) suction tip. d. Apply manual ventilation or oxygenation directly through the endotracheal tube. ANS: A
In these cases, completely remove the tube and provide ventilatory support as needed until the patient can be reintubated or the tracheostomy tube reinserted. DIF: Analysis 91.
REF: p. 774
OBJ: 9
What does a positive cuff leak test indicate? a. The patient has significant upper airway edema. b. The patient’s neuromuscular function is adequate to protect the lower airway. c. The patient is at minimal risk for upper airway obstruction. d. The patient’s muscle strength will provide an effective cough. ANS: C
The presence of a peritubular leak during spontaneous breathing indicates no encroachment of airway (a positive test). DIF: Recall 92.
REF: p. 768
OBJ: 13
Which of the following indicate that a patient being considered for extubation can provide adequate clearance of pulmonary secretions? 1. The patient has a maximum inspiratory pressure of 73 cm H2 O. 2. The patient is alert and cooperative. 3. The patient has a dead space-to-tidal volume ratio of 0.7. 4. The patient coughs rigorously on suctioning. a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Excerpts from the AARC guideline (CPG 36-4) include indications, contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring. DIF: Recall 93.
REF: pp. 776-778 OBJ: 11
Which of the following equipment would you gather before assisting in extubation of a patient? 1. Suctioning apparatus
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. Oxygen or aerosol therapy equipment 3. Manual resuscitator and mask 4. Nebulizer with racemic epinephrine 5. Intubation tray a. 1, 2, and 3 only b. 2 and 4 only c. 2, 3, 4, and 5 only d. 1, 2, 3, 4, and 5 ANS: D
Needed equipment includes suctioning apparatus, two age-appropriate suction kits with sterile suction catheters and gloves, tonsillar suction tip (Yankauer), 10 or 12 ml syringe, oxygen and aerosol therapy equipment, manual resuscitator and mask, aerosol nebulizer with racemic epinephrine and normal saline (if ordered), and an intubation tray. DIF: Recall 94.
REF: p. 775
OBJ: 11
A physician has requested your assistance in extubating an orally intubated patient. Which of the following should be done before the tube itself is removed? 1. Suction the orolaryngopharynx 2. Preoxygenate the patient 3. Suction the endotracheal tube 4. Confirm cuff inflation a. 2 and 4 only b. 1, 2, and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: D
Step 1: Assess Patient for Indications. Generally, a patient should never be suctioned according to a preset schedule. Although very thick secretions may not move with airflow and may not create any adventitious sounds, the patient should be assessed for clinical indicators, such as rhonchi heard on auscultation, which suggest the need for suctioning Step 2: Suction the Endotracheal Tube and Pharynx to Above the Cuff. Suctioning before extubation helps prevent aspiration of secretions after cuff deflation. After use, dispose of the first suction kit and prepare another for use, or prepare a rigid tonsillar (Yankauer) suction tip. Because patients will often cough after the tube is pulled, you may need to help them clear secretions. Step 3: Oxygenate the Patient Well After Suctioning. Extubation is a stressful procedure that can cause hypoxemia and unwanted cardiovascular side effects. Administer 100% oxygen for 1 to 2 min to help avoid these problems. Step 4: Deflate the Cuff. Attach the 10 or 12 ml syringe to the pilot tubing. Withdraw the air from the cuff while applying positive pressure to direct any pooled secretions above the cuff up into the oropharynx where they can immediately be suctioned with the tonsillar suction tip. Listen for an audible leak around the tube. If no audible leak is present reinflate the cuff and discuss with the physician how to proceed. DIF: Application
REF: p. 775
OBJ: 11
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 95.
Although different techniques are used to actually remove the endotracheal tube during an extubation procedure, all aim to ensure which of the following? a. Maximal adduction of the vocal cords b. Maximal abduction of the vocal cords c. Maintenance of the appropriate cuff pressure d. Elimination of the pharyngeal (gag) reflex ANS: B
The technique used to remove the tube should help avoid aspiration of pharyngeal secretions and maximally abduct the vocal cords. DIF: Recall 96.
REF: p. 778
OBJ: 11
To minimize laryngeal swelling, a physician orders ―continuous aerosol therapy‖ after the extubation of a patient. Which of the following specific approaches would you recommend? a. Heated mist therapy through a jet nebulizer and aerosol mask b. Cool mist therapy through a jet nebulizer and aerosol mask c. Oxygen therapy through a ―venti-mask‖ and bubble humidifier d. Racemic epinephrine or saline through a small jet nebulizer ANS: B
If humidity/aerosol therapy is indicated, most clinicians suggest a cool mist immediately after extubation. DIF: Application 97.
REF: p. 778
OBJ: 11
You have been asked to monitor a patient who has just been extubated. Which of the following parameters would you monitor? 1. Color 2. Breath sounds 3. Vital signs 4. Inspiratory force a. 1, 2, and 3 only b. 2 and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: A
After extubation, check for good air movement by auscultation. Stridor or decreased air movement after extubation indicates upper airway problems. Next, assess the patient’s respiratory rate, breathing pattern, heart rate, blood pressure, and oxygen saturation. DIF: Recall 98.
REF: p. 778
OBJ: 11
An adult patient receiving cool mist therapy after extubation begins to develop stridor. Which of the following actions would you recommend? a. Change from cool mist to heated aerosol. b. Re-intubate the patient immediately. c. Administer a racemic epinephrine treatment.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Draw and analyze an arterial blood gas. ANS: C
Because laryngeal edema may worsen with time and stridor may develop, be sure that racemic epinephrine for nebulization is available. DIF: Application 99.
REF: p. 778
OBJ: 11
What is a rare but serious complication associated with endotracheal tube extubation? a. Bradycardia b. Aspiration c. Infection d. Laryngospasm ANS: D
A rare, but serious, complication associated with extubation is laryngospasm. DIF: Recall 100.
REF: p. 778
OBJ: 11
Which of the following approaches may be used in ―weaning‖ a patient from a tracheostomy tube? 1. Using progressively smaller tubes 2. Using a fenestrated tube 3. Using a tracheostomy button a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Weaning is accomplished by using fenestrated tubes, progressively smaller tubes, or tracheostomy buttons. DIF: Recall 101.
REF: p. 779
OBJ: 11
A physician asks you to assess the upper airway function of a patient with a fenestrated tracheostomy tube. How should this be accomplished? a. Replace the inner cannula, plug the proximal opening, and inflate the cuff. b. Remove the inner cannula, plug the proximal opening, and deflate the cuff. c. Remove the inner cannula, plug the proximal opening, and inflate the cuff. d. Replace the inner cannula, plug the proximal opening, and deflate the cuff. ANS: B
Removal of the inner cannula opens the fenestration allowing air to pass into the upper airway. Capping or placing a peaking valve on the proximal opening of the tube’s outer cannula, accompanied by deflation of the cuff, allows for assessment of upper airway function. DIF: Recall
REF: p. 779
OBJ: 11
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 102.
What is the most common problem with fenestrated tracheostomy tubes? a. Relative frequency of accidental extubation b. Increased likelihood of tracheomalacia c. Poor positioning of the tube fenestration d. Inability to provide mechanical ventilation ANS: C
One problem associated with this type of tracheostomy tube is malposition of the fenestration, such as between the skin and stoma, or against the posterior wall of the larynx. DIF: Recall 103.
REF: p. 779
OBJ: 11
For which of the following purposes is a tracheal button appropriate? 1. Facilitate secretion removal. 2. Protect the airways from aspiration. 3. Relieve airway obstruction. 4. Aid in positive-pressure ventilation. a. 1 and 3 only b. 2 and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: A
Because the tracheal button has no cuff, its use is limited to relieving airway obstruction and aiding the removal of secretions. DIF: Recall 104.
REF: p. 779
OBJ: 11
Therapeutic indications for fiberoptic bronchoscopy include which of the following? 1. Inspect the airways. 2. Retrieve foreign bodies. 3. Obtain specimens for analysis. 4. Aid endotracheal intubation. a. 2 and 4 only b. 3 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: D
The purposes of bronchoscopy are to inspect the airway, remove objects from the airway, collect samples from the airway, and place devices into the airway. DIF: Recall 105.
REF: p. 783
OBJ: 13
In which of the following conditions should fiberoptic bronchoscopy not be performed if the risks outweigh the potential benefits? 1. Uncorrected bleeding disorders 2. Presence of lung abscess 3. Refractory hypoxemia
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
4. Unstable hemodynamic status a. 2 and 3 only b. 2 and 4 only c. 1, 3, and 4 only d. 1, 2, 3, and 4 ANS: C
Excerpts from the AARC guideline, including indications, contraindications, precautions and/or possible complications, assessment of need, assessment of outcome, and monitoring, appear on pp. 784-785. DIF: Recall 106.
REF: p. 783
OBJ: 13
Complications of fiberoptic bronchoscopy include which of the following? 1. Hypocapnia 2. Infection 3. Hypotension 4. Hypoxemia a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Excerpts from the AARC guideline (CPG 36-5) include indications, contraindications, precautions and/or possible complications, assessment of need, assessment of outcome, and monitoring. DIF: Recall 107.
REF: p. 785
OBJ: 13
Key points to consider in planning fiberoptic bronchoscopy include which of the following? 1. Equipment preparation 2. Premedication 3. Airway preparation 4. Monitoring a. 2 and 4 only b. 3 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: D
Key points to consider in planning and conducting fiberoptic bronchoscopy include premedication, equipment preparation, airway preparation, and monitoring. DIF: Recall 108.
REF: p. 786
OBJ: 13
Which of the following are appropriate orders before an elective fiberoptic bronchoscopy procedure scheduled for the next morning? 1. Have patient take nothing by mouth (NPO) after midnight.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. Establish vascular access. 3. Premedicate with a benzodiazepine. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
To reduce the risk of aspiration due to gagging and loss of airway reflexes, the patient should refrain from food or drink for at least 8 hr prior to the start of the procedure. In addition, if the intravenous route is not already available, vascular access should be obtained prior to the start of the procedure. Bronchoscopy is an uncomfortable procedure. To decrease anxiety, the patient should be premedicated 30 to 45 min before the procedure. DIF: Recall 109.
REF: p. 786
OBJ: 13
For which of the following reasons is atropine often used during fiberoptic bronchoscopy? 1. To dry the patient’s airway 2. To decrease vagal responses 3. To provide topical anesthesia a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: A
This promotes anesthetic deposition, aids visibility, and can reduce procedure time. An anticholinergic agent, such as atropine given prior to the procedure, is used for this purpose. Atropine may also help decrease vagal responses (such as bradycardia and hypotension) that can occur during bronchoscopy. DIF: Recall 110.
REF: p. 783
OBJ: 13
During fiberoptic bronchoscopy, a patient receiving intravenous fentanyl exhibits signs of respiratory depression. Which of the following would you recommend? a. Increase the oxygen flow rate and continue monitoring. b. Immediately administer naloxone (Narcan). c. Decrease the oxygen flow rate and continue monitoring. d. Immediately administer neostigmine or prostigmine. ANS: B
Of course, caution must be taken to avoid respiratory depression. Should it occur, naloxone (Narcan) must be available. DIF: Application 111.
REF: p. 787
OBJ: 13
Equipment required for patient support and monitoring during a fiberoptic bronchoscopy procedure includes which of the following? 1. Pulse oximeter
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. Oxygen cannula 3. Electrocardiographic monitor 4. Capnometer a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Box 36-9 provides a list of needed equipment. DIF: Recall 112.
REF: p. 786
OBJ: 13
Which of the following are goals of airway preparation before conducting fiberoptic bronchoscopy? 1. To decrease cough and gagging 2. To decrease pain 3. To prevent bleeding a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
The goals of airwaypreparation are to prevent bleeding, decrease cough and gagging, and decrease pain. DIF: Recall 113.
REF: p. 786
OBJ: 13
Which of the following drugs can be used to prevent bleeding during fiberoptic bronchoscopy? 1. Phenylephrine 2. Dopamine HCl 3. Epinephrine a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
Topical vasoconstrictors such as pseudoephedrine or dilute epinephrine (usually 1:10,000) may be used to prevent or treat bleeding. DIF: Recall 114.
REF: p. 786
OBJ: 13
Lower airway anesthesia for fiberoptic bronchoscopy can be achieved via which of the following routes of administration? 1. Bronchoscopic instillation 2. Intravenous administration
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. Nebulization (aerosol delivery) a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: B
Lidocaine is commonly delivered by an atomizer to the nose, by mouthwash to the oropharynx, and by nebulizer and/or instillation through the bronchoscope to the lower airways. DIF: Recall 115.
REF: p. 786
OBJ: 13
During fiberoptic bronchoscopy, a patient’s SpO 2 drops from 91% to 87%. Which of the following actions would be appropriate? 1. Apply suction through the scope’s open channel. 2. Give oxygen through the scope’s open channel. 3. Increase the cannula or mask oxygen flow. a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
If desaturation occurs, the FiO 2 should be increased with an oxygen therapy device. Alternatively, the procedure can be temporarily halted, and oxygen can be given through the scope’s open channel. The latter technique has the advantage of defogging the scope and diffusing any secretions. Suctioning for brief periods will help reduce the incidence or severity of hypoxemia. DIF: Application 116.
REF: p. 787
OBJ: 13
A patient exhibits persistent mild hypoxemia after a fiberoptic bronchoscopy procedure. Which of the following would you recommend? a. Continue oxygen therapy and reassess in 4 hr. b. Administer a benzodiazepine (e.g., Valium or Versed). c. Administer a racemic epinephrine aerosol treatment. d. Have the patient refrain from eating or drinking. ANS: A
Hypoxemia that occurs during the procedure may persist after completion. Oxygen therapy should be maintained for up to 4 hr. DIF: Application 117.
REF: p. 787
OBJ: 13
To avoid the risk of aspiration after a fiberoptic bronchoscopy procedure, what would you recommend that the patient do? a. Be placed in the supine Trendelenburg position for 2 hr. b. Remain in a sitting position and NPO until sensation returns.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. Receive additional aerosolized lidocaine by nebulizer. d. Be continuously monitored for oxygenation through pulse oximetry. ANS: B
The risk of aspiration persists as long as the airway is anesthetized. Therefore, patients should remain in a sitting position and refrain from eating or drinking until sensation returns. DIF: Application 118.
REF: p. 787
OBJ: 13
A patient exhibits persistent stridor after a fiberoptic bronchoscopy procedure. Which of the following would you recommend? a. Aerosol therapy with albuterol (Proventil) b. Administration of a benzodiazepine (e.g., Valium) c. Aerosol therapy with racemic epinephrine d. Administration of a narcotic antagonist (e.g., Narcan) ANS: C
Patients should also be assessed for the development of stridor or wheezes. The physician should be notified and appropriate aerosol therapy with nebulized racemic epinephrine or bronchodilators should be instituted. DIF: Application 119.
REF: p. 787
OBJ: 13
The major limitations of using a laryngeal mask airway are: 1. It should not be used in conscious or semicomatose patients. 2. Gastric distention may occur if ventilating pressures greater than 20 cm H2 O are needed. 3. It does not provide absolute protection against aspiration of gastric contents. a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
There are two major limitations to its use. First, it cannot be used in the conscious or semicomatose patient due to stimulation of the gag reflex. Second, if ventilating pressures greater than 20 cm H 2 O are needed, gastric distention may occur. In addition, it may not provide absolute protection against aspiration. DIF: Recall
REF: p. 781
OBJ: 12
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 38 - Humidity and Bland Aerosol Therapy Kacmarek et al.: Egan’s Funda mentals of Respiratory Care, 12th Editio n MULTIPLE CHOICE 1. What is the point in the respiratory track where inspired gas reaches body temperature,
ambient pressure, saturated (BTPS) conditions? a. Point of thermal equilibrium b. Hygroscopic saturation boundary c. Thermal inversion boundary d. Isothermic saturation boundary ANS: D
As inspired gas moves into the lungs, it achieves BTPS conditions (body temperature, 37° C; barometric pressure; saturated with water vapor [100% relative humidity at 37° C]). This point, normally approximately 5 cm below the carina, is called the isothermic saturation boundary. DIF: Recall
REF: p. 821
OBJ: 1
2. Which of the following is false about the isothermic saturation boundary (ISB)? a. Below the ISB, temperature and relative humidity remain constant. b. Above the ISB, temperature and humidity increase during exhalation. c. The ISB is normally located just below the larynx (vocal cords). d. Above the ISB, temperature and humidity decrease during inspiration. ANS: C
This point, normally approximately 5 cm below the carina, is called the isothermic saturation boundary (ISB). Above the ISB, temperature and humidity decrease during inspiration and increase during exhalation. DIF: Recall
REF: p. 821
OBJ: 1
3. Which of the following factors cause the isothermic saturation boundary (ISB) to shift farther
down into the airways? 1. Decreased ambient temperature 2. Increased tidal volume (VT) 3. Endotracheal intubation a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
The ISB shifts distally when a person breathes through the mouth rather than the nose; when he or she breathes cold, dry air; when the upper airway is bypassed (breathing through an artificial tracheal airway); or when the minute ventilation is higher than normal.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 821 OBJ: 1 4. What is the primary goal of humidity therapy? a. Decrease airway reactivity to cold. b. Maintain normal physiologic conditions. c. Deliver drugs to the airway. d. Reduce upper airway inflammation. ANS: B
The primary goal of humidification is to maintain normal physiological conditions in the lower airways. DIF: Recall
REF: p. 821
OBJ: 3
5. Indications for warming inspired gases include which of the following?
1. Treating a patient whose airways are reactive to cold 2. Providing humidification when the upper airway is bypassed 3. Treating a patient with a low body temperature (hypothermia) 4. Reducing upper airway inflammation or swelling a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
See Box 38-1. DIF: Recall
REF: p. 821
OBJ: 2
6. Administration of dry gases at flows exceeding 4 L/min can cause which of the following?
1. Structural damage 2. Heat loss 3. Water loss a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
Administration of dry medical gases at flows greater than 4 L/min to the upper airway causes immediate heat and water loss and, if prolonged, causes structural damage to the epithelium. DIF: Recall
REF: p. 821
OBJ: 2
7. Inhalation of dry gases can do which of the following?
1. Increase viscosity of secretions. 2. Impair mucociliary motility. 3. Increase airway irritability. a. 1 and 2 only b. 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 1 and 3 only d. 1, 2, and 3 ANS: D
As the airway is exposed to relatively cold, dry air, ciliary motility is reduced, airways become more irritable, mucous production increases, and pulmonary secretions become inspissated (thickened due to dehydration). DIF: Recall
REF: p. 821
OBJ: 2
8. Which of the following inspired conditions should be maintained when delivering medical
gases to the nose or mouth? a. 50% relative humidity (RH) at 20° to 22° C b. 100% RH at 20° to 22° C c. 80% RH at 28° to 32° C d. 100% RH at 32° to 35° C ANS: A
See Table 38-1. DIF: Recall
REF: p. 821
OBJ: 3
9. Which of the following inspired conditions should be maintained when delivering medical
gases to the hypopharynx, as when administering oxygen (O2 ) by nasal catheter? a. 50% relative humidity (RH) at 20° to 22° C b. 100% RH at 20° to 22° C c. 95% RH at 29° to 32° C d. 100% RH at 32° to 35° C ANS: C
See Table 38-1. DIF: Recall
REF: p. 822
OBJ: 3
10. Which of the following inspired conditions should be maintained when delivering medical
gases directly into the trachea through an endotracheal tube or a tracheotomy tube? a. 50% relative humidity (RH) at 20° to 22° C b. 100% RH at 37° to 42° C c. 95% RH at 29° to 32° C d. 100% RH at 32° to 35° C ANS: D
See Table 38-1. DIF: Recall
REF: p. 822
OBJ: 3
11. Clinical indications for delivering cool humidified gas include which of the following?
1. Postextubation edema 2. Upper airway inflammation 3. Croup (laryngotracheal bronchitis)
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
4. Epiglottitis a. 2, 3, and 4 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 2 and 3 only ANS: C
The delivery of cool humidified gas is used to treat upper airway inflammation resulting from croup, epiglottitis, and postextubation edema. DIF: Recall
REF: p. 822
OBJ: 3
12. What device adds molecular water to gas? a. Agitator b. Humidifier c. Nebulizer d. Atomizer ANS: B
A humidifier is a device that adds molecular water to gas. DIF: Recall
REF: p. 822
OBJ: 4
13. Factors affecting a humidifier’s performance include which of the following?
1. Surface area 2. Temperature 3. Time of contact 4. Outlet size a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
The following four variables affect the quality of a humidifier’s performance: (1) temperature, (2) surface area, (3) time of contact, and (4) thermal mass. DIF: Recall
REF: p. 823
OBJ: 5
14. What is the most important factor determining a humidifier’s performance? a. Surface area b. Temperature c. Time of contact d. Gas flow ANS: B
Temperature is an important factor affecting humidifier performance. DIF: Recall
REF: p. 823
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 15. The greater the temperature of the gas, the: a. more water vapor it can hold. b. less water vapor it can hold. c. less efficient the humidifier is. d. more water vapor is lost. ANS: A
The greater the temperature of a gas, the more water vapor it can hold (increased capacity). DIF: Recall
REF: p. 823
OBJ: 5
16. Gas leaving an unheated humidifier at 10° C and 100% relative humidity (absolute humidity =
9.4 mg/L) would provide what relative humidity at body temperature? a. Approximately 100% b. Approximately 60% c. Approximately 40% d. Approximately 20% ANS: D
Although the humidifier fully saturates the gas, the low operating temperature limits total water vapor capacity to approximately 9.4 mg/L water vapor, equivalent to approximately 21% of body humidity. DIF: Recall
REF: p. 823
OBJ: 6
17. What is the simplest way to increase the humidity output of a humidifier? a. Increase the time that the gas and the water are in contact. b. Increase the surface area between the water and the gas. c. Decrease the water vapor pressure of the gas. d. Increase the temperature of either the water or the gas. ANS: D
Simply heating the humidifier to 40° C (Figure 38-3, right) increases its output to 51 mg/L, which is more than adequate to meet BTPS conditions. DIF: Recall
REF: p. 823
OBJ: 6
18. Which of the following are clinical signs and symptoms of inadequate airway humidification?
1. Atelectasis 2. Dry cough 3. Increased airway resistance 4. Increased incidence of infection 5. Increased work of breathing a. 2, 3, and 4 only b. 1, 2, and 3 only c. 3, 4, and 5 only d. 1, 2, 3, 4, and 5 ANS: D
See Box 38-3.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 822
OBJ: 2
19. Which of the following are true about humidification and contact time?
1. The longer a gas is exposed to water, the greater is the amount of evaporation. 2. The rate of gas flow through a humidifier determines contact time. 3. Low flows decrease and high flows increase relative humidity output. 4. Bubble humidifier contact time depends on the water column depth. a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
In passover and wick-type humidifiers, the flow rate of gas through the humidifier is inversely related to contact time, with high flow rates reducing the time available for evaporation to occur. DIF: Recall
REF: p. 824
OBJ: 6
20. Which of the following types of humidifiers are used in clinical practice?
1. Heat and moisture exchanger 2. Passover humidifier 3. Bubble humidifier a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
Active humidifiers typically include (1) bubble humidifiers, (2) passover humidifiers, (3) nebulizers of bland aerosols, and (4) vaporizers. Passive humidifiers refer to typical heat and moisture exchangers (HMEs). DIF: Recall
REF: p. 824
OBJ: 6
21. Simple unheated bubble humidifiers are commonly used to humidify gases with what type of
systems? a. Mechanical ventilation b. Oronasal O2 delivery c. Tracheal O2 airway d. Aerosol drug delivery ANS: B
Unheated bubble humidifiers are commonly used with oronasal O 2 delivery systems (see Chapter 41) to raise the water vapor content of the gas to ambient levels. DIF: Recall
REF: p. 824
OBJ: 6
22. What is the goal of using an unheated bubble humidifier with oronasal O2 delivery systems?
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. Raise the humidity of the gas to ambient levels. b. Fully saturate the inspired gas to body temperature, ambient pressure, saturated
(BTPS) conditions. c. Cool the gas down to below room temperature. d. Fully saturate the inspired gas to ambient temperature, ambient pressure, saturated
(ATPS) conditions. ANS: A
Unheated bubble humidifiers are commonly used with oronasal O 2 delivery systems (see Chapter 41) the goal is to raise the water vapor content of the gas to ambient levels. DIF: Recall
REF: p. 824
OBJ: 6
23. What is the typical water vapor output of an unheated bubble humidifier? a. 5 to 10 mg/L b. 10 to 15 mg/L c. 15 to 20 mg/L d. 20 to 25 mg/L ANS: C
As indicated in Table 38-2, unheated bubble humidifiers can provide absolute humidity levels between approximately 15 and 20 mg/L. DIF: Recall
REF: p. 825
OBJ: 6
24. Increasing the flow through an unheated bubble humidifier has which of the following
effects? a. Decreasing the water vapor content b. Decreasing the relative humidity c. Increasing the water vapor content d. Increasing the relative humidity ANS: A
As gas flow increases, these devices become less efficient as the reservoir cools and contact time is reduced. DIF: Recall
REF: p. 824
OBJ: 6
25. Unheated bubble humidifiers are of limited effectiveness at flows above which of the
following? a. 4 L/min b. 6 L/min c. 8 L/min d. 10 L/min ANS: D
Unheated bubble humidifiers are of limited effectiveness at flow rates higher than 10 L/min. DIF: Recall
REF: p. 824
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
26. Why should you not heat the reservoirs of a bubble humidifier used with an oronasal O 2
delivery system? a. Condensate will obstruct the delivery tubing. b. Heating will melt the reservoir or cause a fire. c. Heating will absorb the extra water vapor. d. Heating will cause too much aerosol impaction. ANS: A
Heating the reservoirs of these units can increase humidity content but is not recommended because the resulting condensate tends to obstruct the small-bore delivery tubing to which they connect. DIF: Recall
REF: p. 825
OBJ: 6
27. The relief valve on a bubble humidifier serves which of the following functions?
1. It indicates when flow has been interrupted. 2. It protects the device from pressure damage. 3. It warns you when the water level is low. a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
The relief valve on a bubble humidifier serves to warn of flow-path obstruction and to prevent bursting of the humidifier bottle. DIF: Recall
REF: p. 825
OBJ: 6
28. To protect against obstructed or kinked tubing, simple bubble humidifiers incorporate which
of the following? a. HEPA outlet filter b. Pressure relief valve c. Automatic hygrometer d. Electronic alarm system ANS: B
Bubble humidifiers incorporate a simple pressure-relief valve or pop-off. DIF: Recall
REF: p. 825
OBJ: 6
29. The typical pressure pop-off incorporated into most simple bubble humidifiers releases
pressure above which of the following? a. 760 mm Hg b. 10 cm H2 O c. 250 kPa d. 2 psig ANS: D
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Typically, the pop-off is either a gravity or spring-loaded valve that releases pressures above 2 psig. DIF: Recall
REF: p. 825
OBJ: 6
30. When checking an O 2 delivery system that incorporates a bubble humidifier running at 6
L/min, you occlude the delivery tubing, and the humidifier pressure relief immediately pops off. What does this indicate? a. Malfunctioning humidifier b. Normal, leak-free system c. Malfunctioning flowmeter d. Leak in the delivery tubing ANS: B
If the system is obstructed at or near the patient interface and the pop-off sounds, the system is leak free. DIF: Recall
REF: p. 825
OBJ: 6
31. At high flow rates, what do some bubble humidifiers produce? a. Additional heat b. Microorganisms c. Low pressures d. Aerosol particles ANS: D
At high flow rates, bubble humidifiers can produce aerosols. DIF: Recall
REF: p. 825
OBJ: 6
32. What are some types of passover humidifiers?
1. Simple reservoir 2. Membrane 3. Wick a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
There are three common types of passover humidifiers: (1) the simple reservoir type, (2) the wick type, and (3) the membrane type. DIF: Recall
REF: p. 825
OBJ: 6
33. A design that increases surface area and enhances evaporation by incorporating an absorbent
material partially submerged in a water reservoir that is surrounded by a heating element best describes what type of humidifier? a. Bubble b. Wick
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. Cascade d. Hygroscopic ANS: B
Typically a wick is placed upright with the gravity-dependent end in a heated water reservoir. DIF: Recall
REF: p. 825
OBJ: 6
34. Which of the following are true regarding a membrane-type humidifier?
1. Water and gas are separated by a hydrophobic membrane. 2. The membrane is permeable to water vapor but not to liquid water. 3. As with other passover humidifiers, there is no bubbling action. 4. A small layer of liquid water remains on both sides of the membrane. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
A membrane-type humidifier separates the water from the gas stream by means of a hydrophobic membrane (Figure 38-3). Water vapor molecules can easily pass through this membrane, but liquid water (and pathogens) cannot. As with the wick-type humidifier, bubbling does not occur. Moreover, if a membrane-type humidifier were to be inspected while it was in use, no liquid water would be seen in the humidifier chamber. DIF: Recall
REF: p. 824
OBJ: 6
35. Advantages of passover humidifiers include which of the following?
1. They add minimal flow resistance to breathing circuits. 2. They do not require heating to maintain body temperature, ambient pressure, saturated (BTPS) conditions. 3. They do not generate any bacteria-spreading microaerosol. 4. They can maintain water vapor saturation at high flows. a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: D
Compared with bubble humidifiers, passover humidifiers offer several advantages. First, unlike bubble devices, they can maintain saturation at high flow rates. Second, they add little or no flow resistance to spontaneous breathing circuits. Third, they do not generate any aerosols and thus pose a minimal risk for spreading infection. DIF: Recall
REF: p. 825
OBJ: 6
36. Which type of humidifier ―traps‖ the patient’s body heat and expire water vapor to raise the
humidity of inspired gas? a. Membrane
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b. Bubble c. Heat and moisture exchanger d. Passover ANS: C
Like the nose, a heat and moisture exchanger captures exhaled heat and moisture and uses it to heat and humidify the next inspiration. DIF: Recall
REF: p. 825
OBJ: 6
37. Heat and moisture exchangers (HMEs) are mainly used to do what? a. Warm and humid gases delivered to the trachea via ventilator circuits. b. Humidify therapeutic gases delivered at high flows to the lower airway. c. Provide extra humidity for a patient with thick or retained secretions. d. Warm and humid dry therapeutic gases delivered to the upper airway. ANS: A
Traditionally, HME use has been limited to providing humidification to patients receiving invasive ventilatory support via endotracheal or tracheostomy tubes. DIF: Recall
REF: p. 825
OBJ: 3
38. Which of the following are types of heat and moisture exchangers (HMEs)?
1. Simple condenser 2. Hygroscopic condenser 3. Hydrophobic condenser a. 1 and 2 only b. 2 and 3 only c. 1, 2, and 3 d. 3 only ANS: C
There are three basic types of HMEs: (1) simple condenser humidifiers, (2) hygroscopic condenser humidifiers, and (3) hydrophobic condenser humidifiers. DIF: Recall
REF: p. 826
OBJ: 6
39. Which of the following best describes the performance of a typical hygroscopic condenser
HME? a. 40 mg/L water vapor exhaled; 27 mg/L returned b. 40 mg/L water vapor exhaled; 20 mg/L returned c. 27 mg/L water vapor exhaled; 40 mg/L returned d. 44 mg/L water vapor exhaled; 37 mg/L returned ANS: A
These devices typically achieve approximately 70% efficiency (40 mg/L exhaled, 27 mg/L returned). DIF: Recall
REF: p. 826
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 40. A heat and moisture exchanger has an efficiency rating of 80%. What does this mean? a. Of the exhaled water vapor, 80% returns to the patient on inspiration. b. The inspired temperature is 80% of the expired temperature. c. Of the exhaled water vapor, 20% returns to the patient on inspiration. d. The device provides 80% relative humidity at body temperature. ANS: A
These devices typically achieve approximately 70% efficiency (40 mg/L exhaled, 27 mg/L returned). DIF: Analysis
REF: p. 826
OBJ: 6
41. An ideal heat and moisture exchanger (HME) should have an efficiency rating of at least
which of the following? a. 30% b. 50% c. 70% d. 90% ANS: C
The ideal HME should operate at 70% efficiency or better. DIF: Recall
REF: p. 826
OBJ: 6
42. Which of the following are features of an ideal heat and moisture exchanger (HME)?
1. High compliance 2. Minimal dead space 3. 70% or higher efficiency 4. Minimal flow resistance a. 1 and 3 only b. 2, 3, and 4 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: A
The ideal HME should operate at 70% efficiency or better (providing at least 30 mg/L water vapor); use standard connections; have a low compliance; and add minimal weight, dead space, and flow resistance to a breathing circuit. DIF: Recall
REF: p. 826
OBJ: 6
43. Which of the following statements is false of heat and moisture exchangers (HMEs)? a. Moisture output falls at high volumes and rates of breathing. b. High inspiratory flows and high FiO 2 values can decrease HME efficiency. c. In-use HMEs have little effect on flow resistance to breathing. d. HMEs reduce bacterial colonization of ventilator circuits. ANS: C
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
As shown in Table 38-3, the moisture output of HMEs tends to fall at high volumes and rates of breathing. In addition, high inspiratory flows and high FiO 2 levels can decrease HME efficiency. Flow resistance through the HME also is important. When an HME is dry, resistance across most devices is minimal. However, because of water absorption, HME flow resistance increases after several hours’ use. For some patients, the increased resistance imposed by the HME may not be well tolerated, particularly if the underlying lung disease already causes increased work of breathing. Because HMEs eliminate the problem of breathing-circuit condensation, many consider these devices (especially hydrophobic filter HMEs) to be helpful in preventing nosocomial infections. DIF: Recall
REF: p. 826
OBJ: 6
44. For which of the following patients would you select a heated humidifier?
1. Patient receiving O2 through a bypassed upper airway 2. Patient receiving long-term mechanical ventilation 3. Patient receiving O2 through an oronasal mask a. 1 and 2 only b. 2 and 3 only c. 2 only d. 3 only ANS: A
Heated humidifiers are used mainly for patients with bypassed upper airways and/or for those receiving mechanical ventilatory support. DIF: Application
REF: p. 828
OBJ: 6
45. A patient receiving nasal O2 at 3 L/min complains of nasal dryness and irritation. Which of
the following actions would be appropriate? a. Recommending that the flow be decreased to 2 L/min b. Adding a humidifier to the delivery system c. Recommending that the flow be increased to 4 L/min d. Switching to a simple mask at 3 L/min ANS: B
For the occasional patient who complains of nasal dryness or irritation when receiving low-flow O2 , a humidifier should be added to the delivery system. DIF: Application
REF: p. 839
OBJ: 15
46. Which of the following is false about a simple heated humidifier (one that does not
incorporate a servo-control mechanism)? a. The controller regulates the heating element’s electric power. b. The controller monitors the temperature of the heating element. c. The controller varies current to achieve a set airway temperature. d. The patient’s airway does affect the controller. ANS: D
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Humidifier heating systems also have a controller that regulates the element’s electric power. In the simplest systems, the controller monitors the heating element, varying the delivered current to match either a preset or an adjustable temperature. In these systems, the patient’s airway temperature has no effect on the controller. DIF: Recall
REF: p. 828
OBJ: 6
47. Characteristics of a servo-controlled heated humidifier include which of the following?
1. Monitors heater temperature. 2. Adjusts heater power automatically. 3. Provides automatic heater shutdown. 4. Includes temperature safety alarms. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Conversely, a servo-controlled heating system monitors temperature at or near the patient’s airway using a thermistor probe. The controller then adjusts heater power to achieve the desired airway temperature. Both types of controller units usually incorporate alarms and alarm-activated heater shutdown. Box 38-4 outlines key features of modern heated humidification systems. DIF: Recall
REF: p. 828
OBJ: 6
48. A heated humidifier should trigger both auditory and visual alarms and interrupt power to the
heater when the delivered temperature exceeds which of the following? a. 25° C b. 30° C c. 35° C d. 40° C ANS: D
See Box 38-5. DIF: Recall
REF: p. 829
OBJ: 6
49. What should happen when the remote temperature sensor of a heated humidifier becomes
disconnected or fails? 1. Power to the heater should be interrupted. 2. Auditory and visual alarms should trigger. 3. The unit’s outlet valve should lock closed. a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
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See Box 38-5. DIF: Recall
REF: p. 829
OBJ: 6
50. Conditions that can cause temperature ―overshoot‖ with servo-controlled heated humid ifiers
include which of the following? 1. The unit is allowed to warm up without flow. 2. Flow is decreased during normal operation. 3. The airway temperature probe becomes dislodged. 4. The unit reservoir is refilled with sterile water. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
See Box 38-5. DIF: Recall
REF: p. 829
OBJ: 6
51. The temperature of gas delivered to a patient’s airway by a servo-controlled heated humidifier
should not vary by more than how much? a. 2° C b. 4° C c. 6° C d. 8° C ANS: A
See Box 38-5. DIF: Recall
REF: p. 829
OBJ: 6
52. Which of the following are necessary features to look for in selecting a heated humidifier?
1. Water level readily visible 2. Over-temperature protection 3. Auditory and visual alarms 4. Minimal temperature overshoot a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
See Box 38-5. DIF: Recall
REF: p. 829
OBJ: 6
53. Where should you place the thermistor probe for a servo-controlled heated humidifier being
used on a patient receiving mechanical ventilation? a. In the expiratory limb of the circuit, near but not at the ―wye‖
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b. In the inspiratory limb of the circuit, as close to the ―wye‖ as possible c. In the expiratory limb of the circuit, as close to the ―wye‖ as possible d. In the inspiratory limb of the circuit, near but not at the ―wye‖ ANS: D
See Rule of Thumb p. 827. DIF: Recall
REF: p. 828
OBJ: 7
54. When using a servo-controlled heated humidifier to deliver gas to an infant, the thermistor
probe should be placed where? a. Inside the circuit, outside the incubator, or away from the radiant warmer b. Outside the circuit, inside the incubator, or away from the radiant warmer c. Inside the circuit, inside the incubator, or away from the radiant warmer d. Outside the circuit, outside the incubator, or away from the radiant warmer ANS: A
Place heated humidifier thermistor probes in the inspiratory limb of a ventilator circuit far enough from the patient Y adaptor to ensure that warm exhaled gas does not fool the controller system. Never place a thermistor probe in an isolette or a radiant warmer, where the probe is warmed externally and the humidifier is fooled into shutting down, reducing the humidity available to the patient. REF: p. 828
OBJ: 8
55. What are some potential problems with manually refilled heated humidifier reservoirs?
1. Cross contamination and infection 2. Variable compliance or delivered volume 3. Delivery of dry and/or hot gases a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
Unfortunately, the use of manually refilled reservoirs requires a momentary interruption of humidifier operation and mechanical ventilation. Moreover, because the system must be ―opened ‖ for refilling, cross contamination can occur. Water levels in manually filled systems are constantly changing, so that changes in the humidifier fill volume alter the gas compression factor and thus the delivered volume during mechanical ventilation. DIF: Recall
REF: p. 828
OBJ: 7
56. Which of the following automatic feed systems are used to regulate water levels when using a
humidifier with a continuous feed system? 1. Leveling reservoirs 2. Flotation controls 3. Optical sensors a. 2 and 3 only
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b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: C
The simplest type of automatic feed system is the level-compensated reservoir (Figure 38-7). In these systems, an external reservoir is aligned horizontally with the humidifier, maintaining relatively consistent water levels between the reservoir and the humidifier chamber. In flotation-type systems, a float rises and falls with the water level. As the water level falls below a preset value, the float opens the feed valve; as the water rises back to the set fill level, the float closes the feed valve. An optical sensor can also be used to sense water level, driving a solenoid valve to allow refilling of the humidifier reservoir. DIF: Recall
REF: p. 829
OBJ: 7
57. Which of the following are contraindications for heat and moisture exchangers?
1. Presence of thick, copious, or bloody secretions 2. Presence of a large leak around artificial airway 3. When a patient is suffering from hyperpyrexia 4. When a patient’s minute ventilation exceeds 10 L/min a. 1 and 3 only b. 1, 2, and 3 only c. 4 only d. 1, 2, and 4 only ANS: D
The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts appear on p. 831. DIF: Recall
REF: p. 831
OBJ: 7
58. Which of the following are potential hazards of using heat and moisture exchangers?
1. Failure of low-pressure alarms to detect disconnection 2. Underhydration or impaction of secretions 3. Hypoventilation due to increased dead space 4. Unintended tracheal lavage from condensate a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 38-1. DIF: Recall
REF: p. 831
OBJ: 7
59. Which of the following are potential hazards of using a heated humidifier during mechanical
ventilation?
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1. Aerosolization of condensate during disconnection 2. Underhydration or impaction of secretions 3. Hypoventilation due to increased dead space 4. Unintended tracheal lavage from condensate a. 1 and 3 only b. 2, and 3 only c. 3 and 4 only d. 1, 2, and 4 only ANS: D
The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 38-1. DIF: Recall
REF: p. 831
OBJ: 7
60. A patient receiving ventilatory support is being provided with humidification using a heat and
moisture exchanger (HME). A physician orders a bronchodilator drug administered through a metered dose inhaler (MDI) via the ventilator circuit. Which of the following must be performed to ensure delivery of the drug to the patient? a. The inspiratory flow setting of the ventilator should be increased. b. The HME must be removed from the circuit during MDI use. c. The V T setting of the ventilator should be decreased. d. A heated humidifier should replace the HME when using the MDI. ANS: B
The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 38-1. DIF: Recall
REF: p. 831
OBJ: 7
61. A patient has been supported by a mechanical ventilator using a heat and moisture exchanger
for the last 3 days. Suctioning reveals an increase in the amount and tenacity of secretions. Which of the following actions is indicated? a. Increase the hygroscopic condenser humidifier temperature. b. Reassess the patient’s secretions over the next 24 to 48 hr. c. Replace the hygroscopic condenser humidifier with a new one. d. Switch the patient to a large-volume heated humidifier. ANS: D
The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 38-1. DIF: Application
REF: p. 831
OBJ: 7
62. How often should heat and moisture exchangers be inspected and replaced? a. At least every shift b. When contaminated by secretions c. At least every day d. When condensate is visible
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ANS: B
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 38-1. DIF: Recall
REF: p. 831
OBJ: 7
63. During routine use on an intubated patient, a heated humidifier should deliver inspired gas at
which of the following? a. Temperature of 33 ± 2° C, with a minimum of 30 mg/L of water vapor b. Temperature of 37 ± 2° C, with a minimum of 44 mg/L of water vapor c. Temperature of 20 ± 2° C, with a minimum of 10 mg/L of water vapor d. Temperature of 30 ± 2° C, with a minimum of 24 mg/L of water vapor ANS: A
The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 38-1. DIF: Recall
REF: p. 831
OBJ: 8
64. Which of the following are the proper temperature alarm settings for a heated humidifier used
during mechanical ventilation? High Low a. 35° C 32° C b. 37° C 30° C c. 39° C 33° C d. 35° C 30° C ANS: B
The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 38-1. DIF: Recall
REF: p. 831
OBJ: 8
65. The amount of condensation occurring in a heated, humidified gas delivery system depends
on which of the following? 1. Length, diameter, and mass of the circuit 2. Temperature differential along the circuit 3. Ambient temperature 4. Rate of gas flow through the circuit a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
Factors influencing the amount of condensation include (1) the temperature difference across the system (humidifier to airway), (2) the ambient temperature, (3) the gas flow, (4) the set airwaytemperature, and (5) the length, diameter, and thermal mass of the breathing circuit. DIF: Recall
REF: p. 832
OBJ: 9
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 66. Which of the following is false about heated humidifier condensate? a. It can block or obstruct the delivery circuit. b. It must be treated as contaminated waste. c. It requires that circuits be drained frequently. d. It poses minimal infection risk. ANS: D
Condensation can disrupt or occlude gas flow through the circuit, potentially altering FiO 2 and/or ventilator function. Moreover, condensate can work its way toward the patient and be aspirated. For these reasons, circuits must be positioned to drain condensate away from the patient and must be checked often, and excess condensate must be drained from heated humidifier breathing circuits on a regular basis. Typically, patients contaminate ventilator circuits within hours, and condensate is colonized with bacteria and thus poses an infection risk. To avoid problems in this area, health care personnel should treat all breathing-circuit condensate as infectious waste. DIF: Recall
REF: p. 832
OBJ: 9
67. Which of the following barrier precautions should be used when heated humidifier circuits are
changed or removed? 1. Wearing gloves 2. Wearing goggles 3. 5-min hand scrub a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
See Rule of Thumb p. 832. DIF: Recall
REF: p. 832
OBJ: 9
68. Which of the following are acceptable means to help minimize the problems caused by
condensation in heated humidifier circuits? 1. Installing water traps in the circuit 2. Using a heated-wire circuit 3. Setting heater temperature to 25° to 28° C a. 1, 2, and 3 b. 2 and 3 only c. 1 and 2 only d. 1 and 3 only ANS: C
One common method is to place water traps at low points in the circuit (both the inspiratory and expiratory limbs of ventilator circuits). The most common approach uses wire heating elements inserted into the ventilator circuit.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 832 OBJ: 9 69. When using water traps to help minimize the problems caused by condensation in a
heated-humidifier ventilator circuit, where would you place the traps? a. In the expiratory limb only, at a high point in the circuit. b. In both the expiratory and inspiratory limbs, at high points in the circuit. c. In the expiratory limb only, at a low point in the circuit. d. In both the expiratory and inspiratory limbs, at low points in the circuit. ANS: D
One common method is to place water traps at low points in the circuit (both the inspiratory and expiratory limbs of ventilator circuits). DIF: Recall
REF: p. 832
OBJ: 9
70. When using nebulizers, where should you place them to minimize risk of contamination? a. In the inspiratory limb only, at a high point in the circuit b. In both the expiratory and inspiratory limbs, at high points in the circuit c. In the expiratory limb only, at a low point in the circuit d. In both the expiratory and inspiratory limbs, at low points in the circuit ANS: A
To minimize this risk, place nebulizers in a superior position, so that any condensate travels downstream from the nebulizer. DIF: Recall
REF: p. 832
OBJ: 9
71. Which of the following are true when heated-wire circuits are used with heated humidifiers
except: a. the humidifier operates at a higher temperature. b. there is less condensate and a reduced need for drainage. c. cost savings (less water and staff time) are realized. d. there is less infection risk for both patient and caregivers. ANS: A
When heated-wire circuits are used, the humidifier heats gas to a lower temperature (32° to 40° C) than it does with conventional circuits (45° to 50° C). The reduction in condensate in the tubing results in less water use, reduced need for drainage, and less infection risk for both patient and health care workers. DIF: Recall
REF: p. 833
OBJ: 9
72. Which of the following reduce the risk of nosocomial infection when using heated
humidification systems? 1. Use of wick or membrane humidifiers 2. Use of heated-wire delivery circuits 3. High humidifier reservoir temperatures 4. Frequent changing of delivery circuits a. 1 and 3 only b. 1, 2, and 3 only
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 3 and 4 only d. 2, 3, and 4 only ANS: B
It is now known that frequent ventilator-circuit changes actually increase the risk of nosocomial pneumonia. DIF: Recall
REF: p. 833
OBJ: 9
73. What is the most reliable indicator that the gas delivered by a servo-controlled heated-wire
humidifier system is fully saturated at the airway? a. Observing no visible condensate anywhere in the delivery tubing b. Confirming an airway temperature between 32° and 35° C c. Observing a few drops of condensate at or near the patient’s airway d. Observing condensate over the full length of the delivery tubing ANS: C
To ensure that the inspired gas is being properly conditioned, clinicians should always adjust the temperature differential to the point that a few drops of condensation form near the patient ―wye.‖ Lacking direct measurement of humidity, observation of this minimal condensate is the most reliable indicator that the gas is fully saturated at the specified temperature. DIF: Recall
REF: p. 834
OBJ: 9
74. In checking a servo-controlled heated-wire humidifier system, you notice that a few drops of
condensate tend to form but only near the patient’s airway. Based on this observation, what can you conclude? a. The gas at the airway is fully saturated. b. The temperature setting of the heater is too high. c. The airway temperature exceeds the dew point. d. The temperature setting of the heater is too low. ANS: A
To ensure that the inspired gas is being properly conditioned, clinicians should always adjust the temperature differential to the point that a few drops of condensation form near the patient ―wye.‖ Lacking direct measurement of humidity, observation of this minimal condensate is the most reliable indicator that the gas is fully saturated at the specified temperature. DIF: Application
REF: p. 834
OBJ: 9
75. When checking a patient attached to a servo-controlled heated-wire humidifier breathing
circuit, you notice no visible condensate anywhere in the tubing. Based on this observation, you can conclude that the relative humidity of the delivered gas is which of the following? a. Less than 25% b. 25% to 90% c. 90% to 100% d. Less than 100% ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
If condensate cannot be seen, there is no way of knowing the level of relative humidity without direct measurement—it could be anywhere between 99% and 0%. DIF: Application
REF: p. 834
OBJ: 8
76. When is a heat and moisture exchanger (HME) performing well? a. Condensate appears in the attached flex tube. b. No condensate is visible on the filter or insert. c. The HME temperature is at least 40° C. d. Condensate is visible on the filter or insert. ANS: A
Lacking direct measurement of humidity, observation of this minimal condensate is the most reliable indicator that the gas is fully saturated at the specified temperature. DIF: Recall
REF: p. 834
OBJ: 9
77. For which of the following patients might you recommend bland aerosol therapy
administration? 1. Patient with upper airway edema 2. Patient with a bypassed upper airway 3. Patient who must provide a sputum specimen a. 1, 2, and 3 b. 2 and 3 only c. 1 and 2 only d. 1 and 3 only ANS: A
The AARC has published Clinical Practice Guideline: Bland Aerosol Administration. Excerpts are in CPG 38-2. DIF: Recall
REF: p. 835
OBJ: 10
78. For which of the following patients would you recommend bland aerosol therapy
administration? 1. Patient with a history of airway hyperresponsiveness 2. Patient with a bypassed upper airway 3. Patient with active bronchoconstriction a. 1, 2, and 3 b. 2 only c. 1 and 2 only d. 1 and 3 only ANS: B
The AARC has published Clinical Practice Guideline: Bland Aerosol Administration. Excerpts are in CPG 38-2. DIF: Recall
REF: p. 835
OBJ: 10
79. Hazards and complications of bland aerosol therapy include which of the following?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1. Bronchospasm 2. Overhydration 3. Infection 4. Hemoconcentration a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
The AARC has published Clinical Practice Guideline: Bland Aerosol Administration. Excerpts are in CPG 38-2. DIF: Recall
REF: p. 835
OBJ: 13
80. Which of the following indicate a potential need for administration of a water or isotonic
saline aerosol? a. Stridor or brassy, crouplike cough b. Evidence of increased volume of secretions c. Hoarseness after extubation d. Patient discomfort after bronchoscopy a. 1 and 3 only b. 1, 3, and 4 only c. 2 and 4 only d. 2, 3, and 4 only ANS: B
The AARC has published Clinical Practice Guideline: Bland Aerosol Administration. Excerpts are in CPG 38-2. The presence of one or more of the following may be an use indication for administration of a water or isotonic or hypotonic saline aerosol: • Stridor • Brassy, crouplike cough • Hoarseness after extubation • Diagnosis of laryngotracheobronchitis or croup • History of upper airway irritation and increased work of breathing (e.g., smoke inhalation) • Patient discomfort associated with airway instrumentation or insult • Bypassed upper airway • Need for sputum induction (e.g., Pneumocystis pneumonia or tuberculosis) is an indication for administration of hypertonic saline aerosol. DIF: Recall
REF: p. 835
OBJ: 13
81. For which of the following patients might you recommend administration of a hypertonic
saline aerosol? 1. Acquired immune deficiency syndrome (AIDS) patient with severe pneumonia symptoms 2. Patient with a bypassed upper airway 3. Patient suspected of having tuberculosis
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a. b. c. d.
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1, 2, and 3 2 and 3 only 1 and 2 only 1 and 3 only
ANS: D
The AARC has published Clinical Practice Guideline: Bland Aerosol Administration. Excerpts are in CPG 38-2. DIF: Application
REF: p. 835
OBJ: 13
82. Which of the following would indicate that administration of a bland water aerosol to a patient
with postextubation upper airway edema was having the desired effect? 1. Decreased work of breathing 2. Improved vital signs 3. Decreased stridor or dyspnea 4. Improved O2 saturation a. 1, 2, and 3 only b. 1, 2, 3, and 4 c. 3 and 4 only d. 1, 2, and 4 only ANS: B
The AARC has published Clinical Practice Guideline: Bland Aerosol Administration. Excerpts are in CPG 38-2. DIF: Recall
REF: p. 835
OBJ: 13
83. What is the most common device used to generate bland aerosols? a. Small-volume jet nebulizer b. Ultrasonic nebulizer c. Large-volume jet nebulizer d. Spinning disk nebulizer ANS: C
The large-volume jet nebulizer is the most common device used to generate bland aerosols. DIF: Recall
REF: p. 835
OBJ: 11
84. Which of the following are true regarding large-volume jet nebulizers?
a. A variable air-entrainment port allows air mixing and different FiO 2 values. b. Liquid particles are generated by mechanical vibration energy. c. They are pneumatically powered and attach directly to a flowmeter. d. Baffling causes impaction or removal of large, unstable particles. a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
As depicted in Figure 38-13, these devices are pneumatically powered, attaching directly to a flowmeter and compressed gas source. Liquid particle aerosols are generated by passing gas at a high velocity through a small ―jet‖ orifice. The resulting low pressure at the jet draws fluid from the reservoir up to the top of a siphon tube, where it is sheared off and shattered into liquid particles. The large, unstable particles fall out of suspension or impact on the internal surfaces of the device, including the fluid surface (baffling). The remaining small particles leave the nebulizer through the outlet port, carried in the gas stream. A variable air-entrainment port allows air mixing to increase flow rates and to alter FiO 2 levels. DIF: Recall
REF: p. 836
OBJ: 11
85. What is the total water output of unheated large-volume jet nebulizers? a. 10 to 16 mg H 2 O/L b. 16 to 25 mg H 2 O/L c. 26 to 35 mg H 2 O/L d. 33 to 55 mg H 2 O/L ANS: C
Depending on the design, input flow, and air-entrainment setting, the total water output of unheated large-volume jet nebulizers varies between 26 and 35 mg H 2 O/L. DIF: Recall
REF: p. 836
OBJ: 11
86. What is the total water output of heated large-volume jet nebulizers? a. 16 to 25 mg H 2 O/L b. 26 to 35 mg H 2 O/L c. 33 to 55 mg H 2 O/L d. 56 to 75 mg H 2 O/L ANS: C
When heated, output increases to between 33 and 55 mg H2 O/L, mainly because of increased vapor capacity. DIF: Recall
REF: p. 836
OBJ: 11
87. Which of the following nebulizers uses a piezoelectric transducer to generate liquid particle
aerosols? a. Hydrodynamic nebulizer b. Ultrasonic nebulizer c. Jet nebulizer d. Centrifugal nebulizer ANS: B
An ultrasonic nebulizer is an electrically powered device that uses a piezoelectric crystal to generate aerosol. DIF: Recall
REF: p. 836
OBJ: 12
88. Which of the following principles is used by the ultrasonic nebulizer to produce aerosol
droplets?
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a. b. c. d.
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Evaporative cooling Mechanical baffling Fractional distillation High-frequency vibrations
ANS: D
This crystal transducer converts radio waves into high-frequency mechanical vibrations (sound). DIF: Recall
REF: p. 836
OBJ: 12
89. Which of the following are components of an ultrasonic nebulizer?
1. Air-entrainment orifice 2. Radiofrequency generator 3. Nebulizer chamber 4. Piezoelectric transducer 5. Blower or fan a. 1, 3, and 4 only b. 2, 3, 4, and 5 only c. 1, 2, 3, 4, and 5 d. 3, 4, and 5 only ANS: B
See Figure 38-15. DIF: Recall
REF: p. 836
OBJ: 12
90. The particle size produced by an ultrasonic nebulizer depends mainly on which of the
following? a. Blower (fan) speed b. Signal amplitude c. Signal frequency d. Chamber baffling ANS: C
The frequency at which the crystal vibrates, preset by the manufacturer, determines aerosol particle size. DIF: Recall
REF: p. 836
OBJ: 12
91. Which of the following mean mass aerodynamic diameter (MMAD) aerosol suspensions is
produced by an ultrasonic nebulizer operated at 1.25 MHz? a. 1 to 2 µm b. 6 to 10 µm c. 4 to 6 µm d. Less than 1 µm ANS: C
A nebulizer operating at 1.25 MHz produces an aerosol with an MMAD of between 4 and 6 µm.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 836
OBJ: 12
92. The aerosol output (in mg/L) of an ultrasonic nebulizer depends mainly on which of the
following? a. Signal amplitude b. Chamber baffling c. Source current d. Signal frequency ANS: A
Amplitude affects water output. DIF: Recall
REF: p. 836
OBJ: 12
93. To produce the highest possible density aerosol from an ultrasonic nebulizer, how would you
set the controls? a. Amplitude low, flow rate high b. Amplitude high, flow rate low c. Amplitude low, flow rate low d. Amplitude high, flow rate high ANS: B
See Rule of Thumb p. 837. DIF: Recall
REF: p. 837
OBJ: 12
94. For which of the following patients might you recommend bland aerosol therapy via an
ultrasonic nebulizer (USN)? 1. Patient with upper airway edema 2. Patient with a bypassed upper airway 3. Patient who must provide a sputum specimen a. 1, 2, and 3 b. 2 and 3 only c. 2 only d. 3 only ANS: D
Exceptions include the use of the USN for sputum induction where the high output (1 to 5 ml/min) and aerosol density seems to yield higher quantity and quality of sputum specimens for analysis, but at some cost increased airway reactivity. DIF: Application
REF: p. 837
OBJ: 12
95. How often would you recommend that a home care patient disinfect a home ultrasonic room
humidifier? a. Per manufacturer’s specifications or at least every day b. Per manufacturer’s specifications or at least every 3 days c. Per manufacturer’s specifications or at least every 6 days d. Per manufacturer’s specifications or at least every 2 weeks
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: C
In the absence of a manufacturer’s recommendation, these units should undergo appropriate disinfection at least every 6 days. DIF: Application
REF: p. 837
OBJ: 13
96. A physician orders bland water aerosol administration to a patient with an intact upper airway.
Which of the following airway appliances could you use to meet this goal? 1. Simple O2 mask 2. Face tent 3. T tube 4. Aerosol mask a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: A
Airway appliances used to deliver bland aerosol therapy include the aerosol mask, face tent, T tube, and tracheostomy mask. DIF: Application
REF: p. 837
OBJ: 12
97. A physician orders bland water aerosol administration to a patient with a tracheostomy.
Which of the following airway devices could you use to meet this goal? 1. Tracheostomy mask 2. Face tent 3. T tube 4. Aerosol mask a. 2 and 4 only b. 1, 2, and 3 only c. 1 and 3 only d. 2, 3, and 4 only ANS: C
The T tube is used for patients who are orally or nasally intubated or who have a tracheostomy. The tracheostomy mask is used solely for patients who have a tracheostomy. DIF: Application
REF: p. 837
OBJ: 12
98. Which of the following devices would you recommend to administer bland water aerosol to
an infant or small child? a. Face tent b. Croup tents c. T tube d. Aerosol mask ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Infants and small children may not readily tolerate direct airway appliances such as masks, so enclosures such as mist tents and aerosol hoods are used to deliver bland aerosol therapy to these patients. DIF: Application
REF: p. 837
OBJ: 12
99. What are some problems common to mist tents?
1. Heat retention 2. CO 2 buildup 3. Hypothermia a. 1, 2, and 3 b. 1 and 2 only c. 2 and 3 only d. 1 and 3 only ANS: B
Any body enclosure poses two problems: CO2 build-up and heat retention. DIF: Recall
REF: p. 838
OBJ: 13
100. All mist tents prevent CO 2 build-up by what process? a. Recirculating the gas b. Providing high gas flows c. Using CO 2 absorbers d. Cooling the gas ANS: B
CO 2 build-up can be reduced by providing sufficiently high gas flow rates. DIF: Recall
REF: p. 838
OBJ: 13
101. Which of the following measures can help to ensure a good sputum sample? a. Using an ultrasonic nebulizer instead of a jet nebulizer b. Using a 5% saline solution instead of a 3% concentration c. Having the patient rinse the mouth or blow the nose before induction d. Using the lowest possible aerosol density (high flow and low output) ANS: C
To ensure a good sputum sample, every effort must be made to separate saliva from true respiratory tract secretions. In some cases, protocols include having patients brush their teeth and tongue surface thoroughly and rinse their mouths before sputum induction. DIF: Recall
REF: p. 838
OBJ: 14
102. For what should sputum collected by aerosol therapy induction be inspected?
1. Color 2. Volume 3. Odor 4. Consistency a. 2 and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
b. 1, 2, and 3 only c. 1 and 3 only d. 1, 2, 3, and 4 ANS: D
See Box 38-5. DIF: Recall
REF: p. 838
OBJ: 14
103. To minimize problems with environmental safety when aerosol therapy is prescribed for
immunosuppressed patients or those with tuberculosis, what precautions should you follow? 1. Those for tuberculosis exposure 2. Centers for Disease Control and Prevention (CDC) standards and contact precautions 3. CDC standards and airborne precautions a. 1, 2, and 3 b. 1 and 2 only c. 2 and 3 only d. 1 and 3 only ANS: A
To minimize problems in this area, all clinicians should strictly follow CDC standards and airborne precautions, including those specified for control of exposure to tuberculosis. DIF: Application
REF: p. 839
OBJ: 13
104. Causes of inadequate mist production with pneumatically powered jet nebulizers include
which of the following? 1. Inadequate input flow 2. Siphon tube obstruction 3. Jet orifice misalignment 4. Tripped circuit breaker a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
With pneumatically powered jet nebulizers, poor mist production can be caused by inadequate input flow of driving gas, siphon tube obstruction, or jet orifice misalignment. DIF: Recall
REF: p. 839
OBJ: 13
105. An ultrasonic nebulizer is not putting out any mist. After confirming (1) good electrical power
supply (cord, plug, and circuit breakers are in good working order), (2) carrier gas is actually flowing through the device, and (3) the output control is set at maximum, what should you do? a. Take the unit out of service and send it to engineering for repair. b. Inspect the couplant chamber to confirm cleanliness and fill level. c. Disassemble the radiofrequency generator and test for electrical leakage.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Hook it up the chamber inlet to a flowmeter set at 10 L/min or higher. ANS: B
If there is still no visible mist output, the clinician should inspect the couplant chamber to confirm proper fill level and the absence of any visible dirt or debris. DIF: Application
REF: p. 839
OBJ: 13
106. The risk of overhydration with continuous delivery of bland water aerosols is greatest among
which patient group? 1. Patients with fluid or electrolyte imbalances 2. Patients with fever and infection 3. Infants and small children a. 1, 2, and 3 b. 1 and 2 only c. 2 and 3 only d. 1 and 3 only ANS: D
The risk of overhydration is highest for infants, small children, and those with preexisting fluid or electrolyte imbalances. DIF: Recall
REF: p. 839
OBJ: 13
107. After administering a 30-min bland water aerosol treatment to a dehydrated elderly patient
with chronic bronchitis, you note increased wheezing and a general decrease in the intensity of breath sounds. Which of the following has probably occurred? a. Reactive bronchospasm has occurred and worsened airway obstruction. b. Inspissated secretions have swollen and worsened airway obstruction. c. Nothing; this is a normal response to bland aerosol therapy. d. The patient is developing atelectasis due to overhydration. ANS: B
In addition to overhydration of the patient, inspissated pulmonary secretions also can swell after high-density aerosol therapy, worsening airway obstruction. DIF: Analysis
REF: p. 839
OBJ: 13
108. A patient with chronic obstructive pulmonary disease (COPD) is receiving heated water
aerosol treatments through a jet nebulizer four times daily as a supplement to other bronchial hygiene measures designed to aid in mobilizing retained secretions. After each session, you notice the presence of moderate wheezing. Which of the following recommendations would you make to the physician? a. Discontinue the heated water aerosol treatments. b. Consider prior treatment with a bronchodilator. c. Switch to a higher-density aerosol (e.g., ultrasonic). d. Discontinue the other bronchial hygiene measures. ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
If the physician still requests bland aerosol therapy for such a patient, pretreatment with a bronchodilator may be needed. DIF: Application
REF: p. 839
OBJ: 15
109. A neonatologist is concerned about the possibility of hearing damage occurring to a premature
infant receiving bland water aerosol delivered via air-entrainment nebulizers inside an incubator or isolette. Which of the following would you recommend as the best way to overcome this problem? a. Use a heated passover humidifier instead. b. Use an ultrasonic nebulizer system instead. c. Place sound baffles in the aerosol tubing. d. Place earplugs in the infant’s outer ears. ANS: A
The best way to avoid this problem and further minimize infection risks is to use heated passover humidification instead of nebulization. DIF: Application
REF: p. 839
OBJ: 15
110. Key considerations in selecting or recommending humidity or bland aerosol therapy for a
patient include which of the following? 1. Required gas flow 2. Presence of an artificial tracheal airway 3. Character of pulmonary secretions 4. Need for or duration of mechanical ventilation 5. Presence of heat and moisture exchanger (HME) contraindications a. 2, 3, and 4 only b. 1, 2, and 3 only c. 3, 4, and 5 only d. 1, 2, 3, 4, and 5 ANS: D
Key considerations include (1) gas flow, (2) presence or absence of an artificial tracheal airway, (3) character of the pulmonary secretions, (4) need for and expected duration of mechanical ventilation, and (5) contraindications to using an HME. DIF: Recall
REF: p. 839
OBJ: 15
111. In general, to deliver O2 to the upper airway, a bubble humidifier is required only when the
gas flow exceeds which of the following? a. 1 L/min b. 2 L/min c. 3 L/min d. 4 L/min ANS: D
Regarding delivery of O 2 to the upper airway, the American College of Chest Physicians advises against using a bubble humidifier at flow rates of 4 L/min or less.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 839
OBJ: 15
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 39 - Aerosol Drug Therapy Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following best defines an aerosol? a. Suspension of liquid droplets in a gas b. Suspension of particulate matter in a gas c. Molecular water dispersed throughout a carrier gas d. Suspension of liquid or solid particles in a gas ANS: D
An aerosol is a suspension of solid or liquid particles in gas. DIF: Recall
REF: p. 844
OBJ: 1
2. With which of the following devices are therapeutic aerosols generated?
1. Atomizers 2. Nebulizers 3. Humidifiers 4. Soft mist inhalers a. 1, 2, and 4 only b. 1 and 4 only c. 2 and 3 only d. 1, 2, 3, and 4 ANS: A
In the clinical setting, medical aerosols are generated with atomizers, nebulizers, soft mist inhalers, or inhalers. DIF: Recall 3.
REF: p. 844
OBJ: 3
The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol? a. Stability b. Density c. Output d. Deposition ANS: C
Aerosol output is defined as the mass of fluid or drug contained in aerosol produced by a nebulizer generated per unit of time. DIF: Recall 4.
REF: p. 844
OBJ: 2
Which of the following describes the mass of drug leaving the mouthpiece of a nebulizer as aerosol? a. Single dose
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
b. Emitted dose c. Multiple dose d. Output dose ANS: B
For drug delivery systems, emitted dose describes the mass of drug leaving the mouthpiece of a nebulizer or inhaler as aerosol. DIF: Recall 5.
REF: p. 844
OBJ: 2
Which of the following is a common method to measure aerosol particle size? a. Scan b. Gravimetric c. Cascade impaction d. Penetration studies ANS: C
The two most common laboratory methods used to measure aerosol particle size are cascade impaction and laser diffraction. DIF: Recall 6.
REF: p. 845
OBJ: 2
What measure is used to identify the particle diameter, which corresponds to the most typical settling behavior of an aerosol? a. Mean mass velocity coefficient (MMVC) b. Logarithmic standard diameter (LSD) c. Mean mass aerodynamic diameter (MMAD) d. Geometric standard deviation (GSD) ANS: C
Because medical aerosols contain particles of many different sizes (are heterodisperse), the average particle size is expressed with a measure of central tendency, such as MMAD for cascade impaction or volume median diameter (VMD) for laser diffraction. DIF: Recall 7.
REF: p. 845
OBJ: 2
What measure is used to describe the variability of particle diameters in an aerosol? a. MMVC b. LSD c. MMAD d. GSD ANS: D
The GSD describes the variability of particle sizes in an aerosol distribution set at 1 standard deviation (SD) above or below the median (15.8% and 84.13%). DIF: Recall 8.
REF: p. 845
OBJ: 2
Most nebulizers used in respiratory care produce which type of aerosol suspension? a. Monodisperse
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
b. Microaerosol c. Heterodisperse d. Macroaerosol ANS: C
Most aerosols found in nature and used in respiratory care are composed of particles of different sizes, described as heterodisperse. DIF: Recall 9.
REF: p. 845
OBJ: 3
What is the retention of aerosol particles resulting from contact with the respiratory tract mucosa called? a. Stability b. Density c. Penetration d. Deposition ANS: D
When aerosol particles leave suspension in gas they deposit on (attach to) a surface. DIF: Recall 10.
REF: p. 845
OBJ: 2
Which of the following factors affect pulmonary deposition of an aerosol? 1. Size of the particles 2. Shape and motion of the particles 3. Physical characteristics of the airways 4. Class of medication being delivered a. 1 and 4 only b. 1 and 3 only c. 2, 3, and 4 only d. 1, 2, and 3 only ANS: D
Whether aerosol particles that are inhaled into the lung are deposited in the respiratory tract depends on the size, shape, and motion of the particles and on the physical characteristics of the airways and breathing pattern. DIF: Recall 11.
REF: p. 845
OBJ: 2
What is the primary mechanism for deposition of large, high-mass particles (>5 µm) in the respiratory tract? a. Inertial impaction b. Sedimentation c. Diffusion d. Brownian motion ANS: A
Inertial impaction occurs when suspended particles in motion collide with and are deposited on a surface. This is the primary deposition mechanism for particles larger than 5 µm.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 845 OBJ: 2 12.
Which of the following will increase aerosol deposition by inertial impaction? 1. High-velocity gas flow 2. Variable or irregular passages 3. Turbulent gas flow 4. Particles of high mass a. 2 and 3 only b. 2, 3, and 4 only c. 1, 3, and 4 only d. 1, 2, 3, and 4 ANS: A
The greater the mass and velocity of a moving object, the greater is its inertia and the greater is the tendency of that object to continue moving along its set path (Figure 39-1). DIF: Recall 13.
REF: p. 845
OBJ: 2
Where do most aerosol particles in the 5- to 10-µm range deposit? a. Alveoli b. Bronchioles c. Central airways d. Upper airways ANS: D
Particles in the 5- to 10-µm range tend to become deposited in the oropharynx and hypopharynx, especially with the turbulence created by the transition of air as it passes around the tongue and into the larynx. DIF: Recall 14.
REF: p. 846
OBJ: 2
What is the primary mechanism for central airway deposition of particles in the 1- to 5-µm range? a. Impaction b. Sedimentation c. Diffusion d. Brownian motion ANS: B
During normal breathing, sedimentation is the primary mechanism for deposition of particles in the 1- to 5-µm range. DIF: Recall 15.
REF: p. 846
OBJ: 2
Where do most aerosol particles in the 1- to 5-µm range deposit? a. Alveoli b. Bronchioles c. Central airways d. Upper airways
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ANS: C
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Sedimentation occurs mostly in the central airways and increases with time, affecting particles down to 1 µm in diameter. DIF: Recall 16.
REF: p. 846
OBJ: 2
Which of the following techniques will increase aerosol deposition by sedimentation in the lungs? a. High inspiratory flow b. Short inspiratory time c. 10-sec breath-hold d. Short expiratory time ANS: C
A 10-sec breath-hold can increase aerosol deposition as much as 10% and increase the ratio of aerosol deposited in lung parenchyma to central airway by four-fold. DIF: Recall 17.
REF: p. 845
OBJ: 2
Which term describes the primary mechanism for deposition of small particles? a. Hygroscopic condensation b. Gravity sedimentation c. Brownian diffusion d. Inertial impaction ANS: C
Brownian diffusion is the primary mechanism for deposition of small particles (<3 µm), mainly in the respiratory region where bulk gas flow ceases and most aerosol particles reach the alveoli by diffusion. DIF: Recall 18.
REF: p. 845
OBJ: 2
What is the primary fate of inhaled aerosol particles that are between 1 and 0.5 µm? a. Most are cleared during exhalation. b. Most deposit in the central airways. c. Most deposit in the upper airways. d. Most deposit in the alveoli. ANS: A
Particles between 1 and 0.5 µm are so stable that most remain in suspension and are cleared with the exhaled gas. DIF: Recall 19.
REF: p. 846
OBJ: 2
Which of the following aerosols would have the highest rate of deposition by diffusion? a. MMAD of 0.1 µm b. MMAD of 3.0 µm c. MMAD of 10.0 µm d. MMAD of 50.0 µm
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: A
Particles smaller than 0.5 µm have a greater retention rate in the lungs. DIF: Recall 20.
REF: p. 846
OBJ: 2
Where do most aerosol particles that are less than 3 µm deposit? a. Alveoli b. Bronchioles c. Central airways d. Upper airways ANS: A
See Rule of Thumb p. 846. DIF: Recall 21.
REF: p. 846
OBJ: 2
A physician wants to deliver a therapeutic aerosol to the upper airway (nose, larynx, trachea). To help ensure maximum deposition in this area, you would select an aerosol generator with an MMAD in what range? a. 5 to 50 µm b. 2 to 5 µm c. 1 to 3 µm d. Less than 1 µm ANS: A
See Rule of Thumb p. 846. DIF: Application 22.
REF: p. 846
OBJ: 2
A physician wants to deliver a therapeutic aerosol to the central and lower airways. To help ensure maximum deposition in this area, you would select an aerosol generator with an MMAD in what range? a. 5 to 20 µm b. 2 to 5 µm c. 1 to 3 µm d. Less than 1 µm ANS: B
See Rule of Thumb p. 846. DIF: Application 23.
REF: p. 846
OBJ: 2
A physician wants to deliver a therapeutic aerosol to the lung parenchyma (alveolar region). To help ensure maximum deposition in this area, you would select an aerosol generator with an MMAD in what range? a. 5 to 20 µm b. 2 to 5 µm c. 1 to 3 µm d. Less than 1 µm
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D
See Rule of Thumb p. 846. DIF: Application 24.
REF: p. 846
OBJ: 2
What is the process by which aerosol suspension changes over time? a. Evaporation b. Deposition c. Aging d. Sublimation ANS: C
The process by which an aerosol suspension changes over time is called aging. DIF: Recall
REF: p. 847
OBJ: 2
Which of the following is false about changes in aerosol suspensions over time? a. Liquid aerosol particles can shrink (evaporation) or grow (water absorption). b. The rate of particle growth is directly proportional to particle size. c. Small water-based particles tend to shrink when exposed to dry gas. d. Aerosols of water-soluble salts tend to grow in a humidified environment. ANS: B
The relative rate of particle size change is inversely proportional to the size of a particle, so the small particles grow or shrink faster than larger particles. DIF: Recall 26.
REF: p. 847
OBJ: 2
As hygroscopic aerosol particles enter the respiratory tract, what do they tend to do? a. Decrease in size because of the absorption of molecular water. b. Increase in size because of the absorption of molecular water. c. Increase in size because of the evaporation of molecular water. d. Decrease in size because of the evaporation of molecular water. ANS: B
Aerosols of water-soluble materials, especially salts, tend to be hygroscopic, absorbing water and growing when introduced into a high-humidity environment. DIF: Recall 27.
REF: p. 847
OBJ: 2
What is the primary hazard of aerosol drug therapy? a. Adverse drug reactions b. Pulmonary infection c. Airway reactivity d. Drug reconcentration ANS: A
The primary hazard of aerosol drug therapy is an adverse reaction to the medication being administered.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 848 OBJ: 4 28.
To minimize the risk of infection associated with aerosol drug therapy, what should you do? 1. Sterilize nebulizers between patients. 2. Frequently replace in-use units. 3. Rinse nebulizers with sterile water. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Guidelines from the Centers for Disease Control and Prevention state that nebulizers should be sterilized between patients, frequently replaced with disinfected or sterile units, or rinsed with sterile water (not tap water), and air-dried every 24 hr. DIF: Recall 29.
REF: p. 848
OBJ: 4
Which of the following drugs or drug categories have been associated with increased airway resistance and bronchospasm during aerosol administration? 1. Steroids 2. Albuterol 3. Acetylcysteine 4. Antibiotics a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
Medications such as acetylcysteine, antibiotics, steroids, cromolyn sodium, ribavirin, and distilled water have been associated with increased airway resistance and wheezing during aerosol therapy. DIF: Recall 30.
REF: p. 848
OBJ: 4
To monitor a patient for the possibility of reactive bronchospasm during aerosol drug therapy, what should you do? 1. Measure pre- and postpeak flow and/or percentage forced expiratory volume in 1 second (%FEV 1 ). 2. Auscultate for adventitious breath sounds. 3. Carefully observe the patient’s response. 4. Communicate with the patient during therapy. a. 1 and 3 only b. 1, 3, and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Monitoring for reactive bronchospasm should include peak flow measurements or percentage forced expiratory volume in 1 second (%FEV 1 ) before and after therapy; auscultation for adventitious breath sounds, and 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 (WOB). DIF: Application 31.
REF: p. 848
OBJ: 4
A patient with chronic bronchitis is receiving heated water aerosol treatments through a jet nebulizer four times daily to aid in mobilizing retained secretions. After each treatment, you note a dramatic increase in the magnitude of coarse crackles heard on auscultation. Which of the following recommendations would you make to the physician? a. Discontinue the heated water aerosol treatments. b. Switch to a higher-density aerosol (e.g., ultrasonic). c. Add coughing and postural drainage to the therapy. d. Consider prior treatment with a bronchodilator. ANS: C
For patients unable to clear their own secretions, suctioning or other airway clearance techniques may be indicated as an adjunct to aerosol therapy. DIF: Application 32.
REF: p. 848
OBJ: 4
Which of the following is not considered a drug aerosol delivery system? a. Dry powder inhalers (DPIs) b. Small-volume jet nebulizers c. Metered dose inhalers (MDIs) d. Spinning disk nebulizers ANS: D
Aerosol generators in use include pressurized metered dose inhalers (pMDIs) with or without spacers/holding chambers, dry powder inhalers (DPIs), small and large volume (jet) nebulizers, ultrasonic nebulizers (USNs), hand-bulb atomizers (including nasal spray pumps), vibrating mesh nebulizers, and a number of emerging technologies. DIF: Recall 33.
REF: p. 848
OBJ: 5
What is the preferred method for delivering bronchodilators to spontaneously breathing and intubated, ventilated patients? a. Dry powder inhaler b. Small-volume jet nebulizer c. Metered dose inhaler d. Hand-bulb atomizer ANS: C
Pressurized metered dose inhalers often are the preferred method for delivering bronchodilators to spontaneously breathing patients as well as those who are intubated and undergoing mechanical ventilation. DIF: Recall
REF: p. 849
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 34.
Immediately after firing, the aerosol particles produced by most metered dose inhalers are approximately how large? a. 1 µm b. 5 µm c. 20 µm d. 35 µm ANS: D
Propellant evaporation causes the initially large particles (35 µm) generated at the actuator orifice to rapidly decrease in size. DIF: Recall 35.
REF: p. 849
OBJ: 5
Each actuation of a typical metered dose inhaler delivers approximately what output volume? a. 10 to 30 mcl b. 30 to 100 mcl c. 10 to 30 ml d. 30 to 100 ml ANS: B
The output volume of pressurized metered dose inhalers varies from 30 to 100 mcl. DIF: Recall 36.
REF: p. 849
OBJ: 5
Most of the spray generated by the majority of metered dose inhalers consists of which of the following? a. Active drug b. Propellant c. Surfactant agents d. Water solution ANS: B
Approximately 60% to 80% by weight of this spray consists of the propellant. DIF: Recall 37.
REF: p. 849
OBJ: 5
Approximately what range of drug dosages can be provided with each firing of a metered dose inhaler? a. 5 to 50 mg b. 50 to 100 mg c. 5 to 50 mcg d. 50 mcg to 5 mg ANS: D
Approximately 60% to 80% by weight of this spray consists of the propellant, with only approximately 1% being active drug (50 mcg to 5 mg, depending on the drug formulation). DIF: Recall
REF: p. 849
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 38.
A typical metered dose inhaler produces which of the following particle distributions? a. 2 to 6-µm mean mass aerodynamic diameter (MMAD) b. 1- to 3-µm MMAD c. 6- to 9-µm MMAD d. Less than 1-µm MMAD ANS: A
Pressurized metered dose inhalers can produce particles in the respirable range (MMAD 2 to 6 µm). DIF: Recall 39.
REF: p. 851
OBJ: 5
When fired inside the mouth, what percentage of the drug dose delivered by a simple metered dose inhaler (MDI) deposits in the oropharynx? a. Approximately 20% b. Approximately 40% c. Approximately 60% d. Approximately 80% ANS: D
The initial velocity and dispersion of the aerosol plume generate larger particles that decrease in size as they leave the pressurized MDI, resulting in approximately 80% of the dose leaving the actuator to impact and become deposited in the oropharynx. DIF: Recall 40.
REF: p. 851
OBJ: 5
When using a metered dose inhaler without a holding chamber or a spacer, the patient should be instructed to fire the device at what point? a. Immediately before beginning a slow inspiration b. Immediately after beginning a slow exhalation c. Immediately after beginning a slow inspiration d. Immediately before beginning a slow exhalation ANS: C
See Box 39-1. DIF: Recall 41.
REF: p. 852
OBJ: 5
Before inspiration and actuation of a metered dose inhaler, the patient should exhale to which of the following? a. Total lung capacity b. Residual volume c. Functional residual capacity d. Expiratory reserve volume ANS: C
See Box 39-1. DIF: Recall
REF: p. 852
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 42.
To ensure delivery of the proper drug dosage with a metered dose inhaler, which of the following must be done before its use? 1. The canister valve stem should be cleaned with a pin. 2. The canister should be warmed to hand or body temperature. 3. The canister should be vigorously shaken. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: C
See Box 39-3. DIF: Recall 43.
REF: p. 854
OBJ: 5
Which of the following groups of patients are most likely to have difficulty using a simple metered dose inhaler for aerosol drug therapy? 1. Patients in acute distress 2. Infants and young children 3. Elderly persons a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Some patients, especially infants, young children, the elderly, and patients in acute distress, may not be able to coordinate actuation of the pressurized metered dose inhaler with inspiration. DIF: Recall 44.
REF: p. 852
OBJ: 5
Which of the following agents has been associated with increased intraocular pressure? a. Anticholinergics b. Epinephrine c. Beta-2 agonists d. Antibiotics ANS: A
Use of anticholinergic agents has been associated with increased ocular pressure, which could be dangerous for patients with glaucoma. DIF: Recall 45.
REF: p. 852
OBJ: 5
To decrease the likelihood of an opportunistic yeast or fungal infection associated with metered dose inhaler (MDI) steroids, what would you recommend that a patient does? 1. Cut in half the number of puffs or treatments. 2. Use a spacer or holding chamber. 3. Rinse the mouth after each treatment.
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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a. b. c. d.
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1 and 2 only 1 and 3 only 2 and 3 only 1, 2, and 3
ANS: C
The high percentage of oropharyngeal drug deposition with use of steroid pressurized MDIs (pMDIs) can increase the incidence of opportunistic oral yeast infection (thrush) and changes in the voice (dysphonia). Rinsing the mouth after steroid use can help avoid this problem, but most pMDI steroid aerosol impaction occurs deep in the hypopharynx, which cannot be easily rinsed with gargling. For this reason, steroid pMDIs should not be used alone but always in combination with a spacer or valved holding chamber. DIF: Application 46.
REF: p. 852
OBJ: 5
What is a potential limitation of flow-triggered metered dose inhaler devices? a. Increased pharyngeal impaction. b. Less effective lung deposition. c. High flows necessary for actuation. d. Requires accessory equipment. ANS: C
Patients experiencing an acute exacerbation of bronchospasm may not be able to generate sufficient flows to trigger the Autohaler. DIF: Recall 47.
REF: p. 850
OBJ: 5
For which of the following patients would you recommend against using a flow-triggered metered dose inhaler (MDI) as the sole bronchodilator delivery system? a. Patient likely to develop acute severe bronchospasm b. Stable elderly patient on maintenance bronchodilator therapy c. Teenage asthmatic who refuses to use a holding chamber d. Patient who cannot coordinate MDI firing with inhalation ANS: A
Caution may be appropriate in ordering breath-triggered pMDIs for small children and patients prone to severe levels of airway obstruction. DIF: Analysis 48.
REF: p. 850
OBJ: 5
Which of the following are beneficial effects of using a holding chamber with a metered dose inhaler (MDI)? 1. Reduction in oropharyngeal aerosol deposition 2. Decrease in need for hand-breath coordination 3. Elimination of medication waste a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
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ANS: A
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Spacers and valved holding chambers are pressurized MDI accessory devices designed to reduce both oropharyngeal deposition and the need for hand-breath coordination. DIF: Recall 49.
REF: p. 852
OBJ: 5
The key difference between a metered dose inhaler (MDI) holding chamber and a spacer is that the holding chamber incorporates which of the following? a. Larger enclosed space b. One-way inspiratory valve c. Heated chamber d. Series of baffles ANS: B
A spacer is a simple valveless extension device that adds distance between the pMDI outlet and the patient’s mouth. See Box 39-2. DIF: Recall 50.
REF: p. 852
OBJ: 5
After actuating a metered dose inhaler with a holding chamber, what should the patient be instructed to do? a. Take a large breath and hold it for at least 5 sec. b. Continue to breathe through the device for three breaths. c. Immediately exhale as fast and as much as possible. d. Take one quick breath and remove the holding chamber. ANS: B
With normal breathing, actuate the pMDI once and have the patient breathe through the device for three to seven breaths (three breaths for adults and seven breaths for infants).* DIF: Recall 51.
REF: p. 854
OBJ: 5
Which of the following devices would you select to deliver an aerosolized bronchodilator to a young child? a. Metered dose inhaler (MDI) and spacer b. MDI, holding chamber, and mask c. MDI and holding chamber d. Dry powder inhaler ANS: B
Holding chambers with masks are available for use in the care of infants, children, and adults. DIF: Recall 52.
REF: p. 854
OBJ: 5
Advantages of the dry powder inhaler (DPI) drug delivery systems include which of the following? 1. Low relative cost 2. No propellants required 3. No hand-breath coordination necessary 4. Unaffected by humidity
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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a. b. c. d.
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1 and 3 only 1, 2, and 3 only 3 and 4 only 2, 3, and 4 only
ANS: B
DPIs are relatively inexpensive, do not need propellants, and do not require the hand-breath coordination needed for pressurized metered dose inhalers. DIF: Recall 53.
REF: p. 855
OBJ: 5
Proper use of a dry powder inhaler (DPI) requires that the patient be able to do which of the following? a. Generate inspiratory flows of 60 L/min or higher. b. Exhale forcibly through the device before drug delivery. c. Inhale slowly (<0.5 L/sec) and perform a breath-hold. d. Coordinate firing of the DPI with inspiration. ANS: A
Individual doses are inhaled as soon as the seal is broken. The high peak inspiratory flow rates (>60 L/min) required to dispense the drug powder from most current DPI designs result in a pharyngeal dose comparable with that received from a typical pressurized metered dose inhaler without an add-on device. DIF: Recall 54.
REF: p. 855
OBJ: 5
Which of the following devices depends on the patient’s inspiratory effort to dispense the dose? a. Small-volume jet nebulizers b. Metered dose inhaler c. Dry powder inhaler d. Soft mist inhaler ANS: C
Passive or patient-driven, dry powder inhalers rely on the patient’s inspiratory effort to dispense the dose. DIF: Recall 55.
REF: p. 855
OBJ: 5
Which of the following would be correct instructions for a patient being taught proper use of a dry powder inhaler? 1. Place mouthpiece 4 cm from mouth 2. Exhale slowly to FRC 3. Inhale slowly (<30 L/min) 4. Repeat until dose is used up a. 2 and 4 only b. 3 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: A
See Box 39-4. DIF: Recall 56.
REF: p. 857
OBJ: 5
For which of the following patient groups is use of a dry powder inhaler (DPI) for bronchodilator administration recommended? 1. Infants and children younger than 5 years 2. Patients with an acute bronchospastic episode 3. Patients requiring maintenance therapy a. 1 and 2 only b. 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: B
Because infants, small children (younger than 5 years) (Figure 39-17), and those not able to follow instructions cannot develop flow this high, these patient groups cannot use DPIs. Patients with severe airway obstruction also may not be able to achieve the required flow; therefore, DPIs should not be used in the management of acute bronchospasm. DIF: Recall 57.
REF: p. 857
OBJ: 5
Exhalation into which device can result in loss of drug delivery? a. Small-volume jet nebulizers b. Metered dose inhaler c. Dry powder inhaler d. Ultrasonic nebulizer ANS: C
Exhalation into the dry powder inhaler before inspiration can result in loss of drug delivery to the lung. DIF: Recall 58.
REF: p. 857
OBJ: 5
Which of the following small-volume jet nebulizer design features affect its performance? 1. Position 2. Residual volume 3. Baffles 4. Reservoirs a. 1, 2, and 3 only b. 2 and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
See Box 39-5. DIF: Recall
REF: p. 859
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 59.
Which of the following source gas characteristics affect the performance of small-volume jet nebulizers? 1. Humidity 2. Flow 3. Pressure 4. Viscosity a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
See Box 39-5. DIF: Recall 60.
REF: p. 859
OBJ: 5
Which of the following drug formulation characteristics affect the performance of small-volume jet nebulizers? 1. Homogeneity 2. Surface tension 3. Viscosity 4. Potency a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
See Box 39-5. DIF: Recall 61.
REF: p. 859
OBJ: 5
What is the average amount of dead volume in a small-volume jet nebulizer after the device runs dry? a. 0.1 ml b. 0.5 to 2.2 ml c. 2.0 to 4.0 ml d. Less than 0.1 ml ANS: B
The residual volume of a 3-ml dose varies from as little as 0.5 ml to more than 2.2 ml, which can be more than two-thirds of the total dose. DIF: Recall
REF: p. 859
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 62.
During aerosol drug delivery using a small-volume jet nebulizer (SVN) set at 8 L/min input flow, a patient asks that the head of the bed be lowered to a semi-Fowler’s position. Immediately after doing so, you observe a significant drop in SVN aerosol output, despite there being at least 3 ml of solution left in the reservoir. What would you do to correct this problem? a. Add 1 to 2 ml more diluent to the nebulizer reservoir. b. Increase the nebulizer input flow to 10 to 12 L/min. c. Reposition the patient so that the SVN is more upright. d. Decrease the nebulizer input flow to 3 to 4 L/min. ANS: C
Some SVNs stop producing aerosol when tilted as little as 30 degrees from vertical. DIF: Analysis 63.
REF: p. 859
OBJ: 6
You increase the fill volume from 2 to 4 ml in a small-volume jet nebulizer being used to administer a bronchodilator agent with an aerosol. What effect will this have on the amount of drug delivered? a. No effect b. Increase c. Decrease d. More waste ANS: B
Increasing the fill volume allows a greater proportion of active medication to be nebulized. DIF: Application 64.
REF: p. 859
OBJ: 6
What happens as the pressure or flow delivered through a small-volume jet nebulizer gets higher? 1. Treatment time becomes shorter. 2. Particle size becomes smaller. 3. Aerosol output becomes greater. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Within operating limits, the higher the pressure or flow, the smaller is the particle size, the greater is the output, and the shorter is the treatment time. DIF: Recall 65.
REF: p. 859
OBJ: 5
Which of the following is the effect of aerosol particles entrained into a warm and fully saturated gas stream? a. No effect b. Increase in size c. Decrease in size
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Increase in number ANS: B
Aerosol particles entrained into a warm and fully saturated gas stream increase in size. DIF: Recall 66.
REF: p. 859
OBJ: 5
Which of the following is false about the optimal technique for using a small-volume jet nebulizer (SVN) for aerosol drug delivery? a. SVNs are less technique- and device-dependent. b. Slow inspiration improves SVN aerosol deposition. c. Deep breathing or breath-holding improves SVN deposition. d. Use of a mouthpiece or mask provides similar results. ANS: C
Use of an SVN is less technique- and device-dependent than use of a pressurized metered dose inhaler or dry powder inhaler delivery system. Slow inspiratory flow does optimize SVN aerosol deposition. However, deep breathing and breath-holding during SVN therapy do little to enhance deposition over normal tidal breathing. Because the nose is an efficient filter of particles larger than 5 mm, many clinicians prefer not to use a mask for SVN therapy. As long as the patient is mouth-breathing, there is little difference in clinical response between therapy given by mouthpiece and that given by mask. DIF: Recall 67.
REF: p. 864
OBJ: 7
In mouth-breathing adult patients, which of the following factors is crucial in determining whether to use a mask or mouthpiece for aerosol drug delivery with a small-volume jet nebulizer? a. Clinician experience b. Drug concentration c. Patient preference and comfort d. Brand of small-volume jet nebulizer ANS: C
The selection of delivery method (mask or mouthpiece) should be based on patient ability, preference, and comfort. DIF: Recall 68.
REF: p. 860
OBJ: 5
Normally, when using a 50-psi flowmeter to drive a small-volume jet nebulizer, to what should you set the flow? a. 2 to 4 L/min b. 4 to 6 L/min c. 6 to 10 L/min d. 8 to 10 L/min ANS: C
See Box 39-6. DIF: Recall
REF: p. 864
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 69.
To decrease the dead space volume of a small-volume jet nebulizer during drug administration, what should you do? a. Decrease the nebulizer flow. b. Turn the nebulizer upside-down. c. Continue treatment until nebulizer begins to sputter. d. Increase the nebulizer flow. ANS: C
See Box 39-6. DIF: Application 70.
REF: p. 864
OBJ: 6
To minimize a patient’s infection risk between drug treatments with a small-volume jet nebulizer (SVN), what would you do? a. Rinse the SVN with sterile water; air dry. b. Carefully repackage the SVN in its wet state. c. Rinse the SVN with tap water; run until dry. d. Throw out the SVN after every treatment. ANS: A
The Centers for Disease Control and Prevention recommends that nebulizers be cleaned and disinfected, or rinsed with sterile water, and air-dried between uses. DIF: Application 71.
REF: p. 863
OBJ: 6
A patient with an acute exacerbation of asthma is not responding to the standard dose and frequency of an aerosolized bronchodilator and is now receiving small-volume jet nebulizer (SVN) therapy every 30 min. Which of the following would you recommend to the patient’s physician at this time? a. Discontinue the aerosolized bronchodilator. b. Increase the frequency of SVN therapy to every 10 min. c. Consider continuous nebulization of the drug. d. Add more diluent to the SVN to extend treatment time. ANS: C
An alternative approach is to provide continuous nebulization with a specialized large-volume nebulizer. DIF: Application 72.
REF: p. 864
OBJ: 6
What is the major problem with using large volume nebulizers for continuous aerosol drug therapy? a. Decreased pulmonary deposition b. Drug reconcentration and toxicity c. Frequent interruption of therapy d. Greater waste of drug ANS: B
A potential problem with continuous bronchodilator therapy is drug concentration increase.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall 73.
REF: p. 864
OBJ: 5
A physician has ordered the antiviral agent ribavirin (Virazole) to be administered by aerosol to an infant with bronchiolitis. Which of the following devices would you recommend in this situation? a. Hydrodynamic (Babbington) nebulizer b. Small-particle aerosol generator (SPAG) c. Ultrasonic (piezoelectric) nebulizer d. Large-volume heated jet nebulizer ANS: B
The SPAG was manufactured by ICN Pharmaceuticals specifically for the administration of ribavirin (Virazole) to infants with respiratory syncytial virus infection. DIF: Recall 74.
REF: p. 864
OBJ: 5
The small-particle aerosol generator (SPAG) produces a small monodisperse aerosol through which of the following? a. Aerosol impaction by sequential baffling b. Particle evaporation in a glass drying chamber c. Use of an inert liquefied gas propellant d. Aerosol generation using vibrational energy ANS: B
The device is unique in clinical respiratory care practice in that it incorporates a drying chamber with its own flow control to produce a stable aerosol. DIF: Recall 75.
REF: p. 864
OBJ: 5
Which of the following drugs present the greatest exposure risks for health care workers? 1. Albuterol (Proventil) 2. Pentamidine (NebuPent) 3. Ribavirin (Virazole) 4. Acetylcysteine (Mucomyst) a. 1 and 4 only b. 2 and 3 only c. 1, 2, and 3 only d. 2, 3, and 4 only ANS: B
The greatest occupational risk for respiratory therapists has been associated with administration of ribavirin and pentamidine. DIF: Recall 76.
REF: p. 879
OBJ: 10
Side effects of environmental exposure to ribavirin or pentamidine aerosols include which of the following? 1. Bronchospasm 2. Skin rashes
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. Conjunctivitis 4. Tachyphylaxis a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
Conjunctivitis, headaches, bronchospasm, shortness of breath, and rashes have been reported among those administering these drugs. DIF: Recall 77.
REF: p. 880
OBJ: 10
Which of the following methods can be used to minimize the harmful effects of environmental exposure to ribavirin or pentamidine aerosols? 1. Use an isolation booth or tent with HEPA filtered exhaust. 2. Have health care personnel wear a HEPA filtered mask. 3. Use a negative pressure room with adequate air exchange. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Patients given aerosolized ribavirin or pentamidine must be treated in a private room, booth, or tent or at a special station designed to minimize environmental contamination. DIF: Recall 78.
REF: p. 880
OBJ: 10
Which of the following are true about a solution that is being aerosolized by an ultrasonic nebulizer? 1. The solute concentration decreases. 2. The temperature of the solution increases. 3. The solute concentration increases. 4. The temperature of the solution decreases. a. 1 and 2 only b. 2 and 3 only c. 2 and 4 only d. 3 and 4 only ANS: B
As the temperature increases, the drug concentration increases, as does the likelihood of undesired side effects. DIF: Recall 79.
REF: p. 865
OBJ: 5
Which of the following make small-volume ultrasonic drug delivery systems different from their large-volume counterparts? 1. They do not use a couplant compartment.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. Drugs are placed directly on the transducer. 3. Battery power is available on some units. 4. Patient flow, not a blower, carries the aerosol. a. 2 and 4 only b. 3 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: D
Unlike the larger units, some of these systems do not use a couplant compartment; the medication is placed directly into the manifold on top of the transducer. The transducer is connected by cable to a power source, often battery-powered to increase portability. These devices have no blower; the patient’s inspiratory flow draws the aerosol from the nebulizer into the lung. DIF: Recall 80.
REF: p. 865
OBJ: 5
Advantages of small-volume ultrasonic nebulizers for drug delivery include which of the following? 1. Greater respirable drug mass 2. Less dead space and waste 3. Increased mobility 4. Decreased cost a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Both theoretical advantages of the ultrasonic devices are outweighed by relatively high purchase costs and poor reliability. DIF: Recall 81.
REF: p. 865
OBJ: 5
What is the average mean mass aerodynamic diameter (MMAD) generated by the vibrating mesh nebulizers? a. 1 to 2 µm b. 2 to 3 µm c. 3 to 4 µm d. 5 to 6 µm ANS: B
The exit velocity of the aerosol is low, less than 4 m/sec, and the particle size can range between 2 and 3 µm MMAD, varying with the exit diameter of the apertures (Figure 39-27). DIF: Recall 82.
REF: p. 866
OBJ: 5
In selecting the appropriate aerosol drug delivery device for a given patient, what must you consider?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1. Available drug formulation(s) 2. Desired site of deposition 3. Patient’s characteristics 4. Patient’s preference a. 1 and 2 only b. 1 and 3 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: C
In selecting the appropriate aerosol delivery device for a given patient, the following must be considered: (1) the available drug formulation, (2) the desired site of deposition, (3) the patient’s characteristics (age, acuity of respiratory problem, alertness, and ability to follow instructions), (4) ability to properly use the device, and (5) the patient’s preference. DIF: Recall 83.
REF: p. 867|p. 869
OBJ: 5
For maintenance administration of bronchodilators to an adult patient with adequate inspiratory flow, which of the following aerosol drug delivery devices would you recommend? 1. Pressurized metered dose inhaler (pMDI) 2. Small-volume jet nebulizer 3. Dry powder inhaler 4. pMDI and holding chamber a. 1 or 2 only b. 2 or 3 only c. 2 or 4 only d. 3 or 4 only ANS: D
For administration of maintenance therapy bronchodilators and antiinflammatory agents to adults, a pMDI with a valved holding chamber is the most convenient, versatile, and cost-effective approach. Dry powder inhalers are gaining popularity as an equivalent to pMDIs for maintenance therapy with available drugs for patients capable of generating adequate inspiratory flow. DIF: Application 84.
REF: p. 869
OBJ: 5
Which of the following aerosol drug delivery devices would you recommend against using with a toddler or small child? 1. Metered dose inhaler (MDI) 2. Small-volume jet nebulizer 3. Dry powder inhaler 4. MDI, holding chamber, and mask a. 1 and 2 only b. 1 and 3 only c. 2 and 4 only d. 3 and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: A
See Rule of Thumb p. 869. DIF: Application 85.
REF: p. 869
OBJ: 9
On the average, what percentage of an aerosol drug delivery device’s output actually deposits in the lungs? a. Less than 10% b. 10% c. 20% d. 30% ANS: B
Depending on device and patient, as little as 10% or less of drug emitted from an aerosol device may be deposited in the lungs (Figure 39-27). DIF: Recall 86.
REF: p. 870
OBJ: 5
Factors associated with reduced pulmonary deposition of aerosolized drugs include which of the following? 1. Mechanical ventilation 2. Artificial airways 3. Poor patient technique 4. Mouth breathing a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
See Box 39-7. DIF: Recall 87.
REF: p. 869
OBJ: 5
Possible complications associated with the selection of an aerosol drug delivery device include which of the following? a. Underdosing or overdosing because of improper technique b. Overhydration or fluid imbalances c. Adverse effects of the specific drug agent d. Environmental contamination or caregiver exposure a. 1 only b. 1, 3, and 4 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
See Box 39-7. DIF: Recall
REF: p. 869
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 88.
A semiconscious patient with inadequate spontaneous ventilation requires aerosol drug administration. Which of the following approaches would you recommend? a. Large-volume continuous nebulizer b. Small-volume jet nebulizer (SVN) c. SVN with delivery by intermittent positive-pressure breathing d. Metered dose inhaler and holding chamber ANS: C
See Box 39-7. DIF: Application 89.
REF: p. 869
OBJ: 5
To assess the effectiveness of a particular aerosol delivery device selection, what would you evaluate? 1. Patient’s technique in using the device 2. Patient’s response to and compliance with procedure 3. Objective measures of improvement (e.g., peak flow) a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
See Box 39-8. DIF: Recall 90.
REF: p. 873
OBJ: 8
Which of the following would you recommend as initial therapy for a patient admitted to the emergency department with acute airway obstruction (wheezing, cough, dyspnea, peak expiratory flow rate [PEFR] <60% predicted)? 1. Assess dose-response of metered dose inhaler (MDI) albuterol (up to 12 puffs). 2. Provide up to three small-volume jet nebulizer (SVN) treatments with albuterol every 20 min. 3. Immediately begin continuous albuterol therapy at 15 mg/hr. a. 1 or 2 only b. 1 or 3 only c. 2 or 3 only d. 1, 2, and 3 ANS: A
A patient with acute airway obstruction (wheezing, cough, dyspnea, and PEFR <60% of predicted value) would receive up to three SVN treatments with a standard dose of albuterol, repeated at 20-min intervals, or four puffs of pressurized MDI albuterol with a holding chamber (up to 12 puffs). DIF: Recall 91.
REF: p. 871
OBJ: 8
Indications for assessment of patient’s response to bronchodilator therapy include which of the following?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
a. Confirm whether the therapy works as intended. b. Individualize the dose, frequency, or type of medication. c. Help follow the patient’s status during long-term therapy. d. Quantify the degree of bronchial hyperresponsiveness. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
The AARC has published Clinical Practice Guideline: Assessing Response to Bronchodilator Therapy at Point of Care. See Box 39-8. DIF: Recall 92.
REF: p. 873
OBJ: 8
Appropriate documentation when conducting point-of-care assessment of a patient’s response to bronchodilator therapy includes which of the following? a. Medication type, dose, and time received b. Vital signs, breath sounds, and pulmonary function test measures c. Patient’s progress and ability to self-assess symptoms d. Blood levels of the bronchodilator agent a. 1 and 2 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
The AARC has published Clinical Practice Guideline: Assessing Response to Bronchodilator Therapy at Point of Care. See Box 39-8. DIF: Recall 93.
REF: p. 873
OBJ: 8
Proper use of a soft mist inhaler requires that the patient be able to do which of the following? a. Generate inspiratory flows of 60 L/min or higher. b. Exhale forcibly through the device before drug delivery. c. Requires hand-breath coordination on the part of the patient. d. Connect the device to the proper gas source. ANS: C
To operate the device, patients twist the body of the device to load an internal spring, place the mouthpiece of the Respimat between the lips, and press a button to release the drug through a uniblock to create the aerosol, which is released over 1.1 to 1.4 sec, depending on the formulation configuration. The Respimat requires hand-breath coordination on the part of the patient, as does a pMDI, but because of the longer aerosolization time, it seems more likely that the patient will get a greater percent of emitted dose despite coordination issues. DIF: Recall
REF: p. 867
OBJ: 7
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 94.
In addition to bedside pulmonary function test measures, what other components of patient assessment are useful in evaluating bronchodilator therapy? 1. Patient interview and observation 2. Measurement of vital signs 3. Chest auscultation 4. Arterial blood gas analysis and oximetry a. 1, 3, and 4 only b. 2 and 3 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: D
Other components of patient assessment useful in evaluating bronchodilator therapy include patient interviewing and observation, measurement of vital signs, auscultation, blood gas analysis, and oximetry. DIF: Recall 95.
REF: p. 870
OBJ: 8
When assessing a patient’s response to bronchodilator therapy, you notice a decrease in wheezing accompanied by an overall decrease in the intensity of breath sounds. Which of the following is most likely? a. Increasing airway obstruction b. Improving ventilation/perfusion ratio (V/Q) c. Decreasing airway obstruction d. Deteriorating oxygenation ANS: A
In terms of breath sounds, a decrease in wheezing accompanied by an overall decrease in the intensity of breath sounds indicates worsening airway obstruction or patient fatigue. DIF: Application 96.
REF: p. 870
OBJ: 8
When assessing a patient’s response to bronchodilator therapy, you notice a decrease in wheezing accompanied by an overall increase in the intensity of breath sounds. Which of the following is most likely? a. Increasing airway obstruction b. Improving c. Decreasing airway obstruction d. Deteriorating oxygenation ANS: C
Improvement is indicated when wheezing decreases and the overall intensity of breath sounds increases. DIF: Application 97.
REF: p. 870
OBJ: 8
Which of the following best describes a proper a dose-response assessment of a metered dose inhaler (MDI) bronchodilator? a. Give 4 puffs one after the other, wait 1 min, repeat up to 16 puffs. The best dose is
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
the highest dose given without side effects. b. Give 4 puffs spaced 1 to 2 min apart; repeat up to 12 puffs with continued improvement. The best dose provides maximum subjective relief and the highest peak expiratory flow rate (PEFR) without side effects. c. Give 12 puffs 1 min apart; repeat every 20 min until maximum relief of symptoms is achieved without side effects. d. Give 2 puffs 1 to 2 min apart; repeat up to 6 puffs with continued improvement. The best dose provides maximum subjective relief and the highest PEFR without side effects. ANS: B
A simple albuterol dose-response titration involves giving an initial 4 puffs (90 mcg/puff) at 1-min intervals through a pressurized MDI with a holding chamber. If after 5 min, airway obstruction is not relieved, the respiratory therapist gives 1 puff/min until symptoms are relieved, heart rate increases to more than 20 beats/min, tremors increase, or 12 puffs are delivered. The best dose is that which provides maximum relief of symptoms and the highest PEFR without side effects. DIF: Recall 98.
REF: p. 872
OBJ: 8
In a dose-response assessment of a patient’s response to a metered dose inhaler bronchodilator, when would you stop increasing the dose? 1. When the peak expiratory flow rate improves less than 10% to 15% 2. When tachycardia occurs 3. When tremors are evident 4. When 6 to 8 puffs are delivered a. 1, 2, and 3 only b. 1, 3, and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: A
See Box 39-8. DIF: Recall 99.
REF: p. 873
OBJ: 8
An asthmatic patient in severe distress with wheezing and dyspnea is admitted to the emergency department and started on albuterol via small-volume jet nebulizer. Which of the following approaches would you recommend to assess this therapy for this patient? 1. Perform arterial blood gas analysis. 2. Continuously monitor the SpO 2 . 3. Assess breath sounds and vital signs before and after each treatment. 4. Measure peak expiratory flow rate or forced expiratory volume in 1 sec before and after each treatment. a. 1 and 2 only b. 1, 3, and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D
See Box 39-8. DIF: Application 100.
REF: p. 873
OBJ: 8
An asthmatic patient in severe distress with wheezing and dyspnea is admitted to the emergency department. After a conducting a full assessment and obtaining a pretreatment baseline, you start the patient on albuterol with a small-volume jet nebulizer. You should continue assessing and documenting all appropriate variables before and after each treatment until what point? a. The patient’s symptoms are relieved or the peak expiratory flow rate (PEFR)/forced expiratory volume in 1 second (FEVl) exceed s 70% of ―personal best.‖ b. The patient’s wheezing disappears and the intensity of breath sounds decreases. c. The patient’s symptoms are relieved or the PEFR/FEV l returns to the predicted normal. d. The patient’s SpO 2 is above 90% and the PEFR/FEV l returns to the predicted normal. ANS: A
See Box 39-8. DIF: Application 101.
REF: p. 873
OBJ: 8
After initially conducting a pre- and postbronchodilator assessment on a stable asthmatic patient admitted to the hospital, how often would you recommend reassessment of peak expiratory flow rate/forced expiratory volume in 1 second? a. With each treatment b. Twice daily c. Once per day d. Every other day ANS: B
See Box 39-8. DIF: Recall 102.
REF: p. 873
OBJ: 8
What schedule of peak expiratory flow rate assessment would you recommend for a home care asthmatic patient? a. 1 to 2 times daily (on rising and at bedtime) b. Once per day (on rising or at bedtime) c. 3 to 4 times daily (on rising, noon, 4 to 7 PM, bedtime) d. 1 to 2 times daily (at noon and around bedtime) ANS: C
See Box 39-8. DIF: Application
REF: p. 873
OBJ: 8
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 103.
For a hospitalized patient who will require ongoing maintenance bronchodilator therapy after discharge, what should your end goal be? a. Complete relief of all patient symptoms b. Normal airflow and cessation of therapy c. Effective self-administration of the drug d. Peak expiratory flow rate that exceeds 70% of ―personal best‖ ANS: C
For patients who need ongoing maintenance therapy after the acute phase of illness, the goal should be effective self-administration of the drug. DIF: Recall 104.
REF: p. 873
OBJ: 8
Which of the following factors is most crucial in developing an effective program of aerosol drug self-administration in an adult patient requiring maintenance of bronchodilator therapy? a. Proper device selection b. Well-written brochures c. Reliable peak expiratory flow rate meter d. Good patient education ANS: D
An effective program of aerosol drug self-administration depends on thorough patient education. DIF: Recall 105.
REF: p. 873
OBJ: 8
Which of the following patient skills are necessary to ensure effectiveness of drug administration via the aerosol route? 1. Ability to keep track of dosing requirements 2. Understanding of the methods and goals of therapy 3. Ability to recognize undesirable side effects a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Whenever possible, patients should be taught to understand the basic administration techniques, to keep track of dosing requirements, to recognize undesirable side effects, and to understand the options and actions required to reduce or eliminate these effects. DIF: Recall 106.
REF: p. 873
OBJ: 7
What is the best way to confirm that an asthmatic outpatient can properly self-manage a newly prescribed aerosol drug therapy? a. Have the patient describe the proper procedural steps. b. Have the patient provide a repeat or return demonstration. c. Have the patient take a written or oral quiz on technique. d. Have the patient maintain detailed treatment logs.
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ANS: B
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Patients should be able to demonstrate good technique regarding the use of each aerosol device that they are expected to use in self-care. Practitioner demonstration followed by repeated patient return demonstration is a must, and should be reviewed frequently, such as with each office/clinic visit. DIF: Recall 107.
REF: p. 873
OBJ: 7
After administering 12 puffs of metered dose inhaler (MDI) albuterol to an acutely ill asthmatic patient in the emergency department, assessment indicates no significant improvement in symptoms. Which of the following would you now recommend? a. Switch over to high-dose MDI steroids. b. Discontinue the bronchodilator therapy. c. Use continuous bronchodilator therapy. d. Switch over to an anticholinergic agent. ANS: C
If these strategies fail to provide relief, continuous bronchodilator therapy (CBT) with nebulized albuterol doses ranging from 5 to 20 mg/hr have proved safe and effective for both adult and pediatric patients. DIF: Application 108.
REF: p. 873
OBJ: 8
What is the recommended dosage for continuous bronchodilator therapy (CBT)? a. 0.5 mg/hr b. 5.0 mg/hr c. 15.0 mg/hr d. 50.0 mg/hr ANS: C
According to this protocol, children older than 6 years with tachypnea and those with hypoxemia, increased work of breathing, and restlessness who do not respond to standard therapy are given CBT with a large volume nebulizer or small-volume jet nebulizer at a dosage of 15 mg/hr. DIF: Recall 109.
REF: p. 873
OBJ: 5
A physician orders continuous bronchodilator therapy with 1:200 albuterol for an asthmatic patient at the dosage of 20 mg/hr. How much 1:200 albuterol will be needed for the first hour of treatment? a. 2 ml b. 3 ml c. 4 ml d. 5 ml ANS: C
See Mini Clini p. 875. DIF: Recall
REF: p. 875
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 110.
Indications of an adverse drug response during continuous bronchodilator therapy include which of the following? 1. Decreased consciousness 2. Worsening tachycardia 3. Vomiting 4. Palpitations a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
The patient must be observed for adverse drug responses, including worsening tachycardia, palpitations, and vomiting. DIF: Recall 111.
REF: p. 875
OBJ: 8
To provide an extra margin of safety during continuous bronchodilator therapy (CBT), which of the following would you recommend be monitored? 1. Eosinophil count 2. Serum potassium levels 3. Electrocardiogram a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: C
To provide an extra margin of safety, some clinicians recommend that patients receiving CBT undergo continuous electrocardiographic monitoring and measurement of serum potassium level every 4 hr. DIF: Recall 112.
REF: p. 875
OBJ: 8
Which of the following device-related factors have a major effect on pressurized metered dose inhaler (MDI) delivery of aerosolized drugs during mechanical ventilation? 1. MDI propellant formula 2. Type of spacer or adapter used 3. Position of spacer in circuit 4. Timing of MDI actuation a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
See Table 39-5. DIF: Recall
REF: p. 875
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 113.
Which of the following circuit-related factors have a major effect on metered dose inhaler delivery of aerosolized drugs during mechanical ventilation? 1. Endotracheal tube size 2. Type of humidifier 3. Relative humidity 4. Temperature a. 1 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
See Table 39-5. DIF: Recall 114.
REF: p. 875
OBJ: 5
Which of the following ventilator-related factors have a major effect on metered dose inhaler delivery of aerosolized drugs during mechanical ventilation? 1. Mode of support 2. Presence of positive end expiratory pressure 3. VT 4. Inspiratory wave form a. 3 only b. 1, 2, and 3 only c. 2, 3 and 4 only d. 1, 3, and 4 only ANS: D
See Table 39-5. DIF: Recall 115.
REF: p. 875
OBJ: 5
On the average, what is the range of the actual pulmonary deposition of small-volume jet nebulizer aerosolized drugs in intubated patients receiving mechanical ventilation? a. 1.5% to 3.0% b. 3.5% to 6.0% c. 6.5% to 9.0% d. 9.5% to 15.0% ANS: A
Under normal conditions with heated humidification and standard jet nebulizers, pulmonary deposition ranges between 1.5% and 3.0%. DIF: Recall 116.
REF: p. 876
OBJ: 1
Which of the following would you recommend to optimize drug delivery with a small-volume jet nebulizer (SVN) to an intubated, mechanically ventilated patient? 1. Increase dose to compensate for decreased delivery.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. Adjust ventilator volume or pressure limit for added flow. 3. Disconnect or bypass heated humidifier system. 4. Turn off flow-by or continuous-flow while nebulizing. a. 1, 2, and 3 only b. 2 and 4 only c. 3 and 4 only d. 1 and 2 only ANS: A
Box 39-9 outlines the optimal technique for drug delivery by SVN to intubated patients undergoing mechanical ventilation. DIF: Application 117.
REF: p. 876
OBJ: 5
A patient on mechanical ventilation was given 4 puffs of albuterol 5 min ago through a metered dose inhaler (MDI) and holding chamber placed 18 in from the circuit’s airway connector. The patient continues to exhibit clinical signs of increased airway resistance but has demonstrated no apparent side effects from the drug. Which of the following would you recommend at this time? a. Discontinue the albuterol and switch to a systemic bronchodilator. b. Repeat administration until the desired response is achieved. c. Remove the circuit-holding chamber and repeat MDI actuation. d. Move the MDI closer to the patient’s airway and repeat use. ANS: B
Box 39-9 outlines the optimal technique for drug delivery by pressurized MDI to intubated patients undergoing mechanical ventilation. DIF: Application 118.
REF: p. 876
OBJ: 6
When using a chamber-style adapter with a metered dose inhaler (MDI) to deliver a bronchodilator to a patient receiving mechanical ventilation, with what would you coordinate MDI firing? a. Beginning of inspiration b. Beginning of exhalation c. End of inspiration d. Middle of inspiration ANS: A
Box 39-9 outlines the optimal technique for drug delivery by pressurized MDI to intubated patients undergoing mechanical ventilation. DIF: Recall 119.
REF: p. 876
OBJ: 5
What is the most reliable indicator of a change in airway resistance due to bronchodilator administration during mechanical ventilation? a. Change in slope of the expiratory flow-volume curve b. Difference between peak airway and plateau pressures c. Change in peak expiratory flow during passive exhalation
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Difference between plateau and baseline (PEEP) pressures ANS: B
A change in the differences between peak and plateau pressures (the most reliable indicator of a change in airway resistance during continuous mechanical ventilation) can be measured. DIF: Recall
REF: p. 876
OBJ: 8
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 40 - Storage and Delivery of Medical Gases Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following are considered therapeutic gases?
1. Oxygen (O 2 ) 2. O2 -NO mixture 3. O2 -He mixture 4. N2 O a. 1 and 2 only b. 2 and 4 only c. 3 and 4 only d. 1, 2, and 3 only ANS: D
Although there are many commercially produced gases, only a few are used medically (Table 40-1). DIF: Recall
REF: p. 885
OBJ: 1
2. What is the fire-risk classification of both N and CO 2 ? a. Flammable b. Supports combustion c. Inflammable d. Nonflammable ANS: D
See Table 40-1. DIF: Recall
REF: p. 885
OBJ: 1
3. Which of the following medical gases support combustion?
1. O2 2. N2 O 3. Compressed air 4. CO 2 a. 1 and 4 only b. 2 and 3 only c. 1, 2, and 3 only d. 1, 3, and 4 only ANS: C
See Table 40-1. DIF: Recall
REF: p. 885
OBJ: 1
4. Which of the following statements regarding O 2 are true?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1. It is only slightly soluble in water. 2. It is odorless and transparent. 3. It is flammable. 4. It is heavier than air. a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 1, 2, 3 only ANS: B
Oxygen is a colorless, odorless, transparent, and tasteless gas. It exists naturally as free molecular O 2 and as a component of a host of chemical compounds. Oxygen constitutes almost 50% by weight of the earth’s crust and occurs in all living matter in combination with hydrogen as water. At standard temperature, pressure, and dry (STPD), O2 has a density of 1.429 g/L, being slightly heavier than air (1.29 g/L). Oxygen is not very soluble in water. DIF: Recall
REF: p. 885
OBJ: 1
5. What factors affect the combustion-supporting properties of O 2 ?
1. Concentration 2. Partial pressure 3. Humidity a. 1 only b. 2 only c. 1 and 2 only d. 1, 2, and 3 ANS: C
Oxygen is nonflammable, but it greatly accelerates combustion. Burning speed increases with either (1) an increase in O 2 percentage at a fixed total pressure or (2) an increase in total pressure of O 2 at a constant gas concentration. Thus, both O 2 concentration and partial pressure influence the rate of burning. DIF: Recall
REF: p. 885
OBJ: 1
6. By what means is O2 for medical use in a hospital most commonly produced? a. Chemical decomposition b. Electrolysis c. Fractional distillation d. Physical separation ANS: C
Most large quantities of medical O2 are produced by fractional distillation of atmospheric air. DIF: Recall
REF: p. 885
OBJ: 2
7. What is the most common and least expensive method for commercial production of O 2 ? a. Electrolysis of water b. Fractional distillation of air
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. Physical separation by molecular sieves d. Chemical decomposition of sodium chlorate ANS: B
Fractional distillation is the most common and least expensive method for producing O2 . DIF: Recall
REF: p. 885
OBJ: 1
8. What is the U.S. Food and Drug Administration (FDA) purity standard for O 2 ? a. 21% b. 90% c. 95% d. 99% ANS: D
FDA standards require an O2 purity of at least 99.0%. DIF: Recall
REF: p. 885
OBJ: 1
9. Which of the following methods of producing O2 is commonly used in the home care setting? a. Chemical decomposition b. Electrolysis c. Fractional distillation d. Physical separation ANS: D
These devices, called O 2 concentrators, are used primarily for supplying low-flow O 2 in the home care setting. DIF: Recall
REF: p. 885
OBJ: 2
10. Components of a large medical air compressor include which of the following?
1. Drying system 2. Diaphragm or turbine 3. Reservoir tank 4. Pressure-reducing valve a. 2 and 3 only b. 2 and 4 only c. 1, 2, and 3 only d. 1, 3, and 4 only ANS: D
Figure 40-1 shows a typical large medical air compressor system. DIF: Recall
REF: p. 886
OBJ: 2
11. Air for medical use in a hospital should be which of the following?
1. Particle-free 2. Oil-free 3. Dry
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a. b. c. d.
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1 and 2 only 1 and 3 only 2 and 3 only 1, 2, and 3
ANS: D
For medical gas use, air must be dry and free of oil or particulate contamination. DIF: Recall
REF: p. 886
OBJ: 2
12. Large hospital air compressor systems must be capable of maintaining 50 pounds per square
inch gauge (psig) at what flows? a. 10 L/min b. 15 L/min c. 50 L/min d. 100 L/min ANS: D
Large medical air compressors must provide high flow (at least 100 L/min) at the standard working pressure of 50 psig for all equipment in use. DIF: Recall
REF: p. 886
OBJ: 2
13. Which of the following equipment(s) could be powered by a small diaphragm or turbine air
compressor? 1. Small-volume medication nebulizer 2. All-purpose large-volume jet nebulizer 3. Intermittent positive-pressure breathing device a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3 ANS: A
Small diaphragm or turbine compressors are ideal for powering devices such as small-volume medication nebulizers. DIF: Recall
REF: p. 886
OBJ: 2
14. Which of the following statements about CO2 are true?
1. It does not support animal life. 2. It is a flammable gas. 3. It is odorless and colorless. 4. It is heavier than air. a. 1 and 3 only b. 2 and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
At STPD, CO 2 is a colorless and odorless gas with a specific gravity of 1.52 (approximately 1.5 times heavier than air). Carbon dioxide does not support combustion or maintain animal life. DIF: Recall
REF: p. 886
OBJ: 1
15. Which of the following statements about He is false? a. It is an inert gas. b. It is odorless. c. It is nonflammable. d. It is heavier than air. ANS: D
Helium is second only to hydrogen as the lightest of all gases; it has a density at STPD of 0.1785 g/L. Helium is odorless, tasteless, nonflammable, and chemically and physiologically inert. DIF: Recall
REF: p. 886
OBJ: 1
16. What key property of He makes it useful as a therapeutic gas? a. Low solubility b. Chemical inertness c. Low cost d. Low density ANS: D
The low density of the results in a more laminar flow of gas thus decreasing the work of breathing. DIF: Recall
REF: p. 887
OBJ: 2
17. Which of the following gases is used to treat conditions causing hypoxic respiratory failure? a. N 2 O b. He c. NO d. Cyclopropane ANS: C
NO is FDA approved for use in the treatment of term and near-term infants for hypoxic respiratory failure. DIF: Recall
REF: p. 887
OBJ: 2
18. Compressed gas cylinders are manufactured from which of the following? a. Copper b. Seamless steel c. Seamless brass d. Fiberglass ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Gas cylinders are made of seamless steel and are classified by the federal Department of Transportation (DOT) according to their fabrication method. DIF: Recall
REF: p. 887
OBJ: 3
19. Department of Transportation (DOT) regulations require compressed gas cylinders to be
hydrostatically tested for leaks and expansion every how often? a. 1 to 2 years b. 3 to 5 years c. 6 to 8 years d. 5 to 10 years ANS: D
Safety tests are conducted on each cylinder every 5 or 10 years, as specified in DOT regulations. DIF: Recall
REF: p. 887
OBJ: 3
20. During inspection of the shoulder of a compressed gas cylinder, you note a plus sign (+) next
to the test date. This indicates what about the cylinder? a. It is made of spun aluminum, not steel. b. It only requires a 10-year DOT inspection. c. It can be filled to 10% above its service pressure. d. It has a high coefficient of elastic expansion. ANS: C
A plus sign (+) means the cylinder is approved for filling to 10% above its service pressure. DIF: Recall
REF: pp. 887-888 OBJ: 3
21. According to the U.S. Department of Commerce, a gas cylinder that is color coded blue
should contain which of the following? a. Air b. He c. N 2 O d. O 2 ANS: C
Table 40-2 lists the color codes for medical gases as adopted by the Bureau of Standards of the U.S. Department of Commerce. DIF: Recall
REF: p. 888
OBJ: 3
22. According to the National Institute of Standards and Technology of the U.S. Department of
Commerce, a gas cylinder that is color-coded brown and green should contain which of the following? a. O 2 -N 2 mixture b. O 2 -CO 2 mixture c. CO 2 d. O 2 -He mixture
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D
Table 40-2 lists the color codes for medical gases as adopted by the Bureau of Standards of the U.S. Department of Commerce. DIF: Recall
REF: p. 888
OBJ: 3
23. To prevent this type of accident, all cylinders have high-23. In clinical practice, how is a
positive identification made of the contents of a medical gas cylinder? a. Noting the color of the cylinder b. Inspecting the cylinder threads c. Reading the cylinder label d. Collecting and analyzing a gas sample ANS: C
As with any drug agent, the cylinder contents always must be identified through careful inspection of the label. DIF: Recall
REF: p. 888
OBJ: 3
24. What is the key difference between small compressed gas cylinders (sizes AA to E) and their
larger counterparts (sizes F to K)? a. Small gas cylinders do not undergo regular DOT testing. b. Small gas cylinders are always filled to lower pressures. c. Small gas cylinders cannot be used for anesthetic gases. d. Small gas cylinders use a yoke (not threaded) connector. ANS: D
Small cylinders have a postvalve and yoke connector. DIF: Recall
REF: p. 888
OBJ: 3
25. Which of the following mechanisms do all compressed gas cylinders use to avoid excessively
high buildup of cylinder pressure? a. Internal convection cooling mechanism b. Pressure-relief mechanism on the valve stem c. Automatic cylinder breech mechanism d. Pressure-relief mechanism on the cylinder body pressure relief valves. ANS: B
Should the temperature increase too much (as in a fire), the high gas pressure could rupture and explode the cylinder. To prevent this type of accident, all cylinders have high -pressure relief valves. DIF: Recall
REF: p. 888
OBJ: 3
26. Which of the following medical gases can be stored in cylinders as liquids at room
temperature? 1. CO 2 2. O2
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. a. b. c. d.
N2O 1 only 1 and 2 only 1 and 3 only 1, 2, and 3
ANS: C
Gases with critical temperatures above room temperature can be stored as liquids at room temperature. These gases include carbon dioxide and nitrous oxide. DIF: Recall
REF: p. 889
OBJ: 3
27. Cylinders of liquid gases are filled according to what specification? a. Filling density b. Critical weight c. Elastic expansion d. Filling pressure ANS: A
Rather than being filled to filling pressure, cylinders of these gases are filled according to a specified filling density. DIF: Recall
REF: p. 889
OBJ: 3
28. The measured pressure in a liquid-filled cylinder is equivalent to which of the following? a. The force necessary to compress its volume within the cylinder b. Its filling density divided by the cylinder gas factor c. The pressure of the surface vapor at any given temperature d. The weight of the liquid divided by the density of water ANS: C
The pressure in a liquid-filled cylinder thus equals the pressure of the vapor at any given temperature. DIF: Recall
REF: p. 890
OBJ: 3
29. The measured pressure in a gas-filled cylinder is equivalent to which of the following? a. Its filling density divided by the cylinder gas factor. b. Gas temperature times its coefficient of expansion. c. Gas density divided by the density of air at standard temperature, standard
pressure, dry (STPD). d. The force required to compress its volume within the cylinder. ANS: D
In a gas-filled cylinder, the pressure represents the force required to compress the gas into its smaller volume. DIF: Recall
REF: p. 890
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 30. When full, a gas cylinder registers a pressure of 2200 psig. After a few hours of use, the
pressure gauge reads 550 psig. The cylinder is now how full? a. One-half b. One-third c. One-fourth d. Two-thirds ANS: C
For gas-filled cylinders, the volume of gas in the cylinder is directly proportional to its pressure at a constant temperature. If a cylinder is full at 2200 psig, it will be half full when the pressure decreases to 1100 psig. DIF: Recall
REF: p. 890
OBJ: 3
31. What is the usual method of monitoring the remaining contents in a gas-filled cylinder? a. Weigh the cylinder. b. Read the pressure gauge. c. Compute the gas density. d. Read the cylinder label. ANS: B
To know how much gas is contained in a compressed gas cylinder, one needs only measure its pressure. DIF: Recall
REF: p. 890
OBJ: 3
32. To accurately determine the remaining contents of a liquid-filled CO 2 cylinder, what would
you do? a. Multiply the pressure by the cylinder factor. b. Divide the pressure by the cylinder factor. c. Weigh the contents of the cylinder. d. Empty the cylinder while timing its flow. ANS: C
Weighing a liquid-filled cylinder an accurate method for determining the contents. DIF: Recall
REF: p. 891
OBJ: 4
33. A cylinder of N2 O has a gauge pressure of 750 psig when full. What will be the pressure in
this cylinder when it is half full? a. 375 psig b. 750 psig c. 1500 psig d. 2200 psig ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Figure 40-6 compares the behavior of compressed gas and liquid gas cylinders during use. The vapor pressure of liquid gas cylinders varies with the temperature of the contents. For example, the pressure in a nitrous oxide cylinder at 70° F is 745 psig; at 60° F, the pressure decreases to 660 psig. As the temperature increases toward the critical point, more liquid vaporizes, and the cylinder pressure increases. DIF: Analysis
REF: p. 890
OBJ: 4
34. Under what conditions will the gauge pressure of a cylinder of N2 O accurately represent its
contents? 1. When the liquid in the cylinder has completely vaporized 2. When the ambient temperature exceeds the critical temperature 3. When the filling density is less than 1.0 (water-filled) a. 1 and 2 only b. 1 and 3 only c. 2 only d. 1, 2, and 3 ANS: C
Should a cylinder of nitrous oxide warm to 97.5° F (its critical temperature), all the contents would convert to gas. Only at this temperature and above does the cylinder gauge pressure accurately reflect cylinder contents. DIF: Recall
REF: p. 890
OBJ: 5
35. When using a Bourdon gauge against high outflow resistance, what will the flowmeter
reading show? a. Exceed actual flow b. Be less than actual flow c. Equal actual flow d. Equal 50 psig ANS: A
See Figure 40-29. DIF: Recall
REF: p. 900
OBJ: 10
36. What cylinder factor is used to compute the duration of flow for a 244 cu/ft (H/K) O 2 or air
cylinder? a. 0.16 b. 0.28 c. 3.14 d. 2.41 ANS: C
Table 40-4 provides cylinder factors for the therapeutic medical gases and common cylinder sizes. DIF: Recall
REF: p. 891
OBJ: 4
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
37. What cylinder factor is used to compute the duration of flow for a 22 cu/ft O2 or air E
cylinder? a. 0.28 b. 1.34 c. 2.41 d. 3.14 ANS: A
Table 40-4 provides cylinder factors for the therapeutic medical gases and common cylinder sizes. DIF: Recall
REF: p. 891
OBJ: 4
38. The gauge on an H cylinder of O2 reads 2000 psig. Approximately how long would the
contents of this cylinder last, until completely empty, at a flow of 6 L/min? a. 1 hr 30 min b. 17 hr 30 min c. 18 hr 10 min d. 21 hr 50 min ANS: B
Once the factor for a given gas and cylinder is known, calculating the duration of flow is a simple matter of applying the following equation: Duration of flow (min) = Pressure (psig) Cylinder factor/Flow (L/min) DIF: Application
REF: p. 891
OBJ: 4
39. The gauge on a G cylinder of O2 reads 400 psig. Approximately how long would the contents
of this cylinder last, until completely empty, at a flow of 5 L/min? a. 2 hr 40 min b. 3 hr 10 min c. 4 hr 30 min d. 9 hr 15 min ANS: B
Once the factor for a given gas and cylinder is known, calculating the duration of flow is a simple matter of applying the following equation: Duration of flow (min) = Pressure (psig) Cylinder factor/Flow (L/min) DIF: Application
REF: p. 891
OBJ: 4
40. The gauge on an E cylinder of O2 reads 800 psig. Approximately how long would the contents
of this cylinder last, until completely empty, at a flow of 3 L/min? a. 1 hr 15 min b. 1 hr 45 min c. 2 hr 10 min d. 2 hr 40 min ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Once the factor for a given gas and cylinder is known, calculating the duration of flow is a simple matter of applying the following equation: Duration of flow (min) = Pressure (psig) Cylinder factor/Flow (L/min) DIF: Application
REF: p. 891
OBJ: 4
41. You are planning a patient transport that will take approximately 1 hr. The patient requires
manual ventilation with 10 L/min of O 2 . What is the minimum number of full E cylinders you would take with you? a. 2 b. 3 c. 4 d. 5 ANS: A
See Rule of Thumb p. 894. DIF: Analysis
REF: p. 891
OBJ: 4
42. One cu/ft of liquid O 2 is the equivalent to approximately how many cu/ft of gaseous O 2 ? a. 28 b. 244 c. 360 d. 860 ANS: D
Because 1 L of liquid O2 weighs 2.5 lb and produces 860 L of O2 in its gaseous state, the amount of gas in a liquid O 2 cylinder can be calculated with the following formula: Amount of gas in cylinder = Liquid O 2 weight (lb) 860/2.5 lb/L DIF: Recall
REF: p. 891
OBJ: 5
43. During inspection of the shoulder of a compressed gas cylinder, you note an asterisk (*) next
to the test date. This indicates what about the cylinder? a. It is made of spun aluminum, not steel. b. It only requires a 10-year DOT testing. c. It can be filled to 10% above its service pressure. d. It has a high coefficient of elastic expansion. ANS: B
An asterisk (*) next to the test date indicates DOT approval for 10-year testing. DIF: Recall
REF: p. 887
OBJ: 3
44. Which of the following components are common to a standard compressed gas cylinder
manifold system? 1. Automatic switch-over control 2. Pressure-reducing valves 3. Primary and reserve bank
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
4. Alarm system a. 1, 2, and 3 only b. 2 and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
The alternating supply or cylinder manifold system consists of large (normally H or K size) cylinders of compressed O 2 banked together in series (Figure 40-7). This alternating supply system has two sides: a primary bank and a reserve bank. When the pressure in the primary bank decreases to a set level, a control valve automatically switches over to the reserve bank. When this occurs, the primary bank is taken off-line, and the empty cylinders are replaced with full ones. The replenished primary bank becomes the reserve bank. Some large alternating supply systems are permanently fixed and are refilled on site by a supply truck. These cylinder manifold systems have pressure-reducing valves for regulation of delivered pressure and normally have low-pressure alarms. These alarms sound when reserve switch-over occurs, and they warn of impending depletion or malfunction. DIF: Recall
REF: p. 892
OBJ: 7
45. Unlike CO 2 or N 2 O, O 2 cannot be stored as a liquid at room temperature but must be kept in
special cryogenic containers. Why is this so? a. O 2 is 20 times less diffusible than CO 2 , N 2 O, or cyclopropane. b. O 2 has a critical temperature well below room temperature. c. O 2 has an extremely high gas solubility coefficient. d. O 2 has a boiling point below well below room temperature. ANS: B
Oxygen has a critical temperature well below room temperature (–181.4° F [–118.6° C]). Liquid O2 must continually be stored below this temperature, or it reverts to its gaseous state. DIF: Recall
REF: p. 893
OBJ: 6
46. What do the components of a liquid O 2 bulk storage tank include?
1. Inner and outer steel shells, separated by a vacuum 2. Safety system that vents O 2 if warming occurs 3. Vaporizer system that converts liquid O2 to gas 4. Pressure-reducing valves to lower pressure to 50 psig a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: C
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
These stand tanks are like giant thermos bottles, consisting of inner and outer steel shells separated by an insulated vacuum chamber (Figure 40-10). Because it eliminates heat conduction, the vacuum keeps the liquid O 2 below its critical temperature without refrigeration. When it flows through vaporizer coils exposed to ambient temperature, the liquid O 2 quickly converts back to a gas. With the O 2 in its gaseous form, the pressure is decreased to the standard working pressure of 50 psi by a pressure-reducing valve. A safety vent allows vaporized liquid O 2 to escape if warming causes cylinder pressure to increase above a set limit. DIF: Recall
REF: p. 893
OBJ: 7
47. The NFPA standard for bulk liquid O 2 systems requires that the reserve supply be which of
the following? a. Fixed cylinder bank of 75 H cylinders b. At least one large liquid O 2 cylinder c. Equal to the average gas use of 1 day d. At least 3000 cu/ft of gaseous O2 ANS: C
Among the key provisions in these standards is the requirement for a reserve or backup gas supply to equal the average daily gas use of the hospital. DIF: Recall
REF: p. 894
OBJ: 7
48. Structural requirements for the central piping systems that are used in hospitals to distribute
gases are established by whom? a. American National Standards Institute (ANSI) b. Department of Transportation c. National Fire Protection Association (NFPA) d. Compressed Gas Association (CGA) ANS: C
Structural standards for piping systems are established by the NFPA and are described in more detail elsewhere. DIF: Recall
REF: p. 894
OBJ: 7
49. The pressure of O 2 or air in a bulk supply system is reduced to what standard working
pressure? a. 10 psig b. 14 psig c. 25 psig d. 50 psig ANS: D
The gas pressure in a central piping system normally is reduced to the standard working pressure of 50 psig at the bulk storage location. DIF: Recall
REF: p. 894
OBJ: 7
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
50. Why are zone valves incorporated into a hospital’s central gas piping systems?
1. To terminate O2 delivery to an area in case of fire 2. To allow selective maintenance without shutting the system down 3. To allow variable pressure reduction throughout the system a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: A
Zone valves (Figure 40-12) throughout the system can be closed for system maintenance or in case of fire. DIF: Recall
REF: p. 894
OBJ: 7
51. What is the primary purpose of indexed connector systems? a. To prevent inadvertent misconnections between equipment b. To speed making connections between equipment c. To allow U.S. equipment to ―mate‖ with foreign equipment d. To provide universal connections among all equipment ANS: A
These safety systems make misconnection between pieces of equipment nearly impossible. DIF: Recall
REF: pp. 895-896 OBJ: 9
52. What is the indexed safety system for threaded high-pressure connections between large
compressed gas cylinders and their attachments? a. Pin-Indexed Safety System (PISS) b. Diameter-Index Safety System (DISS) c. American Standard Safety System (ASSS) d. CGA System ANS: C
Adopted in the United States and Canada, the ASSS provides standards for threaded high-pressure connections between large compressed gas cylinders (sizes F through H/K) and their attachments. DIF: Recall
REF: p. 894
OBJ: 9
53. Which of the following are true about ASSS standards?
1. They provide specifications for more than 60 gases and mixtures. 2. They apply only to cylinders sizes F through H/K. 3. They apply to high-pressure connections. 4. They provide a separate connector for all gases. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
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ANS: B
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Because there are only 26 connections for the 62 listed gases and mixtures, each gas may not have a unique connection. This means that some gases have identical connections. DIF: Recall
REF: p. 894
OBJ: 9
54. Which of the following statements is FALSE about PISS standards? a. The exact positions of pins and pinholes do not vary for each gas. b. In order to work, the yoke nipple has to seat in the recessed valve outlet. c. They apply only to cylinders using a yoke connection. d. They have six pin positions and 10 possible pin/hole combinations. ANS: A
The exact positions of pins and pinholes vary for each gas. Unless the pins and holes align perfectly, the yoke nipple cannot seat in the recessed valve outlet. Six holes and pin positions constitute the total system. Because overlapping holes cannot be used, there are 10 possible pin combinations. DIF: Recall
REF: p. 896
OBJ: 9
55. What is the pin index hole position for O2 ? a. 1 and 5 b. 2 and 5 c. 1 and 6 d. 4 and 6 ANS: B
See Table 40-5. DIF: Recall
REF: p. 896
OBJ: 9
56. What safety system is designed to prevent accidental interchanging among low-pressure
(<200 psig) connectors such as those found on flowmeters and ventilators? a. PISS b. ASSS c. DISS d. CGA ANS: C
Whereas the ASSS and the PISS provide standards for high-pressure connections between cylinders and equipment, the DISS was established to prevent accidental interchange of low-pressure (<200 psig) medical gas connectors. DIF: Recall
REF: p. 896
OBJ: 9
57. Where do respiratory therapists typically find DISS connections?
1. At the outlets of pressure-reducing valves attached to cylinders 2. At the nurse station 3. At the station outlets of central piping systems 4. At the inlets of blenders, flowmeters, ventilators, and other pneumatic equipments
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a. b. c. d.
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1 and 2 only 1, 2, and 3 only 1, 3, and 4 only 3 and 4 only
ANS: C
Respiratory therapists typically find DISS connections (1) at the outlets of pressure-reducing valves attached to cylinders, (2) at the station outlets of central piping systems, and (3) at the inlets of blenders, flowmeters, ventilators, and other pneumatic equipments. DIF: Recall
REF: p. 896
OBJ: 9
58. You must connect a large-volume nebulizer to a bedside compressed-air outlet through a
flowmeter. You have only standard O 2 flowmeters available. Which of the following actions is appropriate? a. Connect the O 2 flowmeter to the air outlet with piping tape. b. Use an O 2 -to-air DISS adapter to join the flowmeter and outlet. c. Connect the O 2 flowmeter to the air outlet with a petroleum jelly seal. d. Try to cross-thread an O2 flowmeter directly on the air outlet. ANS: B
To avoid stocking a large variety of pressure regulators, flowmeters, and connectors for special gas use, adapters can be used to convert various DISS connections so that they can be used for a different purpose. DIF: Analysis
REF: p. 896
OBJ: 11
59. What is the greatest potential problem with quick-connect DISS systems? a. Increased cost of flowmeter equipment b. Decreased accuracy in flowmeter equipment c. Difficulty in training new personnel d. Incompatibility among different manufacturers ANS: D
Various manufacturers have designed specially shaped connectors for each gas (Figure 40-17). Because each connector has a distinct shape, it does not fit into an outlet for another gas, and each manufacturer has its own unique design. DIF: Recall
REF: p. 897
OBJ: 12
60. Which device is used to reduce the pressure and control the flow of a compressed medical
gas? a. Bourdon gauge b. Regulator c. Flowmeter d. Reducing valve ANS: B
If control of both pressure and flow is needed, a regulator is used.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 898 OBJ: 10 61. Helium must always be combined with at least how much O2 ? a. 20% b. 30% c. 40% d. 50% ANS: A
He must always be combined with at least 20% O 2 . The higher the concentration of O 2 used in a heliox mixture, the less likely it is that heliox would be beneficial. Heliox mixtures of less than 60% He are rarely used clinically. DIF: Recall
REF: p. 887
OBJ: 2
62. If you have to deliver medical gas to a patient from a compressed gas cylinder, which of the
following devices would you select to control gas flow? a. Regulator b. O 2 blender c. Reducing valve d. Flowmeter ANS: D
If the goal is to control gas delivery to a patient for O2 therapy or nebulized medication (see Chapters 36 and 38), a flowmeter must also be used. DIF: Recall
REF: p. 898
OBJ: 10
63. A very common application of the adjustable pressure-reducing valve is in combination with
which of the following? a. Flow restrictor b. Thorpe tube flowmeter c. Bourdon gauge d. Uncompensated flowmeter ANS: C
The adjustable reducing valve commonly is used in combination with a Bourdon-type flow gauge. DIF: Recall
REF: p. 899
OBJ: 10
64. How can one determine whether a pressure-reducing valve uses multiple stages for pressure
reduction? a. By noting the number of gauges attached to the valve b. By noting the DISS code c. By noting the ASSS code d. By noting the number of pressure relief vents ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Because each pressure chamber has one safety relief vent, the user usually can determine the number of stages in a reducing valve by noting the number of relief vents present. DIF: Recall
REF: p. 899
OBJ: 10
65. When minimal fluctuations in pressure and flow are critical factors, which of the following
pressure-reducing valves would be the best choice? a. Single-stage preset pressure-reducing valve b. Multiple-stage pressure-reducing valve c. Uncompensated Thorpe tube flowmeter d. Bourdon adjustable pressure regulator ANS: B
For this reason, a multiple-stage reducing valve should be considered only if minimal fluctuations in pressure or flow are critical factors, as in research activities. For routine hospital work, single-stage reducing valves are satisfactory. DIF: Recall
REF: p. 899
OBJ: 10
66. To clean a cylinder valve outlet of foreign material, what should you do? a. Wipe the valve outlet with a light oil. b. Quickly open and then close the valve. c. Blow into the valve outlet a few times. d. Wipe the valve outlet with an alcohol swab. ANS: B
See Box 40-1. DIF: Recall
REF: p. 899
OBJ: 12
67. When used to control the flow of medical gases to a patient, how is a flow restrictor
classified? a. Variable-orifice, constant-pressure flowmeter device b. Fixed-orifice, variable-pressure flowmeter device c. Variable-orifice, variable-pressure flowmeter device d. Fixed-orifice, constant-pressure flowmeter device ANS: D
A flow restrictor is a fixed-orifice, constant-pressure flowmeter device. DIF: Recall
REF: p. 899
OBJ: 8
68. Which of the following are advantages of using a flow restrictor to control the delivery of
medical gases to a patient? 1. Preset metered flow 2. Low cost and simplicity 3. Gravity independence 4. Wide range of utility a. 1, 2, and 3 only b. 1, 2, and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 2 and 4 only d. 3 and 4 only ANS: A
See Table 40-6. DIF: Recall
REF: p. 904
OBJ: 8
69. When used to control the flow of medical gases to a patient, how is a Bourdon gauge
classified? a. Fixed-orifice, variable-pressure flowmeter device b. Fixed-orifice, constant-pressure flowmeter device c. Variable-orifice, variable-pressure flowmeter device d. Variable-orifice, constant-pressure flowmeter device ANS: A
The Bourdon gauge is a fixed-orifice, variable-pressure flowmeter device. DIF: Recall
REF: p. 900
OBJ: 10
70. You are preparing to conduct a complex transport of a patient receiving O 2 , and you expect to
have to alter O 2 flows during the transport. Which of the following devices would best meet your needs? a. Uncompensated Thorpe tube b. Flow restrictor c. Compensated Thorpe tube d. Bourdon gauge ANS: D
The Bourdon gauge is the best choice when a flowmeter cannot be maintained in an upright position. DIF: Recall
REF: p. 900
OBJ: 10
71. Which of the following are true about a Bourdon gauge?
1. It is always used with an adjustable high-pressure reducing valve. 2. It actually senses pressure but is calibrated to display flow. 3. It reads a flow higher than actual if downstream pressure increases. 4. It will register zero flow when the outlet is completely blocked. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Because it measures upstream pressure, the gauge registers flow even when the outlet is completely blocked (Figure 40-24). DIF: Recall
REF: p. 901
OBJ: 10
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
72. If you have to deliver O2 to a patient directly from a bedside outlet station, which of the
following devices would you select? a. Thorpe tube flowmeter b. Bourdon-type gauge c. Pressure-reducing valve d. Medical gas regulator ANS: A
The Thorpe tube flowmeter (Figure 40-26) is always attached to a 50-psig source, either a preset pressure-reducing valve or a bedside station outlet. DIF: Application
REF: p. 902
OBJ: 10
73. When used to control the flow of medical gases to a patient, how is a Thorpe tube classified? a. Variable-orifice, constant-pressure flowmeter device b. Fixed-orifice, constant-pressure flowmeter device c. Variable-orifice, variable-pressure flowmeter device d. Fixed-orifice, variable-pressure flowmeter device ANS: A
Compared with the flow restrictor and the Bourdon gauge, the Thorpe tube functions as a variable-orifice, constant-pressure flowmeter device, so increasing the size of the orifice increases the gas flow. DIF: Recall
REF: p. 902
OBJ: 10
74. Which of the following is true about an uncompensated Thorpe tube? a. Flow lower than actual if downstream pressure increases b. Fixed-orifice, variable-pressure flowmeter device c. Flow-control needle valve placed distal to the flow tube d. Accuracy unaffected by changes in downstream resistance ANS: A
Under these conditions, an uncompensated Thorpe tube falsely shows a flow lower than that actually delivered to the patient. DIF: Recall
REF: p. 902
OBJ: 10
75. Which of the following is false about a compensated Thorpe tube? a. Variable-orifice, constant-pressure flowmeter device b. Calibrated in liters per minute at atmospheric pressure c. Flow-control needle valve placed distal to the flow tube d. Accuracy unaffected by changes in downstream resistance ANS: B
The scale of the compensated Thorpe tube flowmeter is calibrated at 50 psig instead of at atmospheric pressure. DIF: Recall
REF: p. 902
OBJ: 10
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 76. Which of the following devices would you select if the goal was to accurately meter the flow
through a jet nebulizer? a. Bourdon gauge b. Flow restrictor c. Uncompensated Thorpe tube d. Compensated Thorpe tube ANS: D
See Mini Clini p. 902. DIF: Recall
REF: p. 902
OBJ: 10
77. What is the only major factor limiting the use of pressure-compensated Thorpe tube
flowmeters? a. Downstream resistance b. Effect of position (gravity) c. DISS connector availability d. Use with gases other than O2 ANS: B
The only factor limiting the use of a pressure-compensated Thorpe tube is gravity. Because it is accurate only in an upright position, a Thorpe tube is not the ideal choice for patient transport. In these cases, the gravity-independent Bourdon gauge is a satisfactory alternative. DIF: Recall
REF: p. 903
OBJ: 10
78. You are called by a nursing home to help set up O 2 for a patient, delivered through a jet
nebulizer. Unfortunately, all that is available is an old uncompensated Thorpe tube flowmeter. When set to 8 L/min, the nebulizer creates an additional 30 psig of downstream pressure. Approximately what flow of O2 will the patient now receive? a. 4 L/min b. 6 L/min c. 8 L/min d. 12 L/min ANS: D
See Figure 40-28. DIF: Analysis
REF: p. 902
OBJ: 10
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 41 - Medical Gas Therapy Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Specific clinical objectives of oxygen (O2 ) therapy include which of the following?
1. Decrease the symptoms caused by chronic hypoxemia. 2. Decrease the workload hypoxemia imposes on the heart and lungs. 3. Correct documented arterial hypoxemia. 4. Correct documented respiratory acidosis. a. 2 and 4 only b. 3 and 4 only c. 1 and 3 only d. 1, 2, and 3 only ANS: D
Specific clinical objectives of O 2 therapy are to (1) correct documented or suspected acute hypoxemia, (2) decrease the symptoms associated with chronic hypoxemia, and (3) decrease the workload hypoxemia imposes on the cardiopulmonary system. DIF: Recall
REF: p. 906
OBJ: 1
2. Properly applied O2 therapy can decrease which of the following?
1. Ventilatory demand 2. Work of breathing 3. Cardiac output a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: C
In cases of acute hypoxemia, supplemental O 2 can decrease demands on both the heart and the lungs. DIF: Recall
REF: p. 906
OBJ: 1
3. Benefits of properly applied O 2 therapy in patients with chronic hypoxemia include which of
the following? 1. Reversal of pulmonary vasoconstriction 2. Relief of pulmonary hypertension 3. Decreased right ventricular workload 4. Improved pulmonary vital capacity a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
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ANS: B
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Oxygen therapy can reverse pulmonary vasoconstriction and decrease right ventricular workload. DIF: Recall
REF: p. 906
OBJ: 1
4. Which of the following would indicate a need for O2 therapy for an adult or a child?
1. SaO 2 less than 90% 2. PaCO 2 greater than 45 mm Hg 3. PaO 2 less than 60 mm Hg a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: D
Excerpts from the AARC guideline on O2 therapy in acute care hospitals appear in CPG 41-1. DIF: Application
REF: p. 906
OBJ: 1
5. You start a chronic obstructive pulmonary disease (COPD) patient on a nasal O 2 cannula at 2
L/min. What is the maximum time that should pass before assessing this patient’s PaO 2 or SaO 2 ? a. 2 hr b. 8 hr c. 12 hr d. 72 hr ANS: A
Excerpts from the AARC guideline on O2 therapy in acute care hospitals appear in CPG 41-1. DIF: Application
REF: p. 906
OBJ: 1
6. According to AARC clinical practice guidelines, what is the minimum frequency for checking
the functioning of an O 2 delivery system? a. Every 4 hr b. Every 8 hr c. Every 24 hr d. Every 48 hr ANS: C
Excerpts from the AARC guideline on O2 therapy in acute care hospitals appear in CPG 41-1. DIF: Recall
REF: p. 906
OBJ: 1
7. You set up an Oxy-Hood with an FiO 2 of 0.5 for a newborn infant. What is the maximum time
that should pass before assessing this patient’s PaO 2 or SaO 2 ? a. 1 hr b. 2 hr c. 8 hr
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. 12 hr ANS: A
Excerpts from the AARC guideline on O2 therapy in acute care hospitals appear in CPG 41-1. DIF: Application
REF: p. 906
OBJ: 1
8. When determining a need for O2 therapy, the respiratory therapist should assess which of the
following? 1. Neurologic status 2. Pulmonary status 3. Cardiac status a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
Excerpts from the AARC guideline on O2 therapy in acute care hospitals appear I CPG 41-1. DIF: Recall
REF: p. 906
OBJ: 2
9. Which of the following signs and symptoms are associated with the presence of hypoxemia?
1. Tachypnea 2. Tachycardia 3. Cyanosis 4. Bradycardia a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 only d. 1 and 4 only ANS: C
Last, hypoxemia has many manifestations, such as tachypnea, tachycardia, cyanosis, and distressed overall appearance. DIF: Recall
REF: p. 906
OBJ: 2
10. What is/are the primary organ system(s) affected by O 2 toxicity?
1. Central nervous system (CNS) 2. Lungs 3. Kidneys a. 1 only b. 1 and 3 only c. 1 and 2 only d. 1, 2, and 3 ANS: C
Oxygen toxicity primarily affects the lungs and the CNS.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 907 OBJ: 3 11. Which of the following typically occurs first when monitoring the earliest physiologic
response to breathing 100% O 2 ? a. Substernal chest pain b. Decreased using capacity (DLCO) c. Decreased lung compliance (CL) d. Decreased vital capacity (VC) ANS: A
Table 41-2 summarizes the physiologic response to breathing 100% O 2 at sea level. DIF: Recall
REF: p. 908
OBJ: 3
12. A patient breathing 100% O2 for 24 hr or longer would most likely exhibit which of the
following? 1. Decreased DLCO 2. Decreased CL 3. Increased PAO 2 – PaO 2 4. Decreased VC a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
Table 41-2 summarizes the physiological response to breathing 100% O2 at sea level. DIF: Recall
REF: p. 908
OBJ: 3
13. Which of the following is consistent with the radiographic appearance after prolonged
exposure to O 2 ? a. Air bronchograms b. Pulmonary abscess c. Patchy infiltrates d. Pneumothorax ANS: C
Patchy infiltrates appear on chest radiographs and usually are most prominent in the lower lung fields. DIF: Recall
REF: p. 908
OBJ: 3
14. A physician places a patient in respiratory failure on 100% O 2 . To avoid the hazards of O 2
toxicity, you would recommend that every effort is made to reduce this FiO 2 to less than 50% within what timeframe? a. 8 hr b. 24 hr c. 48 hr d. 5 days
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D
Avoiding O 2 toxicity: Limit patient exposure to 100% O 2 to less than 24 hr whenever possible. High FiO 2 is acceptable if the concentration can be decreased to 70% within 2 days and 50% or less in 5 days. DIF: Application
REF: p. 908
OBJ: 3
15. A patient with chronic hypercapnia placed on an FiO 2 of 0.6 starts hypoventilating. What is a
possible cause of this phenomenon? a. Decreased cardiac output b. O 2 toxicity c. O 2 -induced hypoventilation d. Absorption atelectasis ANS: C
When breathing moderate to high O2 concentrations, COPD patients with chronic hypercapnia may tend to ventilate less. DIF: Application
REF: p. 909
OBJ: 3
16. Retinopathy of prematurity (ROP) is a potentially serious management problem mainly in the
care of whom? a. Premature or low-birth-weight infants b. Cystic fibrosis patients c. Children with asthma d. Patients with acute respiratory distress syndrome (ARDS) ANS: A
ROP, also called retrolental fibroplasia, is an abnormal eye condition that occurs in some premature or low-birth-weight infants who receive supplemental O2 . DIF: Application
REF: p. 909
OBJ: 3
17. Some strategies for minimizing the risk of fire hazard with O2 therapy include which of the
following? 1. Using the lowest effective FiO 2 2. Properly educating patients and caregivers 3. Avoiding aluminum regulators and other high-risk devices 4. Mixing the oxygen with carbon dioxide. a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
Common ways to minimize the fire risk with supplemental oxygen include using the lowest effective FiO 2 , properly educating users and avoiding high-risk equipment. DIF: Application
REF: p. 910
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 18. To minimize the risk of retinopathy of prematurity (ROP), the American Academy of
Pediatrics recommends keeping the PaO 2 below what level? a. 60 mm Hg b. 70 mm Hg c. 80 mm Hg d. 90 mm Hg ANS: C
The American Academy of Pediatrics recommends keeping an infant’s arterial PO2 below 80 mm Hg as the best way of minimizing the risk of ROP. DIF: Recall
REF: p. 909
OBJ: 3
19. Which of the following are true about absorption atelectasis?
1. It can occur only when breathing supplemental O2 . 2. Its risk is increased in patients breathing at low tidal volumes (VT values). 3. Its risk is decreased through the natural ―sigh‖ mechanism. 4. It results in an increase in the physiologic shunt fraction. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
The risk of absorption atelectasis is greatest in patients breathing at low tidal volumes as a result of sedation, surgical pain, or CNS dysfunction. In these cases, poorly ventilated alveoli may become unstable when they lose O 2 faster than it can be replaced. The result is a more gradual shrinking of the alveoli that may lead to complete collapse, even when the patient is not breathing supplemental O 2 . For an alert patient this is not a great risk, because the natural sigh mechanism periodically hyperinflates the lung. DIF: Analysis
REF: p. 909
OBJ: 3
20. Which of the following factors should be used in properly selecting an O2 delivery device?
1. Knowledge of general performance of the device 2. Physician’s preference 3. Individual capabilities of the equipment a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: D
Proper device selection requires in-depth knowledge of both the general performance characteristics of these systems and the individual capabilities. DIF: Application
REF: p. 910
OBJ: 4
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
21. To ensure a stable FiO 2 under varying patient demands, what must an O2 delivery system do? a. It must have a reservoir system at least equal to the VT. b. It must provide all the gas needed by the patient during inspiration. c. It must maintain flows that are at least equal to the patient’s peak flows. d. It must be able to deliver any O2 concentration from 21% to 100%. ANS: B
If the system provides all of the patient’s inspired gas, the FiO 2 remains stable, even under changing demands. DIF: Application
REF: p. 910
OBJ: 4
22. Which of the following statements are true about low-flow O2 delivery systems?
1. The greater the patient’s inspiratory flow, the greater is the FiO 2 . 2. All low-flow devices provide variable O2 concentrations. 3. The O2 provided by a low-flow device is diluted with air. 4. The patient’s flow usually exceeds that from a low-flow device. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
In this case, the more the patient breathes, the more air dilutes the delivered O 2 , and the lower is the FiO 2 . Hence, there is an inverse or opposite relationship between FiO 2 and inspiratory flow with such O 2 devices. DIF: Application
REF: p. 911
OBJ: 4
23. Delivery systems that provide only a portion of a patient’s inspired gas are referred to as
what? a. Fixed-performance systems b. Variable-performance systems c. High-flow O2 systems d. Air-entrainment systems ANS: B
A system that supplies only a portion of the inspired gas always provides a variable FiO 2 . An example of a variable-performance system is a nasal cannula. DIF: Application
REF: p. 911
OBJ: 3
24. Low-flow O2 delivery systems used in respiratory care include which of the following?
1. Nasal O 2 cannula 2. Nasal O 2 catheter 3. Air-entrainment mask 4. Transtracheal catheter a. 1 and 3 only b. 1, 2, and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Low-flow O2 delivery systems include the nasal cannula, the nasal catheter, and the transtracheal catheter. DIF: Application
REF: p. 914
OBJ: 4
25. A cooperative and alert postoperative patient who is able to eat requires a continuous but low
FiO 2 . Precise FiO 2 concentrations are not needed. Which of the following devices would best achieve this end? a. Simple O 2 mask b. Air-entrainment mask c. Nasal cannula d. Nonrebreathing mask ANS: C
Table 41-3 outlines the FiO 2 range, FiO 2 stability, advantages, disadvantages, and best use of oxygen delivery devices. Based on these guidelines, the nasal cannula appears most suitable for this patient. DIF:
Application REF: pp. 912-913
OBJ: 4
26. Which of the following are advantages of the nasal cannula as a low-flow O2 delivery system?
1. Stability 2. Low cost 3. Easy application 4. Disposability a. 2 and 4 only b. 1, 2, and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: C
Table 41-3 lists the FiO 2 range, FiO 2 stability, advantages, disadvantages, and best use of the nasal cannula. DIF:
Application
REF: pp. 912-913
OBJ: 4
27. Which of the following is considered an advantage of the transtracheal catheter? a. It does not provide any economic benefit compared with the nasal cannula. b. It decreases the anatomic reservoir. c. It requires 40% to 60% less O 2 flow than the nasal cannula. d. It requires higher flows than the nasal cannula. ANS: C
Compared with a nasal cannula, a transtracheal catheter needs 40% to 60% less O 2 flow to achieve a given arterial partial pressure of O2 (PaO 2 ).
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application REF: p. 914 OBJ: 4 28. Some of the major disadvantages of the transtracheal catheter are which of the following?
1. Infection 2. Mucus plugging 3. Excessive oxygen use 4. Lost tract or insertion opening a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Though there are several advantages to the transtracheal catheter, some of the major disadvantages include infection, mucus plugging, and a lost insertion opening or tract. DIF: Application
REF: p. 914
OBJ: 4
29. Which of the following factors will decrease the FiO 2 delivered by a low-flow O2 system?
1. Short inspiratory time 2. Fast rate of breathing 3. Lower O2 input 4. Large minute ventilation a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
The amount of air dilution depends on several patient and equipment variables. Table 41-4 summarizes these key variables and how they affect the FiO 2 provided by low-flow systems DIF: Application
REF: p. 914
OBJ: 4
30. A 27-year-old woman received from the emergency department is on a nasal cannula at 5
L/min. Approximately what FiO 2 is this patient receiving? a. 28% b. 32% c. 35% d. 40% ANS: D
Estimating the FiO 2 provided by low-flow systems: For patients with a normal rate and depth of breathing, each liter per minute of nasal O 2 increases the FiO 2 approximately 4%. For example, a patient using a nasal cannula at 4 L/min has an estimated FiO 2 of approximately 37% (21 + 16). DIF: Application
REF: p. 914
OBJ: 4
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 31. You enter the room of a patient who is receiving nasal O 2 through a bubble humidifier at 5
L/min. You immediately notice that the humidifier pressure relief is popping off. Which of the following actions would be most appropriate in this situation? a. Check and tighten all connections. b. Replace the humidifier with a new one. c. Look for crimped or twisted delivery tubing. d. Decrease the flow rate to 2 L/min. ANS: C
Table 41-5 provides guidance on troubleshooting the most common clinical problems with nasal cannulas. In this instance, the problem is probably with the tubing which is twisted or crimped downstream from the humidifier. DIF: Analysis
REF: p. 915
OBJ: 4 | 6
32. Which of the following is true about reservoir cannulas? a. They reduce O 2 use as much as 200%. b. During exercise, they do not reduce O 2 use. c. Humidification is absolutely necessary. d. Nasal anatomy and breathing pattern can affect performance of the device. ANS: D
Although flow savings are fairly predictable, factors such as nasal anatomy and breathing pattern can affect the performance of the device. DIF: Application
REF: p. 915
OBJ: 4
33. Disadvantages of standard O 2 masks include which of the following?
1. Being difficult to apply to patients. 2. Patient discomfort (straps and heat). 3. Increasing the risk of aspiration. 4. Must be removed for eating. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Table 41-3 lists the FiO 2 range, FiO 2 stability, advantages, disadvantages, and best use of each of these devices. DIF:
Application REF: pp. 912-913
OBJ: 4
34. Which of the following is false about the simple O 2 mask? a. It has no valving system or reservoir bag. b. It can easily deliver high FiO 2 values (>0.6 to 0.7). c. It requires a minimal input flow of 5 L/min. d. It generally functions as a variable-performance system. ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Table 41-3 lists the FiO 2 range, FiO 2 stability, advantages, disadvantages, and best use of each of these devices. DIF: Application
REF: pp. 912-913 OBJ: 4
35. A physician orders 2 L/min O 2 through a simple mask to a 33-year-old postoperative woman
with moderate hypoxemia breathing room air (PaO 2 = 52 mm Hg). What would be the correct action at this time? a. Carry out the physician’s prescription exactly as written. b. Recommend that the mask be changed to a cannula at 2 L/min. c. Recommend a flow of at least 5 L/min to washout carbon dioxide (CO 2 ). d. Do not apply the O2 until the medical director has been contacted. ANS: C
At a flow less than 5 L/min, the mask volume acts as dead space and causes CO 2 rebreathing. DIF: Analysis
REF: p. 916
OBJ: 4 | 5 | 6
36. What is the minimum flow setting for a simple mask applied to an adult? a. 3 L/min b. 5 L/min c. 8 L/min d. 10 L/min ANS: B
At a flow less than 5 L/min, the mask volume acts as dead space and causes CO 2 rebreathing. DIF: Application
REF: p. 916
OBJ: 4 | 5
37. A 52-year-old man is admitted to the hospital emergency department with a primary
complaint of severe radiating chest pain and signs of central cyanosis. The attending asks for your advice on selecting a device that provides a moderate FiO 2 for this patient. Which of the following would you recommend? a. Simple O 2 mask at 8 L/min b. Air-entrainment mask at 40% O2 c. Nasal cannula at 5 L/min d. Nonrebreathing mask at 10 L/min ANS: A
Table 41-3 lists the FiO 2 range, FiO 2 stability, advantages, disadvantages, and best use of each of these devices. DIF: Analysis
REF: pp. 912-913 OBJ: 4 | 5
38. A physician orders supplemental O 2 for a patient through a nasal cannula at a flow of 12
L/min. When you ask what the goal is, the physician states that the patient should receive approximately 60% O2 . Which of the following should you recommend? a. The O 2 should be given through a reservoir mask at 10 L/min. b. The cannula flow should be set to 15 instead of 12 L/min. c. The O 2 should be given through a simple mask set at 5 to 12 L/min.
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d. The O 2 should be given through a simple mask set at 12 to 15 L/min. ANS: C
Table 41-3 lists the FiO 2 range, FiO 2 stability, advantages, disadvantages, and best use of each of these devices. DIF: Analysis
REF: pp. 912-913 OBJ: 4 | 5
39. A well-fitted nonrebreathing mask, adjusted so that the patient’s inhalation does not deflate
the bag (flows approximately 10 L/min), should provide inspired O 2 concentrations in what range? a. 55% to 70% b. 45% to 60% c. 75% to 90% d. 70% to 85% ANS: A
As indicated in Table 41-3, however, modern disposable nonrebreathing masks normally do not provide much more than approximately 70% O2 . DIF: Application
REF: pp. 912-913 OBJ: 4 | 5
40. You must deliver the highest possible FiO 2 to a 67-year-old man with pulmonary edema
breathing at a rate of 35/min. Which of the following O 2 delivery systems would be most appropriate? a. Nonrebreathing mask at 12 to 15 L/min b. Simple mask at 12 to 15 L/min c. Partial rebreathing mask at 12 to 15 L/min d. Aerosol mask with nebulizer set to 100% ANS: A
Table 41-3 lists the FiO 2 range, FiO 2 stability, advantages, disadvantages, and best use of each of these devices. DIF: Analysis
REF: pp. 912-913 OBJ: 4 | 5
41. A patient is receiving O 2 through a nonrebreathing mask set at 8 L/min. You notice that the
mask’s reservoir bag collapses completely before the end of each inspiration. Which of the following actions is appropriate in this case? a. Change to a partial rebreather. b. Decrease the liter flow. c. Increase the liter flow. d. Change to a simple mask. ANS: C
Table 41-6 provides guidance on troubleshooting the most common clinical problems with reservoir masks. DIF: Application
REF: p. 917
OBJ: 4 | 5 | 6
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42. A true high-flow O2 delivery system should provide at least what flow? a. 60 L/min b. 50 L/min c. 40 L/min d. 30 L/min ANS: A
To qualify as a high-flow device, a system should provide at least 60 L/min total flow. DIF: Application
REF: p. 917
OBJ: 4 | 5
Which of the following are true about air-entrainment systems? 1. Their FiO2 values are directly proportional to their total flow. 2. They can provide variable FiO 2 values under some clinical conditions. 3. They always deliver O 2 concentrations less than 100%. 4. They yield a set FiO 2 only if their flow exceeds the patient’s. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
The more air they entrain, the higher is the total output flow, but the lower is the delivered FiO 2 . DIF: Application
REF: p. 917
OBJ: 4
44. Which of the following factors determine the actual O 2 provided by an air-entrainment
system? 1. O2 input flow to the jet 2. Air-to-O2 ratio of the device 3. Resistance downstream from the jet a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: A
The FiO 2 provided by air-entrainment devices depends on two key variables: the air-to-O2 ratio and the amount of flow resistance downstream from the mixing site. DIF: Application
REF: p. 918
OBJ: 4
45. A patient receiving 35% O 2 through an air-entrainment mask set at 6 L/min input flow
becomes tachypneic. Simultaneously, you notice that the SpO 2 has fallen from 91% to 87%. Which of the following actions would be most appropriate in this situation? a. Switch the patient to a 40% air-entrainment mask. b. Increase the device’s input flow to 10 L/min. c. Switch the patient to a 28% air-entrainment mask.
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d. Decrease the device’s input flow to 4 L/min. ANS: B
A patient is receiving O 2 through an air-entrainment device set to deliver 50% O 2 . The input O 2 flow is set to 15 L/min. What is the total output flow of this system? SOLUTION Step 1: Compute the air-to-O 2 ratio by substituting 50 for the % O 2 Step 2: Add the air-to-O2 ratio parts: 1. 7 + 1 = 2.7 Step 3: Multiply the sum of the ratio parts times the O 2 input flow: 2. 7 15 L/min = 41 L/min An air-entrainment device set to deliver 50% O2 that has an input flow of 15 L/min provides a total output flow of approximately 41 L/min. DIF: Analysis
REF: p. 918
OBJ: 4 | 6
46. You design an air-entrainment system that mixes air with O2 at a fixed ratio of 1:7.
Approximately what O 2 concentration will this device provide? a. 33% b. 40% c. 80% d. 90% ANS: D
Table 41-7 lists the approximate air-to-O2 ratios for several common O2 percentages. DIF: Application
REF: p. 920
OBJ: 4
47. A 45-year-old patient with congestive heart failure is receiving O2 through a 35%
air-entrainment mask. With an O2 input of 6 L/min, what is the total output gas flow? a. 16 L/min b. 24 L/min c. 28 L/min d. 36 L/min ANS: D
Table 41-7 lists the approximate air-to-O2 ratios for several common O2 percentages. DIF: Application
REF: p. 920
OBJ: 4
48. You note that the air intake ports surrounding the jet of a 35% air-entrainment mask are
partially obstructed by the patient’s bedding. Which of the following would you expect? 1. Decrease in the device’s total output flow 2. Increase in the percent O2 delivered by the device 3. Change in the FiO 2 received by the patient a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3
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ANS: A
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
In the presence of flow resistance distal to the jet, the volume of air entrained always decreases. With less air being entrained, total flow output decreases, and the delivered O 2 concentration increases. DIF: Analysis
REF: p. 920
OBJ: 4 | 5 | 6
49. A physician orders 40% O 2 through an air-entrainment nebulizer for a patient with a minute
volume of 12 L/min. What is the minimum nebulizer input flow required to ensure the prescribed FiO 2 ? a. 8 L/min b. 10 L/min c. 12 L/min d. 14 L/min ANS: B
For example, the total output flow of an air-entrainment nebulizer set to deliver 40% O2 ranges from 48 to 60 L/min. DIF: Application
REF: p. 921
OBJ: 4 | 5
50. You connect an intubated patient to an air-entrainment nebulizer system through a T tube set
at 60% with an input flow of 15 L/min. Toward the middle of inspiration, you observe that mist stops exiting from the open end of the T tube. What does this indicate? a. Flow is adequate to meet patient needs. b. Patient has a low inspiratory flow rate. c. Flowmeter must be calibrated. d. Patient is not receiving 60% O 2 . ANS: D
As long as mist can be seen escaping throughout inspiration, flow is adequate to meet the patient’s needs, and the delivered FiO 2 is ensured. DIF: Application
REF: p. 922
OBJ: 4 | 5 | 6
51. What is the maximum FiO 2 expected to be delivered by most air-entrainment masks? a. 30% b. 40% c. 50% d. 60% ANS: C
Most air-entrainment masks can be set to deliver no more than 50% O 2 . DIF: Application
REF: p. 920
OBJ: 4
52. Which of the following alternatives may increase the FiO 2 capabilities of air-entrainment
nebulizers? 1. Add open reservoir to expiratory side of T tube. 2. Connect together two or more nebulizers.
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3. Use a commercial dual-flow system. 4. Add open reservoir to inspiratory side of T tube. a. 1 and 2 only b. 1, 2, and 3 only c. 1 and 4 only d. 1, 2, 3, and 4 ANS: B
The five alternatives for boosting the FiO 2 capabilities in these situations are presented in Box 41-2. DIF: Analysis
REF: p. 921
OBJ: 4 | 5 | 8
53. To ensure the prescribed FiO 2 for a patient receiving 65% O 2 , you apply a closed reservoir
delivery system with a one-way expiratory valve. What other component must be included in this system to ensure a fail-safe operation? a. Water trap b. High-pressure alarm c. Emergency inlet valve d. Low-pressure alarm ANS: C
These systems must be equipped with an emergency inlet valve that allows room air breathing in the event of source gas failure. DIF: Application
REF: p. 922
OBJ: 4 | 5
54. An O 2 delivery device takes separate pressurized air and O 2 sources as input, then mixes these
gases through a precision valve. What does this describe? a. O 2 blending system b. Reservoir system c. Air-entrainment system d. Low-flow system ANS: A
With a blending system, separate pressurized air and O 2 sources are input, and the gases are mixed either manually or with a precision valve (blender). DIF: Application
REF: p. 924
OBJ: 4
55. A physician requests that you provide a patient with exactly 40% O 2 at a flow of 60 L/min.
Lacking a blender, you must manually mix air and O 2 to achieve the desired mixture at the prescribed flow. Which of the following air and O2 flows would you select? O2 (L/min) Air (L/min) a. 45 15 b. 15 45 c. 40 20 d. 20 40 ANS: A
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Manually mixing air and oxygen to achieve specified concentration at a given flow. Use Equation 40-3 to compute the O2 flow. DIF: Analysis
REF: p. 918
OBJ: 4 | 5
56. Which of the following are components of a typical O 2 blender?
1. Precision metering device or mixture control 2. Audible dual low-pressure alarm system 3. Pressure regulating and equalizing valves 4. Variable-size air-entrainment port a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: B
Figure 41-20 shows the major components of a typical O2 blender. DIF: Application
REF: p. 924
OBJ: 4 | 5
57. To confirm proper operation of an O2 blending system, what should you do?
1. Test low-pressure alarms and bypass systems. 2. Analyze FiO 2 at 0.21, 1.00, and prescribed level. 3. Confirm air and O2 inlet pressures. a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
To confirm proper operation, the respiratory therapist always should conduct an operational check of any blender before using it on a patient (Box 41-3). DIF: Application
REF: p. 924
OBJ: 4
58. What is the upper limit of O2 concentrations available through tents? a. 60% to 70% b. 50% to 60% c. 40% to 50% d. 30% to 40% ANS: C
For example, in large tents O 2 input flow of 12 to 15 L/min can provide only 40% to 50% O 2 levels. DIF: Application
REF: p. 915
OBJ: 4 | 5
59. A physician wants a stable FiO 2 of 0.5 for a newborn infant with severe hypoxemia. Which of
the following systems would you select? a. O 2 hood with blender and heated humidifier
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b. Pediatric (―croup‖) tent with O2 input of 8 L/min c. O 2 hood with blender and unheated humidifier d. Infant incubator with O2 input of 10 L/min ANS: A
Oxygen is delivered to the hood through either a heated air-entrainment nebulizer or a blending system with a heated humidifier. DIF: Application
REF: p. 915
OBJ: 4 | 5
60. What is the problem with input flows greater than 10 to 15 L/min in an infant Oxy-Hood? a. Production of harmful noise levels b. Difficulty in maintaining adequate humidification c. Difficulty in maintaining stable high FiO 2 values d. Increased likelihood of cold stress ANS: A
Higher flow generally is not needed and may produce a harmful noise level and additional stress on neonatal patients. DIF: Application
REF: p. 915
OBJ: 4 | 5
61. In giving O2 to an infant through a hood, which of the following are correct?
1. A neutral thermal environment should be maintained. 2. Gases should be directed away from the infant’s face. 3. High input flow (>10 to 15 L/min) should be avoided. 4. A minimum flow of 7 L/min must be maintained. a. 1, 2, and 3 only b. 2 and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: D
In the care of premature infants, it is especially important to ensure that the gas mixture is properly warmed and humidified and not directed toward the patient’s face or head. DIF: Application
REF: p. 915
OBJ: 4 | 5
62. Directing a cool O 2 mixture to an infant in an Oxy-Hood can result in which of the following?
1. Increased O 2 consumption 2. Increased convective heat loss 3. Apnea (cessation of breathing) a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
In premature infants, cold stress can increase O2 consumption and even cause apnea.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application REF: p. 915 OBJ: 4 | 5 | 6 63. What temperature is required to maintain a neutral thermal environment (NTE) in an
Oxy-Hood for infants weighing 2500 g or more? a. 25° C b. 30° C c. 35° C d. 40° C ANS: C
For example, the NTE temperature for newborns weighing less than 1200 g is 35° C. DIF: Application
REF: p. 915
OBJ: 4 | 5
64. An infant requires both a precise high FiO 2 and maintenance of a neutral thermal
environment. Which of the following systems can best achieve these goals? 1. Oxy-Hood or warmed O2 blending system without incubator 2. Heated incubator with automatic O 2 controlling system 3. Heated incubator with Oxy-Hood or O2 blending system a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
Given the highly variable O 2 concentration provided by these devices, the best way to control O 2 delivery to infants in an incubator is with an Oxy-Hood. The Oxy-Hood is placed over the infant’s head inside the incubator. The O2 concentration and gas temperature within the Oxy-Hood, not in the incubator, must be assessed. It is ideal to monitor incubator or Oxy-Hood O2 concentration continuously. DIF: Analysis
REF: p. 915
OBJ: 4 | 5
65. A variant of a common low-flow, nasal O 2 delivery device that is capable of providing both
high humidity and a high FiO 2 is known as which of the following? a. High-flow nasal cannula b. Transtracheal catheter c. Nasal catheter d. Demand-flow oxygen ANS: A
A variation of the standard nasal cannula which can provide both a high FiO 2 and high humidity is known as a high-flow nasal cannula. DIF: Application
REF: p. 926
OBJ: 4 | 5
66. What are some key patient considerations in selecting O2 therapy equipment?
1. Type of airway (natural or artificial) 2. Severity and cause of the hypoxemia 3. Age group (infant, child, adult)
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4. Stability of the minute ventilation a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
Table 41-8 lists guidelines for selecting an O2 delivery system on the basis of the level and stability of the FiO 2 needed. DIF: Application
REF: p. 927
OBJ: 4 | 5
67. In which of the following clinical situations would you recommend hyperbaric oxygen (HBO)
therapy, if available? 1. Carbon monoxide poisoning 2. Respiratory or cardiac arrest 3. Severe trauma 4. Cyanide poisoning a. 1 and 4 only b. 2 and 3 only c. 1, 2, 3, and 4 d. 1, 2, and 4 only ANS: A
Carbon monoxide and cyanide poisoning may necessitate HBO therapy. DIF: Application
REF: p. 930
OBJ: 4 | 5 | 10
68. A patient receiving 3 L/min O 2 through a nasal cannula has a measured SpO 2 of 93% and no
clinical signs of hypoxemia. At this point, what should you recommend? a. Decreasing the flow to 2 L/min and rechecking the SpO 2 b. Maintaining the therapy as is and rechecking the SpO 2 on the next shift c. Increasing the flow to 4 L/min and rechecking the SpO 2 d. Discontinuing the O2 therapy ANS: A
The goal is a PaO 2 greater than 60 mm Hg or hemoglobin saturation greater than 90%. DIF: Application
REF: p. 927
OBJ: 4 | 5 | 7 | 8
69. Which of the following would indicate adequate oxygenation for adult patients with chronic
lung disease and an accompanying acute-on-chronic hypoxemia? 1. SaO 2 of 90% or higher 2. PaO 2 of 50 to 60 mm Hg 3. SaO 2 of 85% to 90% a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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ANS: B
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Adequate oxygenation of these patients generally means an SaO 2 of 85% to 90% with a PaO 2 of 50 to 60 mm Hg. DIF: Application
REF: p. 927
OBJ: 4 | 5
70. What is the level of SpO 2 typically associated with discontinuation of O2 therapy? a. 88% b. 90% c. 92% d. 94% ANS: C
Once the SpO 2 is 92% or higher on room air, therapy is often discontinued. DIF: Application
REF: p. 927
OBJ: 4 | 5 | 7 | 8 | 9
71. What does 1 atmospheric pressure absolute (ATA) equal?
1. 101 kPa 2. 50 psi 3. 760 mm Hg a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
One ATA equals 760 mm Hg (101.32 kPa). DIF: Recall
REF: p. 927
OBJ: 10
72. Physiologic effects of hyperbaric oxygen (HBO) therapy include all of the following except: a. neovascularization. b. bubble reduction. c. enhanced immune function. d. systemic vasodilation. ANS: D
The known physiologic effects of HBO therapy are summarized in Box 41-5. DIF: Application
REF: p. 928
OBJ: 10
73. During hyperbaric oxygen therapy at 3 ATA, plasma contains about how much dissolved O 2 ? a. 1 ml/dl b. 3 ml/dl c. 5 ml/dl d. 7 ml/dl ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
At 3 ATA, plasma contains nearly 7 ml/dl dissolved O2 , a level exceeding average resting tissue uptake. DIF: Recall
REF: p. 928
OBJ: 10
74. Which of the following is false about multiplace hyperbaric oxygenation chambers? a. The chamber normally is filled with 100% O2 . b. Air locks allow entry and egress of caregivers. c. Pressures of 6 ATA or more can be applied. d. Care is provided directly within the chamber. ANS: A
The multiplace chamber is filled with air. DIF: Application
REF: p. 928
OBJ: 10
75. Which of the following conditions can be treated with hyperbaric oxygen (HBO) therapy?
1. Carbon monoxide poisoning 2. Septic shock 3. Air embolism 4. Clostridial gangrene a. 1 and 2 only b. 1, 3, and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
Other indications for HBO therapy are listed in Box 41-6. DIF: Application
REF: p. 930
OBJ: 9 | 10
76. In which of the following procedures is air embolism a potential complication?
1. Central line placement 2. Lung biopsy 3. Hemodialysis a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
Air embolism is a complication that can occur with certain cardiovascular procedures, lung biopsy, hemodialysis, and central line placement. DIF: Application
REF: p. 930
OBJ: 10
77. At an FiO 2 of 1, what is the approximate half-life of blood carboxyhemoglobin? a. 20 min b. 80 min c. 3 hr
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. 5 hr ANS: B
Breathing 100% O2 reduces this ―half-life‖ to 80 min. DIF: Application
REF: p. 930
OBJ: 10
78. During hyperbaric oxygen (HBO) therapy at 3 ATA, what is the approximate half-life of
blood carboxyhemoglobin? a. 23 min b. 80 min c. 5 hr d. 24 hr ANS: A
The half-life of carboxyhemoglobin under HBO at 3 ATA is only 23 min. DIF: Application
REF: p. 930
OBJ: 10
79. Criteria for initiating hyperbaric oxygen (HBO) therapy on an adult patient suspected of
suffering from acute carbon monoxide poisoning include which of the following? 1. History of unconsciousness 2. Carboxyhemoglobin saturation less than 20% 3. Presence of neurologic abnormality 4. Presence of cardiac instability a. 2 and 3 only b. 1, 3, and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
Box 41-7 lists current criteria for selecting patients with acute carbon monoxide poisoning for treatment with HBO. DIF: Application
REF: p. 930
OBJ: 9 | 10
80. At what level of carboxyhemoglobin saturation is hyperbaric oxygen (HBO) therapy indicated
for an adult patient? a. Greater than 10% b. Greater than 15% c. Greater than 20% d. Greater than 25% ANS: D
Box 41-7 lists current criteria for selecting patients with acute carbon monoxide poisoning for treatment with HBO. DIF: Application
REF: p. 930
OBJ: 9 | 10
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 81. Primary safety concerns in the application of hyperbaric oxygenation include which of the
following? 1. Sudden decompression 2. Electrical fires 3. CO 2 accumulation a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
The common complications of hyperbaric oxygenation are listed in Box 41-8. DIF: Application
REF: p. 930
OBJ: 10
82. What is the most common complication of hyperbaric oxygen therapy? a. Air embolism b. Pneumothorax c. Ear or sinus barotrauma d. Seizures or convulsions ANS: C
The most frequent problems involve barotrauma to closed body cavities, such as the middle ear or sinuses. DIF: Application
REF: p. 930
OBJ: 10
83. Physiologic effects of inhaled nitric oxide (NO) include which of the following?
1. Recruitment of collapsed alveoli 2. Improved blood flow to ventilated alveoli 3. Decreased pulmonary vascular resistance 4. Reduced intrapulmonary shunting a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
The result is a reduction in intrapulmonary shunting, an improvement in arterial oxygenation, and a decrease in pulmonary vascular resistance and pulmonary arterial pressure. DIF: Application
REF: p. 931
OBJ: 11
84. A well-designed oxygen protocol will ensure which of the following?
1. The patient undergoes initial assessment. 2. The patient is evaluated for protocol criteria. 3. The patient receives a treatment plan that is modified according to need. 4. The patient stops receiving therapy as soon as it is no longer needed. a. 1, 2, and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
b. 2 and 3 only c. 1 and 3 only d. 1, 2, 3, and 4 ANS: D
An order for ―O2 therapy via protocol‖ permits O 2 therapy to be initiated, modified, or discontinued by the RT, provided that an assessment reveals that the patient meets previously approved clinical criteria. A well-designed O 2 protocol ensures the patient (1) undergoes initial assessment, (2) is evaluated for protocol criteria, (3) receives a treatment plan that is modified according to need, and (4) stops receiving therapy as soon as it is no longer needed. DIF: Recall
REF: p. 927
OBJ: 9
85. What is the recommended maximum initial dose of inhaled NO in neonates with respiratory
distress syndrome? a. 5 ppm b. 10 ppm c. 20 ppm d. 30 ppm ANS: C
The recommended maximum initial dose of NO is 20 ppm. DIF: Application
REF: p. 931
OBJ: 11
86. Toxic side effects of inhaled NO include which of the following?
1. Acute pulmonary edema 2. Direct cellular damage 3. Impaired surfactant production 4. Sulfhemoglobinemia a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Levels greater than 10 ppm can cause cell damage, hemorrhage, pulmonary edema, and death. DIF: Application
REF: p. 931
OBJ: 11
87. Which of the following are true about NO 2 ?
1. NO 2 levels greater than 10 ppm can cause hemorrhage, pulmonary edema, and death. 2. NO 2 is produced spontaneously whenever NO is exposed to O 2 . 3. The Occupational Safety and Health Administration (OSHA) safety limit for NO2 exposure is 5 ppm. 4. NO 2 exposure should be kept below 5 ppm during NO administration. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. 2, 3, and 4 only ANS: B
OSHA has set the safety limit for nitrogen dioxide exposure at 5 ppm. DIF: Application
REF: p. 931
OBJ: 11
88. Potential adverse effects associated with NO therapy include which of the following?
1. Poor or paradoxical response 2. Increased blood clotting 3. Increased left ventricular filling pressures 4. Rebound hypoxemia or pulmonary hypertension a. 1 and 3 only b. 1, 3, and 4 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
Potential adverse effects associated with NO therapy are listed in Box 41-10. DIF: Application
REF: p. 931
OBJ: 11
89. Features of an ideal delivery system for NO for use with mechanical ventilation include which
of the following? 1. Provides precise and stable NO dose delivery. 2. Premixes NO and O2 in a holding reservoir. 3. Provides accurate NO and NO2 monitoring. 4. Maintains proper ventilator function. a. 1 and 3 only b. 1, 3, and 4 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
Features of an ideal NO delivery system are listed in Box 41-11. DIF: Application
REF: p. 932
OBJ: 11
90. To prevent an adverse rebound effect when withdrawing NO therapy, what should you do?
1. Reduce the NO to the lowest effective dose (ideally, less than 5 ppm). 2. Hyperoxygenate the patient just before discontinuing NO. 3. Ensure that the patient is hemodynamically stable. a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
First, the NO level should be reduced to the lowest effective dose (ideally =5 ppm). Second, the patient’s condition should be hemodynamically stable, and the patient should be able to maintain adequate oxygenation while breathing a moderate FiO 2 (0.4 or less) on low levels of positive end expiratory pressure. Third, the patient should be hyperoxygenated (FiO 2 , 0.60 to 0.70) just before discontinuation of NO inhalation. DIF: Analysis
REF: p. 933
OBJ: 11
91. Which of the following is an indication for the use of helium-O 2 mixtures? a. Large-airway obstruction b. Small-airway obstruction c. Restrictive diseases d. Physiologic shunting ANS: A
Helium-oxygen has been used for more than 70 years as an adjunct tool in the management of large airway obstruction. DIF: Application
REF: p. 933
OBJ: 1
92. Compared to air, the density of an 80% He and 20% O 2 mixture is about which of the
following? a. Two-thirds as much b. One-half as much c. One-third as much d. One-fifth as much ANS: C
Although air has a density of 1.293 g/L, the density of an 80% helium mixture is 0.429 g/L. DIF: Recall
REF: p. 933
OBJ: 12
93. A physician orders a 70% He:30% O2 mixture to reduce the work of breathing in a patient
having an acute asthmatic attack. Which of the following delivery systems would be appropriate in this case? a. Adult O2 tent at 15 L/min b. Aerosol mask at 12 L/min c. Nasal cannula at 6 L/min d. Nonrebreathing mask at 10 L/min ANS: D
In general, heliox should be delivered to most spontaneously breathing patients via a tight-fitting (nondisposable) nonrebreathing mask with a fully functional valved exhalation port. DIF: Application
REF: p. 933
OBJ: 12
94. You are giving a 80% He:20% O 2 mixture to an asthmatic patient through a nonrebreathing
mask with a compensated Thorpe tube O 2 flowmeter set at 8 L/min. What is the actual flow being delivered to the patient?
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a. b. c. d.
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
10 L/min 12 L/min 14 L/min 18 L/min
ANS: C
For example, the correction for an 80:20 helium-O2 mixture is 1.8. DIF: Application
REF: p. 933
OBJ: 12
95. Before administering a helium-O2 mixture to a patient with large airway obstruction, what
should you do? a. Analyze the helium concentration of the mixture. b. Heat the cylinder to ensure complete mixing of contents. c. Analyze the O 2 concentration of the mixture. d. Roll the cylinder to ensure complete mixing of contents. ANS: C
In addition to special flow considerations, the respiratory therapist should use an O 2 analyzer to continuously monitor heliox (actually O2 ) concentrations between the source of the mixture and the patient. DIF: Application
REF: p. 933
OBJ: 12
96. Mixtures of carbon dioxide and oxygen in blends of 5%:95% or 7%:93%, which are
occasionally used to prevent complete washout of carbon dioxide during cardiopulmonary bypass or treat hiccoughs is known as which of the following? a. Heliox b. Carbogen c. Nitrogen dioxide d. Flolan ANS: B
A therapeutic mixture of carbon dioxide and oxygen is known as carbogen. DIF: Recall
REF: p. 934
OBJ: 12
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 42 - Lung Expansion Therapy Kacmarek et al.: Egan’s Funda menta ls of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Persistent breathing at small tidal volumes typically results in which of the following? a. Reabsorption atelectasis b. Spontaneous pneumothorax c. Compression atelectasis d. Respiratory alkalosis ANS: C
Compression atelectasis is primarily caused by persistent use of small tidal volumes by the patient. DIF: Recall
REF: p. 938
OBJ: 1
2. Which of the following patient categories are at high risk for developing atelectasis?
1. Those who are heavily sedated 2. Those with abdominal or thoracic pain 3. Those with neuromuscular disorders a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
Patients who have difficulty taking deep breaths without assistance include those with significant obesity, those with neuromuscular disorders, those under heavy sedation, and those who have undergone upper abdominal or thoracic surgery. DIF: Recall
REF: p. 938
OBJ: 1
3. What is the major contributing factor in the development of postoperative atelectasis? a. Uncontrolled hyperpyrexia b. Central nervous system overstimulation c. Decreased cardiac output d. Repetitive, shallow breathing ANS: D
Most postoperative patients also have problems coughing effectively because of their reduced ability to take deep breaths. DIF: Recall
REF: p. 938
OBJ: 1
4. Which of the following groups of patients is not at risk for developing postoperative
atelectasis? a. Those with chronic obstructive pulmonary disease
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
b. Those with a significant history of cigarette smoking c. Those with impaired mucociliary clearance d. Those with pneumonia ANS: D
An ineffective cough impairs normal clearance mechanisms and increases the likelihood of retained secretions and gas absorption atelectasis in the patient with excessive mucus production. For this reason, patients with a history of lung disease that causes increased mucus production (e.g., chronic bronchitis) are most prone to develop complications in the postoperative period. Similarly, a significant history of cigarette smoking should alert the respiratory therapist to the high risk for respiratory complications with surgery. DIF: Recall
REF: p. 938
OBJ: 2
5. Which of the following clinical findings indicate the development of atelectasis?
1. Opacified areas on the chest x-ray film 2. Inspiratory and expiratory wheezing 3. Tachypnea 4. Diminished or bronchial breath sounds a. 1, 3, and 4 only b. 1, 2, 3, and 4 c. 1 and 4 only d. 2, 3, and 4 only ANS: A
When the atelectasis involves a more significant portion of the lungs, the patient’s respiratory rate will increase proportionally. Bronchial-type breath sounds may be present as the lung becomes more consolidated with atelectasis. Diminished breath sounds are common when excessive secretions block the airways and prevent transmission of breath sounds. The chest film is often used to confirm the presence of atelectasis. DIF: Recall
REF: p. 939
OBJ: 3
6. How do all modes of lung expansion therapy aid lung expansion? a. Increasing the transpulmonary pressure gradient b. Decreasing the transthoracic pressure gradient c. Increasing the pressure in the pleural space d. Decreasing the pressure in the alveoli ANS: A
All modes of lung expansion therapy increase lung volume by increasing the transpulmonary pressure (PL) gradient. DIF: Recall
REF: p. 939
OBJ: 4
7. How can the transpulmonary pressure gradient be increased?
1. Increasing alveolar pressure 2. Decreasing pleural pressure 3. Decreasing transthoracic pressure
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a. b. c. d.
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1 and 2 only 2 and 3 only 1 and 3 only 3 only
ANS: A
PL gradient can be increased by either decreasing the surrounding Ppl (Figure 42-1, A) or increasing the Palv . DIF: Recall
REF: p. 939
OBJ: 4
8. Lung expansion methods that increase the transpulmonary pressure gradients by increasing
alveolar pressure include which of the following? 1. Incentive spirometry (IS) 2. Positive end-expiration pressure therapy 3. Intermittent positive-pressure breathing (IPPB) 4. Expiratory positive airway pressure (EPAP) a. 1 and 2 only b. 2, 3, and 4 only c. 1 and 3 only d. 1, 2, 3, and 4 ANS: B
Positive-pressure lung expansion therapies may apply pressure during inspiration only (as in IPPB), during expiration only (as in positive expiratory pressure [PEP] and EPAP), or during both inspiration and expiration (CPAP). DIF: Recall
REF: p. 939
OBJ: 4
9. Which of the following modes of lung expansion therapy is physiologically most normal? a. Continuous positive airway pressure b. Incentive spirometry c. Positive end expiratory pressure d. Intermittent positive-pressure breathing therapy ANS: B
Although all these approaches are used in lung expansion therapy, it should be clear that those methods that decrease Ppl (e.g., incentive spirometry) have more of a physiologic effect than those that raise Palv and often are most effective. DIF: Recall
REF: p. 939
OBJ: 4
10. An alert and cooperative 28-year-old woman with no prior history of lung disease underwent
cesarean section 16 hr earlier. Her x-ray film currently is clear. Which of the following approaches to preventing atelectasis would you recommend for this patient? a. Incentive spirometry b. PEEP therapy c. Deep breathing exercises d. Intermittent positive-pressure breathing therapy
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ANS: A
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
For the patient at high risk for atelectasis (e.g., the upper abdominal surgery patient), incentive spirometry is usually used. DIF: Application
REF: p. 941
OBJ: 4
11. Which of the following are potential indications for incentive spirometry?
1. A restrictive disorder such as quadriplegia 2. Abdominal surgery in a COPD patient 3. Presence of pulmonary atelectasis a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
Indications for incentive spirometry are listed in Box 42-1. DIF: Recall
REF: p. 941
OBJ: 5
12. Which of the following situations is a contraindication for incentive spirometry?
1. A patient whose vital capacity is less than 10 ml/kg 2. A patient who cannot cooperate or follow instructions 3. An unconscious patient a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
Incentive spirometry is a simple and relatively safe modality. For this reason, contraindications are few (Box 42-2). DIF: Recall
REF: p. 941
OBJ: 5
13. Which of the following are potential hazards or complications of incentive spirometry?
1. Pulmonary barotrauma 2. Decreased cardiac output 3. Respiratory alkalosis 4. Fatigue a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: D
See Box 42-3. DIF: Recall
REF: p. 941
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 14. A postoperative patient using incentive spirometry complains of dizziness and numbness
around the mouth after therapy sessions. What is the most likely cause of these symptoms? Gastric insufflation Hyperventilation Pulmonary barotrauma Respiratory acidosis
a. b. c. d.
ANS: B
Dizziness and numbness around the mouth are the most frequently reported symptoms associated with respiratory alkalosis. DIF: Application
REF: p. 941
OBJ: 5
15. Incentive spirometry devices can generally be categorized as which of the following?
1. Pressure-oriented 2. Flow-oriented 3. Volume-oriented a. 3 only b. 1 and 2 only c. 1, 2, and 3 d. 2 and 3 only ANS: D
Incentive spirometry devices can generally be categorized as volume or flow oriented. DIF: Recall
REF: p. 942
OBJ: 5
16. Which of the following is FALSE about flow-oriented incentive spirometry devices? a. Inspired volume is estimated as the product of flow and time. b. Motivation is based on keeping the indicator balls elevated. c. Theyhave proved less effective than volumetric systems. d. They provide only an indirect measure of inspired volume. ANS: C
No evidence to date indicates that one type is more beneficial than the other. DIF: Recall
REF: p. 942
OBJ: 5
17. Which of the outcomes would indicate improvement in a patient previously diagnosed with
atelectasis who has been receiving incentive spirometry? 1. Improved PaO 2 2. Decreased respiratory rate 3. Improved chest radiograph 4. Decreased forced vital capacity (FVC) a. 1, 2, and 3 only b. 1, 3, and 4 only c. 1 and 2 only d. 4 only ANS: A
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See Box 42-4. DIF: Recall
REF: p. 942
OBJ: 6
18. Ideally, when should high-risk surgical patients be oriented to incentive spirometry? a. Postoperatively, after full recovery from the anesthesia b. Preoperatively, before undergoing the surgical procedure c. Postoperatively, while they are still in the recovery room d. Postoperatively, but no sooner than 24 hr after surgery ANS: B
This approach provides an opportunity to orient high-risk patients to the procedure before undergoing surgery, thereby increasing the likelihood of success when incentive spirometry is provided after surgery. DIF: Recall
REF: p. 942
OBJ: 6
19. Successful application of incentive spirometry depends on: a. the use of a true volume-oriented incentive spirometry system. b. the type of surgery previously performed. c. the effectiveness of patient teaching. d. setting an easily achieved initial goal. ANS: C
Successful incentive spirometry requires effective patient teaching. DIF: Recall
REF: p. 942
OBJ: 6
20. In teaching a patient to perform the sustained maximal inspiration maneuver during incentive
spirometry, what would you say? a. ―Exhale normally, then inhale as deeply as you can, then hold your breath for 5 to 10 seconds.‖ b. ―Inhale as deeply as you can, then blow out as much air as you can as fast as possible.‖ c. ―Exhale normally, then inhale as deeply as you can, then hold your breath for 10 to 20 seconds.‖ d. ―Exhale as much as you can, then inhale as deeply as you can, then relax and let it out.‖ ANS: A
The patient should be instructed to inspire slowly and deeply to maximize the distribution of ventilation. DIF: Recall
REF: p. 942
OBJ: 6
21. Correct instruction in the technique of incentive spirometry should include which of the
following? a. Use of accessory muscles at high inspiratory flows b. Diaphragmatic breathing at slow to moderate flows c. ―Panting‖ at volumes approaching total lung capacity
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Use of accessory muscles at low inspiratory flows ANS: B
Correct technique calls for diaphragmatic breathing at slow-to-moderate inspiratory flows. DIF: Recall
REF: p. 942
OBJ: 6
22. In performing the sustained maximal inspiration maneuver during incentive spirometry, the
patient should be instructed to sustain the breath for at least how long? a. 10 to 15 sec b. 5 to 10 sec c. 3 to 5 sec d. 1 to 2 sec ANS: B
Instruct the patient to sustain his or her maximal inspiratory volume for 5 to 10 sec. DIF: Recall
REF: p. 942
OBJ: 6
23. In observing a postoperative woman conduct incentive spirometry, you note repetitive
performance of the sustained maximal inspiration maneuver at a rate of approximately 10 to 12/min. Which of the following would you recommend to her? a. Decrease the treatment frequency to 4 times/day. b. Increase her breathing rate to 12 to 15/min. c. Take a 30-sec rest period between breaths. d. Repeat the treatment every 30 min. ANS: C
Some patients in the early postoperative stage may need to rest for 30 sec to 1 min between maneuvers. DIF: Analysis
REF: p. 942
OBJ: 6
24. For patients receiving incentive spirometry, what is the minimum number of sustained
maximal inspirations (SMIs) per hour that you would recommend? a. 25 to 30 b. 15 to 20 c. 5 to 10 d. 1 to 2 ANS: C
An incentive spirometry regimen should probably aim to ensure a minimum of 5 to 10 SMI maneuvers each hour. DIF: Recall
REF: p. 942
OBJ: 6
25. What should the monitoring of patients using incentive spirometry include?
1. Number of breaths per session 2. Volume and flow goals achieved 3. Maintenance of breath-hold
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
4. Patient effort and motivation a. 1, 3, and 4 only b. 2, 3, and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: C
See Box 42-5. DIF: Recall
REF: p. 943
OBJ: 6
26. The short-term application of inspiratory positive pressure to a spontaneously breathing
patient best defines which of the following? a. Sustained maximal inspiration b. Intermittent positive-pressure breathing c. Continuous positive airway pressure d. Positive end-expiration pressure ANS: B
Intermittent positive-pressure breathing refers to the application of inspiratory positive pressure to a spontaneously breathing patient as an intermittent or short-term therapeutic modality. DIF: Recall
REF: p. 943
OBJ: 6
27. Which of the following are true about intermittent positive-pressure breathing?
1. During inspiration, pressure in the alveoli decreases. 2. The pressure gradients of normal breathing are reversed. 3. During inspiration, alveolar pressure may exceed pleural pressure. 4. Energy stored during inspiration causes a passive exhalation. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Ppl may actually exceed atmospheric pressure during a portion of inspiration. DIF: Recall
REF: p. 943
OBJ: 6
28. Which of the following possesses the most significant risk for hypoventilation? a. IPPB b. IS c. IPAP/EPAP d. CPAP ANS: D
Providing continuous positive airway pressure (CPAP) can cause smaller tidal volumes and may cause issues with hypoventilation.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 945 OBJ: 5 29. Which of the following patient groups should be considered for lung expansion therapy using
intermittent positive-pressure breathing (IPPB)? 1. Patients with clinically diagnosed atelectasis who are not responsive to other therapies 2. Patients at high risk for atelectasis who cannot cooperate with other methods 3. All obese patients who have undergone abdominal surgery a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
IPPB may be useful for patients with clinically diagnosed atelectasis not responsive to other therapies, such as incentive spirometry and chest physiotherapy. In addition, IPPB may be useful for patients who are at high risk for atelectasis and not able to cooperate with more simple techniques such as IS. DIF: Recall
REF: p. 945
OBJ: 2
30. Which of the following statements are true about intermittent positive-pressure breathing
(IPPB)? 1. IPPB could cause lung overinflation. 2. IPPB could cause no expansion of regions affected by secretions. 3. Bronchial hygiene must be used in conjunction with IPPB to adequately manage secretions. 4. IPPB should be the single treatment modality for gas absorption atelectasis. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
In either case, IPPB should not be used as a single treatment modality for the patient with gas absorption atelectasis due to excessive airway secretions. Applying positive pressure to the lung in such cases is likely to cause overinflation of the lung regions not affected by secretions and minimal or no expansion of the affected lung segments. Bronchial hygiene with humidity therapy must be used in conjunction with IPPB for the most optimal results in such cases. DIF: Recall
REF: p. 945
OBJ: 5
31. What is the optimal breathing pattern for intermittent positive-pressure breathing (IPPB)
treatment of atelectasis? a. Slow, deep breaths held at end-inspiration. b. Rapid, deep breaths held at end-inspiration. c. Slow, shallow breaths held at end-inspiration. d. Rapid, shallow breaths held at end-inspiration. ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
The optimal breathing pattern to reinflate collapsed lung units with IPPB consists of slow, deep breaths that are sustained or held at end-inspiration. DIF: Recall
REF: p. 945
OBJ: 6
32. Which of the following are potential contraindications for intermittent positive-pressure
breathing? 1. Hemodynamic instability 2. Recent esophageal surgery 3. Tension pneumothorax 4. Neuromuscular disorders a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
See Box 42-6. DIF: Recall
REF: p. 945
OBJ: 5
33. Which of the following is an absolute contraindication for using intermittent positive-pressure
breathing? a. Hemodynamic instability b. Active untreated tuberculosis c. Tension pneumothorax d. Recent esophageal surgery ANS: C
See Box 42-6. DIF: Recall
REF: p. 945
OBJ: 5
34. What is the most common complication associated with intermittent positive-pressure
breathing (IPPB)? a. Air trapping b. Oral bleeding c. Respiratory alkalosis d. Gastric distention ANS: C
The most common complication associated with IPPB is the inducement of respiratory alkalosis. DIF: Recall
REF: p. 945
OBJ: 5
35. What is the minimum airway pressure at which the esophagus opens, allowing gas to pass
directly into the stomach? a. 25 cm H2 O b. 20 cm H2 O
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
c. 15 cm H2 O d. 10 cm H2 O ANS: B
Normally, the esophagus does not open until a pressure of approximately 20 cm H2 O has been reached. DIF: Recall
REF: p. 945
OBJ: 6
36. Which of the following are true about gastric distention with intermittent positive-pressure
breathing (IPPB)? 1. Gastric distention is uncommon in alert and cooperative patients. 2. Gastric distention is most likely at high airway pressures. 3. Gastric distention is a significant risk in obtunded patients. 4. Gastric distention is a relatively harmless effect of IPPB. a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
Gastric distention represents the greatest risk in patients receiving IPPB at high pressures. DIF: Recall
REF: p. 945
OBJ: 5
37. Which of the following is not a potential hazard of intermittent positive-pressure breathing? a. Increased cardiac output b. Respiratory alkalosis c. Pulmonary barotrauma d. Gastric distention ANS: A
See Box 42-7. DIF: Application
REF: p. 945
OBJ: 5
38. Which of the following are potential hazards of intermittent positive-pressure breathing
(IPPB)? 1. Air trapping, auto-PEEP 2. Hyperventilation 3. Nosocomial infection 4. Increased airway resistance a. 1, 2, 3, and 4 b. 2 and 4 only c. 2, 3, and 4 only d. 3 and 4 only ANS: A
See Box 42-7.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 945 OBJ: 5 39. Preliminary planning for intermittent positive-pressure breathing (IPPB) should include which
of the following? 1. Evaluating alternative approaches to the patient’s problem 2. Setting specific, individual clinical goals or objectives 3. Conducting a baseline assessment of the patient 4. Taking a chest x-ray a. 1 and 3 only b. 1 and 4 only c. 1, 2, and 3 only d. 2 and 4 only ANS: C
Effective IPPB requires careful preliminary planning, individualized patient assessment and implementation, and thoughtful follow-up. In all three phases of the process, the respiratory therapist should work closely with the prescribing physician to determine patient need, select the appropriate therapeutic approach, and assess patient progress toward predefined clinical outcomes. DIF: Recall
REF: p. 945
OBJ: 6
40. Which of the following are potential desirable outcomes of intermittent positive-pressure
breathing (IPPB) therapy? 1. Improved oxygenation 2. Increased cough and secretion clearance 3. Improved breath sounds 4. Reduced pulmonary compliance a. 3 and 4 only b. 1, 2, and 4 only c. 3 and 4 only d. 1, 2, and 3 only ANS: D
Box 42-8 lists potential accepted and desired outcomes of IPPB therapy. DIF: Recall
REF: p. 945
OBJ: 6
41. The general assessment, common to all patients for whom intermittent positive-pressure
breathing (IPPB) is ordered, should include which of the following? 1. Measurement of vital signs 2. Appearance and sensorium 3. Chest auscultation 4. Arterial blood gas analysis a. 1 and 4 only b. 2 and 3 only c. 3 and 4 only d. 1, 2, and 3 only
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ANS: D
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
The general assessment, common to all patients for whom IPPB is ordered, includes (1) measurement of vital signs, (2) observational assessment of the patient’s appearance and sensorium, and (3) breathing pattern and chest auscultation. The more focused assessment is individualized according to the identified clinical goals. DIF: Application
REF: p. 945
OBJ: 2
42. When checking a patient’s intermittent positive-pressure breathing (IPPB) circuit before use,
you notice that the device will not cycle off, even when you occlude the mouthpiece. What would be the most appropriate action in this case? a. Secure a new IPPB ventilator. b. Check the circuit for leaks. c. Decrease the flow setting. d. Increase the pressure setting. ANS: B
Because pressure-cycled IPPB devices will not end inspiration if leaks in the system occur, it is important to check the patency of the patient’s breathing circuit before each use. DIF: Application
REF: p. 946
OBJ: 5
43. Prior to starting intermittent positive-pressure breathing (IPPB) on a new patient, what should
the practitioner explain? 1. Why the physician ordered the treatment. 2. What the IPPB treatment will do. 3. How the IPPB treatment will feel. 4. What the expected results are. a. 1, 2, 3, and 4 b. 2 and 4 c. 2, 3, and 4 d. 1, 3, and 4 ANS: A
(1) Why the physician ordered the treatment, (2) what the treatment does, (3) how it will feel, and (4) what are the expected results should be explained to the patient. DIF: Recall
REF: p. 946
OBJ: 6
44. Which of the following positions is ideal for intermittent positive-pressure breathing therapy? a. Semi-Fowler’s b. Standing c. Supine d. Prone ANS: A
For best results, the patient should be in a semi-Fowler’s position. DIF: Recall
REF: p. 946
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 45. In order to eliminate leaks in an alert patient receiving intermittent positive-pressure breathing
therapy, which of the following adjuncts would you first try? a. Flanged mouthpiece b. Form-fitting mask c. Nasopharyngeal airway d. Nose clips ANS: D
To eliminate airway leaks in the alert patient, an initial trial of nose clips may be needed until the technique is understood and the treatment can be performed without them. DIF: Recall
REF: p. 946
OBJ: 6
46. When adjusting the sensitivity control on an intermittent positive-pressure breathing device,
which of the following parameters are you changing? a. Volume of gas delivered to the patient during inhalation b. Effort required to cycle the device ―off‖ (end inspiration) c. Effort required to cycle the device ―on‖ (begin inspiration) d. Maximum pressure delivered to the patient during inhalation ANS: C
The machine should be set so that a breath can be initiated with minimal patient effort. DIF: Recall
REF: p. 946
OBJ: 6
47. Which of the following are appropriate initial settings for intermittent positive-pressure
breathing given to a new patient? a. Sensitivity −2 cm H2 O; pressure 20 to 25 cm H2 O; high flow b. Sensitivity −3 to −4 cm H 2 O; pressure 5 to 10 cm H2 O; moderate flow c. Sensitivity −1 to −2 cm H 2 O; pressure 10 to 15 cm H 2 O; moderate flow d. Sensitivity −8 cm H2 O; pressure 15 cm H 2 O; moderate flow ANS: C
A sensitivity or trigger level of 1 to 2 cm H2 O is adequate for most patients. Initially, system pressure is set to between 10 and 15 cm H 2 O. DIF: Recall
REF: pp. 956-940 OBJ: 5
48. In administering intermittent positive-pressure breathing therapy, which of the following
breathing patterns would be most desirable? a. 6 to 8 breaths/min, inspiration/expiration ratio (I:E) of 1:3 b. 8 to 10 breaths/min, I:E of 1:1 c. 12 to 15 breaths/min, I:E of 1:2 d. 6 to 8 breaths/min, I:E of 1:1 ANS: A
Generally, the goal is to establish a breathing pattern consisting of approximately 6 breaths/min, with an expiratory time of at least 3 to 4 times longer than inspiration (I:E ratio of 1:3 to 1:4 or lower).
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 956 OBJ: 6 49. Which of the following are appropriate volume goals for intermittent positive-pressure
breathing (IPPB) therapy? 1. 10 to 15 ml/kg ideal body weight 2. At least 30% of the inspiratory capacity (IC) 3. Pressure level as high as 30 to 35 cm H2 O a. 1 and 3 only b. 1 and 2 only c. 2 and 3 only d. 1 only ANS: B
Most clinical centers strive to achieve an IPPB tidal volume of 10 to 15 ml/kg of body weight or at least 30% of the patient’s predicted IC. If the initial volumes fall short of this goal and the patient can tolerate it, the pressure is gradually raised until the goal is achieved. Pressures as high as 30 to 35 cm H 2 O may be needed to achieve this end when lung compliance is reduced. DIF: Recall
REF: p. 944
OBJ: 6
50. Which of the following parameters should be evaluated after intermittent positive-pressure
breathing therapy? 1. Vital signs 2. Sensorium 3. Breath sounds 4. Temperature a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
The general follow-up evaluation of the patient’s clinical status should focus on determining any pertinent changes in vital signs, sensorium, and breath sounds, with emphasis on identifying possible untoward effects. DIF: Recall
REF: p. 946
OBJ: 6
51. Which of the following should be charted in the patient’s medical record after completion of
an intermittent positive-pressure breathing treatment? 1. Results of pretreatment and posttreatment assessment 2. Any side effects 3. Duration of therapeutic session a. 2 and 3 only b. 1 and 3 only c. 1 and 2 only d. 1, 2, and 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D
A succinct but complete account of the treatment session, including the preassessment and postassessment results, must be entered in the patient’s medical record according to the approved institutional protocol. Any untoward patient responses must also immediately be reported to responsible personnel, to include at least the prescribing physician and attending nurse. DIF: Recall
REF: p. 946
OBJ: 6
52. Which of the following machine performance characteristics should be monitored during
intermittent positive-pressure breathing therapy? 1. Flow setting 2. Sensitivity 3. Humidity output 4. Peak pressure a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
See Box 42-9. DIF: Recall
REF: p. 946
OBJ: 6
53. In terms of machine performance, what do large negative pressure swings early in inspiration
typically indicate? a. Inadequate flow setting b. Incorrect sensitivity c. Inadequate pressure setting d. Inadequate humidity ANS: B
In terms of machine performance, large negative pressure swings early in inspiration indicate an incorrect sensitivity or trigger setting. DIF: Analysis
REF: p. 946
OBJ: 6
54. Which of the following will make an intermittent positive-pressure breathing (IPPB) device
cycle off prematurely? 1. Airflow obstructed 2. Kinked tubing 3. Occluded mouthpiece 4. Active resistance to inhalation a. 1 and 2 only b. 1 and 3 only c. 1, 3, and 4 only d. 1, 2, 3, and 4
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D
An IPPB device may cycle off prematurely when airflow is obstructed. Kinked tubing, an occluded mouthpiece, and active resistance to inhalation by the patient are the most common causes of this problem. DIF: Recall
REF: p. 946
OBJ: 6
55. Which of the following mechanisms probably contribute to the beneficial effects of
continuous positive airway pressure (CPAP) in treating atelectasis? 1. Recruitment of collapsed alveoli 2. Decreased work of breathing 3. Improved distribution of ventilation 4. Increased efficiency of secretion removal a. 1, 2, and 4 only b. 2 and 3 only c. 1 and 4 only d. 1, 2, 3, and 4 ANS: D
Exactly how CPAP helps resolve atelectasis is unknown. However, the following factors probably contribute to its beneficial effects: (1) the recruitment of collapsed alveoli via an increase in FRC, (2) a decreased work of breathing due to increased compliance or elimination of auto-positive end expiratory pressure (PEEP), (3) an improved distribution of ventilation through collateral channels (e.g., Kohn pores), and (4) an increase in the efficiency of secretion removal. DIF: Recall
REF: p. 947
OBJ: 6
56. Which of the following are contraindications for continuous positive airway pressure (CPAP)
therapy? 1. Hemodynamic instability 2. Hypoventilation 3. Facial trauma 4. Low intracranial pressures a. 1 and 3 only b. 2 and 3 only c. 1, 2, and 3 only d. 2, 3, and 4 only ANS: C
The patient who is hemodynamically unstable is not likely to tolerate CPAP for even a short period of time. The patient who is suspected of having hypoventilation is not a good candidate for CPAP because it does not ensure ventilation. Other problems that may indicate that CPAP is not an appropriate therapy include nausea, facial trauma, untreated pneumothorax, and elevated intracranial pressure. DIF: Recall
REF: p. 947
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 57. Which of the following are potential complications of continuous positive airway pressure
(CPAP) therapy? 1. Barotrauma 2. Hyperventilation 3. Gastric distention 4. Hypercapnia a. 1 and 3 only b. 2 and 3 only c. 1, 3, and 4 only d. 2, 3, and 4 only ANS: A
The increased work of breathing caused by the apparatus can lead to hypoventilation and hypercapnia. In addition, because CPAP does not augment spontaneous ventilation, patients with an accompanying ventilatory insufficiency may hypoventilate during application. Barotrauma is a potential hazard of CPAP and is more likely to occur in the patient with emphysema and blebs. Gastric distention may occur, especially if CPAP pressures above 15 cm H 2 O are needed. DIF: Recall
REF: pp. 947-948 OBJ: 5
58. Which of the following are essential components of a continuous positive airway pressure
(CPAP) flow system? 1. Blended source of pressurized gas 2. Nonrebreathing circuit with reservoir bag 3. Low-pressure or disconnect alarm 4. Expiratory threshold resistor a. 3 and 4 only b. 1, 2, and 4 only c. 1 and 4 only d. 1, 2, 3, and 4 ANS: D
A breathing gas mixture from an oxygen blender flows continuously through a humidifier into the inspiratory limb of a breathing circuit. A reservoir bag provides reserve volume if the patient’s inspiratory flow exceeds that of the system. The patient breathes in and out through a simple valveless T-piece connector. A pressure alarm system with manometer monitors the CPAP pressure at the patient’s airway. The alarm system can warn of either low (usually due to a disconnection) or high system pressure. The expiratory limb of the circuit is connected to a threshold resistor, in this case a water column (H). DIF: Recall
REF: p. 947
OBJ: 4
59. During administration of a continuous positive airway pressure flow mask to a patient with
atelectasis, you find it difficult to maintain the prescribed airway pressure. Which of the following is the most common explanation? a. System or mask leaks b. Outflow obstruction c. Inadequate system flow
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Inadequate trigger ANS: A
The most common problem with positive airway pressure therapies is system leaks. DIF: Application
REF: p. 948
OBJ: 6
60. While monitoring a patient receiving +12 cm H 2 O flow-mask continuous positive airway
pressure, you note that the pressure drops to +6 cm H 2 O during inspiration, but returns to +12 cm H 2 O during exhalation. Which of the following would likely correct this problem? a. Check and correct any mask leaks. b. Check and correct any outflow obstruction. c. Increase the system flow. d. Increase the system pressure. ANS: C
Flow is adequate when the system pressure drops no more than 1 to 2 cm H2 O during inspiration. DIF: Analysis
REF: p. 948
OBJ: 6
61. A surgeon writes an order for lung expansion therapy for a 28-year-old 110-lb woman who
has undergone lower abdominal surgery. In evaluating this patient at the bedside, you obtain a VC of 800 ml and an IC of 44% predicted. Although a chest radiograph indicates basal atelectasis, she has no problem with retained secretions. What lung expansion treatment would you recommend? a. Intermittent positive-pressure breathing at 6 to 8 breaths/min at 10 to 15 ml/kg b. Continuous positive airway pressure therapy at 10 cm H 2 O for 24 hr c. Positive end expiratory pressure therapy with bronchodilator and bronchial hygiene d. Incentive spirometry 10 times an hour at an initial volume of 500 to 600 ml ANS: D
For the patient having no difficulty with secretions, if the VC exceeds 15 ml/kg of lean body weight, or the IC is greater than 33% of predicted, incentive spirometry is given. DIF: Analysis
REF: p. 949
OBJ: 6
62. A surgeon orders lung expansion therapy for an obtunded 68-year-old, 170-lb man who has
developed atelectasis after thoracic surgery. On baseline assessment, the patient cannot perform an IC or VC maneuver, but has no evidence of retained secretions. Which of the following would you recommend? a. Intermittent positive-pressure breathing (IPPB) at 6 to 8 breaths/min at 10 to 15 ml/kg b. Continuous positive airway pressure therapy at 12 cm H 2 O for 24 hr c. Positive end expiratory pressure therapy with bronchodilator and bronchial hygiene d. Incentive spirometry 10 times an hour at an initial volume of 600 to 800 ml ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
If either the VC or IC is less than these threshold levels, IPPB is initiated, with the pressure gradually manipulated from the initial setting to deliver at least 15 ml/kg. DIF: Analysis
REF: p. 949
OBJ: 6
63. Which of the following has a direct relationship with the degree to which atelectasis can
present itself with a postoperative patient? a. Spontaneous respiratory rate b. Bradycardia c. Hypocapnia d. Hypothermia ANS: A
There is a direct relationship between the spontaneous respiratory rate and the degree of atelectasis present. Typically, as the atelectasis progresses, the respiratory rate increases proportionally. DIF: Recall
REF: p. 938
OBJ: 1
64. Which of the following are the hazards and complications of incentive spirometry?
1. Hyperventilation 2. Fatigue 3. Discomfort secondary to inadequate pain control 4. Barotrauma a. 1 and 2 only b. 2 and 3 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: D
Hyperventilation and respiratory alkalosis, discomfort secondary to inadequate pain control, pulmonary barotrauma, exacerbation of bronchospasm, and fatigue are the hazards and complications of incentive spirometry. DIF: Recall
REF: p. 940
OBJ: 5
65. A 59-year-old COPD patient comes to the hospital with upper abdominal surgery. The
physician diagnoses the patient with pulmonary atelectasis. The patient has a vital capacity of 25 ml/kg. Which of the following lung expansion therapy will you recommend to assist this patient’s atelectasis? a. Incentive spirometry b. IPPB c. CPAP d. EPAP ANS: A
DIF: Analysis
REF: p. 940
OBJ: 2
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 43 - Airway Clearance Therapy (ACT) Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. A normal cough reflex includes which of the following phases?
1. Irritation 2. Inspiration 3. Compression 4. Expulsion a. 1, 2, and 3 only b. 1 and 4 only c. 1, 2, 3, and 4 d. 2 and 3 only ANS: C
As shown in Figure 43-1, there are four distinct phases to a normal cough: irritation, inspiration, compression, and expulsion. DIF: Recall
REF: p. 952
OBJ: 1
2. Which of the following are necessary for normal airway clearance?
1. Patent airway 2. Functional mucociliary escalator 3. Effective cough 4. Normal pulmonary compliance a. 1 and 4 only b. 1, 2, and 3 only c. 2 and 3 only d. 2 and 4 only ANS: B
Normal airway clearance requires a patent airway, a functional mucociliary escalator, and an effective cough. DIF: Recall
REF: p. 952
OBJ: 1
3. Which of the following can provoke a cough?
1. Anesthesia 2. Foreign bodies 3. Infection 4. Irritating gases a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
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Infection is a good example of cough stimulation due to an inflammatory process. Foreign bodies can provoke a cough through mechanical stimulation. Chemical stimulation can occur when irritating gases are inhaled (e.g., cigarette smoke). Finally, cold air may cause thermal stimulation of sensory nerves and produce a cough. DIF: Recall
REF: p. 952
OBJ: 1
4. Which of the following occur(s) during the compression phase of a cough?
1. Expiratory muscle contraction 2. Opening of the glottis 3. Rapid drop in alveolar pressure a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1 only ANS: D
During the third or compression phase, reflex nerve impulses cause glottic closure and a forceful contraction of the expiratory muscles. DIF: Recall
REF: p. 952
OBJ: 1
5. Retention of secretions can result in full or partial airway obstruction. Mucus plugging can
result in which of the following? 1. Hypoxemia 2. Atelectasis 3. Shunting a. 1, 2, and 3 b. 1 and 2 only c. 1 and 3 only d. 2 and 3 only ANS: A
Full obstruction, or mucus plugging, can result in atelectasis and impaired oxygenation due to shunting. DIF: Recall
REF: p. 952
OBJ: 1
6. Partial airway obstruction can result in which of the following?
1. Increased work of breathing 2. Air trapping or overdistention 3. Increased expiratory flows ) imbalances 4. Ventilation/perfusion ratio ( a. 1 and 2 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
By restricting airflow, partial obstruction can increase the work of breathing and lead to air trapping, overdistention, and ventilation/perfusion ( ) imbalances. DIF: Recall
REF: p. 953
OBJ: 1
7. A patient with abdominal muscle weakness is having difficulty developing an effective cough.
Which of the following phases of the cough reflex are primarily affected in this patient? 1. Irritation 2. Inspiration 3. Compression 4. Expulsion a. 1, 2, and 3 only b. 2 and 4 only c. 2, 3, and 4 only d. 3 and 4 only ANS: D
See Table 43-1. DIF: Application
REF: p. 953
OBJ: 1
8. A patient recovering from anesthesia after abdominal surgery is having difficulty developing
an effective cough. Which of the following phases of the cough reflex are primarily affected in this patient? a. Irritation b. Inspiration c. Compression d. Expulsion ANS: A
See Table 43-1. DIF: Application
REF: p. 953
OBJ: 1
9. A patient with a tracheostomy tube is having difficulty developing an effective cough. Which
of the following phases of the cough reflex is primarily affected in this patient? a. Irritation b. Inspiration c. Compression d. Expulsion ANS: C
See Table 43-1. DIF: Application
REF: p. 953
OBJ: 1
10. A patient with a neuromuscular disorder causing generalized muscle weakness is having
difficulty developing an effective cough. Which of the following cough phases are primarily affected in this patient?
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a. b. c. d.
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Irritation Inspiration Compression Expulsion
ANS: B
See Table 43-1. DIF: Application
REF: p. 953
OBJ: 1
11. Which of the following can impair mucociliary clearance in intubated patients?
1. Use of respiratory stimulants 2. Tracheobronchial suctioning 3. Inadequate humidification 4. High inspired oxygen concentrations a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Although suctioning is used to aid secretion clearance, it too can cause damage to the airway mucosa and thus impair mucociliary transport. Inadequate humidification can cause inspissation of secretions, mucus plugging, and airway obstruction. High fractional inspired oxygen concentrations (FiO 2 ) can impair mucociliary clearance, either directly or by causing an acute tracheobronchitis. DIF: Application
REF: p. 953
OBJ: 1
12. Which of the following drug categories can impair mucociliary clearance in intubated
patients? 1. General anesthetics 2. Bronchodilators 3. Opiates 4. Narcotics a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
Several common drugs, including some general anesthetics and narcotic-analgesics, can depress mucociliary transport. DIF: Application
REF: p. 953
OBJ: 1
13. Conditions that can affect airwaypatency and cause abnormal clearance of secretions include
which of the following? 1. Foreign bodies
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2. Tumors 3. Inflammation 4. Bronchospasm a. 1, 2, and 3 only b. 2 and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: D
Examples include foreign bodies, tumors, and congenital or acquired thoracic anomalies such as kyphoscoliosis. Internal obstruction also can occur with mucus hypersecretion, inflammatory changes, or bronchospasm, further narrowing the lumen. DIF: Recall
REF: p. 953
OBJ: 2
14. Which of the following conditions alter normal mucociliary clearance?
1. Bronchospasm 2. Cystic fibrosis (CF) 3. Ciliary dyskinesia 4. Asthma a. 1, 2, and 4 only b. 1 and 2 only c. 1 and 4 only d. 2 and 3 only ANS: D
Diseases that alter normal mucociliary clearance can also cause secretion retention. CF is a common disorder in this category. In CF, the solute concentration of the mucus is altered because of abnormal sodium and chloride transport. This increases mucus viscosity and impairs its movement up the respiratory tract. Although less common, there are several conditions in which the respiratory tract cilia do not function properly. These ciliary dyskinetic syndromes also can contribute to ineffective airway clearance. DIF: Application
REF: p. 953
OBJ: 2
15. Conditions that can lead to bronchiectasis include which of the following?
1. Chronic airway infection 2. Muscular dystrophy 3. Foreign body aspiration 4. Obliterative bronchiolitis a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
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Chronic airway inflammation and infection can lead to bronchiectasis, a common finding in both cystic fibrosis and ciliary dyskinetic syndromes. In bronchiectasis, the airway is permanently damaged, dilated, and prone to constant obstruction by retained secretions. Other conditions that can lead to bronchiectasis include chronic obstructive lung diseases, foreign body aspiration, and obliterative bronchiolitis. DIF: Recall
REF: p. 953
OBJ: 2
16. Which of the following conditions impair secretion clearance by affecting the cough reflex?
1. Muscular dystrophy 2. Amyotrophic lateral sclerosis 3. Chronic bronchitis 4. Cerebral palsy a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
The most common conditions affecting the cough reflex are musculoskeletal and neurological disorders, including muscular dystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy, myasthenia gravis, poliomyelitis, and cerebral palsy. DIF: Application
REF: p. 954
OBJ: 2
17. Which of the following are goals of airway clearance therapy?
1. Help reverse the underlying disease process. 2. Help mobilize retained secretion. 3. Improve pulmonary gas exchange. 4. Reduce the work of breathing. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
The primary goal of airway clearance therapy is to help mobilize and remove retained secretions, with the ultimate aim to improve gas exchange and reduce the work of breathing. DIF: Recall
REF: p. 954
OBJ: 2
18. Which of the following acutely ill patients is least likely to benefit from application of chest
physical therapy? a. Patient with acute lobar atelectasis b. Patient with copious amounts of secretions c. Patient with an acute exacerbation of COPD d. Patient with low due to unilateral infiltrates ANS: C
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Among the acute conditions for which airway clearance therapy may be indicated are (1) acutely ill patients with copious secretions, (2) patients in acute respiratory failure with clinical signs of retained secretions (audible abnormal breath sounds, deteriorating arterial blood gases, chest radiographic changes), (3) patients with acute lobar atelectasis, and (4) patients with abnormalities due to lung infiltrates or consolidation. DIF: Application
REF: p. 954
OBJ: 2
19. Which of the following conditions are associated with chronic production of large volumes of
sputum? 1. Bronchiectasis 2. Pulmonary fibrosis 3. Cystic fibrosis 4. Chronic bronchitis a. 1, 3, and 4 only b. 2 and 4 only c. 2, 3, and 4 only d. 3 and 4 only ANS: A
Airway clearance therapy has proved effective in aiding secretion clearance and improving pulmonary function in chronic conditions associated with copious sputum production, including cystic fibrosis and bronchiectasis, and in certain patients with chronic bronchitis. DIF: Recall
REF: p. 954
OBJ: 2
20. In general, chest physical therapy can be expected to improve airway clearance when a
patient’s sputum production exceeds what volume? a. 30 ml/day b. 20 ml/day c. 15 ml/day d. 10 ml/day ANS: A
In general, sputum production must exceed 25 to 30 ml/day for airway clearance therapy to significantly improve secretion removal. DIF: Recall
REF: p. 954
OBJ: 2
21. Which of the following measures would you use to ask patients for the presence of copious
mucus production? a. 1 pint b. 1 ounce c. 1 gallon d. 1 tablespoon ANS: B
1 ounce is used. DIF: Recall
REF: p. 966
OBJ: 2
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 22. What are the best documented preventive uses of airway clearance therapy?
1. Prevent retained secretions in the acutely ill. 2. Maintain lung function in cystic fibrosis. 3. Prevent postoperative pulmonary complications. a. 1, 2, and 3 b. 1 and 2 only c. 1 and 3 only d. 2 and 3 only ANS: B
The best-documented preventive uses of airway clearance therapy include (1) body positioning and patient mobilization to prevent retained secretions in the acutely ill and (2) postural drainage, percussion, and vibration (PDPV) combined with exercise to maintain lung function in cystic fibrosis. DIF: Recall
REF: p. 955
OBJ: 2
23. When assessing the potential need for postoperative airway clearance for a patient, which of
the following factors are relevant? 1. Patient’s age and respiratory history 2. Nature and duration of current surgery 3. Number of prior surgical procedures 4. Type of anesthesia (e.g., local vs. general) a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
Box 43-3 lists the key factors you must consider when assessing a patient’s need for airway clearance therapy. DIF: Recall
REF: p. 955
OBJ: 2
24. Which of the following laboratory data are essential in assessing a patient’s need for airway
clearance therapy? 1. Chest radiograph 2. Pulmonary function tests 3. Hematology results 4. ABGs/oxygen saturation a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
Box 43-3 lists the key factors you must consider when assessing a patient’s need for airway clearance therapy.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 955
OBJ: 2
25. Key considerations in initial and ongoing patient assessment for chest physical therapy
include which of the following? 1. Posture and muscle tone 2. Breathing pattern and ability to cough 3. Sputum production 4. Cardiovascular stability a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: C
Box 43-3 lists the key factors you must consider when assessing a patient’s need for airway clearance therapy. DIF: Recall
REF: p. 955
OBJ: 2
26. Which of the following clinical signs indicate that a patient is having a problem with retained
secretions? 1. Copious amounts of sputum production 2. Labored breathing 3. Development of a fever 4. Increased inspiratory and expiratory crackles a. 1 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Bedside findings such as a loose, ineffective cough, labored breathing pattern, decreased/bronchial breath sounds, coarse inspiratory and expiratory crackles, tachypnea, tachycardia, or fever may indicate a potential problem with retained secretions. DIF: Recall
REF: p. 955
OBJ: 2
27. Which of the following are considered airway clearance therapies?
1. Postural drainage and percussion 2. Incentive spirometry 3. Positive airway pressure 4. Percussion, vibration, and oscillation a. 1 and 3 only b. 1, 2, and 3 only c. 2, 3, and 4 only d. 2 and 4 only ANS: B
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There are five general approaches to airway clearance therapy, which can be used alone or in combination. These approaches include (1) postural drainage therapy (including turning, percussion, and vibration), (2) coughing and related expulsion techniques, (3) positive airway pressure (PAP) adjuncts (positive expiratory pressure [PEP], continuous PAP [CPAP], expiratory PAP [EPAP]), (4) high-frequency compression/oscillation methods, and (5) mobilization and exercise. DIF: Recall
REF: pp. 955-956 OBJ: 3
28. The application of gravity to achieve specific clinical objectives in respiratory care best
describes which of the following? a. Breathing exercises b. Postural drainage therapy c. Hyperinflation therapy d. Directed coughing ANS: B
Postural drainage therapy involves the use of gravity. DIF: Recall
REF: p. 955
OBJ: 3
29. Postural drainage should be considered in which of the following situations?
1. In patients with chronic obstructive lung disease 2. In patients who expectorate more than 25 to 30 ml sputum per day 3. In the presence of atelectasis caused by mucus plugging 4. In patients with cystic fibrosis or bronchiectasis a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
The AARC has published Clinical Practice Guideline: Postural Drainage Therapy. See CPG 43-1. DIF: Recall
REF: p. 955
OBJ: 3
30. Absolute contraindications for postural drainage include which of the following?
1. Head and neck injury (until stabilized) 2. Active hemorrhage with hemodynamic instability 3. Uncontrolled airway at risk for aspiration a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
The AARC has published Clinical Practice Guideline: Postural Drainage Therapy. See CPG 43-1.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 957
OBJ: 3
31. Which of the following are hazards or complication of postural drainage therapy?
1. Cardiac arrhythmias 2. Increased intracranial pressure 3. Acute hypotension 4. Pulmonary barotraumas a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
The AARC has published Clinical Practice Guideline: Postural Drainage Therapy. See CPG 43-1. DIF: Recall
REF: p. 957
OBJ: 3
32. Primary objectives for turning include which of the following?
1. Prevent postural hypotension. 2. Promote lung expansion. 3. Prevent retention of secretions. 4. Improve oxygenation. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
The primary purposes of turning are to promote lung expansion, improve oxygenation, and prevent retention of secretions. DIF: Recall
REF: p. 968
OBJ: 3
33. Which of the following is the only absolute contraindication to turning? a. When the patient cannot or will not change body position b. When poor oxygenation is associated with unilateral lung disease c. When the patient has or is at high risk for atelectasis d. When the patient has unstable spinal cord injuries ANS: D
There are only two absolute contraindications to turning: unstable spinal cord injuries and traction of arm abductors. DIF: Recall
REF: p. 955
OBJ: 3
34. Which of the following are true of postural drainage?
1. It is most effective in disorders causing excessive sputum. 2. It is most effective in head-down positions greater than 25 degrees.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. It requires adequate systemic hydration to be effective. 4. It improves mucociliary clearance in normal subjects. a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, and 4 only ANS: B
Postural drainage is most effective in conditions characterized by excessive sputum production (>25 to 30 ml/day). For maximum effect, head -down positions should exceed 25 degrees below horizontal. Postural drainage is not likely to succeed unless and until adequate systemic and airway hydration is ensured. DIF: Application
REF: pp. 955-956 OBJ: 3
35. In which of the following patients would you consider modifying any head-down positions
used for postural drainage? 1. A patient with unstable blood pressure 2. A patient with a cerebrovascular disorder 3. A patient with systemic hypertension 4. A patient with orthopnea a. 1, 2, 3, and 4 b. 2 and 4 only c. 2, 3, and 4 only d. 2 and 4 only ANS: A
You may need to modify head-down positions in patients with unstable cardiovascular status, hypertension, cerebrovascular disorders, or dyspnea related to changes in position. DIF: Analysis
REF: p. 956
OBJ: 4
36. In setting up a postural drainage treatment schedule for a postoperative patient, which of the
following information would you try to obtain from the patient’s nurse? 1. Patient’s medication schedule 2. Patient’s meal schedule 3. Location of surgical incision a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
To avoid gastroesophageal reflux and the possibility of aspiration, you should schedule treatment times before or at least 1.5 to 2 hr after meals or tube feedings. If the patient assessment indicates that pain may hinder treatment implementation, you also should consider coordinating the treatment regimen with prescribed pain medication. DIF: Application
REF: p. 955
OBJ: 3
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 37. A patient about to receive postural drainage and percussion is attached to an
electrocardiographic (ECG) monitor and is receiving both intravenous (IV) solutions and O 2 (through a nasal cannula). Which of the following actions would be appropriate for this patient? a. Cancel the therapy because the patient cannot be repositioned. b. Inspect and adjust the equipment to ensure function during therapy. c. Turn off the ECG monitor, but keep the IV line and O 2 going. d. Turn off the IV line, but keep the monitor on and the O2 going. ANS: B
Inspect any monitoring leads, IV tubing, and O2 therapy equipment connected to the patient; if necessary, make adjustments to ensure continued function during the procedure. DIF: Analysis
REF: p. 955
OBJ: 3
38. Which of the following are mandatory components of the preassessment for postural
drainage? 1. Vital signs 2. Bedside pulmonary function tests 3. Auscultation a. 1 and 2 only b. 2 and 4 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
Before starting the procedure, measure the patient’s vital signs and auscultate the chest. DIF: Application
REF: p. 955
OBJ: 3
39. If a patient’s chest radiograph shows infiltrates in the posterior basal segments of the lower
lobes, what postural drainage position would you recommend? a. Head down, patient supine with a pillow under knees b. Patient prone with a pillow under head, bed flat c. Patient supine with a pillow under knees, bed flat d. Head down, patient prone with a pillow under abdomen ANS: D
See Figure 43-2. DIF: Analysis
REF: p. 958
OBJ: 3
40. A physician orders postural drainage for a patient with an abscess in the right middle lobe.
Which of the following positions would you recommend for this patient? a. Head down, patient prone with a pillow under abdomen b. Head down, patient supine with a pillow under knees c. Patient supine with a pillow under knees, bed flat d. Head down, patient half-rotated to left, right lung up
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D
See Figure 43-2. DIF: Analysis
REF: p. 958
OBJ: 3
41. A physician orders postural drainage for a patient with aspiration pneumonia in the superior
segments of the left lower lobe. Which of the following positions would you recommend for this patient? a. Patient prone with a pillow under abdomen, bed flat b. Head down, patient prone with a pillow under abdomen c. Head down, patient supine with a pillow under knees d. Patient supine with a pillow under knees, bed flat ANS: A
See Figure 43-2. DIF: Analysis
REF: p. 958
OBJ: 3
42. A physician orders postural drainage for a patient with aspiration pneumonia in the anterior
segments of the upper lobes. Which of the following positions would you recommend for this patient? a. Head down, patient prone with a pillow under abdomen b. Patient supine with a pillow under knees, bed flat c. Head down, patient supine with a pillow under knees d. Patient prone with a pillow under abdomen, bed flat ANS: B
See Figure 43-2. DIF: Analysis
REF: p. 958
OBJ: 3
43. If tolerated, a specified postural drainage position should be maintained for at least how long? a. 1 to 2 min b. 10 to 20 min c. 20 to 30 min d. 3 to 15 min ANS: D
Maintain the indicated position for a minimum of 3 to 15 min if tolerated, and longer if good sputum production results. See Table 43-2. DIF: Recall
REF: p. 956
OBJ: 3
44. While reviewing the chart of a patient receiving postural drainage therapy, you notice that the
patient tends to undergo mild desaturation during therapy (a drop in SpO 2 from 93% to 89% to 90%). Which of the following would you recommend to manage this problem? a. Increase the patient’s FiO 2 during therapy. b. Discontinue the postural drainage therapy entirely. c. Discontinue the percussion and vibration only. d. Decrease the frequency of treatments.
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: A
See Table 43-2. DIF: Application
REF: p. 956
OBJ: 4
45. Why is strenuous patient coughing during postural drainage in a head-down position
contraindicated? a. It can impair the mucociliary clearance mechanism. b. It can increase expiratory airway resistance (Raw). c. It can cause air trapping and pulmonary distension. d. It can markedly increase intracranial pressure (ICP). ANS: D
When using the head-down position, the patient should avoid strenuous coughing, because this will markedly raise ICP. DIF: Application
REF: p. 957
OBJ: 3
46. Soon after you initiate postural drainage in a Trendelenburg position, the patient develops a
vigorous and productive cough. Which of the following actions would be appropriate at this time? a. Maintain the drainage position while carefully watching the patient. b. Move the patient to the sitting position until the cough subsides. c. Stop the treatment at once and report the incident to the nurse. d. Drop the head of the bed farther and encourage more coughing. ANS: B
If the procedure causes vigorous coughing, have the patient sit up until the cough subsides. DIF: Analysis
REF: p. 957
OBJ: 4
47. Which of the following would indicate a successful outcome for postural drainage therapy?
1. Decreased sputum production 2. Normalization in ABGs 3. Improved breath sounds 4. Improvement in chest radiograph a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Specific outcome criteria indicating a positive response to postural drainage are listed in the AARC Clinical Practice Guideline 40-1: Postural Drainage Therapy. Excerpts appear on pp. 959. DIF: Recall
REF: p. 959
OBJ: 3
48. Which of the following responses indicate that postural drainage should be terminated?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1. Severe tachycardia 2. Complaint of discomfort 3. Irregular blood pressure 4. Severe bradycardia a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: D
Specific outcome criteria indicating a positive response to postural drainage are listed in the AARC Clinical Practice Guideline 40-1: Postural Drainage Therapy. See CPG 43-1. DIF: Recall
REF: p. 959
OBJ: 3
49. Which of the following should be charted after completing a postural drainage treatment?
1. Amount and consistency of sputum produced 2. Patient tolerance of procedure 3. Position(s) used (including time) 4. Any untoward effects observed a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: C
In your chart entry include the position(s) used, time in position, patient tolerance, subjective and objective indicators of treatment effectiveness (including the amount, color, and consistency of sputum produced) and any untoward effects observed. DIF: Application
REF: p. 959
OBJ: 3
50. Percussion should not be performed over which of the following areas?
1. Surgery sites 2. Bony prominences 3. Fractured ribs a. 3 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Take care to avoid tender areas or sites of trauma or surgery and never percuss directly over bony prominences, such as the clavicles or vertebrae. DIF: Recall
REF: pp. 959-960 OBJ: 3
51. Properly performed chest vibration is applied at what point? a. Throughout inspiration
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
b. At the end of expiration c. At the start of inspiration d. Throughout expiration ANS: D
Vibration sometimes is used together with percussion but is limited to application during exhalation. DIF: Recall
REF: pp. 959-960 OBJ: 3
52. Directed coughing is useful in helping to maintain airway clearance in which of the following
cases? 1. Bronchiectasis 2. Acute asthma 3. Cystic fibrosis 4. Spinal cord injury a. 1 and 3 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 1, 3, and 4 only ANS: D
The AARC has published Clinical Practice Guideline: Directed Cough. See CPG 43-2. DIF: Recall
REF: p. 960
OBJ: 3
53. Indications for directed coughing include which of the following?
1. Enhance other airway clearance therapies. 2. Help patients with tuberculosis clear secretions. 3. Help prevent postoperative pulmonary complications. 4. Obtain sputum specimens for diagnostic analysis. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
The AARC has published Clinical Practice Guideline: Directed Cough. See CPG 43-2. DIF: Application
REF: p. 960
OBJ: 3
54. Which of the following are contraindications for directed coughing?
a. The presence of infection spread by droplet nuclei b. Elevated intracranial pressure or intracranial aneurysm c. Reduced coronary artery perfusion d. Necrotizing pulmonary infection a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. 2, 3, and 4 only ANS: B
The AARC has published Clinical Practice Guideline: Directed Cough. See CPG 43-2. DIF: Application
REF: p. 960
OBJ: 3
55. For which of the following patients directed coughing might be contraindicated?
1. Patient with poor coronary artery perfusion 2. Postoperative upper-abdominal surgery patient 3. Long-term care patient with retained secretions 4. Patient with an acute unstable spinal injury a. 2 and 3 only b. 1, 2, and 3 only c. 1 and 4 only d. 2, 3, and 4 only ANS: C
The AARC has published Clinical Practice Guideline: Directed Cough. See CPG 43-2. DIF: Application
REF: p. 960
OBJ: 3
56. What factors can hinder effective coughing?
1. Artificial airways 2. Neuromuscular disease 3. Systemic overhydration 4. Pain or fear of pain a. 1, 2, and 4 only b. 2 and 4 only c. 1 and 3 only d. 3 and 4 only ANS: A
Some patients with advanced chronic obstructive pulmonary disease or severe restrictive disorders (including neurologic, muscular, or skeletal abnormalities) may not be able to generate an effective spontaneous cough. Likewise, pain or fear of pain caused by coughing may limit the success of directed cough. Systemic dehydration, thick, tenacious secretions, artificial airways, or the use of central nervous system depressants can thwart efforts to implement an effective directed cough regimen. DIF: Application
REF: p. 961
OBJ: 3
57. Key consideration in teaching a patient to develop an effective cough regimen includes which
of the following? 1. Strengthening of the expiratory muscles 2. Instruction in breathing control 3. Instruction in proper positioning a. 2 and 3 only b. 1 and 2 only
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 1, 2, and 3 d. 1 and 3 only ANS: C
The three most important aspects involved in patient teaching are (1) instruction in proper positioning, (2) instruction in breathing control, and (3) exercises to strengthen the expiratory muscles. DIF: Application
REF: p. 961
OBJ: 3
58. What is the ideal patient position for directed coughing? a. Sitting with one shoulder rotated inward, the head and spine slightly flexed b. Supine, with knees slightly flexed and feet braced c. Prone, with the head and spine slightly flexed d. Supine, with forearms relaxed and feet supported ANS: A
The patient should assume a sitting position with one shoulder rotated inward and the head and spine slightly flexed. DIF: Recall
REF: p. 961
OBJ: 3
59. A patient recovering from abdominal surgery is having difficulty developing an effective
cough. Which of the following actions would you recommend to aid this patient in generating a more effective cough? 1. Coordinating coughing with pain medication 2. Using the forced expiration technique (FET) 3. Supplying manual epigastric compression 4. ―Splinting‖ the operative site a. 1, 2, and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: A
The postoperative regimen can be enhanced by coordinating the coughing sessions with prescribed pain medication and assisting the patient in splinting the operative site. This may initially be accomplished by the clinician, using his/her hands to support the area of incision. Eventually, the patient can learn to use a pillow to splint the incision site. The FET may also be of value in these patients. DIF: Analysis
REF: pp. 961-962 OBJ: 3
60. Strenuous expiratory efforts in some chronic obstructive pulmonary disease (COPD) patients
limit the effectiveness of coughing. Why is this so? a. The accessory muscles of inspiration oppose the exhalation. b. All COPD patients have severe abdominal muscle weakness. c. High expiratory pleural pressures compress the small airways. d. Strenuous expiration causes the upper airway to collapse.
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ANS: C
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
In some patients with COPD, the high pleural pressures during a forced cough may compress the smaller airways and limit the cough’s effectiveness. DIF: Application
REF: pp. 961-962 OBJ: 3
61. A chronic obstructive pulmonary disease patient cannot develop an effective cough. Which of
the following would you recommend to help this patient generate a more effective cough? 1. Enhancing expiratory flow by bending forward at the waist 2. Using short, expiratory bursts or the ―huffing‖ method 3. Using only moderate (as opposed to full) inspiration 4. Having the patient ―tense‖ the neck muscles while coughing a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, and 4 only ANS: B
Instruct the patient to slowly take in a moderately deep breath through his or her nose. To help enhance expulsion, have the patient exhale with moderate force through pursed lips, while bending forward. This forward flexion of the thorax enhances expiratory flow by upward displacement of the abdominal contents. After three or four repetitions of this maneuver, encourage the patient to bend forward and initiate short staccato-like bursts of air. This technique relieves the strain of a prolonged hard cough, and the staccato rhythm at a relatively low velocity minimizes airway collapse. This technique has a modification called ―huffing‖ whereby the patient is instructed to make the sound of ―huff, huff, huff‖ rapidly with his or her mouth open. DIF: Analysis
REF: pp. 961-962 OBJ: 3
62. A nurse explains to you that a certain neuromuscular patient cannot develop a good cough.
Which of the following would you consider to manage this patient’s clearance problem? 1. Combining manual chest compression with suctioning 2. Coordinating the coughing regimen with pain medication 3. Using the autogenic drainage method 4. Using mechanical insufflation-exsufflation a. 1 and 4 only b. 1, 2, and 3 only c. 2 and 3 only d. 1, 2, and 4 only ANS: A
If this problem results in retained secretions, there are only three options: (1) placement of an artificial airway and removal of secretions by tracheobronchial suctioning (see Chapter 33), (2) manuallyassisted cough, and (3) mechanical insufflation-exsufflation. DIF: Analysis
REF: p. 963
OBJ: 3
63. Which of the following are true about the FET?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1. It causes less bronchiolar collapse than traditional coughing. 2. It occurs from mid to low lung volume without glottis closure. 3. It has a period of diaphragmatic breathing and relaxation. 4. It occurs from mid to high lung volume without glottis closure. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
The FET, or huff cough, consists of one or two forced expirations of middle to low lung volume without closure of the glottis, followed by a period of diaphragmatic breathing and relaxation. The goal of this method is to help clear secretions with less change in pleural pressure and less likelihood of bronchiolar collapse. DIF: Application
REF: p. 961
OBJ: 3
64. Maintaining an open glottis during coughing (as with the FET) can help to minimize increases
in pleural pressure and lessen the likelihood of bronchiolar collapse. Which of the following techniques can aid the practitioner in teaching the patient this maneuver? a. Having the patient inhale slowly through the nose b. Having the patient phonate or ―huff‖ during expiration c. Having the patient ―tense‖ the neck muscles while coughing d. Telling the patient to exert effort, as in straining at stool ANS: B
To help keep the glottis open during an FET, the patient is taught to phonate or ―huff‖ during expiration. DIF: Application
REF: p. 961
OBJ: 3
65. Whether using traditional methods or the FET, a period of diaphragmatic breathing and
relaxation should always follow attempts at coughing. What is the purpose of this approach? a. To restore the patient’s SO 2 b. To restore lung volume and minimize fatigue c. To allow the patient time to ask questions d. To decrease the likelihood of acute air trapping ANS: B
The period of diaphragmatic breathing and relaxation following the forced expiration is essential in restoring lung volume and minimizing fatigue. DIF: Application
REF: p. 961
OBJ: 3
66. What is the correct sequence of actions during the active cycle of breathing (ACB) method?
1. Relaxation and breathing control 2. Three or four thoracic expansion exercises 3. One or two FETs (huffs) a. 1, 2, 1, and 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
b. 1, 3, 1, and 2 c. 3, 1, 2, and 1 d. 1, 3, 2, and 1 ANS: A
See Box 43-4. DIF: Recall
REF: p. 962
OBJ: 3
67. During autogenic drainage, when should patients be encouraged to cough? a. Throughout the procedure b. After phase 1 only c. After phase 2 only d. After phase 3 only ANS: D
Coughing should be suppressed until all three breathing phases are completed. DIF: Recall
REF: p. 963
OBJ: 3
68. What does phase 1 of autogenic drainage involve? a. Breathing at low to mid lung volumes b. An inspiratory capacity maneuver, followed by breathing at low lung volumes c. Vigorous coughing using the FET d. Progressive breaths at higher and higher lung volumes ANS: B
See Figure 43-6. DIF: Recall
REF: p. 963
OBJ: 3
69. What happens during the exsufflation phase of mechanical insufflation-exsufflation?
1. Airway pressure is abruptly decreased to −30 to −50 cm H2 O. 2. Negative airwaypressure is maintained for 2 to 3 sec. 3. Peak expiratory ―cough‖ flows reach near normal values. a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
The airway pressure is then abruptly reversed to −30 to −50 cm H2 O and maintained for 2 to 3 sec. Peak expiratory ―cough‖ flows obtained with this device are in the normal range (mean of 7.5 L/sec), far better than that can be achieved with manually assisted coughing. DIF: Recall
REF: p. 963
OBJ: 3
70. A typical mechanical insufflation-exsufflation treatment session should continue until what
point? 1. Secretions are cleared.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. The vital capacity (VC) returns to baseline. 3. The SpO 2 returns to baseline. a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: C
This process is repeated five or more times until secretions are cleared and the VC and SpO 2 return to baseline. DIF: Application
REF: p. 963
OBJ: 3
71. Under which of the following conditions would mechanical insufflation-exsufflation with an
oronasal mask probably be effective? 1. If the glottis collapses during exsufflation 2. Presence of fixed airway obstruction 3. Presence of a chronic neuromuscular disorder a. 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: A
Mechanical insufflation-exsufflation via an oronasal interface is effective, provided that there is no fixed airway obstruction or glottic collapse during exsufflation. DIF: Application
REF: p. 963
OBJ: 3
72. Which of the following are potential indications for positive airway pressure therapies?
1. Reduce air trapping in asthma or chronic obstructive pulmonary disease. 2. Help mobilize retained secretions. 3. Prevent or reverse atelectasis. 4. Optimize bronchodilator delivery. a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
The AARC has published Clinical Practice Guideline: Use of PAP Adjuncts to Airway Clearance Therapy. See CPG 43-3. DIF: Application
REF: p. 964
OBJ: 3
73. Contraindications for positive airway pressure therapies include which of the following?
a. Intracranial pressure exceeding 20 mm Hg b. Recent facial, oral, or skull surgery or trauma c. Preexisting pulmonary barotrauma (e.g., pneumothorax)
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
d. Air trapping/pulmonary overdistention in chronic obstructive pulmonary disease a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
The AARC has published Clinical Practice Guideline: Use of PAP Adjuncts to Airway Clearance Therapy. See CPG 43-3. DIF: Recall
REF: p. 964
OBJ: 3
74. Which of the following are hazards of positive airway pressure therapies (EPAP, PEP,
CPAP)? 1. Decreased venous return 2. Epistaxis 3. Pulmonary barotrauma 4. Increased intracranial pressure a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
The AARC has published Clinical Practice Guideline: Use of PAP Adjuncts to Airway Clearance Therapy. See CPG 43-3. DIF: Recall
REF: p. 964
OBJ: 3
75. What duration of time and pressure is recommended when using MIE devices to clear airways
secretions in adults? a. 30 to 50 cm H 2 O at 1 to 3 sec b. 10 to 30 cm H 2 O at 1 to 3 sec c. 30 to 50 cm H 2 O at 5 to 10 sec d. 10 to 30 cm H 2 O at 5 to 10 sec ANS: A
The recommended starting pressure and time for applying MIE to adults is 30 to 50 cm H 2 O at 1 to 3 sec. From there, pressures can be adjusted accordingly. DIF: Recall
REF: p. 963
OBJ: 4
76. A physician orders positive expiratory pressure therapy for a 14-year-old child with cystic
fibrosis. Which of the following responses should be monitored on this patient? 1. Peak flow or forced expiratory volume in 1 sec (FEV 1 ) per forced vital capacity percentage 2. Patient’s minute volume 3. Quantity and character of sputum 4. Breath sounds a. 1 and 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
b. 1, 2, and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: D
The AARC has published Clinical Practice Guideline: Use of PAP Adjuncts to Airway Clearance Therapy. See CPG 43-3. DIF: Analysis
REF: p. 966
OBJ: 3
77. Which of the following best describes positive expiratory pressure (PEP) therapy? a. Expiration against a variable flow resistance b. Expiration against a fixed threshold resistance c. Inspiration against a variable flow resistance d. Inspiration against a fixed threshold resistance ANS: A
PEP therapy involves active expiration against a variable flow resistance. DIF: Recall
REF: p. 964
OBJ: 3
78. In theory, how does positive expiratory pressure (PEP) help to move secretions into the larger
airways? 1. Filling underaerated segments through collateral ventilation 2. Preventing airway collapse during expiration 3. Causing bronchodilation during inspiration a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: B
In theory, PEP helps move secretions into the larger airways by (1) filling underaerated or nonaerated segments via collateral ventilation and (2) preventing airway collapse during expiration. DIF: Recall
REF: p. 964
OBJ: 3
79. Proper instructions for positive expiratory pressure include which of the following?
1. Take in a breath that is larger than normal, but do not fill lungs completely. 2. Exhale forcefully and maintain an expiratory pressure of 10 to 20 cm H2 O. 3. After 10 to 20 breaths, take two or three ―huff‖’ coughs, and rest as needed. 4. Repeat the cycle 8 to 10 times, not to exceed 30 min. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: A
See Box 43-5.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 966
OBJ: 3
80. A physician orders bronchodilator drug therapy in combination with positive expiratory
pressure (PEP). Which of the following methods could you use to provide this combined therapy? 1. Attach a dry powder inhaler in-line with the PEP apparatus. 2. Attach a metered dose inhaler to the system’s one-way valve inlet. 3. Place a small volume nebulizer in-line with the PEP apparatus. a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: A
See Box 43-5. DIF: Analysis
REF: p. 966
OBJ: 3
81. What is the movement of small volumes of air back and forth in the respiratory tract at high
frequencies (12 to 25 Hz) called? a. Tidal breathing b. Active cycle breathing c. Oscillation d. Huffing ANS: C
As applied to airway clearance, oscillation refers to the rapid vibratory movement of small volumes of air back and forth in the respiratory tract. DIF: Recall
REF: p. 964
OBJ: 3
82. Which of the following parts are required to conduct high-frequency external chest wall
compression? 1. Variable air-pulse generator 2. Expiratory flow resistor with one-way valve 3. Nonstretch inflatable thoracic vest a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
High-frequency chest wall oscillation is accomplished by using a two-part system: (1) a variable air-pulse generator and (2) a nonstretch inflatable vest that covers the patient’s entire torso (The Vest Airway Clearance System). DIF: Recall
REF: pp. 966-967 OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 83. Which of the following are typical of high-frequency external chest wall compression
therapy? 1. 30-min therapy sessions 2. Long inspiratory oscillations 3. One to six sessions per day 4. Oscillations at 20 to 25 Hz a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: C
Typically, respiratory therapists perform 30-min therapy sessions at oscillatory frequencies between 5 and 25 hertz (Hz). Depending on need and response, between one and six therapy sessions may occur per day. DIF: Application REF: pp. 966-967 OBJ: 3 84. Which of the following determines effectiveness of high-frequency external chest wall
compression therapy? 1. Compression frequency 2. Largest volumes 3. Flow bias a. 1 only b. 2 only c. 1 and 3 only d. 2 and 3 only ANS: C
Compression frequency and flow bias (inspiratory vs. expiratory) determine the effectiveness of therapy. DIF: Recall
REF: p. 967
OBJ: 3
85. The airwayclearance technique that uses a pneumatic device to deliver compressed gas
minibursts to the airway at rates above 100/min best describes which of the following? a. Intrapulmonary percussive ventilation b. Active cycle of breathing c. High-frequency external chest wall compression d. Intermittent positive-pressure breathing ANS: D
Intrapulmonary percussive ventilation is an airway clearance technique that uses a pneumatic device to deliver a series of pressurized gas minibursts at rates of 100 to 225 cycles/min (1.6 to 3.75 Hz) to the respiratory tract, usually via a mouthpiece. DIF: Recall
REF: p. 966
OBJ: 3
86. Which of the following is true about exercise and airway clearance?
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1. Exercise can enhance mucus clearance. 2. Exercise can improve pulmonary function. 3. Exercise can improve matching. 4. Exercise can cause desaturation in some patients. a. 1, 3, and 4 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 2, 3, and 4 only ANS: C
Adding exercise to mobilization and coughing can further enhance mucus clearance. Exercise also improves overall aeration and ventilation-perfusion matching. Besides increasing sputum production, it can also improve pulmonary function. In addition, exercise can improve a patient’s general fitness, self-esteem, and quality-of-life. On the other hand, exercise can be fatiguing and result in oxygen desaturation among patients with significant pulmonary impairment. DIF: Recall
REF: p. 967
OBJ: 3
87. Patients can control a flutter valve’s pressure by changing what? a. Their inspiratory flow b. The angle of the device c. Their expiratory flow d. The expired volume ANS: C
Patients can control the pressure by changing their expiratory flows. DIF: Recall
REF: p. 964
OBJ: 3
88. Advantages of the flutter valve over other airway clearance methods include which of the
following? 1. Good patient acceptance 2. Greater effectiveness 3. Full portability 4. Independent use a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: D
The flutter valve is readily accepted by patients, inexpensive, and fully portable and does not require caregiver assistance. DIF: Recall
REF: p. 964
OBJ: 3
89. Which of the following are advantages of the Acapella over the flutter?
1. It can customize frequency.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. It can be used in any posture. 3. It is more portable. 4. It can customize flow resistance. a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
The Acapella can customize, based on clinical needs, both the frequency and the flow resistance by adjusting the dial. Also, it can be used in any posture, including sitting, standing, and reclining. DIF: Recall
REF: p. 956
OBJ: 3
90. Which of the following should be considered when selecting an airway clearance strategy?
1. Patient’s goals, motivation, and preferences 2. Effectiveness and limitations of technique or method 3. Patient’s age, ability to learn, and tendency to fatigue 4. Need for assistants, equipment, and cost a. 1, 2, and 3 only b. 1, 3, and 4 only c. 2 and 3 only d. 1, 2, 3, and 4 ANS: D
See Box 43-10. DIF: Recall
REF: p. 967
OBJ: 3
91. Which of the following airway clearance techniques would you recommend for a
15-month-old infant with cystic fibrosis? a. Postural drainage, percussion, and vibration b. Positive expiratory pressure therapy c. Mechanical insufflation-exsufflation d. Intrapulmonary percussive ventilation ANS: A
See Table 43-2. DIF: Analysis
REF: p. 967
OBJ: 3
92. Which of the following airway clearance techniques would you recommend for a patient with
a neurologic abnormality (bulbar palsy) and intact upper airway? 1. Postural drainage, percussion, and vibration 2. Positive expiratory pressure therapy 3. Mechanical insufflation-exsufflation a. 2 and 3 only b. 1 and 2 only
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 1, 2, and 3 d. 1 and 3 only ANS: D
See Table 43-2. DIF: Analysis
REF: p. 967
OBJ: 3
93. In assessing an adult outpatient for airway clearance therapy, you notice the following: (1) no
history of cystic fibrosis or bronchiectasis, (2) sputum production of 30 to 50 ml/day, (3) an effective cough, and (4) good hydration. Which of the following would you recommend? a. Postural drainage, percussion, and vibration b. Positive expiratory pressure therapy c. Mechanical insufflation-exsufflation d. Intrapulmonary percussive ventilation ANS: B
PAP adjuncts are used to help mobilize secretions and treat atelectasis. DIF: Analysis
REF: p. 964
OBJ: 3
94. Which of the following is the most appropriate airway clearance method for an infant with
cystic fibrosis? a. PDPV b. MIE c. PEP d. Exercise ANS: A
See Table 43-2. The most suitable airway clearance method for infants is postural drainage, percussion, and vibration (PDPV) therapy. DIF: Application
REF: p. 982
OBJ: 1
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 44 - Respiratory Failure and the Need for Ventilatory Support Kacmarek et al.: Egan’s Funda menta ls of Respiratory Care, 12th Editio n MULTIPLE CHOICE 1. A diagnosis of respiratory failure can be made if which of the following are present?
1. PaO 2 55 mm Hg, FiO 2 0.21, PB 760 mm Hg 2. PaCO 2 57 mm Hg, FiO 2 0.21, PB 760 mm Hg 3. P(A−a)O 2 45 mm Hg, FiO 2 1.0, PB 760 mm Hg 4. PaO 2 /FiO 2 400, PB 750 mm Hg a. 1 and 2 only b. 1, 3, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: A
Criteria for respiratory failure based on arterial blood gases have been established by Campbell and generally define failure as a PaO 2 (arterial partial pressure of oxygen) less than 60 mm Hg and/or a PaCO 2 (alveolar partial pressure of carbon dioxide) greater than 50 mm Hg in otherwise healthy individuals breathing room air at sea level. DIF: Application
REF: p. 973
OBJ: 1
2. What is respiratory failure due to inadequate ventilation? a. Hypoxemic b. Hypercapnic c. Compensated d. Chronic ANS: B
Hypercapnic (type II) respiratory failure describes ―bellows failure‖ of the lungs resulting in elevated carbon dioxide levels. DIF: Recall
REF: p. 973
OBJ: 2
3. Hypercapnic (type II) respiratory failure is a synonym for which one of the following terms? a. Mismatching b. Shunt c. Diffusion impairment d. Ventilatory failure ANS: D
Hypercapnic respiratory failure is also known as ventilatory failure. DIF: Recall
REF: p. 973
OBJ: 2
4. Which of the following can cause hypoxemia?
1. Diffusion impairment
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. Alveolar hypoventilation 3. mismatch 4. Intrapulmonary shunting a. 1, 2, and 3 only b. 1, 3, and 4 only c. 1, 2, 3, and 4 d. 2, 3, and 4 only ANS: C
Hypoxemia can be caused by mismatch, shunt, alveolar hypoventilation, diffusion impairment, perfusion impairment, decreased inspired oxygen, and venous admixture. DIF: Recall
REF: p. 973
OBJ: 2
5. Which of the following best describes the difference between
mismatch and shunt when supplemental oxygen is administered? a. Both will respond equally well. b. mismatch will respond well but shunt will not. c. mismatch will not respond but shunt will respond well. d. Neither will respond to the administration of supplemental oxygen. ANS: B
mismatch will respond to supplemental oxygen. DIF: Recall
REF: pp. 973-974 OBJ: 2
6. Which of the following clinical signs suggest more severe hypoxemia? a. Tachycardia b. Cyanosis with polycythemia c. Central nervous system dysfunction d. Use of accessory muscles ANS: C
More severe hypoxemia can lead to significant central nervous system dysfunction, ranging from irritability to confusion to coma. DIF: Recall
REF: p. 974
OBJ: 2
7. Which of the following clinical signs is most often associated with hypoxemia due to shunt? a. Diffuse wheezing b. ―White‖ chest radiograph c. Stridor d. Loud P2 ANS: B
Shunt usually presents with a ―white‖ chest radiograph. DIF: Recall
REF: p. 974
OBJ: 2
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 8. A patient with interstitial lung disease who presents with hypoxemia due to diffusion defect
would have which of the following clinical signs? 1. Fine bibasilar crackles 2. Clubbing of the finger nail beds 3. Jugular venous distention 4. Thrombocytopenia a. 1 and 2 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Patients may have clubbing of the nail beds. Rheumatologic manifestations may be present if the underlying cause is a connective tissue disorder. Joint abnormalities, Reynaud disease, and telangiectasia (a vascular lesion formed by dilatation of a group of small blood vessels) may be observed. The pallor of anemia can be a clue to poor gas exchange, although chronic hypoxemia may lead to polycythemia and possibly cyanosis. Pulmonary hypertension may present with signs of right heart failure such as edema, jugular vein distension, and a louder pulmonary component of the second heart sound. DIF: Recall
REF: pp. 974-975 OBJ: 2
9. What type of disease is associated with perfusion/diffusion impairment? a. Liver disease b. Renal disease c. Neuromuscular disease d. Vascular disease ANS: D
Perfusion/diffusion impairment is a rare cause of hypoxemia found in individuals with liver disease complicated by the hepatopulmonary syndrome. DIF: Recall
REF: p. 975
OBJ: 3
10. What is the most common cause of low mixed venous oxygen? a. Liver disease b. Cardiac disease c. Neuromuscular disease d. Vascular disease ANS: B
Congestive heart failure with low cardiac output is the most common cause of low mixed venous oxygen, due to increased peripheral extraction of oxygen. DIF: Recall
REF: pp. 975-976 OBJ: 3
11. What is the normal P(A−a)O 2 range while breathing room air? a. 25 to 50 mm Hg b. 10 to 25 mm Hg
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. Greater than 25 mm Hg d. Less than 10 mm Hg ANS: B
The P(A−a)O 2 ranges from 10 mm Hg in young patients to approximately 25 mm Hg in the elderly while breathing room air. DIF: Recall
REF: p. 976
OBJ: 3
12. What happens to the P(A−a)O 2 with mismatch and shunt? a. It increases with mismatch and decreases with shunt. b. It decreases with both mismatch and shunt. c. It increases with both mismatch and shunt. d. It does not change. ANS: C
A
mismatch and shunt both result in elevated P(A−a)O 2 levels.
DIF: Recall
REF: p. 976
OBJ: 3
13. What is the optimal treatment of intrapulmonary shunt? a. Increase the FiO 2 . b. Decrease the FiO 2 . c. Surgery. d. Alveolar recruitment. ANS: D
Treatment of intrapulmonary shunt must be directed toward opening collapsed alveoli or clearing fluid or exudative material before oxygen can be beneficial at below toxic levels. DIF: Recall
REF: p. 976
OBJ: 3
14. A patient with an opiate drug overdose is unconscious an– d exhibits the following blood gas
= 27; PO = 48. Which of the
results breathing room air: pH = 7.19; PCO 2 = 89; HCO following best describes this patient’s condition? a. Chronic hypoxemic respiratory failure b. Chronic hypercapnic respiratory failure c. Acute hypoxemic respiratory failure d. Acute hypercapnic respiratory failure
3
2
ANS: D
Hypercapnic respiratory failure (―pump failure,‖ ―ventilatory failure‖) is characterized by an elevated PaCO 2 , creating an uncompensated respiratory acidosis (whether acute or acute-on-chronic). DIF: Application
REF: p. 977
OBJ: 3
15. Which of the following could cause hypercapnic respiratory failure?
1. Smoke inhalation 2. Opiate drug overdose
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. Chronic obstructive pulmonary disease 4. Hypothyroidism a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
This ventilatory drive can be diminished by various factors such as drugs (overdose/sedation), brainstem lesions, diseases of the central nervous system such as multiple sclerosis or Parkinson’s disease, hypothyroidism, morbid obesity (e.g., obesity-hypoventilation), and sleep apnea. DIF: Recall
REF: pp. 976-977 OBJ: 3
16. Which of the following are associated with hypercapnic respiratory failure due to decreased
ventilatory drive? 1. Brainstem lesions 2. Encephalitis 3. Hypothyroidism 4. Asthma a. 1, 2, and 3 only b. 2 and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: A
This ventilatory drive can be diminished by various factors such as drugs (overdose/sedation), brainstem lesions, diseases of the central nervous system such as multiple sclerosis or Parkinson’s disease, hypothyroidism, morbid obesity (e.g., obesity-hypoventilation), and sleep apnea. DIF: Recall
REF: p. 978
OBJ: 3
17. Which of the following are associated with hypercapnic respiratory failure due to respiratory
muscle weakness or fatigue? 1. Hyperthyroidism 2. Myasthenia gravis 3. Amyotrophic lateral sclerosis 4. Guillain-Barré syndrome a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Examples include spinal trauma, motor neuron disease where lesions of the anterior horn cells may gradually lead to progressive ventilatory failure (such as in amyotrophic lateral sclerosis, or poliomyelitis), motor nerve disorders (including Guillain-Barré syndrome and Charcot-Marie-Tooth disease), disorders of the neuromuscular junction (such myasthenia gravis and botulism), and muscular diseases (including muscular dystrophy, myositis, critical care myopathy, and metabolic disorders). DIF: Recall
REF: p. 978
OBJ: 3
18. Which of the following is a feature of Guillain-Barré? a. Ascending muscle weakness b. Descending muscle weakness c. Limited to lower extremities d. Limited to trunk ANS: A
Guillain-Barré syndrome can commonly show up with lower extremity weakness progressing to the respiratory muscles in one-third of patients. DIF: Recall
REF: p. 978
OBJ: 3
19. Which of the following are associated with hypercapnic respiratory failure due to increased
work of breathing? 1. Asthma 2. COPD 3. Obesity 4. Kyphoscoliosis a. 1 and 2 only b. 1, 2, and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
Most commonly, this situation occurs when increased dead space accompanies COPD or elevated airway resistance accompanies asthma. Both of these obstructive airway diseases may raise respiratory work requirements excessively due to the presence of intrinsic positive end expiratory pressure. Increased workload can also result from thoracic abnormalities such as pneumothorax, rib fractures, pleural effusions, and other conditions creating a restrictive burden on the lungs. Finally, requirements for increased minute ventilation can arise when increased CO 2 production accompanies hypermetabolic states, such as in extensive burns. DIF: Recall
REF: pp. 978-979 OBJ: 3
20. Which of the following information best helps to distinguish chronic hypercapnic respiratory
failure from acute hypercapnic respiratory failure? a. Long-standing dyspnea that worsens on exertion b. Forced expiratory volume in 1 sec to forced vital capacity ratio (FEV 1 /FVC) of less than 75% predicted c. Kidneys retaining bicarbonate to elevate the blood pH
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Physical signs of hypoxemia, such as cyanosis and clubbing ANS: C
Most commonly, chronic hypercapnic respiratory failure accompanying COPD or obesity-hypoventilation syndrome would elicit a renal response by which the kidneys retain bicarbonate to elevate the blood pH. DIF: Application
REF: p. 979
OBJ: 4
21. Which of the following is false about the ―acute-on-chronic‖ form of respiratory failure? a. It usually involves patients with hypoxemic respiratory failure. b. It is most common in patients with chronic airway obstruction. c. Bacterial or viral infections are common precipitating factors. d. Mortality is associated with severity of acidosis. ANS: A
Patients with chronic hypercapnic respiratory failure (chronic ventilatory failure) are at significant risk for this, as indicated by the fact that COPD is now the fourth leading cause of death in the United States. Acute-on-chronic respiratory failure can also be the presenting manifestation of neuromuscular disease in the setting of a concurrent pulmonary infection. Most common precipitating factors include bacterial or viral infections, congestive heart failure, pulmonary embolus, chest wall dysfunction, and medical noncompliance. DIF: Recall
REF: p. 979
OBJ: 4
22. Which of the following is the cardinal sign of increased work of breathing? a. Hyperventilation b. Retractions c. Bradycardia d. Tachypnea ANS: D
Tachypnea is the cardinal sign of increased work of breathing. DIF: Recall
REF: p. 978
OBJ: 5
23. In patients suffering from acute respiratory acidosis, below what pH level are intubation and
ventilatory support generally considered? a. 7.2 b. 7.3 c. 7.1 d. 7.0 ANS: A
See Table 44-3. DIF: Recall
REF: p. 981
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 24. Mr. Adam is in the ICU on an FiO 2 of 100%. An arterial blood gas reveals the following
information: pH of 7.18, PaCO 2 of 59 mm Hg, PaO 2 of 65 mm Hg, HCO 3 of 24 mEq/L What action would you recommend? a. Provide ventilatory support. b. Put patient on steroids. c. Give patient chest PT. d. Put patient on CPAP. ANS: A
The patient is in hypoxic (type I) and hypercapnic (type II) acute respiratory failure. Providing full mechanical ventilatory support will provide the ventilator support needed to normalize pH and improve oxygenation. DIF: Analysis
REF: p. 981
OBJ: 7
25. A need for some form of ventilatory support is usually indicated when an adult’s rate of
breathing rises above what level? a. 35/min b. 30/min c. 25/min d. 20/min ANS: A
See Table 44-3. DIF: Recall
REF: p. 981
OBJ: 6
26. Which of the following measures are useful indicators in assessing the adequacy of a patient’s
oxygenation? 1. PaO 2 –PaO 2 2. PaO 2 -to-FiO 2 ratio 3. VD/VT 4. Pulmonary shunt a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 only ANS: A
See Table 44-3. DIF: Recall
REF: p. 981
OBJ: 6
27. Which of the following measures taken on adult patients indicate unacceptably high
ventilatory demands or work of breathing? a. V E of 17 L/min b. Breathing rate of 22/min c. V D/V T of 0.45 d. MIP of −40 cm H 2 O
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: A
See Table 44-3. DIF: Application
REF: p. 981
OBJ: 6
28. Ventilatory support may be indicated when the VC falls below what level? a. 45 ml/kg b. 65 ml/kg c. 10 ml/kg d. 30 ml/kg ANS: C
See Table 44-3. DIF: Recall
REF: p. 981
OBJ: 6
29. What is the normal range of maximum inspiratory pressure, or MIP (also called negative
inspiratory force, or NIF), generated by adults? a. −80 to −100 cm H 2 O b. −50 to −80 cm H 2 O c. −30 to −50 cm H 2 O d. −20 to −30 cm H 2 O ANS: A
See Table 44-3. DIF: Recall
REF: p. 981
OBJ: 6
30. Which of the following MIP measures taken on an adult patient indicates inadequate
respiratory muscle strength? a. −90 cm H 2 O b. −70 cm H 2 O c. −40 cm H 2 O d. −15 cm H 2 O ANS: D
See Table 44-3. DIF: Recall
REF: p. 981
OBJ: 6
31. Common bedside measures used to assess the adequacy of lung expansion include which of
the following? 1. VC 2. Respiratory rate 3. VT 4. VD/VT a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. 2, 3, and 4 only ANS: B
See Table 44-3. DIF: Recall
REF: p. 981
OBJ: 6
32. Inadequate respiratory muscle strength is likely when a patient’s MVV is which of the
following? a. Less than 2 times the resting V E b. Greater than 3 times the resting V E c. Less than 200 L/min d. Greater than 120 L/min ANS: A
See Table 44-3. DIF: Recall
REF: p. 981
OBJ: 6
33. You determine that an acutely ill patient can generate an MIP of −18 cm H 2 O. Based on this
information, what might you conclude? a. The patient has inadequate respiratory muscle strength. b. The patient has inadequate alveolar ventilation. c. The patient has an excessive work of breathing. d. The patient has an unstable or irregular ventilatory drive. ANS: A
See Table 44-3. DIF: Application
REF: p. 981
OBJ: 6
34. Which of the following indicate severely impaired oxygenation requiring high FiO 2 s and
positive end expiratory pressure? 1. PaO 2 –PaO 2 greater than 350 mm Hg on 100% O2 2. VC less than 10 ml/kg 3. PaO 2 /FiO 2 less than 200 4. PaCO 2 greater than 45 mm Hg a. 1 and 4 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 4 only ANS: B
See Table 44-3. DIF: Recall
REF: p. 981
OBJ: 7
35. Breathing 100% O 2 , a patient has a PaO 2 –PaO 2 of 60 mm Hg. Based on this information, what
might you conclude? a. The patient has severe hypoxemia.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
b. The patient has an excessive work of breathing. c. The patient has acceptable oxygenation. d. The patient has inadequate ventilation. ANS: C
See Table 44-3. DIF: Recall
REF: p. 981
OBJ: 7
36. What is the normal range for PaO 2 /FiO 2 ? a. 350 to 450 b. 250 to 350 c. 150 to 250 d. 75 to 150 ANS: A
See Table 44-3. DIF: Recall
REF: p. 981
OBJ: 7
37. Which of the following measures should be used in assessing the adequacy of a patient’s
alveolar ventilation? 1. PaO 2 2. Arterial pH 3. PaCO 2 4. HCO 3 a. 2 and 4 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 4 only ANS: C
See Table 44-3. DIF: Recall
REF: p. 981
OBJ: 7
38. A patient with a 10-year history of chronic bronchitis and an acute viral pneumonia exhibits
the following blood gas results breathing room air: pH = 7.22; PCO 2 = 67; HCO –3 = 26; PO 2= 60. Which of the following best describes this patient’s condition? a. Chronic hypoxemic respiratory failure b. Acute hypercapnic respiratory failure c. Chronic hypercapnic respiratory failure d. Acute hypoxemic respiratory failure ANS: B
Assessment of the pH allows a determination of whether the problem is acute or chronic. DIF: Application
REF: p. 981
OBJ: 7
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
39. Because an elevated PaCO 2 increases ventilatory drive in normal subjects, the clinical
presence of hypercapnia indicates which of the following? 1. Inability of the stimulus to get to the muscles 2. Weak or missing central nervous system response to the elevated PCO 2 3. Pulmonary muscle fatigue a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Because an elevated PaCO 2 increases ventilatory drive in healthy subjects, the very existence of hypoventilation suggests other problems with the respiratory apparatus. Specifically, the presence of acute respiratory acidosis indicates one of three major problems: (1) the respiratory center is not responding normally to the elevated PaCO 2 , (2) the respiratory center is responding normally, but the signal is not getting through to the respiratory muscles, or (3) despite normal neurologic response mechanisms, the lungs and chest bellows are simply incapable of providing adequate ventilation due to parenchymal lung disease or muscular weakness. DIF: Application
REF: p. 983
OBJ: 7
40. Which of the following indicators are useful in assessing respiratory muscle strength?
1. Maximum voluntary ventilation (MVV) 2. Forced vital capacity (FVC) 3. Dead space-to-tidal volume ratio (V D/VT) 4. Maximum inspiratory pressure (MIP) a. 1 and 3 only b. 2 and 4 only c. 3 and 4 only d. 1, 2, and 4 only ANS: D
The most commonly used tests to assess respiratory muscle strength at the bedside are MIP and maximum expiratory pressure (MEP), FVC, and MVV. DIF: Recall
REF: p. 983
OBJ: 6
41. A reversible impairment in the response of an overloaded muscle to neural stimulation best
describes which of the following? a. Central respiratory muscle fatigue b. Transmission respiratory muscle fatigue c. Contractile respiratory muscle fatigue d. Chronic respiratory muscle fatigue ANS: C
Contractile respiratory muscle fatigue is a reversible impairment in the contractile response to a neural impulse in an overloaded muscle.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 983 OBJ: 6 42. When is respiratory muscle fatigue likely to occur? a. When VE exceeds 20% of the maximum voluntary ventilation (MVV) b. When VE exceeds 40% of the MVV c. When VE exceeds 60% of the MVV d. When VE exceeds 80% of the MVV ANS: C
Comparing the spontaneous minute ventilation with MVV is a helpful index as fatigue and failure are both likely to occur if the minute ventilation exceeds 60% of MVV. DIF: Recall
REF: p. 982
OBJ: 6
43. In intubated patients, what do sources of increased imposed work of breathing include?
1. Endotracheal tube 2. Ventilator circuit 3. Auto-PEEP a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
In intubated patients, sources of imposed work of breathing include the endotracheal tube, ventilator circuit, and auto-PEEP due to dynamic hyperinflation with airflow obstruction, as is commonly seen in the patient with COPD. DIF: Recall
REF: p. 982
OBJ: 7
44. A patient develops acute hypercapnic respiratory failure due to muscle fatigue. Which of the
following modes of ventilatory support would you consider for this patient? 1. Assist-control ventilation with adequate backup 2. Continuous positive airway pressure 3. Intermittent mandatory ventilation with adequate backup rate 4. Bilevel pressure support by mask a. 2 and 4 only b. 3 and 4 only c. 1, 2, and 3 only d. 1, 3, and 4 only ANS: D
Noninvasive positive-pressure ventilation can improve hypoxemia and hypercarbia by several mechanisms including but not limited to (1) compensating for the inspiratory threshold load imposed by intrinsic positive end-expiration pressure, (2) supplementing a reduced tidal volume, (3) partial or complete unloading of the respiratory muscles, (4) reducing venous return and left ventricular afterload, and (5) alveolar recruitment. DIF: Application
REF: p. 982
OBJ: 7
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 45. Which of the following modes of ventilatory support would you recommend for a hypoxemic
patient with congestive heart failure? a. Continuous positive airway pressure (CPAP) b. Intermittent mandatory ventilation (IMV) c. Inverse-ratio pressure-control ventilation (PCV) d. High-level pressure support ventilation (PSV) ANS: A
In a systematic review of randomized trials, noninvasive positive-pressure ventilation was found to reduce intubation rates and mortality in patients with acute cardiogenic pulmonary edema. Overall, the level of evidence was noted to be similar for CPAP without significant advantages of bilevel positive-pressure ventilation over CPAP. DIF: Analysis
REF: p. 983
OBJ: 7
46. Which of the following modes of ventilatory support would you recommend for a severely
hypoxemic patient with acute lung injury or acute respiratory distress syndrome (ARDS)? a. Continuous positive airway pressure b. High VT volume-cycled ventilation c. Pressure-controlled ventilation d. Bilevel pressure support by mask ANS: C
Volume-cycled ventilation in patients with ARDS frequently leads to high-peak airway and plateau pressures. DIF: Analysis
REF: p. 984
OBJ: 7
47. A patient who just suffered severe closed-head injury and has a high intracranial pressure
(ICP) is about to be placed on ventilatory support. Which of the following strategies could help to lower the ICP? a. Maintain a PaCO 2 from 25 to 30 mm Hg (deliberate hyperventilation). b. Allow as much spontaneous breathing as possible (SIMV). c. Maintain a high mean pressure using PEEP levels of 10 to 15 cm H 2 O. d. Maintain a PaCO 2 of 50 to 60 mm Hg (deliberate hypoventilation). ANS: A
Hyperventilation applied acutely and for short periods of time may be used to reduce ICP. The goal is to lower the PaCO 2 to between 25 and 30 mm Hg, which causes alkalosis, which in combination with hypocapnia helps reduce cerebral blood flow until the ICP can be controlled by other measures. DIF: Application
REF: p. 984
OBJ: 7
48. Which of the following patients are at greatest risk for developing auto-PEEP during
mechanical ventilation? a. Those with acute lung injury b. Those with COPD c. Those with congestive heart failure
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Those with bilateral pneumonia ANS: B
These patients frequently have problems with elevated airway pressure or dynamic hyperinflation (auto-PEEP), which can cause barotrauma and increased dyssynchrony between the patient and the ventilator. DIF: Application
REF: p. 985
OBJ: 7
49. What are some causes of dynamic hyperinflation?
1. Increased expiratory time 2. Increased airway resistance 3. Decreased expiratory flow rate a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: C
In such patients, lower tidal volumes (6 to 8 ml/kg), moderate respiratory rates, and high inspiratory flow rates (70 to 100 L/min) are recommended to avoid dynamic hyperinflation. DIF: Recall
REF: p. 985
OBJ: 7
50. Strategies to reduce auto-PEEP in mechanically ventilated patients with obstructive lung
disease include which of the following? 1. Use high inspiratory flows (60 to 100 L/min). 2. Apply extrinsic PEEP. 3. Use low V T values (8 to 10 ml/kg). 4. Use high respiratory rates (>25/min). a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
In such patients, lower tidal volumes (6 to 8 ml/kg), moderate respiratory rates, and high inspiratory flow rates (70 to 100 L/min) are recommended to avoid dynamic hyperinflation. DIF: Recall
REF: p. 985
OBJ: 7
51. Which of the following is the normal alveolar-to-arterial difference for a 56-year-old female
in the emergency department? a. 12 mm Hg b. 14 mm Hg c. 16 mm Hg d. 18 mm Hg ANS: D
[P(A–a)O 2 ] = (age/4) + 4
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
[P(A–a)O 2 ] = (56/4) + 4 [P(A–a)O 2 ] = 18 mm Hg DIF: Application
REF: p. 976
OBJ: 7
52. Which of the following are causes of hypoxemia?
1. Ventilation/perfusion ( ) mismatch 2. Alveolar hypoventilation 3. Diffusion impairment 4. Increased inspired O2 a. 1 and 2 only b. 2 and 3 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
The following are causes of hypoxemia: mismatch (most common cause), shunt, alveolar hypoventilation, diffusion impairment, perfusion/diffusion impairment (rare), decreased inspired oxygen, and venous admixture. DIF: Recall
REF: p. 973
OBJ: 2
53. The respiratory therapist in the ICU is called to assess a patient with ARDS. The patient is
SOB. The x-ray shows ―white‖ chest radiograph and the PAO2 is 60 mm Hg on an F iO2 of 100%. Which of the following is indicated? a. Shunting b. Alveolar hyperventilation c. Decreased CO 2 d. Perfusion impairment ANS: A
Shunt is indicated by the following: shunt usually presents with a white radiograph. ARDS is a classic example of shunting. Shunt also does not respond to high level of supplemental oxygen. DIF: Analysis
REF: p. 974
OBJ: 3
54. Your patient is hypoventilating. Which of the following would be likely findings? a. A normal P(A–a)O 2 with a marked response to an increase in FiO 2 b. An increases P(A–a)O 2 with a marked response to an increase in FiO 2 c. A normal P(A–a)O 2 with no response to an increase in FiO 2 d. A increased P(A–a)O 2 with no response to an increase in FiO 2 ANS: A
See Table 44-1. DIF: Analysis
REF: p. 976
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 45 - Mechanica l Ventilato rs Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following major categories of ventilator function are useful in classifying
ventilators? 1. Control system 2. Power transmission and conversion 3. Output 4. Input a. 1 and 2 only b. 3 and 4 only c. 1, 3, and 4 only d. 1, 2, 3, and 4 ANS: D
To understand mechanical ventilators, we must first understand their four basic functions: • Input power • Power transmission and conversion • Control system • Output (pressure, volume, and flow waveforms) DIF: Recall
REF: p. 988
OBJ: 1
2. A ventilator can derive its input power from which of the following sources?
1. Alternating current (AC) electricity 2. Battery 3. Pneumatic a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
The power source for a ventilator is either electrical energy (Energy = Volts Amperes Time) or compressed gas (Energy = Pressure Volume). DIF: Recall
REF: p. 988
OBJ: 1
3. For which of the following uses might you consider the use of a purely pneumatically
powered ventilator? 1. As a backup to electrically powered ventilators 2. When electrical device cannot be used (e.g., magnetic resonance imaging) 3. During certain types of patient transport a. 1 and 2 only b. 1 and 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 2 and 3 only d. 1, 2, and 3 ANS: D
These devices are ideal in situations where electrical power is unavailable (e.g., during certain types of patient transport) or as a backup to electrically powered ventilators in case of power failures. They are also particularly useful where electrical power is undesirable, as near magnetic resonance imaging equipment. DIF: Application
REF: p. 988
OBJ: 2
4. Primary drive mechanisms used by modern ventilators include which of the following?
1. Compressed gas or reducing valve 2. Hydraulic or fluidic compressor 3. Electrical motor or compressor a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: B
Drive mechanisms can be either (1) a direct application of compressed gas via a pressure reducing valve or (2) an indirect application via an electrical motor or compressor. DIF: Recall
REF: p. 988
OBJ: 2
5. Types of output control valves used in modern ventilators include which of the following?
1. Pneumatic diaphragm valve 2. Proportional valve 3. Electromagnetic poppet or plunger 4. Linear screw valve a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Commonly used output control valves include the pneumatic diaphragm, electromagnetic poppet/plunger valve, and the proportional valve. Descriptions of these devices can be found in respiratory care equipment textbooks. DIF: Recall
REF: p. 988
OBJ: 2
6. Which of the following equations best describes the pressure (P) necessary to drive gas into
the airway and inflate the lungs? a. P = (Elastance Volume) + (Resistance Flow) b. P = (Elastance – Volume) + (Resistance ÷ Flow) c. P = (Volume + Compliance) + (Resistance ÷ Flow) d. P = (Volume ÷ Compliance) – (Resistance Flow)
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ANS: A
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Pvent + Pmus = (E V) + (R V). DIF: Application
REF: pp. 996-997 OBJ: 2
7. How would a ventilatory support device that uses pressure regulators, needle valves, and
balloon valves to regulate most or all of the parameters of ventilation be classified? a. Mechanically controlled b. Electronically controlled c. Fluidically controlled d. Pneumatically controlled ANS: D
Pneumatic control is provided using gas-powered pressure regulators, needle valves, jet entrainment devices, and balloon valves. DIF: Recall
REF: p. 988
OBJ: 2
8. Which of the following types of ventilators would you select for use during an MRI
procedure? 1. Electronically controlled 2. Pneumatically controlled 3. Fluidically controlled 4. Electrically controlled a. 1 and 4 only b. 2 and 3 only c. 1 only d. 2, 3, and 4 only ANS: B
Some transport ventilators use pneumatic control systems. The Ohmeda Logic-07 is an example. Fluidic control mechanisms have no moving parts. In addition, fluidic circuits are immune to failure from surrounding electromagnetic interference, as can occur around MRI equipment. DIF: Application
REF: p. 988
OBJ: 2
9. Which of the following ventilators is controlled by fluidic logic systems? a. Siemens Servo 300 b. Bio-Med MVP-10 c. Bird 8400ST d. Bear 1000 ANS: B
Fluidic logic-controlled ventilators, such as the Bio-Med MVP-10 (Bio-Med Devices, Stanford, CT), also use pressurized gas to regulate the parameters of ventilation. DIF: Recall
REF: p. 989
OBJ: 2
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 10. According to the equation of motion of the respiratory system, a ventilator can control which
of the following variables? 1. Volume 2. Resistance 3. Pressure 4. Flow a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
There are only three variables in the equation of motion that a ventilator can control: pressure, volume, and flow. DIF: Recall
REF: p. 996
OBJ: 2
11. If the pressure waveform of a ventilator remains the same when a patient’s lung mechanics
change, then what is the ventilator? a. Volume controller b. Pressure controller c. Time controller d. Flow controller ANS: B
If the ventilator controls pressure, the pressure waveform will remain consistent but volume and flow will vary with changes in respiratory system mechanics. DIF: Application
REF: p. 988
OBJ: 2
12. Which of the following are characteristics of a ventilator that function as a true volume
controller? 1. Its pressure waveform changes with changes in lung mechanics. 2. It measures and uses volume to control the volume waveform. 3. Its volume waveform stays constant with changes in lung mechanics. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
If the ventilator controls volume, the volume and flow waveforms will remain consistent, but pressure will vary with changes in respiratory mechanics. To qualify as a true volume controller, a ventilator must measure volume and use this signal to control the volume waveform. DIF: Recall
REF: p. 988
OBJ: 2
13. During volume control ventilation, the clinician has control over which of the following?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1. Pressure waveform 2. Volume waveform 3. Flow waveform a. 1 or 2 only b. 2 or 3 only c. 2 only d. 1, 2, and 3 ANS: B
Volume can be controlled directly by the displacement of a device such as a piston or bellows. Volume can be controlled indirectly by controlling flow. DIF: Recall
REF: p. 988
OBJ: 2
14. Which of the following are true of the relationship between flow and volume?
1. Volume is the integral of flow. 2. Volume is the derivative of flow. 3. Flow is the derivative of volume. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: B
This follows from the fact that volume and flow are inverse functions of time (i.e., volume is the integral of flow and flow is the derivative of volume). DIF: Application
REF: p. 998
OBJ: 2
15. A ventilator’s pressure waveform changes when a patient’s lung mechanics change, but its
volume waveform remains the same. The device does not directly control the delivered volume. What is this ventilator? a. Volume controller b. Pressure controller c. Time controller d. Flow controller ANS: D
If the ventilator controls flow, the flow and volume waveforms will remain consistent, but pressure will vary with changes in respiratory mechanics. Flow can be controlled directly using something as simple as a flow meter or as complex as a proportional solenoid valve. Flow can be controlled indirectly by controlling volume. DIF: Recall
REF: p. 999
OBJ: 2
16. The volume waveform generated by a ventilator remains the same against changing lung
mechanics. Which of the following parameters might this device be controlling? 1. Volume 2. Flow
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. Pressure a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: A
If the ventilator controls flow, the flow and volume waveforms will remain consistent, but pressure will vary with changes in respiratory mechanics. Flow can be controlled directly using something as simple as a flow meter or as complex as a proportional solenoid valve. Flow can be controlled indirectly by controlling volume. DIF: Application
REF: p. 1000
OBJ: 2
17. The respiratory therapist has been called to transport a patient from the emergency department
to obtain a CT scan. Which of the following types of ventilator should the therapist chose to transport the patient? a. Electric b. Apneuistic c. Pneumatic d. Electronic ANS: C
For patient transport you must use either a pneumatically powered ventilator or one that can run solely on batteries. Always take along a manually powered bag-valve mask, and for long transports be sure to have backup power available (extra cylinders or batteries). DIF: Application
REF: p. 988
OBJ: 2
18. A complete ventilatory cycle or breath consists of which of the following phases?
1. Expiration 2. Initiation of inspiration 3. Inspiration 4. End of inspiration a. 1 and 4 only b. 2 and 3 only c. 1, 2, and 4 only d. 1, 2, 3, and 4 ANS: D
A complete ventilatory cycle or breath consists of four phases: the initiation of inspiration, inspiration itself, the end of inspiration, and expiration. DIF: Recall
REF: p. 998
OBJ: 2
19. During mechanical ventilation, what variable causes a breath to begin? a. Limit b. Cycle c. Trigger
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Baseline ANS: C
The variable causing a breath to begin is the trigger variable. DIF: Recall
REF: p. 998
OBJ: 2
20. During mechanical ventilation, what variable causes a breath to end? a. Limit b. Cycle c. Trigger d. Baseline ANS: B
The variable causing a breath to end is the cycle variable. DIF: Recall
REF: p. 998
OBJ: 2
21. To describe what happens during the expiratory phase of mechanical ventilation, you must
know the value of which variable? a. Limit b. Cycle c. Trigger d. Baseline ANS: D
To describe what happens during expiration, we must know what baseline variable is in effect. DIF: Recall
REF: p. 996
OBJ: 2
22. If a ventilator, not the patient, initiates a breath, what is the trigger variable? a. Time b. Pressure c. Flow d. Volume ANS: A
If the machine initiates the breath, the trigger variable is time. DIF: Recall
REF: p. 996
OBJ: 2
23. If a patient initiates a ventilator breath, the trigger variable could be which of the following?
1. Pressure 2. Flow 3. Time 4. Volume a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: B
If the patient initiates the breath, pressure, flow, or volume may serve as the trigger variable. DIF: Recall
REF: p. 996
OBJ: 2
24. A patient receiving time-triggered continuous mechanical ventilation at a preset rate of 10/min
stops breathing. Which of the following will occur? a. The high-pressure limit alarm will sound (if properly set). b. The patient will continue to receive 10 breaths/min. c. The low tidal volume (VT) alarm will sound (if properly set). d. Ventilation will drop to zero and the apnea alarm will sound. ANS: B
When triggering by time, a ventilator initiates a breath according to a predetermined time interval, without regard to patient effort. DIF: Application
REF: p. 1002
OBJ: 2
25. Pure time-triggered ventilation is the same as what type of ventilation? a. Assist b. Intermittent mandatory ventilation c. Assist and control d. Proportional assist ANS: B
Currently, time triggering is most commonly seen when using the IMV mode (intermittent mandatory ventilation). DIF: Recall
REF: p. 1002
OBJ: 2
26. A volume-cycled ventilator has a rate knob for setting the controlled frequency of breathing.
If this control is set to 12/min, which of the following other settings will determine the inspiratory and expiratory times? 1. FiO 2 2. Flow 3. Volume a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: C
When a rate control is used, inspiratory and expiratory times will vary according to other control settings, such as flow and volume. DIF: Application
REF: p. 1002
OBJ: 2
27. When you adjust the pressure drop necessary to trigger a breath on a ventilator, what are you
adjusting on the machine? a. Sensitivity
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
b. Pressure limit c. Mode setting d. Positive end expiratory pressure (PEEP) level ANS: A
Pressure triggering occurs when a patient’s inspiratory effort causes a drop in pressure within the breathing circuit. When this pressure drop reaches the pressure sensing mechanism, the ventilator triggers on and begins gas delivery. On most ventilators, you can adjust the pressure drop needed to trigger a breath. The trigger level is often called the sensitivity. DIF: Recall
REF: p. 998
OBJ: 2
28. When using pressure as the trigger variable, where do you typically set the trigger level? a. 0.5 to 1.5 cm H 2 O below the baseline expiratory pressure b. 0.5 to 1.5 cm H2 O above the baseline expiratory pressure c. 2.0 to 3.5 cm H 2 O below the baseline expiratory pressure d. 2.0 to 3.5 cm H2 O above the baseline expiratory pressure ANS: A
Typically, you set the trigger level 0.5 to 1.5 cm H 2 O below the baseline expiratory pressure. DIF: Recall
REF: pp. 998-999 OBJ: 2
29. Which of the following is false about the application of flow triggering on a mechanical
ventilator? a. The ventilator measures both input and output flow. b. Between patient breaths, input flow exceeds output flow. c. A relative drop in output flow triggers the machine to turn on. d. Gas flows continuously through the ventilator circuit. ANS: B
The ventilator measures the flow coming out of the main flow control valve and also the flow through the exhalation valve. Between breaths, these two flows are equal (assuming there are no leaks in the patient circuit). When the patient makes an inspiratory effort, the flow through the exhalation valve falls below the flow from the output valve. The difference between these two flows is the flow trigger variable. DIF: Recall
REF: pp. 998-999 OBJ: 2
30. A physician requests that you switch from pressure-triggering a patient to flow-triggering.
Which of the following new settings would be appropriate? a. Base flow = 0 L/min; trigger at 2 L/min b. Base flow = 10 L/min; trigger at −2 cm H 2 O c. Base flow = 10 L/min; trigger at 2 L/min d. Base flow = 0 L/min; trigger at 10 cm H2 O ANS: C
For example, if you set the base continuous flow at 10 L/min and the trigger at 2 L/min, the ventilator will trigger when the output flow falls to 8 L/min or less.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Analysis REF: p. 1002 OBJ: 2 31. Compared to using pressure as the trigger variable, what is the major advantage of
flow-triggering? a. Decreased work of breathing b. Improved minute ventilation (V E) c. Decreased physiologic dead space d. Improved arterial oxygenation ANS: A
When compared with pressure, using flow as the trigger variable decreases a patient’s work of breathing. DIF: Recall
REF: p. 996
OBJ: 2
32. What ventilatory variable reaches and maintains a preset level before inspiration ends? a. Limit b. Cycle c. Trigger d. Baseline ANS: A
A limit variable is one that can reach and maintain a preset level before inspiration ends but does not terminate inspiration. DIF: Recall
REF: p. 995
OBJ: 2
33. Which of the following parameters can serve as the cycle variable during ventilatory support?
1. Volume 2. Pressure 3. Flow 4. Time a. 1 and 4 only b. 2 and 3 only c. 1, 2, and 4 only d. 1, 2, 3, and 4 ANS: D
The cycle variable can be pressure, volume, flow, or time. DIF: Application
REF: pp. 998-999 OBJ: 2
34. A volume-cycled ventilator provides gas under positive pressure during inspiration until what
point? a. The patient receives a preselected volume of gas. b. An adjustable, preselected airway pressure is reached. c. The inspiratory time equals or exceeds the expiratory time. d. A preselected volume of gas is expelled from the device. ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
When a ventilator is set to volume-cycle, it delivers flow until a preselected volume has been expelled from the device. DIF: Application
REF: p. 999
OBJ: 3
35. Flow serves as a limit variable whenever a ventilator controls what? a. Pressure b. Flow c. Time d. Volume ANS: B
When a ventilator is set to flow cycle, it delivers flow until a preset level is met and then flow stops and expiration begins. DIF: Recall
REF: p. 1000
OBJ: 3
36. You observe that a ventilator reaches a preset pressure early in inspiration but holds it for a
specific time, after which inspiration ends. What mode of ventilatory support is in force? a. Time cycled b. Pressure limited c. Pressure cycled d. Volume limited ANS: A
Time cycling occurs when the inspiratory time has elapsed. DIF: Analysis
REF: p. 1000
OBJ: 3
37. A time-cycled constant flow generator is set up with a flow of 35 L/min and an inspiratory
time of 1.7 sec. What is the approximate VT? a. 750 ml (0.75 L) b. 1000 ml (1.00 L) c. 1900 ml (1.90 L) d. 1200 ml (1.20 L) ANS: B
If it is used, it may be set directly, or it may occur indirectly if the set inspiratory time is longer than the inspiratory flow time (determined by the set tidal volume and flow; time = volume/flow). DIF: Application
REF: p. 996
OBJ: 3
38. What is the name of a breath where a patient is able to change the inspiratory time? a. Patient cycled b. Patient triggered c. Machine triggered d. Machine cycled ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
For the breath to be patient cycled, the patient must be able to change the inspiratory time, such as by making either inspiratory or expiratory efforts. If this is not possible, then the breath is, by definition, machine cycled. DIF: Recall
REF: p. 1000
OBJ: 3
39. In which of the following modes inspiration ends when flow decays to some preset value? a. Intermittent mandatory ventilation b. Pressure support ventilation c. Continuous mandatory ventilation d. Airway pressure release ventilation ANS: B
Another example of patient cycling is the pressure support mode. Here, inspiration ends when flow decays to some preset value (i.e., flow cycling). DIF: Recall
REF: p. 1002
OBJ: 3
40. What parameter serves as the baseline variable on all modern ventilators? a. Pressure b. Flow c. Time d. Volume ANS: A
Although pressure, volume, or flow could serve as the baseline variable, pressure control is the most practical and is implemented by all modern ventilators. DIF: Recall
REF: p. 995
OBJ: 3
41. Which of the following provides clinicians with measured or calculated date related to
ventilatory support over time? a. Waveforms b. Trends c. Compliance d. Minute ventilation ANS: B
Trends provide clinicians with measured or calculated data related to ventilatory support over time. DIF: Recall
REF: p. 990
OBJ: 3
42. What is the application of pressure above atmospheric at the airway throughout expiration
during mechanical ventilation? a. Positive end expiratory pressure (PEEP) b. Pressure support ventilation c. Continuous mandatory ventilation (CMV) d. Continuous positive airway pressure (CPAP)
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ANS: A
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
PEEP is the application of pressure above atmospheric pressure at the airway throughout expiration. DIF: Recall
REF: p. 995
OBJ: 3
43. What is the primary physiological effect of positive end expiratory pressure (PEEP)? a. Increase the functional residual capacity (FRC). b. Increase the inspiratory reserve volume (IRV). c. Decrease the compliance of the lung (CL). d. Increase the length of expiration. ANS: A
PEEP elevates a patient’s FRC and can help improve oxygenation by preventing collapse of alveolar units that are made unstable by lack of surfactant or disease. DIF: Recall
REF: p. 995
OBJ: 3
44. During mechanical ventilation, a spontaneous breath is defined as one that: a. initiated and terminated by the machine. b. begun by the patient and ended by the machine. c. initiated and terminated by the patient. d. begun by the machine and ended by the patient. ANS: C
A spontaneous breath is a breath for which the patient decides the start time and the tidal volume. That is, the patient both triggers and cycles the breath. DIF: Recall
REF: p. 1002
OBJ: 3
45. During mechanical ventilation, a mandatory breath is defined as one that is: a. initiated or terminated by the machine. b. initiated and terminated by the machine. c. initiated and terminated by the patient. d. begun according to a preset time interval. ANS: A
A mandatory breath is a breath for which the machine sets the start time and/or the tidal volume. That is, the machine triggers and/or cycles the breath. DIF: Recall
REF: p. 1002
OBJ: 3
46. While observing a patient receiving ventilatory support, you notice that all delivered breaths
are initiated or terminated by the machine. Which of the following modes of ventilatory support is in force? a. Intermittent mandatory ventilation b. Partial ventilatory support c. Continuous mandatory ventilation d. Continuous spontaneous ventilation
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: C
In continuous mandatory ventilation, all breaths are mandatory. DIF: Application
REF: p. 1002
OBJ: 3
47. While observing a patient receiving ventilatory support, you notice that some delivered
breaths are begun or ended by the machine, whereas others are begun and ended by the patient. Which of the following modes of ventilatory support is in force? a. Intermittent mandatory ventilation (IMV) b. Pressure support ventilation c. Continuous mandatory ventilation (CMV) d. Airway pressure release ventilation ANS: A
In IMV, breaths can be either mandatory or spontaneous. DIF: Application
REF: p. 1003
OBJ: 3
48. A mode that allows spontaneously breathing patients to breathe at a positive-pressure level,
but drops briefly to a reduced pressure level for CO 2 elimination during each breathing cycle is also known as: a. intermittent mandatory ventilation. b. airwaypressure release ventilation. c. continuous mandatory ventilation (CMV). d. continuous spontaneous ventilation. ANS: B
At this level of description, we can avoid the cumbersome verbal ad hoc definition for airway pressure release ventilation such as ―a mode that allows spontaneously breathing patients to breathe at a positive-pressure level, but drops briefly to a reduced pressure level for CO 2 elimination during each breathing cycle.‖ DIF: Recall
REF: pp. 1001-1002
OBJ: 3
49. Which of the following ventilator control systems are considered closed loop?
1. Orientation based 2. Servo 3. Adaptive 4. Optimal a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
The basic concept of closed-loop control has evolved into at least seven different ventilator control systems. DIF: Recall
REF: p. 1005
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 50. Which of the closed-loop controllers is used by all ventilators? a. Set point b. Auto set point c. Adaptive d. Servo ANS: A
Most ventilators use at least set point control. DIF: Recall
REF: p. 1007
OBJ: 3
51. Which of the following modes is a good example of adaptive control? a. Intermittent mandatory ventilation b. Airway pressure release ventilation c. Continuous mandatory ventilation (CMV) d. Pressure-regulated volume control (PRVC) ANS: D
One of the first examples of a mode using adaptive control was PRVC on the Siemens Servo 300 ventilator. DIF: Recall
REF: p. 1006
OBJ: 3
52. What is the mode of ventilatory support in which patient’s inspiratory efforts are augmented
with a set amount of positive airway pressure? a. Intermittent mandatory ventilation b. Continuous mandatory ventilation (CMV) c. Pressure support ventilation (PSV) d. Positive end expiratory pressure (PEEP) ANS: C
PSV is a form of PC-CSV that assists the patient’s inspiratory efforts. DIF: Recall
REF: p. 1001
OBJ: 3
53. Mean airway pressure is highest with what waveform? a. Rectangular flow b. Rectangular pressure c. Ascending ramp flow d. Sinusoidal flow ANS: B
See Figure 45-5. DIF: Recall
REF: p. 992
OBJ: 3
54. During volume-targeted ventilation, which of the following settings determine the
machine-delivered minute volume? 1. Volume 2. Flow
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3.
Rate a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: B
See Table 45-1. DIF: Application
REF: p. 1000
OBJ: 3
55. During volume-targeted ventilation, which of the following settings determine the inspiratory
time? 1. Volume 2. Flow 3. Rate a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: A
See Table 45-1. DIF: Recall
REF: p. 1000
OBJ: 3
56. During volume-targeted ventilation, which of the following settings determine the expiratory
time? 1. Volume 2. Flow 3. Rate a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
See Table 45-1. DIF: Recall
REF: p. 1000
OBJ: 3
57. During volume-targeted ventilation, which of the following setting(s) determine(s) the total
cycle time? 1. Volume 2. Flow 3. Rate a. 1 and 2 only b. 2 and 3 only c. 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. 1, 2, and 3 ANS: C
See Table 45-1. DIF: Recall
REF: p. 1000
OBJ: 3
58. During volume-targeted ventilation, which of the following settings determine I:E ratio?
1. Volume 2. Flow 3. Rate a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
See Table 45-1. DIF: Application
REF: p. 1000
OBJ: 3
59. A patient receiving continuous mandatory ventilation in the control mode has an inspiratory
time of 1.5 sec and an expiratory time of 2.5 sec. What is the frequency of breathing? a. 10/min b. 12/min c. 15/min d. 18/min ANS: C
See Table 45-1. DIF: Application
REF: p. 1000
OBJ: 3
60. A patient is receiving continuous mandatory ventilation in the control mode at a rate of
15/min. The expiratory time is 2.9 sec. What is the inspiratory time? a. 1.1 sec b. 1.3 sec c. 1.5 sec d. 1.7 sec ANS: A
See Table 45-1. DIF: Application
REF: p. 1000
OBJ: 3
61. A patient is receiving continuous mandatory ventilation in the control mode at a rate of
10/min. The inspiratory time control is set at 40%. What is the inspiratory time? a. 1.60 sec b. 1.85 sec c. 2.40 sec
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. 3.50 sec ANS: C
See Table 45-1. DIF: Application
REF: p. 1000
OBJ: 3
62. A patient is receiving continuous mandatory ventilation in the control mode at a rate of
12/min. The inspiratory time control is set at 33%. What is the expiratory time? a. 1.65 sec b. 2.45 sec c. 3.35 sec d. 3.85 sec ANS: C
See Table 45-1. DIF: Application
REF: p. 1000
OBJ: 3
63. A patient is receiving continuous mandatory ventilation in the control mode at a rate of
15/min. The inspiratory time is 0.8 sec. What is the expiratory time? a. 3.2 sec b. 2.8 sec c. 2.4 sec d. 4.2 sec ANS: A
See Table 45-1. DIF: Application
REF: p. 1000
OBJ: 3
64. A patient is receiving continuous mandatory ventilation in the control mode at a rate of
20/min. The inspiratory time is 0.75 sec. What is the percentage inspiratory time? a. 20% b. 25% c. 30% d. 33% ANS: B
See Table 45-1. DIF: Application
REF: p. 1000
OBJ: 3
65. A patient is receiving continuous mandatory ventilation in the control mode at a rate of
10/min. The inspiratory time control is set at 25%. What is the I:E ratio? a. 1:3 b. 1:2 c. 1:4 d. 1:1 ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
See Table 45-1. DIF: Application
REF: p. 1000
OBJ: 3
66. A patient is receiving continuous mandatory ventilation through a constant flow generator in
the control mode at a rate of 20/min with a V T of 750 ml. The inspiratory time is 1 sec. What is the flow? a. 15 L/min b. 30 L/min c. 45 L/min d. 60 L/min ANS: C
See Table 45-1. DIF: Application
REF: p. 1000
OBJ: 3
67. During pressure-targeted ventilation, which of the following setting(s) determine(s) VT?
1. Pressure difference 2. Inspiratory time 3. Time constant a. 1 and 2 only b. 2 and 3 only c. 3 only d. 1, 2, and 3 ANS: D
See Table 45-1. DIF: Recall
REF: p. 1000
OBJ: 3
68. In which of the following situations is volume-controlled ventilation sometimes used?
1. When a precise PaCO 2 has to be maintained (some closed-head injuries) 2. When more even distribution of ventilation is required 3. When ventilating patients with severe, refractory hypoxemia 4. When ventilating patients with unstable or changing ventilatory drives a. 1 and 2 only b. 3 and 4 only c. 1, 2, and 3 only d. 1, 3, and 4 only ANS: A
Volume-controlled continuous mandatory ventilation is indicated when a precise minute ventilation or blood gas parameter, such as PaCO 2 , is therapeutically essential to the care of patients with normal lung mechanics. Theoretically, volume control (with a constant inspiratory flow) results in a more even distribution of ventilation (compared to pressure control) among lung units with different time constants where the units have equal resistances but unequal compliances (e.g., acute respiratory distress syndrome [ARDS]). DIF: Recall
REF: p. 1010
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 69. In which of the following situations is pressure-controlled ventilation sometimes used?
1. When a precise PaCO 2 has to be maintained (some closed-head injuries) 2. When more even distribution of ventilation is required 3. When ventilating patients with severe, refractory hypoxemia 4. When tidal volume in unstable due to leaks a. 1 and 2 only b. 3 and 4 only c. 1, 2, and 3 only d. 1, 3, and 4 only ANS: B
Pressure-controlled continuous mandatory ventilation is indicated when adequate oxygenation has been difficult to achieve in other modes of ventilation. The instability of tidal volume caused by airway leaks can be minimized by using pressure-controlled ventilation rather than volume-controlled ventilation. DIF: Recall
REF: p. 1010
OBJ: 3
70. Which of the following is the primary parameter used to alter the breath size in pressure
controlled? a. Positive inspiratory pressure (PIP)—positive end expiratory pressure (PEEP) b. Continuous positive airway pressure (CPAP) c. Tidal volume d. Flow ANS: A
Because tidal volume is not directly controlled, the pressure gradient (PIP − PEEP) is the primary parameter used to alter the breath size and hence carbon dioxide tensions. DIF: Recall
REF: p. 1000
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 46 - Physiology of Ventilato ry Suppo rt Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. In which of the following types of ventilation is alveolar expansion during inspiration due to a
decrease in pleural pressure? 1. Positive-pressure ventilation (PPV) 2. Negative-pressure ventilation (NPV) 3. Spontaneous ventilation a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: C
NPV decreases pleural pressure (Pp1 ) during inspiration by exposing the chest to sub-atmospheric pressure. DIF: Recall
REF: p. 1019
OBJ: 1
2. Which of the following statements are true about negative-pressure ventilation (NPV)?
1. NPV is similar to spontaneous breathing. 2. Airway (mouth) pressure during NPV is zero. 3. Expiration during NPV is by passive recoil. 4. NPV decreases pressure at the body surface. a. 2 and 4 only b. 1, 2, 3, and 4 c. 3 and 4 only d. 1, 3, and 4 only ANS: B
Mechanical NPV is similar to spontaneous breathing. NPV decreases pleural pressure (P pl) during inspiration by exposing the chest to sub-atmospheric pressure. Negative pressure at the body surface (Pbs ) is transmitted first to the pleural space and then to the alveoli (Palv ). Because the airway opening remains exposed to atmospheric pressure during NPV, a transairway pressure gradient is created. Thus, gas flows from the relatively high pressure at the airway opening (zero) to the relatively low pressure in the alveoli (negative). DIF: Recall
REF: pp. 1010-1020
OBJ: 1
3. In which of the following types of ventilation is alveolar expansion during inspiration due to
an increase in alveolar pressure? 1. Negative-pressure ventilation 2. Positive-pressure ventilation 3. Spontaneous ventilation a. 1 and 2 only b. 2 and 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 2 only d. 1, 2, and 3 ANS: C
Gas flows into the lungs because pressure at the airway opening (Pawo ) is positive and alveolar pressure (Palv ) is initially zero or less positive. DIF: Recall
REF: p. 1019
OBJ: 1
4. Which of the following occur with positive-pressure ventilation (PPV)?
1. During inspiration, pleural pressure decreases. 2. During inspiration, pressure in the alveoli increases. 3. The pressure gradients of normal breathing are reversed. 4. During inspiration, alveolar pressure exceeds pleural pressure. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Because alveolar pressure is greater than pleural pressure (P pl) during PPV, positive pressure is transmitted from the alveoli to the pleural space, causing pleural pressure to increase during inspiration. DIF: Recall
REF: p. 1021
OBJ: 1
5. In which of the following types of ventilation can pleural pressure become positive during
inspiration? 1. Positive-pressure ventilation 2. Spontaneous ventilation 3. Negative-pressure ventilation a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 only ANS: D
Because alveolar pressure is greater than pleural pressure (P pl) during PPV, positive pressure is transmitted from the alveoli to the pleural space, causing pleural pressure to increase during inspiration. DIF: Recall
REF: p. 1021
OBJ: 1
6. Which of the following conditions is associated with a lack of response to increased FiO 2 in
patients receiving positive-pressure ventilation? a. Dead space b. Shunt c. Hypoxemia d. Hypoventilation
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ANS: B
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
If the patient is receiving mechanical ventilation and has adequate alveolar ventilation, failure of the PaO2 to respond to increased FiO2 likely means that the hypoxemia is due to diffusion defect or shunt. DIF: Recall
REF: p. 1023
OBJ: 2
7. Which of the following strategies are useful in the management of shunt?
1. Positive end expiratory pressure 2. Permissive hypercapnia 3. Control of membrane permeability a. 2 and 3 only b. 1 and 3 only c. 1, 2, and 3 d. 1 only ANS: B
The use of PEEP and control of membrane permeability accompany the management of shunt. DIF: Recall
REF: p. 1025
OBJ: 2
8. Administration of positive end expiratory pressure (PEEP) or continuous positive airway
pressure (CPAP) is associated with which of the following benefits? 1. Helps maintain open alveoli. 2. Helps with alveoli stability. 3. Helps maintain fluid-filled alveoli open. 4. Ensures surfactant-depleted alveoli remain closed. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Administration of PEEP with mechanical ventilation or to a spontaneously breathing patient in the form of CPAP helps to maintain open and stabilize small, collapsed, or fluid -filled alveoli. DIF: Recall
REF: p. 1023
OBJ: 2
9. Which of the following is considered a normal spontaneous tidal volume? a. 3 to 5 ml/kg b. 5 to 7 ml/kg c. 7 to 9 ml/kg d. 10 to 12 ml/kg ANS: B
A normal spontaneous tidal volume is approximately 5 to 7 ml/kg. DIF: Recall
REF: p. 1021
OBJ: 2
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 10. Which of the following is the recommended tidal volume for mechanical ventilation in a
patient with ARDS who is in acute respiratory failure? a. 4 to 8 ml/kg b. 3 to 5 ml/kg c. 6 to 10 ml/kg d. 10 to 12 ml/kg ANS: A
The currently accepted tidal volume for mechanical ventilation in acute respiratory failure is 4 to 8 ml/kg for patients with acute respiratory distress syndrome (ARDS). DIF: Recall
REF: p. 1042
OBJ: 2
11. Which of the following conditions may require higher initial respiratory rates?
1. Metabolic alkalosis 2. ARDS 3. Increased intracranial pressure 4. Metabolic acidosis a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Conditions that may necessitate a higher initial rate include ARDS, acutely increased intracranial pressure (with caution), and metabolic acidosis. DIF: Application
REF: p. 1022
OBJ: 2
12. Which of the following is the explanation for the increased ratio when excessive positive end
expiratory pressure (PEEP) is used? a. Diversion of blood from ventilated alveoli to hypoventilated alveoli b. Diversion of blood from hypoventilated alveoli to ventilated alveoli c. Shunt-like effect d. Hyperexpansion ANS: A
When excessive PEEP is used, blood flow is diverted from ventilated alveoli to hypoventilated alveoli; the result is an increased ratio. DIF: Recall
REF: p. 1025
OBJ: 2
13. Which of the following is the consequence of decreased resistance or compliance? a. It takes more time to fill the alveoli. b. It takes more time to empty the alveoli. c. It takes less time to fill and more time to empty the alveoli. d. It takes less time to fill and empty the alveoli. ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
If compliance or resistance decreases, the time constant for a given lung unit decreases, and the lung fills and empties faster. DIF: Recall
REF: p. 1026
OBJ: 2
14. Mean airway pressures can be increased by which of the following factors?
1. Increasing the inspiratory time 2. Increasing compliance 3. Increasing level of PEEP 4. Changing from a square to a decelerating ramp waveform a. 1, 2, and 3 only b. 1, 3, and 4 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
See Box 46-1. DIF: Recall
REF: p. 1027
OBJ: 2
15. During pressure-targeted modes of ventilatory support, the volume delivered depends on
which of the following? 1. Set pressure limit 2. Patient lung mechanics 3. Patient effort a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
The volume delivered during pressure-controlled modes varies with changes in set pressure, patient effort, and lung mechanics. DIF: Recall
REF: p. 1027
OBJ: 3
16. Which of the following occur in pressure-limited modes of ventilation?
1. The volume delivered at a given pressure must decrease as compliance falls. 2. The inspiratory flow varies with patient effort and lung mechanics. 3. Active effort by the patient against inspiration will decrease delivered volume. 4. The volume delivered at a given pressure must increase as Raw rises. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
An increase in resistance, active exhalation, or muscle tensing by the patient during inspiration also decreases delivered volume in pressure ventilation.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application
REF: p. 1027
OBJ: 3
17. The volume delivered by a pressure-limited ventilator will decrease under which of the
following conditions? 1. The patient’s lung or thoracic (chest wall) compliance falls. 2. Airway resistance rises (inspiratory time <3 times the time constant). 3. The patient tenses the respiratory muscles during inspiration. 4. Airway resistance rises (inspiratory time >3 times the time constant). a. 1 and 3 only b. 1, 3, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
However, if insufficient time is available for pressure equilibration, delivered volume decreases as airway resistance increases. DIF:
Application
REF: pp. 1027-1028
OBJ: 3
18. Which of the following are considered safe settings for a recruitment maneuver?
1. Pressures up to 50 cm H2 O 2. Pressures up to 35 cm H2 O 3. Pressures applied for 5 to 10 min 4. Pressures applied for 1 to 3 min a. 1 and 3 only b. 1 and 4 only c. 2 and 3 only d. 2 and 4 only ANS: B
The maximum pressure needed to recruit a given patient’s lung is unknown; however, most agree that pressures up to 50 cm H2 O are safe with most patients when applied for short (1 to 3 min) periods of time. DIF: Recall
REF: p. 1028
OBJ: 3
19. During pressure-controlled continuous mandatory ventilation, when the patient’s lung
compliance increases, which of the following will occur? a. The tidal volume will increase. b. The FRC will increase. c. The peak airwaypressure will increase. d. The inspiratory time will decrease. ANS: A
During pressure-controlled continuous mandatory ventilation, the pressure delivered is constant. In lung mechanics, pressure = tidal volume/lung compliance. Since pressure is constant when lung compliance increases the tidal volume also increases. DIF: Analysis
REF: p. 1035
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 20. In which of the following modes of ventilatory support would the patient’s work of breathing
be greatest? a. Continuous positive airway pressure (CPAP) b. Pressure-supported ventilation (PSV) c. Intermittent mandatory ventilation (IMV) d. Continuous mandatory ventilation (CMV) ANS: A
As the mode is changed from CPAP to PSV to synchronized intermittent mandatory ventilation to time-triggered CMV, the ventilator assumes more of the work. DIF: Application
REF: p. 1030
OBJ: 3
21. In which of the following modes of ventilatory support would the patient’s work of breathing
be least? a. Continuous positive airway pressure (CPAP) b. Pressure-supported ventilation (PSV) c. Intermittent mandatory ventilation (IMV) d. Continuous mandatory ventilation (CMV) ANS: D
As the mode is changed from CPAP to PSV to synchronized intermittent mandatory ventilation to time-triggered CMV, the ventilator assumes more of the work. DIF: Application
REF: p. 1039
OBJ: 3
22. When bedside work of breathing measures are unavailable, you should adjust the level of
pressure-supported ventilation (PSV) to which of the following breathing patterns? Spontaneous Rate VT a. 20 breaths/min 6 ml/kg b. 27 breaths/min 9 ml/kg c. 22 breaths/min 4 ml/kg d. 10 breaths/min 9 ml/kg ANS: A
Most clinicians increase PSV until the breathing pattern approaches normal, that is, until the spontaneous ventilatory rate is 15 to 25 breaths/min and the spontaneous tidal volume (VT) is normal (5 to 8 ml/kg). DIF: Application
REF: p. 1039
OBJ: 3
23. To prevent muscle fatigue or atrophy, the level of PSV should be adjusted to achieve what
work load? a. 0 J/L b. 0.6 to 0.8 J/L c. 0 to 0.5 J/L d. Greater than 0.8 J/L ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Normal work of breathing is 0.6 to 0.8 J/L. DIF: Recall
REF: p. 1039
OBJ: 3
24. Which level of plateau pressure increases the likelihood of causing lung injury? a. Greater than 15 cm H 2 O b. Greater than 25 cm H 2 O c. Greater than 28 cm H 2 O d. Greater than 32 cm H 2 O ANS: C
Alveolar pressures of 28 cm H 2 O or greater have an increased likelihood of causing lung injury. DIF: Recall
REF: p. 1050
OBJ: 3
25. All of the following factors would tend to increase mean airway pressure except: a. short inspiratory times. b. increased mandatory breaths. c. increased levels of positive inspiratory pressure (PIP). d. increased levels of positive end expiratory pressure (PEEP). ANS: A
Mean airway pressure is decreased by decreasing inspiratory time, tidal volume, respiratory rate, PEEP, or PIP. DIF: Recall
REF: p. 1027
OBJ: 3
26. Primary indications for using positive end expiratory pressure (PEEP) in conjunction with
mechanical ventilation include which of the following? 1. When dynamic hyperinflation occurs in chronic obstructive pulmonary disease (COPD) patients. 2. When the imposed work of breathing is excessive. 3. When acute lung injury causes refractory hypoxemia. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: B
PEEP is used primarily to improve oxygenation in patients with refractory hypoxemia. PEEP may be indicated in the care of patients with COPD who have dynamic hyperinflation (auto-PEEP) during mechanical ventilatory support after other efforts to decrease auto-PEEP fail. DIF: Recall
REF: p. 1025
OBJ: 4
27. In which of the following patients is positive end expiratory pressure (PEEP) most indicated?
FiO 2 a. 0.3
PaO 2 80 mm Hg
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b. 0.5 c. 0.3 d. 0.5
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
80 mm Hg 50 mm Hg 50 mm Hg
ANS: C
As a rule, refractory hypoxemia exists when a patient’s PaO 2 cannot be maintained above 50 to 60 mm Hg with an FiO 2 of 0.40 to 0.50 or more. DIF: Analysis
REF: p. 1025
OBJ: 4
28. Beneficial physiological effects of positive end expiratory pressure (PEEP) include which of
the following? 1. Increased PaO 2 for given FiO 2 2. Increased lung compliance (CL) 3. Decreased shunt fraction 4. Increased functional residual capacity a. 1, 2, 3, and 4 b. 3 and 4 only c. 2, 3, and 4 only d. 2 and 4 only ANS: A
See Table 46-2. DIF: Recall
REF: p. 1031
OBJ: 4
29. Detrimental effects of positive end expiratory pressure (PEEP) include which of the
following? 1. Increased incidence of barotrauma 2. Decreased venous return or cardiac output 3. Increased pulmonary vascular resistance 4. Increased CL a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
See Table 46-2. DIF: Recall
REF: p. 1031
OBJ: 4
30. Contraindications for using positive end expiratory pressure (PEEP) in conjunction with
mechanical ventilation include which of the following? 1. Untreated bronchopleural fistula 2. Chronic airway obstruction 3. Untreated pneumothorax a. 1 and 2 only b. 1 and 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 2 and 3 only d. 1, 2, and 3 ANS: B
PEEP is contraindicated in the presence of an unmanaged bronchopleural fistula or pneumothorax. DIF: Recall
REF: p. 1031
OBJ: 4
31. Compared with a square wave flow pattern, a decelerating flow waveform has which of the
following potential benefits? 1. Reduced peak pressure 2. Improved cardiac output 3. Less inspiratory work 4. Decreased volume of dead space-to-tidal volume ratio (VD/V T) a. 1 and 3 only b. 1, 3, and 4 only c. 2 and 4 only d. 2, 3, and 4 only ANS: B
Compared with a square flow waveform, decreasing flow has been shown to reduce peak pressure, inspiratory work, VD/VT, and P(A−a)O 2 without affecting hemodynamic values. DIF: Recall
REF: p. 1032
OBJ: 4
32. Which of the following is a benefit of high inspiratory flows during positive-pressure
ventilation? a. Improved gas exchange b. Higher peak pressures c. Reduced air trapping d. Higher work of breathing ANS: C
High ventilator inspiratory flow allows more time for exhalation and reduces the incidence of air trapping. DIF: Application
REF: p. 1032
OBJ: 4
33. Physiological effects of adding a volume-limited inflation hold to mandatory breaths include
which of the following? 1. Decreased PaCO 2 2. Increased inspiratory time 3. Decreased VD/V T 4. Longer expiratory times a. 2 and 4 only b. 1, 2, 3, and 4 c. 3 and 4 only d. 1, 2, and 3 only
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ANS: D
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
By momentarily maintaining lung volume under conditions of no flow, an inflation hold allows additional time for gas redistribution between lung units with different time constants. In both animal and human studies, increasing the length of an inflation hold decreases the V D/V T, PaCO 2 , and inert gas washout time. Adding an inflation hold effectively increases total inspiratory time, thereby shortening the time available for exhalation. DIF: Recall
REF: p. 1032
OBJ: 4
34. Volume-controlled (VC) modes of mechanical ventilation include which of the following?
1. VC continuous mandatory ventilation 2. VC intermittent mandatory ventilation 3. Volume-assured, pressure-controlled 4. Bilevel positive airway pressure a. 2 and 4 only b. 1, 2, 3, and 4 c. 1 and 2 only d. 1, 3, and 4 only ANS: C
VC modes include VC continuous mandatory ventilation and VC synchronized intermittent mandatory ventilation. DIF: Recall
REF: pp. 1032-1033 |p. 1035
OBJ: 3
35. Which of the following modes of support provides all of the patient’s minute ventilation (V E)
as mandatory volume-controlled (VC) breaths? a. VC continuous mandatory ventilation b. VC intermittent mandatory ventilation c. Pressure-supported ventilation d. Continuous positive airway pressure ANS: A
VC continuous mandatory ventilation provides all of the patient’s minute ventilation as mandatory breaths. DIF: Recall
REF: p. 1032
OBJ: 3
36. Which of the following modes of ventilatory support would result in the highest mean airway
pressure? a. Volume-controlled intermittent mandatory ventilation b. (Volume-controlled intermittent mandatory ventilation) + pressure-supported ventilation c. Pressure-controlled intermittent mandatory ventilation d. Volume-controlled continuous mandatory ventilation ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Because every breath is volume controlled, mean airway pressure tends to be greater compared with the mean airway pressure with synchronized intermittent mandatory ventilation and pressure-supported ventilation, and pulmonary arterial pressure and cardiac output may be lower. DIF: Recall
REF: p. 1027
OBJ: 3
37. What are some key causes of patient-ventilator asynchrony and increased work of breathing
during pressure-triggered volume-controlled continuous mandatory ventilation? 1. Improper trigger setting 2. Insufficient inspiratory flow 3. High peak airway pressures a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: A
If sensitivity is set too low, such that considerable effort is necessary to trigger the ventilator, patient-ventilator asynchrony occurs. A pressure sensitivity of −0.5 to −1.5 cm H 2 O or flow sensitivity of 1 to 2 L/min is regarded as optimal. Inspiratory flow must be set to meet the patient’s inspiratory demand. An insufficient inspiratory flow can cause patient-ventilator asynchrony and increased work of breathing. DIF: Application
REF: p. 1032
OBJ: 8
38. Inspection of the airway pressure waveform of a patient receiving volume-controlled
continuous mandatory ventilation assist-control with constant flow reveals a large dip or drop in pressure at the beginning of inspiration. Which of the following problems is most likely? a. The trigger setting is improper. b. The inspiratory flow is inadequate. c. The set volume is too large. d. The pressure limit is too low. ANS: A
At the beginning of inspiration, a small negative deflection on the manometer suggests an appropriate sensitivity setting. DIF: Recall
REF: p. 1033
OBJ: 8
39. During volume-controlled continuous mandatory ventilation, should either compliance
decrease or airway resistance (Raw) increase, what will happen? a. The peak airway pressure will decrease. b. The inspiratory flow will increase. c. The peak airwaypressure will increase. d. The inspiratory time will decrease. ANS: C
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Should compliance decrease or airway resistance increase, the pressure needed to deliver the volume increases. DIF: Application
REF: p. 1033
OBJ: 3
40. The volume of gas actually delivered to a patient by most positive-pressure ventilation is
always less than that expelled from the machine. Which of the following factors help to explain this finding? 1. Gas compression under pressure 2. Presence of built-in leaks 3. Expansion of the ventilator circuitry a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: D
First, gases are compressed when delivered under pressure. Thus, the generated volume (at atmospheric pressure) occupies less space when delivered under pressure. Second, most ventilator circuits are somewhat compliant. DIF: Application
REF: pp. 1023-1024
OBJ: 3
41. After accounting for the compressed volume loss on a stable adult patient receiving
volume-controlled continuous mandatory ventilation at a preset volume of 500 ml, you still note a 150-ml difference between the expected and the actual delivered volume. Which of the following is most likely causing this problem? a. Gas absorption across the alveolar membrane b. Increase in the respiratory quotient c. Bronchopleural fistula or pneumothorax d. Leak in the patient-ventilator system ANS: D
An additional factor that can cause a patient to receive less volume than the ventilator delivers is a leak. DIF: Application
REF: p. 1049
OBJ: 8
42. Which of the following is considered an acceptable tidal volume for mechanical ventilation? a. 3 to 5 ml/kg b. 5 to 7 ml/kg c. 4 to 8 ml/kg d. 8 to 10 ml/kg ANS: B
The currently accepted VT for mechanical ventilation in acute respiratory failure is 4 to 8 ml/kg predicted body weight (PBW). DIF: Recall
REF: p. 1022
OBJ: 2
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 43. Which of the following modes of ventilatory support is used to help decrease airway and
alveolar pressures? a. Pressure-controlled continuous mandatory ventilation b. Pressure-controlled intermittent mandatory ventilation c. Volume-controlled continuous mandatory ventilation d. Volume-assured pressure-supported ventilation ANS: A
Pressure-controlled continuous mandatory ventilation may be used to reduce airway and alveolar pressures in any ventilated patient. DIF: Recall
REF: p. 1033 |p. 1035
OBJ: 3
44. What mode of pressure-controlled ventilation is designed to prevent alveoli with short-time
constants from collapsing, thereby improving oxygenation? a. Pressure-controlled inverse ratio ventilation b. Pressure-controlled intermittent mandatory ventilation c. Volume-assured pressure-supported ventilation d. Bilevel positive airway pressure ANS: A
Because alveoli affected by ALI/ARDS have short-time constants, more time is allotted for inspiration and less time is allotted for expiration. DIF: Recall
REF: p. 1035
OBJ: 3
45. A patient switched from pressure-controlled continuous mandatory ventilation (CMV) with
positive end expiratory pressure (PEEP) to pressure-controlled inverse ratio ventilation (PC-IRV) shows a good improvement in PaO 2 but a decrease in tissue oxygenation. Which of the following best explains this observation? a. High mean pressures caused by PC-IRV decreased pulmonary blood flow. b. Intrinsic PEEP caused by PC-IRV resulted in increased alveolar recruitment. c. High mean pressures caused by PC-IRV decreased cardiac output. d. Intrinsic PEEP caused by PC-IRV compressed the pulmonary capillaries. ANS: C
Although some studies have shown improvement in oxygenation with PC-IRV versus CMV with PEEP, others have shown concurrent decreases in cardiac output. DIF: Application
REF: p. 1035
OBJ: 7
46. In which mode of ventilatory support does the patient breathe spontaneously at an elevated
airway pressure, with short, intermittent decreases in pressure to a lower level? a. Volume-assured pressure-supported ventilation b. Pressure-controlled inverse ratio ventilation c. Bilevel positive airway pressure d. Airway pressure-release ventilation ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
A mode related to PC-IRV is APRV, in which the patient breathes spontaneously throughout periods of high and low applied continuous positive airway pressure. DIF: Recall
REF: p. 1038
OBJ: 3
47. What does pressure-supported ventilation consist of? a. Patient-triggered, pressure-limited, and flow-cycled breaths b. Machine-triggered, pressure-limited, and flow-cycled breaths c. Patient-triggered, pressure-limited, and time-cycled breaths d. Machine-triggered, flow-limited, and pressure-cycled breaths ANS: A
Pressure-supported ventilation is a pressure-targeted mode of ventilation that is patient-triggered, pressure-limited, and flow-cycled breaths (Figure 46-16). DIF: Recall
REF: p. 1039
OBJ: 3
48. What are some primary uses for pressure-supported ventilation (PSV)?
1. Recruiting collapsed alveoli and improving oxygenation 2. Augmenting patient’s spontaneous V T 3. Overcoming the imposed work of breathing a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: C
Since the first description of PSV in 1982, it has been used either to overcome the imposed resistance associated with the artificial airway or to provide ventilatory support with minimal control. DIF: Recall
REF: p. 1039
OBJ: 3
49. For patients with respiratory insufficiency, pressure-supported ventilation (PSV) has all of the
following advantages over spontaneous breathing except: a. decreased respiratory rate. b. increased VT. c. decreased O2 consumption. d. increased muscle activity. ANS: D
Clinical studies have shown that compared with spontaneous breathing (including that occurring during synchronized intermittent mandatory ventilation), PSV can result in a decreased respiratory rate, increased tidal volume, reduced respiratory muscle activity, and decreased oxygen consumption. DIF: Application
REF: p. 1039
OBJ: 3
50. What spontaneous pressure-controlled breath mode allows separate regulation of the
inspiratory and expiratory pressures?
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a. b. c. d.
TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Bilevel positive airway pressure Continuous positive airway pressure Pressure-supported ventilation Pressure-controlled intermittent mandatory ventilation
ANS: A
With BiPAP, inspiratory positive airway pressure (IPAP or pressure-supported ventilation) and expiratory positive airway pressure (EPAP or positive end expiratory pressure) are set. DIF: Recall
REF: p. 1039
OBJ: 3
51. Bilevel positive airway pressure (BiPAP) is used for which of the following purposes?
1. Nocturnal ventilatory support of chronic disease patients 2. Preventing intubation of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) 3. Treatment of obstructive sleep apnea (OSA) in the home 4. Providing ventilatory support for patients with status asthmaticus a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Although it was originally developed to enhance the capabilities of home CPAP systems used for management of OSA, BiPAP has since been successfully used in the home and the hospital for noninvasive ventilatory support of patients with acute and chronic respiratory failure. BiPAP has been found to be useful in the prevention of intubation in acute exacerbation of COPD. DIF: Recall
REF: p. 1039
OBJ: 3
52. Which of the following modes of ventilatory support combines the advantages of
pressure-controlled and volume-controlled ventilation? a. Volume-assured pressure-supported ventilation b. Pressure-supported ventilation c. Bilevel positive airway pressure d. Airway pressure-release ventilation ANS: A
Pressure-supported ventilation with a volume guarantee is the goal of volume-assured pressure-supported ventilation. DIF: Application
REF: pp. 1040-1041
OBJ: 3
53. During volume-assured pressure-supported ventilation, the breath will be pressure-limited
under what conditions? a. The delivered tidal volume (V T) is greater than the preset minimum VT. b. The patient’s lung or thoracic compliance decreases from the baseline. c. The delivered VT is less than the preset minimum VT.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
d. The patient’s Raw increases from baseline. ANS: A
If delivered tidal volume is greater than the preset minimum tidal volume, the breath becomes a pressure-supported breath. DIF: Recall
REF: p. 1041
OBJ: 3
54. During volume-assured pressure-supported ventilation, if the desired V T is not reached or
exceeded at the preset pressure support level, what happens? a. Flow continues at a constant rate until the desired volume is achieved. b. The breath terminates when a predetermined low flow is achieved. c. Flow decreases exponentially until the desired volume is achieved. d. Flow increases linearly until the desired volume is achieved. ANS: A
Although a minimum tidal volume is guaranteed, volume-assured pressure-supported ventilation allows tidal volume to exceed the set level according to patient demand. DIF: Recall
REF: p. 1041
OBJ: 3
55. What are some physiological advantages of volume-assured pressure-supported ventilation?
1. Improved patient-ventilator synchrony 2. Increased pressure-time product 3. Decreased work of breathing a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: B
Physiological effects of volume-assured pressure-supported ventilation include improved patient-ventilator synchrony and reduced pressure-time product, which is an indicator of decreased work of breathing. DIF: Recall
REF: p. 1041
OBJ: 3
56. Which of the following are true about continuous positive airway pressure (CPAP)?
1. It maintains alveoli at greater inflation volumes. 2. It holds airway pressure essentially constant. 3. It provides the pressure gradient needed for ventilation. 4. It has side effects similar to those of positive pressure ventilation. a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Because airway pressure does not change, CPAP does not provide ventilation.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 1039 OBJ: 4 57. Which of the following variables determine the level of support achieved with adaptive
support ventilation? 1. Patient effort 2. Flow 3. Time constant a. 1 and 3 only b. 2 only c. 1 only d. 1, 2, and 3 ANS: A
Adaptive support ventilation is a dual-controlled mode of ventilation in which an automated increase or decrease in ventilatory support is based on patient effort and time constants. DIF: Recall
REF: p. 1041
OBJ: 3
58. Which of the following variables determine the level of support achieved with proportional
assist ventilation? 1. Patient effort 2. Elastance 3. Resistance a. 1 and 3 only b. 2 only c. 1 only d. 1, 2, and 3 ANS: D
Proportional assist ventilation is a mode of ventilation designed to vary inspiratory pressure in proportion to patient effort, elastance, and resistance. DIF: Recall
REF: p. 1040
OBJ: 3
59. Which of the following variables determine the level of support achieved with adaptive
support ventilation? 1. Patient effort 2. Elastance 3. Resistance of the endotracheal tube a. 1 and 3 only b. 2 only c. 1 only d. 1, 2, and 3 ANS: A
Automatic tube compensation is similar to the flow assist of proportional assist ventilation but only considers the resistance of the endotracheal tube. DIF: Application
REF: p. 1041
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 60. Which of the following parameters are set when volume-supported ventilation (VSV) is used?
1. Tidal volume 2. Maximum peak pressure 3. Positive end expiratory pressure (PEEP) 4. Flow a. 1 and 3 only b. 2 only c. 1, 2, 3, and 4 d. 1, 2, and 3 only ANS: D
In VSV, a desired tidal volume, maximum peak pressure, FiO 2 , and PEEP are set. DIF: Recall
REF: p. 1041
OBJ: 3
61. What factor primarily determines the effect of positive-pressure ventilation (PPV) on the
cardiac output? a. Peak airway pressure b. Mean pleural pressure c. CO 2 d. Expiratory time ANS: B
More specifically, the decrease in left ventricular output corresponded to the increase in pleural pressure that occurred with PPV. DIF: Recall
REF: p. 1043
OBJ: 5
62. Which of the following are potential effects of positive-pressure ventilation on the
cardiovascular system? 1. Decreased venous return 2. Decreased cranial perfusion pressures 3. Increased pulmonary blood flow 4. Decreased ventricular stroke volume a. 2 and 4 only b. 1 and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
Positive pleural pressure compresses the intrathoracic veins and increases central venous and right atrial filling pressures. As these pressures increase, venous return to the heart is impeded and right ventricular preload and stroke volume decrease, as does pulmonary blood flow. DIF: Recall
REF: p. 1044
OBJ: 5
63. Moderate rises in pleural pressure during positive-pressure ventilation have a minimal effect
on cardiac output in normal subjects. What are some reasons for this lack of effect? 1. Compensatory dilation of the large arteries
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. Compensatory increase in venomotor tone 3. Compensatory increase in the cardiac rate a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: A
Compensatory mechanisms used to counter the decrease in stroke volume include an increased heart rate, an increase in systemic vascular and peripheral venous resistance, and shunting of blood away from the kidneys and lower extremities, which results in a consistent blood pressure. DIF: Recall
REF: p. 1044
OBJ: 5
64. Ventricular dysfunction occurs in patients receiving positive-pressure ventilation for which of
the following reasons? 1. Hypovolemia 2. Excessive tidal volume 3. Receiving more than optimal positive end expiratory pressure (PEEP) 4. Hypervolemia a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
It appears that right or left ventricular dysfunction occurs if the patient is hypovolemic, receiving an excessive tidal volume, or receiving more than optimum PEEP. DIF: Recall
REF: p. 1044
OBJ: 5
65. Assuming a constant rate of breathing, which of the following inspiratory-to-expiratory (I:E)
ratio would tend to most greatly impair a patient’s systemic diastolic pressure? a. 1:4 b. 1:3 c. 1:2 d. 1:1 ANS: D
The factors of positive-pressure ventilation that may decrease the systemic diastolic pressure are high mean airway pressure, due to a high positive end expiratory pressure, high tidal volume, or long inspiratory time. DIF: Application
REF: p. 1044
OBJ: 5
66. Potential effects of hyperventilation on the central nervous system include which of the
following? 1. Increased O 2 consumption
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. Increased cerebral vascular resistance (CVR) 3. Increased intracranial pressure (ICP) a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
When mechanical hyperventilation is used, CVR increases, and the result is decreased ICP. DIF: Application
REF: p. 1046
OBJ: 5
67. Hyperventilation should generally be avoided during mechanical ventilatory support.
Exceptions to this rule include: 1. Trying to calm an agitated patient. 2. Failure of other methods to reduce intracranial pressure. 3. Hypokalemia causing cardiac arrhythmias. a. 2 and 3 only b. 1 and 3 only c. 2 only d. 1 and 2 only ANS: C
Hyperventilation should be used temporarily after traumatic brain injury until other methods can be used to decrease elevated intracranial pressure. DIF: Recall
REF: p. 1046
OBJ: 6
68. A patient receiving long-term positive-pressure ventilation support exhibits a progressive
weight gain and a reduction in the hematocrit. Which of the following is the most likely cause of this problem? a. Pulmonary hemorrhage b. Water retention c. Hypovolemia d. Hyponatremia ANS: B
Among critically ill patients, water retention usually is evident when rapid weight gain occurs. In addition, such patients may have a reduced hematocrit, which is also consistent with hypervolemia due to water retention. DIF: Application
REF: p. 1046
OBJ: 6
69. Positive-pressure ventilation (PPV) can reduce urinary output by how much? a. 10% to 20% b. 30% to 50% c. 60% to 70% d. 80% to 90% ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
In terms of direct effect, PPV can reduce urinary output as much as 30% to 50%. DIF: Recall
REF: p. 1047
OBJ: 6
70. Which of the following mechanisms explains the impaired renal function seen in patients
receiving ventilatory support with positive pressure? 1. Decreased secretion of aldosterone 2. Decreased intravascular volume 3. Increased secretion of vasopressin a. 1 only b. 2 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
Results of more recent analysis tend to refute this explanation, instead showing that impaired renal function during positive-pressure ventilation is better associated with a decrease in intravascular volume. DIF: Recall
REF: p. 1047
OBJ: 6
71. Which of the following is the best explanation for the decreased levels of atrial natriuretic
hormone commonly observed among patients receiving positive-pressure ventilation? a. Stimulation of the pulmonary stretch receptors b. Inhibition of posterior pituitary function c. Inhibition of the cortex of the adrenal gland d. Decreased right atrial transmural pressure ANS: D
Decreased right atrial transmural pressure is primarily responsible for the decrease in atrial natriuretic hormone, which leads to sodium retention. DIF: Recall
REF: p. 1046
OBJ: 6
72. Which of the following mechanisms explains the hepatic dysfunction in patients receiving
positive-pressure ventilation (PPV)? a. Decreased hepatic blood flow b. Increased portal venous pressure c. Hepatic congestion d. Increased bilirubin conjugation ANS: A
These effects appear to be directly related to the reduction in hepatic blood flow that occurs with PPV. DIF: Recall
REF: p. 1047
OBJ: 6
73. Which of the following gastrointestinal conditions are commonly associated with long-term
positive-pressure ventilation (PPV)? 1. Bleeding
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. Ulceration 3. Diarrhea a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
An increase in splanchnic resistance can contribute to gastric mucosal ischemia and helps explain the high incidence of gastrointestinal bleeding and stress ulceration in patients receiving long-term PPV. DIF: Recall
REF: pp. 1047-1048
OBJ: 6
74. What is traumatic injury to lung tissue caused by excessive pressure called? a. Pulmonary barotrauma b. Pulmonary hemorrhage c. Pulmonary infarction d. Pulmonary embolism ANS: A
High ventilation pressure has long been associated with barotrauma. DIF: Recall
REF: p. 1049
OBJ: 7
75. Types of damage associated with pulmonary barotrauma include which of the following?
1. Pneumoconiosis 2. Pneumomediastinum 3. Pneumothorax 4. Subcutaneous emphysema a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Barotrauma is categorized as pneumothorax, pneumomediastinum, pneumopericardium, and subcutaneous emphysema (Figure 46-19). DIF: Recall
REF: p. 1049
OBJ: 7
76. Physical assessment indicating the presence of a tension pneumothorax includes which of the
following? 1. Unequal chest excursion 2. Hyperresonance upon chest percussion 3. Absent breath sounds 4. Loud breath sounds a. 1 and 3 only b. 1, 2, and 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Pneumothorax is identified by observation of a decrease in chest movement, hyperresonance on percussion, and decreased or absent breath sounds over the affected side. DIF: Application
REF: p. 1049
OBJ: 7
77. Which of the following terms describe the lung injury associated with the use of low tidal
volumes? a. Biotrauma b. Barotrauma c. Volutrauma d. Atelectrauma ANS: D
Lung damage may also occur when ventilating at low tidal volumes, if alveoli are allowed to deflate and reinflate repeatedly with each breath. This injury is called atelectrauma. DIF: Recall
REF: p. 1050
OBJ: 7
78. Which of the following terms describes the lung injury associated with the release of
prostanoids? a. Biotrauma b. Barotrauma c. Volutrauma d. Atelectrauma ANS: A
These biochemical signals cause the release of cytokines, complement, prostanoids, leukotrienes, reactive oxygen species, and proteases. The release of these substances has been called ―biotrauma.‖ DIF: Recall
REF: p. 1051
OBJ: 7
79. Which of the following lung units would be most prone to air-trapping? a. One with high resistance and low compliance b. One with low resistance and low compliance c. One with normal resistance and low compliance d. One with high resistance and high compliance ANS: D
Air-trapping occurs with incomplete emptying of lung units. Lung units prone to air-trapping are those with long-time constants (i.e., with high resistance or high compliance). DIF: Application
REF: p. 1051
OBJ: 7
80. What factors contribute to the development of auto-positive end expiratory pressure (PEEP)?
1. High expiratory Raw
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. High inspiratory flows 3. Inadequate expiratory time a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: B
By effectively increasing the time constant of the lung, high expiratory resistance prolongs exhalation to the point at which air trapping begins (Figure 46-21, B). Any shortening of the expiratory time (Figure 46-21, C) aggravates the problem and increases both distal airway pressure and lung volume (auto-PEEP). DIF: Recall
REF: pp. 1051-1052
OBJ: 7
81. Detrimental effects of auto-positive end expiratory pressure (PEEP) include which of the
following? 1. Increased work of breathing 2. Increased pulmonary barotrauma 3. Decreased pulmonary vascular resistance 4. Increased venous return a. 1 and 2 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: A
By increasing FRC and alveolar pressure, auto-PEEP increases the risk and severity of barotrauma and volutrauma. Auto-PEEP also increases the work of breathing and impedes venous return, the result being a decrease in cardiac output. Auto-PEEP also can increase pulmonary vascular resistance. DIF: Recall
REF: pp. 1051-1052
OBJ: 7
82. What patients are at greatest risk for auto-PEEP?
1. Those supported by spontaneous breath modes 2. Those with high airway resistance 3. Those with high expiratory flow resistance a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
Patients at greatest risk of development of auto-PEEP are those with high airway resistance who are being supported by modes that limit expiratory time. DIF: Application
REF: p. 1052
OBJ: 7
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 83. Ventilatory support strategies likely to result in auto-positive end expiratory pressure (PEEP)
include which of the following? 1. Continuous mandatory ventilation (CMV) assist-control 2. Inverse ratio ventilation (IRV) 3. Low-rate intermittent mandatory ventilation 4. Low inspiratory flows a. 1 and 3 only b. 1, 3, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
High-risk ventilatory support techniques include any method that increases the I:E ratio, especially CMV at a high rate or in the assist-control mode, and approaches that purposefully shorten expiratory time, such as IRV or the use of low inspiratory flow. DIF: Application
REF: p. 1052
OBJ: 7
84. The increased work of breathing associated with auto-positive end expiratory pressure (PEEP)
during mechanical ventilation is due to: 1. Hyperinflation or impaired contractility of the diaphragm. 2. Large alveolar pressure drops required to trigger breaths. 3. Increased volume of the intrathoracic airways. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: A
First, hyperinflation caused by auto-PEEP stretches the lung, and the stretching impairs the contractile action of the diaphragm. Second, in pressure- or flow-triggered breaths, the high alveolar pressure caused by auto-PEEP must be overcome before any airway pressure change can occur. DIF: Application
REF: p. 1052
OBJ: 7
85. Which level of FiO 2 and what time of exposure has been associated with oxygen toxicity?
1. FiO 2 of 0.5 2. FiO 2 of 0.7 3. FiO 2 of 0.6 4. 24 to 48 hr a. 1 and 2 only b. 3 and 4 only c. 2 and 3 only d. 1 and 4 only ANS: B
An FiO 2 of 0.5 or more for longer than 24 to 48 hr is associated with the development of oxygen toxicity.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 1052
OBJ: 7
86. Which of the following is the recommended tidal volume for mechanical ventilation in
patients with COPD? a. 4 to 8 ml/kg b. 3 to 5 ml/kg c. 6 to 8 ml/kg d. 10 to 12 ml/kg ANS: C
The currently acceptable tidal volume for mechanically ventilated patients in acute respiratory failure with normal lungs or with COPD is 6 to 8 ml/kg. DIF: Recall
REF: p. 1021
OBJ: 2
87. During ventilatory support, peak inspiratory pressure (PIP) is the pressure needed to overcome
which of the following? 1. Chest wall compliance 2. Lung compliance 3. Airway resistance 4. Systemic arterial pressure a. 1 and 2 only b. 2 and 3 only c. 1, 2, and 3 only d. 2, 3, and 4 only ANS: C
During positive pressure mechanical ventilation, peak inspiratory pressure (PIP) is the pressure necessary to overcome airway resistance and lung and chest wall compliance. DIF: Recall
REF: p. 1052
OBJ: 1
88. The respiratory therapist has been called to place a 70-kg male patient with ARDS on
ventilatory support. The physician has requested a respiratory rate of 20/min. Which of the following would be an appropriate VT for this patient? a. 140 ml b. 200 ml c. 350 ml d. 700 ml ANS: C
The currently acceptable tidal volume for a mechanically ventilated patient with ARDS in acute respiratory failure is 4 to 8 ml/kg. Therefore, the VT must be set between 280 (70 kg 4 ml/kg) and 560 ml (70 kg 8 ml/kg). DIF: Application
REF: p. 1022
OBJ: 2
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 89. Patients receiving mechanical ventilation are usually turned every 2 hr to prevent which of the
following? 1. Atelectasis 2. Secretion retention 3. Pressure sores 4. Hyperoxemia a. 1 and 2 only b. 2 and 3 only c. 1, 2 and 3 only d. 1, 2, 3, and 4 ANS: C
Patients receiving mechanical ventilation are turned frequently, usually a minimum of every 2 hr, unless turning is contraindicated. Turning mechanically ventilated patients help prevent atelectasis, hypoxemia, secretion retention, and pressure sores. DIF: Recall
REF: p. 1042
OBJ: 2
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 47 - Patient Ventila tor Interactio n Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following can be adversely affected by poor patient-ventilator interaction?
1. Gas exchange 2. Ventilatory patterns 3. Hemodynamics 4. Length of mechanical ventilation a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: D
At minimum hemodynamics, ventilatory pattern and gas exchange are adversely affected. Recent data indicates that asynchrony occurs in ALL patients receiving assisted patient-triggered ventilation, is most significant during the morning when clinician patient interaction is greatest, is present even during period of sedation, and varies from mild to very severe asynchrony7 . What is most important to remember is that asynchrony has been associated with increased length of mechanical ventilation, ICU and hospital length of stay, the need for tracheostomy, and ICU and hospital mortality. DIF: Recall
REF: p. 1059
OBJ: 1
2. Which of the following is considered a patient-related cause of poor patient-ventilator
interaction? a. Abnormal respiratory drive b. Asynchrony c. Inadequate ventilatory support d. Inadequate FiO 2 ANS: A
See Table 47-1. DIF: Recall
REF: p. 1060
OBJ: 2
3. Which of the following are variables controlled during pressure assist/control mechanical
ventilation? 1. Volume 2. Flow 3. Time 4. Pressure a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: C
See Table 47-2. DIF: Recall
REF: p. 1064
OBJ: 4
4. Which of the following is a technique for minimizing the effects of auto-PEEP? a. Secretion management b. Minimizing bronchodilator therapy c. Increasing inspiratory time d. Smaller sized endotracheal tubes ANS: A
See Box 47-4. DIF: Application
REF: p. 1065
OBJ: 5
5. Possible ways to correct flow asynchrony in volume ventilation include which of the
following? 1. Change to decelerating flow. 2. Increase peak flow to be greater than 60 L/min. 3. Match ventilator’s inspiratory time to the patient’s inspiratory time. 4. Decrease peak flow to be less than 60 L/min. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: B
See Box 47-2. DIF: Recall
REF: p. 1067
OBJ: 6
6. Which of the following is the primary reason that patients poorly interact with the ventilator? a. Mode of mechanical ventilation selected b. Change in their clinical status c. FiO 2 setting d. PEEP setting ANS: B
One of the primary reasons that patients poorly interact with the mechanical ventilator is a change in their clinical status. Excessive secretions, bronchospasm, and agitation are the most common and regularly seen causes of poor patient-ventilator interaction and issues that should be assessed at every patient-ventilator assessment. DIF: Recall
REF: p. 1060
OBJ: 2
7. Which of the following can cause trigger delay?
1. Auto-PEEP 2. Poor sensitivity setting
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. Water in the circuit 4. Ventilator malfunction a. 3 only b. 1, 2, and 4 only c. 2 and 3 only d. 1, 2, 3, and 4 ANS: B
See Box 47-5. DIF: Recall
REF: p. 1072
OBJ: 9
8. Your patient who is orally intubated and receiving mechanical ventilation was just
repositioned by the nursing staff following their bedsheets being changed. Suddenly, airway pressures and tidal volumes rapidly decrease. Which of the following explains this finding? a. Pneumothorax. b. A dislodged mucus plug is obstructing the endotracheal tube. c. Acute bronchospasm. d. Movement of the endotracheal tube. ANS: D
Another common problem with endotracheal tubes is movement of the airway into the oral pharynx or movement into the right main stem bronchus. Both of which can be life threatening although movement into the oral pharynx, essentially extubation, is the most life threatening. In some situations the airway can be moved back into the trachea, in others reintubation is necessary. If this occurs adequate ventilation is generally impossible. Airway pressures and tidal volumes rapidly decrease and there is frequent gas leakage from the mouth and nose. It is thus important to determine at each patient-ventilator assessment the location of the endotracheal tube. DIF: Analysis
REF: p. 1061
OBJ: 5
9. Approximately how deep should an endotracheal tube be placed on an adult male? a. 23 cm at the teeth b. 21 cm at the teeth c. 19 cm at the teeth d. 17 cm at the teeth ANS: A
In men, the tube should be positioned approximately 23 cm at the teeth (incisors) and 21 cm in women. DIF: Recall
REF: p. 1061
OBJ: 5
10. In severe cases of pneumothorax, the mediastinum and trachea: a. remain midline. b. sink posteriorly into the chest cavity. c. are shifted toward from the side with the pneumothorax. d. are shifted away from the side with the pneumothorax.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D
As pressure increases, the affected side’s lung collapses and begins to compress the unaffected side. In severe cases, the mediastinum and trachea are shifted away from the side with the pneumothorax. DIF: Recall
REF: p. 1062
OBJ: 5
11. Your patient’s clinical status abruptly changed and the alarms on the ventilator are sounding.
What is/are the first step(s) you should take? a. Silence the alarms and adjust the alarm parameters. b. Perform a rapid physical examination. c. Remove the patient from the ventilator and manually ventilate. d. Check the patency of the airway. ANS: C
See Box 47-1. DIF: Recall
REF: p. 1062
OBJ: 5
12. Which of the following modes of mechanical ventilation are least likely to cause asynchrony?
1. Proportional assist ventilation 2. Pressure support ventilation 3. Neurally adjusted ventilator assist 4. Volume control/assist ventilation a. 1 and 3 only b. 2, 3, and 4 only c. 2 and 3 only d. 1 and 4 only ANS: A
In pressure support only the pressure is controlled, thus of all the classic modes of ventilation the mode that is least likely if set properly to cause asynchrony is pressure support. However, as well documented in the literature, proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) are the modes of ventilation that are least likely to cause asynchrony because they do not exert any control over the patient. DIF: Analysis
REF: p. 1065
OBJ: 13
13. In which mode does flow asynchrony most commonly occur? a. Volume ventilation. b. Pressure ventilation. c. CPAP. d. No mode is more susceptible. ANS: A
Flow asynchrony occurs when the flow from the ventilator does not match the flow demand of the patient. This can occur in any mode of ventilation but most commonly occurs in volume ventilation because the clinician sets the tidal volume, peak flow, flow waveform, and inspiratory time.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Analysis REF: p. 1064 OBJ: 6 14. In which mode does double triggering most commonly occur? a. Volume ventilation. b. Pressure ventilation. c. CPAP. d. No mode is more susceptible. ANS: A
Double triggering is usually a result of the patients’ ventilatory center wanting a larger breath or a longer inspiratory time than is set on the ventilator. This causes the patient to continue inspiration when the ventilator transitions into the expiratory phase resulting in the ventilator triggering a second time. The biggest problem with double triggering is that normally there is no exhalation after the first breath, so that the actual delivered tidal volume may be up to double what is set on the ventilator. Double triggering is most common with volume A/C because of the precise setting of the tidal volume. DIF: Analysis
REF: p. 1065
OBJ: 7
15. In which mode does cycle asynchrony most commonly occur? a. Volume ventilation. b. Pressure ventilation. c. CPAP. d. No mode is more susceptible. ANS: B
Cycle asynchrony occurs when the ventilator ends the breath at a time different from when the patients’ respiratory center wants to end the breath. It is more common in pressure than volume-targeted ventilation, but it can occur in all modes of ventilation. DIF: Analysis
REF: p. 1065
OBJ: 12
16. Which of the following modes of ventilation can inappropriately set sensitivity cause
asynchrony? 1. Volume A/C 2. Pressure A/C 3. PSV 4. NAVA a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
Across all modes of ventilation, inappropriately set sensitivity, inappropriate selection of PEEP, and the presence of auto-PEEP result in asynchrony. The one exception to this is NAVA, since NAVA is controlled by the diaphragmatic EMG signal; the presence of auto-PEEP does not affect the function of this mode.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Analysis REF: p. 1065 OBJ: 4 17. Your patient that is receiving mechanical ventilation has a high ventilatory demand. Which of
the following is the most appropriate inspiratory time? a. 0.4 sec b. 0.7 sec c. 1.0 sec d. 1.2 sec ANS: B
Many adults with moderate or high ventilatory demands desire an inspiratory time between 0.6 and 0.9 sec. DIF: Analysis
REF: p. 1067
OBJ: 9
18. You have determined your patient receiving volume ventilation has flow asynchrony. How
can this be improved? 1. Increasing peak flow 2. Decreasing inspiratory time 3. Adjusting rise time 4. Adding an inspiratory pause a. 1 and 2 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: A
Flow asynchrony can be greatly improved in volume ventilation by increasing peak flow and decreasing inspiratory time. In pressure ventilation, flow asynchrony can be corrected by adjusting rise time. DIF: Recall
REF: p. 1065
OBJ: 6
19. The most important variable affecting trigger asynchrony is: a. the mode of mechanical ventilation being used. b. the tidal volume being delivered. c. the presence of auto-PEEP. d. the patient’s underlying disease process requiring mechanical ventilation. ANS: C
However, the single most important variable affecting trigger asynchrony is the presence of auto-PEEP. DIF: Recall
REF: p. 1068
OBJ: 12
20. How are the effects of auto-PEEP on missed triggering improved in the presence of dynamic
airway obstruction? a. Adjustment of the sensitivity setting b. The application of PEEP c. Mode change
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Administration of a bronchodilator ANS: B
In the presence of dynamic airways obstruction, the application of PEEP offsets the effect of auto-PEEP on missed triggering. DIF: Recall
REF: p. 1069
OBJ: 8
21. What is the normal trigger delay? a. Less than 100 msec b. Less than 150 msec c. Less than 200 msec d. Less than 250 msec ANS: A
Normally the trigger delay should be minimal, less than 100 msec. When it exceeds 150 msec, the cause should be determined. Adjusting the sensitivity, setting the tidal volume appropriately and/or applying PEEP should correct delayed triggering unless there is a true malfunction of the ventilator. DIF: Recall
REF: p. 1065
OBJ: 9
22. Your patient has relatively normal lungs and is receiving mechanical ventilation following
surgery. You observe double triggering. What is the most likely cause? a. The termination criteria is set too low. b. The flow rate is too slow. c. Auto-PEEP. d. The inspiratory time is too short. ANS: D
In patient with relatively healthy lungs where the termination criteria is set too high or inspiratory time too short, double triggering can occur every breath. These are primarily postoperative patients or overdose patients. DIF: Recall
REF: pp. 1073-1074
OBJ: 9
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 48 - Initiating and Adjusting Invasive Ventilatory Support Kacmarek et al.: Egan’s Funda menta ls of Respira tory Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following is the least frequent cause of acute respiratory failure needing
mechanical ventilation? a. Sepsis b. Postoperative respiratory failure c. Heart failure d. Aspiration ANS: D
The most common causes of acute respiratory failure that necessitate mechanical ventilation are listed in Table 48-1. DIF: Recall
REF: p. 1080
OBJ: 1
2. Which of the following clinical findings is least likely to be seen in a patient with acute
hypoxic respiratory failure? a. Confusion b. Tachycardia c. Hypotension d. Dyspnea ANS: C
Clinical manifestations of acute hypoxemia and acute ventilatory failure are listed in Table 48-6. DIF: Recall
REF: p. 1095
OBJ: 1
3. Which of the following findings would you expect to see in a patient who has acute
ventilatory failure with severe hypercapnia? a. Jugular vein distension b. Pale, dry skin c. Bradycardia d. Hyperresponsiveness and dilated pupils ANS: C
Clinical manifestations of acute hypoxemia and acute ventilatory failure are listed in Table 48-6. DIF: Recall
REF: p. 1095
OBJ: 2
4. Physiological goals of artificial ventilatory support include which of the following?
1. Support or manipulate gas exchange. 2. Reduce or manipulate the work of breathing. 3. Increase lung volume.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. b. c. d.
1 and 2 only 2 and 3 only 1 and 3 only 1, 2, and 3
ANS: D
The goals of mechanical ventilatory support are to maintain adequate alveolar ventilation and oxygen (O 2 ) delivery, restore acid-base balance, and reduce the work of breathing with minimum harmful side effects and complications. DIF: Application
REF: p. 1079
OBJ: 2
5. After starting volume-cycled mechanical ventilation on a patient in respiratory failure with a
V T of 10 ml/kg, you measure and obtain a plateau pressure of 45 cm H 2 O. Which of the following actions would you recommend to the patient’s physician? a. Decrease the inspiratory flow. b. Lower the delivered V T. c. Administer a bronchodilator. d. Add PEEP. ANS: B
Plateau pressure (Pplat) during mechanical ventilation reflects alveolar pressure, the best bedside clinical reflection of transalveolar pressure. Limiting Pplat reduces the likelihood of ventilator-induced lung injury, although patients with decreased thoracic compliance may require plateau pressures greater than 30 cm H 2 O without resulting overdistention. DIF: Application
REF: p. 1079
OBJ: 2
6. Which the following are hazards associated with mechanical ventilation?
1. Reduced cardiac output 2. Liver failure 3. Increased work of breathing 4. Acute lung injury a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
Hazards of mechanical ventilation include decreased venous return and cardiac output, increased work of breathing and ventilatory muscle dysfunction due to inappropriate ventilator settings, and ventilator-induced lung injury. Nosocomial pneumonia poses a significant risk for intubated patients. DIF: Recall
REF: p. 1080
OBJ: 2
7. What goal(s) does the practitioner hope to achieve when selecting initial ventilatory support
settings? 1. Optimize oxygenation.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. Optimize ventilation. 3. Maintain acid-base balance. 4. Avoid harmful side effects. a. 1 only b. 2 and 3 only c. 1, 3, and 4 only d. 1, 2, 3, and 4 ANS: D
In the selection of initial ventilator settings, the goal is to optimize the patient’s oxygenation, ventilation, and acid-base balance while avoiding harmful side effects. DIF: Recall
REF: p. 1080
OBJ: 3
8. To stabilize a patient during the initial application of ventilatory support, which of the
following parameters must be set? 1. Airway temperature 2. Ventilatory support mode 3. O2 concentration (FiO 2 ) 4. Minute ventilation (f, VT) a. 1 and 3 only b. 1, 2, and 3 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: B
Box 48-3 summarizes key decisions that must be made as a part of initial ventilator setup. DIF: Recall
REF: p. 1081
OBJ: 3
9. Which of the following are advantages of Assist Control Volume ventilation?
1. Minimal safe level of ventilation achieved. 2. Patient can set breathing rate. 3. Mayreduce work of breathing. 4. Pressure is limited. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Advantages of assist-control volume ventilation include the assurance that a minimum safe level of ventilation is achieved, yet the patient can still set his or her own breathing rate. In the event of sedation or apnea, a minimum safe level of ventilation is guaranteed by the selection of an appropriate backup rate, usually approximately 4 to 6 breaths/min less than the patient’s assist rate but not less than the rate necessary to provide a minimum safe level of ventilation (e.g., a backup rate of at least 12 to 14 breaths/min). Because assist-control ventilation usually provides full ventilatory support, it may result in less WOB. In volume control ventilation, pressure is variable and not limited.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 1082
OBJ: 3
10. Which of the following is an advantage of Pressure Control Ventilation? a. Higher mean airway pressure can decrease venous return. b. VT varies depending on lung compliance, resistance, and patient effort. c. Improved gas distribution allows for lower VT. d. If VT or minute ventilation alarms are not set properly, alveolar hypoventilation
and acidosis may not be detected. ANS: C
Box 48-5 summarizes the Advantages and Disadvantages of Pressure Control Ventialtion. DIF: Recall
REF: p. 1083
OBJ: 3
11. In which of the following clinical conditions would noninvasive ventilation (NIV) be
recommended? 1. Management of acute exacerbation of chronic obstructive pulmonary disease (COPD) 2. Management of premature extubation 3. Management of cardiogenic pulmonary edema 4. Management of acute respiratory distress syndrome (ARDS) a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Most clinicians consider HFOV and conventional ventilation the best ways to manage ARDS who require mechanical ventilation. DIF: Recall
REF: p. 1103
OBJ: 9
12. Which of the following are specific clinical objectives of ventilatory support?
a. To reverse hypoxemia b. To prevent or reverse atelectasis c. To prevent sedation and neuromuscular blockade d. To reverse acute respiratory acidosis a. 1 and 3 only b. 1, 2, and 4 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
The specific clinical objectives of ventilatory support are listed in Box 48-2. DIF: Application
REF: p. 1080
OBJ: 3
13. What percentage of mechanical ventilated patients has a tracheostomy tube place at some
point? a. 5% to 10%
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK b. 10% to 15% c. 20% to 25% d. 30% to 35% ANS: A
Approximately 5% to 10% of patients receiving mechanical ventilation have a tracheotomy performed at some point. DIF: Recall
REF: p. 1081
OBJ: 4
14. Which of the following modes of ventilatory support would you recommend for a patient who
can breathe spontaneously and only requires assistance to overcome the work of breathing created by the ET tube? a. Pressure-targeted continuous mandatory ventilation b. Pressure-supported ventilation c. Volume-targeted CMV d. Pressure-targeted intermittent mandatory ventilation ANS: B
PSV can reduce work of breathing and may improve patient ventilator synchrony by placing more control with the patient. Many clinicians use PSV simply to overcome WOB imposed by the artificial airway. DIF: Application
REF: p. 1084
OBJ: 4
15. Compared to a pressure-controlled strategy, what is the primary advantage of
volume-controlled ventilatory support? a. Provides a decelerating flow pattern. b. Limits and controls peak airway pressures. c. Improves patient-ventilator synchrony. d. Guarantees a minimum minute ventilation. ANS: D
The primary advantage of volume-controlled ventilation is maintenance of a stable minute ventilation in the face of changing lung mechanics. DIF: Recall
REF: p. 1081
OBJ: 4
16. Compared with a volume-cycled strategy, what are some potential advantages of
pressure-targeted ventilatory support? 1. Limit and control of peak airway pressures 2. Direct control over inspiratory time 3. Provision of a decelerating flow pattern a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
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Pressure-control ventilation is useful in limiting airway pressure and providing a decreasing (decelerating) flow, which may improve gas distribution, patient comfort, and synchrony. DIF: Recall
REF: p. 1081
OBJ: 4
17. What is the recommended range for the tidal volume for the initial ventilator settings in the
volume control mode in a patient with normal lungs? a. 4 to 6 ml/kg b. 6 to 8 ml/kg c. 10 to 12 ml/kg d. 12 to 15 ml/kg ANS: B
Tidal volume of 6 to 8 ml/kg of ideal body weight. DIF: Recall
REF: p. 1083
OBJ: 4
18. If the patient is being ventilated via a mechanical ventilator via intermittent mandatory
ventilation with partial ventilatory support, what would probably happen to PaCO 2 if the patient suddenly had no spontaneous breathing? a. Increase b. Decrease c. Stay the same d. Change according to FiO 2 ANS: A
With partial ventilatory support, if spontaneous breathing ceases or becomes inadequate, as may be the case with the development of rapid shallow breathing or apnea, alveolar ventilation may decrease, and PaCO 2 may increase above an acceptable level. DIF: Analysis
REF: p. 1084
OBJ: 5
19. Which of the following represents a clinical situation where partial ventilatory support is
commonly used? a. Patient with head trauma b. During weaning from continuous mandatory ventilation c. While ventilating an asthmatic d. In a drug overdose case ANS: B
Partial ventilatory support techniques may be especially useful for weaning patients from mechanical ventilatory support, and pressure-supported ventilation (PSV) and synchronized intermittent mandatory ventilation have been used as partial support strategies for weaning. DIF: Application
REF: p. 1084
OBJ: 5
20. Which of the following situations is most likely to call for ventilator settings of low volume
and high rate while allowing for permissive hypercapnia? a. Patient with ARDS b. Patient with neuromuscular disease
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. Patient with chronic obstructive pulmonary disease d. Child with croup ANS: A
Ventilation strategies for lung protection in ARDS include a low VT, rapid respiratory rates, and permissive hypercapnia if necessary to avoid overdistention or P plat greater than 28 cm H 2 O. DIF: Application
REF: p. 1085
OBJ: 5
21. When a patient is initially started on mechanical ventilation common orders from the
physician in the patient’s chart include which of the following? a. FiO 2 b. Mode c. Sensitivity d. Tidal volume a. 1 and 2 only b. 1, 2, and 4 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
Initial ventilator settings include choice of mode, tidal volume, rate, FiO 2 , and PEEP. The respiratory therapist must set the trigger level, inspiratory flow or time, alarms and limits, backup ventilation, and humidification. DIF: Recall
REF: p. 1081
OBJ: 5
22. Which of the following is one of the modes of ventilation that may be considered when partial
ventilatory support is indicated? a. Assist-control pressure ventilation b. Proportional assist ventilation (PAV) c. Volume-control continuous mandatory ventilation d. Assist-control volume ventilation ANS: B
Normally, when partial ventilatory support is indicated, IMV, PSV, volume support, PAV, and NAVA are the modes of choice. DIF: Recall
REF: p. 1081
OBJ: 5
23. Which of the following statements is false regarding ventilation in the assist-control mode? a. Every breath is supported by the ventilator. b. Usually ensures a minimum safe level of ventilation is given. c. Assist-control mode is typically applied using the volume control mode. d. It is usually applied with a backup rate of 5 to 8 breaths/min. ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
With assist-control mode, every breath is supported by the ventilator. Breaths are patient- or time-triggered to inspiration and may be volume or pressure limited. Inspiration may be volume, pressure, or time cycled to the expiratory phase. Assist-control ventilation typically is delivered as volume-controlled (VC) continuous mandatory ventilation. Suggested initial settings for assist-control volume ventilation in the care of adults are listed in Box 48-4. Advantages of assist-control volume ventilation include the assurance that a minimum, safe level of ventilation is achieved. Every breath is a volume breath, yet the patient can set his or her own breathing rate. In the event of sedation or apnea, a minimum, safe level of ventilation is guaranteed by the selection of an appropriate backup rate, usually approximately 2 to 4 breaths/min below the patient’s assist rate, but not less than the rate necessary to provide a minimum safe level of ventilation (e.g., a backup rate of at least 8 to 10 breaths/min, depending on tidal volume set). Because assist-control ventilation usually provides full ventilatory support, it may result in a lower work of breathing than partial support modes. DIF: Application
REF: p. 1083
OBJ: 5
24. Which of the following are primary goals of mechanical ventilation?
1. Adequate alveolar ventilation (VA) 2. Maintaining adequate hemoglobin levels 3. Restoring acid-base balance 4. Maintaining adequate alveolar oxygenation a. 1 and 3 only b. 1, 3, and 4 only c. 2 and 4 only d. 2, 3, and 4 only ANS: B
Primary goals of mechanical ventilation are: adequate alveolar ventilation (V A), maintaining tissue oxygenation, FiO 2 , PEEP, and MAP, restoring acid-base balance, reducing WOB and myocardial work, providing PEEP/CPAP to recruit lung, lung protective strategy: Small V T and appropriate PEEP levels and maintaining Pplat less than 30 cm H 2 O. DIF: Recall
REF: p. 1080
OBJ: 6
25. Patient’s RR is 12 breaths/min, PaCO 2 is 60 mm Hg. If a PaCO 2 of 40 were desired, the RR
be set at what value? a. 18 b. 23 c. 35 d. 40 ANS: B
This formula predicts what RR adjustment effects will be on PaCO 2 , with no change in VCO 2 or VDphys : Initial Desired PaCO 2(1) f (1) = PaCO 2(2) f (2)
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
60 12 = 40 f (2) = Adjust rate to 18 breaths/min DIF: Application
REF: p. 1104
OBJ: 6
26. Air trapping is a major concern in patients with what diagnosis when using the assist-control
mode? a. Pneumonia b. Chronic obstructive pulmonary disease (COPD) c. Chest trauma d. Neuromuscular disease ANS: B
Patients with COPD are at special risk of air trapping in the assist-control mode, especially if they attempt to breathe at an increased rate. DIF: Recall
REF: p. 1109
OBJ: 6
27. Which of the following statements are true regarding the use of controlled ventilation?
1. May allow the muscles of breathing to rest. 2. Can use larger 1:E ratio and may improve oxygenation. 3. Requires use of paralytic agents in spontaneously breathing patients. 4. Therapist has little control of needed inspiratory flow and pressure. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Advantages of controlled ventilation include eliminating the work of breathing and complete control over the patient’s inspiratory and expiratory time, flow, and pressure. In cases in which the work of breathing is high, controlled ventilation may allow for ventilatory muscle rest, reduce the O2 consumption of the ventilatory muscles, and ―free up‖ O2 for delivery to the tissues. Controlled ventilation may allow prolonged inspiratory times and the use of 1:E ratios greater than 1:1 in cases in which other methods have failed to improve oxygenation. Disadvantages of controlled ventilation include the need for sedatives and perhaps paralytic drugs in the care of patients with spontaneous breathing efforts. The administration of paralytic agents has been associated with the development of prolonged neuropathy in some patients. Paralytic agents have no effect on the patient’s level of consciousness and should not be given without concurrent and appropriate sedation. In addition, in the care of apneic patients, ventilator malfunction or disconnection can lead to death of the patient. DIF: Recall
REF: p. 1083
OBJ: 6
28. What phrase is used to describe the situation where the patient with acute lung injury is
ventilated with a smaller tidal volume and the PaCO 2 is allowed to increase above normal range to avoid additional lung injury? a. Physiologic ventilation b. Permissive hypercapnia c. Adjusted ventilation
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Dialed acidosis ANS: B
This technique is known as permissive hypercapnia. DIF: Recall
REF: p. 1107
OBJ: 9
29. Which of the following statements is false regarding pressure-supported ventilation? a. It is patient triggered, pressure limited, and flow cycled. b. It can reduce the work of breathing during intermittent mandatory ventilation
mode.
c. The usual range is 10 to 15 cm H2 O. d. It is recommended for use in most patients in the intermittent mandatory
ventilation (IMV) mode. ANS: C
Pressure support ventilation assists the patient’s spontaneous inspiration with a clinician-selected level of positive pressure. Pressure support is patient triggered, pressure limited, and flow cycled. Pressure support ventilation can reduce work of breathing and may improve patient-ventilator synchrony and comfort while limiting the pressure applied to the airway. Pressure support to overcome WOB I should be considered in the care of all spontaneously breathing patients in the IMV mode. IMV, as originally developed, allowed spontaneous breathing interspersed with volume-limited, patient- or time-triggered machine breaths. The WOB I during spontaneous breathing due to slow demand flow systems, ventilator circuitry, and the artificial airway prompted the addition of pressure support. Today it is suggested that all spontaneous breaths during IMV be supported with an appropriate level of pressure support, usually in the range of 5 to 10 cm H2 O, to overcome the WOBI. DIF: Recall
REF: p. 1084
OBJ: 6
30. In what scenario is pressure-controlled ventilation (PCV) most often used? a. When limiting plateau pressure is needed b. When a pneumothorax is present c. When the patient has chronic obstructive pulmonary disease d. When bilateral pneumonia is present ANS: A
PCV may be used immediately upon ventilator initiation when limiting the plateau pressure is a concern and in the care of patients expected to need prolonged inspiration or an increased 1:E ratio (1:1, 1.5:1, 2:1). These patients typically have acute lung injury or ARDS. DIF: Recall
REF: p. 1083
OBJ: 6
31. Which of the following are used as alternative lung protective strategies in patients with
ARDS? 1. Prone positioning 2. ECMO 3. High-frequency ventilation 4. Pressure support ventilation
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. b. c. d.
1 and 3 only 1, 2, and 3 only 3 and 4 only 2, 3, and 4 only
ANS: B
Alternative lung protective strategies in patients with ALI/ARDS include prone positioning, ECMO, and high-frequency ventilation. DIF: Application
REF: p. 1102
OBJ: 6
32. Which of the following would decrease PaCO 2 when ventilating a patient using intermittent
mandatory ventilation with pressure support? a. Increase the level of pressure support. b. Decrease the tidal volume. c. Decrease the mechanical rate. d. Increase the FiO 2. ANS: A
The PaCO 2 can be decreased by increasing tidal volume, increasing PSV for spontaneous breaths, or increasing the machine rate. DIF: Recall
REF: p. 1104
OBJ: 9
33. A physician orders intubation and mechanical ventilation in volume-controlled ventilation
mode for a 170-lb adult man with neuromuscular disease. Which of the following initial settings would you recommend? VT Rate a. 14 breath/min 540 ml b. 20 breath/min 310 ml c. 10 breath/min 770 ml d. 6 breath/min 500 ml ANS: A
Box 48-4 DIF: Analysis
REF: p. 1083
OBJ: 6
34. A ventilator has separate rate and V T controls. If you set a V T of 650 ml and a respiratory rate
of 12/min in the continuous mandatory ventilation mode, what will the minute ventilation be? a. 7800 ml/min (7.8 L/min) b. 8500 ml/min (8.5 L/min) c. 9600 ml/min (9.6 L/min) d. 10,200 ml/min (10.2 L/min) ANS: A
Tidal volume (VT) and rate (f) determine minute ventilation (E). DIF: Application
REF: p. 1085
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 35. A ventilator has separate rate and minute ventilation controls. A physician orders continuous
mandatory ventilation with a V T of 550 ml at a respiratory rate of 12/min. What minute ventilation would you set on this ventilator? a. 5500 ml/min (7.9 L/min) b. 6600 ml/min (8.6 L/min) c. 7400 ml/min (9.4 L/min) d. 8400 ml/min (11.4 L/min) ANS: B
Tidal volume (VT) and rate (f) determine minute ventilation. DIF: Application
REF: p. 1085
OBJ: 6
36. On a ventilator that has separate rate and minute ventilation (V E) controls, the rate is set at
13/min and the VE at 11 L/min. Approximately what V T is the patient receiving? a. 700 ml b. 850 ml c. 1000 ml d. 1200 ml ANS: B
Tidal volume (VT) and rate (f) determine minute ventilation. DIF: Application
REF: p. 1085
OBJ: 6
37. For adolescents in the 8- to 16-year-old age range, which of the following ranges of ventilator
setting would you initially recommend? Rate a. 12 to 20 breaths/min 6 to 8 ml/kg b. 20 to 25 breaths/min 4 to 6 ml/kg c. 25 to 35 breaths/min 8 to 10 ml/kg d. 25 to 35 breaths/min 6 to 8 ml/kg
VT
ANS: D
Recommended initial tidal volume and frequency for various patient types are described in Table 48-4. DIF: Application
REF: p. 1088
OBJ: 6
38. A physician orders intubation and mechanical ventilation in the continuous mandatory
ventilation assist-control mode for a 125-lb adult woman with normal lungs. Which of the following initial settings would you recommend? Rate VT a. 10 breaths/min 550 ml b. 14 breaths/min 400 ml c. 18 breaths/min 450 ml d. 12 breaths/min 470 ml ANS: B
See Table 48-4.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application
REF: p. 1088
OBJ: 6
39. A physician orders intubation and mechanical ventilation in the continuous mandatory
ventilation mode for a 200-lb predicted body weight (PBW) adult man with acute asthma exacerbation. Which of the following initial ventilator settings would you recommend? Rate VT a. 12 breaths/min 550 ml b. 11 breaths/min 450 ml c. 14 breaths/min 770 ml d. 20 breaths/min 550 ml ANS: B
See Table 48-4. DIF: Application
REF: p. 1088
OBJ: 6
40. A physician orders intubation and mechanical ventilation in the synchronized intermittent
mandatory ventilation mode for a 160-lb adult man with a history of chronic obstructive pulmonary disease. Which of the following settings would you recommend? Rate VT a. 12 breaths/min 500 ml b. 15 breaths/min 550 ml c. 20 breaths/min 300 ml d. 16 breaths/min 500 ml ANS: A
See Table 48-4. DIF: Analysis
REF: p. 1088
OBJ: 6
41. On some ventilators, which of the following can occur if a trigger setting is set too sensitive
on a mechanical ventilator? a. Autotriggering b. Flow dyssynchrony c. Barotrauma d. Increased workload ANS: A
Trigger sensitivity for patient-triggered ventilation should be set at the lowest possible level to minimize trigger work while avoiding ventilator autotriggering. DIF: Recall
REF: p. 1086
OBJ: 6
42. Which of the following trigger levels is appropriate when setting a ventilator for pressure
triggering? a. 0.5 to 1.5 cm H2 O above the baseline pressure b. 1.5 to 2.5 cm H 2 O below the baseline pressure c. 0.5 to 1.5 cm H 2 O below the baseline pressure d. 2.5 to 3.5 cm H 2 O below the baseline pressure
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: C
With pressure triggering, the range is generally –0.5 to –1.5 cm H 2 O. DIF: Recall
REF: p. 1086
OBJ: 6
43. Which of the following is false about flow-triggered ventilatory support? a. The work of breathing with flow triggering is less than with pressure triggering. b. Flow-triggered systems respond to changes in flow rather than pressure. c. Pressure triggering on new ventilators may be as sensitive as flow-triggering. d. Flow triggering will decrease the work of breathing in patients with small
endotracheal tubes and auto-PEEP. ANS: D
Flow triggering may not be effective in reducing work of breathing because of the presence of a small endotracheal tube or auto-PEEP. DIF: Recall
REF: p. 1086
OBJ: 6
44. Which of the following is false about flow triggering of spontaneous breaths during
mechanical ventilation? a. Flow triggering lowers the patient’s work of breathing. b. Flow triggering is preferred for initiating spontaneous breaths. c. Flow triggering reduces the work of breathing due to small endotracheal tubes. d. Flow triggering results in better patient-ventilator synchrony. ANS: C
Flow triggering may not be effective in reducing work of breathing because of the presence of a small endotracheal tube or auto-PEEP. DIF: Recall
REF: p. 1086
OBJ: 6
45. Which of the following trigger levels is appropriate when setting a ventilator for flow
triggering? a. 9 to 11 L/min below baseline flow b. 7 to 9 L/min below baseline flow c. 4 to 6 L/min below baseline flow d. 1 to 2 L/min below baseline flow ANS: D
In general, for flow triggering the trigger flow should be set 1 to 2 L/min below baseline or bias flow. DIF: Recall
REF: p. 1086
OBJ: 6
46. For adults with otherwise normal lungs who are receiving ventilatory support in the
continuous mandatory ventilation control or assist-control mode, inspiratory flow should be set to provide what 1:E? a. 2:1 b. 3:1
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 1:1 d. 1:2 ANS: D
For most adults, an initial inspiratory time of approximately 1 sec (0.8 to 1.2 sec) with a resultant 1:E ratio of 1:2 or lower is a good starting point. DIF: Recall
REF: p. 1087
OBJ: 6
47. When starting flow-limited ventilatory support on an adult patient, which of the following
inspiratory flow settings would you initially select? a. 60 L/min b. 50 L/min c. 40 L/min d. 30 L/min ANS: A
This value corresponds to an initial peak flow setting of approximately 60 L/min with a range of 40 to 80 L/min and a down ramp or square flow waveform. DIF: Recall
REF: p. 1087
OBJ: 6
48. A chronic obstructive pulmonary disease (COPD) patient receiving ventilatory support in the
CMV assist-control mode at a rate of 14 and a V T of 750 ml exhibits clinical signs of air trapping. Which of the following would you recommend to correct this problem? 1. Decrease ―E‖ time. 2. Increase the inspiratory flow rate. 3. Decrease the assist-control rate. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: C
Higher flow (up to 100 L/min) may improve gas exchange in COPD patients, probably because of the resulting increase in expiratory time. DIF: Analysis
REF: p. 1087
OBJ: 6
49. Beneficial effects of using high inspiratory flows in patients with chronic airflow obstruction
receiving flow-limited mechanical ventilation include which of the following? 1. Decreased work of breathing 2. Improved gas exchange 3. Decreased auto-PEEP a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Higher flow (up to 100 L/min) may improve gas exchange in chronic obstructive pulmonary disease patients, probably because of the resulting increase in expiratory time. DIF: Recall
REF: p. 1087
OBJ: 6
50. Which of the following ventilator adjustments would decrease inspiratory time?
1. Increase the peak flow. 2. Increase the tidal volume. 3. Change the flow pattern from a decelerating wave to a square wave. a. 1 and 3 only b. 1 only c. 2 and 3 only d. 1, 2, and 3 ANS: A
To decrease inspiratory time, one may increase the peak flow, decrease the tidal volume, or change from a down ramp or sine wave to a square wave flow pattern. DIF: Recall
REF: p. 1088
OBJ: 6
51. Which of the following would decrease PaCO 2 when ventilating a patient using intermittent
mandatory ventilation with pressure support? a. Increase the level of pressure support. b. Decrease the tidal volume. c. Decrease the mechanical rate. d. Increase the FiO 2. ANS: A
The PaCO 2 can be decreased by increasing tidal volume, increasing PSV for spontaneous breaths, or increasing the machine rate. DIF: Recall
REF: pp. 1104-1105
OBJ: 9
52. What flow pattern is least optimal for ventilating a patient with cardiovascular instability? a. Accelerating flow pattern b. Square flow pattern c. Decelerating flow pattern d. Constant flow pattern ANS: C
A square or even accelerating waveform may be useful in reducing mean airway pressure in patients with severe hypotension or cardiovascular instability. DIF: Recall
REF: p. 1090
OBJ: 6
53. Which of the following statements is false regarding the use of an inspiratory pause during
mechanical ventilation? a. It may be useful in ARDS patients. b. It may be useful when obtaining a chest radiograph. c. It has been shown to increase effectiveness of bronchodilator therapy.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. It will increase mean airway pressure. ANS: C
The use of a single long inspiratory pause (up to 40 sec) has been advocated in the management of acute lung injury/ARDS as a lung recruitment maneuver, and the results have been encouraging. Use of an inspiratory pause has been suggested for administration of bronchodilators to improve medication delivery. In the treatment of chronic obstructive pulmonary disease patients, however, a 5-sec inspiratory pause did not result in significant improvement in measures related to the effectiveness of the bronchodilator. If a brief inspiratory pause is used, 1:E ratio and mean airway pressure increase. An inspiratory pause of 0.5 to 1.0 sec applied for a single breath is used for measurement of plateau pressure (Pplat) and in estimation of airway resistance (Raw) where PIP is peak inspiratory pressure and is inspiratory peak flow (square wave). An inspiratory pause can also be used to ensure a full inspiration before a chest radiograph is obtained, and this step may improve the quality of the resulting radiograph. DIF: Recall
REF: p. 1092
OBJ: 6
54. Immediately after cardiac arrest and resuscitation, a patient is placed on a ventilator in the
continuous mandatory ventilation assist-control mode. What initial FiO 2 would you recommend? a. 1.0 b. 0.8 c. 0.6 d. 0.4 ANS: A
Examples of disease states or conditions that typically warrant an initial FiO 2 of 1.0 include acute pulmonary edema, ARDS, near drowning, cardiac arrest, severe trauma, suspected aspiration, severe pneumonia, carbon monoxide poisoning, and any disease state or condition resulting in a large right-to-left shunt. DIF: Recall
REF: p. 1092
OBJ: 6
55. When adjusting the FiO 2 setting for a patient receiving mechanical ventilatory support, what
should your goal be? a. Decrease the FiO 2 to below 0.70 as soon as possible. b. Maintain the highest possible FiO 2 as long as needed. c. Decrease the FiO 2 to below 0.30 as soon as possible. d. Decrease the FiO 2 to below 0.50 as soon as possible. ANS: D
After initiation of mechanical ventilation with an FiO 2 of 1.0, the FiO 2 should be reduced to 0.40 to 0.50 or less as soon as is practical to avoid O2 toxicity and absorption atelectasis. DIF: Recall
REF: p. 1092
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 56. An adult patient in respiratory failure has the following blood gases on a nasal cannula at 5
L/min: pH = 7.20; PaCO 2 = 67 mm Hg; HCO 3– = 27 mEq/L; PaO 2 = 89 mm Hg. The attending physician orders intubation and ventilatory support. What FiO 2 would you recommend to start with? a. 0.21 b. 0.30 c. 0.50 d. 0.90 ANS: C
Patients who have undergone previous blood gas measurement or oximetry who are doing well clinically and patients with disease states or conditions that normally respond to low to moderate concentrations of O 2 may begin ventilation with 50% to 70% O2 . DIF: Application
REF: p. 1096
OBJ: 6
57. In which of the following conditions is PEEP likely to be useful?
1. ARDS 2. Pulmonary edema 3. Acute lung injury 4. Neuromuscular disease a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
PEEP and continuous positive airway pressure are effective techniques for improving and maintaining lung volume and improving oxygenation for patients with acute restrictive disease such as acute lung injury, pneumonia, pulmonary edema, and ARDS. A PaO 2 less than 50 to 60 mm Hg with an FiO 2 greater than 0.40 to 0.50 is a good general starting place for considering use of PEEP or continuous positive airway pressure. DIF: Recall
REF: p. 1097
OBJ: 6
58. Which of the following criteria represents the recommended starting point for considering the
use of PEEP? a. PaO 2 less than 40 to 50 on FiO 2 greater than 0.80 – 1.0 b. PaO 2 less than 50 to 60 on FiO 2 greater than 0.40 – 0.50 c. PaO 2 less than 100 on FiO 2 of 1.0 d. PaO 2 less than 50 on FiO 2 greater than 0.75 ANS: B
DIF: Recall
REF: p. 1097
OBJ: 6
59. To prevent atelectasis and improve gas exchange, most thoracic surgery patients placed on
ventilatory support receive which of the following? a. 0 cm H2 O PEEP b. 5 cm H2 O PEEP c. 8 cm H2 O PEEP
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d. 10 cm H 2 O PEEP ANS: B
In terms of ventilator initiation, initial PEEP/CPAP levels usually are 5 cm H2 O. DIF: Recall
REF: pp. 1093-1104
OBJ: 6
60. In which of the following clinical situations is the incidence of auto-PEEP the greatest?
1. Patients with high respiratory rates 2. Intubated patients with obstructive lung disease 3. Patients with low minute volumes a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: A
PEEP has been advocated in small increments (2 to 3 cm H2 O) for overcoming auto-PEEP, particularly in the care of patients with obstructive lung disease. DIF: Recall
REF: p. 1094
OBJ: 6
61. A patient receiving continuous mandatory ventilation in the assist-control mode develops
auto-PEEP. Which of the following general approaches would you consider to minimize the effects of auto-PEEP in this patient? 1. Increasing expiratory time 2. Applying PEEP 3. Switching ventilating mode to synchronized intermittent mandatory ventilation a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: C
Box 48-11 summarizes methods for minimizing the effects of auto-PEEP. DIF: Recall
REF: p. 1103
OBJ: 6
62. A patient receiving continuous mandatory ventilation in the assist-control mode develops
auto-PEEP. Which of the following changes in ventilatory patterns would you consider to minimize the effects of auto-PEEP in this patient? 1. Decreasing the rate or increasing V T 2. Using low-rate synchronized intermittent mandatory ventilation 3. Decreasing the peak inspiratory flow 4. Lowering the VT and letting the PaCO2 rise a. 2 and 4 only b. 3 and 4 only c. 1, 2, and 3 only d. 1, 2, and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D
Box 48-11 summarizes methods for minimizing the effects of auto-PEEP. DIF: Recall
REF: p. 1105
OBJ: 6
63. A chronic obstructive pulmonary disease (COPD) patient in respiratory failure is receiving
ventilatory support in the volume-targeted intermittent mandatory ventilation mode at a rate of 6/min. You measure an auto-PEEP level of 9 cm H 2 O. Which of the following would you recommend to decrease the effects of auto-PEEP in this patient? a. Decreasing the rate and increasing VT. b. Lowering the VT and letting the PaCO 2 rise. c. Applying 4 to 6 cm H 2 O PEEP. d. Decreasing the peak inspiratory flow. ANS: C
Box 48-11 summarizes methods for minimizing the effects of auto-PEEP. DIF: Analysis
REF: p. 1103
OBJ: 9
64. When the therapist is initially setting the high-pressure alarm on the ventilator and the
patient’s plateau pressure is less than 30 cm H2 O, what should the high-pressure alarm be set at? a. 5 to 10 cm H 2 O above the peak pressure b. 10 to 20 cm H 2 O above the peak pressure c. 10 to 12 cm H 2 O above the plateau pressure d. 10 to 15 cm H 2 O above the mean airway pressure ANS: B
If the plateau pressure is less than 30 cm H2 O, the high pressure limit can be adjusted to 10 to 20 cm H 2 O above the peak inspiratory pressure. DIF: Application
REF: p. 1093
OBJ: 6
65. After placing a patient on a volume-cycled ventilator in the continuous mandatory ventilation
assist-control mode, you note that 55 cm H 2O pressure is required to deliver the preset V T of 950 ml. What high-pressure limit would you now set for this patient? a. 60 cm H2 O b. 70 cm H2 O c. 80 cm H2 O d. 90 cm H2 O ANS: B
If the plateau pressure is less than 30 cm H2 O, the high pressure limit can be adjusted to 10 to 20 cm H 2 O above the peak inspiratory pressure. DIF: Analysis
REF: p. 1093
OBJ: 6
66. If available, the FiO 2 alarm should be set to what percentage? a. ±3% b. ±5%
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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Suggested initial settings for these alarms and backup ventilator settings are described in Table 48-5. DIF: Recall
REF: p. 1093
OBJ: 6
67. What limits should be initially set for high and low VT values and/or minute volume alarms on
a ventilatory support device? a. ±5% to 10% b. ±10% to 15% c. ±15% to 20% d. ±20% to 25% ANS: B
Suggested initial settings for these alarms and backup ventilator settings are described in Table 48-5. DIF: Recall
REF: p. 1093
OBJ: 6
68. A heat-moisture exchanger (HME) should be avoided in which of the following
circumstances? 1. Patients with excessive secretions 2. Patients with a high FiO 2 3. Patients with low body temperature a. 1 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
Use of HMEs should be avoided in the care of patients with secretion problems and those with low body temperature (<32° C), high spontaneous minute ventilation (>10 L/min), or air leaks in which exhaled tidal volume is less than 70% of delivered tidal volume. DIF: Recall
REF: p. 1093
OBJ: 6
69. Which of the following criteria should be met before considering use of a heat-moisture
exchanger (HME) for a patient being placed on ventilatory support? 1. There should be no problem with retained secretions. 2. The patient should not have fever (normothermic). 3. The patient should be adequately hydrated. 4. The support should be short term (24 to 48 hr). a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only
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Use of HMEs should be avoided in the care of patients with secretion problems and those with low body temperature (<32° C), high spontaneous minute ventilation (>10 L/min), or air leaks in which exhaled tidal volume is less than 70% of delivered tidal volume. DIF: Recall
REF: p. 1093
OBJ: 6
70. For which of the following patients requiring ventilatory support would you recommend
against using a heat-moisture exchanger (HME) for airway humidification? 1. Patient with an expired VT less than 70% of the delivered VT 2. Patient with a spontaneous minute ventilation of 14 L/min 3. Patient with body temperature less than 32° C a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
Use of HMEs should be avoided in the care of patients with secretion problems and those with low body temperature (<32° C), high spontaneous minute ventilation (>10 L/min), or air leaks in which exhaled tidal volume is less than 70% of delivered tidal volume. DIF: Recall
REF: p. 1093
OBJ: 6
71. A dehydrated, feverish patient suffering from acute bacterial pneumonia is being intubated in
order to provide mechanical ventilatory support. Which of the following devices would you select to control humidification and airway temperature for this patient? a. Unheated large-volume wick humidifier b. Heated wick humidifier with servo-control c. Large-reservoir, high-output heated jet nebulizer d. Heat-moisture exchanger ANS: B
We prefer an optimal humidity approach and use of a heated humidifier to deliver gas in the range of 35° to 37° C at the airway. DIF: Analysis
REF: p. 1093
OBJ: 6
72. A patient suffering from postoperative complications has been receiving mechanical
ventilation for 6 days with a volume ventilator. A heat-moisture exchanger (HME) is providing control over humidification and airway temperature. Over the past 24 hr, the patient’s secretions have decreased in quantity but are thicker and more purulent. Which of the following actions would you suggest at this time? a. Replace the HME. b. Switch over to a heated wick humidifier. c. Administer acetylcysteine every 2 hr via the nebulizer. d. Increase the frequency of suctioning. ANS: B
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We prefer an optimal humidity approach and use of a heated humidifier to deliver gas in the range of 35° to 37° C at the airway. DIF: Analysis
REF: p. 1093
OBJ: 6
73. When using a heated humidifier during mechanical ventilation, the inspired gas temperature at
the airway should be set to what level? a. 29° to 31° C b. 31° to 35° C c. 35° to 37° C d. 38° to 40° C ANS: C
We prefer an optimal humidity approach and use of a heated humidifier to deliver gas in the range of 35° to 37° C at the airway. DIF: Recall
REF: p. 1093
OBJ: 6
74. Indications for delivering sigh breaths during mechanical ventilation include which of the
following? 1. Before and after suctioning 2. During chest physical therapy 3. In patients with stiff lungs 4. When small VT values are used a. 1 and 3 only b. 1, 2, and 4 only c. 2 and 4 only d. 2, 3, and 4 only ANS: B
Constant, monotonous tidal ventilation at a small volume (<7 ml/kg) may result in progressive atelectasis. Sighs may be used to prevent atelectasis. Atelectasis may be caused before and after suctioning and when using small tidal volumes. CPT is also used when attempting to correct atelectasis. DIF: Recall
REF: p. 1093
OBJ: 6
75. Which of the following would you assess immediately after a patient is placed on a ventilatory
support device? 1. ABGs 2. Patient’s airway 3. Patient’s vital signs a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3 ANS: D
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Initial patient evaluation should include physical assessment, assessment of ventilator settings, cardiovascular assessment, oximetry, and measurement of arterial blood gases (Box 48-12). DIF: Recall
REF: p. 1094
OBJ: 6
76. When setting the tidal volume on a patient being mechanically ventilated, what criteria should
be kept in mind? a. It should never cause the plateau pressure to exceed 28 mm Hg. b. It should never cause the peak pressure to exceed 35 mm Hg. c. It should result in the static pressure of less than 10 mm Hg. d. It should result in a peak pressure of no more than 25 mm Hg. ANS: A
Tidal volume usually is based on specific patient considerations but should ideally never result in a plateau pressure of 28 cm H 2 O or greater. DIF: Recall
REF: p. 1085
OBJ: 9
77. What is the predicted change in tidal volume by adding 6 in of tubing to a ventilator circuit? a. Decrease of 50 to 70 ml b. Decrease of 30 to 50 ml c. Decrease of 20 to 30 ml d. No change ANS: A
In general, V T reduces between 50 and 70 ml for each 6 in (15 cm) of dead space added by tubing in a circuit. DIF: Recall
REF: p. 1104
OBJ: 9
78. Which of the following would you initially verify in assessing the airway of a patient placed
on ventilatory support? 1. Cuff pressure 2. Tube position 3. Tube patency a. 1 and 2 only b. 1, 2, and 3 c. 1 and 3 only d. 2 and 3 only ANS: B
The artificial airway should be assessed for proper placement, patency, and cuff inflation. Size, position, and depth of the endotracheal tube and cuff pressure, including volume used to inflate the cuff, should be recorded. DIF: Recall
REF: p. 1095
OBJ: 6
79. After setting up a patient on a ventilatory support device, which of the following
supplementary equipment would you require to be available at the bedside? 1. Suction source and catheters
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2. Backup artificial airway 3. Manual resuscitator with O 2 a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: C
An extra endotracheal tube or tracheostomy tube of the correct size should be placed at the patient’s bedside, and the equipment needed to replace the airway must be available and easily accessible. A clean, functioning manual resuscitator with O 2 supply and suction equipment, including an appropriate supply of suction catheters, sterile water or saline solution, and sterile gloves also must be placed near the bedside. DIF: Recall
REF: p. 1095
OBJ: 6
80. You have just placed a chronic obstructive pulmonary disease (COPD) patient on intermittent
mandatory ventilation at a rate of 8/min, a V T of 550 ml, and an FiO 2 of 0.40. To ensure proper equilibration between the alveolar and arterial gas tensions, how long should you wait before drawing a sample for measurement of the ABG? a. 5 min b. 10 min c. 15 min d. 30 min ANS: D
ABGs should be measured 20 to 30 min after initiation of mechanical ventilation. DIF: Analysis
REF: p. 1095
OBJ: 9
81. When adjusting a patient’s oxygenation during mechanical ventilatory support, what should
your goal be? a. SaO 2 of 80% to 90% b. PaO 2 of 100 to 150 mm Hg c. SaO 2 of 95% to 100% d. PaO 2 of 60 to 100 mm Hg ANS: D
The FiO 2 is then titrated to achieve a PaO 2 in the range of 60 to 80 mm Hg with an SaO 2 of 90% or greater or an SpO 2 of 92% or greater. DIF: Recall
REF: p. 1096
OBJ: 9
82. When titrating the FiO 2 level downward from 100% to 40%, what is the maximum increment
that should be applied between estimates of oxygenation? a. b. c. d.
5% 10% 20% 25%
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: C
In either case, it is suggested that O 2 levels be titrated down from 100% to 50% O 2 in decrements not to exceed 20%. DIF: Recall
REF: p. 1096
OBJ: 9
83. When titrating the FiO 2 down from 50% to 21%, in what increments should it be reduced? a. All at once is acceptable. b. No more than 5%. c. 5% to 10%. d. 10% to 20%. ANS: C
For reducing O 2 concentration from 50% to 21%, O 2 changes should be in steps of 5% to 10% followed by oximetry or measurement of blood gases. DIF: Recall
REF: p. 1096
OBJ: 9
84. A patient with ARDS receiving ventilatory support with PEEP through a volume-cycled
ventilator has a plateau pressure of 38 cm H2 O. ABGs on 55% O2 are as follows: pH = 7.44; PCO 2 = 37 mm Hg; HCO 3– = 25 mEq; PO 2 = 55 mm Hg; SaO 2 = 88%. Which of the following would you recommend? a. Increase the PEEP level. b. Make no changes. c. Reduce the V T. d. Increase the FiO 2 . ANS: B
An SaO 2 of 88% to 90% may be acceptable for patients who need an FiO 2 of 0.80 or more for an extended time. DIF: Analysis
REF: p. 1094
OBJ: 7
85. When is the PEEP/CPAP level optimum? a. O 2 delivery to the tissues is maximized. b. Pressures are maintained below 15 cm H2 O. c. CaO 2 -CvO 2 is maximized. d. The PaO 2 is 60 to 100 mm Hg. ANS: A
Optimal or best PEEP may be defined as the PEEP that maximizes O 2 delivery (DO 2 ). DIF: Recall
REF: p. 1097
OBJ: 7
86. The following data are gathered during a PEEP study (FiO 2 = 0.60). Based on these data, what
is the optimum PEEP level? PEEP cm H2 O 0 PaO 2 mm Hg 46 Compliance ml/cm H2 O 18
5 54 23
10 67 26
15 73 30
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20 75 24
25 74 19
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Systolic pressure Diastolic pressure a. b. c. d.
125 90
123 88
114 83
115 84
104 76
94 68
10 cm H2 O 15 cm H2 O 20 cm H2 O 25 cm H2 O
ANS: B
Best PEEP has been exceeded at the point when an increase in PEEP is followed by a decrease in compliance. DIF: Application
REF: p. 1099
OBJ: 7
87. When using a pressure-volume curve to identify optimal PEEP levels, what does the upper
inflection point represent? a. Point of lung recruitment b. Point of lung over distension c. Optimal PEEP level d. Optimal compliance level ANS: B
The upper inflection point may indicate lung overdistention. DIF: Recall
REF: p. 1100
OBJ: 7
88. When performing a lung recruitment strategy, which of the following would cause the
therapist to stop? 1. Mean blood pressure drops of 80 to 65 mm Hg. 2. Heart rate increases from 88 to 110/min. 3. Patient has a run of premature ventricular complexes. a. 1 only b. 2 only c. 3 only d. 1, 2, and 3 ANS: C
The recruitment maneuver is stopped if there is a decrease in SpO 2 to less than 88%, a significant change in heart rate (>140 beats/min or <60 beats/min), a significant change in mean arterial blood pressure (<60 mm Hg or decrease >20 mm Hg from baseline) or the development of cardiac arrhythmia. DIF: Recall
REF: pp. 1101-1102
OBJ: 7
89. When the patient stabilizes on mechanical ventilation with a PEEP of 12 cm H 2 O and the FiO 2
has been reduced to 0.40, how should the PEEP level reduce? a. In increments of 2 cm H2 O every 6 hr b. In increments of 3 to 5 cm H2 O every 2 hr c. In increments of 3 to 5 cm H2 O every 1 hr
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d. In increments of 5 cm H2 O every 2 hr ANS: A
After reduction of the FiO2 to 0.40, PEEP can be reduced gradually as the patient improves at a rate of 2 cm H 2 O every 6 to 8 hr. DIF: Recall
REF: p. 1108
OBJ: 8
90. What is the recommended response to a drop in PaO 2 when the PEEP level is reduced in a
mechanically ventilated patient? a. Increase the FiO 2 . b. Return the PEEP to the previous level. c. Increase the rate of mechanical breaths. d. Do nothing. ANS: B
If the PaO2 decreases after PEEP is decreased the PEEP level should be returned to its prior setting. DIF: Recall
REF: p. 1101
OBJ: 8
91. Which of the following techniques can be used to improve oxygenation beyond increasing the
FiO 2 or PEEP level? 1. Proning the patient 2. Use of an expiratory pause 3. Use of inverse I:E ratio ventilation a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1 and 3 only ANS: D
Other techniques that may be helpful in improving arterial O 2 levels include the use of PCV with a prolonged inspiratory time, use of an inspiratory pause, inverse 1:E ratio ventilation, and prone positioning. DIF: Recall
REF: p. 1102
OBJ: 8
92. In what clinical condition has pressure-controlled ventilation with a prolonged inspiratory
time been shown to be helpful? a. ARDS/acute lung injury b. Pulmonary embolism c. Bilateral pneumonia d. Severe pulmonary fibrosis ANS: A
Pressure-control ventilation with prolonged inspiratory time has been associated with improvement in PaO 2 in patients with acute lung injury/ARDS. DIF: Recall
REF: p. 1116
OBJ: 9
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 93. How frequently should a clinician make changes when weaning from PEEP? a. 10 to 20 min b. 30 to 45 min c. 1 hr d. 6 to 8 hr ANS: D
Generally, PEEP is sustained at the set level until FiO 2 is less than 0.5, and when PEEP is decreased, it should be decreased in increments of 2 cm H 2 O no more frequently than approximately every 6 to 8 hr. DIF: Recall
REF: p. 1108
OBJ: 8
94. What is the primary concern when using proning to improve oxygenation in the patient with
ARDS? a. Sudden increase in PaCO 2 b. Displacement of tubes and lines c. Pneumothorax d. Hemodynamic compromise ANS: B
Care must be taken to ensure that endotracheal tubes, intravenous lines, and catheters are not blocked or dislodged. DIF: Recall
REF: pp. 1102-1103
OBJ: 7
95. What is considered to be the single best indicator of effective ventilation? a. PaO 2 b. SaO 2 c. PaCO 2 d. pH ANS: C
Arterial PaCO 2 is considered the single best index of effective ventilation. DIF: Recall
REF: pp. 1102-1103
OBJ: 7
96. Your patient develops a fever while being mechanically ventilated in the control mode. As a
result of the fever, the patient’s CO 2 production increases while alveolar ventilation is unchanged. What is the probable change in ABGs? a. Increase in PaCO 2 b. Decrease in PaO 2 c. Decrease in PaCO 2 d. All of the above ANS: A
Increases in A or decreases in CO 2 result in a decrease in PaCO 2 , whereas increases in CO 2 or decreases in A result in an increase in PaCO 2 .
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application REF: p. 1110 OBJ: 7 97. A patient receiving control-mode continuous mandatory ventilation has the following ABGs
on an FiO 2 of 0.4: pH = 7.51; PCO 2 = 30 mm Hg; HCO 3– = 25 mm Hg. Her current minute ventilation (V E) is 7.9 L/min. What new VE would you recommend? a. 9.0 L/min b. 6.7 L/min c. 7.5 L/min d. 5.9 L/min ANS: D
Box 48-20 gives an example of the effect of a change in A on PaCO 2 . DIF: Analysis
REF: p. 1114
OBJ: 9
98. A patient receiving control-mode continuous mandatory ventilation has the following ABGs
on an FiO 2 of 0.5: pH = 7.23; PCO 2 = 61 mm Hg; HCO 3– = 26 mm Hg. The current minute ventilation (V E) is 9.2 L/min. What new VE would you recommend? a. 10.6 L/min b. 14.0 L/min c. 12.4 L/min d. 5.8 L/min ANS: B
Box 48-20 gives an example of the effect of a change in A on PaCO 2 . DIF: Analysis
REF: p. 1122
OBJ: 9
99. During initial mechanical ventilation of the chronic obstructive pulmonary disease (COPD)
patient with chronic hypercapnia, what PaCO 2 is most likely used as a target value? a. 30 mm Hg b. 40 mm Hg c. 55 mm Hg d. 75 mm Hg ANS: C
In the care of patients with acute exacerbation of COPD and accompanying chronic ventilatory failure, the clinician may target ventilatory support to achieve the patient’s ―normal‖ PaCO2 and pH. For COPD patients with chronic hypercapnia, this may mean a target PaCO 2 of 50 to 60 mm Hg with a pH of 7.30 to 7.35. DIF: Recall
REF: p. 1128
OBJ: 9
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 49 - Noninv asive Ventilatio n Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following devices is considered to be the first electrically powered
negative-pressure ventilator? a. The Bird b. The iron lung c. The chest cuirass d. The rocking bed ANS: B
The first electrically powered, negative-pressure ventilator was known as the ―iron lung.‖ DIF: Recall
REF: p. 1112
OBJ: 5
2. Why did the use of intermittent positive-pressure breathing decline in the 1980s? a. Due to a lack of scientific evidence to support its use for delivering aerosolized
medication b. Due to its cost of implementation c. Due to its complexity d. Replaced by newer technology ANS: A
The use of intermittent positive-pressure breathing declined significantly in the mid -1980s after a randomized, controlled trial revealed no benefit, compared to a simple small-volume nebulizer, in the treatment of patients with chronic obstructive pulmonary disease. DIF: Recall
REF: p. 1114
OBJ: 5
3. All of the following are goals of noninvasive ventilation (NIV) in the acute care setting,
except: a. avoid intubation. b. decrease incidence of ventilation-associated pneumonia. c. decrease length of stay. d. improve mobility. ANS: D
Avoiding intubation and invasive positive-pressure ventilation, improving survival, decreasing the length of ventilatory support, decreasing the length of hospitalization, and decreasing the incidence of ventilator-associated pneumonia are major goals of NIV in the acute care setting (emergency department, intensive care unit, or hospital ward). DIF: Recall
REF: p. 1114
OBJ: 1
4. Which of the following therapies should be considered as first line of therapy in patients with
exacerbation of chronic obstructive pulmonary disease (COPD)?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. b. c. d.
Noninvasive ventilation (NIV) Mechanical ventilation High-flow nasal cannula Systemic steroids
ANS: A
The differences in reported outcome between these studies suggest that NIV should be considered standard of care for COPD patients in an acute exacerbation and offered as first-line therapy to patients in all institutions treating the COPD patient. DIF: Recall
REF: p. 1114
OBJ: 5
5. Your patient has acute pulmonary edema from left heart failure. Which therapy should be
tried first? a. Noninvasive ventilation (NIV) b. Continuous positive airway pressure (CPAP) c. Mechanical ventilation d. Positive end-expiratory pressure ANS: B
CPAP is considered by most first-line therapy for acute cardiogenic pulmonary edema. DIF: Application
REF: p. 1114
OBJ: 5
6. Which of the following noninvasive ventilation (NIV) settings are adequate for a patient with
cardiogenic pulmonary edema? a. CPAP at 10 to 15 cm H2 O with 100% oxygen b. CPAP at 10 to 15 cm H2 O with 50% oxygen c. CPAP at 8 to 12 cm H 2 O with 100% oxygen d. CPAP at 8 to 12 cm H 2 O with 50% oxygen ANS: C
CPAP should be administered at 8 to 12 cm H 2 O with 100% oxygen. DIF: Application
REF: p. 1115
OBJ: 5
7. Which of the following indications for noninvasive ventilation (NIV) is where the greatest
controversy exists? a. Chronic obstructive pulmonary disease b. Pneumonia c. Hypoxemic respiratory failure d. Nocturnal hypoventilation ANS: C
This is the indication for NIV where the greatest controversy exists. DIF: Recall
REF: p. 1115
OBJ: 1
8. Which of the following are benefits of continuous positive airway pressure (CPAP) in
postoperative major abdominal surgery?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1. Lower mortality 2. Lower intubation rate 3. Lower incidence of pneumonia 4. Lower rate of sepsis a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
The CPAP group had a lower rate of intubation, pneumonia, overall infection, and sepsis. DIF: Recall
REF: p. 1117
OBJ: 1
9. Which of the following are potential benefits of using noninvasive ventilation (NIV) during
weaning? 1. Reduced length of intensive care unit (ICU) stay 2. Reduced incidence of nosocomial pneumonia 3. Reduced mortality rate 4. Reduced incidence of pulmonary embolism a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
In one study, it was found that NIV reduced weaning time, length of ICU stay, incidence of nosocomial pneumonia, and 60-day mortality compared with conventional weaning with invasive pressure support ventilation. DIF: Recall
REF: p. 1115
OBJ: 2
10. Which of the following groups of patients are considered at risk for reintubation?
1. Patients with APACHE 2 score greater than 12 on the day of extubation 2. Patients older than 45 years 3. Patients with congestive heart failure (CHF) 4. Patients with one or more weaning failure a. 1 and 3 only b. 1, 3, and 4 only c. 2 and 4 only d. 2, 3, and 4 only ANS: B
Overall, patients at risk were defined as those with chronic obstructive pulmonary disease (COPD) or CHF, ineffective cough and excessive secretions, one or more weaning failure, one or more comorbid condition, upper airway obstruction, age older than 65 years, and APACHE 2 score of greater than 12 on the day of extubation. DIF: Recall
REF: p. 1117
OBJ: 1
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 11. Which of the following restrictive thoracic diseases are successfully managed with
noninvasive ventilation (NIV)? 1. Postpolio syndrome 2. Neuromuscular disease 3. Spinal cord injuries 4. Severe kyphoscoliosis a. 1, 2, and 4 only b. 1, 2, 3, and 4 c. 2 and 4 only d. 2, 3, and 4 only ANS: B
Restrictive thoracic diseases successfully managed with NIV include postpolio syndrome, neuromuscular diseases, chest wall deformities, spinal cord injuries, and severe kyphoscoliosis. DIF: Recall
REF: p. 1117
OBJ: 1
12. How does noninvasive ventilation (NIV) benefit the patient with restrictive thoracic disease?
1. It rests the respiratory muscles. 2. It lowers the PaCO 2. 3. It improves lung compliance. 4. It improves pulmonary function testing. a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, and 4 only d. 1, 3, and 4 only ANS: A
The first mechanism is the ability of NIV to rest the respiratory muscles. Second, NIV lowers the PaCO 2 , and the decrease is believed to reset the central ventilatory controller and establish a new baseline PaCO 2 . The third mechanism is the improvement in lung compliance, lung volume, and dead space that result from NIV. DIF: Recall
REF: p. 1118
OBJ: 1
13. The use of noninvasive ventilation (NIV) in the long-term care of patients with chronic
obstructive pulmonary disease (COPD) will benefit the patient in which the following ways except: 1. better gas exchange. 2. improved sleep quality. 3. resetting the respiratory center to better respond to hypoxemia. 4. unloading the respiratory muscles. a. 1 and 3 only b. 1, 2, and 4 only c. 2 and 4 only d. 2, 3, and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: B
First, positive inspiratory pressure may improve gas exchange and unload the respiratory muscles, allowing these muscles to recover, gain strength, and reduce fatigue. These benefits should reduce symptoms associated with hypoventilation and improve quality-of-life. Second, patients with severe COPD have poor sleep quality, shorter sleep time, and nocturnal hypoventilation. DIF: Recall
REF: p. 1118
OBJ: 1
14. Which of the following groups of patients with nocturnal hypoventilation respond to
noninvasive ventilation (NIV)? a. Hypoxic b. Hypercapnic c. Acidotic d. Hypocapnic ANS: B
Patients with hypercapnic and nocturnal desaturation may be most likely to benefit from nocturnal NIV. DIF: Recall
REF: p. 1117
OBJ: 3
15. Which of the following are indications to use noninvasive ventilation (NIV) in patients who
have chronic obstructive pulmonary disease (COPD) with nocturnal hypoventilation? 1. PaCO 2 greater than 55 mm Hg 2. More than two hospitalizations related to hypercapnic respiratory failure 3. PaCO 2 greater than 65 mm Hg 4. PaCO 2 between 50 and 54 mm Hg with nocturnal desaturation a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, and 4 only d. 1, 3, and 4 only ANS: C
The current recommendation from a consensus conference is to use NIV in the care of patients with severe COPD who have symptoms of nocturnal hypoventilation and one of the following: PaCO 2 of 55 mm Hg or greater, a PaCO 2 between 50 and 54 mm Hg with nocturnal desaturation, or more than two hospital admissions related to hypercapnic respiratory failure. DIF: Recall
REF: p. 1117
OBJ: 2
16. Which of the following is least likely to indicate the need for noninvasive ventilation (NIV) in
the acute care setting? a. Paradoxical breathing b. Jugular venous distention c. Respiratory rate more than 25/min d. Use of accessory muscles
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: B
Signs and symptoms of respiratory distress include use of accessory muscles, paradoxical breathing, a respiratory rate of 25 breaths/min or greater, and the presence of moderate to severe dyspnea. DIF: Recall
REF: p. 1117
OBJ: 2
17. Which of the following findings are exclusion criteria for using noninvasive ventilation (NIV)
in the patient with acute respiratory failure? 1. Apnea 2. Hemodynamic or cardiac instability 3. Low risk of aspiration 4. Lack of cooperation by the patient a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Exclusion criteria include apnea, hemodynamic or cardiac instability, lack of cooperation by the patient, facial burns, facial trauma, copious amounts of secretions, high risk of aspiration, and anatomic abnormalities that interfere with gas delivery. DIF: Recall
REF: p. 1119
OBJ: 2
18. The respiratory therapist has placed a patient on noninvasive ventilation. After 2 hr the patient
showing significant improvement in her work of breathing but is experiencing nasal and oral dryness. Which of the following corrective action should be performed? a. Add heated humidifier. b. Add ultrasonic nebulizer. c. Immediately discontinue NIV. d. Intubate the patient. ANS: A
Heated humidity (approximately 30° C) should always be provided with NIV to avoid nasal symptoms, the accumulation of secretions in the back of the oral pharynx and enhance patient tolerance. DIF: Recall
REF: p. 1129
OBJ: 8
19. Your patient is being ventilated with a nasal mask to relieve dyspnea. He has a long history of
chronic obstructive pulmonary disease and hypercarbia. What is the goal of noninvasive ventilation in this setting with regard to the ABGs? a. Return the PaCO 2 to 40 to 45 mm Hg. b. Return the pH to near normal. c. Return the PaCO 2 to less than 60 mm Hg. d. Return the bicarbonate level to near normal. ANS: C
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
See Box 49-5. DIF: Application
REF: p. 1120
OBJ: 2
20. Which of the following are contraindications for the use of noninvasive ventilation (NIV)?
1. Nonsupportive family 2. Lack of financial resources 3. Copious amounts of secretions 4. Uncooperative behavior on the part of the patient a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, and 4 only d. 1, 2, 3, and 4 ANS: D
Relative contraindications for the use of NIV for restrictive thoracic disease, nocturnal hypoventilation, and chronic obstructive pulmonary disease include an nonsupportive family, lack of financial resources, required ventilator assistance for most of the day, copious amounts of secretions, uncooperative behavior on the part of the patient, high risk of aspiration, and any anatomic abnormality that interferes with gas delivery. DIF: Recall
REF: p. 1119
OBJ: 2
21. Which of the following interfaces is/are most commonly used to apply noninvasive ventilation
(NIV) in the acute setting? 1. Nasal or full-face mask 2. Mouthpiece 3. Endotracheal tube 4. Nasal pillows a. 1 and 2 only b. 1 and 3 only c. 1, 2, and 4 only d. 1 only ANS: A
Full-face and nasal masks are the most commonly used interfaces in the acute care setting. DIF: Recall
REF: p. 1120
OBJ: 5
22. Which of the following is a potential risk of overtightening the straps of the mask? a. Absence of an air leak b. Tissue necrosis c. Eye irritation d. Claustrophobia ANS: B
Caution must be taken not to overtighten the straps on the mask because excessive pressure on the bridge of the nose can cause tissue necrosis. DIF: Recall
REF: p. 1121
OBJ: 4
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 23. Compared with nasal masks, full-face masks are associated with all of the following, except: a. increase in dead space. b. risk of aspiration. c. claustrophobia. d. hypocapnia. ANS: D
Compared with nasal masks, full-face masks are associated with an increase in dead space, risk of aspiration, and claustrophobia. DIF: Recall
REF: p. 1121
OBJ: 4
24. Which of the following interfaces should be used in greater than 90% of the patients with
hypoventilation? a. Full-face mask b. Nasal mask c. Nasal pillows d. Oral mask ANS: A
If the problem is ventilation, the full-face mask is the interface of choice and should be used initially in greater than 90% of patients requiring noninvasive positive-pressure ventilation for acute respiratory failure. DIF: Recall
REF: p. 1121
OBJ: 4
25. Which of the following interfaces appear to be more efficient to improve ventilation?
1. Nasal pillows 2. Full-face mask 3. Nasal mask 4. Oral mask a. 1 only b. 1 and 2 only c. 1, 2, 3, and 4 d. 1 and 4 only ANS: B
The investigators reported that the full-face mask and nasal pillows improved ventilation more than the nasal mask but that the nasal mask was better tolerated. DIF: Recall
REF: p. 1121
OBJ: 4
26. Which of the following interfaces that improve ventilation appears to be more tolerated? a. Nasal pillows b. Full-face mask c. Nasal mask d. Oral mask ANS: A
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
The investigators reported that the full-face mask and nasal pillows improved ventilation more than the nasal mask but that the nasal mask was better tolerated. DIF: Recall
REF: p. 1122
OBJ: 4
27. Which of the following are factors associated with pressure and flow-related complications
during noninvasive ventilation? 1. Sinus and ear pain 2. Nasal congestion 3. Upper airway dryness 4. Gastric insufflations a. 1 and 2 only b. 2 and 2 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: D
Air pressure and flow-related complications include nasal congestion, upper airway dryness, sinus and ear pain, eye irritation, and gastric insufflations. DIF: Application
REF: p. 1132
OBJ: 8
28. Which of the following ventilators is generally only used for chronic noninvasive ventilation
(NIV)? a. Critical care b. Portable c. Noninvasive d. Negative pressure ANS: B
However, portable volume ventilators are generally used only for chronic NIV. DIF: Recall
REF: p. 1128
OBJ: 5
29. Which of the following is/are characteristics of most noninvasive ventilators?
1. Electrically powered 2. Blower driven 3. Microprocessor controlled 4. Double-circuit design a. 1 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 1 and 4 only ANS: B
Most noninvasive ventilators are electrically powered, blower driven, and microprocessor controlled (Figure 49-12). DIF: Recall
REF: p. 1123
OBJ: 5
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 30. Which of the following is required for noninvasive ventilators to work properly? a. Exhalation valve b. Pressure alarm c. Leak d. Blender ANS: C
A small leak is required in the circuit or patient interface for these ventilators to work properly. DIF: Recall
REF: p. 1123
OBJ: 5
31. Which of the following is the most important advantage of noninvasive ventilators over other
types of ventilators? a. Cost b. Ability to trigger and cycle appropriately when small-to-moderate air leaks are present c. Ability to remove CO 2 d. Ability to oxygenate ANS: B
The most important advantage of noninvasive ventilators over other types of ventilators is the ability to trigger and cycle appropriately when small- to moderate-size air leaks are present. DIF: Recall
REF: p. 1123| p. 1125
OBJ: 5
32. Which of the following is/are the minimum performing characteristics of most noninvasive
ventilators? 1. Mandatory rate of 50 breaths/min or less 2. Inspiratory pressure of 30 cm H 2 O or less 3. PEEP of 15 cm H 2 O or less 4. Inspiratory flow of 180 L/min or less at 20 cm H2 O a. 1 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 2, 3, and 4 only ANS: D
Noninvasive positive-pressure ventilators should provide a mandatory rate of 30 breaths/min or less, inspiratory pressure of 30 cm H 2 O or less, positive end-expiratory pressure (PEEP or end-positive airway pressure [EPAP]) of 15 cm H 2 O or less, inspiratory flow of 180 L/min or less at 20 cm H 2 O, ideally an FiO 2 from 0.21 to approximately 1.0, minimal rebreathing potential, and antiasphyxia capabilities. DIF: Recall
REF: p. 1125
OBJ: 6
33. Which of the following are a required ventilator alarm for noninvasive ventilation (NIV)?
1. Loss of power 2. Circuit disconnect
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. Battery failure 4. Blender alarm a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
The ventilator must have alarms for circuit disconnect, loss of power, and battery failure if a battery is present. DIF: Recall
REF: p. 1125
OBJ: 6
34. Which level of positive end-expiratory pressure (PEEP) is necessary to prevent rebreathing of
carbon dioxide? a. 1 to 3 cm H 2 O b. 3 to 5 cm H 2 O c. 5 to 7 cm H 2 O d. 7 to 9 cm H 2 O ANS: B
These reports suggest the use of 3 to 5 cm H2 O PEEP or the use of a nonrebreathing valve to prevent rebreathing of carbon dioxide. DIF: Recall
REF: p. 1125
OBJ: 6
35. Which of the following modes are commonly seen on noninvasive ventilators?
1. Continuous positive airway pressure (CPAP) 2. Spontaneous (pressure assist) 3. Pressure assist 4. Volume control a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Modes on noninvasive ventilators usually include CPAP, pressure support (spontaneous), and pressure assist/control (timed). DIF: Recall
REF: p. 1125
OBJ: 6
36. What mode of ventilation is most often used for noninvasive ventilation (NIV) when a critical
care ventilator is in use? a. Pressure support ventilation (PSV) b. Continuous positive airway pressure c. Intermittent mandatory ventilation d. Control ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
The mode of ventilation most used for NIV on intensive care unit ventilators is PSV. DIF: Recall
REF: p. 1126
OBJ: 7
37. Your patient is being ventilated with a common critical care ventilator using pressure support
ventilation (flow cycled) with a nasal mask. A leak is present that is preventing the appropriate termination of the inspiratory cycle. What is the best response? a. Switch to volume control mode. b. Switch to time-cycled mode. c. Switch to nasal pillows. d. Switch to full-face mask. ANS: B
Time-cycled (instead of flow-cycled), pressure-limited ventilation in the presence of air leaks markedly improves patient-ventilator synchrony and patient comfort. DIF: Analysis
REF: p. 1126
OBJ: 7
38. Which of the following statements are true about the use of home care ventilators for
delivering noninvasive ventilation (NIV)? 1. They operate only with pressure triggering. 2. They can operate on AC or DC power sources. 3. They can have a single-limb ventilator circuit. 4. Flow delivery pattern can be adjusted. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
In some, flow delivery is limited to a sine-wave flow pattern. DIF: Recall
REF: p. 1126
OBJ: 5
39. What strategy should be used when the patient complains of nasal congestion during the use
of a nasal mask for noninvasive ventilation (NIV)? a. Switch to an oral mask. b. Switch to a face mask. c. Add a heated humidifier. d. Reduce the inspiratory flow. ANS: C
The application of heated humidity relieves nasal resistance and congestion. DIF: Application
REF: p. 1129
OBJ: 8
40. Which of the following is the current recommendation for adding humidity while using
noninvasive ventilation (NIV)? a. It is never recommended. b. It is recommended for short-term application (<1 day).
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. It is recommended for long-term application (>1 day). d. It is always recommended. ANS: C
Because the upper airway is not bypassed during NIV, the current recommendation is no humidity for short-term applications (<1 day). DIF: Recall
REF: p. 1129
OBJ: 8
41. What is the recommended initial setting for positive end-expiratory pressure (PEEP) when
delivering noninvasive ventilation in the pressure triggered timed mode? a. 2 to 5 cm H 2 O b. 5 to 8 cm H 2 O c. 8 to 12 cm H 2 O d. 12 to 20 cm H 2 O ANS: B
The vast majority of patients only require PEEP levels of 5 to 8 cm H2 O. DIF: Recall
REF: p. 1129
OBJ: 6
42. What is the recommended initial setting for ventilating pressure when delivering noninvasive
ventilation in the pressure triggered timed mode? a. 2 to 5 cm H 2 O b. 5 to 8 cm H 2 O c. 8 to 12 cm H 2 O d. 12 to 20 cm H 2 O ANS: C
The majority of patients only require ventilating pressure of 8 to 12 cm H2 O. DIF: Recall
REF: p. 1129
OBJ: 6
43. Which of the following define successful application of noninvasive ventilation (NIV)?
1. Overall improvement of patient’s blood gas 2. Normal blood gas 3. PaO 2 increased 4. PaCO 2 decreased a. 1 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 1, 3, and 4 only ANS: D
Successful application of NIV is easy to define: the patient’s blood gases improve, PaCO 2 decreases, and pH normalizes, while PaO 2 increases. DIF: Recall
REF: p. 1129
OBJ: 7
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 44. What physiologic effect will raising the expiratory positive airway pressure have in the patient
receiving noninvasive ventilation? a. Increase the functional residual capacity. b. Increase the tidal volume. c. Decrease the PCO 2. d. Lower the mean airway pressure. ANS: A
See Table 49-1. DIF: Recall
REF: p. 1130
OBJ: 8
45. Which of the following is likely to occur when decreasing the expiratory positive airway
pressure in the patient being ventilated using noninvasive ventilation? a. Improved PaO 2 b. Increased functional residual capacity c. Increased tidal volume d. Increased inspiratory positive airway pressure ANS: C
See Table 49-1. DIF: Recall
REF: p. 1130
OBJ: 8
46. What is the best option for the patient in respiratory failure who continues to deteriorate 30
min after the initiation of noninvasive ventilation? a. Wait another 30 min and monitor the patient. b. Begin continuous positive airway pressure. c. Intubate and begin mechanical ventilation. d. Ventilate the patient using a bag-valve-mask. ANS: C
If the patient’s vital signs and blood gas values are worsening after 30 min on optimal settings, intubation should be considered. DIF: Recall
REF: p. 1130
OBJ: 8
47. Initiating noninvasive ventilation (NIV) can be done in which of the following settings?
1. Emergency department 2. Intensive care unit 3. Hospital ward 4. Nursing home a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
In the acute care setting, NIV can be initiated in the emergency department, critical care unit, intermediate care unit, or hospital ward.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 1131
OBJ: 7
48. What patient population is the only group currently accepted for the use of noninvasive
ventilation (NIV) in the hospital ward? a. Chronic obstructive pulmonary disease (COPD) patients with near normal pH b. Postoperative patients without pneumonia c. No-code patients d. Asthma patients with normal SpO 2 ANS: A
Currently, the only patient population for whom initiation and management of NIV on hospital wards are recommended is hypercapnic COPD patients with a pH of 7.30 or greater. DIF: Recall
REF: p. 1131
OBJ: 8
49. What complication associated with noninvasive ventilation (NIV) is most common? a. Aspiration b. Hypotension c. Nasal congestion d. Air leaks ANS: D
See Table 49-2. DIF: Recall
REF: p. 1132
OBJ: 8
50. Which of the following techniques are useful to avoid claustrophobia in the patient being
ventilated by face mask? 1. Allow patient to hold the mask. 2. Increase the inspiratory flow. 3. Use sedation. 4. Use a larger mask. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
See Table 49-2. DIF: Recall
REF: p. 1132
OBJ: 8
51. Which of the following are possible solutions to correct a large air leak during noninvasive
ventilation? 1. Selecting an appropriately sized mask 2. Applying chin straps 3. Using a full-face mask 4. Decreasing the inspiratory time a. 1 and 2 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK b. 2 and 2 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
Small air leaks should be expected during noninvasive ventilation. Large air leaks should be addressed immediately. Air leaks can be avoided by selecting an appropriately sized mask, changing to a full-face mask, repositioning the mask, readjusting the straps and adding a forehead spacer. DIF: Application
REF: p. 1132
OBJ: 8
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 51 - Monitoring the Patient in the Intensive Care Unit Kacmarek et al.: Egan’s Fundamentals of Respiratory Care, 12th Edition MULTIPLE CHOICE 1.
While monitoring patients, signals, or values are susceptible to variability due to which of the following? 1. Artifacts 2. Factitious events 3. Instrument drift 4. Seasonal variation e. 1 and 3 only f. 1, 2, and 3 only g. 3 and 4 only h. 2, 3, and 4 only ANS: B
Signals or values are susceptible to variability due to artifacts, factitious events, physiologic variation, and instrument drift. DIF: •
Recall
REF:
pp. 1155-1156
OBJ:
1
Temporary variation in pulmonary artery pressure readings due to movement of the hemodynamic monitoring line is an example of what type of variability? 3. Artifact 4. Factitious event 5. Physiologic variation 6. Instrument drift ANS: A
Artifacts are frequently seen, for example, when the patient or monitoring lines are moved. DIF:
Application
REF:
p. 1156
OBJ:
1
e. You are monitoring blood pressure during mechanical ventilation of a patient with pneu-
monia. A temporary increase in blood pressure occurs when the patient coughs. This temporary spike in blood pressure represents what type of variability? • Artifact • Factitious event • Physiologic variation • Instrument drift ANS: C
The signal itself can exhibit a random variability related to the inherent imprecision of the signal or due to normal physiologic variability in the patient. Blood pressure, for example, changes within a certain range for many reasons.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application REF: p. 1156 OBJ: 1 4. Which of the following are reasons monitoring is needed? d. Continuous assessment e. Analysis of vital signs f. Measurement of values that caregivers cannot detect e. 1 only f. 1 and 2 only g. 1 and 3 only h. 1, 2, and 3 ANS: C
Monitors are needed for two main reasons: (1) continuous assessment (humans need breaks) and (2) measurement of values that caregivers cannot detect such as ECG findings and airway pressure. DIF: 5.
Recall
REF:
p. 1155
OBJ:
1
Which of the following parameters are major factors in determining tissue oxygenation? 5. Arterial oxygenation 6. Tissue perfusion 7. Oxygen (O 2 ) uptake 8. P/F ratio 5. 1 and 3 only 6. 1, 2, and 3 only 7. 3 and 4 only 8. 2, 3, and 4 only ANS: B
Tissue oxygenation depends on inspired oxygen levels (FiO 2 ), inspired partial pressure of oxygen (PIO 2 ), alveolar oxygen tension (PAO 2 ), arterial oxygenation (PaO 2 , SaO 2 , oxygen content of arterial blood [CaO 2 ]), oxygen delivery (DO 2 ), tissue perfusion, and O 2 uptake. DIF:
Recall
REF:
p. 1156
OBJ:
4
e. In low-perfusion patients, what site would be best for monitoring SpO 2 ? 6. Finger 7. Earlobe 8. Nose 9. Forehead ANS: A
Finger probes appear more accurate than forehead, nose, or earlobe probes during low-perfusion states. DIF:
Recall
REF:
p. 1157
OBJ:
4
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK e. Which of the following are likely to cause errors in SpO 2 readings? 7. Anemia 8. Deeply pigmented skin 9. Motion due to shivering 10. Significant tachycardia e. 1 and 3 only f. 1, 2, and 3 only 8. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
Intense daylight and fluorescent, incandescent, xenon, and infrared light sources have caused errors in pulse oximetric readings. Anemia and deeply pigmented skin can affect the accuracy of pulse oximetry; however, the effect of anemia is not clinically significant until the hemoglobin level is markedly reduced. DIF:
Recall
REF:
p. 1157
OBJ:
4
e. What is the normal approximate value for O2 consumption? 9. 150 ml/min 10. 200 ml/min 11. 250 ml/min 12. 300 ml/min ANS: C
Normal resting O 2 consumption is approximately 250 ml/min and O 2 consumption increases with activity, stress, and temperature. DIF:
Recall
REF:
p. 1157
OBJ:
4
e. What method(s) is/are used to measure O2 consumption? 10. Fick method 11. Analysis of inspired and expired gases 12. V/Q scans
5. 1 only 6. 1 and 2 only 7. 1 and 3 only 8. 1, 2, and 3 ANS: B
Two primary methods are in general use: the Fick method and analysis of inspired and expired gases. DIF: e.
Recall
REF:
p. 1157
OBJ:
4
What is the normal range for P(A−a)O 2 in a healthy 30-year-old person breathing room air? 5. 0 to 10 mm Hg
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
6. 5 to 15 mm Hg 7. 10 to 20 mm Hg 8. Cannot predict ANS: B
For example, a healthy person has a P(A−a)O 2 of 5 to 15 mm Hg while breathing room air. DIF: e.
Recall
REF:
p. 1158
OBJ:
4
Your patient has a P(A−a)O 2 of 200 mm Hg while breathing 100% O 2 . What is the estimated percentage shunt? 12. 5% e. 10% f. 20% g. 30% ANS: B
P(A–a)O 2 increases to 100 to 150 mm Hg when the person is breathing 100% O2 . DIF:
Application
REF:
p. 1158
OBJ:
4
13. What is considered normal for the PaO 2 /FiO 2 ratio?
5. 6. 7. 8.
Greater than 50 Greater than 150 Greater than 250 Greater than 400
ANS: D
A normal PaO 2 /FiO 2 ratio while breathing room air is approximately 400 to 500 mm Hg. DIF: e.
Recall
REF:
p. 1158
OBJ:
4
Which parameter is considered to be the most accurate and reliable measure of oxygenation efficiency? 5. PaO 2 /FiO 2 ratio 6. P(A–a)O 2 /PaO 2 ratio 7. Q s /Qt 8. PaO 2 /SaO 2 ratio ANS: C
The most accurate and reliable measure of oxygenation efficiency is direct computation of the physiologic shunt. DIF:
Recall
REF:
p. 1158
OBJ:
4
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK e.
Which of the following parameters are used in calculating the Murray lung injury score of a patient with acute lung injury? 9. Results of chest radiograph 10. PEEP setting 11. Lung compliance 12. Cardiac output 15. 1 and 3 only 16. 1, 2, and 3 only 17. 3 and 4 only 18. 2, 3, and 4 only ANS: B
The Murray lung injury score quantifies the injury level using four factors: chest radiographic findings, PaO 2 /FiO 2 ratio, positive end-expiratory pressure (PEEP) setting, and compliance. DIF: e.
Recall
REF:
p. 1159
OBJ:
14
What is the best single measure of effective ventilation in the intensive care unit patient? 16. Dead space-tidal volume ratio c. PaCO 2 d. End-tidal PCO 2 e. Q s /Q t ANS: B
Because of the relationship between alveolar ventilation and PaCO 2 , the single best index of effective ventilation is measurement of the PaCO 2 . DIF: e.
Recall
REF:
pp. 1159-1160
OBJ:
5
What is the best measure of the efficiency of gas exchange in the lung? 17. PaCO 2 18. V DS/V T 19. End-tidal PCO 2 20. PaCO 2 /PETCO 2 ANS: B
The dead space-tidal volume ratio (V D/VT) is a measure of the efficiency of gas exchange. DIF: e.
Recall
REF:
p. 1161
OBJ:
6
What is the normal range for VD/V T? 18. 0.10 to 0.20 19. 0.20 to 0.40 20. 0.30 to 0.50 21. 0.40 to 0.55 ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
In healthy persons who are sitting, the VD/VT ratio is 0.20 to 0.40. DIF:
5.
Recall
REF:
p. 1161
OBJ:
6
In which of the following disorders would an increased V D/VT ratio not be likely? e. Congestive heart failure f. Pulmonary embolism g. Acute lung injury h. Hypothalamus tumor ANS: D
Frequently the V D/VT ratio is increased in patients with congestive heart failure, pulmonary embolism, acute lung injury, or pulmonary hypertension and in patients undergoing mechanical ventilation. DIF:
5.
Application
REF:
p. 1161
OBJ:
6
Which of the following values of VD/V T, are suitable for weaning? e. 0.10 f. 0.20 g. 0.30 h. 0.60 20. 1 and 3 only 21. 1, 2, and 3 only e. 3 and 4 only 21. 2, 3, and 4 only ANS: B
A VD/VT ratio greater than 0.60 is predictive of lack of success at discontinuance of ventilation. DIF:
Recall
REF:
p. 1161
OBJ:
6
22. What is the normal disparity between end-tidal PCO 2 and PaCO 2 ?
5. 6. 7. 8.
End-tidal PCO 2 is 1 to 5 mm Hg less than PaCO 2 End-tidal PCO 2 is 5 to 10 mm Hg less than PaCO 2 End-tidal PCO 2 is 1 to 5 mm Hg higher than PaCO 2 End-tidal PCO 2 is 5 to 10 mm Hg higher than PaCO 2
ANS: C
The PETCO 2 normally is 1 to 5 mm Hg less than the PaCO 2 . DIF: e.
Recall
REF:
p. 1161
OBJ:
6
Which of the following lead to an increased end-tidal PCO 2 ? 4. Decreased effective ventilation 5. Increased metabolic rate
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
6. Decreased minute ventilation 7. Exercise a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Positive pressure ventilation (especially with PEEP), pulmonary embolism, cardiac arrest, and pulmonary hypoperfusion also may cause an increase in PaCO 2 to PETCO 2 gradient [P(a– ET)CO 2 ]. Exercise and a large tidal volume can reverse the P(a–ET)CO 2 gradient, the PETCO 2 can actually exceed the PaCO 2 . DIF: 22.
Application
REF:
p. 1161
OBJ:
6
Which of the following are associated with a decreased end-tidal PCO 2 ? 1. Decreased metabolic rate 2. Increase in lung perfusion 3. Rapid and very shallow breathing 4. Decreased CO2 production a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: D
Positive pressure ventilation (especially with PEEP), pulmonary embolism, cardiac arrest, and pulmonary hypoperfusion also may cause an increase in PaCO 2 to PETCO 2 gradient[P(a– ET)CO 2 ]. Exercise and a large tidal volume can reverse the P(a–ET)CO 2 gradient, the PETCO 2 can actually exceed the PaCO 2 . DIF:
Application
REF:
p. 1161
OBJ:
6
23. What is the value of determining the lower inflection point during measurement of the
pressure-volume curve? a. Best tidal volume b. Best PEEP level c. To determine best airway size d. To determine type of ventilator inspiratory flow pattern ANS: B
A recommended strategy for setting PEEP is to set a level slightly above the lower inflection point with the goal of recruitment and stabilization of dependent alveoli that would otherwise sustain injury from repetitive opening, closing, and reopening during tidal ventilation. DIF:
Recall
REF:
p. 1161
OBJ:
7
24. What is the normal range for lung compliance?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. b. c. d.
40 to 60 ml/cm H2 O 60 to 100 ml/cm H2 O 80 to 120 ml/cm H2 O 100 to 120 ml/cm H2 O
ANS: B
Normal compliance ranges between 60 and 100 ml/cm H2 O. DIF:
Recall
REF:
p. 1162
OBJ:
7
25. Which of the following is the Raw of intubated patients receiving ventilatory support? a. 1 to 2 cm H2 O/L/sec b. 3 to 5 cm H2 O/L/sec c. 5 to 10 cm H 2 O/L/sec d. 10 to 20 cm H 2 O/L/sec ANS: C
Intubated patients receiving mechanical ventilatory support typically have a R aw of 5 to 10 cm H 2 O/L/sec. DIF:
Recall
REF:
p. 1164
OBJ:
7
26. Which of the following conditions is associated with an increased lung compliance
measurement? a. Atelectasis b. Pneumonia c. Emphysema d. Bronchial intubation ANS: C
See Box 51-7. DIF:
Application
REF:
p. 1162
OBJ:
7
27. Which of the following are causes of increased airway resistance?
1. Small endotracheal tube 2. High gas flow 3. Increased secretions 4. Frequent suctioning a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
See Box 51-7. DIF:
Application
REF:
p. 1162
OBJ:
7
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 28. What is the upper limit for plateau airway pressure that is recommended during mechanical
ventilation? a. Less than 28 cm H 2 O b. 30 to 40 cm H 2 O c. 40 to 50 cm H 2 O d. Depends on the patient ANS: A
The Pplat ideally should not exceed 28 cm H 2 O because elevated Pplat increases the likelihood of developing ventilator-induced lung injury. DIF:
Recall
REF:
p. 1164
OBJ:
8
29. Which of the following factors is/are associated with an increased risk for auto-PEEP?
1. Mechanical ventilation of a patient with obstructive lung disease 2. High-minute volume during mechanical ventilation 3. Acute respiratory distress syndrome (ARDS) patients 4. Pulmonary fibrosis a. 1 and 4 only b. 1, 2, and 3 only c. 3 only d. 1, 2, 3, and 4 ANS: B
Patients receiving mechanical ventilation for obstructive airways disease have a large degree of inhomogeneity in the emptying of lung units, and auto-PEEP can develop even at relatively low-minute ventilation. Auto-PEEP is common in mechanically ventilated patients with high-minute ventilation and thus occurs in some patients with ARDS. DIF: 30.
Application
REF:
p. 1164
OBJ:
9
Which of the following are associated with auto-PEEP? 1. Erroneous calculation of static lung compliance 2. Hemodynamic compromise 3. Barotraumas 4. Increasing mean airway pressure a. 1 and 3 only b. 1 and 2 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: D
The presence of auto-PEEP results in the underestimation of mean alveolar pressure when mean airway pressure is being monitored to reflect mean alveolar pressure. An increase in mean alveo lar pressure due to auto-PEEP may exacerbate the hemodynamic effects of positive pressure ventilation and increase the likelihood of barotrauma in a manner similar to that seen with the appli cation of PEEP.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application REF: p. 1164 OBJ: 9 31. What is the average total work of breathing for healthy persons? a. 0.31 to 0.2 J/L b. 0.3 to 0.5 J/L c. 0.5 to 0.8 J/L d. 0.8 to 1.5 J/L ANS: B
For healthy persons, the average total work of breathing ranges between 0.030 and 0.050 kg/m/L (0.3 to 0.5 J/L). DIF:
Recall
REF:
p. 1166
OBJ:
9
32. What is the normal range for the percent of O 2 consumption consumed by the respiratory
muscles? a. 2% to 5% b. 5% to 10% c. 10% to 15% d. 20% to 25% ANS: A
Normal O2 R is approximately 2% to 5% of total O 2 consumption. DIF:
Recall
REF:
p. 1166
OBJ:
9
33. Which of the following breathing patterns suggests respiratory muscle decompensation? a. Rapid and deep breaths b. Rapid and shallow breaths c. Slow and shallow breaths d. Slow and deep breaths ANS: B
When muscular strength is limited, patients tend to meet minute ventilation ( by increasing frequency (f) while decreasing tidal volume (V T). DIF:
Recall
REF:
p. 1167
OBJ:
E) requirements
9
34. Which of the following two parameters are most commonly used for bedside assessment of
respiratory muscle strength? a. Vital capacity and maximum inspiratory pressure b. Vital capacity and peak flow c. Maximum inspiratory pressure and MVV d. MVV and vital capacity ANS: A
The two values most commonly used for bedside assessment of respiratory muscle strength are vital capacity (VC) and maximal inspiratory pressure (MIP).
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 1167 OBJ: 9 35. A vital capacity (VC) value below what value indicates significant muscle weakness? a. 10 to 15 ml/kg b. 20 to 25 ml/kg c. 30 to 40 ml/kg d. 50 to 60 ml/kg ANS: A
A VC less than 10 to 15 ml/kg indicates considerable muscle weakness, which may inhibit the ability to breathe spontaneously. DIF:
Recall
REF:
p. 1167
OBJ:
9
36. What is the best parameter to measure when trying to assess respiratory muscle endurance? a. FVC b. MIP c. MVV d. NIF ANS: C
A measure used to assess respiratory muscle reserve, endurance, or fatigue is MVV. DIF:
Recall
REF:
p. 1167
OBJ:
9
37. Which of the following are common purposes of using ventilator graphics?
1. To detect auto-PEEP 2. To assess effects of bronchodilators 3. To determine patient ventilator synchrony 4. To determine best FiO 2 a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Ventilator graphics clearly show many important patient-ventilator interactions, such as presence of auto-PEEP, elevated airway pressure, presence of secretions, and the general pattern and dependability of supported ventilation (Figure 51-8). DIF:
Application
REF:
p. 1174
OBJ:
10
38. What is the normal range for mean arterial pressure? a. 60 to 80 mm Hg b. 50 to 100 mm Hg c. 80 to 100 mm Hg d. 90 to 120 mm Hg
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: C
See Table 51-1. DIF:
Recall
REF:
p. 1169
OBJ:
11
39. What is the normal central venous pressure reading? a. 2 to 6 mm Hg b. 5 to 12 mm Hg c. 8 to 16 mm Hg d. 12 to 22 mm Hg ANS: A
See Table 51-3. DIF:
Recall
REF:
p. 1178
OBJ:
11
40. What is the normal mean pulmonary artery pressure? a. 5 mm Hg b. 10 mm Hg c. 15 mm Hg d. 20 mm Hg ANS: C
See Table 51-3. DIF:
Recall
REF:
p. 1178
OBJ:
11
OBJ:
11
41. What is the normal range for cardiac output? a. 2 to 4 L/min b. 4 to 8 L/min c. 5 to 10 L/min d. Depends on patient age ANS: B
See Table 51-1. DIF:
Recall
REF:
p. 1169
42. What is the normal range for pulmonary capillary wedge pressure? a. 5 to 10 mm Hg b. 15 to 20 mm Hg c. 20 to 25 mm Hg d. 30 to 35 mm Hg ANS: A
See Table 51-3. DIF:
Recall
REF:
p. 1178
OBJ:
11
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 43. Which of the following are associated with an increase in central venous pressure?
1. Right heart failure 2. Pulmonary valvular stenosis 3. Pulmonary embolism 4. Dehydration a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
See Box 51-11. DIF:
Application
REF:
p. 1178
OBJ:
11
44. What hemodynamic parameter is best useful for estimated left ventricular end-diastolic
pressure? a. CVP b. PCWP c. SVR d. PVR ANS: B
PCWP is an estimate of left atrial pressure, which reflects left ventricular end-diastolic pressure. DIF:
Recall
REF:
p. 1179
OBJ:
11
45. What parameter is best used to assess left ventricular afterload? a. CVP b. PCWP c. SVR d. PVR ANS: C
An increase in systemic vascular resistance increases left ventricular afterload. DIF:
Recall
REF:
p. 1180
OBJ:
11
46. What medication is associated with dilated and fixed pupils in the intensive care unit patient? a. Atropine b. Lidocaine c. Vanceril d. Aminophylline ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Dilated and fixed (unresponsive to light) pupils are seen in patients who have been given atropine. DIF:
Recall
REF:
p. 1182
OBJ:
12
47. At what level of intracranial pressure will venous drainage be impeded and cerebral edema
develop in uninjured tissue? a. 10 to 15 mm Hg b. 20 to 30 mm Hg c. 30 to 35 mm Hg d. 40 to 45 mm Hg ANS: C
At intracranial pressure levels of 30 to 35 mm Hg, venous drainage is impeded and edema develops in uninjured tissue. DIF:
Recall
REF:
p. 1183
OBJ:
12
48. What is the Glasgow Coma Scale (GCS) score that requires intracranial pressure monitoring? a. Less than 8 b. Less than 9 c. Less than 10 d. Less than 11 ANS: A
Head-injured patients with GCS scores of 8 and less need monitoring of intracranial pressure. DIF:
Recall
REF:
p. 1183
OBJ:
12
49. What is the most common method of estimating GFR? a. Blood urea nitrogen b. Blood urea nitrogen and creatinine c. Plasma creatinine and creatinine clearance d. Urine output ANS: C
The most common method of estimating GFR (renal function) is measurement of plasma creatinine and creatinine clearance rate. DIF:
Recall
REF:
p. 1183
OBJ:
13
50. What level of urine output is considered anuria? a. Less than 500 ml/day b. Less than 250 ml/day c. Less than 150 ml/day d. Less than 50 ml/day ANS: D
Anuria is present when urine output is less than 50 ml/day.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: pp. 1183-1184 OBJ: 13 51. Elevation of which of the following substances is consistent with hepatic inflammation? a. Aspartate aminotransferase b. Bilirubin c. Alkaline phosphatase d. Blood urea nitrogen ANS: A
Elevated levels of aspartate aminotransferase and alanine aminotransferase suggest hepatic inflammation. DIF:
Recall
REF:
pp. 1183-1184
OBJ:
13
52. Which of the following physical findings is not consistent with starvation? a. Temporal muscle wasting b. Sunken supraclavicular fossae c. Decreased adipose stores d. Less than 50 ml/day ANS: D
Temporal muscle wasting, sunken supraclavicular fossae, and decreased adipose stores are easily recognized signs of starvation. DIF:
Application
REF:
p. 1184
OBJ:
13
53. Which of the following levels of albumin are consistent with severe malnutrition? a. Less than 3.0 g/dl b. Less than 2.5 g/dl c. Less than 2.2 g/dl d. Less than 4.0 g/dl ANS: C
Serum albumin concentration is the most frequently used laboratory measure of nutritional status, a value less than 2.2 g/dl generally reflecting severe malnutrition. DIF:
Recall
REF:
p. 1184
OBJ:
13
54. Which of the following are global monitoring indexes?
1. APACHE 2. APS 3. TISS 4. ATS a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 2, 3, and 4
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: B
These indices (Acute Physiology and Chronic Health Evaluation [APACHE 1, 2, 3 and 4], Acute Physiology Score [APS], Therapeutic Intervention Scoring System [TISS], and Burns Weaning Assessment Program [BWAP]) are determinations of scores from a number of monitored values obtained from snapshots of the patient’s condition, usually during the first 24 hr after hospital admission. DIF: Recall REF: p. 1185 OBJ: 14 55. Which of the following should be considered first if medical and mechanical problems have
been excluded and the patient continues to fight the ventilator or exhibit high levels of agitation or distress? a. Paralytics b. Sedatives c. Narcotics d. Anesthetics ANS: B
If medical and mechanical problems have been excluded and the patient continues to fight the ventilator or exhibit high levels of agitation or distress, sedation should be considered. DIF:
Analysis
REF:
p. 1185
OBJ:
15
56. Which of the following are used to determine a patient’s neurologic status?
1. Measuring VD/VT ratio 2. Pupillary response and eye movement 3. Corneal and gag reflex 4. Respiratory rate and pattern a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Neurologic examinations include evaluation of the following: mental status, pupillary response, eye movements, corneal responses, gag reflex, respiratory rate and pattern, motor evaluation, and sensory evaluation. DIF:
Application
REF:
p. 1182
OBJ:
12
57. Which of the following bedside assessment of respiratory muscle strength is commonly used
on ventilated patients? a. Tidal volume b. Maximal inspiratory pressure c. Minute ventilation d. Respiratory rate ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Two values commonly used for bedside assessment of respiratory muscle strength are vital capacity (VC) and maximal inspiratory pressure (MIP). DIF:
Recall
REF:
p. 1167
OBJ:
9
58. Which of the following are primary reasons to measure intracranial pressure (ICP)?
1. To monitor patients at risk of life-threatening intracranial hypertension 2. To monitor for evidence of infection 3. To assess the effects of therapy aimed at reducing ICP 4. To maintain the mean ICP greater than 20 mm Hg a. 1 only b. 1, 2, and 4 only c. 1, 2, 3 only d. 1, 2, 3, and 4 ANS: C
There are three primary reasons to measure intracranial pressure (ICP): (1) to monitor patients at risk of life-threatening intracranial hypertension, (2) to monitor for evidence of inflection, and (3) to assess the effects of therapy aimed at reducing ICP. Also, normal mean ICP for a patient in the supine is normally 10 to 15 mm Hg, ICP. Elevations in ICP to 15 to 20 mm Hg compress the capillary bed and compromise microcirculation. DIF: 59.
Recall
REF:
p. 1183
OBJ:
12
Which of the following factors affect cardiac performance? 1. Preload 2. Afterload 3. Contractility 4. Cardiac output a. 1 and 2 only b. 1 and 3 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
Cardiac performance is affected by preload, contractility, and afterload, and is evaluated by the measurement of cardiac output. DIF: 60.
Recall
REF:
pp. 1179-1180
OBJ:
11
Which of the following are included in the Berlin definition of moderate ARDS? 1. Bilateral infiltrates on chest radiograph 2. Absence of left ventricular failure 3. PaO 2 /FiO 2 100 – 200 mm Hg 4. Oxygenation index (OI) less than 10 a. 1 and 3 only b. 1, 2, and 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 2 and 4 only d. 1, 2, 3, and 4 ANS: B
The Berlin definition of ARDS includes: Bilateral infiltrates on chest radiograph • Absence of left ventricular failure • PaO 2 /FiO 2 200 to 300 mm Hg for mild ARDS (previously considered acute lung injury or ALI) • PaO 2 /FiO 2 100 to 200 mm Hg for moderate ARDS • PaO 2 /FiO 2 less than 100 mm Hg for severe ARDS DIF:
Recall
REF:
p. 1158
OBJ:
15
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 52 - Discontin uing Ventilato ry Support Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following factors will increase ventilatory demand (workload)?
1. Severe hypoxemia 2. Pulmonary infection 3. Increased compliance 4. Bronchospasm a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Factors that may increase ventilatory workload are summarized in Box 52-1. DIF: Recall
REF: p. 1192
OBJ: 1
2. Ventilatory capacity is determined by which of the following?
1. Central nervous system (CNS) drive 2. Trigger level 3. Muscle strength 4. Muscle endurance a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: D
Ventilatory capacity is determined by (1) CNS drive, (2) ventilatory muscle strength, and (3) ventilatory muscle endurance. DIF: Recall
REF: p. 1192
OBJ: 1
3. Which of the following factors can reduce a patient’s ventilatory drive?
1. Respiratory alkalosis 2. Metabolic acidosis 3. Depressant drugs 4. Decreased metabolism a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: D
Box 52-2 summarizes factors that may reduce ventilatory drive.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 1193
OBJ: 2
4. When is ventilator dependence likely to occur?
1. When ventilatory capacity exceeds demand 2. When arterial hypoxemia is present 3. When the patient is malnourished 4. When the cardiovascular system is unstable a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
Other factors that may contribute to ventilator dependence include inadequate arterial oxygenation, poor tissue oxygen (O2 ) delivery, myocardial ischemia, arrhythmias, low cardiac output, and cardiovascular instability. DIF: Recall
REF: p. 1193
OBJ: 2
5. What is the most important prerequisite for weaning a patient from ventilatory support? a. Improvement in the original problem requiring mechanical ventilation b. Assurance that the patient’s ventilatory demand exceeds the patient’s capacity c. Objective evidence indicating good respiratory muscle endurance d. Ability to maintain adequate oxygenation with an FiO 2 less than 0.4 ANS: A
The single most important criterion to consider when evaluating a patient for ventilator discontinuation or weaning is whether there has been significant alleviation or reversal of the disease state or condition that necessitated use of the ventilator in the first place. DIF: Recall
REF: p. 1193
OBJ: 3
6. What is the least reliable weaning index? a. Vital capacity (VC) b. Maximum inspiratory capacity (MIP) c. Minute ventilation (V E) d. Rapid-shallow breathing index (f/V T) ANS: A
With respect to the more traditional weaning indices, vital capacity can be highly variable, whereas MIP, minute ventilation, respiratory rate (f), and f/VT tend to be more reliable. DIF: Recall
REF: p. 1194
OBJ: 3
7. Which of the following oxygenation measures support a patient’s readiness to wean?
1. PaO 2 /PAO 2 (a/A) = 0.45 2. PaO 2 /FiO 2 (P/F) = 110 3. PAO 2 – PaO 2 = 240 mm Hg 4. Physiologic shunt (Qs /Q t) = 12%
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. b. c. d.
1 and 3 only 1, 2, and 3 only 2 and 4 only 1, 3, and 4 only
ANS: D
See Table 52-1. DIF: Analysis
REF: p. 1195
OBJ: 3
8. Which of the following indicate that an adult patient is ready to be weaned from ventilatory
support? 1. VC = 1.9 L 2. Spontaneous rate of 32/min 3. Q s /Qt = 8% 4. MIP = –45 cm H2 O a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
See Table 52-1. DIF: Analysis
REF: p. 1195
OBJ: 3
9. Which of the following indicate that an adult patient is ready to be weaned from ventilatory
support? 1. PAO 2 – PaO 2 = 430 on 100% O 2 2. VD/VT = 0.55 3. MIP = –33 cm H2 O 4. PO 2 = 76 mm Hg on 40% O 2 a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
See Table 52-1. DIF: Analysis
REF: p. 1195
OBJ: 3
10. Which of the following four adult patients receiving ventilatory support is the best candidate
for weaning? VE VC a. 12 8 b. 8 8 c. 20 12 d. 12 12
MVV 22 22 18 18
MIF
–22 –15 –22 –10
VD/VT 0.58 0.40 0.60 0.40
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: A
See Table 52-1. DIF: Analysis
REF: p. 1195
OBJ: 3
11. Which of the following patients exhibits an acceptable ventilatory demand?
VE a. 12 b. 10 c. 8 d. 6
PaCO 2 60 55 45 60
ANS: C
See Table 52-1. DIF: Analysis
REF: p. 1195
OBJ: 3
12. A patient has an adequate ventilatory reserve if which of the following is true? a. Ability to double the resting minute ventilation b. Normal PaCO 2 and minute ventilation less than 10 L/min c. MIP = –55 cm H2 O d. V D/V T less than 0.4 ANS: A
See Table 52-1. DIF: Analysis
REF: p. 1195
OBJ: 3
13. You measure the spontaneous rate of breathing and V T on four patients receiving ventilator
support. For which one is successful weaning most likely? Breathing frequency VT a. 42 250 ml b. 22 400 ml c. 22 350 ml d. 20 200 ml ANS: B
See Table 52-1. DIF: Analysis
REF: p. 1195
OBJ: 3
14. A patient receiving ventilator support has a spontaneous rate of breathing of 26/min and an
average VT of 300 ml. What is this patient’s rapid-shallow breathing index? a. 12 b. 87 c. 105 d. 66 ANS: B
See Table 52-1.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application
REF: p. 1195
OBJ: 3
15. Which of the following signs observed on a mechanically ventilated patient indicate that
successful weaning is unlikely? 1. Palpable scalene muscle use during inspiration 2. Palpable abdominal tensing during expiration 3. Presence of an irregular breathing pattern 4. Patient unable to alter breathing pattern on command a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
Evaluation of patients for the presence of palpable scalene muscle use during inspiration, an irregular ventilatory pattern, palpable abdominal muscle tensing during expiration, and inability to alter ventilatory pattern on command can be helpful in assessment of the potential for prolonged spontaneous ventilation. DIF: Recall
REF: pp. 1194-1195
OBJ: 3
16. Which of the following is false about the P0.1 measure? a. P0.1 correlates well with central respiratory drive. b. P0.1 is the airway pressure measured 100 msec after occlusion. c. P0.1 is an effort-dependent measure of respiratory drive. d. Chronic obstructive pulmonary disease (COPD) patients with a P0.1 greater than 6
cm H2 O are difficult to wean. ANS: C
Airway occlusion pressure (P0.1 ) is the inspiratory pressure measured 100 msec after airway occlusion. The P0.1 is effort independent and correlates well with central respiratory drive. Ventilator-dependent patients with COPD who have a P 0.1 greater than 6 cm H 2 O tend to be difficult to wean. DIF: Recall
REF: p. 1196
OBJ: 3
17. Successful weaning is less likely when a patient’s work of breathing exceeds what level? a. 4 J/min b. 8 J/min c. 12 J/min d. 16 J/min ANS: D
Successful weaning has been found to be less likely among patients with spontaneous work levels greater than 1.6 kg/m/min (16 J/min) or 0.14 kg/m/L (1.4 J/L). DIF: Application
REF: p. 1196
OBJ: 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 18. Above what pressure-time index (PTI) will most patients be unable to sustain spontaneous
breathing? a. 0.03 b. 0.05 c. 0.10 d. 0.15 ANS: D
A PTI greater than 0.15 to 0.18 has been associated with diaphragmatic fatigue, and a PTI greater than 0.15 cannot be sustained indefinitely. DIF: Application
REF: p. 1196
OBJ: 4
19. Which of the following metabolic factors can hinder weaning?
1. Excessive carbohydrate feeding 2. Amino acid–based parenteral nutrition 3. Calorie intake = 1.5 resting energy expenditure (REE) a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: B
Excessive carbohydrate feeding can increase carbon dioxide production and may precipitate acute hypercapnic respiratory failure. Parenteral nutrition solutions containing amino acid formulations (arginine/lysine) can cause metabolic acidosis and thus increase ventilatory demand. DIF: Recall
REF: p. 1196
OBJ: 5
20. Which of the following indicate that a patient’s renal function is adequate for weaning?
1. Urine output = 20 ml/hr 2. No major weight gain 3. No edema present 4. Normal electrolytes a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
The patient ideally should have an adequate urine output (>1000 ml/day), and there should be no inappropriate weight gain or edema. DIF: Application
REF: p. 1197
OBJ: 5
21. Which of the following electrolyte imbalances can hinder weaning from ventilatory support?
1. Hypochloremia 2. Hypomagnesemia
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. Hypokalemia 4. Hyponatremia a. 2 and 3 only b. 1 and 2 only c. 3 and 4 only d. 1 and 4 only ANS: A
Key electrolytes should be normal (magnesium, 1.8 to 3.0 mEq/L; phosphate, 2.5 to 4.8 mEq/L; potassium, 3.5 to 5.0 mEq/L). DIF: Recall
REF: p. 1197
OBJ: 5
22. Which of the following cardiovascular signs would indicate that a patient’s cardiovascular
status is unstable and that weaning should not begin at this time? a. Cardiac index of 2.5 L/min/m2 b. Hemoglobin content of 10 g/dl c. Heart rate of 108/min d. Systolic blood pressure of 80 mm Hg ANS: D
Table 52-2 provides criteria for confirming cardiovascular stability. DIF: Application
REF: p. 1197
OBJ: 4
23. Which of the following health care disciplines should be involved in the care of a patient who
is considered difficult to wean? 1. Physical therapy 2. Speech therapy 3. Social services 4. Occupational therapy a. 1 and 2 only b. 2 and 3 only c. 1, 2, and 4 only d. 1, 2, 3, and 4 ANS: D
This patient should be classified as a difficult to wean patient that would benefit from a program designed specifically for patients failing to wean. This program should systemically evaluate all systems to determine the cause of weaning failure and include the assistance of other health care providers, specifically physical therapy, occupational therapy, speech and language pathology, as well as social service. Ideally this should take place in a unit specifically designed for patients who are difficult to wean. DIF: Recall
REF: pp. 1197-1198
OBJ: 5
24. Prerequisites for successful weaning include:
1. psychological readiness. 2. adequate gag and swallow reflexes.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. ability to follow instructions. 4. adequate cough. a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: C
Adequate central nervous system function is needed to ensure stable ventilatory drive, adequate secretion clearance (cough and deep breathing), and protection of the airway (gag reflex and swallow). In addition, level of consciousness, dyspnea, anxiety, depression, and motivation can affect weaning success. The patient ideally is awake and alert, free of seizures, and able to follow instructions. DIF: Recall
REF: pp. 1197-1198
OBJ: 5
25. Which of the following must you verify when considering weaning an obtunded patient?
1. Adequate gag reflex 2. No depressant drugs 3. Adequate cough a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: D
Obtunded patients should, at a minimum, have an adequate gag reflex and cough. DIF: Recall
REF: p. 1197
OBJ: 5
26. Which of the following drug categories can depress ventilatory drive and hinder weaning?
1. Analgesics 2. Narcotics 3. Hypnotics 4. Antibiotics a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Level of consciousness is affected by the use of narcotic, sedative, and analgesic drugs. DIF: Recall
REF: p. 1197
OBJ: 5
27. Which of the following techniques can help to decrease a patient’s imposed work of breathing
during weaning from ventilatory support? 1. Use of pressure-supported ventilation (PSV) 2. Trigger breath by flow, not pressure
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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3. Application of small amounts of continuous positive airway pressure (CPAP) or positive end expiratory pressure (PEEP) 4. Use of automatic tube compensation (ATC) a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
The patient’s ventilatory workload should be minimized with PSV. Flow trigger, flow-by, or ATC also may be helpful in minimizing imposed ventilatory work. Intrinsic PEEP during mechanical ventilation may increase trigger work, and small amounts of PEEP or CPAP can help overcome this problem. DIF: Application
REF: p. 1208
OBJ: 6
28. Common approaches used to wean patients from ventilatory support include which of the
following? 1. T tube alternating with mechanical ventilation 2. Pressure-supported ventilation (PSV) 3. Intermittent mandatory ventilation a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: C
There are three basic methods of discontinuing ventilatory support: (1) spontaneous breathing trials (usually with a T tube) alternating with mechanical ventilatory support, (2) intermittent mandatory ventilation, and (3) PSV. DIF: Recall
REF: p. 1200
OBJ: 6
29. Which of the following ventilator strategies would you consider as a good alternative to T
tube trials when using a rapid weaning protocol? 1. Continuous positive airway pressure (CPAP) with flow-by (flow triggering) 2. Low-level pressure-supported ventilation (PSV) 3. Intermittent mandatory ventilation a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: B
Rather than using a T tube trial, some clinicians prefer to maintain the patient attached to the ventilator with zero PSV and zero CPAP. DIF: Recall
REF: p. 1200
OBJ: 6
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 30. Which method of weaning may be useful to minimize auto-PEEP? a. Intermittent mandatory ventilation b. Intermittent mandatory ventilation c. Continuous positive airway pressure d. T-piece ANS: C
Low levels of CPAP may be useful in maintaining lung volumes and overcoming intrinsic PEEP, if present. DIF: Application
REF: p. 1201
OBJ: 6
31. A physician orders a T tube trial for a patient receiving ventilatory support in the
assist-control mode with an FiO 2 of 0.4. What FiO 2 would you recommend for this patient during the spontaneous breathing period? a. 0.3 b. 0.4 c. 0.5 d. 0.6 ANS: C
See Box 52-8. DIF: Application
REF: p. 1201
OBJ: 6
32. Advantages of adding continuous positive airway pressure (CPAP) to T tube weaning include
which of the following? 1. Improved blood oxygenation 2. Decreased work of breathing 3. Compensation for auto-PEEP 4. Faster weaning or extubation a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
CPAP has the advantage of maintaining lung volume during the weaning phase and thus of improving the patient’s oxygenation status. Minimal levels of CPAP may be useful in reducing work of breathing and compensating for auto-PEEP, particularly in patients with obstructive lung disease. DIF: Recall
REF: p. 1203
OBJ: 6
33. An alert patient receiving intermittent mandatory ventilation at a rate of 8/min and V T of 600
ml has stable vital signs and satisfactory blood gases on an FiO 2 of 0.45. What would you do to initiate weaning for this patient? a. Lengthen the automatic sigh interval. b. Decrease the mandatory rate to 5 to 6/min.
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
c. Increase FiO 2 to 60%. d. Decrease the VT to 500 ml. ANS: B
At this point, the rate is reduced in a stepwise manner until complete spontaneous breathing can be achieved. DIF: Application
REF: p. 1204
OBJ: 6
34. A physician has selected a pressure support protocol to wean a patient off ventilatory support.
Which of the following pressure levels would you recommend to begin the weaning process? a. Pressure sufficient to obtain a VT of 3 to 5 ml/kg of predicted body weight (PBW) b. Pressure sufficient to overcome the imposed workload c. Pressure sufficient to obtain a VT of 4 to 8 ml/kg PBW d. Pressure equal to 30% of the volume-cycled peak inspiratory pressure ANS: C
For initial ventilator setup in the pressure support mode, the beginning pressure level can be adjusted to deliver an appropriate tidal volume, usually approximately 4 to 8 ml/kg of PBW. DIF: Application
REF: p. 1204
OBJ: 6
35. A physician is using a pressure support protocol to wean a patient off ventilatory support. The
patient is now at a 5 cm H 2 O pressure level and has a spontaneous respiratory rate of 21/min. Other cardiovascular and respiratory signs indicate that the patient remains stable. Which of the following actions would you recommend at this point? a. Switch the patient to 5 cm H2 O continuous positive airway pressure (CPAP) through the endotracheal tube. b. Extubate the patient and provide supplemental O2 . c. Switch the patient to intermittent mandatory ventilation at a rate of 2/min. d. Decrease the pressure support level to 3 cm H 2 O. ANS: B
In general, patients who can spontaneously breathe comfortably at this level of pressure support can be extubated without problems. DIF: Analysis
REF: p. 1204
OBJ: 6
36. An alert patient receiving ventilatory support through a demand flow intermittent mandatory
ventilation system exhibits clinical signs of an increased work of breathing whenever you try to decrease the mandatory rate below 6/min. In order to aid in weaning this patient, which of the following would you recommend? a. Apply a low level of pressure support. b. Apply a high level of inspiratory pressure. c. Increase the mandatory V T. d. Decrease the mandatory V T. ANS: A
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With intermittent mandatory ventilation, the addition of pressure support can overcome the work of breathing imposed during ―spontaneous‖ breaths because of the presence of endotracheal and tracheostomy tubes, demand-flow systems, and ventilator circuits. DIF: Application
REF: p. 1204
OBJ: 6
37. What are some advantages of mandatory minute ventilation (MMV) as a weaning tool?
1. It provides greater control over PaCO 2 than intermittent mandatory ventilation does. 2. It prevents acidemia with acute hypoventilation. 3. It eliminates concerns over depressant drugs. 4. It ensures an efficient pattern of ventilation. a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
See Box 52-12. DIF: Recall
REF: p. 1205
OBJ: 7
38. Which of the following ventilator modes can ensure delivery of a preset V T during
spontaneous breathing? 1. Volume support 2. Volume-assured pressure support 3. Mandatory minute ventilation a. 2 and 3 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
Volume-assured pressure support is similar to volume support in that a minimum preset tidal volume is maintained by means of automatic adjustment of the ventilator. DIF: Recall
REF: p. 1205
OBJ: 7
39. Which of the following is false about noninvasive positive-pressure ventilation (NIV)? a. NIV can support ventilation without a tracheal airway. b. NIV should not be used with patients at risk for aspiration. c. Patients likely to fail weaning are good candidates for NIV. d. NIV can be used to prevent reintubation when weaning fails. ANS: C
Patients who are likely to be unsuccessful at weaning are not good candidates for NIV. DIF: Recall
REF: p. 1202
OBJ: 7
40. In most weaning protocols, what minimum blood gas parameters are needed to start the
process?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. PaO 2 greater than 70 mm Hg and PaCO 2 less than 50 mm Hg on FiO 2 less than 0.6
and PEEP less than 5 cm H2 O b. PaO 2 greater than 70 mm Hg and PaCO 2 less than 50 mm Hg on FiO 2 less than 0.4 and PEEP 5 cm H 2 O or greater c. PaO 2 greater than 50 mm Hg and PaCO 2 less than 50 mm Hg on FiO 2 less than 0.6 and PEEP less than 10 cm H 2 O d. PaO 2 greater than 70 mm Hg and PaCO 2 less than 70 mm Hg on FiO 2 less than 0.6 and PEEP 5 cm H 2 O or greater ANS: B
See Box 52-10. DIF: Recall
REF: p. 1203
OBJ: 6
41. Which of the following weaning methods provides the best respiratory muscle strength
conditioning? a. Pressure-supported ventilation b. T tube c. Intermittent mandatory ventilation d. Volume-assured pressure support ANS: B
See Table 52-4. DIF: Recall
REF: p. 1208
OBJ: 7
42. Which of the following are disadvantages of using the T tube method for weaning?
1. More staff time required 2. Abrupt transition sometimes difficult 3. High imposed work of breathing 4. Lack of alarm systems a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2 and 4 only ANS: B
See Table 52-4. DIF: Recall
REF: p. 1208
OBJ: 7
43. Which of the following are disadvantages of using intermittent mandatory ventilation for
weaning? 1. Potentially high work of breathing 2. Weaning time possibly prolonged 3. Patient-ventilator asynchrony 4. Higher mean airway pressures a. 1 and 3 only b. 1, 2, and 3 only
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 3 and 4 only d. 2, 3, and 4 only ANS: B
See Table 52-4. DIF: Recall
REF: p. 1208
OBJ: 7
44. Which of the following are advantages of using pressure-supported ventilation for weaning?
1. Guaranteed VT 2. Reduced work of breathing 3. Respiratory muscle fatigue prevented 4. Better patient comfort and synchrony a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
See Table 52-4. DIF: Recall
REF: p. 1208
OBJ: 7
45. Which of the following cardiovascular changes would you consider a bad sign during weaning
a patient from ventilatory support? a. Development of chest pain b. Increase in both stroke volume and cardiac index c. Increase in heart rate from 95 to 110/min d. Fall in blood pressure from 143/95 to 126/88 mm Hg ANS: A
See Table 52-6. DIF: Application
REF: p. 1209
OBJ: 6
46. While monitoring a patient being weaned through a T tube protocol, signs indicating that
mechanical ventilation should be restored include which of the following? 1. Development of cardiac arrhythmias 2. Asynchronous or paradoxical breathing 3. Development of severe hypotension 4. Moderate rise in respiratory rate a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
See Table 52-6. DIF: Recall
REF: p. 1209
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 47. While monitoring a patient during a T tube weaning trial, you notice the following: an
increase in heart rate from 86 to 100/min; an increase in respiratory rate from 12 to 23/min; an increase in PaCO 2 from 39 to 45 mm Hg; and a decrease in PaO 2 from 82 to 73 mm Hg. Which of the following actions would be appropriate at this time? a. Reconnect the patient to the ventilator with prior settings. b. Request that the patient be administered a mild sedative. c. Suction the patient after manual hyperinflation or oxygenation. d. Encourage the patient to relax, and continue careful monitoring. ANS: D
See Table 52-6. DIF: Analysis
REF: p. 1209
OBJ: 6
48. Which of the following changes can be expected when weaning a patient through a T tube
trial? 1. Increase in respiratory rate of 10/min 2. Increase in heart rate of 15 to 20/min 3. 5 to 10 mm Hg rise in the arterial PCO 2 4. Doubling of the minute ventilation a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
See Table 52-6. DIF: Application
REF: p. 1209
OBJ: 6
49. While monitoring a patient during a T tube weaning trial, you notice the following: increased
patient agitation; increased heart rate (from 90 to 118/min); increased respiratory rate (from 17 to 33/min with some paradoxical motion); and premature ventricular contractions (PVCs) increasing to an average of 5/min. Which of the following actions would be appropriate at this time? a. Reconnect the patient to the ventilator with prior settings. b. Encourage the patient to relax, and continue careful monitoring. c. Request that the patient be given a stat (immediate) bolus of lidocaine. d. Request that the patient be given a strong sedative or hypnotic. ANS: A
See Table 52-6. DIF: Analysis
REF: p. 1209
OBJ: 6
50. Which of the following is false about artificial tracheal airways and weaning? a. There are decreases in tube inner diameter (ID) and increases in V E increase the
work of breathing.
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK b. The added work due to artificial airways can increase ventilator dependence. c. Artificial airways can increase the work of breathing nearly three-fold. d. Tracheostomy tubes increase the work of breathing more than can endotracheal
tubes. ANS: D
The presence of an artificial airway may increase airway resistance nearly three-fold, although some evidence calls into question the assumption that breathing through an endotracheal tube offers a greater work of breathing than does breathing through a natural airway postextubation. In a study with 14 successfully extubated patients, at the end of a 2-hr spontaneous breathing trial, there was no difference in work of breathing before and after extubation. DIF: Recall
REF: p. 1209
OBJ: 6
51. What is the best way to decrease the work of breathing imposed by an artificial airway on a
patient receiving ventilatory support? a. Provide pressure support. b. Decrease inspiratory flow. c. Lower the minute ventilation. d. Use low rates of breathing. ANS: A
Pressure support ventilation can be very effective in overcoming this imposed work. DIF: Application
REF: p. 1208
OBJ: 6
52. What are some factors that indicate a patient’s readiness for extubation?
1. Adequate oxygenation or ventilation with spontaneous breathing 2. Minimal risk for upper airway obstruction 3. Adequate airway protection or minimal aspiration risk 4. Adequate clearance of pulmonary secretions a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
See Box 52-13. DIF: Recall
REF: p. 1210
OBJ: 8
53. What patients are at high risk for postextubation upper airway obstruction?
1. Those with neuromuscular disorders 2. Those who have had major neck surgery 3. Those with infectious masses or abscesses a. 2 and 3 only b. 1 and 2 only c. 1 and 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. 1, 2, and 3 ANS: D
Compression of the airway due to traumatic or postoperative hematoma of the neck, infectious masses or abscesses, and malignant tumors or compression after major head or neck surgery can lead to upper airway obstruction after extubation. DIF: Recall
REF: p. 1210
OBJ: 6
54. In considering a patient for endotracheal tube extubation, which of the following procedures
would you recommend to determine the risk of postextubation upper airway obstruction? a. Methylene blue test b. Pre- and postbronchodilator c. Cuff leak test d. Forced vital capacity ANS: C
The cuff leak test is recommended to detect airway obstruction before extubation. DIF: Recall
REF: p. 1210
OBJ: 5
55. Which of the following patients are at high risk for severe laryngeal edema after an
endotracheal tube extubation? 1. Pediatric burn victim 2. Patient with epiglottitis 3. Smoke inhalation patient 4. Pulmonary fibrosis patient a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: B
Children, patients with epiglottitis or angioedema (dermal, subcutaneous, or submucosal edema of the face or larynx), and patients who have sustained smoke inhalation are at greater risk. DIF: Recall
REF: p. 1210
OBJ: 5
56. In considering a patient for extubation, which of the following would you recommend to
minimize the risk of postextubation aspiration? a. Perform and confirm a positive cuff leak test. b. Discontinue (DC) tube feeding 4 to 6 hr before extubation. c. Perform deep endotracheal suctioning before extubation. d. Keep the cuff inflated when removing the tube. ANS: B
Withholding feeding 4 to 6 hr before extubation and clamping feeding tubes may be prudent. DIF: Recall
REF: p. 1210
OBJ: 8
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 57. Common causes for weaning failure include which of the following?
1. Myocardial ischemia 2. Critical illness polyneuropathy 3. Psychological dependence 4. Secondary polycythemia a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Myocardial ischemia may occur frequently among ventilator-dependent patients and has been associated with weaning failure. Critical illness polyneuropathy has been cited as a frequent cause of neuromuscular weaning failure among critically ill patients. Unsuspected neuromuscular disease may be an important factor in ventilator dependency. Inability to wean can sometimes be attributed to psychological dependence, poor oxygenation status, or cardiovascular instability (congestive heart failure or ischemia). DIF: Recall
REF: p. 1211
OBJ: 9
58. A patient whom you are trying to wean below 5 cm H 2 O pressure support develops respiratory
muscle fatigue. Which of the following would you recommend to overcome this problem? 1. Make sure there is adequate O2 transport or cardiac output. 2. Make sure that the patient is adequately nourished. 3. Check and replace any depleted electrolytes. 4. Clear secretions and provide bronchodilation. a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
See Table 52-7. DIF: Application
REF: pp. 1212-1213
OBJ: 9
59. Which of the following are useful strategies in managing the psychological problems
encountered in weaning some patients from ventilator support? 1. Secure a psychiatric consult. 2. Decrease environmental stress. 3. Avoid mental stimulation. 4. Teach relaxation methods. a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2 and 3 only ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
See Table 52-7. DIF: Recall
REF: pp. 1212-1213
OBJ: 10
60. Who should make the decisions related to terminal weaning? a. Patient b. Patient’s family and patient’s physician c. Nurse d. Respiratory therapist ANS: B
The decision should be made by the family in consultation with the patient’s physician and in accordance with established ethical and legal guidelines. DIF: Recall
REF: p. 1211
OBJ: 10
61. In an effort to determine a patient’s need for ventilatory support, which of the following
factors increase(s) ventilatory workload? 1. Decreased lung compliance 2. Decreased thoracic compliance 3. Increased airway resistance 4. Artificial airways a. 1 only b. 1 and 2 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: D
See Box 52-1. DIF: Recall
REF: p. 1192
OBJ: 2
62. The physician has requested that the respiratory therapist determine a patient’s rapid shallow
breathing index (RSBI) before placing the patient on PSV. The patient has a respiratory rate of 32/min and VT of 300 ml. What is the patient’s RSBI? a. 107 b. 110 c. 112 d. 114 ANS: A
The formula for calculating RSBI is f/VT. The therapist would calculate 32/0.30 = 107. DIF: Application
REF: p. 1195
OBJ: 3
63. Which factors lead to the development of computer-based weaning protocols?
1. Respiratory therapists are unable to successfully wean most patients using protocols. 2. Computer-based weaning protocols are relatively easy to develop. 3. Weaning is time-consuming. 4. Weaning is a labor-intensive process.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. 3 only b. 1, 2, and 3 only c. 2, 3, and 4 only d. 1, 2, 3, and 4 ANS: C OBJ: 7
DIF: Recall
REF: pp. 1205-1206
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 54 - Patient Education and Health Promotion Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Which of the following are among the top common causes of death in the United States?
1. Heart disease 2. Cerebrovascular disease 3. Chronic obstructive lung disease 4. Cystic fibrosis a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
The top five causes of death in the United States are heart disease, cancer, cerebrovascular disease, chronic obstructive lung disease (bronchitis and emphysema), and accidents. DIF: Recall
REF: p. 1250
OBJ: 1
2. Which of the following are acceptable phrases for writing an educational objective?
1. ―At the end of the lesson, the patient will be able to list …‖ 2. ―At the end of the lesson, the patient will be able to understand …‖ 3. ―At the end of the lesson, the patient will be able to describe …‖ 4. ―At the end of the lesson, the patient will be able to demonstrate …‖ a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: B
Format for writing an objective: 1. Begin with the phrase ―At the end of the lesson, the patient will be able to:‖ 2. Write the action verb (e.g., list, describe, demonstrate, etc.). 3. Write a condition if needed (e.g., with or without the use of notes). 4. Write a standard if needed (e.g., how fast, how accurate, etc.). DIF: Recall
REF: p. 1251
OBJ: 1
3. Which of the following are learning domains?
1. Cognitive 2. Affective 3. Psychomotor 4. Analytical a. 1, 2, and 3 only b. 1, 3, and 4 only c. 3 and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. 2 and 4 only ANS: A
Learning occurs in three domains: cognitive, psychomotor, and affective. DIF: Recall
REF: p. 1251
OBJ: 1
4. Teaching physical skills to patients is learning in what domain? a. Cognitive b. Affective c. Psychomotor d. Analytical ANS: C
The cognitive domain is very important because it will address the knowledge patients need regarding their illness and how to treat it. The psychomotor domain addresses the skills that the patient will need to acquire to perform specific treatment modalities (e.g., the use of metered-dose inhalers). The affective domain involves teaching patients about the necessary attitudes and motivations for successfully living with their diseases. DIF: Recall
REF: p. 1252
OBJ: 1
5. Teaching facts to patients involves learning in what domain? a. Cognitive b. Affective c. Psychomotor d. Analytical ANS: A
The cognitive domain is very important because it will address the knowledge patients need regarding their illness and how to treat it. The psychomotor domain addresses the skills that the patient will need to acquire to perform specific treatment modalities (e.g., the use of metered-dose inhalers). The affective domain involves teaching patients about the necessary attitudes and motivations for successfully living with their diseases. DIF: Recall
REF: p. 1252
OBJ: 1
6. What type of information is associated with teaching in the affective domain? a. Motivation and attitude b. Tasks and skills c. Knowledge and facts d. Organization and definitions ANS: A
The patient’s attitude and motivation influences his or her ability to learn. Demonstrate genuine concern for yourself by using your oxygen therapy correctly. DIF: Recall
REF: p. 1253
OBJ: 1
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
7. The objective that states ―Verbalize willingness to use oxygen properly and safely‖ falls in
which domain? a. Cognitive b. Affective c. Psychomotor d. Analytical ANS: B
Objectives in the affective domain, using the oxygen therapy example mentioned earlier, might include the following: demonstrate genuine concern for yourself by using your oxygen therapy correctly. DIF: Recall
REF: p. 1253
OBJ: 1
8. What concept will be most emphasized in teaching new skills to patients? a. Handouts and illustrations b. Repetition c. Proper evaluation d. Use of a pretest ANS: B
Repeat, repeat, repeat! DIF: Recall
REF: p. 1253
OBJ: 1
9. Which of the following may be necessary with children before learning can take place? a. Television shows b. Patience c. Games d. Reward system ANS: D
Children may need a more obvious reward system in place before learning can take place. DIF: Recall
REF: p. 1253
OBJ: 2
10. Which of the following is used to evaluate cognitive objectives? a. Verbal exam b. Demonstration c. Written exam d. Performance checklist ANS: C
Cognitive objectives are often evaluated through the use of a written examination. DIF: Recall
REF: p. 1253
OBJ: 3
11. Which of the following is used to evaluate the affective and psychomotor domains? a. Verbal exam b. Demonstration
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. Written exam d. Performance checklist ANS: D
Objectives in the affective and psychomotor domains are evaluated through the use of performance checklists. DIF: Recall
REF: p. 1253
OBJ: 3
12. Which of the following is the primary goal of health education? a. Cure the disease. b. Prevent the disease. c. Change the behavior. d. Provide knowledge about the disease. ANS: C
The primary goal of health education is behavior change. DIF: Recall
REF: p. 1254
OBJ: 4
13. Which of the following is the primary goal of health promotion? a. Cure the disease. b. Prevent the disease. c. Change the lifestyle. d. Provide knowledge about the disease. ANS: C
Health promotion helps people change their lifestyle in a variety of settings, from the home or school to the workplace or health care agency or institution. DIF: Recall
REF: p. 1254
OBJ: 5
14. Which of the following factors are linked to one of the major causes of death in the United
States? 1. Use of tobacco 2. High-fat diet 3. Excessive alcohol use 4. High-sodium diet a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Primary causes include tobacco use, poor diet, physical inactivity, and excessive alcohol use. DIF: Recall
REF: p. 1256
OBJ: 5
15. Which of the following is the goal of tertiary prevention? a. To prevent acceleration of the disease process once it has occurred
DownDlo oa wdnelodabdye:dDbIyC:KBSeO tte NrtghreaN dU eR |e SrEick|odm i kd uiscikqs7o@ n1 g3 m@ aigl.m c oam il.com Di s tr i buti o n o f th i s d o c umen t i s i l l eg al
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK b. To cure the disease c. To prevent related diseases d. To stop recurrent episodes ANS: A
The goal of tertiary prevention is to prevent acceleration of the disease process once it has occurred, with pulmonary rehabilitation being a good example. DIF: Recall
REF: p. 1256
OBJ: 5
16. Which of the following examples of health care represents tertiary prevention? a. Pulmonary rehabilitation b. Mammogram c. Immunization d. Bronchial provocation testing ANS: A
The goal of tertiary prevention is to prevent acceleration of the disease process once it has occurred, with pulmonary rehabilitation being a good example. DIF: Recall
REF: p. 1262
OBJ: 5
17. When instructing children on asthma management, which factors should be considered in
teaching children versus adults on such a topic? 1. Motivated by external factors 2. Directed by others 3. Limited experience 4. Learn slowly a. 1 only b. 2 and 3 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
See Box 54-1. DIF: Application
REF: p. 1254
OBJ: 2
18. What percentage of smokers has been reported to want to stop the smoking habit? a. 10% b. 25% c. 50% d. 70% ANS: D
Seventy percent of smokers report that they would like to quit but cannot. DIF: Recall
REF: p. 1258
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 19. Which of the following are involved in work site wellness activities performed by respiratory
therapists? 1. Performing pulmonary function and/or blood pressure screenings 2. Developing and implementing stress management or nicotine intervention programs 3. Consulting on policies related to smoking and occupational or environmental exposure to foreign dusts such as silica or asbestos or noxious fumes such as smog 4. Prescribing nicotine patches a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Respiratory therapists may find themselves involved in work site wellness by participating in the following: (1) performing pulmonary function and/or blood pressure screenings; (2) developing and implementing stress management or nicotine intervention programs; and (3) consulting on policies related to smoking and occupational or environmental exposure to foreign dusts such as silica or asbestos or noxious fumes such as smog. DIF: Recall
REF: p. 1262
OBJ: 6
20. Which of the following are verbs the respiratory therapist can use within the cognitive domain
to educate patients? 1. Cite 2. Define 3. Identify 4. Recognize a. 1 and 2 only b. 2 and 3 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: D
See Table 54-1. DIF: Recall
REF: p. 1252
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 55 - Cardio pulmo nary Rehabilita tio n Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1. Patients with chronic cardiopulmonary disorders all share an inability to do what? a. Understand the disease process. b. Regain functional use of atrophied muscles. c. Improve tolerance for physical activity. d. Cope effectively with their disease process. ANS: D
Although differences in diagnoses can have an impact on treatment outcomes and survival, patients with chronic pulmonary disorders have much in common. All have difficulty coping with the physiologic limitations of their diseases. DIF: Recall
REF: p. 1265
OBJ: 1
2. What is the term used to describe the restoration of individuals to the fullest possible medical,
mental, emotional, social, and vocational potential? a. Disease prevention b. Rehabilitation c. Intensive care d. Homecare ANS: B
The Council on Rehabilitation defines rehabilitation as ―the restoration of the individual to the fullest medical, mental, emotional, social, and vocational potential of which he or she is capable.‖ DIF: Recall
REF: p. 1265
OBJ: 1
3. What are the overall goals of rehabilitation?
1. To reverse the course or progression of the disease process 2. To minimize the disability’s impact on the individual or family 3. To maximize the functional ability of the individual a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
The overall goal is to maximize the functional ability and to minimize the impact the disability has on the individual, the family, and the community. DIF: Recall
REF: p. 1265
OBJ: 1
4. The principal objectives of pulmonary rehabilitation include which of the following?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1. To control and alleviate the symptoms 2. To restore functional capabilities as much as possible 3. To improve quality-of-life a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
The general goals of pulmonary rehabilitation are to control and alleviate the symptoms, restore functional capabilities as much as possible, and improve the quality-of-life. DIF: Recall
REF: p. 1265
OBJ: 1
5. Which of the following would you not expect to observe after a chronic obstructive
pulmonary disease (COPD) patient completes a sound pulmonary rehabilitation program? a. Reduced pulse rate during exercise b. Decreased breathing rates during exercise c. Reduction in CO 2 production during exercise d. Permanent increase in forced expiratory volume in 1 sec (FEV 1 ) and forced expiratory flow (FEF25% to 75%) ANS: D
Pulmonary rehabilitation does not reverse or stop the disease progression, but it can improve a patient’s overall quality-of-life. DIF: Analysis
REF: p. 1281
OBJ: 1
6. Knowledge from the clinical sciences is used in pulmonary rehabilitation programming for
mainly what purpose? 1. To quantify the extent of physiological impairment 2. To establish ways to improve the quality-of-life 3. To set expectations for reasonable outcomes a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
Knowledge from the clinical sciences can help quantify the degree of physiologic impairment and establish outcome expectations for reconditioning. DIF: Application
REF: p. 1265
OBJ: 1
7. In which of the following ways does the body respond to increased levels of physical activity?
1. Decreased cardiac output 2. Increased minute ventilation 3. Neuroendocrine stimulation a. 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
Figure 55-1 shows how the body responds to exercise. DIF: Recall
REF: p. 1265
OBJ: 1
8. Knowledge from the social sciences is used in pulmonary rehabilitation programming for
mainly what purpose? 1. To determine the impact of the disability on the patient or family 2. To quantify the extent of physiological impairment due to disease 3. To establish ways to improve the patient’s quality-of-life a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
Application of the social sciences is helpful in determining the psychological, social, and vocational impact of the disability on the patient and family and in establishing ways to improve the patient’s quality-of-life. DIF: Application
REF: p. 1265
OBJ: 1
9. During exercise, the point at which increased levels of lactic acid production result in an
increased VCO 2 and V E is referred to as what? a. Respiratory quotient (RQ) b. Ventilatory threshold c. Crossover point d. Exercise limit ANS: B
As excess lactic acid is buffered, CO 2 levels rise and the stimulus to breathe increases. The result is an abrupt upswing in both CO2 and VE (referred to as the ventilatory threshold, or V T). DIF: Recall
REF: p. 1266
OBJ: 1
10. Which of the following occur when the ventilatory threshold is exceeded during exercise?
1. Metabolism becomes anaerobic. 2. Energy production increases. 3. Fatigue increases. a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
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Metabolism becomes anaerobic, the efficiency of energy production decreases, lactic acid accumulates, and fatigue sets in. DIF: Recall
REF: p. 1266
OBJ: 1
11. To physically recondition a patient and increase exercise tolerance, which of the following
must be accomplished? 1. The body’s overall O2 utilization must be improved. 2. The patient’s essential muscle groups must be strengthened. 3. The cardiovascular response to exercise must be enhanced. a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: C
Reconditioning involves strengthening essential muscle groups, improving overall oxygen utilization, and enhancing the body’s cardiovascular response to physical activity. DIF: Recall
REF: p. 1266
OBJ: 1
12. Attrition in pulmonary rehabilitation programs is most associated with which of the
following? a. Success of the physical reconditioning component b. Degree to which patients’ psychosocial needs are met c. Scope and depth of the group educational activities d. Availability of adequate and reliable exercise equipment ANS: B
Studies show that the relative success of reconditioning plays less of a role in determining whether patients complete a program than does meeting their psychosocial support needs. DIF: Recall
REF: p. 1266
OBJ: 2
13. Which of the following elements should be considered in most pulmonary rehabilitation
programs? 1. Individual needs 2. Patient’s education 3. Patient’s personality 4. Patient’s aptitudes a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: C
Such a program should be based on the individual needs and expectations of each patient. Not only each patient’s physical ability must be considered, but also his or her education, past experience, aptitude, and personality must be considered as well.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall
REF: p. 1268
OBJ: 1 | 2
14. Common goals shared by most pulmonary rehabilitation programs include which of the
following? 1. Improvement in physical activity levels 2. Control of respiratory infections 3. Reduction in medical costs and hospitalizations 4. Family education, counseling, and support a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: C
Pulmonary rehabilitation programs vary in their design and implementation but generally share common goals. Examples of these common goals appear in Box 55-1. DIF: Recall
REF: p. 1268
OBJ: 1 | 3
15. Which of the following are reasonable expectations for a pulmonary rehabilitation program?
1. Reduction in hospitalizations 2. Improvement in ambulation 3. Reversal of the disease process 4. Control of respiratory infections a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, and 4 only ANS: D
Pulmonary rehabilitation programs vary in their design and implementation but generally share common goals. Examples of these common goals appear in Box 55-1. DIF: Recall
REF: p. 1268
OBJ: 1 | 7
16. Specific patient objectives for a pulmonary rehabilitation program could include which of the
following? 1. Proper use of medications, O2 , and breathing equipment 2. Reconditioning of both skeletal and respiratory muscles 3. Adherence to proper hygiene and good nutrition 4. Improvement in the results of pulmonary function tests a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Depending on the specific needs of the participants, program objectives can include the following: development of diaphragmatic breathing skills; development of stress management and relaxation techniques; involvement in a daily physical exercise regimen to condition both skeletal and respiratory-related muscles; adherence to proper hygiene, diet, and nutrition; smoking cessation (if applicable); proper use of medications, oxygen, and breathing equipment (if applicable); application of airway clearance techniques (when indicated); focus on group support; and provisions for individual and family counseling. DIF: Recall
REF: p. 1268
OBJ: 1
17. What is the first step in evaluating patients for participation in a pulmonary rehabilitation
program? a. Complete blood gas analysis b. Complete patient history c. Cardiopulmonary stress test d. Pulmonary function testing ANS: B
Patient evaluation begins with a complete patient history: medical, psychological, vocational, and social. DIF: Recall
REF: p. 1267
OBJ: 3
18. A patient is being considered for participation in a pulmonary rehabilitation program. Which
of the following test regimens would you recommend in order to ascertain the patient’s cardiopulmonary status? 1. Cardiopulmonary exercise evaluation 2. Pulmonary function testing 3. Cardiac catheterization a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: B
To determine the patient’s cardiopulmonary status and exercise capacity, both pulmonary function testing and a cardiopulmonary exercise evaluation may be performed. DIF: Application
REF: p. 1267
OBJ: 3
19. A patient is being considered for participation in a pulmonary rehabilitation program. Which
of the following pulmonary function tests would you recommend be performed as a component of the preliminary evaluation? 1. Lung volumes, including functional residual capacity (FRC) 2. Diffusing capacity (DLCO) 3. Pre- and post-bronchodilator flows 4. Lung and thoracic compliance a. 2 and 4 only b. 1, 2, and 3 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 1, 2, 3, and 4 d. 1, 2, and 4 only ANS: B
The pulmonary function testing can include assessment of pulmonary ventilation, lung volume determinations, diffusing capacity (DLCO), and pre-bronchodilator and post-bronchodilator spirometry. DIF: Application
REF: p. 1267
OBJ: 3
20. A cardiopulmonary exercise evaluation is conducted on a patient before participation in
pulmonary rehabilitation for what purposes? 1. To quantify the patient’s baseline exercise capacity 2. To develop an exercise prescription (including target heart rate) 3. To determine how much desaturation occurs with exercise a. 2 and 3 only b. 1, 2, and 3 c. 1 and 2 only d. 1 and 3 only ANS: B
The cardiopulmonary exercise evaluation serves two key purposes in pulmonary rehabilitation. First, it quantifies the patient’s initial exercise capacity. This provides the basis for the exercise prescription (including setting a target heart rate) and also yields the baseline data for assessing a patient’s progress over time. In addition, the evaluation helps to determine the degree of hypoxemia or desaturation that can occur with exercise. DIF: Recall
REF: p. 1267
OBJ: 3
21. Absolute contraindications for conducting a cardiopulmonary exercise evaluation include
which of the following? 1. Diastolic blood pressure greater than 110 mm Hg 2. Serious cardiac arrhythmias 3. Unstable angina 4. Recent myocardial infarction a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
To guide practitioners in implementing exercise evaluation, the AARC has published Clinical Practice Guidelines: Exercise Testing for Evaluation of Hypoxemia and/or Desaturation and Pulmonary Rehabilitation. DIF: Recall
REF: p. 1270
OBJ: 3
22. Under which of the following conditions would you recommend ending a cardiopulmonary
exercise evaluation?
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1. Electrocardiogram indicating sinus tachycardia 2. 10% fall from baseline oxyhemoglobin (HbO 2 ) saturation 3. Fall in systolic blood pressure of more than 20 mm Hg 4. Request from the patient to terminate the test a. 2, 3, and 4 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 1, 2, and 4 only ANS: A
To guide practitioners in implementing exercise evaluation, the AARC has published Clinical Practice Guidelines: Exercise Testing for Evaluation of Hypoxemia and/or Desaturation and Pulmonary Rehabilitation. DIF: Application
REF: p. 1270
OBJ: 3 | 7
23. While you are assisting in a treadmill cardiopulmonary stress test procedure, the patient
complains to you of severe shortness of breath and some chest pain. Which of the following actions would you recommend at this time? a. Increase the O 2 flow rate. b. Decrease the treadmill speed. c. Decrease the treadmill incline. d. Terminate the procedure at once. ANS: D
To guide practitioners in implementing exercise evaluation, the AARC has published Clinical Practice Guidelines: Exercise Testing for Evaluation of Hypoxemia and/or Desaturation and Pulmonary Rehabilitation. DIF: Analysis
REF: p. 1270
OBJ: 7 | 8
24. Which of the following should be monitored during a cardiopulmonary exercise evaluation?
1. Respiratory rate 2. HbO 2 saturation 3. ECG and blood pressure 4. FEV 1 and FVC a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
The actual exercise evaluation procedure involves serial or continuous measurements of several physiologic parameters during various graded levels of exercise on either an ergometer or a treadmill. DIF: Recall
REF: p. 1270
OBJ: 4
25. What are some relative contraindications for cardiopulmonary exercise testing?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1. Severe pulmonary hypertension or cor pulmonale 2. Known electrolyte disturbances (e.g., hypokalemia) 3. SaO 2 or SpO 2 less than 85% breathing room air 4. Untreated or unstable asthma a. 2 and 4 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 1, 2, and 4 only ANS: C
Relative contraindications to exercise testing include (1) patients who cannot or will not perform the test, (2) severe pulmonary hypertension/cor pulmonale, (3) known electrolyte disturbances (hypokalemia, hypomagnesemia), (4) resting diastolic blood pressure greater than 110 mm Hg or resting systolic blood pressure greater than 200 mm Hg, (5) neuromuscular, musculoskeletal, or rheumatoid disorders exacerbated by exercise, (6) uncontrolled metabolic disease (e.g., diabetes), (7) SaO 2 or SpO 2 less than 85% with the subject breathing room air, (8) untreated or unstable asthma, or (9) angina with exercise. DIF: Recall
REF: p. 1270
OBJ: 3
26. Which of the following measures during cardiopulmonary exercise evaluation are most useful
in differentiating between exercise intolerance of cardiac versus ventilatory origin? 1. Maximum heart rate 2. O2max 3. PaCO 2 4. PaO 2 a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: C
Table 55-1 summarizes these key similarities and differences. DIF: Analysis
REF: p. 1272
OBJ: 3 | 8
27. To maximize patient safety during cardiopulmonary stress testing, which of the following
precautions would you recommend? 1. Immediate availability of a crash cart 2. Staff training in emergency life support 3. Presence of a physician throughout testing 4. Patient physical exam or ECG before testing a. 1, 2, and 3 only b. 1, 2, 3, and 4 c. 1 and 3 only d. 3 and 4 only ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
To minimize patient risk during exercise evaluation, certain safety measures are implemented. First, the patient should undergo a physical examination just before the test, including a resting ECG. Second, a qualified physician should be present throughout the entire test. Third, emergency resuscitation equipment (cardiac crash cart with monitor, defibrillator, oxygen, cardiac drugs, suction, and airway equipment) must be readily available. Fourth, staff conducting and assisting with the procedure should be certified in basic and advanced life support techniques. Finally, the test should be terminated promptly whenever indicated. DIF: Application
REF: pp. 1271-1272
OBJ: 3 | 8
28. In preparing an outpatient for a cardiopulmonary stress test to be conducted the next day,
which of the following instructions would you provide? 1. The patient should fast for at least 8 hr before testing. 2. The patient should wear loose-fitting clothing and sneakers. 3. The patient should stop all medications at once. 4. The patient should review the drugs with the physician. a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 1, 2, and 4 only ANS: D
With regard to test preparation, patients should fast 8 hr before the procedure. If the purpose of the test is to formulate an exercise prescription, the patient can take his or her regular medications. The patient should wear comfortable, loose-fitting clothing and footwear with adequate traction for treadmill or ergometer activity. The mouthpiece or face mask used during the test should be sized properly and fit comfortably with no leaks. DIF: Application
REF: p. 1271
OBJ: 3
29. Which of the following patients are good candidates for pulmonary rehabilitation?
1. Unstable cardiovascular patients who require monitoring 2. Patients with exercise limitations due to severe dyspnea 3. Patients with malignant neoplasms involving the lungs a. 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
Indications for pulmonary rehabilitation are listed in Box 55-4. DIF: Application
REF: pp. 1271-1272
OBJ: 3
30. Which of the following patients would benefit least from pulmonary rehabilitation? a. Patient with chronic bronchitis b. Patient with pulmonary emphysema c. Patient with pulmonary fibrosis d. Patient with malignant lung cancer
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: D
Indications for pulmonary rehabilitation are listed in Box 55-4. DIF: Recall
REF: p. 1292
OBJ: 3
31. Which of the following patients are good candidates for pulmonary rehabilitation?
1. Those with malignant neoplasms involving the lungs 2. Those with severe arthritis or neuromuscular abnormalities 3. Those with exercise limitations due to severe dyspnea 4. Those with moderate to severe obstructive lung disease a. 1, 2, and 3 only b. 2 and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: C
Indications for pulmonary rehabilitation are listed in Box 55-4. DIF: Application
REF: p. 1272
OBJ: 3
32. The O 2max at termination of exercise (as a percentage of the predicted) for five patients
appears below. Which of these patients is the best candidate for pulmonary rehabilitation? a. 65% b. 80% c. 90% d. 95% ANS: A
Patients in whom there is a respiratory limitation to exercise resulting in termination at a level less than 75% of the predicted maximum oxygen consumption (O 2max ). DIF: Analysis
REF: p. 1272
OBJ: 1
33. Below what level of the predicted FEV 1 /FVC are patients with irreversible airway obstruction
considered good candidates for pulmonary rehabilitation? a. 75% b. 80% c. 60% d. 70% ANS: C
Patients in whom there is significant irreversible airway obstruction with a forced expiratory volume in 1 sec (FEV 1 ) of less than 2 L or an FEV 1 % (FEV 1 /FVC) of less than 60%. DIF: Recall
REF: p. 1272
OBJ: 3
34. Which of the following patients with irreversible airway obstruction are the best candidates
for pulmonary rehabilitation?
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
1. 2. 3. 4.
Patient A B C D
FEV 1 3.2 L 1.6 L 2.3 L 3.1 L
FEV 1 /FVC 65% 67% 53% 72%
a. 2 and 4 only b. 1, 2, and 3 only c. 2 and 3 only d. 1, 2, 3, and 4 ANS: C
Patients in whom there is significant irreversible airway obstruction with an FEV 1 of less than 2 L or an FEV 1 % (FEV 1 /FVC) of less than 60%. DIF: Analysis
REF: p. 1272
OBJ: 3
35. Which of the following pulmonary function tests are most useful in determining whether a
patient with restrictive lung disease should be considered for pulmonary rehabilitation? 1. DLCO 2. Total lung capacity (TLC) 3. FEV 1 /FVC a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
DLCO and TLC are the most useful pulmonary function tests to evaluate the need of pulmonary rehabilitation of patients with restrictive lung disease. Patients in whom there is a significant restrictive lung disease with a TLC of less than 80% of predicted and single-breath carbon monoxide–diffusing capacity (DLCO) of less than 80% of predicted. DIF: Application
REF: p. 1272
OBJ: 3
36. For which of the following patients would you recommend an open-ended format for a
pulmonary rehabilitation program? 1. Those with scheduling difficulties 2. Those who require individual attention 3. Those who are self-directed a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: C
This format is good for self-directed patients, or those with scheduling difficulties. It also may be the best format for patients requiring individual attention.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application REF: p. 1272 OBJ: 4 37. To increase the likelihood that positive patient results are lasting, what must pulmonary
rehabilitation programs provide? a. Vocational and social counseling b. Staff training in rehabilitation methods c. Financial support for re-hospitalization d. Periodic follow-up and reinforcement ANS: D
Follow-up or reinforcement could be open-ended (available during regular rehabilitation sessions and offering open attendance) or could be scheduled weekly, monthly, bimonthly, or quarterly. The important thing is to have some type of follow-up available. DIF: Application
REF: pp. 1272-1273
OBJ: 4
38. The physical reconditioning component of a pulmonary rehabilitation program usually
includes which of the following? 1. Aerobic exercises for the extremities 2. Timed walking exercise 3. Ventilatory muscle training a. 1, 2, and 3 b. 2 and 3 only c. 1 and 3 only d. 3 only ANS: A
Typically, the exercise prescription includes the following four related components: (1) lower extremity (leg) aerobic exercises, (2) timed walking (6- or 12-min walk), (3) upper extremity (arm) aerobic exercises, and (4) ventilatory muscle training. DIF: Recall
REF: p. 1273
OBJ: 4
39. Which of the following exercises are useful for reconditioning the lower extremities of
patients undergoing pulmonary rehabilitation? 1. Walking on a flat surface for a specified period of time 2. Walking on a treadmill for a specified distance or time 3. Pedaling a stationary bicycle for a specified distance a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: C
Lower extremity exercises may include either walking or bicycling. Patients can walk on a stationary treadmill (with set goals for distance or time and grade) or on a flat, smooth surface. Patients can bicycle on an exercise cycle. With the treadmill or stationary bicycle, patients are required to cover a certain distance or duration every day that they are in the program.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application
REF: p. 1273
OBJ: 4
40. A patient in your pulmonary rehabilitation program has an orthopedic disability that precludes
her from walking or using a stationary bicycle. Which of the following activities would you recommend to help recondition the lower extremities? a. Use of a rowing machine b. Calisthenic exercises c. Aquatic exercises d. Use of a treadmill ANS: C
Patients with significant orthopedic disabilities can participate in aerobic aquatic exercises. DIF: Application
REF: p. 1273
OBJ: 4
41. Which of the following exercises are useful for reconditioning the upper extremities of
patients undergoing pulmonary rehabilitation? 1. Using a rowing machine 2. Using an arm ergometer 3. Pedaling a stationary bicycle 4. Using free hand weights a. 1, 2, 3, and 4 b. 1 and 3 only c. 1, 2, and 4 only d. 2 and 4 only ANS: C
Arm ergometers or rowing machines are available for this purpose; however, simple calisthenics using either a broomstick or free weights (by prescription and with training) are a satisfactory alternative. DIF: Application
REF: pp. 1273-1274
OBJ: 4
42. Reconditioning the inspiratory muscles of patients undergoing pulmonary rehabilitation is
accomplished through which of the following methods? a. Walking aerobically for a specified time b. Using a rowing machine for a specified time c. Pedaling a stationary bicycle for a specified distance d. Performing inspiratory resistive breathing exercises ANS: D
Ventilatory muscle training is based on the concept of progressive resistance. DIF: Application
REF: pp. 1273-1274
OBJ: 4
43. Which of the following is/are true about the flow-resistor breathing exerciser?
1. Exhaled gas flows unimpeded out a one-way valve. 2. Resistance is created by a variable-size orifice. 3. Imposed load varies with the rate of flow.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK a. b. c. d.
2 and 3 only 1, 2, and 3 1 and 2 only 2 only
ANS: C
Varying the size of this orifice varies the inspiratory load, as do changes in the patient’s inspiratory flow. During expiration, gas flows unimpeded out the one-way exhalation valve. Other types of devices are also available. One model replaces the variable size orifice with an adjustable spring-loaded valve. This ensures a relatively constant load regardless of how fast or slowly the patient breathes. DIF: Application
REF: pp. 1274-1275
OBJ: 4
44. During inspiratory resistive exercises, the desired load should be about what percentage of the
maximum inspiratory pressure? a. 15% b. 25% c. 30% d. 20% ANS: C
If the patient’s inspiratory pressure is less than 30% of the measured PImax, the next smaller orifice is selected, with this procedure repeated until the 30% effort is consistently achieved. DIF: Recall
REF: p. 1275
OBJ: 4
45. Which of the following educational topics covered in a typical pulmonary rehabilitation
program are most suitable for presentation by a respiratory care practitioner? 1. Methods of relaxation and stress management 2. Recreation and vocational counseling 3. Diaphragmatic and pursed-lip breathing techniques 4. Respiratory structure, function, and disease a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
Table 55-4 provides an example of topics covered during a 12-week rehabilitation program. DIF: Recall
REF: p. 1296
OBJ: 5
46. Which of the following health professionals would be best for conducting a pulmonary
rehabilitation session on methods of relaxation and stress management? a. Clinical psychologist b. Physical therapist c. Respiratory therapist d. Pulmonary physician
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: A
Table 55-4 provides an example of topics covered during a 12-week rehabilitation program. DIF: Recall
REF: p. 1275
OBJ: 5 | 6
47. Which of the following health professionals would be best for conducting a pulmonary
rehabilitation session on recreation and vocational counseling? a. Physical therapist b. Respiratory therapist c. Clinical psychologist d. Occupational therapist ANS: D
Table 55-4 provides an example of topics covered during a 12-week rehabilitation program. DIF: Recall
REF: p. 1275
OBJ: 5 | 6
48. Which of the following topics should be covered in a rehabilitation education session on
respiratory homecare? 1. Self-administration of therapy 2. Care of home equipment (e.g., cleaning) 3. Safe use of home care equipment a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
Table 55-4 provides an example of topics covered during a 12-week rehabilitation program. DIF: Recall
REF: p. 1275
OBJ: 5
49. Appropriate topical areas to be covered in a rehabilitation education session on nutrition
include which of the following? 1. Elements of a good diet 2. Proper eating habits 3. Foods to avoid 4. Daily menu planning a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: C
Dietary guidelines focus on weight management and good nutrition as they relate to cardiopulmonary health. Emphasis should be on the importance of a sound high-protein, low-carbohydrate diet. The facilitator also should cover proper eating habits, methods of gaining and losing weight, foods to avoid, ways to increase appetite, and daily menu planning. This session will stimulate patients to eat better.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall REF: p. 1276 OBJ: 5 50. A small-group discussion format for pulmonary rehabilitation educational sessions is
recommended in order to foster which of the following? 1. Group interaction 2. Peer support 3. Group identity a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
To foster group identity, interaction, and support, small-group discussions are encouraged. DIF: Application
REF: p. 1276
OBJ: 6
51. What is the ideal class size for pulmonary rehabilitation programs? a. 5 to 15 b. 10 to 20 c. 20 to 30 d. 3 to 10 ANS: D
The ideal class size should range from 3 to 10 participants. DIF: Recall
REF: p. 1277
OBJ: 6
52. A small pulmonary rehabilitation program class size has which of the following beneficial
effects? 1. It facilitates group interaction. 2. It allows for more individualized attention. 3. It helps to sustain participant motivation. 4. It reduces the likelihood of attrition. a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
Keeping the class size manageable facilitates vital group interaction processes and allows for more individualized attention. These factors help to sustain motivation, thereby reducing the likelihood of participant attrition. DIF: Recall
REF: p. 1277
OBJ: 6
53. Minimum equipment requirements for the physical reconditioning component of a pulmonary
rehabilitation program include which of the following? 1. Inspiratory resistive breathing devices 2. Rowing machines or upper extremity ergometers
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. Pulse oximeters (for pulse rate/SaO 2 ) 4. Stationary bicycles a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: C
For physical reconditioning, stationary bicycles, treadmills, rowing machines, upper extremity ergometers, weights, pulse oximeters, and inspiratory resistance breathing devices represent the minimum equipment requirements. DIF: Application
REF: pp. 1277-1278
OBJ: 6
54. To deal with incidents of hypoxemia, dyspnea, or airway hyperreactivity during physical
reconditioning activities, which of the following should be available in the rehabilitation area? 1. Intubation tray 2. Bronchodilator agents 3. Emergency oxygen a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
Emergency oxygen and bronchodilator medications should also be maintained in the rehabilitation area. DIF: Application
REF: pp. 1277-1278
OBJ: 6 | 8
55. Which of the following are factors affecting the cost of a pulmonary rehabilitation program?
1. Space and utility expenses 2. Equipment and supplies 3. Patient health insurance 4. Program promotion costs a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, and 4 only ANS: D
Several factors must be considered when projecting program costs (Box 55-5). DIF: Application
REF: p. 1278
OBJ: 6 | 7
56. By following the reimbursement guidelines for a comprehensive outpatient rehabilitative
facility (CORF), Medicare will reimburse up to what percentage of the allowable charge for a rehabilitation program? a. 60%
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK b. 80% c. 20% d. 40% ANS: B
By following recognized guidelines, Medicare will be able to establish an allowable charge for the program and reimburse 80% of this rate after the patient meets the annual prescribed deductible. DIF: Recall
REF: p. 1279
OBJ: 1
57. Which of the following are legitimate ways to obtain reimbursement from third-party payers
for pulmonary rehabilitation programs? 1. Charge sessions as physical therapy exercises for COPD patients 2. Charge sessions as office visits with therapeutic exercises 3. Charge sessions as physician office visits—intermediate a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: D
Box 55-6 provides a listing of all possible sources of reimbursement. DIF: Recall
REF: p. 1279
OBJ: 6
58. What government programs can serve as a source for reimbursement for pulmonary
rehabilitation? 1. Prospective payment system (PPS) 2. Comprehensive outpatient rehabilitative facility (CORF) 3. Veterans Administration benefits 4. Civilian Health and Medical Programs of the Uniformed Services (CHAMPUS) a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 2, 3, and 4 only ANS: D
Box 55-6 provides a listing of all possible sources of reimbursement. DIF: Recall
REF: p. 1279
OBJ: 6
59. Which of the following outcome measures is considered a major predictor for improvement in
a COPD patient’s health-related quality-of-life? a. Frequent attendance in a maintenance program b. Repeated admission to a rehabilitation program c. Frequent medical evaluations d. Antibiotic therapy ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
One of the major predictors for improvement in a COPD patient’s health-related quality-of-life is frequent attendance in a maintenance program. DIF: Recall
REF: p. 1280
OBJ: 7
60. For which of the following procedures pulmonary rehabilitation has become recognized as a
prerequisite? a. Thoracotomy b. Lung volume reduction surgery c. Lung transplantation d. Heart transplantation ANS: B
Pulmonaryrehabilitation has become recognized as a prerequisite for certain emphysema patients who are able to undergo lung volume reduction surgery. DIF: Recall
REF: p. 1280
OBJ: 7
61. Common cardiovascular hazards of physical reconditioning for patients with chronic lung
disease include which of the following? 1. Cardiac arrhythmias 2. Systemic hypotension 3. Muscle contractures a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
Potential hazards include the following: (1) cardiovascular abnormalities, such as cardiac arrhythmias (can be reduced with supplemental oxygen during exercise) and systemic hypotension and hypertension tension; (2) blood gas abnormalities (arterial desaturation, hypercapnia, and acidosis); and (3) muscular abnormalities (functional or structural injuries, diaphragmatic fatigue and failure, and exercise-induced muscle contracture). DIF: Application
REF: p. 1281
OBJ: 9
62. Where are most cardiac rehabilitation programs conducted? a. Private practice offices b. Clinics c. Hospital facilities d. Homes ANS: C
Most cardiac rehabilitation programs are conducted within a hospital facility, and these programs are generally divided into monitored and maintenance segments, with home options available. Exercise prescriptions are individualized for participating patients in an effort to maximize outcomes and reduce the likelihood of adverse effects. DIF: Recall
REF: p. 1281
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 63. Which of the following are differences between cardiac and pulmonary rehabilitation?
1. Cardiac patients are typically younger. 2. Most cardiac patients are not able to walk for 1 hr. 3. Reimbursement is easier to obtain with cardiac rehabilitation. 4. Breathing exercises are not essential to cardiac patients. a. 1 and 2 only b. 2 and 3 only c. 1, 3, and 4 only d. 1, 2, and 3 only ANS: C
Differences include disease focus, patient age (most cardiac patients will range from their late 30s on up to their 60s and 70s, while pulmonary patients, for the most part, will be 50 years or older), and exercises used within the program. Many cardiac patients will walk for up to 1 hr, while this may be virtually impossible for most respiratory patients. On the other hand, breathing exercises to improve ventilation are essential to the respiratory patient but are not that important to patients with cardiovascular diseases. Reimbursement variables between the two types of programs also exist, with cardiac rehabilitation being more recognized by insurance payers. DIF: Recall
REF: p. 1281
OBJ: 6
64. What is the level of involvement of the respiratory therapist in cardiac rehabilitation? a. Same as in the pulmonary rehabilitation b. Greater than in pulmonary rehabilitation c. Significantly less than in pulmonary rehabilitation d. Respiratory therapist does not participate in cardiac rehabilitation ANS: C
Respiratory involvement in cardiac rehabilitation is significantly less. DIF: Recall
REF: p. 1281
OBJ: 6
65. Which of the following clinicians are commonly involved in the cardiac rehabilitation
programs? 1. Nurse specialist 2. Cardiologist 3. Dietitian a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
Most often, the cardiologist and cardiac nurse specialist are involved with program facilitation and administration. DIF: Recall
REF: p. 1281
OBJ: 6
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Chapter 56 - Respiratory Care in Alternative Settings Kacmarek et al.: Egan’s Funda mentals of Respirato ry Care, 12th Editio n MULTIPLE CHOICE 1.
Postacute care settings include which of the following? 1. Rehabilitation facilities 2. The home 3. Trauma centers 4. Skilled nursing facilities (SNFs) a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Although home care remains the most common alternative site for providing health care, a host of other postacute care settings, including subacute, rehabilitation, and SNFs, provides respiratory care to patients. DIF: Recall 2.
REF: p. 1285
OBJ: 1
Which patients are better suited for subacute rather than for acute care? 1. Those who no longer need diagnostics or invasive procedures 2. Those who have a determined course of treatment 3. Those who are recovering from an acute illness a. 2 and 3 only b. 1 and 2 only c. 3 only d. 1, 2, and 3 ANS: A
According to the National Association of Subacute/Post Acute Care, subacute care is a comprehensive level of inpatient care for stable patients who (1) have experienced an acute event resulting from injury, illness, or exacerbation of a disease process; (2) have a determined course of treatment; and (3) require diagnostics or invasive procedures but not those requiring acute care. DIF: Application 3.
REF: p. 1286
OBJ: 1
Where is most postacute respiratory care provided? a. Skilled nursing facilities b. The home c. Rehabilitation facilities d. Subacute care facilities ANS: B
Currently, most postacute respiratory care is provided in the home.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall 4.
REF: p. 1286
OBJ: 1
Under which conditions is the home the best setting for providing subacute care? 1. When the patient is unable to do self-care 2. When adequate caregiver support is unavailable 3. When the patient’s physician cannot make home visits a. 2 and 3 only b. 1 and 2 only c. 3 only d. 1, 2, and 3 ANS: C
Home care should generally be the first choice, but when patients have multiple ailments and are unable to care for themselves, when adequate patient support is unavailable, or when the home environment is unsuitable, an alternative care site must be selected. DIF: Application 5.
REF: p. 1286
OBJ: 1
Respiratory home care contributes to achieving which of the following goals? 1. Improving patients’ physical and social well-being 2. Ensuring cost-effective delivery of care 3. Supporting and maintaining patients’ lives 4. Promoting patient and family self-sufficiency a. 2 and 4 only b. 1, 2, and 3 only c. 2 and 3 only d. 1, 2, 3, and 4 ANS: D
Respiratory home care can contribute to supporting and maintaining life; improving patients’ physical, emotional, and social well-being; promoting patient and family self-sufficiency; ensuring cost-effective delivery of care; and maximizing patient comfort near the end of life. DIF: Application 6.
REF: p. 1286
OBJ: 1
For which of the following categories of disorders is respiratory home care considered appropriate? 1. Cystic fibrosis 2. Chronic neuromuscular disorders 3. Acute restrictive disorders 4. Pulmonary obstructive lung disease a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Applicable categories of disorders include chronic obstructive pulmonary disease, cystic fibrosis, chronic neuromuscular disorders, chronic restrictive conditions, and carcinomas of the lung. DIF: Recall 7.
REF: p. 1286
OBJ: 1
Studies have shown that carefully selected home treatment regimens can play an important role in achieving which of the following? 1. Maintaining patients’ lives 2. Improving patients’ quality-of-life 3. Increasing patients’ functional performance 4. Reducing hospitalization costs a. 2 and 4 only b. 1, 2, 3, and 4 c. 3 and 4 only d. 1, 2, and 3 only ANS: B
These benefits include increased longevity, improved quality-of-life, increased functional performance, and a reduction in the individual and societal costs associated with hospitalization. DIF: Recall 8.
REF: p. 1286
OBJ: 2
From where do standards for the delivery of subacute and home health care derive? 1. State licensing laws 2. Private-sector standards 3. Federal regulations a. 2 and 3 only b. 1 and 2 only c. 3 only d. 1, 2, and 3 ANS: D
Other standards are established by federal and state laws, as well as private-sector accreditation. DIF: Recall 9.
REF: pp. 1286-1287
OBJ: 3
What statutory regulations ensure that skilled nursing facilities and home health agencies meet minimum health and safety requirements? 1. The Joint Commission accreditation standards 2. Medicare provider certification program 3. State health agency regulations a. 2 and 3 only b. 1 and 2 only c. 3 only d. 1, 2, and 3
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: A
The majority of reimbursement for postacute care is through either the federal Medicare or federal/state Medicaid programs. DIF: Recall 10.
REF: pp. 1286-1287
OBJ: 3
What agency is primarily responsible for voluntary accreditation of postacute care providers? a. The Joint Commission b. AARC c. CAAHEP d. ASTM ANS: A
The primary organization responsible for standard setting and voluntary accreditation of postacute care providers is TJC. DIF: Recall 11.
REF: p. 1287
OBJ: 3
Patient- and resident-focused functions addressed in The Joint Commission (formerly Joint Commission on Accreditation of Hospitals Organization [JCAHO]) standards for long-term, subacute care, and home care include which of the following? 1. Patient education 2. Treatment 3. Rights and ethics 4. Infection control a. 1 and 3 only b. 1, 2, and 4 only c. 2 and 4 only d. 2, 3, and 4 only ANS: B
The patient safety goals target for improvement, common problem areas for health care organizations such as proper patient identification, medication safety, and infection control. DIF: Recall 12.
REF: p. 1287
OBJ: 4
While visiting a home care patient who uses a multidose vial of an expensive bronchodilator, you notice that the expiration date for this medication has passed. Which of the following actions would you recommend at this time? a. Mix the remaining medication with a fresh batch. b. Dispose of the medication as recommended by the manufacturer. c. Dilute the remaining medication with saline. d. Use the remaining medication until it is gone. ANS: B
It is further recommended that manufacturers’ guidelines for the proper handling of specific medications be strictly followed. DIF: Application
REF: p. 1308
OBJ: 12
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 13.
Which of the following is typically not included as part of a good discharge plan? a. Evaluating both the patient and the discharge site b. Providing caregiver travel to and from the discharge site c. Confirming or securing financial resources d. Providing patient and caregiver education and training ANS: C
To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Discharge Planning for the Respiratory Care Patient. Excerpts appear on p. 1288. DIF: Recall 14.
REF: p. 1288
OBJ: 5
Which of the following is an additional goal of home care of the terminally ill patient near the end of life? a. Prolong life. b. Maximize comfort and well-being. c. Maximize equipment use. d. Minimize medication use. ANS: B
Although the primary goal of home care involves minimizing a patient’s dependence on institutional care, an additional goal is to maximize the comfort and well-being of the terminally ill patient near the end of life. DIF: Recall 15.
REF: p. 1298
OBJ: 12
What are some desired outcomes of the discharge plan? 1. Prevent hospital readmission due to poor planning 2. Satisfactory performance of all treatments by caregivers 3. Caregivers’ ability to assess the patient and solve problems 4. Patient’s and family’s satisfaction a. 1, 2, 3, and 4 b. 2 and 4 only c. 1, 2, and 3 only d. 3 and 4 only ANS: A
To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Discharge Planning for the Respiratory Care Patient. Excerpts appear on pp. 1289. DIF: Recall 16.
REF: p. 1289
OBJ: 5
Which of the following are normally parts of the respiratory home care team? 1. Respiratory care 2. Durable medical equipment supplier 3. Pulmonary function 4. Nursing a. 1 and 3 only b. 1, 2, and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Although a physician normally initiates an order to discharge a patient to a postacute care site, many other health care professionals are involved in the discharge process. Table 56-2 identifies these key professionals, along with their major responsibilities. DIF: Recall 17.
REF: p. 1288
OBJ: 5
Establishing therapeutic objectives for home care is normally the responsibility of which member of the respiratory home care team? a. Physical therapist b. Respiratory care practitioner c. Nurse d. Attending physician ANS: D
Although a physician normally initiates an order to discharge a patient to a postacute care site, many other health care professionals are involved in the discharge process. Table 56-2 identifies these key professionals, along with their major responsibilities. DIF: Recall 18.
REF: p. 1288
OBJ: 6
Making necessary contacts with outside agencies that can help with home care is the responsibility of which member of the respiratory home care team? a. Attending physician b. Social services representative c. Respiratory care practitioner d. Nurse ANS: B
Although a physician normally initiates an order to discharge a patient to a postacute care site, many other health care professionals are involved in the discharge process. Table 56-2 identifies these key professionals, along with their major responsibilities. DIF: Recall 19.
REF: p. 1288
OBJ: 6
Providing regular in-home follow-up visits and assessing the patient’s overall progress is the responsibility of which member of the respiratory home care team? a. Social services representative b. Nurse c. Attending physician d. Respiratory care practitioner ANS: D
Although a physician normally initiates an order to discharge a patient to a postacute care site, many other health care professionals are involved in the discharge process. Table 56-2 identifies these key professionals, along with their major responsibilities.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application REF: p. 1288 OBJ: 6 20.
Providing necessary home care equipment and supplies and handling any emergency situations involving delivery or equipment operation is the responsibility of which member of the respiratory home care team? a. Social services representative b. Respiratory care practitioner c. Nurse d. Durable medical equipment (DME) company representative ANS: D
Equipment support and selected clinical services for respiratory home care patients are often provided by a DME supplier. DIF: Application 21.
REF: p. 1288
OBJ: 6
Durable medical equipment (DME) companies usually provide which of the following respiratory home care services? 1. Third-party insurance processing 2. Most respiratory care modalities 3. 24-hr/7-days-a-week service 4. Home instruction and follow-up a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
These companies, both large and small, usually provide the following services: 24-hr/7-days-a-week service, third-party insurance processing, home instruction and follow-up by a respiratory therapist, and most forms of respiratory care. DIF: Recall 22.
REF: pp. 1289-1290
OBJ: 6
Factors to consider when advising a patient on selection of durable medical equipment (DME) include which of the following? 1. Accreditation 2. Finder’s fees 3. Cost 4. Availability a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
When selecting a DME supplier, the discharge planning team, including the patient and family members, should consider the company’s accreditation status, cost and scope of services, dependability, location, personnel, past track record, and availability.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall 23.
REF: pp. 1289-1290
OBJ: 6
To determine if a home setting can support the equipment needs of a mechanically ventilated patient being considered for discharge, which of the following would you assess? 1. Available space for equipment 2. Amperage of power supply 3. Number and location of grounded outlets 4. Presence of hazardous appliances a. 2 and 4 only b. 1, 2, 3, and 4 c. 3 and 4 only d. 1, 2, and 3 only ANS: B
Box 56-1 lists some key factors one should assess in planning the discharge of a respiratory care patient to the home environment. DIF: Application 24.
REF: p. 1290
OBJ: 6
Key environmental factors that should be assessed in considering discharge of a patient to the home care setting include which of the following? 1. Heating and ventilation 2. Humidity 3. Lighting 4. Airborne pollutants a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Box 56-1 lists some key factors one should assess in planning the discharge of a respiratory care patient to the home environment. DIF: Application 25.
REF: p. 1290
OBJ: 6
What is the most common respiratory home care modality? a. Aerosol therapy b. Mechanical ventilation c. O 2 therapy d. Nasal continuous positive airway pressure (CPAP) ANS: C
Oxygen therapy is by far the most common mode of respiratory care in postacute care settings. DIF: Recall
REF: p. 1291
OBJ: 7
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 26.
Which of the following are acceptable indicators of hypoxemia for purposes of justifying home O2 therapy? 1. Resting PaO 2 of 55 mm Hg (room air) 2. Drop in SaO 2 below 89% during ambulation 3. Resting arterial SaO 2 below 88% (room air) a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on p. 1291. DIF: Recall 27.
REF: p. 1291
OBJ: 7
Home O2 therapy can be justified in patients with PaO 2 values greater than 55 mm Hg in which of the following conditions? 1. Cor pulmonale 2. Erythrocythemia (hematocrit >56%) 3. Congestive heart failure 4. Peripheral vascular disease a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on p. 1291-1292. DIF: Recall 28.
REF: pp. 1291-1292
OBJ: 7
Physical hazards associated with home O2 therapy equipment include which of the following? 1. Unsecured cylinders 2. Gaseous explosions 3. Ungrounded equipment 4. Liquid O2 burns a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on p. 1291-1292.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall 29.
REF: pp. 1291-1292
OBJ: 7
To determine the need for long-term home O2 therapy after initial justification, when should blood gas analysis be repeated? a. 1 to 3 weeks after initiation b. 1 to 3 days after initiation c. 1 to 3 months after initiation d. 1 to 3 years after initiation ANS: C
To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on p. 1291-1292. DIF: Application 30.
REF: pp. 1291-1292
OBJ: 7
Once the need for long-term home O2 therapy has been documented, why should repeated laboratory assessment (ABG or oximetry) be conducted? 1. To follow the course of the disease 2. To assess changes in clinical status 3. To facilitate changes in the prescription a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on p. 1291-1292. DIF: Recall 31.
REF: pp. 1291-1292
OBJ: 7
CMS regulations require that prescriptions for home O 2 therapy be based on: a. documented hypoxemia. b. documented symptoms. c. written diagnosis. d. presence of cyanosis. ANS: A
As indicated in the practice guideline, O2 prescriptions must be based on documented hypoxemia, as determined by either blood gas analysis or oximetry. DIF: Application 32.
REF: p. 1291
OBJ: 7
Which of the following are acceptable methods of documenting the presence of hypoxemia in patients being considered for home O 2 therapy? 1. Blood gas analysis 2. Pulse oximetry
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. Physical examination a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
As indicated in the practice guideline, O2 prescriptions must be based on documented hypoxemia, as determined by either blood gas analysis or oximetry. DIF: Recall
REF: p. 1291
OBJ: 7
Which of the following is false about home O 2 therapy? a. A PRN (as needed) prescription for O 2 is acceptable. b. Hypoxemia can be confirmed by arterial blood gas (ABG) or oximetry. c. A PaO 2 at or below 55 mm Hg documents need. d. An SaO 2 below 88% is clinical evidence of need. ANS: A
As-needed O2 is no longer acceptable in the postacute care setting. DIF: Recall 34.
REF: p. 1291
OBJ: 7
Which of the following agents is recommended by the American Respiratory Care Foundation for disinfection of respiratory home care equipment? a. Activated glutaraldehyde b. 70% ethyl alcohol solution c. Sodium hypochlorite solution d. Quaternary ammonium compound ANS: A
High-level disinfection with glutaraldehyde is initially recommended. DIF: Application 35.
REF: p. 1308
OBJ: 14
Home O2 can be supplied by which of the following systems? 1. REDOX chemical reactors 2. Liquid O2 systems 3. O2 concentrators a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
In these settings, O2 normally is supplied from one of the following three sources: (1) compressed O2 cylinders, (2) liquid O 2 systems, or (3) O2 concentrators. DIF: Recall
REF: p. 1313
OBJ: 8
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 36.
Advantages of using compressed O2 cylinders in the home include which of the following? 1. Minimal waste or loss 2. Unlimited storage time 3. Widespread availability 4. Minimal user hazards a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 1, 2, and 4 only ANS: A
Table 56-3 summarizes the major advantages and disadvantages of each system. DIF: Application 37.
REF: p. 1291
OBJ: 8
Disadvantages of using compressed O 2 cylinders in the home include which of the following? 1. High-pressure hazards 2. Limited volume of O2 3. Gas waste when not used 4. Need for frequent deliveries a. 1 and 3 only b. 1, 2, and 4 only c. 2 and 4 only d. 2, 3, and 4 only ANS: B
Table 56-3 summarizes the major advantages and disadvantages of each system. DIF: Application 38.
REF: p. 1291
OBJ: 8
What is the primary use of compressed O2 cylinders in alternative settings? 1. Ambulation (small cylinders) 2. Backup supply (large cylinders) 3. Primary supply (large cylinders) a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
The primary use of compressed O2 cylinders in alternative settings is for either ambulation (small cylinders) or as a backup to liquid or concentrator supply systems (H/K cylinders). DIF: Application 39.
REF: p. 1291
OBJ: 8
A home care patient will be receiving nasal O 2 at 0.5 L/min using a large compressed gas cylinder. Which of the following additional equipment would you specify for this patient? 1. Bubble humidifier 2. Pressure-reducing valve
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
3. Calibrated low-flow flowmeter a. 1 and 2 only b. 1, 2, and 3 c. 2 and 3 only d. 1 and 3 only ANS: C
In addition to the cylinder gas, a pressure-reducing valve with flowmeter is needed to deliver O 2 at the prescribed flow. Standard clinical flowmeters deliver flows up to 15 L/min; flows used in alternative settings are typically in the 0.25 to 5.0 L/min range. For this reason, the respiratory therapist should select a calibrated low-flow flowmeter whenever possible. Alternatively, a preset flow restrictor can be used. DIF: Application 40.
REF: p. 1291
OBJ: 8
Which of the following would you recommend as the solution used to fill a bubble humidifier used for home O2 therapy? a. Sterile water b. Distilled water c. 0.9% saline d. Tap water ANS: B
Because the mineral content of tap water may be high (hard water), water used in these humidifiers should be distilled. DIF: Application 41.
REF: p. 1292
OBJ: 8
A home care patient receiving long-term O 2 therapy at 5 L/min complains that her nondisposable humidifier is not bubbling properly. Upon inspection of the humidifier, you notice hard white deposits in and around the diffusing element. Which of the following would you recommend to this patient? a. Stop using the humidifier because there is no need for it at this flow. b. Replace the device and fill with distilled water, not tap water. c. Increase the flow at night to help clean out the humidifier. d. Replace the device and fill with sterile water, not tap water. ANS: B
Otherwise, the porous diffusing element may become occluded. Although complete blockage is unlikely, occlusion of the diffusing element can impair humidification and alter flow. DIF: Analysis 42.
REF: p. 1292
OBJ: 8
One cubic foot (1 cu/ft) of liquid O2 equals how many cu/ft of gaseous O2 ? a. 22.80 b. 7.48 c. 860.00 d. 3.14 ANS: C
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
One cubic foot of liquid O 2 equals 860 cu/ft of gas. DIF: Recall 43.
REF: p. 1293
OBJ: 8
The O 2 in the inner reservoir of a home liquid O2 system is maintained at what temperature? a. –300° F b. 212° F c. 0° F d. –150° F ANS: A
The liquid O2 is kept at approximately –300° F. DIF: Recall 44.
REF: p. 1293
OBJ: 8
When not in use, vaporization in a home liquid O 2 system maintains the pressure in the container at what range? a. 10 to 15 psi b. 45 to 55 psi c. 80 to 90 psi d. 20 to 25 psi ANS: D
When the cylinder is not in use, this vaporization maintains pressures between 20 and 25 psi. DIF: Recall 45.
REF: p. 1293
OBJ: 8
When the flow-metering device of a home liquid O 2 system is turned on, O 2 leaves the container through a vaporizing coil, where it is heated by exposure to which of the following? a. Hot water b. Ambient air c. Electrical energy d. Ultrasound ANS: B
When flow is turned on, gaseous O2 passes through a vaporizing coil, where it is warmed by exposure to room temperature. DIF: Recall 46.
REF: p. 1293
OBJ: 8
At normal liquid cylinder operating pressures, 1 lb of stored liquid O2 equals approximately how many liters of gaseous O 2 ? a. 860.00 b. 344.00 c. 22.80 d. 7.48 ANS: B
At normal liquid cylinder operating pressures, 1 lb of liquid O 2 equals approximately 344 L of gaseous O2 .
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Recall 47.
REF: p. 1293
OBJ: 8
The gauge reading of a 50-lb home liquid O2 system indicates that the cylinder is a third full. What is the approximate duration of flow of this system at 2 L/min? a. 24 hr b. 48 hr c. 72 hr d. 95 hr ANS: B
See Mini Clini Computing a Liquid Oxygen System’s Duration of Flow for an example of how you can compute a liquid O2 system’s duration of flow. DIF: Application 48.
REF: p. 1293
OBJ: 8
What is the purpose of the small refillable liquid O 2 tank that comes with many stationary home liquid O 2 reservoirs? a. To provide O 2 to ambulatory patients outside the home b. To serve as a backup should the primary reservoir fail c. To collect and save gas vented by the primary reservoir d. To provide higher flows for patients requiring high FiO 2 values ANS: A
Many personal liquid O2 systems also come with smaller portable units (Figure 56-3). This system is ideal for the ambulatory patient who is capable of physical activity. DIF: Application 49.
REF: p. 1294
OBJ: 8
Most portable home liquid O 2 systems can provide low-flow O 2 (2 L/min) for approximately how long? a. 1 to 3 hr b. 3 to 5 hr c. 8 to 12 hr d. 5 to 8 hr ANS: D
Most portable units come with a carrying case or small cart and can provide 5 to 8 hr of O 2 at a flow of 2 L/min. DIF: Application 50.
REF: p. 1293
OBJ: 8
An ambulatory home O2 therapy patient complains that the portable liquid (at 3 L/min) does not last long enough for a visit with the grandchildren. What might you recommend to overcome this limitation? a. Decrease the flow to 2 L/min. b. Put a couple of E cylinders in her car. c. Use an O 2 -conserving device. d. Put the large liquid unit in the car.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: C
The functional use time of portable liquid O2 units can be extended with O2 -conserving devices, including the demand-flow systems. DIF: Analysis 51.
REF: p. 1294
OBJ: 8
Advantages of home liquid O 2 systems include which of the following? 1. Usually include a small refillable portable subsystem. 2. Do not require an O2 service delivery company. 3. Provide large-volume O2 storage in a small space. 4. Are useful for rehabilitation activities (e.g., walking). a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
Table 56-3 summarizes the major advantages and disadvantages of each system. DIF: Application 52.
REF: p. 1293
OBJ: 8
Disadvantages of home liquid O2 systems include which of the following? 1. Oxygen is lost when not used (because of venting). 2. The low temperature of liquid O2 can be a hazard. 3. Liquid O2 must be delivered when needed. 4. These systems cannot drive pneumatic equipment. a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: C
Table 56-3 summarizes the major advantages and disadvantages of each system. DIF: Application 53.
REF: p. 1293
OBJ: 8
What electrically powered device can separate the O2 in room air from N2 , thereby providing an enriched flow of O 2 for therapeutic use? a. O 2 concentrator b. O 2 -conserving device c. Joule-Thompson enricher d. Molecular impactor ANS: A
An O 2 concentrator is an electrically powered device that physically separates the O2 in room air from N 2 . DIF: Recall 54.
REF: p. 1294
OBJ: 8
Advantages of O2 concentrators for home O2 therapy include which of the following?
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1. Operate at safe low pressures. 2. Are cost-effective for continuous use. 3. Do not waste or lose any O 2 . 4. Can power most pneumatic equipment. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Table 56-3 summarizes the major advantages and disadvantages of each system. DIF: Application 55.
REF: p. 1294
OBJ: 8
What are some disadvantages of O2 concentrators for home O2 therapy? 1. FiO 2 values decrease with increased flow. 2. Backup O2 is required in case of electrical failure. 3. They cannot operate high-pressure devices. 4. Loss of electricity disrupts delivery. a. 2 and 4 only b. 1, 2, and 3 only c. 2 and 3 only d. 1, 2, 3, and 4 ANS: D
Table 56-3 summarizes the major advantages and disadvantages of each system. DIF: Application 56.
REF: p. 1294
OBJ: 8
At flows between 1 and 2 L/min, a typical molecular sieve O2 concentrator provides an O2 concentration of approximately what level? a. 65% b. 75% c. 85% d. 95% ANS: D
At flows of 1 to 2 L/min, the typical molecular sieve concentrator provides between 92% and 95% O2 . DIF: Application 57.
REF: p. 1294
OBJ: 8
At 3 to 5 L/min output, a typical molecular sieve O 2 concentrator provides O2 concentrations at what level? a. 65% to 78% b. 78% to 85% c. 85% to 93% d. Greater than 93% ANS: C
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At 3 to 5 L/min, O2 concentrations fall to between 85% and 93%. DIF: Application 58.
REF: p. 1294
OBJ: 8
To help prevent problems with home O2 therapy, you should have the patient or caregiver check all delivery equipment at least how often? a. Once a day b. Once a week c. Every other day d. Once a month ANS: A
To avoid problems before they occur, have the patient or caregiver check all O 2 delivery equipment at least once a day. DIF: Application 59.
REF: p. 1294
OBJ: 8
In setting up a home care chronic obstructive pulmonary disease patient for continuous low-flow O2 therapy through an O2 concentrator, which of the following additional equipment must you provide? a. Pressure-reducing valve b. Backup gas cylinder c. Emergency generator d. Backup concentrator ANS: B
You must ensure that all such systems have an emergency backup supply. DIF: Application 60.
REF: p. 1295
OBJ: 8
Other than providing a backup H cylinder for a home care O 2 therapy patient who uses a concentrator, what other safety measure would you take to ensure an uninterrupted supply? a. Provide an emergency backup battery-powered concentrator. b. Arrange for emergency transport of the patient to a hospital. c. Notify the power company that life-support equipment is in use. d. Provide an emergency backup liquid O 2 system. ANS: C
If a home care patient’s primary O 2 supply is by concentrator, the home care respiratory therapist should notify the electric power company in writing that life-support equipment is in use at that location. DIF: Application 61.
REF: p. 1295
OBJ: 8
Routine in-home monthly maintenance of an O2 concentrator should include which of the following? 1. Flushing the system for 20 min with an inert gas 2. Confirming the FiO 2 with a calibrated O2 analyzer 3. Cleaning and replacing the internal and external filters a. 1 and 2 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
In the home, O 2 concentrator fractional inspired O 2 concentration (FiO 2 ) levels should be checked and confirmed as part of a routine monthly maintenance visit. Routine maintenance of these devices should include cleaning and replacing filters, checking the alarm system, and confirming the FiO 2 levels using either the unit’s O 2 sensor or a separate calibrated O 2 analyzer. DIF: Application 62.
REF: p. 1295
OBJ: 8
When visiting a home care patient receiving nasal O 2 at 2 L/min through an O2 concentrator, you measure the FiO 2 of the outlet gas as 0.63. Which of the following best explains this finding? a. This FiO 2 is normal at this flow. b. The sieve pellets are exhausted. c. The gas inlet filter must be clogged. d. Electrical power is inadequate. ANS: B
If the concentration is less than the manufacturer’s specification at the given flow, the pellet canisters are probably exhausted and should be replaced. DIF: Application 63.
REF: p. 1295
OBJ: 8
A home care patient with kyphoscoliosis requires intermittent positive pressure breathing (IPPB) treatments twice per day with O2 . A local charitable organization has given the family a pneumatically powered IPPB device for this purpose. Which of the following gas sources would you recommend to drive this device? 1. Liquid O2 reservoir 2. O2 concentrator 3. Compressed gas cylinder a. 1 and 2 only b. 2 and 3 only c. 3 only d. 1, 2, and 3 ANS: C
Because both concentrators and personal liquid O 2 systems operate at low pressures, they cannot be used to drive equipment needing 50 psi, such as pneumatically powered ventilators and large-volume jet nebulizers. DIF: Analysis 64.
REF: p. 1301
OBJ: 8
What is the most common O2 delivery system for long-term care? a. Simple mask b. Entrainment mask
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. Transtracheal catheter d. Nasal cannula ANS: D
The most common O 2 delivery system for long-term care is the nasal cannula. DIF: Application 65.
REF: p. 1295
OBJ: 8
Oxygen-conserving delivery systems include which of the following? 1. Transtracheal catheter 2. Reservoir cannula or pendant 3. Pulse dose a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: C
These include the transtracheal O2 catheter, the reservoir cannula, and the demand or pulse-dose O 2 delivery systems. DIF: Application 66.
REF: p. 1295
OBJ: 8
A home care patient using a reservoir cannula for long-term, low-flow O2 therapy objects to the cosmetic appearance of the device. Which of the following alternatives would you recommend to this patient’s physician as capable of addressing the patient’s concerns? 1. Transtracheal catheter 2. Entrainment mask 3. Pendant reservoir a. 1 only b. 2 and 3 only c. 1 and 2 only d. 1, 2, and 3 ANS: A
This delivery method offers advantages of improved cosmetic appearance and lower flows to achieve the same therapeutic effect. DIF: Application 67.
REF: p. 1295
OBJ: 8
Basic principles of infection control in the home care setting include which of the following? 1. Avoid visits by friends with respiratory infections. 2. Have caregivers follow proper handwashing techniques. 3. Incinerate all disposable equipment and supplies. a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
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In regard to infection control, the ARCF and applicable AARC clinical practice guidelines mandate proper handwashing technique by all caregivers. In addition, visits to the patient by friends or relatives with respiratory infections are discouraged. DIF: Application 68.
REF: p. 1308
OBJ: 14
Who should perform routine removing and cleaning of a transtracheal O2 catheter? a. Visiting nurse b. Respiratory care practitioner c. Physician d. Patient ANS: D
Key patient responsibilities include routine catheter cleaning and recognizing and troubleshooting common problems. DIF: Application 69.
REF: pp. 1295-1296
OBJ: 8
A home care patient on transtracheal O 2 therapy at 0.5 L/min frantically calls you, unable to reinsert the catheter after cleaning. What would you recommend? a. Use a clean, pointed instrument to guide catheter reinsertion. b. Put on a nasal cannula at 1 L/min and call the physician. c. Insert the catheter into the nasal cavity approximately 3 to 4 in. d. Insert the catheter into the oral cavity. ANS: B
Key patient responsibilities include routine catheter cleaning and recognizing and troubleshooting common problems. DIF: Analysis 70.
REF: pp. 1295-1296
OBJ: 8
To avoid product failure, transtracheal catheters and their tubing should be replaced every how often? a. Every week b. Every 3 months c. Every month d. Every 6 months ANS: B
Key patient responsibilities include routine catheter cleaning and recognizing and troubleshooting common problems. See Box 56-3. DIF: Application 71.
REF: pp. 1295-1296
OBJ: 8
Which O2 delivery system would you recommend for an active home care patient with low FiO 2 needs who desires increased mobility? a. Traditional low-flow nasal cannula supplied by O2 concentrator b. Compressor-driven humidifier with supplemental O2 through a concentrator c. Conserving device used in conjunction with a portable liquid O 2 system d. Air entrainment mask driven by a large (H/K) compressed gas cylinder
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: C
Patients requiring low-flow home O2 and enhanced mobility should be considered for a liquid O 2 set-up with a pulsed-dose O2 -conserving device. DIF: Analysis 72.
REF: p. 1295
OBJ: 8
Complications associated with insertion of a transtracheal O2 catheter include all of the following except: a. bleeding. b. pneumothorax. c. bronchospasm. d. abscess. ANS: D
The most common complications of transtracheal O2 therapy are listed in Box 56-4. DIF: Recall 73.
REF: pp. 1295-1296
OBJ: 8
You are caring for a patient who has just received a transtracheal catheter for long-term continuous home O2 therapy. Which of the following problems should you be on guard for with this patient? 1. Airway obstruction 2. Catheter clogging 3. Stoma infection a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
The most common complications of transtracheal O2 therapy are listed in Box 56-4. DIF: Application 74.
REF: p. 1297
OBJ: 8
While visiting a patient who has been receiving transtracheal O 2 therapy for 6 months, you note marked erythema and swelling at the stoma site. Which of the following actions would be appropriate at this time? a. Question the patient and family about their cleaning methods. b. Promptly report your observations to the prescribing physician. c. Liberally apply tincture of benzoin to the stoma site. d. Flush the catheter and the tubing with H2 O2 . ANS: B
In particular, you should immediately report any evidence of tract tenderness, fever, excessive cough, increased dyspnea, or subcutaneous emphysema to the patient’s physician. DIF: Analysis 75.
REF: pp. 1295-1297
OBJ: 8
What are some major problems with demand-flow O2 delivery systems?
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1. They are cumbersome and unattractive. 2. Equipment and maintenance costs are high. 3. The device valve may have slow response times. 4. Catheter and sensor malfunction is common. a. 2 and 4 only b. 1, 2, and 3 only c. 2 and 3 only d. 1, 2, 3, and 4 ANS: D
These and other potential problems with demand-flow O2 delivery systems are listed in Box 56-5. DIF: Application 76.
REF: p. 1297
OBJ: 8
Which of the following are good candidates for home mechanical ventilation? 1. A patient who cannot maintain adequate ventilation at night 2. A patient who requires continuous ventilation to survive 3. A terminally ill patient who requires ventilatory support a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: C
Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 56-5 provides more detailed profiles of these patient groups. DIF: Recall 77.
REF: p. 1298
OBJ: 9
Conditions in which patient need for home mechanical ventilation is generally limited to daytime or nocturnal support include which of the following? 1. Kyphoscoliosis 2. High spinal cord injuries 3. Amyotrophic lateral sclerosis 4. Myasthenia gravis a. 1 and 3 only b. 1, 3, and 4 only c. 2 and 4 only d. 2, 3, and 4 only ANS: B
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Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 56-5 provides more detailed profiles of these patient groups. DIF: Recall 78.
REF: p. 1298
OBJ: 9
Home care patients requiring continuous ventilatory support for long-term survival include which of the following? 1. Those with high spinal cord injuries 2. Those with late-stage muscular dystrophy 3. Those with bronchogenic carcinoma a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 56-5 provides more detailed profiles of these patient groups. DIF: Application 79.
REF: p. 1298
OBJ: 9
Examples of terminally ill patients with short life expectancies who can receive ventilatory support in the home setting include which of the following? 1. Patients with end-stage chronic obstructive pulmonary disease 2. Patients with kyphoscoliosis 3. Patients with lung cancer a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 56-5 provides more detailed profiles of these patient groups. DIF: Application 80.
REF: p. 1298
OBJ: 9
All of the following indicate that a patient is stable enough to be considered for home ventilatory support except: a. pH = 7.34; PCO 2 = 48; HCO 3 – = 27
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
b. FiO 2 = 35% c. 15 cm H2 O positive end expiratory pressure (PEEP) d. Absence of cardiac arrhythmias ANS: C
Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 56-5 provides more detailed profiles of these patient groups. DIF: Application 81.
REF: p. 1298
OBJ: 9
Which of the following would indicate that a patient is not sufficiently stable for home mechanical ventilation? 1. Severe dyspnea while breathing on the ventilator 2. Airway secretions cleared only by suctioning 3. Frequent premature ventricular contractions 4. Use of a cuffed oral endotracheal tube a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 3, and 4 only ANS: D
In regard to assessing patient stability, Box 56-6 outlines the criteria developed by the American College of Chest Physicians (ACCP). DIF: Application 82.
REF: p. 1298
OBJ: 9
Mechanical ventilation in the home setting can be provided by which of the following methods? 1. Positive pressure through an oral endotracheal tube 2. Positive pressure through an intact upper airway 3. Intermittent abdominal displacement methods 4. Negative pressure through an intact upper airway a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: D
In alternative settings, invasive ventilatory support always involves application of positive pressure ventilation by tracheotomy. Noninvasive approaches include positive and negative pressure ventilation via an intact upper airway or abdominal displacement methods. DIF: Application
REF: p. 1301
OBJ: 9
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 83.
According to the AARC, which of the following standards should be met when considering ventilatory support outside the acute care hospital? 1. Services must be based on the attending physician’s prescription. 2. Those providing the support should be appropriately trained. 3. Appropriate recording and reporting mechanisms should exist. 4. Safe, effective, and appropriate equipment must be provided. a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: C
The AARC developed a Clinical Practice Guideline on Long-Term Invasive Mechanical Ventilation in the Home. Excerpts appear on pp. 1299-1300. DIF: Recall 84.
REF: pp. 1299-1300
OBJ: 9
What equipment function should lay caregivers of home mechanical ventilation assess regularly? 1. Cleanliness and function of bag-valve-mask 2. Internal and external battery power levels 3. Cleanliness of filters and alarm functions 4. Accuracy of ventilator tidal volume (VT) output a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: A
The AARC developed a Clinical Practice Guideline on Long-Term Invasive Mechanical Ventilation in the Home. Excerpts appear on pp. 1299-1300. DIF: Recall 85.
REF: pp. 1299-1300
OBJ: 9
Patient parameters that lay caregivers of home mechanical ventilation should assess regularly include which of the following? 1. Vital signs 2. Skin color or diaphoresis 3. Chest excursions 4. Breath sounds a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
The AARC developed a Clinical Practice Guideline on Long-Term Invasive Mechanical Ventilation in the Home. Excerpts appear on pp. 1299-1300.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application REF: pp. 1299-1300 OBJ: 9 86.
Which of the following are prerequisites to successful home-based mechanical ventilation? 1. Presence of adequate professional support 2. Willingness of family to accept responsibility 3. Patient’s condition, especially stability 4. Overall viability of the home care plan a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: C
For home ventilatory support to be successful, several prerequisites must be met. These include the following: • Willingness of family to accept responsibility • Adequacy of family and professional support • Overall viability of the home care plan • Stability of patient • Adequacy of home setting DIF: Recall 87.
REF: p. 1298
OBJ: 9
What is the first step in discharging a patient from an acute care facility who will require home-based mechanical ventilation? a. Patient and family education and training are initiated. b. The family is consulted about the feasibility. c. All equipment and necessary supplies are readied. d. The physician writes appropriate orders and sets objectives. ANS: B
Basic steps in the discharge process for a ventilator-dependent patient include the following: 1. Family is consulted regarding feasibility. 2. Physician writes appropriate orders. 3. Discharge planner coordinates efforts of team members and discharge plan is formulated. 4. Physician and other team members discuss plan with family and/or caregivers. 5. Education and training are initiated and completed. 6. Patient and family are prepared for discharge. 7. Home layout is assessed with necessary changes made. 8. Equipment and supplies are readied. 9. Discharge planner meets with team and makes final preparations. 10. Patient is discharged (with trial period, if necessary). 11. Local power company is notified regarding the presence of life-support equipment; appropriate backup power (battery or compressed gas source) is made available. 12. Ongoing and follow-up care provided by visiting nurse, respiratory therapist, and other health care professionals (as necessary). DIF: Application
REF: p. 1300
OBJ: 10
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 88.
You have been asked to organize a patient and family education program as part of a discharge plan for a patient requiring home ventilatory support. Which of the following areas would you be sure to cover? 1. Equipment operation and disinfection 2. Patient assessment and monitoring 3. Airway management and clearance 4. Emergency procedures a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only ANS: C
Essential skills that must be taught include the following: • Simple patient assessment • Airway management, including tracheostomy and stoma care, cuff care, suctioning, changing tubes/ties • Chest physical therapy techniques, including percussion, vibration, coughing • Medication administration, including oral and aerosol • Patient movement and ambulation • Equipment operation and maintenance • Equipment troubleshooting • Cleaning and disinfection • Emergency procedures DIF: Recall 89.
REF: p. 1300
OBJ: 10
Emergency situations that home mechanical ventilation caregivers must be trained to recognize and manage include all of the following except: a. ventilator or power failure. b. tension pneumothorax. c. artificial airway obstruction. d. ventilator circuit problems. ANS: B
Emergency situations that caregivers must be trained to recognize and properly deal with include ventilator or power failure, ventilator circuit problems, airway emergencies, and cardiac arrest. DIF: Recall 90.
REF: p. 1300
OBJ: 10
You have been asked to organize a patient and family education program as part of a discharge plan for a patient requiring home ventilatory support. Which of the following methods would be best for training the family in the operation of the ventilator chosen? a. Put the patient on the selected device while still hospitalized. b. Set up and review the ventilator after the patient gets home. c. Take the family into a back room and show them a ventilator.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. Give the family the operating manual for the ventilator. ANS: A
Ideally, the patient should have a trial period on the actual home ventilator before discharge. DIF: Application 91.
REF: p. 1301
OBJ: 10
In the early stages after a patient requiring mechanical ventilation is discharged to the home, how often should patient follow-up by a respiratory care practitioner occur? a. Every week b. Biweekly c. Every month d. Every day ANS: D
In the early stages after discharge, patient follow-up by a respiratory therapist will likely occur every day. DIF: Recall 92.
REF: p. 1301
OBJ: 10
Which of the following conditions is an indication for application of noninvasive ventilation (NIV)? a. The patient requires low concentrations of supplemental O 2 . b. The patient cannot swallow without the risk of aspiration. c. The patient’s peak cough flows are less than 3 L/sec. d. Because of facial trauma, an airtight mask seal is impossible. ANS: A
Any individual requiring mechanical ventilation can be supported with NIV if: 1. The patient is mentally competent, cooperative, and not using heavy sedation or narcotics. 2. Supplemental O2 therapy is unnecessary or minimal. 3. SaO 2 can be maintained above 90% by aggressive airway clearance techniques. 4. Bulbar muscle function is adequate for swallowing without potentially dangerous aspiration. 5. No history exists of substance abuse or uncontrollable seizures. 6. Unassisted or manually assisted peak expiratory flows during coughing exceed 3 L/sec. 7. No conditions are present that interfere with NIV interfaces (e.g., facial trauma, inadequate bite for mouthpiece, presence of nasogastric tube, or facial hair that can hamper airtight seal). DIF: Application 93.
REF: p. 1301
OBJ: 11
Which of the following can benefit most from intermittent use of noninvasive ventilation? a. A patient with muscular dystrophy b. A patient with pulmonary edema c. A high cervical spine injury patient d. A chronic obstructive pulmonary disease patient in respiratory failure ANS: A
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Type 2 patients generally require only intermittent or nocturnal support. Examples of patients in this category include those with chronic neuromuscular and chest wall diseases, such as muscular dystrophy and kyphoscoliosis. DIF: Application 94.
REF: p. 1301
OBJ: 11
Relative contraindications for using noninvasive ventilation (NIV) include all of the following except: a. severe upper airway dysfunction. b. copious secretions that require suctioning. c. FiO 2 requirements exceeding 40%. d. absence of respiratory muscle activity. ANS: D
Relative contraindications to NIV include severe upper airway dysfunction, copious secretions that cannot be cleared by spontaneous or assisted cough, or O 2 concentration requirements exceeding 40%. DIF: Recall 95.
REF: p. 1301
OBJ: 11
For which of the following groups would you recommend long-term negative pressure ventilation in an alternative setting? 1. Patients who cannot or will not use noninvasive positive pressure ventilation 2. Patients who need frequent airway access for suctioning 3. Patients with severe nasal congestion or obstruction a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
Nonetheless, negative pressure ventilation may be appropriate in those patients who are unable to use or who have failed noninvasive positive pressure ventilation trials. Negative pressure ventilation may also be considered for patients who require frequent airway access for suctioning or those with severe nasal congestion. DIF: Recall 96.
REF: p. 1301
OBJ: 11
In addition to a ventilator, which of the following equipment or supplies would you recommend for a home care patient receiving long-term invasive positive pressure ventilation? 1. Self-inflating bag-valve-mask 2. Portable suction system 3. Portable DC defibrillator 4. Tracheal tubes and care kits 5. Disposable circuits and catheters a. 2, 3, 4, and 5 only b. 1, 3, and 4 only c. 1, 2, 4, and 5 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK d. 1, 2, 3, 4, and 5 ANS: C
Box 56-7 lists the essential equipment and supplies needed for ventilator-dependent patients in alternative settings. DIF: Application 97.
REF: p. 1301
OBJ: 12
In which of the following situations would you recommend that more than one ventilator be provided for a home care patient? 1. If the patient cannot maintain spontaneous ventilation for at least 1 hr 2. If the patient’s care plan requires mechanical ventilation during mobility 3. If a replacement ventilator cannot be secured within 2 hr a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
A second back-up ventilator should be provided for patients who cannot maintain spontaneous ventilation for more than four consecutive hours, for patients living in an area where a replacement ventilator cannot be secured within 2 hr, and for patients whose care plan requires mechanical ventilation during mobility. DIF: Application 98.
REF: p. 1301
OBJ: 12
Which of the following strategies would you recommend for a patient with a tracheotomy who requires home ventilatory support? a. Positive pressure ventilation b. Noninvasive positive pressure ventilation c. Abdominal displacement ventilation d. Negative pressure ventilation ANS: A
If invasive ventilation by tracheostomy is the selected approach, the best choice is a positive pressure ventilator. DIF: Application 99.
REF: p. 1301
OBJ: 12
Which of the following strategies would you recommend for a cooperative patient with an intact upper airway who requires home ventilatory support? a. Invasive positive pressure ventilation b. Noninvasive positive pressure ventilation c. Abdominal displacement ventilation d. Negative pressure ventilation ANS: B
For patients with an intact upper airway, a device capable of noninvasive positive pressure ventilation is the first choice.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application REF: p. 1301 OBJ: 12 100.
Absolute contraindications for using noninvasive positive pressure ventilation include which of the following? 1. Hemodynamic instability 2. Uncooperative patient 3. Copious secretions 4. Need for airway protection a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Box 56-8 lists the absolute contraindications against using noninvasive positive pressure ventilation. DIF: Application 101.
REF: p. 1302
OBJ: 11
Which of the following strategies would you recommend for a hemodynamically unstable patient with an intact upper airway who requires home ventilatory support? a. Invasive positive pressure ventilation b. Noninvasive positive pressure ventilation c. Abdominal displacement ventilation d. Negative pressure ventilation ANS: D
In patients with an intact upper airway for whom noninvasive positive pressure ventilation is contraindicated or unsuccessful, a negative pressure ventilator should be considered. DIF: Application 102.
REF: p. 1303
OBJ: 11
Characteristics common to most positive pressure ventilation designed for use in the home setting include which of the following? 1. Volume cycling to end inspiration 2. High-pressure pneumatic power source 3. Backup internal power supply 4. Rotary piston drive mechanism a. 1 and 3 only b. 1, 2, and 3 only c. 2 and 4 only d. 1, 3, and 4 only ANS: D
Table 56-6 lists the essential, recommended, and optional features of positive pressure ventilators used in alternative care settings. DIF: Application
REF: p. 1302
OBJ: 12
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 103.
Essential features of positive pressure ventilators that are used in alternative care settings on patients with intact ventilatory drive and respiratory muscles include which of the following? 1. Mandatory minimum rate 2. Flow or inspiratory time control 3. Breath-triggering mechanism 4. Spontaneous breathe mode a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Table 56-6 lists the essential, recommended, and optional features of positive pressure ventilators used in alternative care settings. DIF: Application 104.
REF: p. 1302
OBJ: 12
Which of the following are advantages of pressure-limited ventilators used in alternative settings except? 1. Are responsive to changing flow demands. 2. Can deliver higher volumes and pressures. 3. Are lightweight and less expensive. 4. Can compensate for small leaks. a. 1 and 3 only b. 1, 2, and 4 only c. 2 and 4 only d. 2, 3, and 4 only ANS: B
Table 56-7 compares the advantages and disadvantages of current-generation portable volume-cycled and pressure-limited ventilators for use in alternative settings. DIF: Recall 105.
REF: p. 1303
OBJ: 12
For which home care patients requiring mechanical ventilation would you recommend a portable volume-cycled ventilator rather than a pressure-limited device? 1. Those with a neuromuscular or neurologic disorder 2. Those who cannot sustain any spontaneous breathing 3. Those with chronic obstructive pulmonary disease a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
Those with neuromuscular or neurologic disorders often favor the consistent high inflations provided by volume ventilation, which enhance coughing and phonation. In addition, the alarm capabilities and internal battery backup provided with current portable volume ventilators make them the best choice for patients who cannot sustain any spontaneous breathing. DIF: Application 106.
REF: p. 1301
OBJ: 12
A home care patient receiving continuous noninvasive positive pressure ventilation through a nasal mask complains of pressure sores over the nasal bridge. Which of the following actions could help to alleviate this problem? 1. Artificial skin 2. Forehead spacer 3. Reduce strap tension 4. Try nasal pillows a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4 ANS: D
Table 56-7 summarizes some of the common problems associated with noninvasive positive pressure ventilation interfaces and how to correct them. DIF: Application 107.
REF: p. 1303
OBJ: 12
Which of the following alarm systems is needed for postacute care patients who require only intermittent pressure-limited noninvasive positive pressure ventilation? a. High-pressure alarm b. Loss of power alarm c. Low-pressure alarm d. Low-exhaled-volume alarm ANS: B
All positive pressure ventilators used in alternative settings must have an alarm to indicate loss of power (pneumatic and/or electrical). DIF: Application 108.
REF: p. 1309
OBJ: 12
Types of negative pressure ventilators used in postacute care include which of the following? 1. Iron lung (tank ventilator) 2. Chest cuirass (shell ventilator) 3. Body wrap or pneumosuit 4. Abdominal displacement device a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: B
With the increased popularity of noninvasive positive pressure ventilation and continued extensive use of invasive ventilation, negative pressure ventilators are rarely used today for ventilatory support in postacute care settings. The original negative pressure ventilator was the ―iron lung,‖ popularized by postpolio patients needing ventilator assistance. For practical reasons, the cumbersome iron lung was essentially replaced by the chest cuirass and wrap or ―pneumosuit.‖ The chest cuirass (a rigid shell) and wrap-type systems (nylon fabric surrounding a semicylindrical tentlike support) are simply enclosures that allow application of negative pressure to the thorax. Thus, these devices require a separate electrically powered negative pressure generator. An example of a negative pressure generator used to power cuirass or wrap-type systems is the Respironics NEV-100. DIF: Application 109.
REF: p. 1304
OBJ: 12
Which of the following negative pressure ventilation systems require a separate negative pressure generator? 1. Body wrap 2. Iron lung 3. Chest cuirass a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: C
With the increased popularity of noninvasive positive pressure ventilators and continued extensive use of invasive ventilation, negative pressure ventilators are rarely used today for ventilatory support in postacute care settings. The original negative pressure ventilator was the ―iron lung,‖ popularized by postpolio patients needing ventilator assistance. For practical reasons, the cumbersome iron lung was essentially replaced by the chest cuirass and wrap or ―pneumosuit.‖ The chest cuirass (a rigid shell) and wrap-type systems (nylon fabric surrounding a semicylindrical tentlike support) are simply enclosures that allow application of negative pressure to the thorax. Thus, these devices require a separate electrically powered negative pressure generator. An example of a negative pressure generator used to power cuirass or wrap-type systems is the Respironics NEV-100. DIF: Application 110.
REF: p. 1304
OBJ: 12
You are conducting a routine visit to a ventilator-dependent patient in a home care setting. Which of the following would you be sure to perform while on this visit? 1. Carefully assess patient’s status. 2. Administer prescribed respiratory therapy. 3. Check and clean equipment (as needed). 4. Complete all appropriate documentation. a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK ANS: C
Routine follow-up visits by a respiratory therapist help to ensure the success of patient management within the home. Equipment must be checked and cleaned as necessary. The patient’s status should be carefully assessed and appropriate recommendations for change should be made to the primary or prescribing physician. Any prescribed respiratory therapy should be administered during the visit and all necessary supply items left with the patient’s caregivers. After each visit, a report form must be completed and kept on record as part of the documentation process. DIF: Application 111.
REF: p. 1304
OBJ: 12
What is the major potential problem in the application of bland aerosol therapy in the home care setting? a. Overhydration b. Electrical shock c. Mechanical failure d. Infection ANS: D
The potential problem is infection from contaminated equipment. DIF: Application 112.
REF: p. 1304
OBJ: 12
Which of the following are first-line aerosol drug delivery systems for home care patients? 1. Small volume nebulizer 2. Dry powder inhaler 3. Metered dose inhaler a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
Most pulmonary drug agents are available in either metered dose inhaler or dry powder inhaler form. DIF: Application 113.
REF: p. 1304
OBJ: 12
Who can provide routine tracheostomy care for a home care patient? 1. Respiratory care practitioner 2. Trained family member 3. Visiting nurse a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: C
Tracheostomy care can be provided by any trained caregiver.
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK DIF: Application REF: p. 1304 OBJ: 12 114.
Which of the following personnel should be allowed to change a tracheostomy tube on a home care patient? 1. Trained family member 2. Respiratory care practitioner 3. Visiting nurse a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: B
Tube changes should only be performed by the patient’s nurse, physician, or respiratory therapist. DIF: Recall 115.
REF: p. 1304
OBJ: 12
Which of the following are components of a portable home suction unit? 1. Electric suction pump 2. Suction tubing 3. Collection bottle 4. DISS vacuum connector a. 2 and 4 only b. 1, 3, and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: C
In most postacute care settings, tracheobronchial suctioning is accomplished using a portable electrically powered suction pump with collection bottle and suction tubing. DIF: Recall 116.
REF: p. 1304
OBJ: 12
In order to control the cost of suction supplies for a home care patient, which of the following is an acceptable strategy? a. Wash catheters in detergent and hot water between uses. b. Use one catheter per day, and place it in disinfectant between uses. c. Save used catheters for resterilization through the autoclave. d. Wash catheters in soap and cold water when not in use. ANS: B
To prevent bacterial growth, catheters are placed in a disinfecting solution such as hydrogen peroxide or 2.5% acetic acid between suctioning attempts. DIF: Application 117.
REF: p. 1304
OBJ: 14
Which of the following secretion clearance methods could be considered for a home care patient who lives alone? 1. Forced expiratory technique
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
2. Positive end expiratory pressure mask therapy 3. Active cycle of breathing 4. Postural drainage, percussion, and vibration a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only ANS: B
Patients can be taught to independently apply coughing, forced exhalation, active cycle of breathing, and autogenic drainage methods. Caregiver assistance will be required with traditional postural drainage, percussion and vibration, and directed or assisted cough. DIF: Application 118.
REF: p. 1304
OBJ: 12
Which of the following evidence would support Medicare reimbursement for adult nasal CPAP equipment to treat sleep apnea? a. History of loud snoring while sleeping and marked obesity b. Polysomnography confirming sleep apnea c. 6-hr sleep video demonstrating major sleep disturbances d. Clinical laboratory evaluation showing erythrocytosis and hypercapnia ANS: B
For Medicare reimbursement of home nasal CPAP equipment, the sleep apnea diagnosis must be confirmed by polysomnography. DIF: Application 119.
REF: p. 1305
OBJ: 12
After making a home care visit, to whom should you forward copies of your written report? 1. Patient’s physician 2. Patient’s family 3. Home care agency a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: D
Copies should be sent to the patient’s physician, the home care referral source, and any other member of the team requiring this information. DIF: Recall 120.
REF: p. 1308
OBJ: 13
What is the most common way to determine the proper CPAP level for an individual patient? a. Assess the apnea-hypopnea index at different CPAP levels during a sleep study. b. Have the patient keep a log of sleep problems at different CPAP levels. c. Measure and record the patient’s SpO 2 continuously throughout sleep. d. Have the patient’s spouse keep a log of sleep problems at different CPAP levels. ANS: A
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK
The proper CPAP level for a given patient is determined by one of several methods. The most common method is to conduct the sleep study, titrating different levels of CPAP. DIF: Application 121.
REF: p. 1305
OBJ: 12
Which of the following methods can eliminate the need for conducting a separate sleep study to adjust a patient’s CPAP level? 1. Use an auto-adjusting CPAP system. 2. Use SpO 2 values to titrate the CPAP level. 3. Use a patient sleep log or diary. a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: A
Recently, CPAP units have been developed that automatically adjust the airway pressure in response to apnea, hypopnea, airflow limitation, or snoring. This auto-CPAP may result in lower effective pressures and better patient compliance, while eliminating the need for sleep-study titration. Alternatively, CPAP may be titrated against pulse oximetry data (Figure 56-10). In this case, the goal is to use the lowest CPAP pressure that will prevent arterial desaturation (SpO 2 < 90%). DIF: Application 122.
REF: p. 1305
OBJ: 12
Common problems encountered when using adult nasal CPAP to treat sleep apnea include which of the following? 1. Nasal discomfort 2. Barotrauma 3. Conjunctivitis 4. Skin irritation a. 1 and 3 only b. 1, 3, and 4 only c. 2 and 4 only d. 2, 3, and 4 only ANS: B
Patient problems associated with nasal CPAP include reversible upper airway obstruction, skin irritation, conjunctivitis, epistaxis, and nasal discomfort (dryness, burning, and congestion). DIF: Recall 123.
REF: p. 1306
OBJ: 12
Which of the following procedures can help to minimize skin irritation in home care patients using nasal CPAP? 1. Replace the mask every 3 months. 2. Adjust the mask straps. 3. Clean the mask daily. a. 1 and 2 only
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D
Adjusting the straps (while maintaining a good mask seal) can help to prevent irritation. In addition, the patient interface should be cleaned daily to remove dirt and facial oils. Even with proper care, most interfaces such as masks harden over time, causing problems with irritation and leaks. For this reason, masks and nasal pillows should be replaced approximately every 3 to 6 months, or sooner if leakage or discomfort occur. DIF: Application 124.
REF: p. 1305
OBJ: 12
Which of the following would you consider recommending for a home care patient receiving nasal CPAP who complains of severe nasal dryness? 1. Room vaporizer 2. Heat and moisture exchanger (HME) 3. In-line humidifier 4. Saline nasal spray a. 2 and 4 only b. 1, 3, and 4 only c. 1, 2 and 3 only d. 1, 2, 3, and 4 ANS: D
Methods used to overcome excessive drying include in-line humidifiers, room vaporizers, HMEs, chin straps (to decrease loss of upper airway moisture), and saline nasal sprays. DIF: Application 125.
REF: pp. 1305-1306
OBJ: 12
After fitting a home care patient with a CPAP nasal mask, you set the prescribed pressure and turn on the flow generator. At this point, the mask pressure reading is 0 cm H 2 O. What is the most likely cause of this problem? a. Patient asynchrony b. Too high a flow c. Jammed CPAP valve d. Large system leak ANS: D
Methods used to overcome excessive drying include in-line humidifiers, room vaporizers, heat and moisture exchangers, chin straps (to decrease loss of upper airway moisture), and saline nasal sprays. DIF: Analysis 126.
REF: pp. 1305-1306
OBJ: 12
Which of the following groups of hospitalized infants are frequently set up on apnea monitors? a. Those at risk for respiratory syncytial virus b. Those at risk for sudden infant death syndrome (SIDS)
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK c. Those at risk for epiglottitis d. Those at risk for pneumonia ANS: B
Hospitalized infants at risk for SIDS are frequently set up on apnea monitors. DIF: Recall 127.
REF: p. 1307
OBJ: 12
During what phase of subacute or long-term care management does the respiratory care practitioner establish short- and long-term rehabilitation goals for the patients? a. Ongoing assessment b. Screening c. Treatment planning d. Discharge ANS: C
A typical treatment plan would include patient demographics, assessment information, shortand long-term goals reflective of overall rehabilitation potential, and measures to be used to achieve such goals. DIF: Recall 128.
REF: p. 1307
OBJ: 3
All of the following are included in a respiratory care practitioner’s weekly summary of a subacute or long-term care resident’s progress except: a. complete course of respiratory therapy. b. changes in respiratory status. c. explanation of any patient education. d. recommendations for additional therapy. ANS: A
The weekly summary provides a synopsis of residents’ progress, including any changes in their respiratory status, results of any additional tests, explanation of any patient education, and recommendations for additional therapy. DIF: Application 129.
REF: p. 1307
OBJ: 13
For patients receiving home respiratory care, follow-up evaluation by a home care team member should occur at least how often? a. Daily b. Biweekly c. Monthly d. As needed ANS: C
For patients receiving respiratory care at home, follow-up by a home care team member should occur at least monthly, particularly patients on ―hi-tech‖ equipment such as apnea monitors. DIF: Recall
REF: p. 1308
OBJ: 13
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TEST BANK FOR EGAN'S FUNDAMENTALS OF RESPIRATORY CARE 12th EDITION BY KACMAREK 130.
Which of the following factors would you consider in determining the frequency of follow-up visits needed by a home care patient? 1. Level of self-care the patient is able to provide 2. Type and complexity of home care equipment used 3. Patient’s condition and therapeutic objectives 4. Level of family or caregiver support available a. 1, 2, 3, and 4 b. 2 and 4 only c. 1 and 3 only d. 3 and 4 only ANS: A
Factors to consider when deciding on the frequency of home visits include the following: • The patient’s condition and therapeutic needs (objectives) • The level of family or caregiver support available • The type and complexity of home care equipment • The overall home environment • The ability of the patient to provide self-care DIF: Application 131.
REF: p. 1308
OBJ: 13
Which of the following functions should a respiratory care practitioner perform when making a home care visit? 1. Identify any problem areas or concerns of the patient. 2. Assess the equipment (operation, cleanliness, and supply needs). 3. Determine the patient’s compliance with the therapy. 4. Assess the patient (including pre- and post-treatment measures). a. 1, 2, and 3 only b. 1, 2, 3, and 4 c. 1 and 3 only d. 3 and 4 only ANS: B
When a visit is made by a respiratory therapist, a number of functions must be performed. These include the following: • Patient assessment (objective and subjective data), including pretreatment and posttreatment measurements of pulse, respiratory rate, blood pressure, and expiratory flows (FEV 1 , PEFR) • Patient’s compliance with prescribed respiratory home care • Equipment assessment (operation, cleanliness, and need for related supplies) • Identification of any problem areas or patient concerns • Statement related to patient goals and therapeutic plan DIF: Application
REF: p. 1308
OBJ: 13
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W an t to earn $1.236 ex tr a p er y ear ?