Procedures 101 finals

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What is the normal range for PaO2? (include unit of measurement

80-100mmHg

A post-operative pt is on a 5 Lpm nasal cannula. A physician has written an order for a blood gas. After the gas has been analyzed the results are as follow:
pH7.40 PCO 40mmHg
HCO3 34mEq/l PaO2 50mmHg
What FiO2 and device would you need to change the pt to in order to correct the ABG to normal?

100% nonrebreather

What is the principle of which mist tents work to produce an aerosol

Babbington principle

What is the mass of aerosol that reaches the lungs

respirable mass

Normally, when using a 50psi flowmeter to power a SVN, what should the flow be set at?

6-10 Lpm

What is the preferred method for delivering aerosolized bronchodilators to intubated, mechanically ventilated pts

MDI

What are some types of passover humidifiers?
I. simple reservoir
II. membrane
III. wick
IV. bubble humidifier

I, II, and III only

Which of the following methods can assess therapeutic effective of aerosolized bronchodilator medication?
A. peak flow meter
B. spirometer
C. breath sounds
D. all the above

All the above

Which of the following methods can be used to minimize harmful effects of environmental exposure to ribavirin or pentamidine aerosols?
I. use an isolation booth or tent with HEPA filtered exhaust
II. have health care professional wear a HEPA filtered mask.
III. Use negative pressure room with adequate air exchange

I, II and III only

What is the recommended dosage of continuous nebulization of albuterol?

10 mg/hr

To ensure delivery of the proper drug dosage with a MDI, which of the following must be done before used?
I. The cannister valve stem must be cleaned with a pin.
II. The cannister should be warmed
III. The cannister should be shakened well
IV. The cannister should be primed

II, III, and IV only

When assessing a pt's response to bronchodilator therapy, notice a decrease in wheezing accompanied by an overall decrease in the intensity of breath sounds. Which of the following is most likely.

Increase in bronchial constriction.

When using water traps to help minimize the problems caused by condensation in heated humidifier ventilator cicuit, where would you place the traps?

in both the expiratory and inspiratory limbs, at low points in the circuit.

Board Exam question:::While preparing to analyze the O2 concentration on a pt's aerosol mask, you notice there is water in the aerosol tubing. What effect does this have on the operation of the device?

Increases the FiO2

Which of the following depends on the pt's inspiratory effort to dispense the dose?

dry powder inhaler

To minimize a patient's infection risk between drug treatments with a SVN, what should you do?

Rinse the SVN with sterile water, air dry

How long should you instruct a patient to wait between puffs while using an MDI?

1 minute

Which of the following setting adjusts aerosol particle size in an ultrasonic nebulizer?

frequency

The aerosol ouput (in mg/L) of an ultrasonic nebulizer depends mainly on which of the following?

signal amplitude

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?
I. tracheostomy collar
II. face tent
III. Venturi mask
IV. aerosol mask

II and IV only

Advantages of the dry powder inhaler delivery system include any of the following except:
A: easy to use
B: no propellants required
C: no-hand breath coordination
D: unaffected by humidity

unaffected by humidity

What is the propellant used in the manufacturing of today's MDI?

Hydrofluoroalkane

The breath hold improves aerosol deposition by approximately how much percentage?

10%

Which of the following would be correct instructions for a patient being taught the proper use of a DPI?
I. Place mouthpeice 4 cm from mouth
II. Exhale slowly to FRC
III. Inhale slowly
IV. Repeat until dose is completed

II and IV only

What type of breath would you instruct patient to perform while taking a SVN treatment?

Normal tidal breathing

To monitor a patient for possibility of reactive bronchospasm during aerosol drug therapy, what should you do?
I. Measure pre and post peak flow
II. Auscultation for abnormal breath sounds
III Carefully observe the patient's response
IV. Communicate with the patient during treatment

I, II, III and IV

What is used to produce aerosol particles in an ultrasonic nebulizer?

piezoelectric crystal

Board Exam question: You are instructing a patient about the proper procedure for using an MDI. You would instruct the patient to activate the medication in the inhaler?

just after inspiration has begun

What is the most common device used to generate bland aerosols?

Large-volume jet nebulizer

Which of the following is FALSE about heated humidifier condensate?

It poses minimal infection risk

Before inspiration and actuation of a metered dose inhaler, the patient should exhale to which of the following?

functional residual capacity

What happens as the pressure or flow delivered through a small volume nebulizer increases?
I. Treatment time becomes shorter
II. Particle size becomes smaller
III. Aerosol output increases

I, II, and III

What is the primary mechanism for deposition of large particles (>5 microns) in the respiratory tract?

inertial impaction

Which of the following devices generates aerosol only during inspiration?

breath actuated nebulizer

Which type of humidifier "traps" the patient's body heat and expired water vapor to raise the humidity of inspired gas?

heat-moisture exchanger

What type of breathing would you instruct a patient to perform when teaching the use of a dry powder inhaler?

inhale deeply and forcefully

The temperature of gas delivered to a patient's airway by a servo-controlled heated humidifier should be maintained at what temperatures?

35 *C

Bubble humidifiers are of limited effectiveness at flows below which of the following flow rates?

4 Lpm

Board Exam question: A patient with acute exacerbation of asthma is not responding to the standard dose and frequency of aerosolized bronchodilator and is now receiving small volume nebulizer every 30 minutes. Which of the following would you recommend to the patient's physician at this time?

Consider continuous nebulization of the drug

Indications for warming inspired gases include all of the following except:
a. treating a patient whose airways are reactive to cold
b. providing humidification when the upper airway is bypassed
c. treating a patient with a low body temperature
d. reducing upper airway inflammation or swelling

reducing upper airway inflammation or swelling

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?

wick

Which of the following are systems for aerosol drug delivery?
I. dry powder inhalers
II. metered dose inhalers
III. small volume nebulizers
IV. bubble humidifier

I, II and IV only

Which of the following creates aerosol particles in a small volume nebulizer?

baffle

Board Exam question: Which of the following devices would be most indicated in the treatment of a patient with large amounts of thick secretions?

ultrasonic nebulizer

Board Exam Question: A physician has ordered the antiviral agent ribavirin to be administered to an infant with bronchiolitis and RSV. Which of the following devices would you recommend in this situation?

small-particle aerosol generator

To protect against obstructed or kinked tubing, simple bubble humidifiers incorporate which of the following?

pressure relief valve

After administering a 30-minute continuous aerosol treatment to an elderly patient with chronic bronchitis, you note increased wheezing and a general increase in the intensity of breath sounds. Which of the following has probably occurred?

airflow has impoved

Which of the following patients might you recommend bland aerosol therapy administration?
I. patient with upper airway swelling (edema)
II. patient with a bypassed upper airway
III. patient who must provide a sputum specimen

I, II and III

What is the minimum peak flow rate that must be generated to successfully use a dry powder inhaler?

60 Lpm

What is the primary problem with manually refilling heated humidifier reservoir?

cross-contamination and infection

A patient has been supported by a mechanical ventilator using a heat-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?

Switch the patient to a heated humifider

What characteristics of sputum should be inspected after aerosol therapy
sputum induction?
I. color
II. volume
III. odor
IV. consistency

I,II,III, and IV

The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol?

output

Which of the following techniques will increase aerosol deposition and sedimentation in the lungs?

breath hold

What type of breathing technique would you instruct your patient to perform when teaching a metered dose inhaler?

slow and deep inhalations

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?
I. tracheostomy mask
II. face tent
III. T-piece (Brigg's adapter)
IV. aerosol mask

I and III only

Which of the following defines an aerosol?

suspension of liquid or solid particles in a gas

Where do particles in the 5-10 micron range deposit?

upper airway

What are some problems common to mist tents?
I. heat retention
II. CO2 buildup
III. hypothermia

I, II only

Why are zone valves into a hospital piping system?
I. to terminate oxygen flow in case of fire
II. to allow selective maintenance without shutting the entire system down
III. To allow variable pressure reduction throughout the system

I and II only

Which of the following is the most common type of DISS safety system?

Ohio Diamond Quick connect system

The clinical use for nitrous oxide is which of the following?

anesthesia gas

What is the minimum backup an acute care facility must have for oxygen supply?

One times daily usage

To clean the cylinder valve of foreign material, what should you do?

Quickly open and close the valve

Which of the following cylinders have a threaded valve outlet?

H tank

A Thorpe tube measures flow in:

liters per minute

The gauge on an E cylinder of O2 reads 800 psi. About how long will the cylinder contents last at a flow of 3LPM?

1 hour 15 minutes

Which of the following devices are approved for storage of medical oxygen?
I. high pressure cylinders
II. Large bulk reservoirs
III. Cryogenic containers

I, II, and III

What cylinder factor is used to calculate duration of flow for an H cylinder filled with air?

3.14

Board Exam question: The respiratory therapist is setting up a portable liquid oxygen system for a patient with chronic lung condition who attends church each week. The patient is using a 2 L/min nasal cannula, and the portable oxygen container holds 4 lb. of oxygen. The therapist should explain to the patient that the oxygen supply will last for approximately what length of time?

11.5 h

If you have to deliver oxygen to a patient from a bedside outlet station, which of the following devices should you select?

Thorpe tube

What cylinder factor is used to calculate duration of flow for an E cylinder filled with oxygen?

0.28

The most commonly used oxygen tank for patient transportation in the acute care setting is:

E tank

A gas cylinder color coded yellow should contain which of the following gases?

Air

You are planning to transport a patient via ambu bag at 10 LPM to another acute care facility. The transport time is approximately 1 hour and 30 minutes. How many full E tanks (2000 psi) would you need to take with you?

2

Which of the following is true when there is downstream resistance with a compensated Thorpe Tube?

The float will not change and the actual flow is what the reading indicates

Which type of centrally located gas supply systems is most common in an acute care facility ?

Liquid bulk O2 system

Board Exam Question: Which of the following devices should be selected to administer nebulized bronchodilator therapy in the home?

air compressor

In clinical practice, which of the following should be done to identify the contents of a gas cylinder?
I. Inspect the cylinder threads
II. Inspect the color of the tank
III. Read the cylinder label
IV. Analyze the gas

II and III only

Board Exam question: A patient is recieving oxygen via simple mask at 6 LPM from a Bourdon gauge flowmeter. When the respiratory therapist repositions the patient, the patient becomes cyanotic. The flowmeter reveals a flow of 6 LPM. The practitioner's most appropriate initial action is to:

check the tubing to the oxygen mask for kinks

Which of the following gases can be used in treatment of hypoxemic respiratory failure of neonates when mechanical ventilation and traditional therapies are not successful?

nitric oxide

What is the most common and least expensive method for commercial production of medical oxygen?

Fractional distillation of air

Which of the following methods of oxygen production is commonly used in home care oxygen equipment?

physical seperation

What is the approximate duration of flow for 12 lbs of liquid oxygen running at 3 LPM?

23 hrs

Which of the following gases in conjunction with oxygen aids in management in severe airway obstructions?

helium

Which of the following is true with Bourdon gauges when there is downstream resistance?

flow output decreases

If you were to go on a local transport that required you to place a cylinder on the side, which of the following would be the the device of choice?

E tank with a Bourdon gauge

A gas cylinder that is color coded brown should contain which of the following gases?

helium

By what means is medical air produced for use in the hospital?

compression of atmospheric air

The gauge of an H cylinder reads 2000 psi. About how long would the cylinder contents last at a flow of 6 LPM?

17 hours 30 minutes

What is the fire risk for medical oxygen?
I. Flammable
II. Nonflammable
III. Supports combustion
IV. no fire risk

II and III only

Which of the following cylinders have a yoke connector and a valve stem?
a. E tank
b. AA tank
c. D tank
d. all of the above

all of the above

What device is used to reduce the pressure and control the flow of a medical gas?

Regulator

What is the standard method in measuring the contents in a gas filled cylinder?

Read the pressure gauge

Helium is most effective for therapeutic use when mixed with which of the following oxygen concentrations?

20%

Board Exam question: A patient is receiving from an "E" cylinder at 4 L/min through a nasal cannula. The cylinder pressure is 1900 psig. How long will the cylinder run until it is empty?

2.2 hr

At approximately what pressure would a cylinder be 3/4 full?

1500 psi

A gas cylinder that is color coded green should contain which of the following gases?

oxygen

Which of the following mechanisms do all medical gas cylinders use to avoid excessively high pressure buildup in the cylinder?

Pressure relief in the valve stem

To accurately determine the amount of oxygen remaining in a liquid filled cylinder, what would you do?

Weigh the contents of the cylinder

Which of the following are considered therapeutic medical gases?
I. Oxygen
II. Nitrogen
III. Heliox
IV. Nitrous oxide

I and III only

The pressure of O2 or air in a bulk supply O2 system must be reduced to a working pressure of:

50 psi

Which type of relief valve is most commonly used in the valve system of E cylinders?

Fusible plug

Which type of index safety system uses a yoke-type connection?

Pin Index Safety System

To ensure a stable FiO2 under varying patient demand, what must an O2
delivery system do?

maintain flows at least equal to patient's inspiratory demand

A 27 year old patient is receiving O2 via nasal cannula at 5 LPM. What is the approximate FiO2 the patient is receiving?

40%

In which of the following clinical situations would you recommend hyperbaric O2 therapy?
I. CO poisoning
II. Respiratory or Cardiac arrest
III.Decompression sickness
IV.Cyanide poisoning

I, III and IV only

What does 2 atmospheric pressure absolute (ATA) equal in mmHg?

1520 mmHg

A patient with a transtrachel catheter is receiving O2 at 2 LPM. When you enter the room to check the patient's oxygenation status, you notice the patient is cyanotic and in moderate distress. What is the most likely problem with the device?

Obstruction from secretions

An ambu bag is used to provide oxygen during cardiac arrest.

True

You enter a patient's room and the patient is wearing a nonrebreather. You notice the bag collapses when the patient inhales. What is the appropriate action to take?

Increase the flow to the bag

Temperature and FiO2 must be monitored when using an oxyhood for an infant.

True

What is the approximate FiO2 that can be delivered with a partial rebreather mask?

60-65%

Low flow O2 delivery systems contain all of the following devices except:
a. Nasal Cannula
b. Partial Rebreather
c. Air Entrainment mask
d. Simple Mask

Air Entrainment mask

Board Exam question:
A doctor orders 40% O2 via air entrainment nebulizer for a patient with a minute volume of 12 LPM. What is the minimum nebulizer input flow required to meet the patient's inspiratory demand?

10 Lpm

Which of the following flows is the minimum setting for a infant receiving oxygen by an oxyhood?

7 Lpm

Board Exam question:
A physician has ordered a controlled FiO2 concentration of a patient with a tracheostomy tube. Which would be the appropriate device for the patient?

Air/O2 Blending system with T-piece

A patient with chronic hypercapnia placed on 60% O2 becomes lethargic and difficult to arouse. What is the probable cause of this response?

Oxygen induced hypoventilation

Which of the following would require humidification of oxygen gas via bubble humidifier?

4 LPM nasal cannula

A patient is wearing a Venturi mask oxygen device delivering 30%. The flowmeter is set at 9 LPM. What is the approximate total flow of the device?

79 Lpm

What is the initial oxygen device of choice for a COPD patient?

Nasal Cannula

In which of the following conditions would you initially seek to provide the
highest FiO2 possible?
I. CO poisoning
II. Cyanide poisoning
III. Severe shock or trauma

I, II, and III

What is the minimum flow setting for a simple mask being worn by an adult?

5 Lpm

What FiO2 changes occur when the air entraiment port is fixed and the jet orifice increases in size?

FiO2 increases

Board Exam Question:
A patient receiving 40% O2 through an air entrainment nebulizer mask set at 6LPM input flow becomes tachypneic. Simultaneously, you notice the patient's SpO2 has fallen from 91% to 87%. Which of the following actions would be most appropriate at this time?

Increase the flow to 10 LPM

A physician orders a 70% He and 30% O2 mixture to reduce the work of breathing in a patient having an acute asthma attack. Which of the following devices would be appropriate in this case?

Nonrebreather

A physician orders O2 for a patient with documented chronic hypercapnia and hypoxemia (PaO2=47 mmHg). What is the most appropriate action in this case?

Administer O2 to achieve a PaO2 between 50-60 mmHg

A patient who requires a fixed FiO2 is receiving a 70% FiO2 via air entrainment nebulizer. At 15 LPM O2 input flow, the device is unable to meet the inspiratory demand of the patient. What would be the next appropriate action?

Switch to a tandem set-up

You set up a nasal cannula with a humidifier. The flow is set at 5 LPM. Upon entering the room for a nebulizer treatment, you notice the pop-off alarm is sounding. What should be your initial action to correct the problem?

check for kinks in the tubing

A physician has requested delivery of a stable, low O2 concentration to an alert patient. Which of the following devices would be best suited for the patient?

Air Entrainment Mask

Heliox is used to treat hypoxemic respiratory failure in infants when traditional therapies are unsuccessful.

False

Physiologic effects of hyperbaric O2 therapy include all of the following except:
a. Bubble reduction
b. Neovascularization
c. Systemic vasodilation
d. Hyperoxygenation

c. Systemic vasodilation

What is the most common complication of hyperbaric oxygen therapy?

Ear or Sinus trauma

A medical indication for the use of heliox mixtures may be necessary in the management of which of the following?

large airway obstruction

What is the key functional difference between a partial and nonrebreather mask?

The nonrebreather has a one way valve flap between the reservoir bag and the mask

A physician wants a stable FiO2 of 50% for a newborn patient with moderate hypoxemia. Which of the following would you recommend?

Oxyhood with blender and a heated humidifier

Delivery systems that only provide a portion of the patient's inspiratory demands are referred to as what?

Low flow system

During hyperbaric O2 therapy at 3 ATA, what is the approximate half life of carbon monoxide in the blood?

20 minutes

Which of the following devices is the most appropriate oxygen device for a COPD patient?

Venturi Mask

You are giving a 80% he and 20% O2 mixture to an asthmatic patient with a compensated Thorpe tube set at 8 LPM. What is the actual flow being delivered to the patient?

14 LPM

Which of the following statements is false about low flow oxygen devices?

The greater the patient's inspiratory flow, the higher the FiO2

Retinopathy of prematurity that results from oxygen toxicity may result in which of the following?

Blindness

Which of the following devices is a low flow device that can deliver 40-55%

simple mask

Directing a cool O2 mixture to an infant can cause which of the following?

apnea

You connect an air entrainment nebulizer to an ET tube of a COPD patient. When the patient inhale the mist disappears from the reservoir tubing. Which of the following would you do next?

Increase the flow

Which of the following are specific clinical objectives of oxygen therapy?
I. Decrease symptoms caused by chronic hypoxemia
II. Decrease the workload hypoxemia poses on the cardiac and pulmonary systems
III.Correct document arterial hypoxemia

I, II and III

Primary safety concerns in the application of hyperbaric O2 therapy include which all of the following except?
a. Sudden decompression
b. Electrical Fires
c. CO2 accumulation
d. Pneumothorax

c. CO2 accumulation

What is the problem of flows greater than 15 LPM in an Oxyhood?

a. Production of distressful noises

The air entrainment ports of a Venturi mask are partially obstructed by patient's bedding. Which of the following can you expect to change in total FiO2 delivered?

FiO2 will increase

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