Mosbys Respiratory Care Equipment 9th Edition By J.M. Cairo - Test Bank

Mosbys Respiratory Care Equipment 9th Edition By J.M. Cairo – Test Bank

 

Instant Download – Complete Test Bank With Answers

 

 

Sample Questions Are Posted Below

 

Chapter 05: Airway Management Devices and Advanced Cardiac Life Support

 

MULTIPLE CHOICE

 

1. “Elevating the head and extending the neck” describes which of the following?

a.	The position for transtracheal invasive airway insertion
b.	The position for a nasopharyngeal airway insertion
c.	A maneuver called the jaw thrust or chin lift
d.	A maneuver called the sniffing position

 

 

ANS:  D

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

 

PTS:   1                    REF:   Page 115, Table 5-1

 

2. Which of the following statements is true concerning the sniffing position?

a.	It is the best position for oral intubation.
b.	It is indicated when a patient is vomiting.
c.	It is used for an unstable cervical spine injury.
d.	It is contraindicated for temporomandibular joint disease.

 

 

ANS:  A

The jaw thrust is the maneuver used to intubate a patient with an unstable cervical spine injury. The presence of temporomandibular joint disease can be an indication of a difficult intubation, but it is not a contraindication for the sniffing position. When a patient is vomiting, his head should be turned to one side to prevent aspiration.

 

PTS:   1                    REF:   Page 115, Table 5-1

 

3. An accident victim with an unstable cervical spine injury needs to be intubated. This type of intubation will be facilitated by which of the following?

a.	Chin lift	c.	Neck extension
b.	Fowler position	d.	Sniffing position

 

 

ANS:  A

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

 

PTS:   1                    REF:   Page 115, Table 5-1

 

4. The most appropriate method for opening the airway of an awake patient with a fractured mandible is which of the following?

a.	Chin lift	c.	Guedel airway
b.	Jaw thrust	d.	Sniffing position

 

 

ANS:  D

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

 

PTS:   1                    REF:   Page 115, Table 5-1

 

5. Which of the following is the most common cause of an obstructed airway?

a.	Tongue falling backward	c.	Mucus production
b.	Bleeding from the nose	d.	Cardiac arrest

 

 

ANS:  A

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

 

PTS:   1                    REF:   Page 117

 

6. Which of the following are complications associated with the placement of an oropharyngeal airway?
7. Gagging
8. Vomiting
9. Esophageal injury
10. Dissection of the posterior pharyngeal wall

a.	1 and 4	c.	2, 3, and 4
b.	1 and 2	d.	1, 2, 3, and 4

 

 

ANS:  B

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

 

PTS:   1                    REF:   Page 115, Table 5-1

 

7. The airway examination of a patient reveals Mallampati airway class II and a thyromental distance of 7 cm. The statement that is most appropriate about the intubation of this patient is which of the following?

a.	An oral intubation should be attempted first.
b.	Routine intubation of this patient may be impossible.
c.	This patient will have an airway management problem.
d.	This patient may require invasive airway management in the future.

 

 

ANS:  A

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

 

PTS:   1                    REF:   Page 117, Table 5-3

 

8. Which of the following is true of a Guedel airway?

a.	There is no protected central channel.
b.	It consists of a hollow central channel.
c.	Its length is measured in centimeters.
d.	It is identical to a Berman airway.

 

 

ANS:  B

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

 

PTS:   1                    REF:   Page 120

 

9. Which of the following is true about a Berman airway?

a.	It has a central channel.
b.	It is smaller than a Guedel airway.
c.	It must be inserted upside down.
d.	Its shape is similar to that of a Guedel airway.

 

 

ANS:  D

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

 

PTS:   1                    REF:   Page 120

 

10. After inserting an oropharyngeal airway, the respiratory therapist notices that the flange is protruding excessively from the patient’s mouth. Attempts to push the airway back cause it to bounce forward. Which of the following is the most appropriate action?

a.	Remove and replace the airway immediately.
b.	Turn the airway to the side, and try to catch the tongue in the curve.
c.	Take no action; the airway should protrude excessively from the mouth.
d.	Turn the airway upside down, and attempt to advance it farther into the mouth.

 

 

ANS:  A

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

 

PTS:   1                    REF:   Page 121

 

11. Insertion of a laryngeal mask airway:

a.	is superior to the insertion of a nasopharyngeal device.
b.	requires airway manipulation.
c.	usually requires a special device.
d.	protects the lungs from aspiration.

 

 

ANS:  A

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

 

PTS:   1                    REF:   Pages 124-125

 

12. A respiratory therapist notices that a semiconscious patient is not moving enough air and has a problem coughing up mucus. An attempt to insert an oropharyngeal airway is unsuccessful because the patient is struggling. Which of the following is the most appropriate action?

a.	Perform a tracheostomy.
b.	Insert a Berman airway.
c.	Use a nasopharyngeal airway.
d.	Sedate the patient, and insert the oropharyngeal airway.

 

 

ANS:  C

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

 

PTS:   1                    REF:   Page 123

 

13. Which of the following is the method for the insertion of a nasopharyngeal airway?

a.	Upside-down and then turned
b.	Parallel to the nasal pharynx floor
c.	Parallel to the long axis of the nose
d.	Perpendicular to the floor of the nasal pharynx

 

 

ANS:  B

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

 

PTS:   1                    REF:   Page 123

 

14. Insertion of a nasopharyngeal airway is accomplished by using which of the following?

a.	A tongue blade	c.	An Endotrol tube
b.	Intermittent pressure	d.	Gentle, continuous pressure

 

 

ANS:  D

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

 

PTS:   1                    REF:   Page 118, Figure 5-3

 

15. A long-term risk of nasopharyngeal tube placement is represented by which of the following?

a.	Penetration of the brain by the airway
b.	Nasal bleeding
c.	Sinus infection
d.	Hypoxia

 

 

ANS:  C

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

 

PTS:   1                    REF:   Page 124

 

16. The airway device that has a cuff that rests against the upper esophageal sphincter when in place is a(n):

a.	laryngeal mask airway.	c.	endotracheal tube.
b.	tracheostomy tube.	d.	Guedel airway.

 

 

ANS:  A

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

 

PTS:   1                    REF:   Page 115, Table 5-1

 

17. Laryngeal mask airways are useful in emergency situations because:

a.	an appropriate size is easy to choose.
b.	placement does not have to be checked.
c.	they protect the lungs from aspiration.
d.	minimum head and neck movement is required.

 

 

ANS:  D

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

 

PTS:   1                    REF:   Page 125

 

18. The maximum laryngeal mask airway cuff pressure is ____ cm H₂O.

a.	15	c.	45
b.	30	d.	60

 

 

ANS:  D

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

 

PTS:   1                    REF:   Page 124

 

19. Which of the following is the most appropriate type of airway for use with a semiconscious patient for whom intubation with an endotracheal tube is unsuccessful?

a.	Berman airway	c.	Laryngeal mask airway
b.	Tracheostomy tube	d.	Nasopharyngeal airway

 

 

ANS:  C

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

 

PTS:   1                    REF:   Page 118, Figure 5-3

 

20. The most effective type of emergency airway to manually ventilate a patient in her 36th week of pregnancy is a(n):

a.	laryngeal mask airway.	c.	oropharyngeal airway.
b.	nasopharyngeal airway.	d.	tracheostomy tube.

 

 

ANS:  A

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

 

PTS:   1                    REF:   Page 127

 

21. The airway of choice for an obese patient with a known difficult airway is a:

a.	Guedel airway.	c.	laryngeal mask airway.
b.	Berman airway.	d.	nasopharyngeal airway.

 

 

ANS:  C

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

 

PTS:   1                    REF:   Page 125

 

22. Which of the following is considered a secure airway device?

a.	Combitube	c.	Endotracheal tube
b.	Berman airway	d.	Laryngeal mask airway

 

 

ANS:  C

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

 

PTS:   1                    REF:   Page 115, Table 5-1

 

23. A non-disposable laryngeal mask airway should be checked for:

a.	ability of the cuff to hold water.
b.	number of times it was sterilized.
c.	discoloration and integrity of the cuff.
d.	resilience of the self-inflating foam cuff.

 

 

ANS:  C

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

 

PTS:   1                    REF:   Page 127

 

24. Laryngeal mask airway placement includes the use of which of the following?

a.	Stylet	c.	Lighted stylet
b.	Finger	d.	Miller laryngoscope

 

 

ANS:  B

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

 

PTS:   1                    REF:   Page 126, Figure 5-20

 

25. After several unsuccessful attempts at endotracheal intubation and an inability to adequately ventilate a patient with a face mask, the most appropriate method to ensure ventilation is with the placement of which of the following?

a.	Guedel airway	c.	Nasopharyngeal airway
b.	Berman airway	d.	Laryngeal mask airway

 

 

ANS:  D

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

 

PTS:   1                    REF:   Page 118, Figure 5-3

 

26. Two cuffs are incorporated into which of the following artificial airways?

a.	Combitube	c.	Endotracheal tube
b.	Berman airway	d.	Laryngeal mask airway

 

 

ANS:  A

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

 

PTS:   1                    REF:   Page 129, Figure 5-26

 

27. If the esophageal lumen of the Combitube enters the trachea, the Combitube:

a.	will not secure the airway.
b.	must be removed immediately.
c.	can be used as an endotracheal tube.
d.	must be pulled back to rest in the pharynx.

 

 

ANS:  C

The small distal lumen of the Combitube usually advances into the esophagus, but in the case of a tracheal entry of the distal lumen, the Combitube can be used as a conventional endotracheal tube. This will secure the airway.

 

PTS:   1                    REF:   Page 129

 

28. High positive airway pressure can be maintained with which of the following airways?

a.	Guedel airway	c.	Nasopharyngeal airway
b.	Laryngeal mask airway	d.	Endotracheal tube airway

 

 

ANS:  D

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

 

PTS:   1                    REF:   Page 129

 

29. A blind nasotracheal intubation may be aided by a(n):

a.	Combitube.	c.	foil-wrapped tube.
b.	Endotrol tube.	d.	Cole endotracheal tube.

 

 

ANS:  B

The endotracheal tube tip can be controlled with an Endotrol tube. With this device, an implanted string with a pull-ring turns the tip anterior when pulled (Figure 5-35). This device is particularly well-suited for blind nasotracheal intubation.

 

PTS:   1                    REF:   Page 133

 

30. Which of the following statements concerning endotracheal tubes and their insertion is true?

a.	The straight blade gives better tongue control than the curved blade.
b.	The Macintosh blade must be inserted along the left side of the tongue.
c.	The Miller blade is inserted along the right side of the tongue.
d.	The epiglottis must be hooked with the tip of the Macintosh blade.

 

 

ANS:  C

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

 

PTS:   1                    REF:   Page 132

 

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

a.	Chin lift	c.	Neutral head
b.	Sniffing	d.	Jaw thrust

 

 

ANS:  B

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

 

PTS:   1                    REF:   Page 133

 

32. During intubation, the intubator should stand in which of the following positions?

a.	As close as possible to the patient
b.	Approximately 2 feet away from the patient’s mouth
c.	As far away from the patient’s mouth as possible
d.	Far enough away from the mouth to allow binocular vision

 

 

ANS:  D

Manipulation of the endotracheal tube into the trachea can be facilitated by the proper position of the intubator with respect to the patient. The intubator’s head should be far enough away from the patient’s mouth to allow binocular vision, as seen in Figure 5-34, A. When the intubator is too close, the clinician’s depth perception is compromised.

 

PTS:   1                    REF:   Page 134, Figure 5-34, A and B

 

33. A blind nasal intubation is facilitated by which of the following patient positions?

a.	Chin lift	c.	Neutral head
b.	Jaw thrust	d.	Extreme head

 

 

ANS:  C

Instead of the sniffing position, a neutral or slightly flexed head position is optimal for blind nasal intubation. Jaw thrust and chin lift are used for patients with cervical spine injuries. An extreme head position would not facilitate either a nasal intubation or an oral intubation.

 

PTS:   1                    REF:   Page 135

 

34. A patient’s endotracheal tube cuff pressure is measured at 35 mm Hg. The most appropriate immediate action to take is:

a.	extubate the patient immediately.
b.	do nothing; this pressure is acceptable.
c.	add more volume to the cuff, and recheck pressure.
d.	remove some volume from the cuff, and recheck pressure.

 

 

ANS:  D

Because of tracheal mucosal blood pressure-flow characteristics, cuff pressure should be below 25 mm Hg to prevent tracheal ischemic damage. High cuff pressure is not an indication for extubation. Adding more volume would increase the cuff pressure even more, creating more of a blockage to blood and lymph circulation in the area surrounding the cuff.

 

PTS:   1                    REF:   Page 137

 

35. Blood flow to the tracheal mucosa will become compromised if endotracheal tube cuff pressures are greater than ____ mm Hg.

a.	15	c.	25
b.	20	d.	30

 

 

ANS:  C

Because of the flow characteristics of tracheal mucosal blood pressure, cuff pressure should be below 25 mm Hg to prevent tracheal ischemic damage. The acceptable range for cuff pressures is 20 to 25 mm Hg or 25 to 35 cm H₂O.

 

PTS:   1                    REF:   Page 137

 

36. When a Macintosh type of laryngoscope blade is used, which of the following actions is most appropriate?

a.	Insert the blade along the left side of the tongue.
b.	Insert the tip of the blade below the level of the vallecula.
c.	Identify the epiglottis, and hook it with the tip of the blade.
d.	Lift the laryngoscope forward and upward to visualize the larynx.

 

 

ANS:  D

A curved blade enables identification of the epiglottis; the blade tip should be inserted above the epiglottis into the vallecula, which is the space between the tongue base and the epiglottis. With a forward and upward lift, the larynx is illuminated and the endotracheal tube can be passed into the trachea. The blade is inserted along the right side of the tongue. The tip of the blade needs to be in the vallecula. The epiglottis should not be hooked with the tip of the blade.

 

PTS:   1                    REF:   Page 132

 

37. Rapid feedback to confirm the correct placement of an endotracheal tube immediately after intubation is achieved by which of the following?

a.	Capnography	c.	CAT Scan
b.	Chest radiography	d.	Fiberoptic bronchoscopy

 

 

ANS:  A

The most sensitive and rapid way to confirm correct placement is to detect expired carbon dioxide by means of a capnograph or a color-change capnometric device. A chest radiograph is used to determine proper position with respect to the carina. Chest auscultation is subjective, and referred sounds from the stomach might be confused with breath sounds. Fiberoptic bronchoscopy is another way to confirm placement, but this procedure may take time for preparation.

 

PTS:   1                    REF:   Page 135

 

38. A newly intubated patient is assessed with a color-changing CO₂ detection device. The presence of CO₂ is confirmed, as is moisture on exhalation. However, auscultation reveals decreased breath sounds on the right side. This problem can be corrected by doing which of the following?

a.	Extubate and use a laryngeal mask airway.
b.	Order a chest radiograph to determine what is happening.
c.	Reposition the endotracheal tube, and auscultate again.
d.	Push the tube in farther, and listen for bilateral breath sounds.

 

 

ANS:  C

This problem is caused by intubation of the right mainstem airway. The patient’s endotracheal tube must be repositioned by suctioning the pharynx, deflating the cuff, pulling the endotracheal tube back slightly, reinflating the cuff, then auscultating for bilateral breath sounds.

 

PTS:   1                    REF:   Page 137

 

39. If breath sounds are not heard over the left lung after intubation, the most likely cause is which of the following?

a.	An endotracheal tube that is not inserted far enough
b.	Cuff not inflated enough
c.	Left mainstem intubation
d.	Right mainstem intubation

 

 

ANS:  D

A common problem with endotracheal tubes is that they are either inserted too far or migrate too far into the trachea, so the cuff might obstruct a bronchus or only one lung might be ventilated. Right mainstem intubation is most common, especially in children, because not only is the angle of take-off of the right main bronchus less than that of the left, but the distance between the glottis and carina is quite small.

 

PTS:   1                    REF:   Page 137

 

40. Both the respiratory therapist and the physician have made several attempts to intubate a patient. The patient is becoming more and more cyanotic. Face mask ventilation is inadequate. The most appropriate action to take is which of the following?

a.	Administer a paralyzing agent.
b.	Make another attempt at oral intubation.
c.	Establish an airway with a tracheostomy.
d.	Attempt to establish a nasopharyngeal airway.

 

 

ANS:  C

According to the “Difficult Airway Algorithm”, in this type of situation, emergency invasive airway access should be initiated. This includes either surgical or percutaneous tracheostomy or cricothyrotomy.

 

PTS:   1                    REF:   Page 118, Figure 5-3

 

41. The proper location for transtracheal needle insertion is:

a.	into the cricoid cartilage.
b.	through the cricothyroid membrane.
c.	between the first and second tracheal cartilage rings.
d.	under the hyoid bone, through the thyrohyoid ligament.

 

 

ANS:  B

The simplest invasive airway device is a large-bore intravenous catheter inserted percutaneously through the cricothyroid membrane, a procedure called needle cricothyroidotomy. This easily identified space is located between the thyroid cartilage and the cricoid ring.

 

PTS:   1                    REF:   Page 143, Figure 5-51

 

42. Complications of a cricothyroidotomy include which of the following?

a.	Tracheal stenosis	c.	Ruptured epiglottis
b.	Laryngeal stenosis	d.	Vocal cord paralysis

 

 

ANS:  B

Subglottic or laryngeal stenosis can be a long-term problem after cricothyroidotomy.

 

PTS:   1                    REF:   Page 135

 

43. Complications from needle-jet ventilation include:

a.	hyperventilation.	c.	subcutaneous emphysema.
b.	subglottic stenosis.	d.	right bronchus intubation.

 

 

ANS:  C

Complications of needle-jet ventilation include formation of a false passage into subcutaneous tissue, development of subcutaneous emphysema, creation of a pneumothorax, bleeding, failure to ventilate, and damage to neck structures.

 

PTS:   1                    REF:   Page 143

 

44. Complications from an emergency cricothyroidotomy can be prevented by doing which of the following?

a.	Using a small scalpel	c.	Orally intubating the patient
b.	Using a large-gauge needle	d.	Converting to a tracheostomy

 

 

ANS:  D

Most authorities suggest elective conversion of an emergency cricothyroidotomy to a formal tracheostomy within 24 hours to reduce the likelihood of severe problems.

 

PTS:   1                    REF:   Page 144

 

45. After reinsertion of a tracheostomy tube (TT), manual ventilation is difficult. What immediate action should be taken?

a.	Reattempt insertion.
b.	Perform a cricothyroidotomy.
c.	Remove the tube, and insert another tracheostomy tube.
d.	Manually ventilate the patient through the upper airway.

 

 

ANS:  D

If ventilation is difficult after urgent replacement of a dislodged TT, it might not lie in the trachea and manual ventilation through the upper airway should be initiated without delay.

 

PTS:   1                    REF:   Page 146

 

46. The appropriate device for maintaining a small stoma to facilitate tracheal suctioning is which of the following?

a.	Tracheal button	c.	Transtracheal needle
b.	Luer-Lok system	d.	Silastic TT

 

 

ANS:  A

A tracheal button can be used to maintain a small stoma and may be removed for suctioning.

 

PTS:   1                    REF:   Page 147, Figure 5-56

 

47. A patient with an Olympic button arrives in the emergency department via ambulance and has a respiratory arrest in the hospital. To establish a secure airway that could be attached to a mechanical ventilator, the respiratory therapist should:

a.	insert an laryngeal mask airway.
b.	place a nasopharyngeal airway in the nose.
c.	intubate the patient with an uncuffed endotracheal tube.
d.	replace the Olympic button with a cuffed TT.

 

 

ANS:  D

The tracheal button must be changed to a cuffed TT in order to maintain positive-pressure ventilation.

 

PTS:   1                    REF:   Page 146

 

48. The function of a double-lumen endotracheal tube is to:

a.	facilitate speaking.
b.	protect one lung from the other.
c.	maintain a tracheostomy stoma.
d.	assist in weaning a patient from a TT.

 

 

ANS:  B

A double-lumen endotracheal tube is used outside the operating room to protect the “good,” or healthy, lung from blood contamination in patients with massive hemoptysis or infection from an empyema.

 

PTS:   1                    REF:   Page 141

 

49. The size of a suction catheter should be:

a.	a 12-French catheter.
b.	the same as the internal diameter (ID) of the endotracheal tube.
c.	two thirds the size of the outer diameter of the endotracheal tube.
d.	less than half of the ID of the artificial airway.

 

 

ANS:  D

The general recommendation is that the catheter diameter should be no more than half the internal diameter of the artificial airway.

 

PTS:   1                    REF:   Page 147

 

50. The maximum size catheter that can be used for a size 9.0 (ID) TT is ___ French.

a.	6	c.	12
b.	11	d.	13

 

 

ANS:  D

(9 ´ 3) / 2 = 13.5 French. Therefore, out of the choices given the maximum size is a 13 French.

 

PTS:   1                    REF:   Page 147

 

51. The appropriate size of suction catheter for a size 5.0 TT is ___ French.

a.	3.5	c.	12
b.	7.5	d.	15

 

 

ANS:  B

(5 ´ 3) / 2 = 7.5 French.

 

PTS:   1                    REF:   Page 147

 

52. Endotracheal tube suctioning should be preceded by:

a.	pulse oximetry.
b.	instillation of 15 mL of sterile saline solution.
c.	preoxygenation for 30 seconds.
d.	hyperinflation for 60 seconds.

 

 

ANS:  C

Preoxygenation of the patient with 100% oxygen for a minimum of 30 to 60 seconds before suctioning is required to avoid the hazards of hypoxemia.

 

PTS:   1                    REF:   Page 147

 

53. Failure to secure an appropriately placed endotracheal tube with the addition of air into the cuff might be due to which of the following?

a.	Herniation of the cuff
b.	Malfunction of the pilot valve
c.	Pilot tubing that is too long
d.	An endotracheal tube that is too small

 

 

ANS:  B

A malfunction of the pilot valve will cause a leak. This will not allow for the endotracheal cuff to maintain appropriate pressure to seal the airway.

 

PTS:   1                    REF:   Page 149

 

54. The American Society for Testing and Materials (ASTM) and the International Standards Organization (ISO) recommend that manual resuscitators be capable of delivering a minimum fractional inspired oxygen (F_IO₂) of _____ with an oxygen flow of ______ L/min.

a.	1.00; 12	c.	0.85; 15
b.	0.95; 20	d.	0.50; 10

 

 

ANS:  C

The ASTM and the ISO recommend that manual resuscitators be capable of delivering a fractional inspired oxygen of 0.85 with an oxygen flow of 15 L/min.

 

PTS:   1                    REF:   Page 152, Box 5-3

 

55. The patient connectors of a resuscitator valve must have which of the following inside diameter to outside diameter?

a.	15:22 mm (inside diameter [ID]:outside diameter [OD])
b.	20:25 mm (ID:OD)
c.	12:20 mm (ID:OD)
d.	18:24 mm (ID:OD)

 

 

ANS:  A

According to the ASTM and the ISO patient connectors of the resuscitator valve must have a 15:22-mm ID:OD.

 

PTS:   1                    REF:   Page 152

 

56. Oxygen-powered resuscitators are classified as which of the following?
57. Volume-limited
58. Pressure-limited
59. Patient-triggered
60. Operator-triggered

a.	1 and 3	c.	2 and 4
b.	2 and 3	d.	1 and 4

 

 

ANS:  B

Oxygen-powered resuscitators are pressure-limited devices that work similarly to reducing valves. A typical oxygen-powered resuscitator consists of a demand valve that can be manually operated or patient triggered.

 

PTS:   1                    REF:   Page 151

 

57. When resuscitating a newborn, which of the following devices is most appropriate?

a.	Manual resuscitator bag with a minimum volume of 600 mL
b.	Oxygen-powered resuscitator with a 60-cm H2O pressure-release valve
c.	Oxygen-powered resuscitator with a 50-cm H2O pressure-release valve
d.	Manual resuscitator bag with a 35- to 45-cm H2O pressure-release valve

 

 

ANS:  D

According to the ASTM and ISO devices used for infants may incorporate a pressure-release valve that limits peak inspiratory pressure to 40 ± 5 cm H₂O.

 

PTS:   1                    REF:   Page 127, Box 5-2

 

58. Inability to maintain an adequate mask seal during manual ventilation will cause:

a.	gastric distention.	c.	lower tidal volumes to be delivered.
b.	pressures to exceed 40 cm H2O.	d.	tidal volumes to exceed 800 mL.

 

 

ANS:  C

Failure to maintain an adequate seal between the mask and the patient’s face can lead to the delivery of low tidal volumes.

 

PTS:   1                    REF:   Page 153

 

59. The ventilation patterns specified by the American Heart Association require that:

a.	infant resuscitator bags deliver 20 mL at a rate of 60 breaths/min.
b.	adult resuscitation bags deliver 600 mL at a rate of 20 breaths/min.
c.	infant resuscitator bags deliver 6 to 8 mL/kg at a rate of 40 breaths/min.
d.	child resuscitator bags deliver at least 300 mL at a rate of 20 breaths/min.

 

 

ANS:  C

The American Heart Association recommends 6 to 8 mL/kg at a rate of 40 breaths/minute for infants.

 

PTS:   1                    REF:   Page 154, Table 5-6

 

60. An ideal manual resuscitator should be able to deliver a minimum of _____ F_IO₂ when oxygen is available.

a.	0.35	c.	0.45
b.	0.40	d.	0.50

 

 

ANS:  B

One feature of an ideal manual resuscitator is to be able to deliver oxygen concentrations of 0.40 when oxygen is available.

 

PTS:   1                    REF:   Page 152, Box 5-3

 

61. A reservoir on a manual resuscitator does which of the following?

a.	Accumulate exhaled tidal volume with high oxygen concentrations.
b.	Allow for higher oxygen concentrations to be delivered.
c.	Increase the amount of volume being delivered.
d.	Collect exhaled volume for measurement.

 

 

ANS:  B

The presence of reservoirs allows for oxygen accumulation and the potential delivery of 100% oxygen.

 

PTS:   1                    REF:   Page 150

 

62. With a manual resuscitator bag, the use of rapid rates causes which of the following?
63. An increase in fractional delivered oxygen concentration (FDO₂)
64. A decrease in FDO₂
65. An increase in tidal volume delivered
66. A decrease in tidal volume delivered

a.	1 and 4	c.	1 and 3
b.	2 and 4	d.	2 and 3

 

 

ANS:  B

Rapid rates with a manual resuscitator will decrease the amount of time the bag has to refill with the appropriate amount of volume and will also decrease the amount of oxygen accumulating in the reservoir thereby decreasing the delivered oxygen concentration and decreasing the tidal volume delivered.

 

PTS:   1                    REF:   Page 151

 

63. Properties of an ideal adult manual resuscitator bag include which of the following?

a.	Dead space volume greater than 30 mL
b.	Bag volume of at least 800 mL
c.	Bag construction allowing for slow refill
d.	Low inspiratory and expiratory airflow resistance

 

 

ANS:  D

A manual resuscitator bag should have low inspiratory and expiratory airflow resistance to ensure ease of use.

 

PTS:   1                    REF:   Page 153

 

64. The minimum volume of a child manual resuscitator bag should be _____ mL.

a.	800	c.	300
b.	500	d.	200

 

 

ANS:  B

Resuscitation bags used for children should have a volume of at least 500 mL to ventilate children appropriately.

 

PTS:   1                    REF:   Page 154, Box 5-4

 

65. Compression of a 2.0-L manual resuscitator bag is not moving the patient’s chest. Possible causes include which of the following?
66. The diaphragm valve is missing.
67. The mask seal is inadequate.
68. The oxygen level is too low.
69. The bag volume is too small.
70. The leaf valve is missing.

a.	2 and 3	c.	1, 2, and 5
b.	3 and 4	d.	1, 3, and 4

 

 

ANS:  C

If the mask seal is inadequate the volume necessary to ventilate the patient will be inadequate, which will result in lack of chest movement. If the resuscitator bag is too small there is not enough volume to adequately ventilate the patient and the chest will not rise appropriately. If the leaf valve is missing the gas from the bag will not be directed to the patient and will therefore result in inadequate chest movement.

 

PTS:   1                    REF:   Page 150

 

66. The following diagram represents which artificial airways?

 

a.	Combitube	c.	Guedel airway
b.	Endotrol tube	d.	Laryngeal mask airway

 

 

ANS:  A

This figure depicts a Combitube. This tube has a double-lumen and two cuffs and can be inserted blindly in comatose patients with airway difficulty. It can function with either the esophagus intubated or the trachea intubated.

 

PTS:   1                    REF:   Page 130, Figure 5-27

 

67. The safety air inlet is represented in this diagram by which of the following letters?

 

a.	A	c.	C
b.	B	d.	D

 

 

ANS:  C

If the reservoir bag’s inlet valve malfunctions the safety air inlet allows room air to enter the resuscitator bag.

 

PTS:   1                    REF:   Page 152, Figure 5-64

 

68. In this diagram, where does the part labeled A-1 fit into this tracheostomy tube?

 

a.	A	c.	C
b.	B	d.	D

 

 

ANS:  C

A-1 is the cap that fits into the fenestrated TT when the inner cannula is removed.

 

PTS:   1                    REF:   Pages 145-146

 

69. When performing endotracheal intubation the respiratory care practitioner is unable to successfully intubate the patient. He or she is unable to visualize the uvula or the soft palate; only the hard palate is visible. Which of the following statements best describe this situation?

a.	The patient has increased neck circumference.
b.	The epiglottis shows evidence of inflammation.
c.	The data indicates a Mallampati classification of IV.
d.	The data indicates that a smaller endotracheal tube is necessary.

 

 

ANS:  C

A Mallampati classification of IV is indicated by an inability to visualize the uvula or soft palate; only the hard palate will be visible.

 

PTS:   1                    REF:   Page 117, Table 5-3

 

70. A 30-year-old male is admitted to the emergency room after a severe motor vehicle accident. Assessment reveals he had a full stomach with significant reflux. His effective static compliance is measured at 20 mL/cm H₂O. Which of the following types of airways would be appropriate to provide ventilatory support for this patient?

a.	Nasopharyngeal airway	c.	Endotracheal tube
b.	Laryngeal mask airway	d.	Endobronchial tube

 

 

ANS:  C

A laryngeal mask airway is contraindicated for three reasons; there was evidence he had a full stomach, there was evidence of gastroesophageal reflux, and his lung compliance is decreased. This would require an endotracheal tube to support ventilation. There is no evidence that a double lumen endotracheal tube is necessary.

 

PTS:   1                    REF:   Page 125, Box 5-1