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RES 235 TEST 4 QUESTIONS AND CORRECT ANSWERS
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Which of the following techniques may be used to diagnose injury associated with artificial airways?
- Laryngoscopy or bronchoscopy
- Physical examination
- Air tomography
- 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 - ANSWER d)1, 2, 3, and 4
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 d)Tracheoinnominate fistula - ANSWER c)Tracheoesophageal fistula
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. - ANSWER d)Switch from the T tube to a tracheostomy collar.
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 - ANSWER c)3 to 6 cm
Tracheal airways increase the incidence of pulmonary infections for which of the following reasons?
- Lower levels of humidification
- Increased aspiration of pharyngeal material
- Contaminated equipment or solutions
- 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 - ANSWER d)2, 3, and 4 only
c)1, 2, 3, and 4 d)2, 3, and 4 only - ANSWER c)1, 2, 3, and 4
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 - ANSWER a)Partial obstruction of the tracheostomy tube
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 - ANSWER c)Complete tube obstruction
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. - ANSWER a)Immediately extubate the patient.
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. - ANSWER a)Remove the tube and provide manual ventilation or oxygenation as necessary.
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. - ANSWER c)The patient is at minimal risk for upper airway obstruction.
Which of the following indicate that a patient being considered for extubation can provide adequate clearance of pulmonary secretions?
- The patient has a maximum inspiratory pressure of 73 cm H2O.
- The patient is alert and cooperative.
- The patient has a dead space-to-tidal volume ratio of 0.7.
- The patient coughs rigorously on suctioning.
a)1 and 3 only
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 - ANSWER b)Maximal abduction of the vocal cords
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 - ANSWER b)Cool mist therapy through a jet nebulizer and aerosol mask
You have been asked to monitor a patient who has just been extubated. Which of the following parameters would you monitor?
- Color
- Breath sounds
- Vital signs
- Inspiratory force
a)1, 2, and 3 only b)2 and 4 only
c)3 and 4 only d)2, 3, and 4 only - ANSWER a)1, 2, and 3 only
What is a rare but serious complication associated with endotracheal tube extubation?
a)Bradycardia b)Aspiration c)Infection d)Laryngospasm - ANSWER d)Laryngospasm
Minimal leak technique can also be used to reduce the chance of tracheal stenosis when an artificial airway is in place
True False - ANSWER True
an adult patient receiving cool mist therapy after extubation begins to develop stridor. Which of the following actions would you recommend?
1.change to heated aerosol 2.admin racemic epinephrine 3.re-intubate 4.draw ABG - ANSWER 2.admin racemic epinephrine
Which of the following approaches may be used in "weaning" a patient from a tracheostomy tube?
1.using progressively smaller tubes
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 4.unstable hemodynamic status - ANSWER 1,3,
Complications of fiberoptic bronchoscopy include which of the following
1.hypocapnia 2.infection 3.hypotension 4.hypoxemia - ANSWER 2,3,
Key points to consider in planning fiberoptic bronchoscopy include which of the following?
1.equipment preparation 2.premedication 3.airway preparation 4.monitoring - ANSWER 1,2,3,
A mechanically ventilated patient continues to have rhonchi after deep suctioning. The respiratory therapist should recommend which of the following?
- prone position
- vest airway clearance
- supine position with foot of bed elevated - ANSWER 2. vest airway clearance
To maintain positive end expiratory pressure (PEEP) and high FiO2 when suctioning a mechanically ventilated patient, what would you recommend? - ANSWER use closed system multi-use suction catheter
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 of a catheter as possible 4.limit the amount of negative pressure - ANSWER 2,
Absolute contraindication for nasotracheal suctioning includes which of the following?
1.epiglottis 2.croup 3.irritable airway - ANSWER 1,
After repeated nasotracheal suctioning over 2 days, a patient with retained secretions develops minor bleeding through the nose. What do you recommend? - ANSWER stop the bleeding, and use a nasopharyngeal airway
Before the suctioning of a patient, ausculatation 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? - ANSWER Pt has hyper-reactive airways, developed bronchospasm
What general condition requires airway management?
1.increase in tidal volume 2.decrease in tidal volume 3.increase in peak inspiratory pressure 4.high pressure alarm alert - ANSWER 2.decrease in tidal volume
