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Procedures 101 finals
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What is the normal range for PaO2? (include unit of measurement - answer 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? - answer 100% nonrebreather What is the principle of which mist tents work to produce an aerosol
- answer Babbington principle What is the mass of aerosol that reaches the lungs - answer respirable mass Normally, when using a 50psi flowmeter to power a SVN, what should the flow be set at? - answer 6-10 Lpm What is the preferred method for delivering aerosolized bronchodilators to intubated, mechanically ventilated pts - answer MDI What are some types of passover humidifiers?
I. simple reservoir II. membrane III. wick IV. bubble humidifier - answer 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 - answer 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 - answer I, II and III only What is the recommended dosage of continuous nebulization of albuterol? - answer 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 - answer II, III, and IV only
I. tracheostomy collar II. face tent III. Venturi mask IV. aerosol mask - answer 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 - answer unaffected by humidity What is the propellant used in the manufacturing of today's MDI? - answer Hydrofluoroalkane The breath hold improves aerosol deposition by approximately how much percentage? - answer 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 - answer II and IV only What type of breath would you instruct patient to perform while taking a SVN treatment? - answer 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 - answer I, II, III and IV What is used to produce aerosol particles in an ultrasonic nebulizer?
- answer 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? - answer just after inspiration has begun What is the most common device used to generate bland aerosols? - answer Large-volume jet nebulizer Which of the following is FALSE about heated humidifier condensate? - answer It poses minimal infection risk Before inspiration and actuation of a metered dose inhaler, the patient should exhale to which of the following? - answer 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 - answer I, II, and III What is the primary mechanism for deposition of large particles (> microns) in the respiratory tract? - answer inertial impaction
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? - answer 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 - answer I, II and IV only Which of the following creates aerosol particles in a small volume nebulizer? - answer 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? - answer 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? - answer small-particle aerosol generator To protect against obstructed or kinked tubing, simple bubble humidifiers incorporate which of the following? - answer 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? - answer 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 - answer I, II and III What is the minimum peak flow rate that must be generated to successfully use a dry powder inhaler? - answer 60 Lpm What is the primary problem with manually refilling heated humidifier reservoir? - answer 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? - answer 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 - answer 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? - answer output
III. To allow variable pressure reduction throughout the system - answer I and II only Which of the following is the most common type of DISS safety system? - answer Ohio Diamond Quick connect system The clinical use for nitrous oxide is which of the following? - answer anesthesia gas What is the minimum backup an acute care facility must have for oxygen supply? - answer One times daily usage To clean the cylinder valve of foreign material, what should you do?
- answer Quickly open and close the valve Which of the following cylinders have a threaded valve outlet? - answer H tank A Thorpe tube measures flow in: - answer 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? - answer 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 - answer I, II, and III
What cylinder factor is used to calculate duration of flow for an H cylinder filled with air? - answer 3. 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? - answer 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? - answer Thorpe tube What cylinder factor is used to calculate duration of flow for an E cylinder filled with oxygen? - answer 0. The most commonly used oxygen tank for patient transportation in the acute care setting is: - answer E tank A gas cylinder color coded yellow should contain which of the following gases? - answer 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? - answer 2 Which of the following is true when there is downstream resistance with a compensated Thorpe Tube? - answer The float will not change and the actual flow is what the reading indicates
What is the approximate duration of flow for 12 lbs of liquid oxygen running at 3 LPM? - answer 23 hrs Which of the following gases in conjunction with oxygen aids in management in severe airway obstructions? - answer helium Which of the following is true with Bourdon gauges when there is downstream resistance? - answer 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? - answer E tank with a Bourdon gauge A gas cylinder that is color coded brown should contain which of the following gases? - answer helium By what means is medical air produced for use in the hospital? - answer 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? - answer 17 hours 30 minutes What is the fire risk for medical oxygen? I. Flammable II. Nonflammable III. Supports combustion IV. no fire risk - answer 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 - answer all of the above What device is used to reduce the pressure and control the flow of a medical gas? - answer Regulator What is the standard method in measuring the contents in a gas filled cylinder? - answer Read the pressure gauge Helium is most effective for therapeutic use when mixed with which of the following oxygen concentrations? - answer 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? - answer 2.2 hr At approximately what pressure would a cylinder be 3/4 full? - answer 1500 psi A gas cylinder that is color coded green should contain which of the following gases? - answer oxygen Which of the following mechanisms do all medical gas cylinders use to avoid excessively high pressure buildup in the cylinder? - answer Pressure relief in the valve stem To accurately determine the amount of oxygen remaining in a liquid filled cylinder, what would you do? - answer Weigh the contents of the cylinder
What does 2 atmospheric pressure absolute (ATA) equal in mmHg? - answer 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? - answer Obstruction from secretions An ambu bag is used to provide oxygen during cardiac arrest. - answer 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? - answer Increase the flow to the bag Temperature and FiO2 must be monitored when using an oxyhood for an infant. - answer True What is the approximate FiO2 that can be delivered with a partial rebreather mask? - answer 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 - answer 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? - answer 10 Lpm Which of the following flows is the minimum setting for a infant receiving oxygen by an oxyhood? - answer 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? - answer 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? - answer Oxygen induced hypoventilation Which of the following would require humidification of oxygen gas via bubble humidifier? - answer 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? - answer 79 Lpm What is the initial oxygen device of choice for a COPD patient? - answer Nasal Cannula In which of the following conditions would you initially seek to provide the highest FiO2 possible? I. CO poisoning II. Cyanide poisoning
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? - answer Air Entrainment Mask Heliox is used to treat hypoxemic respiratory failure in infants when traditional therapies are unsuccessful. - answer False Physiologic effects of hyperbaric O2 therapy include all of the following except: a. Bubble reduction b. Neovascularization c. Systemic vasodilation d. Hyperoxygenation - answer c. Systemic vasodilation What is the most common complication of hyperbaric oxygen therapy? - answer Ear or Sinus trauma A medical indication for the use of heliox mixtures may be necessary in the management of which of the following? - answer large airway obstruction What is the key functional difference between a partial and nonrebreather mask? - answer 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? - answer 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? - answer Low flow system During hyperbaric O2 therapy at 3 ATA, what is the approximate half life of carbon monoxide in the blood? - answer 20 minutes Which of the following devices is the most appropriate oxygen device for a COPD patient? - answer 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? - answer 14 LPM Which of the following statements is false about low flow oxygen devices? - answer The greater the patient's inspiratory flow, the higher the FiO Retinopathy of prematurity that results from oxygen toxicity may result in which of the following? - answer Blindness Which of the following devices is a low flow device that can deliver 40-55% - answer simple mask Directing a cool O2 mixture to an infant can cause which of the following? - answer 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? - answer Increase the flow
