Fundamentals II final

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Fundamentals II final
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  1. Which of the following are the most common sites for the percutaneous sampling of arterial blood for blood gas analysis?
    I. earlobe
    II. Radial artery
    III. Brachial artery
    IV. Side of the heel

    a.I and II
    b. II and III
    c. III and IV
    d. I and IV
    • II. Radial artery
    • III. Brachial Artery

    Blood is most often drawn from the radial, brachial, or femoral arteries or the dorsalis peids artery of the foot.
  2. Which of the following statements is true concerning capillary blood gases?
    a. They can be drawn from an earlobe.
    b. They coincide with ABGs.
    c. They can be drawn from a peripheral artery.
    d.  They require the performance of an Allen's test.
    They can be drawn from an earlobe.

    Capillary blood samples from an earlobe or the side of the heel can be substituted when arterial blood cannot be obtained.
  3. When an Allen's test result is negative, blood for blood gas analysis should be drawn from which of the following sites?
    a. Earlobe
    b. Radial Artery
    c. Brachial Artery
    d. Side of the heel
    Brachial artery.
  4. The purpose of an Allen's test is to check blood flow in the ___ artery
    I. Ulnar
    II. Radial
    III. Brachial
    IV. Posterior tibial
    V. Lateral plantar

    a. I, II, and III
    b. II, III, and IV
    c. I, IV, and V
    d. III, IV, and V
    • I. Ulnar
    • IV. Posterior tibial
    • V. Lateral plantar

    • Ulnar is to check when puncturing radial.
    • Posterior tibial and lateral plantar is for when dorsal artery.
  5. Which is the correct sequence of events when one is obtaining arterial blood from the radial artery of a patient?
    I.  Perform the modified Allen's test.
    II. Remove any air bubbles from the sample
    III. Apply direct pressure to the puncture site
    IV. Clean the puncture site with a suitable antiseptic solution.
    V. Use a 23-gauge needle and a plastic syringe containing an anticoagulant.

    a. I, IV, III, V, II
    b. IV, I, V, II, III
    c. I, IV, V, III, II
    d. I, V, II, IV, III
    • I.  Perform the modified Allen's test
    • IV. Clean the puncture site with a suitable antiseptic solution
    • V. Use a 23-gauge needle and a plastic syringe containing an anticoagulant
    • III. Apply direct pressure to the puncture site
    • II. Remove any air bubbles from the sample.
  6. Which size of needle should be used to draw arterial blood from an adult?
    a. 22 gauge
    b. 24 gauge
    c. 26 gauge
    d. 28 gauge
    Blood needles from adult patients should be 23-25 gauge.
  7. Which is the correct order of steps to perform the modified Allen's test?
    I. Pressure is applied to both the radial and ulnar arteries.
    II. The fist is opened, but not fully extended
    III. Pressure on the ulnar artery is removed
    IV.  The hand is clenched into a tight fist.
    V. The palm and fingers are blanched.

    a. IV, I, II, V, III
    b. IV, V, I, III, II
    c. I, IV, III, II, V
    d. IV, II, I, III, V
    • IV. The hand is clenched into a tight fist.
    • I. Pressure is applied to both the radial and ulnar arteries
    • II. The fist is opened, but not fully extended.V.  The palm and fingers are blanched
    • III. Pressure on the ulnar artery is removed
  8. Capillary blood gas (CBG) samples should not be used to measure which of the following?
    I. Partial pressure of arterial carbon dioxide (PaCO2)
    II.  Partial pressure of arterial oxygen (Pa02)
    III. pH
    IV. Hemoximetry oxygen saturation (Sa02)

    a. I and III
    b. II and IV
    c. I and IV
    d. II and III
    • II. Partial pressure of arterial oxygen (Pa02)
    • IV. Hemoximetry oxygen saturation (Sa02)
  9. Which of the following factors will cause analysis of blood gas samples to be erroneous?
    I. Warming the sample
    II. Low leukocyte counts
    III. The presence of air bubbles in the sample
    IV. Icing the sample between obtaining and analyzing
    V. Prolonged time delay between obtaining and analyzing a sample.
    a. II and III
    b. II and IV
    c. I, III, and V
    d. I, II, IV, and V
    • I. Warming the sampleIII. The presence of air bubbles in teh sample
    • V. Prolonged time delay between obtaining and analyzing a sample
  10. The maximum amount of blood that should be discared from the indwelling arterial catheter of an infant is __ mL.
    a. 0.3
    b. 0.5
    c. 0.8
    d. 1.0
    • 0.5
    • The discarded volume for an infant is typically only approximately 0.2 to 0.5 mL
  11. In a PC02 electrode, carbon dioxide does which of the following?

    I. It reacts with potassium chloride
    II. It reacts with water to form carbonic acid
    III. It diffuses through a polyethylene membrane
    IV. It diffuses through a semipermeable teflon membrane
    • II. It reacts with water to form carbonic acid
    • IV. It diffuses through a semipermeable teflon membrane
  12. If the PC02 of an arterial blood sample is 60 mm Hg, the expected pH is:
    a. 7.20
    b. 7.30
    c. 7.50
    d. 7.60
    7.20
  13. Erroneous PC02 measurements can be caused by which of the following?
    I. A worn electrode
    II. A cracked electrode
    III. Wearing out of the silver anode
    IV. Increased temperature of the patient
    V. Dehydration of bicarbonate solution
    a. I and V
    b. II and III
    c. III and IV
    d. I, II and V
    • I.Worn electrode
    • II. A cracked electrode
    • V Dehydration of bicarbonate solution
  14. The partial pressure of oxygen in the blood is measured by which electrode?
    a. Sanz
    B. Severinghaus
    C. Pauling
    D. Clark
    • Clark.
    • Clark is 02
    • Sanz is pH
    • Severinghaus is PC02
    • Pauling is a type of oxygen analyzer
  15. The PC02 electrode uses which of the following?
    a. HC03- solution
    b. Mercury bead
    c. KCl solution
    d. Silver anode
    HC03 solution

    • mercury bead = pH electrode
    • KCl = pH electrodeSilver anode = Clark
  16. What is the pH of the phosphate buffer solution in a Sanz electrode?
    a. 6.84
    b. 7.00
    c. 7.32
    d. 7.90
    6.84
  17. The blood gas factor results from the :
    a. Slow rate of oxygen diffusion in fluids
    b. Slow rate of carbon dioxide diffusion in blood
    c. Amount of carbon dioxide necessary to change the pH by 0.01
    d. Quantity of electrons that need to be added to the silver anode to reduce oxygen
    Slow rate of oxygen diffusion in fluids
  18. Exposure of a Clark electrode to gaseous anesthetic agents such as nitrous oxide will cause of the following to occur?
    a. The pH will increase.
    b. The electrode will function normally.
    c. There will be an increase in the production of peroxide ions
    d. The carbon dioxide in the blood will increase and cause an erroneous reading.
    There will be an increase in the production of peroxide ions.
  19. Which of the following are measured directly by a blood gas machine?
    I. pH
    II. Pa02
    III. Hc03-
    IV. Sa02
    a. I and II
    b. II and III
    c. III and IV
    d. I and IV
    pH and Pa02

    The pH is measured directly by using a Sanz electrode. The PaO2 is measured directly by using a Clark electrode. The HCO3– is derived from measurements of pH and PaCO2 by using the Henderson-Hasselbalch equation. The saturation of hemoglobin can be calculated by using an equation empirically derived from the oxyhemoglobin saturation curve.
  20. Which of the following can be calculated form measured ABG values?
    I. The partial pressure of oxygen at which hemoglobin is 50% saturated (P50)
    II. pH
    III. PC02
    IV. HC03-
    V. Sa02
    a. I, III, and IV
    b. II, IV, and V
    c. I, IV, and V
    d. II and III
    • I. pH
    • IV, HC03-
    • V. Sa02

    The P50 can be derived by using the oxyhemoglobin dissociation curve to look for the PaO2 at 50% hemoglobin saturation. The HCO3– is derived from measurements of pH and PaCO2 by using the Henderson-Hasselbalch equation. The saturation of hemoglobin can be calculated by using an equation empirically derived from the oxyhemoglobin saturation curve. The pH is measured directly by using a Sanz electrode, and the PaO2 is measured directly by using a Clark electrode.
  21. A P50 measurement refers to which of the following?
    a. The amount of oxygen diffusion in fluids
    b. The P02 when hemoglobin is 50% saturated with oxygen
    c. The partial pressure of fetal hemoglobin at 50% saturation
    d. The partial pressure of oxygen consumed by the oxygen electrode
    The P02 when hemoglobin is 50% saturated with oxygen

    P50 is a convenient way of describing hemoglobin affinity for oxygen because it identifies the PO2 in millimeters of mercury when hemoglobin is 50% saturated with oxygen.
  22. A left shift in the oxyhemoglobin dissociation curve is caused by:
    a. Methemoglobin
    b. Acute acidosis
    c. Increased temperature
    d. High 2,3 diphosphoglycerate (2,3 DPG)
    A Methehemoglobin

    Methemoglobin will increase hemoglobin’s affinity, causing a left shift in the oxyhemoglobin dissociation curve. Acute acidosis, hyperthermia, and increased levels of 2, 3-DPG will decrease hemoglobin affinity.
  23. Which of the following will decrease oxygens affinity for hemoglobin?
    a. Increased CO2
    b. Acute alkalosis
    c. Methemoglobin
    d. Hypothermia
    Increased C02

    Increased CO2 causes acidosis, which decreases hemoglobin affinity for oxygen. Acute alkalosis, methemoglobin, and hypothermia cause left shifts in the oxyhemoglobin dissociation curve.
  24. What type of electrode is used to measure calcium and sodium?
    A. Clark
    b. ion-selective
    c. polarographic
    d. glucose-oxidase
    Ion selective

    The sensors used for electrolyte measurements are ion-selective electrodes. A Clark electrode is used to measure the partial pressure of oxygen in the blood. A polarographic electrode is a Clark electrode. Glucose-oxidase is an enzyme that is used to coat the ion-selective electrode used to measure glucose.
  25. What type of calibration should be performed after an electrode is changed?
    a. Quality control
    b. Three-point
    c. Two-point
    d. One-point
    Three-point

    A three-point calibration should be performed every 6 months or whenever an electrode is replaced. A two-point calibration is usually performed at least three times daily, typically every 8 hours. In many cases, analyzers can be programmed to perform a two-point calibration at predetermined intervals. The one-point calibration involves adjusting the electronic output to a single, known standard and should be performed before an unknown sample is analyzed, unless the analyzer is programmed to perform a one-point calibration automatically at regular intervals, such as every 20 to 30 minutes. Quality control is the system that includes the analysis of control samples and assessment of the measurements against defined limits, identification of problems, and specification of corrective actions.
  26. Quality control includes which of the following?
    I. Analyzing unknown samples and submitting to the sponsoring organization
    II. Assessing control sample measurements against defined limits
    III. Addressing problems through corrective actions
    IV. Identifying problems

    a. I and II
    b. III and IV
    c. II, III, and IV
    d. I, II, III, and IV
    • II. Assessing control sample measurements against defined limits
    • III. Addressing problems through corrective actions
    • IV. Identifying problems

    Quality control is the system that entails the analysis of control samples and assessment of the measurements against defined limits, identification of problems, and specification of corrective actions. The analysis of unknown samples and submitting the analysis results to a sponsoring organization is known as proficiency testing.
  27. The gold standard for quality control for PC02 and P02 electrodes is:
    a. capnography
    b. polarography
    c. tonometry
    d. anometry
    Tonometry

    Although tonometry remains the gold standard for quality control of PCO2 and PO2 electrodes, most laboratories use commercially prepared quality control systems for biosafety and convenience.
  28. Which of the following statements is true concerning quality control of a blood gas analyzer?
    a. Commercially prepared controls ensure instrument accuracy
    b. A Levy-Jennings chart is used to record quality control data
    c. Protein buildup on electrodes will not cause errors in the instrument.
    d. Commercial controls are not susceptible to variations at room temperature.
    A levy-jennings chart is used to record quality control data

    The most common method of recording quality control data involves the use of Levy-Jennings charts. These charts allow the operator to detect trends and shifts in electrode performance, which helps prevent problems associated with reporting of inaccurate data because of analyzer malfunction. Commercially prepared control systems provide information on the instrument’s precision—not the accuracy of the data—and are susceptible to variations in room storage temperature.
  29. What organizations offer proficiency testing programs?
    I. JCAHO
    II. AARC
    III. ACCPIV. CAP
    V. ATS
    a. IV and V
    b. III and V
    c. I, II, and III
    d. I, IV and V
    • IV. CAP
    • V. ATS

    CAP and ATS currently offer two proficiency testing programs that provide a means of assessing blind samples (periodically) and the technical competence of laboratory personnel, as well as a means of reporting the variability of individual blood gas analyzers.
  30. Which size of scalp vein needle size should be used to draw arterial blood from an infant?
    a. 22 gauge
    b. 24 gauge
    c. 26 gauge
    d. 28 gauge
    26 gauge

    For infants, a 25-gauge to 26-gauge scalp vein needle can be used to collect arterial samples.
  31. What type of instrument could be used to analyze pH, P02, and PC02 and various electrolytes at the patient's bedside?
    a. Point-of-care blood gas analyzer
    b. co-oximeter
    c. potentiometer
    d. capnograph
    point of care blood gas analyzer

    Point-of-care testing typically involves the use of portable devices that can be located at or near the point of patient care. These devices are not only portable but also lightweight, allowing in vitro ABG and pH measurements to be made in the emergency department, intensive care unit, physician’s office, or a transport vehicle.
  32. Which of the following is true concerning the typical point-of care blood gas analyzers
    A. It is only able to measure pH, PaCo2 and Pa02
    b. It measures actual hemoglobin oxygen saturation
    c. It uses silicone chips with microelectrodes
    d. It requires 1-2 mL of blood
    It uses silicone chips with microelectrodes

    Point-of-care blood gas analyzers use solid-state sensors, which rely on either fluorescence technology or thin-film electrodes that have been fabricated onto silicone chips. The microelectrodes are incorporated into a single-use disposable cartridge that also contains calibration reagents, a sampling stylus, and a waste container.
  33. What are the two wavelengths of light used to determine hemoglobin saturation with a pulse oximeter
    a. 550 nm and 730 nm
    b. 660 nm and 940 nm
    c. 730 nm and 940 nm
    d. 550 nm and 840 nm
    660 nm and 940 nm
  34. Which of the following techniques allows a pulse oximeter to determine the amount of hemoglobin in a blood sample?
    a. Tonometry
    b. Spectrophotometry
    c. Fluorescent technology
    d. Optical plethysmography
    Spectrophotometry

    Pulse oximeters use spectrophotometry to determine the amount of hemoglobin in a blood sample. They use optical plethysmography to estimate the heart rate by measuring cyclic changes in light transmission through the sample site during each cardiac cycle.
  35. Measurement of oxygen saturation by a pulse oximeter can be adversely effected by which of the following?
    I. Hypobilirubinemia
    II.peripheral vasodilation
    III. hypothermia
    IV. Dapsone
    • Hypothermia
    • Dapsone

    Hypothermia causes a low perfusion state, which interferes with the accuracy of a pulse oximeter. Dapsone, an antibiotic used to treat malaria and Pneumocystis carinii, can cause increased levels of metHb, which interferes with the proper function of a pulse oximeter. Hypobilirubinemia is a low bilirubin blood level and will not interfere with a pulse oximeter. Peripheral vasodilation will cause more blood to circulate through the extremities, which is good for pulse oximetry. Peripheral vasoconstriction will affect pulse oximetry readings because low perfusion states are associated with a diminished pulsatile signal, resulting in an intermittent or absent SpO2 reading.
  36. Which of the following are important blood tests to perform on a victim of a fire?
    I. Na+
    II. PaO2
    III. O2Hb
    IV. HbCO
    V. Glucose
    • II. PaO2
    • III. O2Hb
    • IV. HbCO

    Patients who have been exposed to fires have a high risk of developing CO poisoning. CO will compete with oxygen for hemoglobin. Therefore, measurements of HbCO, O2Hb, and PaO2 are important for these patients.
  37. What are the two principles of operation for pulse oximetry?
    I. Photoplethysmography
    II. Tonometry
    III. Spectrophotometry
    IV. Amperometry
    V. Potentiometry
    • I. Photoplethysmography
    • III. Spectrophotometry
  38. 69. Shining a red light with a wavelength of 660 nm on a blood sample will cause which of the following?
    A. Sulfhemoglobin will absorb more light than HHb.
    B. O2Hb will absorb less light than HHb.
    C. HHb will absorb less light than O2Hb.
    D. MetHb will absorb less light than O2Hb.
    B. O2Hb will absorb less light than HHb.
    (this multiple choice question has been scrambled)
  39. Which site will provide the most accurate pulse oximetry reading in the event of low peripheral perfusion?
    a. Toe
    b. Thumb
    c. Earlobe
    d. First digit
    Earlobe

    The earlobe is more central and is not as susceptible to reductions in peripheral perfusion as are the fingers and toes.
  40. To produce capillary vasodilatation below the surface of a transcutaneous PO2 electrode, which of the following should be done to the electrode?
    A. Icing to 0° C
    B. Heating to 44° C
    C. Warming to 35° C
    D. Cooling to 25° C
    B. Heating to 44° C

    The transcutaneous PO2 electrode is heated to 42° C to 45° C to produce capillary vasodilatation below the surface of the electrode. Heating improves gas diffusion across the skin, because it increases local blood flow at the site of the electrode and alters the structure of the stratum corneum, the fibrinous tissue within a lipid-and-protein matrix. Cooling or icing the skin will decrease blood flow to the area, making it difficult to obtain an accurate PO2. A temperature of 35° C is not warm enough to arterialize the area under the skin.
    (this multiple choice question has been scrambled)
  41. Which of the following cause erroneous transcutaneous oxygen (PtcO2) readings?
    I. Hypovolemia
    II. Hypothermia
    III. Septic shock
    IV. Asthma

    a. I and III
    b. I and IV
    c. I, II, and III
    d. II, III, and IV
    • I. Hypovolemia
    • II. Hypothermia
    • III. Septic shock

    Hypovolemia, hypothermia, and septic shock will decrease peripheral perfusion caused by reductions in cardiac output. This can significantly affect the accuracy of PtcO2 measurements. Asthma does not necessarily cause a decrease in cardiac output.
  42. The standard transcutaneous carbon dioxide electrode is which of the following?
    a. Clark
    b. Levy-Jennings
    c. Spectrophotometer
    d. Modified Stowe-Severinghaus
    • d. Modified Stowe-Severinghaus
    • The standard transcutaneous carbon dioxide electrode is a modified Stowe-Severinghaus blood gas electrode composed of pH-sensitive glass with a silver–silver chloride (Ag/AgCl) electrode. The Clark electrode measures oxygen. Levy-Jennings is a chart that allows the operator of blood gas analyzers to detect trends and shifts in electrode performance. A spectrophotometer is a device for measuring light that can measure intensity as a function of the wavelength of light. It is used in pulse oximeters.
  43. Which of the following statements is true concerning the operation of
    a transcutaneous carbon dioxide electrode?
    PtcCO2 readings are slightly lower than the PaCO2 value.
    b. Electrodes should be calibrated when they are repositioned.
    c. Heating the PtcCO2 to 43°C will adversely affect its operation.
    d. Before its use, the electrode should be calibrated to 20% and 40% CO2.
    b. Electrodes should be calibrated when they are repositioned.

    Manufacturers typically suggest calibration of an electrode each time it is repositioned. PtcCO2 readings are slightly higher than the PaCO2 value because of the higher metabolic rate at the site of the electrode caused by heating the skin. The PtcCO2 electrode must be heated to 42° C to 44° C. The PtcCO2 electrodes are calibrated with a two-point calibration procedure by using 5% CO2 and 10% calibration gases.
  44. Which of the following statements is true concerning the operation of
    a transcutaneous carbon dioxide electrode?
    PtcCO2 readings are slightly lower than the PaCO2 value.
    b. Electrodes should be calibrated when they are repositioned.
    c. Heating the PtcCO2 to 43°C will adversely affect its operation.
    d. Before its use, the electrode should be calibrated to 20% and 40% CO2.
    b. Electrodes should be calibrated when they are repositioned.

    Manufacturers typically suggest calibration of an electrode each time it is repositioned. PtcCO2 readings are slightly higher than the PaCO2 value because of the higher metabolic rate at the site of the electrode caused by heating the skin. The PtcCO2 electrode must be heated to 42° C to 44° C. The PtcCO2 electrodes are calibrated with a two-point calibration procedure by using 5% CO2 and 10% calibration gases.
  45. During the calibration of a transcutaneous electrode, the signal is found to be drifting. Which of the following is the most appropriate action to take?
    a. Move the electrode to another site.
    b. Increase the temperature of the electrode. c. Clean off the silver deposit on the cathode. d. Change the electrolyte and the sensor membrane.
    d. Change the electrolyte and the sensor membrane.

    The electrolyte and the sensor’s membrane should be checked regularly and changed weekly or whenever a signal drift during calibration is noticed.
  46. A 38-year-old woman is currently in the emergency department and has a diagnosis of an asthma attack. The most current ABG result reveals the following: pH of 7.24; PaCO2 of 55 mm Hg; and an HCO3– of 27 mEq/L. The acid-base status of this patient can be interpreted as:
    a. Uncompensated respiratory acidosis
    b. Partially compensated respiratory acidosis c. Partially compensated metabolic alkalosis d. Partially compensated metabolic acidosis
    b. Partially compensated respiratory acidosis

    A pH of 7.24 indicates acidosis because it is below 7.35. The PaCO2 of 55 mm Hg is a respiratory acidosis because it is greater than 45 mm Hg. The ABG is partially compensated because the HCO3– of 27 mEq/L is greater than 26 mEq/L and the pH is less than 7.35.
  47. Which of the following is the correct interpretation of the following ABG results taken from a patient receiving no supplemental oxygen: pH = 7.37; PaCO2 = 55 mm Hg; PaO2 = 53 mm Hg; SaO2 = 88%; and HCO3– = 31 mEq/L?

    A. Partially compensated respiratory acidosis with mild hypoxemia
    B. Compensated metabolic alkalosis with mild hypoxemia
    C. Partially compensated respiratory acidosis with severe hypoxemia
    D. Compensated respiratory acidosis with moderate hypoxemia
    D. Compensated respiratory acidosis with moderate hypoxemia

    The pH of 7.37 indicates acidosis, but it is compensated because it is greater than 7.35 and less than 7.40 and the HCO3– is greater than 26 mEq/L. The PaCO2 of 55 mm Hg is indicative of a respiratory acidosis. The PaO2 of 53 mm Hg shows that the patient has moderate hypoxemia.
    (this multiple choice question has been scrambled)
  48. A patient has the following acid-base status: pH = 7.26; PaCO2= 70 mm Hg; and HCO3– = 31 mEq/L. Which of the following could be the cause of his ABG status?
    A. Diabetes mellitus
    B. Excess antacid ingestion
    C. Salicylate intoxication
    D. Acute airway obstruction
    D. Acute airway obstruction

    First, the acid-base balance must be analyzed. A pH of 7.26 indicates acidosis. A PaCO2 of 70 mm Hg indicates respiratory acidosis. The HCO3– of 31 mEq/L is indicative of a compensation for the respiratory acidosis. Therefore, this blood gas result is indicative of partially compensated respiratory acidosis. Respiratory acidosis can be caused by acute airway obstruction. Diabetes mellitus causes metabolic acidosis. Salicylate intoxication causes metabolic acidosis. Excess antacid ingestion will cause metabolic alkalosis.
    (this multiple choice question has been scrambled)
  49. Which of the following ABG results could be caused by diarrhea?

    A. pH = 7.20; PaCO2 = 65 mm Hg; and HCO3– = 26 mEq/L
    B. pH = 7.57; PaCO2 = 22 mm Hg; and HCO3– = 20 mEq/L
    C. pH = 7.15; PaCO2 = 20 mm Hg; and HCO3– = 7.4 mEq/L
    D. pH = 7.49; PaCO2 = 49 mm Hg; and HCO3– = 38 mEq/L
    C. pH = 7.15; PaCO2 = 20 mm Hg; and HCO3– = 7.4 mEq/L

    Diarrhea can be caused by a metabolic acidosis. ABG values in which the pH is 7.15 (acidosis), PaCO2 is 20 mm Hg, and the HCO3– is 7.4 mEq/L are indicative of a partially compensated metabolic acidosis. Answer B is an uncompensated respiratory acidosis. Answer C is a partially compensated respiratory alkalosis, and answer D is a partially compensated metabolic alkalosis.
    (this multiple choice question has been scrambled)
  50. What is the correct interpretation of the following ABG values: pH = 7.36; PaCO2 = 65 mm Hg; and HCO3– = 35 mEq/L?
    A. Acute respiratory acidosis
    B. Chronic metabolic alkalosis
    C. Chronic respiratory acidosis
    D. Acute metabolic acidosis
    C. Chronic respiratory acidosis

    A pH of 7.36 is indicative of an acidosis; a PaCO2 of 65 mm Hg indicates a respiratory acidosis; a HCO3– of 35 mEq/L represents a metabolic alkalosis. Because the pH is greater than 7.35, it is compensated. Therefore, this ABG value is a compensated respiratory acidosis. This level of blood gas is consistent with chronic ventilatory failure or chronic respiratory acidosis.
    (this multiple choice question has been scrambled)
  51. Respiratory alkalosis can be caused by which of the following?
    I. Encephalitis
    II. Diuretic therapy
    III. Renal dysfunction
    IV. Nasogastric suctioning
    V. Excessive mechanical ventilatory support
    • I. Encephalitis
    • V. Excessive mechanical ventilatory support..

    Respiratory alkalosis can be caused by encephalitis and excessive mechanical ventilatory support. Diuretic therapy and nasogastric suctioning can cause metabolic alkalosis, and renal dysfunction can cause metabolic acidosis
  52. Which of the following are true if a patient has a PaO2 of 155 mm Hg?
    I. The patient has mild hypoxemia.
    II. The patient has an overcorrected PaO2. III. The patient is in need of supplemental oxygen.
    IV. The patient is receiving supplemental oxygen therapy.
    • II. The patient has an overcorrected PaO2.
    • IV. The patient is receiving supplemental oxygen therapy.

    When the PaO2 is greater than 100 mm Hg, the oxygen status is considered excessively or overly corrected. A PaO2 of 155 mm Hg is not possible without supplemental oxygen.
  53. Excessive nasogastric suction will cause what type of acid-base disorder?
    A. Acute metabolic alkalosis
    B. Uncompensated respiratory alkalosis
    C. Uncompensated metabolic acidosis
    D. Chronic respiratory acidosis
    A. Acute metabolic alkalosis
    (this multiple choice question has been scrambled)
  54. Renal failure will cause what acid-base disorder?
    A. Metabolic alkalosis
    B. Respiratory acidosis
    C. Metabolic acidosis
    D. Respiratory alkalosis
    C. Metabolic acidosis
    (this multiple choice question has been scrambled)
  55. Which is the correct interpretation of the following ABG values: pH = 7.26; PCO2 = 64 mm Hg; PO2 = 48 mm Hg; HCO3– = 26 mEq/L; and fractional inspired oxygen (FIO2) = 0.21?
    A. Compensated respiratory acidosis with moderate hypoxemia
    B. Acute metabolic acidosis with severe hypoxemia
    C. Acute respiratory acidosis with moderate hypoxemia
    D. Acute metabolic alkalosis with severe hypoxemia
    C. Acute respiratory acidosis with moderate hypoxemia

    A pH of 7.26 indicates an acidosis; a PaCO2 of 64 mm Hg is indicative of a respiratory acidosis; a HCO3– of 26 mEq/L is within normal limits. Therefore, the acid-base balance of the blood gas represents an acute respiratory acidosis. A PO2 of 48 mm Hg represents moderate hypoxemia.
    (this multiple choice question has been scrambled)
  56. Which is the correct interpretation of the following values: pH = 7.36; PaCO2 = 22 mm Hg; and HCO3– = 12 mEq/L?
    A. Combined alkalosis
    B. Compensated respiratory alkalosis
    C. Combined acidosis
    D. Compensated metabolic acidosis
    D. Compensated metabolic acidosis

    The pH of 7.36 is a compensated acidosis; any value greater than 7.35 is indicative of acidosis. A PaCO2 of 22 mm Hg is indicative of a respiratory alkalosis and a HCO3– of 12 mEq/L represents a metabolic acidosis. Therefore, the interpretation is a compensated metabolic acidosis.
    (this multiple choice question has been scrambled)
  57. Respiratory alkalosis may be caused by which of the following?

    A. Pneumothorax
    B. Salicylate overdose
    C. Hyperventilation
    D. Vomiting
    C. Hyperventilation

    Hyperventilation will decrease the amount of carbon dioxide in the blood, causing a respiratory alkalosis. Vomiting can cause a metabolic alkalosis, salicylate overdose can cause a metabolic acidosis, and a pneumothorax can cause a respiratory acidosis.
    (this multiple choice question has been scrambled)
  58. After arterial blood has been drawn from a patient, which of the following should be done to the blood?
    A. Transported at 37° C
    B. Placed in the freezer until processed
    C. Transported in an ice bath
    D. Processed after 5 minutes
    C. Transported in an ice bath

    Chilling the blood specimen to below 5° C by placing the syringe in ice water can reduce the metabolic rate of the white blood cells. Transporting without the ice bath may take longer than 5 minutes, prolonging the delay between obtaining and analyzing the specimen, which can lead to erroneous results. Placing the blood in a freezer will not cool all sides of the syringe uniformly as well as an ice water bath will.
    (this multiple choice question has been scrambled)
  59. Placing blood gas samples in an ice bath serves to do which of the following?

    A. Keep the specimen cold.
    B. Slow down in vitro metabolism.
    C. Allow the red blood cells to remain intact. d. Prevent the white blood cells from destroying the red blood cells.
    B. Slow down in vitro metabolism.

    Chilling the blood specimen to below 5° C by placing the syringe in ice water can reduce the metabolic rate of the white blood cells. The ice bath does keep the specimen cold, but the purpose of keeping it cold is to reduce the in vitro metabolism rate.
    (this multiple choice question has been scrambled)
  60. A 60-year-old male patient is admitted to the medical unit with a bowel obstruction causing him to vomit frequently. What is the correct interpretation of the most recent ABG values for this patient: pH = 7.51; PaCO2 = 43 mm Hg; and HCO3– = 34 mEq/L?
    A. Metabolic acidosis
    B. Respiratory alkalosis
    C. Metabolic alkalosis
    D. Respiratory acidosis
    C. Metabolic alkalosis

    The increased pH indicates alkalosis, and the HCO3– is increased, reflecting a primary metabolic problem most likely caused by the patient’s vomiting.
    (this multiple choice question has been scrambled)
  61. The respiratory system compensates for metabolic problems by changing which of the following levels?
    A. H2O
    B. CO2
    C. HHb
    D. HCO3–
    B. CO2
    (this multiple choice question has been scrambled)
  62. What is the correct interpretation of the following ABG values: pH of 7.38, PaCO2 of 38 mm Hg, and HCO3– of 23 mEq/L?
    A. Respiratory alkalosis
    B. Normal
    C. Metabolic acidosi
    D. Respiratory acidosis
    B. Normal
    (this multiple choice question has been scrambled)
  63. Which of the following will not cause a respiratory acidosis?
    A. Diabetes mellitus
    B. Neuromuscular disorder
    C. Overdose with sedatives
    D. Restrictive pulmonary disease
    A. Diabetes mellitus

    Diabetes mellitus will primarily cause a metabolic acidosis that will lead to the body compensating by hyperventilating, resulting in a respiratory alkalosis. Neuromuscular disorders, overdosing with sedatives, and restrictive pulmonary diseases can cause respiratory acidosis.
    (this multiple choice question has been scrambled)
  64. Compared with the nasal route, the advantages of oral intubation include all of the following except:
    A. reduced risk of kinking
    B. less retching and gagging
    C. easier suctioning
    D. less traumatic insertion
    B. less retching and gagging
    (this multiple choice question has been scrambled)
  65. Compared with the oral route, the advantages of nasal intubation include all of the following except:
    A. less retching and gagging
    B. greater long-term comfort
    C. less accidental extubation
    D. reduced risk of kinking
    D. reduced risk of kinking
    (this multiple choice question has been scrambled)
  66. Compared with translaryngeal intubation, the advantages of tracheostomy include all of the following except:
    A. greater patient comfort
    B. decreased frequency of aspiration
    C. no upper airway complications
    D. reduced risk of bronchial intubation
    B. decreased frequency of aspiration
    (this multiple choice question has been scrambled)
  67. What is the standard size for endotracheal or tracheostomy tube adapters?
    A. 15 mm external diameter
    B. 22 mm internal diameter
    C. 15 mm internal diameter
    D. 22 mm external diameter
    A. 15 mm external diameter
    (this multiple choice question has been scrambled)
  68. 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
    d. ensure gas flow if the main port is blocked
  69. 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
    A. to seal off and protect the lower airway
    (this multiple choice question has been scrambled)
  70. What is the purpose of the pilot balloon on an endotracheal or a tracheostomy tube?
    A. to help ascertain proper tube position
    B. to protect the airway against aspiration
    C. to monitor cuff status and pressure
    D. to minimize mucosal trauma during insertion
    C. to monitor cuff status and pressure
    (this multiple choice question has been scrambled)
  71. 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 or mask
    4. tube stylet
    • 2. syringe(s)
    • 3. resuscitator bag or mask
    • 4. tube stylet
  72. 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
    • 1. laryngoscope light source
    • 2. endotracheal tube cuff
    • 3. suction equipment

    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.
  73. 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. Check and clean the laryngoscope handle electrical contact.
    B. Replace the batteries in the laryngoscope handle.
    C. Check and replace the bulb in the MacIntosh blade.
    D. Swap the defective MacIntosh for the good Miller blade.
    C. Check and replace the bulb in the MacIntosh blade.
    (this multiple choice question has been scrambled)
  74. What size endotracheal tube would you select to intubate a 3-year-old child?
    A. 6.0 to 7.0 mm
    B. 4.5 to 5.0 mm
    C. 5.5 to 6.0 mm
    D. 3.0 to 4.0 mm
    B. 4.5 to 5.0 mm
    (this multiple choice question has been scrambled)
  75. What size endotracheal tube would you select to intubate a 1500-g newborn infant?
    A. 2.5 mm
    B. 3.0 mm
    C. 4.0 mm
    D. 3.5 mm
    B. 3.0 mm
    (this multiple choice question has been scrambled)
  76. What size endotracheal tube would you select to intubate an adult female?
    A. 6 mm
    B. 7 mm
    C. 8 mm
    D. 9 mm
    C. 8 mm
    (this multiple choice question has been scrambled)
  77. What is the purpose of an endotracheal tube stylet?
    A. It helps ascertain proper tube position.
    B. It minimizes mucosal trauma during insertion.
    C. It adds rigidity and shape to ease insertion.
    D. It protects the airway against aspiration.
    C. It adds rigidity and shape to ease insertion.
    (this multiple choice question has been scrambled)
  78. 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
    neck flexed, with head supported by towel and tilted back
  79. What should be the maximum time devoted to any intubation attempt?
    A. 90 seconds
    B. 60 seconds
    C. 2 minutes
    D. 30 seconds
    D. 30 seconds
    (this multiple choice question has been scrambled)
  80. Which of the following statements are FALSE about methods used to displace the epiglottis during oral intubation?
    A. Levering the laryngoscope against the teeth can aid displacement.
    B. The curved (MacIntosh) blade lifts the epiglottis indirectly.
    C. The straight (Miller) blade lifts the epiglottis directly.
    D. Regardless of the blade used, the laryngoscope is lifted up and forward.
    A. Levering the laryngoscope against the teeth can aid displacement.
    (this multiple choice question has been scrambled)
  81. 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. until its cuff has passed the cords by 2 to 3 inches
    C. until its tip has passed the cords by 2 to 3 cm
    D. just far enough so that the tube cuff is no longer visible
    A. until its cuff has passed the cords
    (this multiple choice question has been scrambled)
  82. 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.
    • 1. Stabilize it with your right hand.
    • 2. Inflate the tube cuff.
    • 3. Provide ventilation or oxygenation.
  83. Ideally, the distal tip of a properly positioned endotracheal tube (in an adult man) should be positioned about how far above the carina?
    A. 3 to 6 cm
    B. 4 to 6 inches
    C. 7 to 9 cm
    D. 1 to 3 cm
    A. 3 to 6 cm
    (this multiple choice question has been scrambled)
  84. Which of the following bedside methods can absolutely confirm proper endotracheal tube position in the trachea?
    A. tube length (cm to teeth)
    B. fiberoptic laryngoscopy
    C. observation of chest movement
    D. auscultation
    B. fiberoptic laryngoscopy
    (this multiple choice question has been scrambled)
  85. What is the average distance from the tip of a properly positioned oral endotracheal tube to the incisors of an adult man?
    A. 24 to 26 cm
    B. 21 to 23 cm
    C. 16 to 18 cm
    D. 19 to 21 cm
    B. 21 to 23 cm
    (this multiple choice question has been scrambled)
  86. 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?
    a. The bulb fails to reexpand upon release.
    b. The bulb quickly reexpands upon release. c. The bulb cannot be completely squeezed closed.
    d. The bulb cannot be attached to the endotracheal tube.
    a. The bulb fails to reexpand upon release.
  87. After an intubation attempt, an expired capnogram indicates a CO2 level near zero. What does this finding probably indicate?
    A. placement of the endotracheal tube in the trachea
    B. placement of the endotracheal tube in the esophagus
    C. failure of the cuff to properly seal the airway
    D. abnormally high ventilation/perfusion ratio ()
    B. placement of the endotracheal tube in the esophagus
    (this multiple choice question has been scrambled)
  88. 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 CO2 present even when the tube is in the trachea)?
    A. right mainstem intubation
    B. gastric CO2 diffusion
    C. cardiac arrest
    D. delivery of a high FIO2
    C. cardiac arrest
    (this multiple choice question has been scrambled)
  89. After intubation of a cardiac arrest victim, you observe a slow but steady rise in the expired CO2 levels as measured by a bedside capnometer. Which of the following best explains this observation?
    A. abnormally high
    B. failure of the cuff to properly seal the airway
    C. placement of the endotracheal tube in the esophagus
    D. return of spontaneous circulation
    D. return of spontaneous circulation
    (this multiple choice question has been scrambled)
  90. Serious complications of oral intubation include which of the following?
    1. cardiac arrest
    2. acute hypoxemia
    3. bradycardia
    4. tongue lacerations
    • 1. cardiac arrest
    • 2. acute hypoxemia
    • 3. bradycardia

    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.
  91. 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. Intubate via the nasal route.
    C. Insert an oropharyngeal airway.
    D. Perform an emergency tracheotomy.
    B. Intubate via the nasal route.
    (this multiple choice question has been scrambled)
  92. 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 minutes
    C. SVN aerosol delivery of 0.25% phenylephrine for 10 minutes
    D. mixture 0.25% phenylephrine and 3% lidocaine
    D. mixture 0.25% phenylephrine and 3% lidocaine
    (this multiple choice question has been scrambled)
  93. When performing blind nasotracheal intubation, successful tube passage through the larynx is indicated by which of the following?
    1. louder breath sounds
    2. harsh cough
    3. vocal silence
    • 2. harsh cough
    • 3. vocal silence
  94. 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
    • 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
  95. 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 before the tracheotomy is performed.
    B. Withdraw the oral tube 2 to 3 inches while the incision is made.
    C. Remove the oral tube just before tracheostomy tube insertion.
    D. Pull the oral tube only after the tracheostomy tube is placed.
    B. Withdraw the oral tube 2 to 3 inches while the incision is made.

    After dissection to the anterior tracheal wall, the endotracheal tube is retracted to keep the tip of the tube inside the larynx.
    (this multiple choice question has been scrambled)
  96. Compared with traditional surgical tracheostomy, all of the following are TRUE about percutaneous dilatational tracheostomy except:
    a. Percutaneous dilatational tracheostomy has a lower incidence of complications.
    b. Percutaneous dilatational tracheostomy is faster than traditional tracheostomy.
    c. Percutaneous dilatational tracheostomy can be performed at the bedside.
    d. Percutaneous dilatational tracheostomy does not require anterior neck dissection.
    • d. Percutaneous dilatational tracheostomy does not require anterior neck dissection.
    • 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
  97. 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
    • 1. laryngoscopy or bronchoscopy
    • 2. physical examination
    • 3. air tomography
    • 4. pulmonary function studies


    Techniques commonly used to diagnose airway damage include physical examination, air tomography, fluoroscopy, laryngoscopy, bronchoscopy, magnetic resonance imaging, and pulmonary function studies.
  98. What is the most common sign associated with the transient glottic edema or vocal cord inflammation that follows extubation?
    A. orthopnea
    B. wheezing
    C. hoarseness
    D. difficulty in swallowing
    C. hoarseness

    The primary symptoms of glottic edema and vocal cord inflammation are hoarseness and stridor.
    (this multiple choice question has been scrambled)
  99. 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 hours
    d. immediate reintubation via the nasal route
    b. STAT racemic epinephrine aerosol treatment

    Stridor is often treated with epinephrine (2.25% racemic solution or levoepinephrine 1:1000) via aerosol.
  100. 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. tracheoesophageal fistula
    B. vocal cord paralysis
    C. tracheomalacia
    D. glottic edema or cord inflammation
    B. vocal cord paralysis

    Vocal cord paralysis is likely in extubated patients with hoarseness and stridor that does not resolve with treatment or time.
    (this multiple choice question has been scrambled)
  101. Which of the following injuries are NOT seen with tracheostomy tubes?
    1. tracheomalacia
    2. tracheal stenosis
    3. glottic edema
    4. vocal cord granulomas
    • 3. glottic edema
    • 4. vocal cord granulomas

    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.
  102. 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
    • 1. cuff site
    • 2. tip of the tube
    • 3. stoma site

    In patients with tracheostomy tubes, stenosis may occur at the cuff, tube tip, or stoma sites, with the stoma site being the most common.
  103. 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
    Tracheal stenosis will appear as a fixed obstructive pattern, with flattening of both the inspiratory and expiratory limbs of the flow-volume loop (Figure 33-25).
  104. 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. underinflated tube cuff
    B. tracheoinnominate fistula
    C. tracheoesophageal fistula
    D. paralysis of the vocal cords
    C. tracheoesophageal fistula

    Diagnosis can be made by a history of recurrent aspiration and abdominal distention as air is forced into the esophagus during positive-pressure ventilation
    (this multiple choice question has been scrambled)
  105. 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 7 to 8 cm (using tube markings as a guide).
    B. Withdraw the tube by 2 to 3 cm (using tube markings as a guide).
    C. Advance the tube by 7 to 8 cm (using tube markings as a guide).
    D. Advance the tube by 2 to 3 cm (using tube markings as a guide).
    B. Withdraw the tube by 2 to 3 cm (using tube markings as a guide).
    (this multiple choice question has been scrambled)
  106. 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. 30° to 32° C
    C. 40° to 42° C
    D. 37° to 40° C
    A. 32° to 35° C
    (this multiple choice question has been scrambled)
  107. Tracheal airways increase the incidence of pulmonary infections for all of the following reasons except:

    a. lower levels of humidification
    b. increased aspiration of pharyngeal material c. contaminated equipment or solutions
    d. ineffective clearance through cough
    a. lower levels of humidification b. increased aspiration of pharyngeal material c. contaminated equipment or solutions d. ineffective clearance through cough
  108. Which of the following is likely to increase the likelihood of damage to the tracheal mucosa?

    A. using a low-residual-volume, low-compliance cuff
    B. maintaining cuff pressures below 20 to 25 mm Hg
    C. monitoring intracuff pressures every 1 to 2 hours
    D. using the minimal leak technique for inflation
    A. using a low-residual-volume, low-compliance cuff
    (this multiple choice question has been scrambled)
  109. What is the maximum recommended range for tracheal tube cuff pressures?
    A. 20 to 25 mm Hg
    B. 30 to 35 mm Hg
    C. 25 to 30 mm Hg
    D. 15 to 20 mm Hg
    A. 20 to 25 mm Hg
    (this multiple choice question has been scrambled)
  110. 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. rupture the cuff
    B. decrease cuff pressure
    C. increase cuff pressure
    D. not affect cuff pressure
    B. decrease cuff pressure
    (this multiple choice question has been scrambled)
  111. 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 H2O. What is most likely the problem?

    A. The cuff has herniated over the tube tip.
    B. The tube chosen is too small for the patient.
    C. The cuff pilot balloon and line are obstructed.
    D. The tube is in the right mainstem bronchus.
    B. The tube chosen is too small for the patient.

    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.
    (this multiple choice question has been scrambled)
  112. \Which of the following is false about cuff inflation techniques (MOV = minimal occluding volume; MLT = minimal leak technique)?
    A. With MLT, secretions tend to be blown upward during inflation.
    B. The MLT approach negates the need for pressure monitoring.
    C. At MOV, air leakage around the tube cuff should cease.
    D. The MLT allows a small leak at peak or end of inspiration.
    B. The MLT approach negates the need for pressure monitoring.

    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.
    (this multiple choice question has been scrambled)
  113. Which of the following tracheal tube cuff designs are used as alternatives to cuff pressure measurement?

    1. Kamen-Wilkinson foam cuff
    2. low-residual-volume cuff
    3. Lanz pressure-regulated cuff
    • 1. Kamen-Wilkinson foam cuff
    • 3. Lanz pressure-regulated cuff

    The Lanz tube incorporates an external pressure regulating valve and control reservoir designed to limit the cuff pressure between 16 and 18 mm Hg. The foam cuff is another alternative, which is designed to seal the trachea with atmospheric pressure in the cuff
  114. Which of the following statements is false about the potential for aspiration in patient with cuffed tracheal tubes?
    A. Aspiration is least likely in spontaneously breathing patients.
    B. Aspiration is more likely with tracheostomy tubes than with endotracheal tubes.
    C. The methylene blue test can help detect leakage-type aspiration.
    D. Periodic oropharyngeal suctioning can help to minimize aspiration.
    A. Aspiration is least likely in spontaneously breathing patients.

    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.
    (this multiple choice question has been scrambled)
  115. 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.
    • 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.

    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.
  116. 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.
    • 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.

    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
  117. After coming on a patient with 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. Try to pass a suction catheter.
    B. Immediately extubate the patient.
    C. Call for an emergency tracheotomy.
    D. Apply manual positive pressure.
    B. Immediately extubate the patient.

    If you cannot clear the obstruction by using the above techniques, you must remove the airway and replace it.
    (this multiple choice question has been scrambled)
  118. 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. Apply manual ventilation or oxygenation directly through the endotracheal tube.
    B. Suction the oropharynx with a Yankauer (tonsillar) suction tip.
    C. Push the tube back into the trachea by moving the patient’s neck up and down.
    D. Remove the tube and provide manual ventilation or oxygenation as necessary.
    D. Remove the tube and provide manual ventilation or oxygenation as necessary.
    (this multiple choice question has been scrambled)
  119. 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.
    c. The patient is at minimal risk for upper airway obstruction.

    The presence of a peritubular leak during spontaneous breathing indicates no encroachment of airway (a positive test).
  120. All of the following indicate that a patient being considered for extubation can provide adequate clearance of pulmonary secretions except:
    A. The patient has a dead space-to-tidal volume ratio of 0.7.
    B. The patient is alert and cooperative.
    C. The patient has a maximum inspiratory pressure of 73 cm H2O.
    D. The patient coughs rigorously on suctioning.
    A. The patient has a dead space-to-tidal volume ratio of 0.7.
    (this multiple choice question has been scrambled)
  121. Which of the following equipment would you gather before assisting in extubation of a patient?
    1. suctioning apparatus
    2. oxygen or aerosol therapy equipment
    3. manual resuscitator and mask
    4. nebulizer with racemic epinephrine
    5. intubation tray
    • 1. suctioning apparatus
    • 2. oxygen or aerosol therapy equipment
    • 3. manual resuscitator and mask
    • 4. nebulizer with racemic epinephrine
    • 5. intubation tray

    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.
  122. 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.
    • 1. Suction the orolaryngopharynx.
    • 2. Preoxygenate the patient.
    • 3. Suction the endotracheal tube.
    • 4. Confirm cuff inflation.

    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 minutes to help avoid these problems.

    Step 4: Deflate the Cuff. Attach the 10 or 12 mL syringe to the pilot tubing. Withdraw at 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 re-inflate the cuff and discuss with the physician how to proceed.
  123. 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. maintenance of the appropriate cuff pressure
    C. elimination of the pharyngeal (gag) reflex
    D. maximal abduction of the vocal cords
    D. maximal abduction of the vocal cords
    (this multiple choice question has been scrambled)
  124. 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. oxygen therapy through a “venti-mask” and bubble humidifier
    B. heated mist therapy through a jet nebulizer and aerosol mask
    C. cool mist therapy through a jet nebulizer and aerosol mask
    D. racemic epinephrine or saline through a small jet nebulizer
    C. cool mist therapy through a jet nebulizer and aerosol mask
    (this multiple choice question has been scrambled)
  125. 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
    • 1. color
    • 2. breath sounds
    • 3. vital signs

    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
  126. 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.
    d. Draw and analyze an arterial blood gas.
    c. Administer a racemic epinephrine treatment.

    Because laryngeal edema may worsen with time and stridor may develop, be sure that racemic epinephrine for nebulization is available.
  127. What is a rare but serious complication associated with endotracheal tube extubation?
    A. bradycardia
    B. aspiration
    C. infection
    D. laryngospasm
    D. laryngospasm
    (this multiple choice question has been scrambled)
  128. 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
    • 1. Inspect the airways.
    • 2. Retrieve foreign bodies.
    • 3. Obtain specimens for analysis.
    • 4. Aid endotracheal intubation.
  129. 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
    • 1. uncorrected bleeding disorders 
    • 3. refractory hypoxemia
    • 4. unstable hemodynamic status
  130. Complications of fiberoptic bronchoscopy include all of the following except:

    A. Hypoxemia
    B. Hypotension
    C. Hypocapnia
    D. Infection
    C. Hypocapnia
    (this multiple choice question has been scrambled)
  131. ey points to consider in planning fiberoptic bronchoscopy include which of the following?
    1. equipment preparation
    2. premedication
    3. airway preparation
    4. monitoring
    • 1. equipment preparation
    • 2. premedication
    • 3. airway preparation
    • 4. monitoring
  132. 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.
    2. Establish vascular access.
    3. Premedicate with a benzodiazepine.
    • 1. Have patient take nothing by mouth (NPO) after midnight.
    • 2. Establish vascular access.
    • 3. Premedicate with a benzodiazepine.

    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 hours 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 30-45 minutes before the procedure.
  133. .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
    • 1. to dry the patient’s airway
    • 2. to decrease vagal responses

    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.
  134. During fiberoptic bronchoscopy, a patient receiving intravenous fentanyl exhibits signs of respiratory depression. Which of the following would you recommend?
    A. Immediately administer neostigmine or prostigmine.
    B. Immediately administer naloxone (Narcan).
    C. Increase the oxygen flow rate and continue monitoring.
    D. Decrease the oxygen flow rate and continue monitoring.
    B. Immediately administer naloxone (Narcan)

    Of course, caution must be taken to avoid respiratory depression. Should it occur, naloxone (Narcan) must be available.
    (this multiple choice question has been scrambled)
  135. Equipment required for patient support and monitoring during a fiberoptic bronchoscopy procedure includes all of the following except:

    A. pulse oximeter
    B. oxygen cannula
    C. capnometer
    D. electrocardiographic monitor
    C. capnometer
    (this multiple choice question has been scrambled)
  136. 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
    • 1. to decrease cough and gagging
    • 2. to decrease pain
    • 3. to prevent bleeding
  137. Which of the following drugs can be used to prevent bleeding during fiberoptic bronchoscopy?
    1. phenylephrine
    2. dopamine HCl
    3. cocaine HCl
    1. phenylephrine

    Topical vasoconstrictors such as pseudoephedrine or dilute epinephrine (usually 1:10,000) may be used to prevent or treat bleeding.
  138. Lower airway anesthesia for fiberoptic bronchoscopy can be achieved via which of the following routes of administration?
    1. bronchoscopic instillation
    2. intravenous administration
    3. nebulization (aerosol delivery)
    • 1. bronchoscopic instillation
    • 3. nebulization (aerosol delivery)

    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.
  139. During fiberoptic bronchoscopy, a patient’s SpO2 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
    • 2. Give oxygen through the scope’s open channel.
    • 3. Increase the cannula or mask oxygen flow

    If desaturation occurs, the FIO2 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.
  140. A patient exhibits persistent mild hypoxemia after a fiberoptic bronchoscopy procedure. Which of the following would you recommend?
    A. Administer a benzodiazepine (e.g., Valium or Versed).
    B. Have the patient refrain from eating or drinking.
    C. Continue oxygen therapy and reassess in 4 hours.
    D. Administer a racemic epinephrine aerosol treatment.
    C. Continue oxygen therapy and reassess in 4 hours.
    (this multiple choice question has been scrambled)
  141. To avoid the risk of aspiration after a fiberoptic bronchoscopy procedure, what would you recommend that the patient do?
    A. remain in a sitting position and NPO until sensation returns
    B. be continuously monitored for oxygenation through pulse oximetry
    C. be placed in the supine Trendelenburg position for 2 hours
    D. receive additional aerosolized lidocaine by nebulizer
    A. remain in a sitting position and NPO until sensation returns
    (this multiple choice question has been scrambled)
  142. 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 a narcotic antagonist (e.g., Narcan)
    c. aerosol therapy with racemic epinephrine
  143. A sputum sample can be obtained by having the patient expectorate into a sterile specimen cup or by suctioning.
    a. True
    b. False
    a. True

    There are two methods to obtain sputum samples. One method is to have the patient expectorate into a sterile specimen cup. The second is to suction the patient nasotracheally or with a catheter which is in-line with the ventilator circuit.
  144. 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 H2O are needed.
    3. It does not provide absolute protection against aspiration of gastric contents.
    • 1. It should not be used in conscious or semicomatose patients.
    • 2. Gastric distention may occur if ventilating pressures greater than 20 cm H2O are needed.
    • 3. It does not provide absolute protection against aspiration of gastric contents.

    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 H2O are needed, gastric distention may occur. In addition, it may not provide absolute protection against aspiration.
  145. “Elevating the head and extending the neck” describes which of the following?

    A. A maneuver called the jaw thrust or chin lift
    B. The position for transtracheal invasive airway insertion
    C. A maneuver called the sniffing position
    D. The position for a nasopharyngeal airway insertion
    C. A maneuver called the sniffing position
    (this multiple choice question has been scrambled)
  146. . 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.
    a. It is the best position for oral intubation.
  147. 16. The airway device that has a cuff that rests against the upper esophageal sphincter when in place is a(n):
    A. Guedel airway
    B. Laryngeal mask airway (LMA)
    C. Tracheostomy tube
    D. Endotracheal tube
    B. Laryngeal mask airway (LMA)
    (this multiple choice question has been scrambled)
  148. 17. LMAs are useful in emergency situations because:
    A. Minimum head and neck movement is required.
    B. Placement does not have to be checked.
    C. They protect the lungs from aspiration.
    D. An appropriate size is easy to choose.
    A. Minimum head and neck movement is required.
    (this multiple choice question has been scrambled)
  149. The maximum laryngeal mask airway cuff pressure is ____ cm H2O.
    a. 15
    b. 30
    c. 45
    d. 60
    60
  150. Absorbance or fluorescent sensors are used with which of the following?
    A. Photoplethysmography
    B. Capnography
    C. In vivo blood gas analysis
    D. In vitro blood gas analysis

    In vivo blood gas monitors use optical sensors that are generally categorized in terms of how they modify the initial optical signal; they are classified as either absorbance or fluorescent sensors. Absorbance sensors absorb a fraction of the incident light as it is transmitted down the fiber and through the microcuvette. The amount of light transmitted is proportional to the concentration of the analyte in question. Fluorescent sensors use dyes that fluoresce when they are struck by light in the UV or near-UV visible range. Light from the monitor is transmitted to the microcuvette containing the dye. The concentration of the analyte in question can be measured by determining the ratio of fluorescent light emitted to the original excitation light signal.
    C. In vivo blood gas analysis
    (this multiple choice question has been scrambled)
  151. A fluorescent sensor can measure which range of pH values?
    A. 6.8 to 7.8
    B. 7.0 to 8.0
    C. 6.0 to 7.5
    D. 6.5 to 7.5
    A. 6.8 to 7.8
    (this multiple choice question has been scrambled)
  152. Which of the following in vivo ABG values is comparable with in vitro measurements?
    A. PO2
    B. Bicarbonate
    C. pH
    D. PCO2
    C. pH

    Compared with in vitro blood gas analysis, intra-ABG monitoring systems are comparable for pH, but the correlation may not be as good for PCO2 and PO2 measurements.
    (this multiple choice question has been scrambled)
  153. Which of the following statements are true concerning in vivo ABG analyzers?
    a . They incorporate a polarographic electrode.
    b. The operating principle is light transmission.
    c. Temperature correction is unnecessary.
    d. They are more accurate than in vitro blood gas analyzers
    b. The operating principle is light transmission.

    In vivo ABG monitors use optical sensors and fiberoptic technology for light transmission through the sensors. Polarographic electrodes are not used in vivo. In many cases, temperature corrections might be required because the sensor may be in a peripheral artery, where the measured temperature might not equal the patient’s core temperature. Correlations may not be as good for PCO2 and PO2 as they are for pH and therefore may be less accurate than in vitro blood gas analyzers.
  154. A patient with a bilirubin level of 28 mg/dL has arterial blood drawn for CO-oximetry. The respiratory therapist should expect a(n) _____ measurement

    A. Accurate O2Hb
    B. Lower-than-actual O2Hb
    C. Higher-than-actual O2Hb
    D. Higher-than-actual HbCO
    B. Lower-than-actual O2Hb

    The presence of bilirubin in quantities greater than 20 mg/dL of whole blood can alter measurements because it absorbs near-infrared (IR) and IR light. Absorbance of light by bilirubin lowers the actual O2Hb measured.
    (this multiple choice question has been scrambled)
  155. Which device allows in vitro ABG and pH measurements in a transport vehicle?
    A. CO-oximeter
    B. Pulse oximeter
    C. Plethysmograph
    D. Point-of-care analyze
    D. Point-of-care analyze

    Point-of-care analyzers provide in vitro ABG and pH measurements, and they are lightweight, portable, and usually battery powered, which makes them perfect for transport use.
    (this multiple choice question has been scrambled)
  156. The oxygenation status of a burn victim is most appropriately measured by which of the following?
    A. CO-oximeter
    B. Pulse oximeter
    C. In vitro blood gas analyzer
    D. In vivo blood gas monitor
    D. In vivo blood gas monitor

    Patients who have been in a fire have been exposed to carbon monoxide (CO) and are very likely to have elevated HbCO levels. In vitro and in vivo blood gas analyzers calculate O2Hb levels, so a CO-oximeter is appropriate because it measures the O2Hb directly and will also provide the HbCO level. High levels of HbCO can adversely affect a pulse oximeter because HbCO is relatively transparent to IR light and can lead to an overestimation of pulse oximetry oxygen saturation (SpO2).
    (this multiple choice question has been scrambled)
  157. A patient is being treated with dapsone, an antibiotic, for P. carinii infection. Which of the following ways of measuring oxygen saturation would be most appropriate for him?
    A. Pulse oximetry
    B. In vitro blood gas monitoring
    C. In vivo blood gas monitoring
    D. CO-oximetry
    D. CO-oximetry

    The use of dapsone causes an increase in metHb, which will interfere with the accuracy of a pulse oximeter. The presence of metHb will decrease the actual saturation of Hb. Therefore, direct measurement of O2Hb is most appropriate in this case. A CO-oximeter will not only measure the O2Hb, but it will also measure the metHb level.
    (this multiple choice question has been scrambled)
  158. Indications for artline?
    • •Need
    • for continuous Blood Pressure monitoring
    • •Frequent
    • blood draws ( if you expect to draw samples over several days)
  159. Complications of artline
    • •Risk
    • of infection and thrombosis are more likely with indwelling catheters than
    • punctures

    • When coolness of the extremity is observed the catheter should be removed because of
    • tissue damage requiring amputation can occur in less than 2 hours



    •Hemorrhage

    •Severe vascular occlusion

    •Clot

    •Gangrene

    • •Infection ( to reduce infection risk it
    • should be removed within 4 days)

    •Loss of limb
  160. Most common sites for ART line?
    • •Most
    • Commonly used sites for Arterial lines are the radial and brachial

    • •Other
    • indwelling catheters are a

      CVP line –(central venous pressure line)

      in the venacava ( venous blood)

      PAP line- pulmonary artery pressure line

    •    ( mixed
    • venous blood)
  161. What is Dicrotic Notch-
    closure of aortic valve. And the beginning of diastole
  162. Damped Pressure Tracings caused by what
    Caused by

    •Occlusion of the catheter by a clot

    • •Catheter tip resting against the wall of
    • the vessel

    •Clot in transducer or stopcock

    •Air bubbles in the line
  163. Abnormally high or low readings caused by what
    •Improper calibration

    • •Improper transducer position (should be
    • level with the patients heart). If the transducer is higher than the heart the
    • pressure reading will read lower than actual. If the transducer is lower than
    • the heart the pressure reading will read higher than the actual.
  164. No pressure reading caused by what
    •Improper scale size

    •Transducer is not open to the catheter

    • “This happens when you are drawing a
    • sample and have turned the “stopcock
  165. How fast does heparin flow?
    2-4 ml/ hour of heparinized fluid.
  166. How much do you aspirate from art line?
    at least 5, or 5-6 times tube length
  167. What should assess daily in art line?
    • Catheter site for evidence of inflammation
    • Distal extremity for evidence of ischemia
  168. When should you remove catheter?
    • Distal ischemia
    • Local infection
    • Persistently damped pressure tracing
    • Difficulty with blood withdrawal
  169. Flush solution?
    • 2,500 units/500 cc NS
    • 1,000 units/ 500 cc NS
  170. How much pressure in bag?
    • Enough pressure to prevent blood flow back into the system (higher than blood pressure)
    • Red = bad
    • Green good
  171. While taking ABG and you change FIO2, how long should you wait?
    • If a change has been made in Fio2 or ventilation, you must wait
    • 20- 30 minutes to “draw” the sample
  172. If you are using ABG to measure electrolytes, what should you use?
    Lithium heparin
  173. Three types of Quality Control used in Analyzers
    • •Analysis
    • of test standard samples

    • •Proficiency
    • Testing

    • •Interinstrumental
    • comparisons
  174. Analysis of test standard samples
    • Is done using pre-prepared “control media”
    • Acidotic (ph, pco2,po2)
    • Normal ( ph, pco2, po2)
    • Alkalotic ( ph, pco2, po2)



    • Each
    • level is run at least one time per day. All three must be analyzed every 24
    • hours.

    • The
    • analyzer is then calibrated to these values

    • After 20- 30 consecutive values. The information is plotted on a Levy Jennings
    • Control Sheet.
  175. Auto calibration
    • The ABG machine calibrates itself using calibrating gases.
    • PCO2 5% (low)
    •           10% (high)
    • PO2 0% (low)
    • 12 % or 20% (high)

    Readouts are in mm Hg
  176. •AARC
    and CLIA recommend tonometry as the best standard reference for PO2 and Paco2
    measurements.
    • •The
    • tonometry method requires fresh blood (<24 hours) from a asymptomatic donor.
    • Gas mixtures are verified in this reference sample with a mass spectrometer
    • prior to analysis in the ABG analyzer.
  177. Levy-Jennings Chart
    Uses a + or- 2 standard deviation. Gives a “visual” of the calibration data
  178. Analytical errors
    • Are situations in which the control
    • measurements fall outside the statistical limits. ( falls outside the mean
    • standard deviation of + or – 2)
  179. Calibration involves
    • •1.  Offset
    • (balancing or zeroing the analyzer)
    • •2.  Gain
    • or slope
  180. One point calibration
    You can only adjust the gain (slope
  181. Calibration can be a one- point or a two- point calibration
  182. Proficiency Testing (external quality control)
    • •Required
    • by the Clinical Laboratory Amendments of 1988 (CLIA’88)

    • •Performed
    • a minimum of 3 times a year.

    • •Specimens
    • of unknown values from a external source are analyzed. The results are sent
    • back to the source and reports are then sent back to the lab. Reports are then
    • reviewed by Lab Supervisor and Medical Director.
  183. Instrumental Comparison
    • •The
    • ABG lab will send reports to the  machine
    • manufacture once a month.

    • •This
    • is used to compare your brand and model of ABG machine with the same brand and
    • model.
  184. Things that effect CO2 Elimination
    • Circulation
    • Diffusion
    • Ventilation
  185. Decrease EtCo2
    Increase PaC02
    Waveform :(
    Widened gradient
    • Hypoventilation/Airway obstruction
    • Leakage in system
  186. Decreased EtC02
    Decreased PaCO2
    Waveform :)
    Gradient normal
    • Hypothermia
    • Hyperventilation
    • Increased depth of anesthesia
  187. Decreased EtC02
    Decreased PaCO2
    Waveform :)
    Gradient Widened
    Cardiac arrest
  188. Decreased EtC02
    Decreased PaCO2
    Waveform Possible cleft
    Gradient normal
    Use of muscle relaxants
  189. Increased EtC02
    Decreased PaCO2
    Waveform :)
    Gradient Reversed
    Exercise, prolonged I time, increased tidal volume, with a very healthy, compliant lungs
  190. increased EtC02
    increased PaCO2
    Waveform :)
    Gradient normal
    • Hypotherpia sepsis pain shiver convulsions
    • Mild hypoventilation
    • Release of tourniquet, increased CO2 to the lungs
    • Injection of sodium bicarb
  191. increased EtC02
    increased PaCO2
    Waveform :(
    Gradient normal
    • airway obstruction, elevated baseline, rebreathing
    • elevated baseline, increased apparatus dead space, malfunctioning exhalation valve
  192. decreased EtC02
    increased PaCO2
    Waveform :)
    Gradient Widened
    • Increased physiologic dead space, peep high rate and low tidal volume ventilation
    • Decreased CO2 to the lungs, pulmonary embolism, right to left s hunt, decreased blood volume
  193. decreased EtC02
    increased PaCO2
    Waveform absent
    Gradient Widened
    • apnea
    • ventilatory disconnent
    • esophageal intubation

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