CRT Review

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CRT Review
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  1. Which of the following specialized imaging tests would be most useful in diagnosing a pulmonary emboli?
    a. Chest X-ray
    b. Pulmonary function test (PFT)
    c. Ventilation-perfusion scan (V/Q scan)
    d. Arterial blood gas
    Ventilation-perfusion scan (V/Q scan)

    A chest X-ray and an ABG might be useful in detecting an abnormality, but not specifically a pulmonary emboli.  Pulmonary function tests (PFTs) may reveal abnormal flow and volumes/capacities but not perfusion problems inherent in a pulmonary emboli.  A ventilation-perfusion scan would show a lack of blood flow due to emboli (a clot) in the blood pulmonary circulation.  Ventilation to lung regions would be shown as well.
  2. While examining a patient in the ICU, you note that he appears somewhat edematous, and the nurse has indicated that the patient's urine output is "minimal".  In what section of the medical record would you check to determine the patient's fluid balance (intake vs output)?
    a. Physician orders
    b. Consent
    c. Lab results
    d. Nurses' notes and flow sheet
    Nurses' notes and flow sheet

    A patient's fluid balance is the relationship between fluid intake and outputs primarily from urination.  It is normally noted in the nurses' notes and flow sheet section of the medical record.  The normal fluid intake and output for adults is 1-2 L/day. or 25-50 mL/hour.  A positive fluid balance results from excessive intake and/or decreased output and may contribute to pulmonary or peripheral edema and hypertension.  A negative fluid balance is generally due to insufficient hydration and/or excessive urination from medications such as diuretics or theophylline and may lead to hypotension and low cardiac output.
  3. Which of the following physical findings would you expect to see in an alert but anxious asthmatic who has just been admitted to the emergency department?
    a. Respiratory acidosis
    b. Respiratory alkalosis
    c. Clubbing
    d. Cor pulmonale
    Respiratory alkalosis

    Asthmatics typically prsent with respiratory alkalosis.  Shortness of breath and accompanying hypoxemia cause the patient to increase his rate of breathing and alkalosis occurs.  It is important to note here that once hypoxemia is relieved by the administration of supplemental oxygen, patient's PaCO2 and pH will normalize.
  4. In the lab results sectino of a patient's medical record, the overall WBC count is shown as 22,000 for a febrile patient who appears acutely ill and in moderate respiratory distress.  Which of the following is this patient's most likely diagnosis?
    a. Bacterial pneumonia
    b. Emphysema
    c. Pulmonary embolus
    d. Pulmonary fibrosis
    Bacterial pneumonia

    The elecated WBCs suggest a bacterial infection.  The respiratory distress further points to a respiratory infection such as bacterial pneumonia.  In addition, the other choices are not infectious processes, and therefore you would not likely see elevated WBCs.
  5. A PET scan would be most useful in the diagnosis of which of the following conditions?
    a. Bronchogenic carcinoma
    b. Chronic bronchitis
    c. Pulmonary fibrosis
    d. Smoke inhalation
    Bronchogenic carcinoma

    A PET scan is a nuclear imaging technique used in the diagnosis/staging/management of tumors and cancer.  The answer choice bronchogenic carcinoma describes lung cancer.
  6. Negative inspiratory force (NIF) is useful in the determination of which of the following?
    a. Airway resistance
    b. Functional residual capacity
    c. Respiratory muscle strength
    d. Sustained maximal inspiration
    Respiratory muscle strength.

    Negative inspiratory force (NIF) or maximal inspiratory pressure (MIP) is used for the bedside assessment of respiratory muscle strength.  You probably know that it is a measurement of pressure only.  Since airway resistance is a measurement of pressure divided by flow, and since functional residual capacity and sustained maximal inspiration are measurements of volume, the process of elimination leaves muscle strength as the only correct answer.
  7. Assessment of a 28-year old trauma patient reveals diminished breath sounds, asymmetrical chest expansion, severe chest pain, and an SPO2 of 90%, despite receiving oxygen via cannula at 5 L/min.  These findings are most consistent with what diagnosis?
    a. Complete airway obstruction
    b. Pneumothorax
    c. Viral pneumonia
    D. Pleural effusion
    Pneumothorax

    Both viral pneumonia and pleural effusion can be ruled out as correct answers as they are not related to trauma.  Breath sounds, though diminished, can be heard, and chest expansion, though asymmetrical, is present;  both of these are not consistent with a complete airway obstruction.  The physical assessment is consistent with the corret answer, pneumothorax.
  8. A 23 year-old firefighter is admitted with suspected smoke inhalation.  You place him on a nonrebreathing mask.  What is the most appropriate method of monitoring his oxygenation?
    a. Arterial blood gas analysis
    b. CO-oximetry
    c. Pulse oximetry
    d. Calculation of P(A-a)02
    CO-oximetry

    In the case of smoke inhalation, carbon monoxide binds to the hemoglobin in place of oxygen.  Neither ABGs, pulse oximetry, or calculation of A-a gradient will indicate how much oxygen is bound to hemoglobin.  Any victim of suspected smoke inhalation must be monitored with CO-oximetry.
  9. The ratio of lecithin to sphingomyelin, or L/S ratio, is a test to determine fetal lung maturity.  Such a test may be done in the later stages of pregnancy. and the values will initially be noted in the lab results section of the mother's medical record.  Approximately what ratio is associated with the onset of mature surfactant production?
    a. 2:1
    b. 20:1
    c. 1:2
    d. 1:20
    2:1

    The lecithin to sphingomyelin ratio, or L/S ratio, is used to determine fetal lung maturity.  Generally, this ratio reaches 2:1 (twice as much lethicin as sphingomyelin) near week 35 of gestation, which corresponds to the onset of mature surfactant production.  The L/S ratio will generally be noted in the lab results section of hte mother's medical record.
  10. Sputum culture and sensitivity would be indicated in the evaluation of which of the following clinical conditions?
    a. Pulmonary edema
    b. Bacterial pneumonia
    c. Bronchiectasis
    d. Empyema
    Bacterial pneumonia

    Sputum culture and sensitivity are used to identify microorganisms and their most appropriate drug therapy.  Bacterial pneumonia is the obvious infectious process in the choice of answers.
  11. What is in the Admitting sheet/face sheet?
    Patient's next-of-kin, address, religion, and employer; health insurance information
  12. What is in the patient history?
    Past and present medical history; family, social, and medical history, including at-home medications as well as demographics.
  13. What is in the progress notes?
    Discipline-specific notes on a patient's progress and treatment plan, generally entered at frequent (daily) intervals by physicians and allied health professionals such as respiratory therapists, dieticians, and social workers.
  14. What is in the physicians' orders?
    Doctors' diagnostic and therapeutic orders, including those pertaining to respiratory care.  All incomplete or unclear orders should be clarified with the prescribing physician.
  15. What is in the informed consent?
    Consent forms signed by the patient (and witness) for various diagnostic and therapeutic procedures, including those for bronchoscopy and surgery.
  16. What is in the DNR/advanced directives?
    Properly signed and witnessed do-not-resuscitate (DNR), do-not-intubate (DNI), and/or advanced directives.
  17. What is in the lab results?
    CBC counts (including WBCs) ABGs,electrolytes, coagulation studies (PT and INR) and cultures (sputum, blood, and urine).
  18. What is in the Imaging studies (radiology and nuclear medicine)
    X-rays (including chest x-rays) and CT, MRI, angiography, PET, and V/Q scans.
  19. What is in the therapy/respiratory therapy?
    Respiratory therapy charting; results of PFTs and sleepy study results; as an alternative to being in lab results section, ABGs may also be in this section.  Documentation related to other disciplines, such as physical and occupational therapy, may be included.
  20. What is in the ECGs and ultrasound studies?
    The results of electrocardiograms (ECG/EKGs), echocardiograms, and general ultrasound studies.
  21. What is in the Nurses' notes and flow sheet?
    Nurses' subjective and objective record of the patient's condition, including vital sign trending and fluid intake/outut (I&O) and hemodynamic monitoring such as CVP, PAP, and PCWP.
  22. An otherwise healthy 25-year-old male patient who took an overdose of sedatives is being supported on a ventilator.  Which of the following measures of total static compliance (lungs + thorax) would you expect in this patient?
    a. 100 mL/cm H20
    b. 10 mL/cm H20
    c. 1 mL/cm H20
    d. 0.1 mL/cm H20
    100 mL/cm H20

    To evaluate and monitor a patient, you need to know what is normal and what is abnormal.  This item tests your ability to recall normal static compliance.  It also separately assesses your ability to differentiate the common bedsite units used for this measure (mL/cm H20) from that typically employed in a pulmonary lab (L/cm H20)
  23. An adult patient receiving volume-oriented assist/control ventilation has a corrected tidal of 700 mL, a peak pressure of 50 cm H20 and a plateau pressure of 40 cm H20 and is receiving 5 cm H20 positive end-expiratory pressure (PEEP).  What is this patient's static compliance?
    a. 200 mL/cm H20
    b. 20 mL/ cm H20
    c. 2 mL/ cm H20
    d. 0.2 mL/ cm H20
    This item tests your ability to apply a formula to a clinical situation (most formula-type questions are at the application level).  To answer it correctly, you need to "plug" the correct data into the formula for computing static compliance -- i.e . C (ml)/cmH20) = delivered volume divided by (plateau pressure - peep).
  24. A patient in the intensive care unit with congestive heart failure receiving assist/control ventilation with a set volume of 650 mL exhibits the following data on three consecutive patient-ventilator checks.

    1:
    Time - 9:00 AM
    Peak pressure - 40
    Plateau pressure - 25
    Peep - 8

    2:
    Time - 10:00 AM
    Peak Pressure - 50
    Plateau Pressure - 35
    Peep - 8

    3:
    Time - 11:00 AM
    Peak Pressure - 60
    Plateau Pressure 45
    Peep - 8

    The patient also exhibits diffuse crackles at the bases and some wheezing.  Which of the following would you recommend for this patient?
    a. A diuretic
    b. A bronchodilator
    c. A mucolytic
    d. A steroid
    A diuretic

    This item assesses your ability to analyze monitoring data and apply this information to recommend a treatment approach for this patient.  First, you must analyze the data,m which should reveal that the patient is suffering form a progressive decrease in compliance (rising plateau - PEEP pressure difference).  Second, you need to recognize that in patients with congestive heart failure, the most common cause for a progressive decrease in compliance is the development of pulmonary edema.  Last, you need to apply these data and your knowledge of pathophysiology and pharmacology to recommend the correct course of action, in this case the administration of a diuretic like Lasix.
  25. Which of the following is true regarding patients in the early stages of an asthmatic attack?
    a. They all exhibit respiratory alkalosis
    b. They always have moderate hypoxemia
    c. They have decreased expiratory flows
    d. They never respond to beta adrenergics.
    They have decreased expiratory flows.

    In this hypothetical example, optionas A, B, and D all contain specific determiners or absolutes.  More often than not, options that use absolutes are false.  Generaly, you should avoid choosin any option that must be true or false every time.  In every case or without exception.  In this case, applyhing this strategy helps you easily zero in on the correct answer, the only one not containing an absolute.
  26. A patient's advanced directive:
    a.  Is usually obtained at the time of admission.
    b. Can be found in the doctor's progress notes.
    c. Represents a guideline, not a legal requirement.
    d. Cannot be altered after it is written and signed.
    Is usually obtained at the time of admission.

    Options that contain qualifiers usually represent good choices.  In this example, only option A contains a qualifier and is in fact the correct option.  As with absolutes, note that the NBRC minimizes the use of qualifiers in its exam questions, especially in question options.  Nonetheless, you need to be on the lookout for these key words and apply the appropriate strategy when needed.
  27. An intubated patient is receiving volume control ventilation.  The patient's condition has not changed, but you observe higher peak inspiratory pressures than before.   Which of the following in the most likely cause of this problem?
    a. There is a leak in the patient-ventilator system.
    b. The endotracheal tube cuff is deflated or burst.
    c. The endotracheal tube is partially obstructed.
    d. The endotracheal tube is displaced into the pharynx.
    Note that options A and B are equivalent because a deflated or burst endotracheal (ET) tube cuff represents a leak in the patient-ventilator system.  Usually when two items are very similar or equivalent to each other, they are distractors and should be eliminated from consideration.  Then make your choice from among the remaining two options (in this case option C is the correct choice).  By doing so, you immediately improve your odds of correctly answering this question from 25% to 50%.  As noted previously, this is exactly what test-wise candidates do.
  28. Over a 3-hour period, you note that a patient's plateau pressure has remained stable, but her peak pressure has been steadily increasing.  Which of the following is the best explanation for this observation?
    a. The patient's airway resistance has increased.
    b. The patient is developing atelectasis
    c. The patient's compliance has decreased.
    d. The patient is developing pulmonary edema.
    In this example, options B, C, and D, are similar in that they all correspond to a decrease in the patient's compliance.  When this occurs, turn your attention to the different or "Odd Man Out" option which is most likely the correct one (option A in this example.)
  29. You are assisting with the oral intubation of an adult patient.  After the ET tube has been placed, you note that breath sounds are decreased on the left compared with the right lung.  What is the most likely cause of this?
    a. The tip of the tube is in the right mainstem bronchus
    b. The cuff of the endotracheal tube has been overinflated
    c. The endotracheal tube has been inserted into the esophagus
    d. The tip of the tube is in the left mainstem bronchus.
    The tip of the tube is in the right mainstem bronchus

    In general, when you encounter two options that are opposites, chances are the correct choice is one of the two.  In this example, options A and D are literally mirror images of each other , and one of them is likely the correct answer.  Referral back to the scenario (breath soudns decreased on the left compared to the right) should help you decide which of these two responses is correct (A).
  30. A patient receiving long-term positive-pressure ventilatory support exhibits a progressive weight gain an da reduction in the hematocrit.  Which of the following is the most likely cause of this problem?
    a. Leukocytosis
    b. Chronic hypoxemia
    c. Water retention
    D. Leukocytopenia
    Water retention

    In this example, leukocytosis and leukocytpoenia are polar opposites.  Is one of them the correct choice, or are they both distractors?  To makethis decision often requires referring back to the scenario or stem (which are combined in this question).  Logically, both leukocytosis and leukocytopenia are more often the result of abnormal processes (such as infection) and less often the cause (a key word in the stem).  So here these two options are more likely both being used as distractors and should be eliminated.  Now, by selecting form the two remaining options, your odds of correctly answering this question have improved to 50-50.  If you also remember that chronic hypoxemia tends to increase and not decrease the hematocrit, you can now be almost certain of selecting the correct option (C).
  31. 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.III and IV
    B.I and II
    C.I and IV
    D.II and III
    D.II and III

    Specimens for arterial blood gas (ABG) analysis can be drawn from a peripheral artery by means of a percutaneous needle puncture or from an indwelling intravascular cannula. Blood is most often drawn from the radial, brachial, or femoral arteries or the dorsalis pedis artery of the foot.
    (this multiple choice question has been scrambled)
  32. What is the primary indication for tracheal suctioning?
    A.ineffective coughing
    B.presence of atelectasis
    C.retention of secretions
    D.presence of pneumonia
    C.retention of secretions

    Excerpts from the AARC guideline (CPG 33-1), includes indications, contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring
    (this multiple choice question has been scrambled)
  33. What is the most common complication of suctioning?
    A.hypoxemia
    B.infection
    C.arrhythmias
    D.hypotension
    A.hypoxemia

    Excerpts from the AARC guideline (CPG 33-1), includes indications, contraindications, hazards and complications, assessmentof need, assessment of outcome, and monitoring
    (this multiple choice question has been scrambled)
  34. Complications of tracheal suctioning include all of the following except:
    A.elevated intracranial pressure
    B.mucosal trauma
    C.bronchospasm
    D.hyperinflation
    D.hyperinflation
    (this multiple choice question has been scrambled)
  35. How often should patients be suctioned?
    A.when physical findings support the need
    B.whenever they are moved or ambulated
    C.at least once every 2 to 3 hours
    D.whenever the charge nurse requests it
    A.when physical findings support the need

    A patient should never be suctioned according to a preset schedule.
    (this multiple choice question has been scrambled)
  36. What is the normal range of negative pressure to use when suctioning an adult patient?
    A.–80 to –100 mm Hg
    B.–20 to –30 mm Hg
    C.–100 to –120 mm Hg
    D.–60 to –80 mm Hg
    C.–100 to –120 mm Hg

    For adults, a pressure of –100 to –120 mm Hg is usually adequate
    (this multiple choice question has been scrambled)
  37. What is the normal range of negative pressure to use when suctioning children?
    a.–60 to –80 mm Hg
    b.–80 to –100 mm Hg
    c.–100 to –120 mm Hg
    d.–150 to –200 mm Hg
    For children, limit the suction pressure to –80 to –100 mm Hg
  38. You are about to suction a 10-year-old patient who has a 6-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter that you would use in this case?
    A.6 Fr
    B.8 Fr
    C.10 Fr
    D.14 Fr
    D.14 Fr

    See Rule of Thumb 33-1
    (this multiple choice question has been scrambled)
  39. You are about to suction a female patient who has an 8-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter you would use in this case?
    A.10 Fr
    B.14 Fr
    C.8 Fr
    D.12 Fr
    B.14 Fr

    See Rule of Thumb 33-1
    (this multiple choice question has been scrambled)
  40. To prevent hypoxemia when suctioning a patient, the respiratory care practitioner should initially do which of the following?
    A.Preoxygenate the patient with 100% oxygen.
    B.Give the patient a bronchodilator treatment.
    C.Manually ventilate the patient with a resuscitator.
    D.Have the patient hyperventilate for 2 minutes.
    A.Preoxygenate the patient with 100% oxygen.

    First, preoxygenation helps minimize the incidence of hypoxemia during suctioning
    (this multiple choice question has been scrambled)
  41. To maintain positive end-expiratory pressure (PEEP) and high FIO2 when suctioning a mechanically ventilated patient, what would you recommend?
    A.Limit suction time to no more than 5 seconds.
    B.Use a closed-system multiuse suction catheter.
    C.Limit suctioning to once an hour.
    D.Use the smallest possible catheter.
    B.Use a closed-system multiuse suction catheter.

    Basic indications for the use of closed suction catheters can be found in Box 33-2.
    (this multiple choice question has been scrambled)
  42. Total application time for endotracheal suction in adults should not exceed which of the following?
    A.15 to 20 seconds
    B.10 to 15 seconds
    C.3 to 5 seconds
    D.20 to 25 seconds
    B.10 to 15 seconds

    Keep total suction time to less than 10 to 15 seconds.
    (this multiple choice question has been scrambled)
  43. While suctioning a patient, you observe an abrupt change in the electrocardiogram wave form being displayed on the cardiac monitor. Which of the following actions would be most appropriate?
    A.Stop suctioning and report your findings to the nurse.
    B.Decrease the amount of negative pressure being used.
    C.Stop suctioning and immediately administer oxygen.
    D.Change to a smaller catheter and repeat the procedure.
    C.Stop suctioning and immediately administer oxygen.

    If any major change is seen in the heart rate or rhythm, immediately stop suctioning and administer oxygen to the patient, providing manual ventilation as needed
    (this multiple choice question has been scrambled)
  44. Which of the following methods can help to reduce thelikelihood of atelectasis due to tracheal suctioning?
    1.Limit the amount of negative pressure used.
    2.Hyperinflate the patient before and after the procedure.
    3.Suction for as short a period of time as possible.
    A.1 and 3
    B.1, 2, and 3
    C.1 and 2
    D.2 and 3
    B.1, 2, and 3

    ANS:D

    Atelectasis can be caused by removal of too much air from the lungs. You can avoid this complication by (1) limiting the amount of negative pressure used, (2) keeping the duration of suctioning as short as possible, and (3) providing hyperinflation before and after the procedure.
    (this multiple choice question has been scrambled)
  45. Which of the following can help to minimize the likelihood of mucosal trauma during suctioning?
    1.Use as large a catheter as possible.
    2.Rotate the catheter while withdrawing.
    3.Use as rigid a catheter as possible.
    4.Limit the amount of negative pressure.
    A.1, 2, and 4
    B.2 and 4
    C.1 and 2
    D.3 and 4
    B.2 and 4

    ANS:B
    To avoid this problem, limit the amount of negative pressure used and always rotate the catheter while withdrawing
    (this multiple choice question has been scrambled)
  46. Absolute contraindication for nasotracheal suctioning includes which of the following?
    1.epiglottitis
    2.croup
    3.irritable airway
    a.1 and 2
    b.1 and 3
    c.2 and 3
    d.1, 2, and 3
    • ANS:A
    • Excerpts from the AARC guideline (CPG 33-2), includes indications, contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring.
  47. Which of the following equipment is NOT needed to perform nasotracheal suctioning?
    a.suction kit (catheter, gloves, basin, etc.)
    b.laryngoscope with MacIntosh and Miller blades
    c.oxygen delivery system (mask and manual resuscitator)
    d.bottle of sterile water or saline solution
    • ANS:B
    • See Box 33-1
  48. After repeated nasotracheal suctioning over 2 days, a patient with retained secretions develops minor bleeding through the nose. Which of the following actions would you recommend?
    a.Perform a tracheotomy for better access to the lower airway.
    b.Discontinue nasotracheal suctioning for 48 hours and reassess.
    c.Stop the bleeding and use a nasopharyngeal airway for access.
    d.Orally intubate the patient for better access to the lower airway.
    • ANS:C
    • Placement of a nasopharyngeal airway can help minimize nasal trauma when repeated access is needed.
  49. Before the suctioning of a patient, auscultation reveals coarse breath sounds during both inspiration and expiration. After suctioning, the coarseness disappears, but expiratory wheezing is heard over both lung fields. What is most likely the problem?
    a.Secretions are still present and the patient should be suctioned again.
    b.The patient has hyperactive airways and has developed bronchospasm.
    c.A pneumothorax has developed and the patient needs a chest tube.
    d.The patient has developed a mucous plug and should undergo bronchoscopy
    • ANS:B
    • The bronchospastic response may be particularly strong in patients with hyperactive airway disease. These patients should be assessed for the development of wheezes associated with suctioning
  50. What general condition requires airway management?
    1.airway compromise
    2.respiratory failure
    3.need to protect the airway
    a.1 and 2
    b.1 and 3
    c.2 and 3
    d.1, 2, and 3
    ANS:D

    Excerpts from the AARC guideline (CPG 33-3), includes indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring.
  51. Which of the following conditions require emergency tracheal intubation?
    1.upper airway or laryngeal edema
    2.loss of protective reflexes
    3.cardiopulmonary arrest
    4.traumatic upper airway obstruction
    A.1 and 4
    B.1, 2, and 3
    C.3 and 4
    D.1, 2, 3, and 4
    D.1, 2, 3, and 4

    ANS:D
    Excerpts from the AARC guideline (CPG 33-3), includes indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring.
    (this multiple choice question has been scrambled)
  52. Which of the following autonomic or protective neural responses represent potential hazards of emergency airway management?
    1.hypotension
    2.bradycardia
    3.cardiac arrhythmias
    4.laryngospasm
    A.1 and 4
    B.3 and 4
    C.1, 2, and 3
    D.1, 2, 3, and 4
    D.1, 2, 3, and 4

    Excerpts from the AARC guideline (CPG 33-3), includes indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome; and monitoring.
    (this multiple choice question has been scrambled)
  53. All of the followingindicate an inability to adequately protect the airway except:
    a.wheezing
    b.coma
    c.lack of gag reflex
    d.inability to cough
    • ANS:A
    • Excerpts from the AARC guideline (CPG 33-3), includes indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring.
  54. Which of the following types of artificial airways are inserted through the larynx?
    1. pharyngeal airwasy
    2. tracheostomy tubes
    3. nasotracheal tubes
    4. orotracheal tubes

    a. 1 and 4
    b. 1, 2 and 3
    c. 3 and 4
    d. 1, 2, 3, and 4
    ANS:C

    The two basic types of tracheal airways are endotracheal (translaryngeal) tubes and tracheostomy tubes. Endotracheal tubes are inserted through either the mouth or nose (orotracheal or nasotracheal), through the larynx, and into the trachea.
  55. 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
    • ANS:B
    • A summary of the advantages and disadvantages of each of these three approaches appears in Table 33-1
  56. Compared with the oral route, the advantages of nasal intubation include all of the following except:
    a.reduced risk of kinking
    b.less retching and gagging
    c.less accidental extubation
    d.greater long-term comfort
    • ANS:A
    • A summary of the advantages and disadvantages of each of these three approaches appears in Table 33-1
  57. Compared with translaryngeal intubation, the advantages of tracheostomy include all of the following except:
    a.greater patient comfort
    b.reduced risk of bronchial intubation
    c.no upper airway complications
    d.decreased frequency of aspiration
    • ANS:D
    • A summary of the advantages and disadvantages of each of these three approaches appears in Table 33-1.
  58. What is the standard size for endotracheal or tracheostomy tube adapters?
    a.22 mm external diameter
    b.15 mm external diameter
    c.15 mm internal diameter
    d.22 mm internal diameter
    • ANS:B
    • The proximal end of the tube is attached to a standard adapter with a 15-mm external diameter.
  59. 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
    • ANS:D
    • In addition to the beveled opening at the tip, there should be an additional side port or “Murphy eye,” which ensures gas flow if the main port should become obstructed.The tube cuff is permanently bonded to the tube body. Inflation of the cuff seals off the lower airway, either for protection from aspiration or to provide positive pressure ventilation.
  60. 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
    ANS:A
  61. What is the purpose of the pilot balloon on an endotracheal or a tracheostomy tube?
    a.to help ascertain proper tube position
    b.to minimize mucosal trauma during insertion
    c.to monitor cuff status and pressure
    d.to protect the airway against aspiration
    • ANS:C
    • A small filling-tube leads from the cuff to a pilot balloon, used to monitor cuff status and pressure once the tube is in place.
  62. Which of the following features incorporated into most modern endotracheal tubes assist in verifying proper tube placement?
    1.length markings on the curved body of the tube
    2.imbedded radiopaque indicator near the tube tip
    3.additional side port (Murphy eye) near the tube tip
    a.1 and 2
    b.1 and 3
    c.2 and 3
    d.1, 2, and 3
    • ANS:A
    • Not shown, but included with most modern endotracheal tubes, is a radiopaque indicator that is embedded in the distal end of the tube body. This indicator allows for easy identification of tube position on radiograph.
  63. The removable inner cannula commonly incorporated into modern tracheostomy tubes serves which of the following purposes?
    1.aid in routine tube cleaning and tracheostomy care
    2.prevent the tube from slipping into the trachea
    3.provide a patent airway should it become obstructed
    a.1 and 3
    b.2 and 3
    c.3
    d.1, 2, and 3
    • ANS:A
    • A removable inner cannula with a standard 15-mm adapter is normally kept in place within the outer cannula but can be removed for routine cleaning or if it becomes obstructed
  64. What is the purpose of a tracheostomy tube obturator?
    a.to minimize trauma to the tracheal mucosal during insertion
    b.to provide a patent airway should the tube become obstructed
    c.to help ascertain the proper tube position by radiograph
    d.to provide a means to inflate and deflate the tube cuff
    • ANS:A
    • An obturator with a rounded tip is used for tube insertion. Prior to insertion, the obturator is placed within the outer cannula, with its tip extending just beyond the far end of the tube. This minimizes mucosal trauma during insertion.
  65. In the absence of neck or facial injuries, what is the procedure of choice to establish a patent tracheal airway in an emergency?
    a.surgical tracheotomy
    b.orotracheal intubation
    c.nasotracheal intubation
    d.cricothyrotomy
    • ANS:B
    • Orotracheal intubation is the preferred route for establishing an emergency tracheal airway
  66. 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
    a. 1, 2, and 3
    b. 2 and 4
    c. 2, 3, and 4
    d. 1, 2, 3, and 4
    • ANS:C
    • Box 33-3 lists the equipment necessary for intubation.
  67. 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
    a.1, 2, and 3
    b.2 and 4
    c.3 and 4
    d.1, 3, and 4
    • ANS:A
    • 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
  68. 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.Swap the defective MacIntosh for the good Miller blade.
    b.Check and replace the bulb in the MacIntosh blade.
    c.Replace the batteries in the laryngoscope handle.
    d.Check and clean the laryngoscope handle electrical contact
    • ANS:B
    • If the light does not function, first check that the bulb is tight. If the scope still does not light, check the batteries or replace the bulb
  69. What size endotracheal tube would you select to intubate a 3-year-old child?
    a.3.0 to 4.0 mm
    b.4.5 to 5.0 mm
    c.5.5 to 6.0 mm
    d.6.0 to 7.0 mm
    • ANS:B
    • Table 33-4 lists recommended orotracheal tube sizes according to patient weight or age.
  70. What size endotracheal tube would you select to intubate a 1500-g newborn infant?
    a.2.5 mm
    b.3.0 mm
    c.3.5 mm
    d.4.0 mm
    • ANS:B
    • Table 33-4 lists recommended orotracheal tube sizes according to patient weight or age
  71. What size endotracheal tube would you select to intubate an adult female?
    a.6 mm
    b.7 mm
    c.8 mm
    d.9 mm
    • ANS:C
    • Table 33-4 lists recommended orotracheal tube sizes according to patient weight or age
  72. What is the purpose of an endotracheal tube stylet?
    a.It helps ascertain proper tube position.
    b.It adds rigidity and shape to ease insertion.
    c.It minimizes mucosal trauma during insertion.
    d.It protects the airway against aspiration
    • ANS:B
    • Some clinicians insert a stylet into the tube to add rigidity and maintain shape during insertion
  73. To make oral intubation easier, how should the patient’s head and neck be positioned?
    a.neck extended over the edge ofthe 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
    ANS:D

    You achieve this alignment by combining moderate cervical flexion with extension of the atlanto-occipital joint. Placement of one or more rolled towels under the patient’s head helps. You then flex the neck and tilt the head backward with your hand (Figure33-14)

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