Basic Test 3
When analyzing an ABG sample from a patient with acute respiratory distress syndrome and refractory hypoxemia, you notice a PaO2 of 141 mm Hg and a PaCO2 of 14 mm Hg. What errors should you suspect?
Exposure of the blood sample to the air
What is the maximum depth that the standard adult bronchoscope can visualize in some patients?
Fifth-level bronchi
Complications of fiberoptic bronchoscopy include all of the following EXCEPT:
Hypocapnia
During fiberoptic bronchoscopy, a patient receiving intravenous fentanyl exhibits signs of respiratory depression. Which of the following would you recommend?
Immediately administer naloxone (Narcan)
A mechanically ventilated patient exhibits a sudden decrease in end-tidal CO2 levels. What are possible causes of this change except:
Increased CO2 production
What is the advantage of using fluoroscopy during bronchoscopy for peripheral lesions?
Increased diagnostic yield
Which of the following is a true statement regarding the term hypoxemia?
It occurs when the patient's PaO2 is lower than predicted
Which of the following is true regarding the PaO2?
It shows moderate hypoxemia.
What aerosolized medication is administered to most patients before the bronchoscopic procedure is begun?
Lidolocaine
Hypoxemia during FB on a mechanically ventilated patient is typically due to:
Loss of lung volume
What is the major challenge of ultrathin bronchoscopy?
Maintaining proper anatomical orientation in the peripheral airways
For what condition is the rigid bronchoscope most likely to be used?
Massive hemoptysis
In which patients or situations is hypoxemia most likely to develop?
Prolonged bronchoscopic procedures
You are asked to provide continuous monitoring of the FIO2 provided by a humidified O2 delivery system using a galvanic cell analyzer. Where would you install the analyzer's sensor?
Proximal to the heated humidifier
You are asked to perform an ABG on a patient that comes into the ER feeling light-headed with a blood pressure of 90/60. What may you need to do to obtain an adequate blood sample on this patient?
Pull gently on the syringe barrel to apply suction
Which of the following would be the best indicator of tissue oxygenation?
PvO2
To obtain lavage fluid, the bronchoscope is wedged at which of the following locations?
The level of fourth or fifth generation bronchus
During bronchoscopy of an intubated patient receiving mechanical ventilation, what should the RT be aware of?
The resistance imposed by the bronchoscope may cause tracheal pressures to increase noticeably
How are lung brushings handled?
They are smeared onto a glass slide.
For which of the following reasons is atropine often used during fiberoptic bronchoscopy?
To dry the patient's airway and to decrease vagal responses.
When is the endobronchial biopsy performed?
To obtain a tissue sample from a visible endobronchial lesion
What is the primary purpose of bronchoscopy in a patient with interstitial lung disease?
To perform microscopic assessment of the biopsy sample, which often is diagnostic
In which of the following conditions should fiberoptic bronchoscopy NOT be performed if the risks outweigh the potential benefits?
Uncorrected bleeding disorders, Refractory hypoxemia, Unstable hemodynamic status
What is the most common physiologic cause of hypoxemia in patients with lung disease?
V/Q mismatch
An outpatient scheduled for an arterial blood sample enters the pulmonary lab 20 minutes late and out of breath, having run up four flights of stairs. What should you do?
Wait 5 minutes before taking the sample
What is the greatest hazard of pulse oximetry?
false results leading to incorrect decisions
Which of the following shifts the oxyhemoglobin dissociation curve to the left?
fetal hemoglobin
What is the most common indication for the use of a bronchoscope?
help diagnose abnormalities seen on chest x-ray
If patient pain or anxiety occurs during arterial puncture, which of the following will probably occur?
hyperventilation
What is a decrease in tissue oxygenation called?
hypoxia
What is the primary purpose of bronchoscopy in a patient with pneumonia?
identify the causative organism
What could cause tissue hypoxia with normal arterial oxygenation?
inadequate cardiac output
What is the most common technique used to measure CO2 in respiratory gases?
infrared absorption
During a single-breath capnogram, the sharp downstroke and return to baseline that normally occurs after the end-tidal point indicates what?
inspiration of fresh respiratory gas
A patient suffering from traumatic brain injury in the ICU has a PtO2 (tissue oxygen) value of 10-15 mmHg, what does this indicate?
ischemic brain damage
what can you determine regarding oxygen-carrying capacity if the Hb is 10.1 g/dL?
it is decreased
How does the Clark polarographic O2 electrode function?
it uses O2 to produce a reduction-oxidation reaction
What is the best site for capillary puncture in an infant?
lateral aspect of the heel's plantar surface
A PaO2 below what value would be considered moderate hypoxemia?
less than 60 mm Hg
What can help avoid the problem of arterial blood sample contamination with air EXCEPT:
mixing before expelling air
For what purpose are lasers used during bronchoscopy?
obliterate obstructing tumors
What are double-shielded brushes used for during bronchoscopy?
obtain microbiologic samples
What is the smooth-cusped flexible forceps used for during bronchoscopy?
obtain microbiologic samples
A 32-year-old man comes to the emergency department after a traffic accident with the following data: pulse, 118 beats/min; respiratory rate, 27 breaths/min; blood pressure, 100/68 mm Hg; paradoxical chest movement on the left side; breath sounds decreased on the left; and ABG on room air (21%) as follows: pH, 7.32; PaCO2, 70 mm Hg; PaO2, 57 mm Hg; HCO3-, 23 mEq/L; base excess, 0; SaO2, 86%, CaO2, 15.2 vol%; Hb, 13.0 g/dL; P(A - a)O2, 18 mm Hg. Based on this information, what is the primary cause of the patient's hypoxemia?
overall hypoventilation
What media are used to calibrate a blood gas analyzer's gas electrodes?
precision mixtures of O2 and CO2
What is the quality control procedure of analysis and reporting on externally provided control media with unknown values?
proficiency testing
To assess gas exchange at the tissues, you would obtain a blood sample from what?
pulmonary artery (balloon-inflated)
You must immediately begin monitoring the oxygenation status of an infant admitted to the emergency department in severe respiratory distress. What approach(es) would you select?
pulse oximetry (SpO2)
Which of the following is the most common site for arterial puncture?
radial artery
The shape of the expired CO2 tracing of a patient is normal but instead of being zero, the baseline is elevated to about 12 mm Hg. Which of the following is the most likely problem?
rebreathing
The advantage that point-of-care testing has over traditional laboratory testing is that point-of-care testing:
reduces turnaround time
Which of the following could cause metabolic acidosis?
renal disease, diabetic ketoacidosis
Oximetry is the measurement of blood hemoglobin saturations using what technique?
spectrophotometry
What portion of the airway are bronchial washings generally obtained?
the large airways
All of the following are common sites for transcutaneous blood gas electrode placement except the:
thigh
What is the normal gradient between PaCO2 and PETCO2?
3-5 mm Hg
Under ideal conditions, pulse oximeter readings patients usually fall in what range of those obtained with invasive hemoximetry?
3-5%
What is a normal end-tidal PETCO2 range?
35-43 mm Hg
What is the normal range for end-tidal CO2 as measured by capnography?
5-6% (35-43 mmHg)
You obtain a SpO2 reading of 90% using an oximeter with an approximate accuracy of 5%. This could indicate a PO2 as low as what level?
55 mm Hg or less
For patient safety, to help avoid methemoglobinemia, the total dosed of lidocaine should not exceed:
7 mg/kg
What is the normal value for arterial pH?
7.35-7.45
Pulse oximeter readings are generally unreliable at saturations below what level?
80%
What is the normal value for PaO2 in the adult patient?
80-100 mm Hg
For continuous monitoring of adults and children, you should set a pulse oximeter's low alarm in what range?
88-92%
When is capillary blood gas sampling indicated?
ABG analysis is needed, but arterial access is not available
A patient exhibits persistent mild hypoxemia after a fiberoptic bronchoscopy procedure. Which of the following would you recommend?
Continue oxygen therapy and reassess in 4 hr
You determine that a blood gas sample that requires analysis has been sitting in ice slush for 90 minutes. What should you do?
Discard the sample and notify the appropriate clinician
Metallic stents are placed during:
Either flexible or rigid bronchoscopy
Continuous SpO2 monitoring (versus a spot check) is indicated in what types of situations?
Exercise therapy, Bronchoscopy, Sleep Studies
What is often the first clinical sign that suggests the presence of hypoxemia?
Exertional dyspnea
During a single-breath capnogram, what does the occurrence of a plateau indicate?
Exhalation of mainly alveolar gas
After obtaining an arterial blood sample through percutaneous puncture using a syringe that does not have a capping safety device, what should you do?
"Scoop" the needle cap up with one hand, then plug the syringe
What can result in falsely high HbO2 readings with a laboratory hemoximeter? (pg. 388)
- Elevated bilirubin levels (>20 mg/dl) - Dirty cuvette chamber
At the very beginning of exhalation, the PETCO2 normally should be at what level?
0 mm Hg
An acute increase in PaCO2 of 10 to 15 mm Hg causes a corresponding increase in plasma HCO3- of how many mEq/L?
1
You are asked to calibrate an O2 analyzer. Which of the following gases would you use for this procedure? 1. 100% oxygen 2. 50% oxygen 3. 21% oxygen (room air)
1. 100% oxygen 3. 21% oxygen (room air)
Which of the following are TRUE about a blood gas analyzer's waste fluids? 1. A strong disinfectant should be added to waste fluid containers 2. Waste fluids should be handled as if they were blood samples 3. Waste fluids should be treated as potentially infectious.
1. A strong disinfectant should be added to waste fluid containers 2. Waste fluids should be handled as if they were blood samples 3. Waste fluids should be treated as potentially infectious
which of the following factors determine the volume needed for an arterial blood sample: 1. ABG analyzer's requirements 2. specific anticoagulant used 3. site used for sampling 4. other tests that will be needed
1. ABG analyzer's requirements 2. specific anticoagulant used 4. other tests that will be needed
Before taking a spot reading with a pulse oximeter, what should you do? 1. Allow sufficient response time 2. Set the low alarm to 88% to 90% 3. Confirm adequacy of pulse signal
1. Allow sufficient response time 2. Set the low alarm to 88% to 90% 3. Confirm adequacy of pulse signal
After obtaining an arterial blood sample, what should you do? 1. Apply pressure to the puncture site until bleeding stops 2. Place the sample in a transport container with ice slush 3. Check to see if the patient is getting anticoagulant therapy 4. Mix the sample by rolling and inverting the syringe.
1. Apply pressure to the puncture site until bleeding stops 2. Place the sample in a transport container with ice slush 4. Mix the sample by rolling and inverting the syringe.
Which of the following are TRUE about capillary blood gas sampling? 1. Capillary sampling can be used in lieu of direct arterial access in some infants and small children 2. A capillary sample PO2 provides a fairly close estimate of actual arterial oxygenation 3. Clinicians should exercise caution when using capillary samples to guide decisions 4. Properly obtained capillary blood can provide estimates of arterial pH and PCO2 levels.
1. Capillary sampling can be used in lieu of direct arterial access in some infants and small children 3. Clinicians should exercise caution when using capillary samples to guide decisions 4. Properly obtained capillary blood can provide estimates of arterial pH and PCO2 levels.
Which of the following must be continuously monitored during bronchoscopy? 1. Cardiac monitoring 2. Blood pressure 3. Oximetry 4. MetHb levels
1. Cardiac monitoring 2. Blood pressure 3. Oximetry
To avoid thermal injury with transcutaneous blood gas monitor sensors, what should you do? 1. Carefully monitor the sensor temperature 2. Apply hydrocortisone cream under the sensor 3. Regularly rotate the sensor site
1. Carefully monitor the sensor temperature 3. Regularly rotate the sensor site
While analyzing a blood gas control sample, you notice a trending of several PCO2 values above the 2 SD range over the last six control samples run. What corrective action would you consider at this time? 1. Check the function of the PCO2 electrode 2. Rerun the control sample a second time 3. Repair or replace any failed components
1. Check the function of the PCO2 electrode 3. Repair or replace any failed components
To avoid the dilution effects caused by too much sodium heparin during ABG sampling of an adult, what should you do? 1. Ensure a sample volume greater than 2 ml 2. Use dry heparin instead 3. Fill the needle dead space only
1. Ensure a sample volume greater than 2 ml 2. Use dry heparin instead 3. Fill the needle dead space only
Which of the following are roles of the RT during bronchoscopic procedures? 1. Ensures that all documentation is in place before the procedure 2. Helps to recognize the patient's oxygen requirement and anticipates appropriate oxygen supplement during the procedure 3. Assists the physician in operating the bronchoscopic accessories
1. Ensures that all documentation is in place before the procedure 2. Helps to recognize the patient's oxygen requirement and anticipates appropriate oxygen supplement during the procedure 3. Assists the physician in operating the bronchoscopic accessories
Key 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
Which of the following are divisions of imaging systems used during flexible bronchoscopy? 1. Fiber optic 2. Video 3. Hybrid 4. Fusion
1. Fiber optic 2. Video 3. Hybrid
After obtaining an arterial blood sample from an arterial line, you would do which of the following: 1. Flush the line and stopcock with the heparinized intravenous solution 2. Aspirate at least 5 ml of fluid or blood (dead space or waste) 3. Confirm stopcock port open to intravenous bag solution and catheter 4. Confirm undamped pulse pressure waveform on monitor.
1. Flush the line and stopcock with the heparinized intravenous solution 3. Confirm stopcock port open to intravenous bag solution and catheter 4. Confirm undamped pulse pressure waveform on monitor
Which of the following are appropriate orders before an elective fiberoptic bronchoscopy procedure scheduled for the next morning? 1. Have the patient take nothing by mouth (NPO) after midnight 2. Establish vascular access 3. Premedicate with a benzodiazepine
1. Have the patient take nothing by mouth (NPO) after midnight 2. Establish vascular access 3. Premedicate with a benzodiazepine
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
Why is the radial artery the preferred site for arterial blood sampling? 1. It is near the surface and easy to palpate and stabilize 2. The ulnar artery normally provides good collateral circulation 3. The radial artery is not near any large veins 4. It is the largest artery located in the upper extremities
1. It is near the surface and easy to palpate and stabilize 2. The ulnar artery normally provides good collateral circulation 3. The radial artery is not near any large veins
Which of the following are considered indications for rigid bronchoscopy? 1. Large foreign body extraction 2. Management of massive hemoptysis 3. Self-expandable stent replacement 4. Mediastinal and hilar lymphadenopathy
1. Large foreign body extraction 2. Management of massive hemoptysis 3. Self-expandable stent replacement
Which of the following guidelines should you adhere to when performing pulse oximetry? 1. Never mix different sensors among different devices 2. Make sure that the sensors are the correct size and are properly applied 3. Avoid using pulse oximetry to monitor hyperoxia in neonates 4. Whenever possible, validate the initial SpO2 against the actual SaO2
1. Never mix different sensors among different devices 2. Make sure that the sensors are the correct size and are properly applied 3. Avoid using pulse oximetry to monitor hyperoxia in neonates 4. Whenever possible, validate the initial SpO2 against the actual SaO2
To avoid transmission of blood-borne diseases when handling a used needle, what should you do? 1. Never recap the needle without a safety device (or scoop method) 2. Never handle the needle with both hands, or point it toward the body 3. Never bend, break, or remove the needle from the syringe by hand 4. Always dispose of the syringe or needle in a proper sharps container
1. Never recap the needle without a safety device (or scoop method) 2. Never handle the needle with both hands, or point it toward the body 3. Never bend, break, or remove the needle from the syringe by hand 4. Always dispose of the syringe or needle in a proper sharps container
Which of the following drugs can be used to prevent bleeding during fiberoptic bronchoscopy? 1. Phenylephrine 2. Dopamine HCl 3. Epinephrine
1. Phenylephrine 3. Epinephrine
Before attaching a transcutaneous blood gas monitor sensor to a patient, which of the following should you do? 1. Provide a specified warm-up time and set the probe temperature 2. Check the membrane and prepare a sensor with an adhesive ring and gel 3. Prepare the monitoring site (remove excess hair and clean the skin)
1. Provide a specified warm-up time and set the probe temperature 2. Check the membrane and prepare a sensor with an adhesive ring and gel 3. Prepare the monitoring site (remove excess hair and clean the skin)
Equipment required for patient support and monitoring during a fiberoptic bronchoscopy procedure includes which of the following? 1. Pulse oximeter 2. Oxygen 3. Electrocardiographic monitor 4. Esophageal detection device
1. Pulse oximeter 2. Oxygen 3. Electrocardiographic monitor
When analyzing a blood gas control sample, you notice that the result falls outside the 2 SD range. How could you verify that this was a random error (error of imprecision)? 1. Repeat the analysis on a different analyzer 2. Compare the control to an actual patient sample 3. Rerun the control sample a second time.
1. Repeat the analysis on a different analyzer 3. Rerun the control sample a second time
Which of the following are considered contradictions for flexible bronchoscopy? 1. Severe hypercapnia 2. Impaired neck mobility 3. Hemoptysis 4. Recent myocardial infarction
1. Severe hypercapnia 2. Impaired neck mobility 4. Recent myocardial infarction
A mixed venous blood sample obtained from a pulmonary artery catheter sample has a PO2 of 85 mm Hg and a hemoglobin saturation of 95%. Which of the following is likely? 1. The pulmonary artery catheter balloon was not deflated 2. The sample was drawn from the proximal, not distal port 3. The blood sample was withdrawn too quickly
1. The pulmonary artery catheter balloon was not deflated 3. The blood sample was withdrawn too quickly
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
Which of the following are considered indications for flexible bronchoscopy? 1. Unexplained lung collapse 2. Need for large size tissue specimen 3. Evaluate endotracheal tube-related injury 4. Bronchogenic carcinoma
1. Unexplained lung collapse 3. Evaluate endotracheal tube-related injury 4. Bronchogenic carcinoma
Required equipment and supplies for percutaneous arterial blood sampling of an adult include which of the following? 1. antiseptic (alcohol or Betadine) 2. patient or sample label 3. 20- to 22-gauge needle 4. local anesthetic
1. antiseptic (alcohol or Betadine) 2. patient or sample label 3. 20- to 22-gauge needle
Precautions and/or possible complications of arterial puncture include which of the following? 1. arteriospasm 2. embolization 3. infection 4. hemorrhage
1. arteriospasm 2. embolization 3. infection 4. hemorrhage
Which of the following changes would occur if an arterial blood sample of a patient breathing room air were exposed to a large air bubble? 1. decreased PCO2 2. decreased pH 3. increased PO2
1. decreased PCO2 3. increased PO2
Tissue injuries to be on guard for at the site of transcutaneous blood gas electrode placement include which of the following? 1. erythema 2. hematomas 3. burns or blisters 4. skin tears
1. erythema 3. burns or blisters 4. skin tears
Which of the following are indications for capnography: 1. evaluating the response to therapies affecting ventilation/perfusion ratio relationships 2. determining the position of an artificial airway (trachea versus esophagus) 3. assessing a patient's readiness for weaning from ventilatory support 4. monitoring the integrity of the ventilatory circuit and artificial airway
1. evaluating the response to therapies affecting ventilation/perfusion ratio relationships 2. determining the position of an artificial airway (trachea versus esophagus) 4. monitoring the integrity of the ventilatory circuit and artificial airway
What are indications for self expanding metallic stent placement?
1. extrinsic compression of central airways 2. stabilizing airway patency after endoscopic removal of an intrinsic tumor 3. sealing fistula between the lung and the gastrointestinal tract
Which of the following are advantages of mainstream capnometry: 1. fast response time 2. short lag time 3. no bulky sensor 4. no lost volume
1. fast response time 2. short lag time 4. no lost volume
Which of the following Centers for Disease Control and Prevention (CDC) barrier precautions would you use when obtaining an arterial blood gas (ABG) through percutaneous puncture? 1. gloves 2. protective eyewear 3. gown or apron
1. gloves 2. protective eyewear
You are monitoring a nurse acquiring a capillary blood sample from an infant. The nurse immediately punctures the infant's heel with a lancet and then squeezes the puncture site to increase the flow of blood. What mistakes has the nurse made while obtaining the capillary blood sample? 1. inadequate warming of the capillary bed 2. squeezing of the puncture site 3. puncture of the infant's heel 4. use of a lancet
1. inadequate warming of the capillary bed 2. squeezing of the puncture site
Possible complications of capillary blood gas sampling include which of the following: 1. infection 2. hematoma 3. hemorrhage 4. hypotension
1. infection 2. hematoma 3. hemorrhage
Capillary puncture should NOT be performed at or through what location? 1. inflamed or edematous tissue 2. localized areas of infection 3. the fingers of neonates 4. previous puncture sites
1. inflamed or edematous tissue 2. localized areas of infection 3. the fingers of neonates 4. previous puncture sites
Treatment parameters that should be assessed as part of arterial blood sampling include which of the following: 1. mode of ventilatory support and settings 2. time of last incentive breathing exercise 3. FIO2 (analyzed) or prescribed flow 4. proper application of the O2 device
1. mode of ventilatory support and settings 3. FIO2 (analyzed) or prescribed flow 4. proper application of the O2 device
Indications for arterial blood sampling by percutaneous needle puncture include which of the following: 1. monitor the severity of a disease process 2. assess the adequacy of tissue oxygenation 3. evaluate ventilation and acid-base status 4. evaluate a patient's response to therapy
1. monitor the severity of a disease process 3. evaluate ventilation and acid-base status 4. evaluate a patient's response to therapy
Which of the following indicates venous admixture during arterial puncture? 1. need to use syringe suction 2. dark-colored blood 3. small sample volumes
1. need to use syringe suction 3. small sample volumes
The equipment necessary for capillary blood sampling includes which of the following? 1. operator interface 2. measuring chamber incorporating three electrode system 3. Calibrating gas tanks 4. Reagent and waste containers 5. Results display, storage and transmission system
1. operator interface 2. measuring chamber incorporating three electrode system 3. Calibrating gas tanks 4. Reagent and waste containers 5. Results display, storage and transmission system
What chart information should be checked before performing artery puncture? 1. patient's primary diagnosis and history 2. presence of bleeding disorders or blood-borne infections 3. anticoagulant or thrombolytic drug prescriptions 4. respiratory care orders (e.g., O2 therapy)
1. patient's primary diagnosis and history 2. presence of bleeding disorders or blood-borne infections 3. anticoagulant or thrombolytic drug prescriptions 4. respiratory care orders (e.g., O2 therapy)
A physician requests that you obtain and set up an arterial line system for invasive monitoring of blood pressure. Which of the following equipment would you gather? 1. pressurized intravenous bag 2. continuous flush device 3. arterial catheter 4. pressure transducer 5. amplifier or monitor
1. pressurized intravenous bag 2. continuous flush device 3. arterial catheter 4. pressure transducer 5. amplifier or monitor
Most preanalytical ABG errors can be avoided by ensuring that the sample is which of the following? 1. properly anticoagulated 2. obtained anaerobically 3. analyzed within 15 to 30 minutes
1. properly anticoagulated 2. obtained anaerobically 3. analyzed within 15 to 30 minutes
You return to a patient's room 20 minutes after drawing an ABG. Which of the following should you check at this time? 1. puncture site for hematoma 2. adequacy of distal circulation 3. prothrombin or partial thromboplastin times
1. puncture site for hematoma 2. adequacy of distal circulation
When inspecting an internal quality-control plot for a blood gas analyzer, you notice several data points sporadically appearing outside the 2 standard deviations (SD) range. This represents what type of analytic error? 1. random error 2. bias 3. imprecision 4. systematic error
1. random error 3. imprecision
Potential benefits of continuous, intraarterial (In Vivo) blood gas analysis include: 1. real-time monitoring 2. less blood loss 3. lower infection risk 4. elimination of specimen transport
1. real-time monitoring 2. less blood loss 3. lower infection risk 4. elimination of specimen transport
Factors contributing to imprecision (random) errors during blood gas analysis include what? 1. sample contamination 2. contaminated buffers 3. statistical probability 4. sample mishandling
1. sample contamination 3. statistical probability 4. sample mishandling
A patient being monitored by capnography exhibits a sudden rise in end-tidal CO2 levels. Which of the following are possible causes of this change: 1. sudden release of a tourniquet 2. massive pulmonary embolism 3. sudden increase in cardiac output 4. injection of NaHCO3
1. sudden release of a tourniquet 3. sudden increase in cardiac output 4. injection of NaHCO3
Components of a laboratory blood gas analyzer include which of the following? 1. three-electrode measuring chamber 2. reagent containers 3. calibrating gas tanks 4. waste container
1. three-electrode measuring chamber 2. reagent containers 3. calibrating gas tanks 4. waste container
Which of the following are use of capnometry? 1. to assess blood flow during cardiac arrest 2. to determine PEEP levels 3. to detect esophageal intubation 4. to assess the condition of the alveolar-capillary membrane
1. to assess blood flow during cardiac arrest 2. to determine PEEP levels 3. to detect esophageal intubation
Indications for pulse oximetry include which of the following? 1. to assess changes in HbO2 during certain procedures 2. for measurements of abnormal Hb 3. to comply with external regulations or recommendations 4. to monitor the adequacy of HbO2 saturation
1. to assess changes in HbO2 during certain procedures 3. to comply with external regulations or recommendations 4. to monitor the adequacy of HbO2 saturation
Transcutaneous blood gas monitoring is indicated when what need exists? 1. to continuously analyze gas exchange in infants or children 2. to quantify the real-time responses to bedside interventions 3. to continuously monitor for hyperoxia in newborn infants
1. to continuously analyze gas exchange in infants or children 2. to quantify the real-time responses to bedside interventions 3. to continuously monitor for hyperoxia in newborn infants
Purposes of a needle-capping device include which of the following? 1. to isolate the sample from air exposure 2. to help prevent needlestick injuries 3. to hold the excess anticoagulant
1. to isolate the sample from air exposure 2. to help prevent needlestick injuries
which of the following will tend to cause false low readings when using a pulse oximeter : 1. vascular dyes 2. anemia 3. high metHb 4. dark nail polish
1. vascular dyes 2. anemia 3. high metHb
During capnography monitoring of a mechanically ventilated patient, you note that the PETCO2 has dropped to 0 mm Hg. Which of the following are possible causes of this finding: 1. ventilator disconnection 2. esophageal intubation 3. increased cardiac output 4. cardiac arrest
1. ventilator disconnection 2. esophageal intubation 4. cardiac arrest
Before a sample of capillary blood is taken, what should you do to the site? 1. warmed to 42° C for 10 minutes 2. squeezed lightly until blanched 3. cleaned with an antiseptic solution
1. warmed to 42° C for 10 minutes 3. cleaned with an antiseptic solution
For the test of collateral circulation in an Allen's Test, "pinking up" of the hand is normal if it occurs within ____ seconds.
10-15
You obtain a SpO2 reading of 100% on a patient receiving O2 through a nonrebreathing mask. What range of PaO2 levels is possible in this patient?
100 to 600 mm Hg
What is the normal value for CaO2?
16-20%
What is a normal level for CaO2?
18 to 20 ml/100 ml
What two directions can the distal tip of a FB be flexed?
180 ante-flexion and 130 in retro flexion
Statistically derived limits for internal quality control of blood gas samples are usually set at what appropriate level?
2 standard deviations from the mean
What is the appropriate interval for changing the site for a transcutaneous blood gas monitor sensor?
2 to 6 hours (book says 2-12 hours so idk)
Under ideal conditions, electrochemical oxygen (O2) analyzers have approximately what degree of accuracy?
2%
During fiberoptic bronchoscopy, a patient's without secretion 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
Warming a capillary bed to 42° C has which of the following effects? 1. It constricts the underlying blood vessels 2. It increases blood flow well above tissue needs 3. It "arterializes" the capillary blood
2. It increases blood flow well above tissue needs 3. It "arterializes" the capillary blood
Which of the following is FALSE about invasive versus noninvasive monitoring? 1. Invasive procedures provide more accurate data but carry greater risks 2. Laboratory analysis of gas exchange is usually noninvasive in nature 3. Invasive procedures require insertion of a device into the body 4. Physiologic monitoring can be either invasive or noninvasive.
2. Laboratory analysis of gas exchange is usually noninvasive in nature
Which of the following is FALSE about transcutaneous blood gas monitoring? 1. Transcutaneous blood gas monitoring provides a reasonable estimate of PaO2 and PaCO2 2. Transcutaneous blood gas monitoring is most accurate when used with older adults 3. Accurate estimates of transcutaneous blood gases are difficult in patients with shock 4. Transcutaneous blood gas monitors use heated skin electrodes to arterialize the blood.
2. Transcutaneous blood gas monitoring is most accurate when used with older adults
Which of the following must be charted after obtaining an ABG sample through the brachial artery: 1. patient's temperature, position, activity level 2. date, time, and site of sampling 3. inspired O2 concentration or ventilator settings 4. results of the modified Allen test
2. date, time, and site of sampling 3. inspired O2 concentration or ventilator settings 4. results of the modified Allen test
Which of the following should be monitored during the sampling of arterial blood? 1. blood pressure proximal to puncture site 2. presence of pulsatile blood return 3. presence of air bubbles or clots in sample 4. appearance of puncture site
2. presence of pulsatile blood return 3. presence of air bubbles or clots in sample 4. appearance of puncture site
Which of the following conditions make interpreting the results of a modified Allen test difficult? 1. dark skin pigmentation 2. severe circulatory insufficiency 3. burns about the wrists or hands 4. systemic jaundice
2. severe circulatory insufficiency 3. burns about the wrists or hands 4. systemic jaundice
Patient parameters that should be assessed as part of arterial blood sampling include which of the following: 1. blood pressure 2. temperature 3. position or activity level 4. clinical appearance
2. temperature 3. position or activity level 4. clinical appearance
After changing the FIO2 of a patient with emphysema, how long should you wait to draw an ABG to monitor the patient's respiratory status?
20-30 minutes
How long should you wait before drawing an ABG on a chronic obstructive pulmonary disease (COPD) patient whose FIO2 has just been changed?
20-30 minutes
Which of the following ratios of HCO3- /PaCO2 results in a pH of 7.40?
20:1
What size needle would you recommend to obtain an ABG sample through percutaneous puncture of
25 gauge
In a patient with suspected bronchogenic carcinoma, how many biopsy specimens need to be collected during an endobronchial biopsy?
3
Your patient is being scheduled for a flexible bronchoscopy and is inquiring about when to stop taking her warfarin. After consulting the physician, what would you tell her?
3 to 5 days prior to the procedure
An arterial puncture site normally should be compressed for a minimum of ___ minutes after the puncture.
3-5
Which of the following is an advantage of brachytherapy?
A higher dose of radiation can be delivered to the tumor cells while minimizing radiation to the normal tissue
A technique of obtaining a specimen of the lung parenchyma by using flexible forceps positioned distally through the working channel of the bronchoscope is referred to as:
A transbronchial biopsy
Which of the following criteria is LEAST important before a patient is discharged after bronchoscopy?
Ability to swallow without pain
A patient exhibits persistent stridor after a fiberoptic bronchoscopy procedure. Which of the following would you recommend?
Aerosol therapy with racemic epinephrine
Which of the following tests is performed to check the collateral circulation of the radial artery before puncture?
Allen's test
Before connecting the sample syringe to an adult's arterial line stopcock, what would you do?
Aspirate at least 2ml of fluid or blood using a waste syringe
How often should blood gas calibration verification by control media take place?
At least two levels of control media should be analyzed every 8 hours
The total instrument error (inaccuracy) of a blood gas analyzer equals what?
Bias and imprecision
What is the primary method of transporting oxygen in the blood?
Bound to hemoglobin
The bronchoscopy technique that flushes 100 mL of normal saline through the scope's suction channel in four or five increments of 20 to 30 mL to distend the distal bronchioles and fill the alveoli, thereby washing out samples of any microorganisms, is which of the following?
Bronchoalveolar lavage
Factors contributing to bias (systematic) errors during blood gas analysis include what?
Contaminated buffers, incorrect gas concentration, incorrect procedures, component failure
Which of the following would be best used to assess arterial oxygenation?
CaO2
Which of the following can cause false high readings when using a pulse oximeter?
Carboxyhemoglobin or CO poisoning
During calibration of a Clark polarographic O2 analyzer, you cannot get the sensor to read 100% when exposed to 100% O2, even after adjusting its calibration control. The unit has new batteries. What action(s) would be correct?
Change the sensor or electrode
While monitoring an active infant through a transcutaneous blood gas system, you notice a rapid rise in PtcO2 from 63 to 145 mm Hg. During the same time, the (PtcCO2) drops from 35 to 7 mm Hg. What is the most appropriate action in this case?
Check the sensor for air leaks or dislodgment
To validate patient readings obtained from a transcutaneous blood gas monitor, what should you do?
Compare the monitor reading to those obtained with a concurrent ABG sample
What describes the correct procedure for an Allen test?
Compress both the radial and ulnar arteries, then release the ulnar artery
Because of an extremely low PO2, you suspect that an arterial blood sample taken from a patient's brachial artery might have been contaminated with venous blood. What might help to confirm your suspicion?
Cross-check the sample with an SPO2 reading
What is the most difficult parameter to monitor during FB?
Depth of sedation
A practitioner forgets to ice an ABG sample and leaves it at room temperature for 45 minutes. What parameters can you predict will increase in this sample during that period?
PCO2
Which of the following parameters is the respiratory component of acid-base status?
PaCO2
All of the following would prevent a physician from performing bronchoscopy for a patient EXCEPT:
PaCO2 of 38 mm Hg
When performing an Allen test on the left hand of a patient, you notice that the palm, fingers, and thumb remain blanched for more than 15 seconds after pressure on the ulnar artery is released. What should you do?
Perform the Allen test on the right hand
Before performing puncture or cannulation of the radial artery, what should you do?
Perform the Allen test to ensure collateral circulation
What are the two major complications of transbronchial biopsy?
Pneumothorax and bleeding
During continuous monitoring of an active 5-year-old patient with a finger pulse oximetry probe, you obtain frequent and repeated false low HbO2 alarms (less than 90%). Which of the following would be the best action to take in this situation?
Relocate the sensor to a more stable location
To avoid the risk of aspiration after a fiberoptic bronchoscopy procedure, what would you recommend that the patient do?
Remain in a sitting position and NPO until sensation returns
While checking a polarographic (Clark) electrode, you determine that the device fails to read 100% when exposed to pure O2. What actions would be the proper first step?
Replace the batteries
Analysis of an arterial blood sample taken from a healthy athlete reveals a pH of 7.36, a PCO2 of 45 mm Hg, and a PO2 of 43 mm Hg. What analytic errors should you suspect?
Sample admixture with venous blood
What is the most common sign of xylocaine overdose during bronchoscopy?
Seizures
To measure PCO2, blood gas analyzers use what electrode?
Severinghaus
When performing a percutaneous needle puncture of the radial artery, you get only a small spurt of blood. What is the best action at this time?
Slowly withdraw the needle until a pulsatile flow fill the syringe
An alert outpatient awaiting bronchoscopy has a SpO2 reading of 81% breathing room air. The patient appears in no distress and exhibits no signs of hypoxemia. Which of the following would be the best initial action to take in this situation?
Switch sites or replace the sensor probe
During thermal ablation, how are endobronchial ignitions prevented?
The FiO2 should always be maintained below 40%
The assessment of the upper airway to a flexible bronchoscopy procedure to help identify patients in whom it may be difficult to secure an airway is referred to as:
The Mallampati Classification
Which of the following is true regarding respiratory alkalosis?
The PaCO2 is less than 35 mm Hg.
What complication associated with bronchoscopy is most common?
adverse reaction to medications used in the procedure
When conducting ABG analysis in the laboratory, what are the obvious signs of pre-analytical error?
air bubbles, gross dilution, clotting
Where should a bronchoalveolar lavage be obtained?
alveolar level of lung
causes of uncompensated respiratory acidosis
asthma, COPD
Which of the following is the best indicator of metabolic acid-base status?
base excess
Before an arterial blood gas (ABG) value is obtained, the patient's clotting parameters should be evaluated because:
bleeding time may be prolonged if they are abnormal
All of the following are grounds for finding an alternative site for arterial puncture EXCEPT: a. failed Allen test b. history of peripheral vascular disease c. anticoagulation therapy d. presence of a surgical shunt
c. anticoagulation therapy
What is the measurement of CO2 in respiratory gases called?
capnometry
What sites are used for arterial blood sampling by percutaneous needle puncture EXCEPT:
carotid
What is the direct effect of an increased PaCO2 on HCO3-?
causes it to increase
How is the accuracy of a blood gas analyzer determined?
comparing the analyzer's measurements to known values
Which of the following would you expect to occur if too much heparin was used in gathering an ABG sample from a patient breathing room air?
decrease in PCO2
A shift to the right in the oxyhemoglobin dissociation curve has what effect on the affinity of hemoglobin for oxygen?
decreased
Through which pulmonary artery catheter port would you obtain a mixed venous blood sample?
distal (catheter tip) port
The respiratory therapist (RT) who is assisting the pulmonologist during bronchoscopy should have medication cups of xylocaine, normal saline, and ________ ready before beginning the procedure.
epinephrine
The negative log of the hydrogen ion concentration is defined as which of the following?
pH
Which blood gas analyzer electrode uses a separate reference electrode?
pH
What defines acidosis in a human?
pH < 7.35
Which of the following is a correct representation of the Henderson-Hasselbalch equation?
pH = pK + log HCO3- /(PaCO2 x 0.03)
A blood gas analyzer measures what?
pH, PaCO2, PaO2
To ensure that the output of a blood gas analyzer is both accurate and linear across the range of measured values, a calibration procedure must measure what?
parameters with known input values at two points
In which of the following patients would transcutaneous blood gas monitoring most likely provide inaccurate or erroneous results?
patient in hypovolemic shock
What is the most common source of error and false alarms with pulse oximetry?
patient motion artifact
What is the process of testing a new blood gas analyzer to confirm a manufacturer's claims?
performance validation
What is known about the galvanic fuel cell O2 analyzer?
uses a gold cathode and a lead anode; requires an external power source
