Exam 6
80. Which of the following is not a common tissue injury to be on guard for at the site of transcutaneous blood gas electrode placement? a. Erythema b. Hematomas c. Burns or blisters d. Skin tears
ANS: B
84. What is the appropriate interval for changing the site for a transcutaneous blood gas monitor sensor? a. 1 to 2 hr b. 2 to 6 hr c. 6 to 8 hr d. 8 to 12 hr
ANS: B
92. Which of the following indicate that a patient being considered for extubation can provide adequate clearance of pulmonary secretions? 1. The patient has a maximum inspiratory pressure of 73 cm H2O. 2. The patient is alert and cooperative. 3. The patient has a dead space-to-tidal volume ratio of 0.7. 4. The patient coughs rigorously on suctioning. a. 1 and 3 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: B
38. The numerator of the Henderson-Hasselbalch (H-H) equation (HCO3-) relates to which of the following? a. Blood concentration of nonbicarbonate buffers b. Excretion of volatile acid by the lungs c. Renal buffering and excretion of fixed acids d. Respiratory component of acid-base balance
...ANS: C
11. Which of the following are reasons for finding an alternative site for arterial puncture? 1. Failed Allen test 2. History of peripheral vascular disease 3. Anticoagulation therapy 4. Presence of a surgical shunt a. 1, 2, and 4 only b. 2 and 4 only c. 1, 2, and 3 only d. 1, 3, and 4
ANS: A
15. 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 a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: A
17. 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 a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: A
55. Capillary puncture should be performed at or through what location? 1. Edematous tissue 2. Areas with new signs of infection 3. The heal of neonates 4. Previous puncture sites a. 2 and 3 b. 4 only c. 1, 2, and 4 d. 1, 2, 3, and 4
ANS: A
7. 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? a. Proximal to the heated humidifier b. On the expiratory side of the circuit c. Distal to the heated humidifier d. As close to the patient as possible
ANS: A
7. 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? a.Proximal to the heated humidifier b.On the expiratory side of the circuit c.Distal to the heated humidifier d.As close to the patient as possible
ANS: A
76. The advantage that point-of-care testing has over traditional laboratory testing is that point-of-care testing: a. reduces turnaround time. b. utilizes equipment that is less expensive. c. does not require trained personnel to run the tests. d. is more accurate than traditional laboratory testing.
ANS: A
103. What is the measurement of CO2 in respiratory gases called? a. Oximetry b. Capnometry c. Optometry d. Barometry
ANS: B
13. 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 a. 1, 2, and 3 only b. 2, 3, and 4 only c. 1, 2, 3, and 4 d. 2 and 3 only
ANS: B
21. Which of the following describes the correct procedure for an Allen test? a. Compress both the radial and ulnar arteries, and then release the radial artery. b. Compress both the radial and ulnar arteries, and then release the ulnar artery. c. Compress both the radial and ulnar arteries, and then release both arteries at once. d. Compress the brachial artery only and observe circulation to the hand.
ANS: B
33. 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? a. Increase in HCO3- b. Decrease in PCO2 c. Decrease in pH d. Decrease in PO2
ANS: B
37. According to the Henderson-Hasselbalch equation, the pH of the blood will be normal as long as the ratio of HCO3- to dissolved CO2 is which of the following? a. 10:1 b. 20:1 c. 24:1 d. 30:1
ANS: B
37. 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 a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: B
38. Which of the following can help avoid the problem of arterial blood sample contamination with air? 1. Discarding frothy samples 2. Fully expelling any bubbles 3. Mixing before expelling air 4. Capping syringe quickly a. 2 and 3 only b. 1, 2, and 4 only c. 1 and 4 only d. 1, 2, 3, and 4
ANS: B
51. All of the following are true about capillary blood gas sampling except: a. capillary sampling can be used in lieu of direct arterial access in some infants and small children. b. a capillary sample PO2 provides a fairly close estimate of actual arterial oxygenation. c. clinicians should exercise caution when using capillary samples to guide decisions. d. properly obtained capillary blood can provide estimates of arterial pH and PCO2 levels.
ANS: B
77. Which of the following is false about transcutaneous blood gas monitoring? a. Transcutaneous blood gas monitoring provides a reasonable estimate of PaO2 and PaCO2. b. Transcutaneous blood gas monitoring is most accurate when used with older adults. c. Accurate estimates of transcutaneous blood gases are difficult in patients with shock. d. Transcutaneous blood gas monitors use heated skin electrodes to arterialize the blood
ANS: B
39. According to the Henderson-Hasselbalch equation, the blood pH will rise (alkalemia) under which of the following conditions? 1. The buffer capacity increases. 2. The volatile acid (CO2) increases. 3. The volatile acid (CO2) decreases. 4. The buffer capacity decreases. a. 1 only b. 3 only c. 1 and 3 only d. 2 and 4 only
ANS: C
8. Which of the following sites are used for arterial blood sampling by percutaneous needle puncture? 1. Femoral 2. Radial 3. Brachial 4. Carotid a. 2 and 3 only b. 1 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4
ANS: C
82. To validate patient readings obtained from a transcutaneous blood gas monitor, what should you do? a. Measure and compare the PtcO2 and PtcCO2 at three or more different sites. b. Compare the monitor's readings to a concurrent pulse oximetry reading. c. Compare the monitor's readings to those obtained with a concurrent ABG sample. d. Compare the patient reading to those obtained when calibrating the sensor.
ANS: C
91. 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.
ANS: C
12. Precautions and/or possible complications of arterial puncture include which of the following? 1. Arteriospasm 2. Embolization 3. Infection 4. Hemorrhage a. 1, 2, and 3 only b. 2 and 3 only c. 2 and 4 only d. 1, 2, 3, and 4
ANS: D
18. What size needle would you recommend to obtain an ABG sample through percutaneous puncture of an infant? a. 18 gauge b. 20 gauge c. 22 gauge d. 25 gauge
ANS: D
19. Required equipment and supplies for percutaneous arterial blood sampling of an adult include all of the following except: a. antiseptic (alcohol or Betadine). b. patient or sample label. c. 20- to 22-gauge needle. d. local anesthetic.
ANS: D
20. Of what use is the Henderson-Hasselbalch equation for a clinician? a. It can guide therapeutic decision for critically ill patients. b. It establishes the baseline values for buffer enhancement treatments. c. Given H2CO3 and CO2 values, the pH can be computed. d. It allows validation of the reported values on a blood gas report.
ANS: D
32. Most pre-analytical 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 min. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: D
6. 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. Which of the following actions would be correct? a. Use it only with low FiO2 values. b. Send the device out for repair. c. Replace the unit's batteries. d. Change the sensor or electrode.
ANS: D
71. A physician is concerned about the potential for tracheal damage due to tube movement in a patient who recently underwent tracheotomy and is now receiving 40% oxygen through a T tube (Briggs adapter). Which of the following would be the best way to limit tube movement in this patient? a. Give a neuromuscular blocker to prevent patient movement. b. Secure the T tube delivery tubing to the bed rail. c. Tape the T tube to the tracheostomy tube connector. d. Switch from the T tube to a tracheostomy collar.
ANS: D
78. In which of the following patients would transcutaneous blood gas monitoring most likely provide inaccurate or erroneous results? a. Newborn infant with respiratory distress syndrome (RDS) b. Patient with hypoxemia c. Patient with a hyperpyrexia d. Patient in hypovolemic shock
ANS: D
79. 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 4. To monitor CO levels following hyperbaric oxygen treatment a. 3 and 4 only b. 1 and 3 only c. 2 and 4 only d. 1, 2, and 3 only
ANS: D
81. The transcutaneous blood gas electrode should not be placed on the: a. chest. b. abdomen. c. lower back. d. thigh.
ANS: D
83. Before attaching a transcutaneous blood gas monitor sensor to a patient, what 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). a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: D
9. 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. a. 1 and 4 only b. 3 only c. 2 and 4 only d. 1, 2, and 3 only
ANS: D
93. 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 a. 1, 2, and 3 only b. 2 and 4 only c. 2, 3, 4, and 5 only d. 1, 2, 3, 4, and 5
ANS: D