1227 unit 4

After obtaining an arterial blood sample through percutaneous puncture using a syringe that does not have a capping safety device, what should you do? Force the needle into a rubber cork or plastic stopper Remove the needle with a Kelly clamp , then plug the syringe. "Scoop" the needle cap up with one hand, then plug the syringe. Manually remove and bend the needle, then plug the syringe.

"Scoop" the needle cap up with one hand, then plug the syringe.

Approximately how much CO 2 is removed daily by the lungs ? -24,000 mmol/L of CO2 -14,000 mmol/L of CO2 -4,000 mmol/L of CO2 -34,000 mmol/L of CO2

-24,000 mmol/L of CO2

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 ? Gloves Protective eyewear Gown or apron

1 and 2 only

A mixed venous blood sample obtained from a pulmonary artery catheter sample has a PO 2 of 85 mm Hg and a hemoglobin saturation of 959. 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 The blood sample was withdrawn too quickly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 and 3 only

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 and 3 only

When inspecting an internal quality control plot for a blood gas analyzeryou notice several data points sporadically appearing outside the 2 standard deviation (SD) range . This represents what type of analytic error? 1. Random error 2. Bias 3. Imprecision 4. Systematic error

1 and 3 only

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 and 3 only

While analyzing a blood gas control sample, you notice a trending of several PCO 2 values above the 2 SD range over the last six control samples runWhat 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 and 3 only

A practitioner forgets to ice an ABG sample and leaves it at room temperature for 45 min Which of the following parameters can you predict will increase in this sample during that period? 1. PCO2 2. PH 3, PO 2

1 only

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

1,2 and 4 only

An area of the lung has no blood flow but is normally ventilated. Which of the following statements are true about this area? 1. The alveolar gas is like air (PO 2 =150;PCO 2 =O) . 2. The area represents alveolar dead space. 3. The/is elevated.

1,2, and 3

Possible complications of capillary blood gas sampling include which of the following? 1. Infection 2. Hematoma 3. Hemorrhage 4. Hypotension

1,2, and 3

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.

1,2, and 3

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.

1,2, and 3 only

After obtaining an arterial blood sample from an arterial line, you would do which of the following? a. flush the line and stopcock with the heparinized intravenous solution. b. aspirate at least 5 ml of fluid or blood (dead space or waste). C. confirm stopcock port open to intravenous bag solution and catheter. d. confirm undamped pulse pressure waveform on monitor.

1,3, and 4 only

Which of the following are true about invasive versus noninvasive monitoring? 1. Invasive procedures require insertion of a device into the body 2. Laboratory analysis of gas exchange is usually noninvasive in nature. 3. Physiologic monitoring can be either invasive or noninvasive. 4. Invasive procedures provide more accurate data but carry greater risks.

1,3, and 4 only

You obtain an SpO 2 reading of 100% on a patient receiving O 2 through a nonrebreathing mask. What range of PaO 2 levels is possible in this patient? a. 100 to 600 mm Hg b. 100 to 200 mm Hg c. 90 to 100 mm Hg d. 60 to 90 mm Hg

100 to 600 mm Hg

What amount of water can be lost through fever?

1000 ml of fluid is lost per day for each degree of temperature above 99°F that persists for 24 hours or longer. More is lost when the person is sweating with the fever.

If a patient ingested HCO3 for stomach problems and the pH went up from 7.0 and 8.0. How much alkaline did the body become?

10x greater

What is a normal level for CaO 2 ? 14 to 16 ml/100 ml 18 to 20 ml/100 ml 12 to 15 ml/100 ml 16 to 22 ml/100 ml

18 to 20 ml/100 ml

Under ideal conditions, electrochemical oxygen (O 2 ) analyzers have approximately what degree of accuracy? 2% 1% 3% 4%

2%

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

2,3, and 4 only

How long should you wait before drawing an ABG on a chronic obstructive pulmonary disease (COPD) patient whose FiO 2 has just beer changed? 15 to 20 min 10 to 15 min . 20 to 30 min 5 to 10 min

20 to 30 min

Under ideal conditions, pulse oximeter readings patients usually fall in what range of those obtained with invasive hemoximetry? a 3 % to 5 % b. 1% to 2% c. 5% to 7\% d. 2% to 3%

3% to 5%

You obtain an SpO 2 reading of 90% using an oximeter with an approximate accuracy of 5%. This could indicate a PO 2 as low as what level? a, 60mmHg b . 55 mm Hg c. 70 mm Hg d. 65 mm Hg

55 mm Hg

A healthy person breathing 100% O2 at sea level would have PAO 2 of approximately what level?

670 mmHg

For continuous monitoring of adults and children, you should set a pulse oximeter's low alarm in what range? a.88 % to 92% b . 85 % to 88\% c. 80 % to 85\% d . 93% to 97%

88% to 92%

An individual with pneumonia receiving 30% supplemental O2 by facemask. Arterial blood gas values are pH= 7.40, PaCO2= 44 mmHg, and PaO2= 70 mm Hg and assume that the individualis at sea level and his respiratory quotient is 0.8. What is his AaDO2? a. 94 mm Hg b, 35mmHg c. 15 mm Hg d. 55 mm Hg

94 mmHg

What specific type of WBC is elevated in bacterial and viral pneumonia ?

A. Bacterial : neutrophils B. Viral: lymphocytes

Before performing an ABG, you would be wise to check which two specific laboratory values?

A. Blood count : platelets B. Blood chemistry test: prothrombin time, clotting times/studies

Give at least one clinical example of how a patient develops a very high or very low potassium level.

A. Hyperkalemia: renal failure B. Hypokalemia: diuretics

Why is the chloride level in sweat so important? What is the critical value?

A. Importance: It may be used to assess cystic fibrosis. B. Value : >60 to 80mEq / L

What is a normal HgB level, and why are you especially interested in HgB levels?

A. Normal : 12 to 16g / dL B. Respiratory role: Hemoglobin carries oxygen, CO 2 , and is a buffer

Name the two common liver enzymes that might be elevated in patients with hepatitis.

AST and ALT

Based on the following ABG results, what is the most likely acid-base diagnosis? pH=7.43,PCO 2 =39 mml Hg, HCO3- =25.1 mEq/L a . Acid- base status within normal limits b. Fully compensated respiratory alkalosis c. Fully compensated metabolic acidosis d. Partially compensated metabolic acidosis

Acid- base status within normal limits

An increase in dead space ventilation without a change in tidal volume will result in a. No change in alveolar PCO2 or alveolar PO2 b. An increase in alveolar PCO2 with a decrease in alveolar PO2 c. A decrease in alveolar PCO2 without significant change alveolar PO2 d. A decrease in alveolar PCO2 without significant change in alveolar PO2

An increase in alveolar PCO2 with a decrease in alveolar PO2

Anions-

Anions- negatively charged; Cl- and HCO3 are common in the body

Before connecting the sample syringe to an adult's arterial line stopcock , what would you do? a. Flush the line and stopcock with the heparinized intravenous solution. b. Increase the flush-solution bag pressure by 20 to 30 mm Hg. c. Align the stopcock off to the patient and on to the flush solution. d. Aspirate 1 to 2 ml of fluid or blood using a waste syringe.

Aspirate 1 to 2 ml of fluid or blood using a waste syringe.

How often should blood gas calibration verification by control media take place? a. At least two levels of control media should be analyzed every day. B. At least two levels of control media should be analyzed every 8 hr c.At least one level of control media should be analyzed every 8 hr. d. At least two levels of control media should be analyzed every hour .

B. At least two levels of control media should be analyzed every 8 hr

The total instrument error (inaccuracy) a blood gas analyzer equals which of the following? a. Bias + impr imprecision b. Bias + syst systematic error c. Imprecision ion + ran random error d. Trend error + bias

Bias + imprecision

List three common causes of low WBC.

Bone marrow disease, (e.g., leukemia) Chemotherapy or radiation therapy Acquired immunodeficiency syndrome (AIDS)

Buffering

Buffering- minimizing the change in pH

Cations

Cations- positively charged ion. Na+ and K are common in the body

During calibration of a Clark polarographic O 2 analyzer, you cannot get the sensor to read 100% when exposed to 100% O 2 , even after adjusting its calibration control. The unit has new batteries. Which of the following actions would be correct? Change the sensor or electrode Use it only with low FiO2 values Send the device out of repair Replace the units batteries

Change the sensor or electrode

While monitoring an active infant through a transcutaneous blood gas system, you notice a rapid rise in P tc O 2 from 63 to 145 mm Hg . At that same time, the (P tc CO 2 ) drops from 35 to 7 mm Hg What is the most appropriate action in this case? a Remove the sensor and recalibrate the instrument . b Check the sensor for air leaks or dislodgment c. Perform a quick assessment of the infant's airway . d. Stabilize the infant and call for emergency assistance .

Check the sensor for air leaks or dislodgment

Which WBCS are invloved in problems such as allergic asthma?

Eosinophils

After drawing up 1mL of a 5% of albuterol into a syringe, the place the RTs place the bronchodilator into a nebulizer along with 2mL of saline for dilution. The total solution is now 3mL in the nebulizer. What is the new concentration of the drug?

Formula: C2 = C1V1 / V2 5%=0.05 Solution: C2= (0.05 1mL) / 3 mL = 0.05/3=0.0166 Answer: 0.0166%

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. Hematomas a b. Burns or blisters c. Erythema d. Skin tears

Hematomas

Hypertonic

Hypertonic- saltier than your body fluids

Hypotonic

Hypotonic- a really weak solution

What does a large elevation in WBC count suggest ?

Infection Immune response Stress/ trauma

What is the most common technique used to measure CO 2 in respiratory gases? a. Raman scattering b. Infrared absorption c. Mass spectroscopy d . Photoacoustics

Infrared absorption

In what processes of gas compression or expansion does the temperature remain constant? Isothermal Hypothermal Adiabatic Neutral kinetic

Isothermal

Isotonic

Isotonic- has the same amount of salt as your body fluids

Both a compressed gas cylinder and its regulator are at room temperature with all valves in the off position After the cylinder is opened and gas begins flowing you note that the regulator is extremely cold to touch. Which of the following principles best explains this observation? Venturi principle Joule-Thompson effect Adiabatic compression Gay-Lussac's Law

Joule-Thompson effect

What is the name of the movement of water across a semipermeable membrane?

Osmosis

What is the process of testing a new blood gas analyzer to confirm a manufacturer's claims? a. Automated calibration b . Performance validation c. Proficiency testing d . Preventive maintenance

Performance validation

You are asked to provide continuous monitoring of the FiO 2 provided by a humidified O 2 delivery system using a galvanic cell analyzer Where would you install the analyzer's sensor? a. On the expiratory side of the circuit b. As close to the patient as possible c. Proximal to the heated humidifier d. Distal to the heated humidifier

Proximal to the heated humidifier

A medical student asked a the saline in neb tx would hurt her patient who was on sodium restriction for his heart. No problem answer the following question said the RT. Use this scenario If you give 3 of normal saline by nebulizer, how much sodium chloride is being delivered to the airway in theory?

Remember that about 10delivered to the airway. of 0.9% NaCi contain 9 mg of sodium per or mg total. About 3 mg would go into the patient

While checking a polarographic (Clark) electrode, you determine that the device fails to read 100% when exposed to pure O 2 . Which of the following actions would be the proper first step ? Change the analyzer's fuel cell . Replace the analyzer's batteries. Send the device out for repair Check the silica crystals .

Replace the analyzers batteries

To measure PCO 2 , blood gas analyzers use what electrode? a. Clark b. Severinghaus c. Sahn d. White

Severinghaus

List the predominantly extracellular electrolytes.

Sodium (Na+); Chloride (Cl); bicarbonate (HCO3-)

Solute

Solute- the stuff that gets dissolved

Solution

Solution- a stable mixture of two substances. Heat helps make this happen

Solvent

Solvent- the medium you dissolved something into

Which of the following factors does not contributing to bias (systematic) errors during blood gas analysis? a.Incorrect procedures b. Contaminated buffers c. Statistical probability d. Component failure

Statistical probability

The transcutaneous blood gas electrode should not be placed on the a chest b. lower back. c. thigh d. abdomen .

Thigh

What blood cell is vital to clotting, and what is the normal value of that blood cell?

Thrombocytes or platelets; 150, 000 to 400, 000

What value on the venous chemistry panel represents bicarboonate?

Total CO2

Which of the following is false about transcutaneous blood gas monitoring? a. Transcutaneous blood gas monitoring provides a reasonable estimate of PaO 2 and PaCO 2 . b. Transcutaneous blood gas monitors use heated skin electrodes to arterialize the blood. c Transcutaneous blood gas monitoring is most accurate when used with older adults D. Accurate estimates of transcutaneous blood gases are difficult in patients with shock.

Transcutaneous blood gas monitoring is most accurate when used with older adults

______ is a test that can identify strains of tuberculosis that are resistant to Rifampicin?

Xperia MTB/RIF

Acid-

a compound that gives off H+ in water

What is the greatest hazard of pulse oximetry? a. Pressure sores at the measuring site b. Skin burns due to using incompatible probes c. False results leading to incorrect decisions d. Electrical shock at the measuring site

c. False results leading to incorrect decisions