ASSEMBLE & TROUBLESHOOT EQUIPMENT
48/4 = 12 L/min.
A patient has a peak inspiratory flow of 48 L/min. What is the MINIMUM flowmeter setting needed to meet the patient's requirements if a 40% nebulizer is being used?
change to an aerosol mask
A patient in the neurologic ICU requires aerosol bronchodilator therapy. The treatments have been administered with a mouthpiece. Since the last treatment, the patient has become very lethargic. You should
the total output liter flow will increase
A large volume jet nebulizer is operating at the 100% O2 setting with an input flow of 12 L/min. What effect will changing the entrainment port setting from 100 to 70% have on the system?
drain any accumulated water from the delivery tubing
A large volume jet nebulizer is operating on 70% O2 at 12 L/min. You observe that the aerosol being delivered in short rapid puffs and note a gurgling sound in the system. Which of the following actions would be most appropriate?
the down tube is plugged
A nondisposable humidifier will not bubble if
4.0 mm
A 1 year-old child is apneic and cyanotic and will likely require mechanical ventilation. The physician asks you to prepare for oral intubation. Which of the following size ET tubes would you recommend in this situation?
vibrating mesh nebulizer
A 15-year-old with cystic fibrosis is receiving pressure control SIMV with pressure support due to a severe bilateral pneumonia. The pulmonologist asks you to administer aerosolized dornase alfa (Pulmozyme, DNase) in-line with the ventilator. Which of these devices would you select to administer this therapy?
nasopharyngeal airway
A conscious patient with an intact gag reflex requires an artificial airway solely to prevent obstruction of the upper airway by the tongue. Which of the following types of airways is most suitable in this situation?
nasal cannula
A cooperative and alert post-operative patient taking food orally requires a small increment in FIO2, to be provided continuously. Precise O2 concentrations are not needed. Which of the following devices would best achieve this end?
MacIntosh blade
A curved laryngoscope blade is also called a
750 psig
A cylinder of nitrous oxide (N2O) has a gauge pressure of 750 psig when full. What will be the pressure in this cylinder when it is half full?
oxyhood, air+O2 flowmeters, heated humidifier
A doctor orders 50% O2 for a newborn infant being cared for in a radiant warmer. No O2 blender is available and the doctor wants to avoid the infection risk associated with a using a nebulizer. Which of the following equipment would you select to fulfill the doctor's order?
gas-injection nebulizer with air+O2 mixed/titrated via high flow flowmeters
A doctor orders 70% O2 with water aerosol for a spontaneously patient breathing at 25-30/min intubated with an 8 mm ET tube. Which of the following equipment would you select to meet this order?
dual O2 concentrators
A home care patient needs 8 L/min oxygen bled into an air nebulizer system. Which of the following would you recommend as the most efficient and cost-effective way to provide the oxygen?
explain that the hissing is due to normal reservoir venting
A home care patient who uses O2 only during ambulation calls you and complains that her large liquid oxygen reservoir tank is 'hissing.' You would:
aerosol particle size (MMD) would decrease
A jet nebulizer is operating at an O2 input flow of 10 L/min on the 100% setting. If the input flow remains constant when the air-entrainment port is opened to the 40% O2 setting, which of the following would occur?
total aerosol output (mL/min) would increase
A jet nebulizer is operating at an O2 input flow of 10 L/min on the 100% setting. If the input flow remains constant when the air-entrainment port is opened to the 40% O2 setting, which of the following would occur?
the mask is too loose on the face
A patient is receiving oxygen via a nonrebreathing mask set at 12 L/min. You notice that the mask's reservoir bag does not deflate at all during inspiration. Which of the following is the most likely cause of this problem?
occlude the cannula to see if the humidifier pop-off sounds
A patient receiving humidified oxygen at 2 L/min via nasal cannula complains that she cannot 'feel' any gas flow at her nose. Which of the following actions would help determine the nature of this problem?
check the equipment connections
A patient receiving oxygen at 6 L/min via nasal cannula complains that he does not feel any oxygen coming out. You should do which of the following?
nasal drying
A patient receiving oxygen by nasal cannula at 8 L/min complains of discomfort. Which the following is the most likely explanation for problem?
switch from the T-tube to a tracheostomy collar
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 via T-tube (Briggs adapter). Which of the following would be the best way to limit tube movement in this patient?
. water level fluctuating with breathing
A spontaneous breathing patient has a chest tube inserted to drain pleural fluid. The drainage system is connected to -60 cm H2O wall suction. Which of the following would you expect to see in the system's water-seal chamber?
low compliance tubing
A toddler is receiving volume-controlled ventilation. To minimize volume loss due to compression and tubing expansion, which of the following should you select?
8
At a low to moderate setting (e.g., '2') the typical 1 L liquid portable O2 system with pulse dosing can provide about how many hours of O2?
reposition the pulse oximeter
At an FIO2 of 0.30, a pulse oximeter attached to the right index finger of a 6 week-old infant displays an SaO2 of 87% and a pulse of 64/min. A heart monitor reads a simultaneous heart rate of 120/min. Which of the following would be the most appropriate action?
inspect for proper blender gas connections/pressures
After calibrating an O2 analyzer, you obtain a reading of 45% in an infant oxyhood being supplied by an O2 blender set to 40% with an input flow of 8 L/min. Which of the following should be your next step?
a sensor port open to atmosphere
After changing the circuit on a patient receiving volume control ventilation, you note that the exhaled volume is 250 mL less than before and the peak inspiratory pressure is 8 cm H2O lower. Which of the following is the most likely source of the problem?
loose humidifier/circuit connection
After changing the circuit on a patient receiving volume control ventilation, you note that the exhaled volume is 250 mL less than before and the peak inspiratory pressure is 8 cm H2O lower. Which of the following is the most likely source of the problem?
the larger the air-entrainment ports, the lower the delivered FIO2
All else being equal, which of the following statements is correct regarding a device that mixed air and oxygen using air-entrainment (Venturi principle)?
the smaller the jet orifice, the lower the delivered FIO2
All else being equal, which of the following statements is correct regarding a device that mixes air and oxygen using air-entrainment (Venturi principle)?
D/C the device and switch to a nonrebreathing mask @ 15 L/min
An adult patient is receiving 100% O2 via a high flow nasal cannula set to 40 L/min. A persistent high temperature alarms has been occurring over the last several minutes, which you cannot correct. Which of the following actions would be appropriate?
Yankauer tip
An adult patient requires frequent suctioning of oral secretions. Which of the following should be made available at the patient's bedside?
FIO2 = [(.21 x 1) + 3]/4 = 3.21/4 = 0.803 or about 80% oxygen
An air entrainment device mixes air with oxygen at a fixed ratio of 1:3 (1 liter air to 3 liters oxygen). About what O2 concentration will this device provide?
low oxygen inlet pressure
An air/oxygen blender is used to provide an FIO2 of 0.50 by cool aerosol mask to a 15-year-old pediatric patient being treated for epiglottis. Suddenly the blender alarms and the low oxygen alarm on the analyzer trigger. Which of the following is the most probable cause?
use an oxygen-conserving device
An ambulatory home oxygen therapy patient complains that her portable liquid system (at 2 L/min) doesn't last long enough for her to visit with her grandchildren. What might you recommend to overcome this limitation?
Time to peak flow Back extrapolated volume End-of-test volume
An electronic bedside spirometer should provide which of the following automated validity checks on the forced expiratory maneuver?
Laryngoscope light Suction equipment Endotracheal tube cuff
BEFORE beginning an intubation procedure, you should check and confirm the operation of which of the following?
decrease the likelihood of condensate occluding the tubing
The rationale for using large-bore (22 mm) delivery tubing with large volume heated humidifier systems is to:
tighten the cylinder connection
When turning on an H cylinder valve, gas leaks around the regulator connection to the cylinder. Your most appropriate action to correct the problem would be to:
Check and reconnect/replace gas sampling line and filter
During inhaled nitric oxide (INO) therapy at 6 ppm, the NO and NO2 analyzer readings suddenly drop to 0. You should
ET tube cuff deflated
During manual bag-valve ventilation of an adult patient via endotracheal tube, you note poor chest expansion. Which of the following is the most likely cause of this problem?
ET tube improperly placed
During manual bag-valve ventilation of an adult patient via endotracheal tube, you note poor chest expansion. Which of the following is the most likely cause of this problem?
Size of ]gas jet Size of entrainment port Downstream resistance
Factors that affect the concentration of oxygen delivered by an air-entrainment (Venturi) mask include
an airway or patient circuit leak
You observe that a pressure-cycled ventilator fails to cycle off when the patient exhales. The most likely cause of this problem is:
static/slowly changing pressures
Fluid column manometers are best used to measure:
replace the regulator washer
You open the valve on an E cylinder which has a regulator attached and hear a hissing noise. The flowmeter/gauge is turned off. Which of the following corrective actions would you take first?
verify that the O2 and air lines are providing the required pressure
If an oxygen blender pressure alarm sounds, which of the following should be your FIRST ACTION?
reducing valve
If you had to power a ventilator from a large cylinder of compressed gas, which of the following devices would be required?
30%
If you increase the oxygen input flow to a 30% air-entrainment mask from 9 to 12 L/min, what will be the oxygen concentration
35%
If you increase the oxygen input flow to a 35% air-entrainment mask from 7 to 10 L/min, what is the resulting O2 concentration?
the ventilator outlet and heated humidifier
In a dual-limb or 'Y' ventilatory breathing circuit with heated humidifier, you should place the inspiratory HEPA filter between
arterial thrombosis distal to the cannula
In a patient with a brachial artery catheter in place, you note loss of a palpable radial pulse. Which of the following is the most likely cause of this problem?
it pressurizes the expiratory valve and prevents gas outflow during inspiration
In a single-limb transport ventilator breathing circuit with a built-in expiratory valve, what is the purpose of the small pneumatic line that accompanies the large-bore main tubing?
water is obstructing the delivery tubing
In checking a oxyhood system which uses nebulizer air-entrainment to deliver an FIO2 of 0.40, you note that the FIO2 has been rising over the last hour, but no settings have been changed. Which of the following is the most likely cause of this problem?
reading the cylinder label
In clinical practice, positive identification of medical gas cylinder contents is made by:
the presence of a leak in the patient-ventilator system
In comparing previously recorded values to those currently observed on a patient receiving volume control ventilation, you note a decrease in expired volume and a decreased airway pressure. There has been no change in ventilator settings. Which of the following best explains these findings?
provide all the gas needed by the patient during inspiration
In order to assure a stable FIO2 under varying patient demands, an oxygen delivery system must:
- Use the highest acceptable O2 flow - Connect an O2 reservoir to the bag
In order to deliver as high a concentration of oxygen as possible with a self-inflating bag-valve unit (manual resuscitator), you would:
water seal chamber
In which chamber of a three-chamber pleural drainage system would you expect to see fluctuations of the fluid level with each breath?
immediately take the piece of equipment out of service
In working with an electrically powered apparatus, you notice a slight tingling sensation when the metal parts of the equipment are touched. In this case, you should:
increase in inspired PCO2
Increasing the amount of tubing between the "wye" connector of a dual limb ventilator breathing circuit and the patient's airway will have which of the following effects?
minimize compressed volume loss
Low volume, low compliance ventilator circuits should be used on infants in order to:
positive pressure via an intact upper airway
Mechanical ventilation in the home setting can be provided by which of the following methods?
inspiration ends when a preset pressure limit is reached
Most IPPB devices are classified as pressure-cycled ventilators because:
decrease the flow to a lower level
On a pneumatically-powered IPPB device, switching the air-mix control to 100% oxygen will have which of the following effects on flow?
rate/depth of breathing
Other than the O2 flow setting, which of the following factors is the primary determinant of the FIO2 received by a patient on a standard nasal cannula?
negative pressure ventilation
Plans are being made for a patient with a chronic neuromuscular condition requiring ventilatory support to be discharged to home. Swallow testing indicates that he is able to protect his upper airway and adequately clear secretions. However, he did not tolerate an in-hospital trial of nasal noninvasive positive-pressure ventilation (NPPV). Which of the following support options would you recommend?
Altered heat and water exchange Possibility of thermal injury Possibility of electrical shock
Potential risks of long-term humidity therapy with a large volume heated humidifier include which of the following?
replace the endotracheal tube
Prior to intubation in an emergency, injection of air into the pilot line fails to inflate the cuff. You should
gas flow exceeds patient's inspiratory flow
Room air will NOT enter the ports of an aerosol face mask if the
increase the delivered O2 concentration
The accumulation of condensate in a low-lying loop of the delivery tubing will have which of the following effects on a jet nebulizer set to an FIO2 of 0.40?
less than saturated air at ambient temperature
The humidity output of a simple unheated humidifier is always:
the O2 and air supply alarms will not sound
The oxygen and air supply lines of an ICU ventilator are accidentally switched at set-up. When attached to a patient, the oxygen percentage is set to 100%. Which of the following is correct about this situation?
downstream resistance in the delivery tubing
The oxygen concentration delivered by an air entrainment nebulizer to a patient's airway is usually higher that set. What is the reason for this discrepancy?
assure a stable/fixed FIO2
The primary reason for selecting a high flow nasal cannula system for a patient would be to
an electronic pressure transducer
To continuously measure, display, record and analyze airway pressures of a patient on a ventilator, which of the following pressure measuring devices would you choose?
incorporate a pulse-dose delivery system
To maximize the duration of flow/runtime outside the home, liquid portable O2 systems
avoid covering the circuit with linens
To prevent heated wires from melting ventilator circuit tubing, you would:
occlude the circuit and manually toggle the device between inhalation and exhalation
To test that a cough assist or mechanical in-exsufflation (MI-E) device is working properly, you should
if the reservoir bag volume cannot meet inspired volume demands
Under which of the following conditions will the FIO2 of a O2 mask with reservoir bag vary?
80 - 100 mL
What approximate volume should be used to inflate the larger #1 cuff of an esophageal-tracheal Combitube® (ETC)?
either the patient's inspiratory efforts or a timing mechanism
When a ventilator is being used in the assist/control mode, the ventilator will trigger on in response to which of the following?
recheck the handle/blade connection
When checking a nondisposable steel laryngoscope blade prior to intubation, you note that the bulb does not light when connected to the handle. Your first step should be to
Water has collected in the delivery tubing
When checking on a patient receiving aerosol therapy via large volume jet nebulizer, you notice that the device is delivering 'puffs' of aerosol instead of a continuous aerosol stream. What is the likely cause of this problem?
turn the analyzer off, wait 10-20 seconds, and then turn it on
When conducting a point-of-care analysis of a patient's arterial blood gas sample in ICU, you turn the analyzer on but it fails to display proper start-up information. The best action at this time would be to:
addition of cool water to humidifier
When performing a routine ventilator check, you note that the airway temperature indicator reads 26° C. The flowsheet indicates a prior temperature of 35° C. Which of the following best explains this discrepancy?
Oxygen blender 'Wye' tubing circuit Threshold resistor
Which of the following are essential components of a continuous flow CPAP system?
Household AC current 12 volt DC car outlet Portable battery pack
Which of the following are power sources can be used with most portable O2 concentrators?
increase in patient inspiratory flow
Which of the following conditions will cause a DECREASE in the FIO2 delivered to a patient receiving oxygen at 4 L/min via a nasal cannula?
bleeding in/titrating extra O2 via a T-adapter
Which of the following could be done to help assure delivery of 70% O2 via a standard air-entrainment nebulizer to an intubated patient?
compensated Thorpe tube
Which of the following devices would you select to meter the flow of medical gas to a patient if accuracy under changing downstream pressure conditions were a primary consideration?
cm length markings
Which of the following endotracheal tube features assist in verifying proper tube placement?
small volume drug nebulizer
Which of the following equipment could be powered by a portable electric diaphragm or turbine air compressor?
heated wick humidifier
Which of the following humidifiers would be most effective in overcoming a humidity deficit?
there is continuous bubbling in the suction control chamber
Which of the following indicate that a 3 chamber pleural drainage system is working properly?
production of harmful noise levels
Which of the following is a potential problem when using an air-entrainment nebulizer to deliver gas to an infant in an oxyhood?
it ends inspiration after a preset volume is delivered by the ventilator
Which of the following is characteristic of volume controlled ventilation?
Magill forceps
Which of the following is commonly used to aid in a nasotracheal intubation?
unstable FIO2s due to frequent opening/closing
Which of the following is the most common problem with modern O2 therapy enclosures such as tents, isolettes and oxyhoods?
the remote alarm should sound whenever it goes out of monitor range
Which of the following is true regarding using a remote alarm unit in conjunction with a home apnea monitor?
high flow cannula
Which of the following oxygen administration devices is capable of providing a stable FIO2 to patients with changing rates and depths of breathing?
a portable oxygen concentrator
Which of the following portable O2 systems provides the greatest overall mobility and freedom for patients receiving long-term O2 therapy?
ungrounded equipment
Which of the following represents a potential hazard associated with home oxygen therapy?
add additional baffling to the system
Which of the following techniques would you recommend in order to decrease the mass median diameter (MMD) of liquid aerosol particles generated by a jet nebulizer?
Inhalation time Exhalation time Pause time
Which of the following time parameters can be set on a typical mechanical in-exsufflation (cough assist) device in the auto mode?
an increase in resistance downstream from the jet
Which of the following would cause the FIO2 delivered by an air entrainment mask to be different than that specified by the manufacturer?
an ultrasonic nebulizer
Which of the following would deliver the most particulate water to a patient's airway?
the reservoir will be cooler than room temperature
Which of the following would you expect to occur AFTER an unheated bubble-diffusion humidifier is set-up and operating?
absence of the inlet valve
While a patient is being ventilated with a bag-valve resuscitator, the bag fills rapidly and collapses on minimal pressure, although little chest movement by the patient is noted. The cause of the problem may be which of the following?
replace the flowmeter
While performing equipment rounds, you observe continuous bubbling in the humidifier of a standby oxygen setup. You also note that the flowmeter needle valve is completely closed. Which of the following should be done initially?
increase the suction pressure to -120 mm Hg
While using a Yankauer device to orally suction an adult patient, you are unable to remove thick secretions. The regulator attached to the oropharyngeal suctioning device displays a reading of -70 mm Hg. Which of the following should you do at this time?
a pneumatically powered and controlled ventilator
You are asked to transport a mechanically ventilated a patient to the MRI center. What type of ventilator would you recommend to support the patient during this procedure?
condensate is blocking the delivery tubing
You are called to assess an intubated COPD patient who is receiving humidified O2 via T-tube and air-entrainment nebulizer set to 28%. The nurse indicates that the patient has become increasingly drowsy over the past couple hours. You note an SpO2 of 100% and measure an FIO2 of 0.65 at the T-tube. Which of the following is the most likely cause of the discrepancy between set and analyzed FIO2?
tighten the bulb on the MacIntosh blade
You are checking a battery-powered laryngoscope and its separate blades/light bulbs in the drawer of a code cart. When you attach the Miller blade the bulb shines bright white. When you attach the MacIntosh blade the bulb fails to shine You should initially
replace the nebulizer
You attach a disposable jet nebulizer to a flowmeter at 12 L/min. If no mist is generated, you should
an air leak at the transducer site
You note a sudden increase in PO2 measurement and decrease in the PCO2 measurement on a transcutaneous monitor. The most likely cause is:
check/confirm proper temperature setting
You note that a patient who is being mechanically ventilated has thick, mucoid secretions. It is determined that the wick humidifier is producing insufficient humidity. You should do which of the following?
increase the inspiratory flow
You note that the pressure gauge on a continuous flow CPAP set-up for a patient with post-operative atelectasis falls to zero each time the patient inhales. Which of the following actions would most likely correct this problem?
replace the nebulizer
You notice that a disposable nebulizer is delivering large water droplets down the large bore tube. To correct this problem, you should
trap secretions
You would add a corrugated extension tubing to the standard circuit of an in-exsufflation (cough assist) device in order to: