Egans Ch 41/42 Medical Gas Therapy

An infant requires both a precise high FiO2 and maintenance of a neutral thermal environment. Which of the following systems can best achieve these goals? 1. Oxy-Hood or warmed O2 blending system without incubator 2. Heated incubator with automatic O2 controlling system 3. Heated incubator with Oxy-Hood or O2 blending system A) 1 and 2 only B) 2 and 3 only C) 1 and 3 only D) 1, 2, and 3

A) 1 and 2 only

Primary safety concerns in the application of hyperbaric oxygenation include which of the following? 1. Sudden decompression 2. Electrical fires 3. CO2 accumulation A) 1 and 2 only B) 2 and 3 only C) 1 and 3 only D) 1, 2, and 3

A) 1 and 2 only

In which of the following clinical situations would you recommend hyperbaric oxygen (HBO) therapy, if available? 1. Carbon monoxide poisoning 2. Respiratory or cardiac arrest 3. Severe trauma 4. Cyanide poisoning A) 1 and 4 only B) 2 and 3 only C) 1, 2, 3, and 4 D) 1, 2, and 4 only

A) 1 and 4 only

You set up an Oxy-Hood with an FiO2 of 0.5 for a newborn infant. What is the maximum time that should pass before assessing this patient's PaO2 or SaO2? A) 1 hr B) 2 hr C) 8 hr D) 12 hr

A) 1 hr

Which of the following equipment(s) could be powered by a small diaphragm or turbine air compressor? 1. Small-volume medication nebulizer 2. All-purpose large-volume jet nebulizer 3. Intermittent positive-pressure breathing device A) 1 only B) 1 and 2 only C) 2 and 3 only D) 1, 2, and 3

A) 1 only

Which of the following factors determine the actual O2 provided by an air-entrainment system? 1. O2 input flow to the jet 2. Air-to-O2 ratio of the device 3. Resistance downstream from the jet A) 2 and 3 only B) 1 and 2 only C) 1, 2, and 3 D) 1 and 3 only

A) 2 and 3 only

During hyperbaric oxygen (HBO) therapy at 3 ATA, what is the approximate half-life of blood carboxyhemoglobin? A) 23 min B) 80 min C) 5 hr D) 24 hr

A) 23 min

A physician requests that you provide a patient with exactly 40% O2 at a flow of 60 L/min. Lacking a blender, you must manually mix air and O2 to achieve the desired mixture at the prescribed flow. Which of the following air and O2 flows would you select? Air (L/min) O2 (L/min) A) 45 15 B) 15 45 C) 40 20 D) 20 40

A) 45 15

A well-fitted nonrebreathing mask, adjusted so that the patient's inhalation does not deflate the bag (flows approximately 10 L/min), should provide inspired O2 concentrations in what range? A) 55% to 70% B) 45% to 60% C) 75% to 90% D) 70% to 85%

A) 55% to 70%

A true high-flow O2 delivery system should provide at least what flow? A) 60 L/min B) 50 L/min C) 40 L/min D) 30 L/min

A) 60 L/min

A patient receiving 3 L/min O2 through a nasal cannula has a measured SpO2 of 93% and no clinical signs of hypoxemia. At this point, what should you recommend? A) Decreasing the flow to 2 L/min and rechecking the SpO2 B) Maintaining the therapy as is and rechecking the SpO2 on the next shift C) Increasing the flow to 4 L/min and rechecking the SpO2 D) Discontinuing the O2 therapy

A) Decreasing the flow to 2 L/min and rechecking the SpO2

A variant of a common low-flow, nasal O2 delivery device that is capable of providing both high humidity and a high FiO2 is known as which of the following? A) High-flow nasal cannula B) Transtracheal catheter C) Nasal catheter D) Demand-flow oxygen

A) High-flow nasal cannula

You must deliver the highest possible FiO2 to a 67-year-old man with pulmonary edema breathing at a rate of 35/min. Which of the following O2 delivery systems would be most appropriate? A) Nonrebreathing mask at 12 to 15 L/min B) Simple mask at 12 to 15 L/min C) Partial rebreathing mask at 12 to 15 L/min D) Aerosol mask with nebulizer set to 100%

A) Nonrebreathing mask at 12 to 15 L/min

Which of the following is false about multiplace hyperbaric oxygenation chambers? A) The chamber normally is filled with 100% O2. B) Air locks allow entry and egress of caregivers. C) Pressures of 6 ATA or more can be applied. D) Care is provided directly within the chamber.

A) The chamber normally is filled with 100% O2.

Which of the following are advantages of the nasal cannula as a low-flow O2 delivery system? 1. Stability 2. Low cost 3. Easy application 4. Disposability A) 2 and 4 only B) 1, 2, and 4 only C) 2, 3, and 4 only D) 1, 2, 3, and 4

C) 2, 3, and 4 only

What temperature is required to maintain a neutral thermal environment (NTE) in an Oxy-Hood for infants weighing 2500 g or more? A) 25° C B) 30° C C) 35° C D) 40° C

C) 35° C

What is the upper limit of O2 concentrations available through tents? A) 60% to 70% B) 50% to 60% C) 40% to 50% D) 30% to 40%

C) 40% to 50%

To minimize the risk of retinopathy of prematurity (ROP), the American Academy of Pediatrics recommends keeping the PaO2 below what level? A) 60 mm Hg B) 70 mm Hg C) 80 mm Hg D) 90 mm Hg

C) 80 mm Hg

What is the level of SpO2 typically associated with discontinuation of O2 therapy? A) 88% B) 90% C) 92% D) 94%

C) 92%

A patient breathing 100% O2 for 24 hr or longer would most likely exhibit which of the following? 1. Decreased DLCO 2. Decreased CL 3. Increased PAO2 - PaO2 4. Decreased VC A) 2 and 4 only B) 1, 2, and 3 only C) 3 and 4 only D) 1, 2, 3, and 4

D) 1, 2, 3, and 4

Properly applied O2 therapy can decrease which of the following? 1. Ventilatory demand 2. Work of breathing 3. Cardiac output A) 2 and 3 only B) 1 and 2 only C) 1, 2, and 3 D) 1 and 3 only

C) 1, 2, and 3

Which of the following signs and symptoms are associated with the presence of hypoxemia? 1. Tachypnea 2. Tachycardia 3. Cyanosis 4. Bradycardia A) 2 and 3 only B) 1 and 2 only C) 1, 2, and 3 only D) 1 and 4 only

C) 1, 2, and 3 only

Benefits of properly applied O2 therapy in patients with chronic hypoxemia include which of the following? 1. Reversal of pulmonary vasoconstriction 2. Relief of pulmonary hypertension 3. Decreased right ventricular workload 4. Improved pulmonary vital capacity A) 1 and 3 only B) 1, 2, and 3 only C) 3 and 4 only D) 2, 3, and 4 only

B) 1, 2, and 3 only

Toxic side effects of inhaled NO include which of the following? 1. Acute pulmonary edema 2. Direct cellular damage 3. Impaired surfactant production 4. Sulfhemoglobinemia A) 1 and 3 only B) 1, 2, and 3 only C) 3 and 4 only D) 2, 3, and 4 only

B) 1, 2, and 3 only

Which of the following alternatives may increase the FiO2 capabilities of air-entrainment nebulizers? 1. Add open reservoir to expiratory side of T tube. 2. Connect together two or more nebulizers. 3. Use a commercial dual-flow system. 4. Add open reservoir to inspiratory side of T tube. A) 1 and 2 only B) 1, 2, and 3 only C) 1 and 4 only D) 1, 2, 3, and 4

B) 1, 2, and 3 only

Which of the following are true about ASSS standards? 1. They provide specifications for more than 60 gases and mixtures. 2. They apply only to cylinders sizes F through H/K. 3. They apply to high-pressure connections. 4. They provide a separate connector for all gases. A) 1 and 3 only B) 1, 2, and 3 only C) 3 and 4 only D) 2, 3, and 4 only

B) 1, 2, and 3 only

Low-flow O2 delivery systems used in respiratory care include which of the following? 1. Nasal O2 cannula 2. Nasal O2 catheter 3. Air-entrainment mask 4. Transtracheal catheter A) 1 and 3 only B) 1, 2, and 4 only C) 3 and 4 only D) 2, 3, and 4 only

B) 1, 2, and 4 only

Features of an ideal delivery system for NO for use with mechanical ventilation include which of the following? 1. Provides precise and stable NO dose delivery. 2. Premixes NO and O2 in a holding reservoir. 3. Provides accurate NO and NO2 monitoring. 4. Maintains proper ventilator function. A) 1 and 3 only B) 1, 3, and 4 only C) 2 and 4 only D) 1, 2, 3, and 4

B) 1, 3, and 4 only

Which of the following conditions can be treated with hyperbaric oxygen (HBO) therapy? 1. Carbon monoxide poisoning 2. Septic shock 3. Air embolism 4. Clostridial gangrene A) 1 and 2 only B) 1, 3, and 4 only C) 3 and 4 only D) 1, 2, 3, and 4

B) 1, 3, and 4 only

A physician orders 40% O2 through an air-entrainment nebulizer for a patient with a minute volume of 12 L/min. What is the minimum nebulizer input flow required to ensure the prescribed FiO2? A) 8 L/min B) 10 L/min C) 12 L/min D) 14 L/min

B) 10 L/min

Which of the following would indicate adequate oxygenation for adult patients with chronic lung disease and an accompanying acute-on-chronic hypoxemia? 1. SaO2 of 90% or higher 2. PaO2 of 50 to 60 mm Hg 3. SaO2 of 85% to 90% A) 1 and 2 only B) 2 and 3 only C) 1 and 3 only D) 1, 2, and 3

B) 2 and 3 only

What is the minimum flow setting for a simple mask applied to an adult? A) 3 L/min B) 5 L/min C) 8 L/min D) 10 L/min

B) 5 L/min

Delivery systems that provide only a portion of a patient's inspired gas are referred to as what? A) Fixed-performance systems B) Variable-performance systems C) High-flow O2 systems D) Air-entrainment systems

B) Variable-performance systems

Before administering a helium-O2 mixture to a patient with large airway obstruction, what should you do? A) Analyze the helium concentration of the mixture. B) Heat the cylinder to ensure complete mixing of contents. C) Analyze the O2 concentration of the mixture. D) Roll the cylinder to ensure complete mixing of contents.

C) Analyze the O2 concentration of the mixture.

According to AARC clinical practice guidelines, what is the minimum frequency for checking the functioning of an O2 delivery system? A) Every 4 hr B) Every 8 hr C) Every 24 hr D) Every 48 hr

C) Every 24 hr

A patient is receiving O2 through a nonrebreathing mask set at 8 L/min. You notice that the mask's reservoir bag collapses completely before the end of each inspiration. Which of the following actions is appropriate in this case? A) Change to a partial rebreather. B) Decrease the liter flow. C) Increase the liter flow. D) Change to a simple mask.

C) Increase the liter flow.

Which of the following is considered an advantage of the transtracheal catheter? A) It does not provide any economic benefit compared with the nasal cannula. B) It decreases the anatomic reservoir. C) It requires 40% to 60% less O2 flow than the nasal cannula. D) It requires higher flows than the nasal cannula.

C) It requires 40% to 60% less O2 flow than the nasal cannula.

A cooperative and alert postoperative patient who is able to eat requires a continuous but low FiO2. Precise FiO2 concentrations are not needed. Which of the following devices would best achieve this end? A) Simple O2 mask B) Air-entrainment mask C) Nasal cannula D) Nonrebreathing mask

C) Nasal cannula

A patient with chronic hypercapnia placed on an FiO2 of 0.6 starts hypoventilating. What is a possible cause of this phenomenon? A) Decreased cardiac output B) O2 toxicity C) O2-induced hypoventilation D) Absorption atelectasis

C) O2-induced hypoventilation

When full, a gas cylinder registers a pressure of 2200 psig. After a few hours of use, the pressure gauge reads 550 psig. The cylinder is now how full? A) One-half B) One-third C) One-fourth D) Two-thirds

C) One-fourth

Compared to air, the density of an 80% He and 20% O2 mixture is about which of the following? A) Two-thirds as much B) One-half as much C) One-third as much D) One-fifth as much

C) One-third as much

A physician orders 2 L/min O2 through a simple mask to a 33-year-old postoperative woman with moderate hypoxemia breathing room air (PaO2 = 52 mm Hg). What would be the correct action at this time? A) Carry out the physician's prescription exactly as written. B) Recommend that the mask be changed to a cannula at 2 L/min. C) Recommend a flow of at least 5 L/min to washout carbon dioxide (CO2). D) Do not apply the O2 until the medical director has been contacted.

C) Recommend a flow of at least 5 L/min to washout carbon dioxide (CO2).

A physician orders supplemental O2 for a patient through a nasal cannula at a flow of 12 L/min. When you ask what the goal is, the physician states that the patient should receive approximately 60% O2. Which of the following should you recommend? A) The O2 should be given through a reservoir mask at 10 L/min. B) The cannula flow should be set to 15 instead of 12 L/min. C) The O2 should be given through a simple mask set at 5 to 12 L/min. D) The O2 should be given through a simple mask set at 12 to 15 L/min.

C) The O2 should be given through a simple mask set at 5 to 12 L/min.

Which of the following factors should be used in properly selecting an O2 delivery device? 1. Knowledge of general performance of the device 2. Physician's preference 3. Individual capabilities of the equipment A) 2 and 3 only B) 1 and 2 only C) 1, 2, and 3 D) 1 and 3 only

D) 1 and 3 only

Which of the following would indicate a need for O2 therapy for an adult or a child? 1. SaO2 less than 90% 2. PaCO2 greater than 45 mm Hg 3. PaO2 less than 60 mm Hg A) 2 and 3 only B) 1 and 2 only C) 1, 2, and 3 D) 1 and 3 only

D) 1 and 3 only

A well-designed oxygen protocol will ensure which of the following? 1. The patient undergoes initial assessment. 2. The patient is evaluated for protocol criteria. 3. The patient receives a treatment plan that is modified according to need. 4. The patient stops receiving therapy as soon as it is no longer needed. A) 1, 2, and 4 only B) 2 and 3 only C) 1 and 3 only D) 1, 2, 3, and 4

D) 1, 2, 3, and 4

In giving O2 to an infant through a hood, which of the following are correct? 1. A neutral thermal environment should be maintained. 2. Gases should be directed away from the infant's face. 3. High input flow (>10 to 15 L/min) should be avoided. 4. A minimum flow of 7 L/min must be maintained. A) 1, 2, and 3 only B) 2 and 4 only C) 2, 3, and 4 only D) 1, 2, 3, and 4

D) 1, 2, 3, and 4

What are some key patient considerations in selecting O2 therapy equipment? 1. Type of airway (natural or artificial) 2. Severity and cause of the hypoxemia 3. Age group (infant, child, adult) 4. Stability of the minute ventilation A) 2 and 4 only B) 1, 2, and 3 only C) 3 and 4 only D) 1, 2, 3, and 4

D) 1, 2, 3, and 4

Which of the following factors will decrease the FiO2 delivered by a low-flow O2 system? 1. Short inspiratory time 2. Fast rate of breathing 3. Lower O2 input 4. Large minute ventilation A) 2 and 4 only B) 1, 2, and 3 only C) 3 and 4 only D) 1, 2, 3, and 4

D) 1, 2, 3, and 4

Directing a cool O2 mixture to an infant in an Oxy-Hood can result in which of the following? 1. Increased O2 consumption 2. Increased convective heat loss 3. Apnea (cessation of breathing) A) 1 and 2 only B) 2 and 3 only C) 1 and 3 only D) 1, 2, and 3

D) 1, 2, and 3

To prevent an adverse rebound effect when withdrawing NO therapy, what should you do? 1. Reduce the NO to the lowest effective dose (ideally, less than 5 ppm). 2. Hyperoxygenate the patient just before discontinuing NO. 3. Ensure that the patient is hemodynamically stable. A) 1 and 2 only B) 2 and 3 only C) 1 and 3 only D) 1, 2, and 3

D) 1, 2, and 3

Specific clinical objectives of oxygen (O2) therapy include which of the following? 1. Decrease the symptoms caused by chronic hypoxemia. 2. Decrease the workload hypoxemia imposes on the heart and lungs. 3. Correct documented arterial hypoxemia. 4. Correct documented respiratory acidosis. A) 2 and 4 only B) 3 and 4 only C) 1 and 3 only D) 1, 2, and 3 only

D) 1, 2, and 3 only

Disadvantages of standard O2 masks include which of the following? 1. Being difficult to apply to patients. 2. Patient discomfort (straps and heat). 3. Increasing the risk of aspiration. 4. Must be removed for eating. A) 1 and 3 only B) 1, 2, and 3 only C) 3 and 4 only D) 2, 3, and 4 only

D) 2, 3, and 4 only

Physiologic effects of inhaled nitric oxide (NO) include which of the following? 1. Recruitment of collapsed alveoli 2. Improved blood flow to ventilated alveoli 3. Decreased pulmonary vascular resistance 4. Reduced intrapulmonary shunting A) 1 and 3 only B) 1, 2, and 3 only C) 3 and 4 only D) 2, 3, and 4 only

D) 2, 3, and 4 only

Which of the following are true about air-entrainment systems? 1. Their FiO2 values are directly proportional to their total flow. 2. They can provide variable FiO2 values under some clinical conditions. 3. They always deliver O2 concentrations less than 100%. 4. They yield a set FiO2 only if their flow exceeds the patient's. A) 1 and 3 only B) 1, 2, and 3 only C) 3 and 4 only D) 2, 3, and 4 only

D) 2, 3, and 4 only

Which of the following statements are true about low-flow O2 delivery systems?1. The greater the patient's inspiratory flow, the greater is the FiO2. 2. All low-flow devices provide variable O2 concentrations. 3. The O2 provided by a low-flow device is diluted with air. 4. The patient's flow usually exceeds that from a low-flow device. A) 1 and 3 only B) 1, 2, and 3 only C) 3 and 4 only D) 2, 3, and 4 only

D) 2, 3, and 4 only

A 45-year-old patient with congestive heart failure is receiving O2 through a 35% air-entrainment mask. With an O2 input of 6 L/min, what is the total output gas flow? A) 16 L/min B) 24 L/min C) 28 L/min D) 36 L/min

D) 36 L/min

During hyperbaric oxygen therapy at 3 ATA, plasma contains about how much dissolved O2? A) 1 ml/dl B) 3 ml/dl C) 5 ml/dl D) 7 ml/dl

D) 7 ml/dl

You design an air-entrainment system that mixes air with O2 at a fixed ratio of 1:7. Approximately what O2 concentration will this device provide? A) 33% B) 40% C) 80% D) 90%

D) 90%

Which of the following devices would you select if the goal was to accurately meter the flow through a jet nebulizer? A) Bourdon gauge B) Flow restrictor C) Uncompensated Thorpe tube D) Compensated Thorpe tube

D) Compensated Thorpe tube

Which of the following is true about reservoir cannulas? A) They reduce O2 use as much as 200%. B) During exercise, they do not reduce O2 use. C) Humidification is absolutely necessary. D) Nasal anatomy and breathing pattern can affect performance of the device.

D) Nasal anatomy and breathing pattern can affect performance of the device.

What is the fire-risk classification of both N and CO2? A) Flammable B) Supports combustion C) Inflammable D) Nonflammable

D) Nonflammable

According to the National Institute of Standards and Technology of the U.S. Department of Commerce, a gas cylinder that is color-coded brown and green should contain which of the following? A) O2-N2 mixture B) O2-CO2 mixture C) CO2 D) O2-He mixture

D) O2-He mixture

You connect an intubated patient to an air-entrainment nebulizer system through a T tube set at 60% with an input flow of 15 L/min. Toward the middle of inspiration, you observe that mist stops exiting from the open end of the T tube. What does this indicate? A) Flow is adequate to meet patient needs. B) Patient has a low inspiratory flow rate. C) Flowmeter must be calibrated. D) Patient is not receiving 60% O2.

D) Patient is not receiving 60% O2

Physiologic effects of hyperbaric oxygen (HBO) therapy include all of the following except: A) neovascularization. B) bubble reduction. C) enhanced immune function. D) systemic vasodilation.

D) systemic vasodilation.