Exam Prep Exam 5 (Ch. 12, ,13, and 14)

A respiratory therapist is going to assist in the ambulance transport of a 25-year-old patient. The patient has an oral endotracheal tube, and bag/mask ventilation will be performed during the trip. Which of the following should be chosen to help ensure that the endotracheal tube stays properly placed within the trachea?

Colorimetric CO2 detector

A 2-year-old child admitted with severe croup has just been extubated after 2 days with an oral endotracheal tube. The child is given oxygen and aerosolized water through a heated large-volume nebulizer. Thirty minutes later, mild inspiratory stridor is heard over the child's throat area. What should be done first?

Deliver nebulized racemic epinephrine.

While connecting the suction catheter to the vacuum tubing, a respiratory therapist accidentally touches the tip of the catheter with the clean-gloved hand. What should be done?

Discard the catheter and start over

An adult patient receiving mechanical ventilation with 80% oxygen and 10 cm H2O PEEP experiences hypoxemia, tachycardia, and hypotension every time open-airway suctioning is performed. What should the respiratory therapist recommend to the physician?

Discontinue suctioning until a closed-airway suctioning system can be set up

An 18-year-old woman has been admitted after being found unconscious from a drug overdose. She has severe atelectasis of the left lung caused by lying on her left side for 2 days. Her right lung is normal. She is going to require mechanical ventilation to open the atelectatic areas. What endotracheal tube should be suggested to properly treat the abnormal lung?

Double lumen

A respiratory therapist is ordered to give an IPPB treatment to a comatose patient who has lip ulcers. What patient-machine connection should be used?

Face mask

A 50-year-old male patient with throat cancer will be having a laryngectomy tomorrow with the placement of a voice prosthesis. What type of airway would best serve the patient's long-term needs?

Fenestrated laryngectomy tube

A 67 year old woman who suffered a stroke is having difficulty swallowing her oral secretions. An order is written to perform oropharyngeal suctioning. What risks or hazards are associated with this procedure?

Gagging

If a patient has a PaO2 of 65 mm Hg, the most important step to take to prevent hypoxemia during suctioning is to

Give the patient 100% O2 before and after the procedure

During a CPR attempt, a pediatric patient had an oral endotracheal tube placed. To ensure that the endotracheal tube is placed properly, all of the following should be recommended EXCEPT:

Have a lateral neck radiograph taken.

A spontaneously breathing patient's tracheostomy tube cuff pressure has been measured at 10 mm Hg. What would be recommended?

Increase the cuff pressure to 15 mm Hg.

It is difficult to remove the tracheal secretions from an adult patient using -60 mm Hg of vacuum pressure. What should be done?

Increase the vacuum pressure to -80 mm Hg

A semiconscious patient with many tracheal secretions will need frequent nasotracheal suctioning. What can be done to minimize trauma from the procedure?

Insert a nasopharyngeal airway.

A patient who suffered facial burns and smoke inhalation has recovered enough to be extubated. Although the patient is receiving 40% oxygen with a bland aerosol, significant inspiratory stridor is noticed within 15 minutes. Following the inhalation of a vasoconstricting medication, the patient's breath sounds are improved. Thirty minutes later the patient's SpO2level is 80% and the inspiratory stridor is more serious. The patient is very anxious and is pulling off the oxygen mask. What should the respiratory therapist recommend to best manage the patient's problem?

Intubate the patient.

All of the following statements about the use of a Lukens trap are true EXCEPT:

It is indicated for a patient with a strong, productive cough

During a surgical procedure, the anesthesiologist wishes to protect the patient's airway and provide mechanical ventilation, but does not want to place an endotracheal tube. What airway should be used?

Laryngeal mask airway

A respiratory therapist has just assisted with the endotracheal intubation of a normotensive adult patient. To minimize the risk of soft-tissue injury to the trachea, the tube cuff pressure should be

Less than 30 cm H2O

During nasotracheal suctioning, it is important to:

Lubricate the catheter tip with a sterile, water soluble lubricant jelly

When a catheter OD is selected for suctioning through an infant's TT, it is important that the OD be:

No more than 70% the ID of the tube

An unconscious 17-year-old patient has arrived in the Emergency Department. The patient was involved in an automobile accident, has a neck injury, and is wearing a neck brace. If the patient were to show signs of an upper-airway obstruction, all of the following could be used to maintain the airway EXCEPT:

Oral endotracheal tube

An intubated patient has pneumonia, and a sputum sample must be sent to the labortory for culture and sensitivity testing. What is the most appropriate way to obtain a sample?

Place a Lukens trap between the suction catheter and the vacuum tubing

A 45-year-old female patient is brought into the Emergency Department from an automobile accident. She has facial trauma, including a broken nose and jaw. Because of heavy bleeding into her mouth, she is having difficulty breathing. Which of the following should be recommended to ensure a safe, effective airway?

Place a tracheostomy tube.

A hospitalized patient rapidly develops ventilatory failure because of an accidental overdose of morphine sulfate for pain control. The preferred way to quickly provide a safe, secure airway is to:

Place an oral endotracheal tube.

Auscultation of a recently intubated patient in respiratory failure reveals absent breath sounds on the left side of the chest. The most likely cause of this finding is:

Placement of the endotracheal tube into the right mainstem bronchus

An intubated and mechanically ventilated adult patient has been returned to the long-term care unit after being transported to the radiology department for an abdominal radiograph examination. The respiratory therapist observes that the patient's trachea is midline; however, the patient's left chest area does not rise with inspiration as much as the right chest area. The endotracheal tube is at the 28-cm mark at the patient's teeth. What should be done now?

Pull the endotracheal tube back about 4 cm.

A ventilator-dependent patient required a vacuum pressure of -120 mm Hg to remove thick secretions. After treatment with a mucolytic drug, that patient's secretions are muc easier to remove. What should be recommended?

Reduce the vacuum pressue to -100 mm Hg and monitor the ease of secretion removal

An adult patient with a tracheostomy button and an attached speaking valve is complaining that it is difficult to breathe. You find that a 12-Fr suction catheter cannot be passed through the button. What should be done?

Remove the speaking valve and assess the patient.

A patient with a tracheostomy has just returned from a series of radiography procedures. Suddenly, the patient develops respiratory distress and cannot breathe. A suction catheter cannot be passed through the tracheostomy tube. What should be done?

Remove the tracheostomy tube.

A respiratory therapist notices that a patient's Yankauer suction catheter is cracked. The best thing to do is:

Replace the catheter

A 55-year-old, 77-kg (170-lb) ventilator-dependent male patient has returned from the operating room with a 6.0-mm-ID tracheostomy tube. The respiratory therapist determines the cuff pressure to be 35 mm Hg. The ventilator is delivering a tidal volume of 750 mL and returning a tidal volume of 650 mL, and a leak can be heard at the tracheostomy site. What should be done?

Replace the tracheostomy tube with one that is 8.5-mm ID.

After a successful CPR attempt, a patient with an oral endotracheal tube is placed on a mechanical ventilator in the Intensive Care Unit. The respiratory therapist notices that the exhaled CO2 monitor is appropriately changing color with each breath cycle. The patient's breath sounds are present on the right side but diminished on the left side. What is the most likely cause of this situation?

Right bronchial intubation

If a patient complains of difficulty in starting the IPPB treatment, which control should be adjusted?

Sensitivity

When preparing to suction a patient, all of the following should be done EXCEPT:

Set the vacuum control to FULL

A conscious patient requires nasotracheal suctioning. During the procedure, the patient's blood pressure decreases to 100/60 mm Hg, and the heart rate decreases from 110 to 60 beats/min. What should be done?

Shorten the suctioning time

A 17 year old patient with an oral ET has just had open-airway suctioning performed. The respiratory therapist notes that bright red blood is removed, along with some clear secretions. What sould be done?

Stop the suctioning procedure and monitor the patient

A respiratory therapist is giving an IPPB treatment when the patient complains of a sharp chest pain. After a few more deep breaths, the patient is short of breath. The therapist notices that the patient's breath sounds are now diminished on the left side. What should be done?

Stop the treatment and notify the physician of the patient's complaints

A conscious patient is recovering from Guillain-Barré syndrome and is able to breathe spontaneously off of the mechanical ventilator for several hours. The patient currently has a single-cannula 7.5-mm-ID tracheostomy tube. To help the patient's weaning process but enable the patient to be ventilated at night, what should be done?

Substitute a fenestrated tracheostomy tube.

A patient is receiving mechanical ventilation through an 8-mm oral ET. Over the course of the shift, the patient is seen to have more tracheal secretions. What is the best course of action?

Suction more often

A patient is having difficulty keeping a tight seal around the mouthpiece. The patient comaplains that the breath is too long and takes out the mouthpiece. To help cycle off the PR-2, what should be adjusted?

Terminal flow

While giving IPPB treatment with a Vortran unit, a hissing sound is heard and the patient complains that the inspiratory time is too long. What is the most likely problem?

The nebulizer medication jas is loose

Indications for oral intubation include all the following EXCEPT:

The patient has a cervical spine injury.

A respiratory therapist replaces a patient's tracheostomy tube with another one of the same size and inflates the cuff with 5 mL of air as was done previously. Immediately, the patient has difficulty breathing and no air can be felt coming from the tube. What could be the problem?

The tip of the tube has been placed into the subcutaneous tissues.

A patient is being mechanically ventilated with 60% oxygen and 8 cm H2O of PEEP. The patient's SpO2 and blood pressure have decreased twice when removed from the ventilator for suctioning. What should be recommended to prevent this from happening again?

Use a closed-system suction catheter

An adult patient with epilepsy has been having unpredictable seizure activity. What oral endotracheal tube should be suggested to provide a secure airway?

Wire reinforced

The respiratory therapist is called to set up a suctioning system for a new patient in the intensive care unit. To measure the vacuum pressure, what should be done?

check the manometer while pinching off the connecting tube

A respiratory therapist is about to give an asthmatic 16 year old female patient her second IPPB treatment with a bronchodilator medication. When checking the equipment, it is noticed that the equipment is set with a rather fast inspiratory flow. Her chart had a notes that she was very anxious when first admitted. She seems calmer now. How should the treatment be started?

decrease the flow on the machine

A respiratory therapist is giving an IPPB treatment with a Bird Mark 7 unit. To give the patient 100% O2, the air-mix control knob is pushed in. What effect does this adjustment have on the flow rate to the patient?

decreases the flow of gas

A patient has a IPPB Vt goal of 900 mL but is exhaling only 700 mL. There is no air leak. What should be done to deliver a larger volume?

increase the delivered pressure

A 13 year old patient with cystic fibrosis is receiving IPPB to deliver an aerosolized bronchodilator and mucolytic. The respiratory therapist notices that the pressre gauge needle is bouncing higher and lower as the patient takes a breath. What should be done?

increase the flow

A 30 year old postoperative patient with clear breath sounds is receiving mechanical ventilation. The patient was suctioned 2 hours ago with scant results. The nurse wants to suction the patient again before the shift change. What should be recommended?

shallow suctioning

A 40 year old patient has pneumonia in the left lower lobe with a large amount of secretions. What should be recommended for better suctioning?

use a suction catheter with a Coude tip

At the start of IPPB treatment, at what level should the sensitivity control be set at on a Bird unit?

-1 cm H2O

A 47 year old woman with chronic obstructive pulmonary disease and pneumonia has copious amount of thick secretions. Nasotracheal suctioning is being initiated because of her weak, ineffective cough. What is the maximum suctioning pressure that may be used?

-150 mm Hg

A newborn child with macroglossia is having moderate airway obstruction episodes. What could be done to help manage the current situation? 1. Place a nasopharyngeal airway. 2. Place a tracheostomy button. 3. Place the newborn in the prone position. 4. Place an oral endotracheal tube.

1 and 3 only

An IPPB treatment should be stopped under which of the following conditions? 1. you suspect the patient has a pneumothorax 2. the patient has difficulty keeping the lips sealed 3. the patient feels faint and dizzy 4. the patient coughs up blood

1 and 4 only

A patient is about to have an oral endotracheal tube inserted. What can be done during and/or after the procedure to determine its position within the trachea? 1. Get a chest radiograph. 2. Palpate the larynx during insertion. 3. Auscultate bilateral breath sounds. 4. Attach an EDD after the tube is placed. 5. Check for exhaled carbon dioxide.

1, 2, 3, 4, 5

An intubated patient has thick secretions. The nurse has recommended that normal saline be instilled inot the patient's trachea. What are the possible adverse effects of doing this? 1. endotracheal tube biofilm is displaced 2. hypoxemia 3. bronchospasm 4. excessive coughing

1, 2, 3, and 4

While working the night shift, a respiratory therapist is called to intubate an apneic patient. Which of the following would be needed for an emergency oral intubation? 1. Laryngoscope handle 2. Stylet 3. Proper laryngoscope blade 4. 10-mL syringe 5. Magill forceps

1, 2, 3, and 4 only

A patient in the recovery room is found to have a tracheostomy tube cuff pressure of 35 mm Hg. If left unchanged, this cuff pressure could cause which of the following? 1. Tracheomalacia 2. Tracheoesophageal fistula 3. Innominate artery erosion 4. Damage to the vocal cords 5. Loss of venous flow through the tracheal soft tissues

1, 2, 3, and 5 only

Immediate complications of an oral intubation include all of the following: 1. Tooth trauma 2. Esophageal intubation 3. Tracheoesophageal fistula 4. Bronchial intubation

1, 2, and 4 only

Placing a suction catheter into a patient's trachea and applying vacuum pressure causes: 1. transient hypozemia 2. removal of secretions 3. stopping of the hypoxic drive because of vagal stimulation 4. Removal of air from the lungs

1, 2, and 4 only

While a respiratory therapist is preparing to suction a patient for a mucus sample it is noticed that the vacuum is not reaching the end of the catheter. Which of the following are possible causes? 1. The vacuum is not turned on 2. All connections are airtight 3. The catheter is plugged with foreign matter 4. The specimen jar is not screwed tightly into the special lid

1, 3, and 4 only

The proper-size suction catheter should be no larger than what fraction of an adult Et's inner diameter?

1/2

A patient with pulmonary edema has cyanotic lips and nail beds. What O2 percentage should be recommended for IPPB treatment?

100%

An 82-kg (180 pound) male is recovering after an accidental drug overdose. Because of hypoventilation and being semicomatose, he has developed bilateral atelectasis. Calculate the ideal minimum IPPB-delivered Vt goal for him. His spontaneous Vt is 600 mL.

1400 mL

The Combitube has advantages over the standard LMA because: 1. It can be placed nasally. 2. A gastric tube can be placed through it to empty the stomach. 3. It is available in small pediatric sizes. 4. The patient can be ventilated whether it is placed into the esophagus or the trachea.

2 and 4 only

A properly inserted Combitube will usually: 1. Intubate the trachea 2. Intubate the esophagus 3. Prevent vomiting 4. Maintain the airway

2, 3, and 4 only

An oropharyngeal airway would be indicated under which of the following conditions? 1. Maintain the airway before a tracheostomy. 2. Seizure activity is expected or present. 3. Supine unconscious patient with an upper-airway obstruction 4. Patient with a traumatic jaw injury 5. An orally intubated patient is biting the tube.

2, 3, and 5 only

While working in the neonatal Intensive Care Unit, a respiratory therapist is called to assist in the care of a 900-gram premature newborn. The neonatologist asks you to get the proper endotracheal tube for intubation. What would be the correct size tube?

2.5-mm ID

The best positions in which to place a patient before nasotracheal suctioning are: 1. Supine 2. Trendelenburg 3. Sniff (neck and head hyperextended) 4. Semi-Fowler's

3 and 4 only

A respiratory therapist is preparing a stainless-steel-type laryngoscope handle and blade for an anesthesiologist. The light does not shine. Which of the following should be done to fix the problem? 1. Get a smaller blade to fit the handle. 2. Get a larger blade to fit the handle. 3. Tighten the light bulb. 4. Replace the handle with a plastic one. 5. Replace the batteries.

3 and 5 only

A 45 year old female 50 kg (110 pound) patient is recovering after abdominal surgery. The physician has ordered IPPB to help correct her atelectasis after IS was found to be ineffective, Her spontaneous Vt is 350 mL. Based on this information at what level should her minimum initial IPPB Vt be seT?

450mL

A 28-year-old patient is brought into the Emergency Department. The patient has a cervical spine injury from a diving accident and is wearing a neck brace. The patient is unconscious and inspiratory stridor can be heard. Arterial blood gases on 40% oxygen show the following: PaO257 mm Hg, PaCO2 56 mm Hg, and pH 7.30. The physician has decided to establish a secure airway. What device should be recommended?

7.0-mm nasotracheal tube

A 59-kg (130-lb) woman must be intubated to initiate mechanical ventilation. What size tube should be used?

7.5-mm ID

While assisting with a CPR attempt, the anesthesiologist asks for a properly sized endotracheal tube so that the patient's airway can be quickly intubated. The patient is a large, physically fit man. What tube would be best?

A 9.0-mm-ID oral endotracheal tube

All of the following indicate the need for IPPB EXCEPT:

A cooperative patient with atelectasis

In the emergency department, a respiratory therapist is giving an IPPB treatment with albuterol (AccuNeb) to an asthmatic male patient. During a break in the treatment, the patient complains that his lungs feel too full and he does not feel like all the IPPB volume is getting out. What should be done?

Add expiratory retard

A respiratory therapist is assisting with the extubation of an adult patient. At what point in the procedure should the tube be removed?

At the end of a peak inspiratory effort

All of the following should be monitored after a patient returns from having a tracheostomy tube placed EXCEPT: A. Cuff pressure B. Bowel sounds C. Breath sounds D. Excessive bleeding

Bowel sounds

An adult female patient is recovering from her neuromuscular disease. She has a standard tracheostomy tube and requires mechanical ventilation only during the night when sleeping. The physician asks the respiratory therapist for a recommendation about what can be done to enable her to communicate during the day but be put on the ventilator at night. What should be recommended?

Change her to a fenestrated tracheostomy tube.

A 16 year old young woman is receiving mechanical ventilation via a 7 mm ET. After she is suctioned with a 14 Fr catheter, the electrocardiograph monitor shows that she is bradycardic. What should be recommended?

Change to a 10-Fr catheter