RC2013 Exam 2 Study Guide

after obtaining an arterial blood sample through percutaneous puncture using a syringe that does not have a capping safety device, what should you do?

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

how long should you wait before drawing an ABG on a chronic obstructive pulmonary disease (COPD) patient who's FIO2 has just been changed?

20-30 minutes

what is the maximum total dose of lidocaine that can be administered during CPR?

3 mL/kg

under ideal conditions, pulse oximeter reading patients usually fall in what range of those obtained with invasive hemoximetry?

3% to 5%

if tolerated, a specific postural drainage position should be maintained for at least how long?

3-5 minutes

in general, chest physical therapy can be expected to improve airway clearance when a patient's sputum production exceeds what volume?

30 mL/day

what is normal end-tidal PetCO2 range?

35 go 43 mmHg

what is the normal range for end-tidal CO2 as measured by capnography?

5% to 6% (35-46 mmHg)

you obtain a SpO2 reading of 90% using an oximeter with an approximate accuracy of 5%. this could indicate a PO2 as low as what level?

60%

pulse oximeter readings are generally unreliable at saturations below what level?

80%

tissue injuries to be on guard for at the site of transcutaneous blood gas electrode placement includes all of the following except which one?

Hematomas

to measure PO2, blood gas analyzers use what electrode?

Clark polargraphic

a blood gas analyzer measures all of the following except which one?

HCO3-

all of the following are true about capillary blood gas sampling except which one?

a capillary sample PO2 provides a fairly close estimate of actual arterial oxygenation

which of the following would be most useful in assessing the proper tube placement after endotrachial intubation?

a colorimetric capnometer is used to confirm proper tube placement by identifying the presence of CO2

you are asked to provide continous monitoring of the FIO2 provided by a humidified O2 delivery system using a galvanic cell analyzer. where would you install the analyzer's sensor?

as close to the patient as possible

all of the following are indications for capnography except which one?

assessing a patient's readiness for weaning from ventilation support

what is the measurement of CO2 in respiratory gases called?

capnometry

all of the following sites are used for arterial blood sampling by percutaneous needle puncture except which one?

carotid

which site would be the optimal choice to palpate a pulse on a unresponsive patient?

carotid

after you power on an AED and attach the pads to the victim, what is the next step you should do?

clear the victim so the AED can analyze the heart rhythm

which type of oximeter would you use to determine a patient's carbon monoxide level from smoke inhalation?

co-oximeter

to validate patient readings obtained from a transcutaneous blood gas monitor, what should you do?

compare the monitor's readings to those obtained with a concurrent ABG sample

how is the accuracy of a blood gas analyzer determined?

comparing the analyzer's measurements to known values

which of the following describes the correct procedure for an Allen test?

compress both the radial and ulnar arteries, then release the ulnar artery

which portion of the capnogram most closely corresponds to true alveolar gas?

end of exhalation

what is the greatest hazard of pulse oximetry?

false results leading to incorrect decisions

a physician orders postural drainage for a patient with an abscess in the right middle lobe. which of the following positions would you recommend for this patient?

head down, patient half-rotated to let right lung up

why is strenuous patient coughing during postural drainage in a head-down position contraindicated?

high increase in ICP, hemorrhage

postural drainage should be considered in all of the following situations except which one?

in patients with chronic obstructive lung disease

a mechanically ventilated patient exhibits a sudden decrease in end-tidal CO2 levels. all of the following are possible causes of this change except which one?

increase in CO2 production

while reviewing the chart of a patient receiving postural drainage therapy, you notice that the patient tends to undergo mild desaturation during therapy (a drop in SpO2 from 93% to 89% to 90%) which of the following would you recommend to manage this problem?

increase the patient's FIO2 during therapy

during capnography monitoring of a mechanically ventilated patient, you note that the PetCO2 has dropped to 0 mmHg. all of the following are possible causes of this finding except which one?

increased cardiac output

what is the most common technique used to measure CO2 in respiratory gases?

infared absorption

which of the following is false about laboratory co-oximetry?

it combines the principle of spectrophotometry only is co-ox and photoplethysmography

if assessment of a postoperative surgery patient indicates that pain may hinder implementation of postural drainage therapy, what would you recommend?

keep pain medication schedule in line

Which of the following is false about invasive versus noninvasive monitoring?

laboritory analysis of gas exchange is usually in nature

you are using an AED on an adult victim and the AED gives a "no shock indicated" message. until advance care personnel arrive, what should you do next?

leave the pads on the victim's chest and continue CPR

you must check adequate breathing before giving breaths to an unresponsive victim. you do this by looking for chest rise and feeling for air flow over the victim's nose and mouth. what other signs should you assess?

listen to the airflow from the victim's nose or mouth

required equipment and supplies for percutaneous blood sampling of an adult include all of the following except which one?

local anesthetic

indications for pulse oximetry include all of the following except which one?

measurements of abnormal HB

how long do you check for a pulse before starting chest compressions?

more than 5 seconds but no longer than 10 seconds

soon after you initiate postural drainage in a trendelenburg position, the patient develops a vigorous and productive cough. which of the following actions would be appropriate at this time?

move the patient to the sitting position until the cough subsides

what would be the next step when you find an unresponsive victim who has agonal gasps and you have sent someone to activate the emergency response system?

open the airway and give 2 breaths

what is the most common source of error and false alarms with pulse oximetry?

patient motion artifact

a physician orders postural drainage for a patient with aspiration pneumonia in the superior segment of the left lower lobe. which of the following positions would you recommend for this patient?

patient prone with a pillow under abdomen, bed flat

a physician orders postural drainage for a patient with aspiration pneumonia in the anterior segment of the upper lobes. which of the following positions would you recommend for this patient?

patient supine with a pillow under knees, bed flat

which of the following are not likely to benefit from the application of chest physical therapy techniques?

patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD)

what is the best way to relieve severe chocking in a responsive adult?

perform abdominal thrusts

before performing puncture or cannulation of the radial artery, what should you do?

perform the Allen test to ensure collateral circulation

the application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following?

postural drainage therapy

you must immediately begin monitoring the oxygenation status of an infant admitted to the emergency department in severe respiratory distress. which of the following approaches would you select?

put them on a pulse-ox

during continuous monitoring of an active 5-year-old patient with a finger pulse oximetry probe, you obtain frequent and repeated false low HbO2 alarms (<90%). which of the following would be the best action to take in this situation?

relocate the sensor to a more stable location

during calibration of a Clark polarographic O2 analyzer, you cannot get the sensor read 100% O2, even after adjusting its calibration control. The unit has new batteries. Which of the following actions would be correct?

replace the fuel cell

after you open the airway and pinch the nose of an unresponsive adult or child, which of the following describes the best way to give mouth to mouth breaths?

seal your mouth over the victim's mouth and give 2 breaths, watching the chest rise

to measure PCO2, blood gas analyzers use which electrode?

severinghaus

during chest physical therapy, a patient has an episode of hemoptysis. which of the following actions would be appropriate at this time?

stop therapy, sit the patient up, give O2, and contact the physician

an alert outpatient awaiting bronchoscopy has a SpO2 reading of 81% breathing room air. the patient appears in no distress and exhibits no signs of hypoxemia. which of the following would be the best initial action to take in this situation?

switch sites or replace the sensor probe

which of the following describes a way you can allow the chest to recoil completely after each chest compression?

take your weight off your hands and allow the chest to come back to its normal position

which of the following statements tells why it is important to give early defibrillation to an adult?

the probability of successful defibrillation diminishes rapidly over time

properly performed chest vibration is applied at what point?

throughout expiration

if a patient's chest x-ray shows infiltrates in the posterior basal segments of the lower lobes, what postural drainage position would you recommend?

trandelenburg, on stomach, percussing bases

the polyargraphic analyzer has a quicker response time than the galvanic analyzer. True or false?

true

a doctor orders postural drainage therapy for a postoperative patient who has a history of gastroesophageal reflux. which of the following would you recommend?

wait 1.5 to 2 hours between meals

all of the following would indicate a successful outcome for postural drainage therapy except which one?

decreased sputum production

at the very beginning of exhalation, the PetCO2 normally should be at what level?

0 mmHg

what is the normal gradient between PaCO2 and PetCO2?

1 to 5 mmHg

which of the following conditions are associated with chronic production of large volumes of sputum?

1. bronchiectasis 2. cystic fibrosis 3. chronic bronchitis

after obtaining an arterial blood sample, what should you do?

1. apple pressure to the puncture site until the bleeding stops 2. place the sample in a transport container with ice slush 3. mix the sample by rolling and inverting the syringe

precautions and/or possible complications of arterial puncture include which of the following?

1. arteriospasm 2. embolization 3. infection 4. hemorrhage

while checking the galvanic fuel cell O2 analyzer, you determine that the device fails to read 100% when exposed to pure O2. which of the following actions would be correct?

1. check the function of the PCO2 electrode 2. repair or replace any failed components

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. increased PO2

which of the following centers for disease control (CDC) barrier precautions would you use when obtaining an arterial blood gas (abg) through percutaneous puncture?

1. gloves 2. protective eyewear

absolute contraindications for postural drainage include which of the following?

1. head and neck injury (until stabilized) 2. active hemorrhage with hemodynamic instability

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

which of the following is (are) necessary for normal airway clearance?

1. patent airway 2. functional mucociliary escalator 3. effective cough

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)

percussion should not be performed over which of the following areas?

1. surgery sites 2. bony prominences 3. fractured ribs

which of the following indicate venous admixture during arterial puncture?

1. the need to use syringe suction 2. dark colored blood 3. small sample volumes

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

before a sample of capillary blood is taken, what should you do to the site?

1. warmed to 42 degrees C for 10 minutes 2. cleaned with an antiseptic solution

what is the rate for performing chest compressions for a victim of any age?

100 compressions per minute

you obtain a SpO2 reading of 100% on a patient receiving O2 through a non-rebreathing mask. what range of PaO2 level is possible in this patient?

100 to 600 mmHg

what is the minimum arterial blood gas sample volume recommended for adults?

2 mL

statistically derived limits for internal quality control of blood gas samples are usually set at what appropriate level?

2 standard deviations from the mean

what is the appropriate interval for changing the site for a transcutaneous blood gas monitor sensor?

2-6 hours

continuous SpO2 monitoring (verses a spot check) is indicated in all of the following except which one?

O2 therapy

when performing a modified Allen test on the left hand of a patient, you notice that the palm, fingers, and thumb remain blanched for more than 15 seconds after pressure on the ulnar artery is released. what should you do?

Perform the Allen test on the right hand

to measure PH, blood gas analyzers use which electrode?

Sahn

all of the following are common sites for transcutaneous blood gas electrode placement except which one?

Thigh

which of the following is an antiarrhythmic drug?

amiodarone