Egan's Chapter 38 humidity and bland aerosol therapy

for which of the following patients would you select a heated humidifier? 1. patient receiving oxygen through a bypassed upper Airway 2. patient receiving long-term mechanical ventilation 3. patient receiving oxygen through an oronasal mask a. 2 b. 2 & 3 c. 3 d. 1 & 2

1 & 2

the relief valve on a bubble humidifier serves which of the following functions? 1. it indicates when flow has been interrupted 2. it protects the device from pressure damage 3. it warns you when the water level is low a. 2 & 3 b. 1 & 3 c. 1 & 2 d. 1 2 & 3

1 & 2

what are some problems common to mist tents? 1. heat retention 2. CO2 buildup 3. hypothermia a. 1 & 2 b. 1 & 3 c. 1 2 & 3 d. 2 & 3

1 & 2

what should happen when the remote temperature sensor of a heated humidifier becomes disconnected or fails? 1. power to the heater should be interrupted 2. auditory and visual alarm should be triggered 3. the units outlet valve should lock closed a. 2 & 3 b. 1 2 & 3 c. 1 & 2 d. 1 & 3

1 & 2

For which of the following patients would you NOT recommend Bland aerosol therapy administration? 1. Patient with a history of Airway hyperresponsiveness 2. patient with bypassed upper Airway 3 patient with active bronchoconstriction a. 2 & 3 b. 1 & 2 c. 1 2 & 3 d. 1 & 3

1 & 3

a physician orders bland water aerosol administration to a patient with a tracheostomy. Which of the following Airway devices would you use to meet this goal? 1. tracheostomy mask 2. face tent 3. T tube 4. aerosol mask a. 1 2 & 3 b. 2 & 4 c. 1 & 3 d. 2 3 & 4

1 & 3

For which of the following patients might you recommend bland aerosol therapy administration? 1. patient with upper airway edema 2. patient with the bypassed upper airway 3. patient who must provide a sputum specimen a. 1 2 & 3 b. 1 & 2 c. 2 & 3 d. 1 & 3

1 2 & 3

administration of dry gases at flows exceeding 4 liters per minute can cause which of the following? 1. structural damage 2. heat loss 3. water loss a. 1 & 2 b. 1 & 3 c. 1 2 & 3 d. 2 & 3

1 2 & 3

inhalation of dry gases can do which of the following? 1. increase viscosity of secretions 2. impaired mucociliary motility 3. increase airway irritability a. 3 b. 1 & 2 c. 1 & 3 d. 1 2 & 3

1 2 & 3

what are some types of Passover humidifiers? 1. simple reservoir 2. membrane 3. wick a. 1 2 & 3 b. 1 & 3 c. 1 & 2 d. 2 & 3

1 2 & 3

which of the following are types of heat moisturizer exchangers (HMEs)? 1. simple condenser 2. hygroscopic condenser 3. hydrophobic condenser a. 3 b. 2 & 3 c. 1 & 2 d. 1 2 & 3

1 2 & 3

which of the following types of humidifiers are used in clinical practice? 1. heat moisture exchanger 2. Passover humidifier 3. bubble humidifier a. 2 & 3 b. 1 2 & 3 c. 1 & 3 d. 1 & 2

1 2 & 3

Clinical indications for delivering cool humidified gas include which of the following? 1. Post-extubation edema 2. Upper Airway inflammation 3. Croup ( Layngotracheol bronchitis) 4. Epiglottitis a. 2 3 & 4 b. 1 2 & 3 c. 1 2 3 & 4 d. 2 & 3

1 2 3 & 4

for what should sputum collected by aerosol therapy induction be inspected? 1. color 2. volume 3. odor 4. consistency a. 1 & 3 b. 1 2 & 3 c. 2 & 4 d. 1 2 3 & 4

1 2 3 & 4

key considerations in selecting a recommended humidity or bland aerosol therapy for a patient include which of the following? 1. require gas flow 2. presence of an artificial tracheal airway 3.character of pulmonary secretions 4. need for or duration of mechanical ventilation 5.lresence of heat moisture exchanger contraindications a. 1 2 & 3 b. 2 3 & 4 c. 3 4 & 5 d. 1 2 3 4 & 5

1 2 3 4 & 5

which of the following are components of an ultrasonic nebulizer? 1. air-entrainment orifice 2. radio-frequency generator 3. nebulizer chamber 4. piezoelectric transducer 5. blower or fan a. 2 3 4 & 5 b. 3 4 & 5 c. 1 2 3 4 & 5 d. 1 3 & 4

2 3 4 & 5

all of the following are features of an ideal heat moisturizer exchanger except: a. minimal flow resistance b. 70% or higher efficiency c. minimal dead space d. High compliance

High compliance

simple unheated bubble humidifiers are commonly used to humidify gases with what type of systems? a. mechanical ventilation b. oronasal oxygen delivery c. aerosol drug delivery d. tracheal oxygen Airway

Oronasal oxygen delivery

a patient has been supported by a mechanical ventilator using a heat moisturizer exchanger for the last 3 days. Suctioning reveals an increase in the amount of tenacity of secretions. Which of the following actions is indicated? a. Switch the patient to a large volume heated humidifier b. Reassess the patient secretions over the next 24 to 48 hours c. Replace the hygroscopic condenser humidifier with a new one d. Increase the hygroscopic condenser humidifier temperature

Switch the patient to a large volume heated humidifier

All of the following are TRUE when heated wire circuits are used with heated humidifiers except: a. The humidifier works at a higher temperature b. There is less infection risk for both patient and caregivers c. Cost savings (less water and staff time) are realized d. There is less condensate and a reduced need for drainage

a. The humidifier operates at a higher temperature

When using nebulizers, where should you place them to minimize risk of contamination? a. in the inspiratory limb only, at a high point in the circuit b. in the expiratory limb only, at a low point in the circuit c. in both the expiratory and inspiratory limbs, at high points in the circuit d. both the expiratory and inspiratory limbs, at low points in the circuit

a. in the inspiratory limb only, at a high point in the circuit

When using a servo-controlled heated humidifier to deliver gas to an infant, the thermistor probe should be placed where? a. inside the circuit, outside the incubator, or away from the radiant warmer. b. inside the circuit, inside the incubator, or away from the radiant warmer c. outside the circuit, inside the incubator, or away from the radiant warmer d. outside the circuit, outside the incubator, or away from the radiant warmer

a. inside the circuit, outside the incubator, or away from the radiant warmer.

a patient receiving nasal oxygen at 3 liters per minute complains of nasal dryness and irritation. which of the following actions would be appropriate? a. recommending that the flow be increased 4 liters per minute b. adding a humidifier to the delivery system c. recommending that the flow should be decreased to 2 liters per minute d. switching to simple mask at 3 liters per minute

adding a humidifier to the delivery system

Which of the following would indicate that administration of a bland water aerosol to a patient with post-extubation upper airway edema was having the desired effect? 1. decreased work of breathing 2. improved vital signs 3. decreased stridor or dyspnea 4. improved oxygen saturation a. 1, 2 and 4 b. 1, 2, 3 and 4 c. 3 and 4 d. 1, 2, and 3

b. 1, 2, 3 and 4

when is a heat moisture exchanger(HME) performing well? a. condensate appears in the attached flex tube b. condensate is visible on the filter or insert c. the HME temperature is at least 40° C d. no condensate is visible on the filter or insert

condensate appears in the attached flex tube

why should you NOT heat the reservoirs of a bubble humidifier used with an oronasal oxygen delivery system? a. heating what causes too much aerosol impaction b. condensate will obstructed delivery tubing c. heating will melt the reservoir or cause a fire d. heating will absorb the extra water vapor

condensate will obstructed delivery tubing

a patient with chronic obstructive pulmonary disease is receiving heated water aerosol treatments through a jet nebulizer for times daily as a supplement to other bronchial hygiene measures designed to aid in mobilizing retain secretions. After each session, you notice the presence of moderate wheezing. Which of the following recommendations would you make to the physician? a. discontinue the heated water aerosol treatments b. consider prior treatment with a bronchodilator c. discontinue the other bronchial hygiene measures d. switch to a higher density aerosol

consider prior treatment with a bronchodialator

In checking a servo-controlled heated-wire humidifier system, you notice that a few drops of condensate tend to form but only near the patients airway. Based on this observation, what can you conclude? a. The temperature setting of the heater is to high b. The temperature setting off the heater is to low c. The airway temperature exceeds the dew point d. The gas at the airway is fully saturated

d. The gas at the airway is fully saturated.

hazards and complications of bland aerosol therapy include all of the following except: a. bronchospasm b. infection c. hemoconcentration d. overhydration

hemoconcentration

what device adds molecular water to gas? a. agitator b. nebulizer c. atomizer d. humidifier

humidifier

all of the following are potential hazards of using a heated humidifier during mechanical ventilation except: a. aerosolization of condensate during disconnection b. unintended tracheal lavage from condensate c. hypoventilation due to increased dead space d. under hydration or impaction of secretions

hypoventilation due to increased dead space

when using water traps to help minimize the problems caused by condensation in a heated humidifier ventilator circuit, where would you place the traps? a. in both the expiratory and inspiratory limbs at high points in the circuit b. in both the expiratory and inspiratory limbs at low points in the circuit c. in the expiratory limb only at high point in the circuit d. in the expiratory limb only at low point in the circuit

in both the expiratory and inspiratory limbs at low points in the circuit

where should you place the thermistor probe for a servo-controlled heated humidifier being used on a patient receiving mechanical ventilation?a. a. in the inspiratory limb of the circuit as close to the Wye as possible b. in the inspiratory limb of the circuit near but not at the Wye c. in the expiratory limb of the circuit as close to the Wye as possible d. in the expiratory limb of the circuit near but not at the Wye

in the inspiratory limb of the circuit near but not at the Wye

all of the following are true of heat moisture exchanger except: a. in-use HMEs have little effect of low resistance of breathing b. moisture output falls at high volumes and rates of breathing c. High inspiratory flows and high FIO2 values can decrease HME efficiency d. HMEs reduce bacterial colonization of ventilatory circuits

in-use HMEs have little effect of low resistance of breathing

characteristics of a servo-control heated humidifier include all of the following except: a. includes temperature safety alarms b. monitors heater temperature c. adjust heater power automatically d. provides automatic heater shut down

monitors heater temperature

All of the following are potential hazards of using heat moisturizer exchangers except: a. failure of low pressure alarms to detect disconnection b. hypoventilation due to increased dead space c. unintended tracheal lavage from condensate d. under hydration or impaction of secretions

unintended tracheal lavage from condensate

unheated bubble humidifiers are of limited effectiveness at flows above which of the following? a. 10 L/m b. 8 L/m c. 4 L/m d. 6 L/m

10 L/m

all mist tents prevent CO2 to build up by what process? a. recirculating the gas b. providing high gas flows c. using CO2 absorbers d. cooling the gas

Providing high gas flows

all of the following indicate a potential need for administration of water or isotonic saline aerosol except: a. evidence of increase volume of secretions b. stridor or brassy, croup like cough c. horseness after extubation d patient discomfort after bronchoscopy

evidence of increase volume of secretions

which of the following devices would you recommend to administer Bland water aerosol to an infant or small child? a. face tent b. aerosol mask c. t-tube d. croup tents

face tent

after administering a 30-minute bland water aerosol treatment to a dehydrated elderly patient with chronic bronchitis you notice increased wheezing and a general decrease in the intensity of breath sounds. Which of the following is probably occurred? a. patient is developing atelectasis due to over hydration b. nothing: this is a normal response to bland aerosol therapy c. reactive bronchospasm has occurred and worsened airway obstruction d. inspissated secretions have swollen and worsened airway obstruction

inspissated secretions have swollen and worsened airway obstruction

what is the most common device used to generate bland aerosols? a. large volume jet nebulizer b. small volume jet nebulizer c. ultrasonic jet nebulizer d. spinning disk nebulizer

large volume jet nebulizer

what is the primary goal of humidity therapy? a. deliver drugs to the airway b. maintain normal physiological conditions c. decreased airway reactivity to cold d. reduce upper airway inflammation

maintain normal physiological conditions

particle size produced by an ultrasonic nebulizer depends mainly on which of the following? a. chamber baffling b. signal amplitude c. blower (fan) speed d. signal frequency

signal frequency

A patient receiving ventilatory support is being provided with humidification using a heat moisturizer exchanger. A physician orders a bronchodilator drug administered through a metered dose inhaler via the ventilator circuit. Which of the following must be performed to ensure delivery of the drug to the patient? a. the VT setting of the ventilator should be decreased b. the inspiratory flow setting of the ventilator should be increased c. the HME must be removed from the circuit during the MDI use d. a heated humidifier should replace the home when using the MDI

the HME must be removed from the circuit during the MDI use

conditions that can cause temperature "overshoot" with servo-control heated humidifiers include all of the following except: a. the airway temperature probe becomes dislodged b. flow is decreased during normal operation c. the unit is allowed to warm up without flow d. the unit reservoir is refilled with sterile water

the unit reservoir is refilled with sterile water

A neonatologist is concerned about the possibility of hearing damage occurring to a premature infant receiving bland water aerosol delivered via air entrainment nebulizers inside an incubator or isolette. Which of the following would you recommend as the best way to overcome this problem? a. use a heated pass over humidifier instead b. use an ultrasonic nebulizer system instead c. play sound baffles in the aerosol tubing d. Place earplugs in the infant's outer ears

use a heated pass over humidifier instead

Heat moisturizer exchangers are mainly used to do what? a. provide extra humidity for patient with thick or retained secretions b. warm and humidify gases deliver to the trachea via ventilator circuits c. warm and humidify dry therapeutic gas is delivered to the upper Airway d. humidy therapeutic gases delivered at high flows to the lower airway

warm and humidify gases deliver to the trachea via ventilator circuits

all of the following are contraindications for heat moisturizer exchangers except: a. when a patient is suffering from hyperpyrexia b. presence of a large leak around the artificial airway c. when a patient's minute ventilation exceeds 10 liters per minute d. presence of thick, copious, or bloody secretions

when a patient is suffering from hyperpyrexia

how often should heat moisturizer exchangers be inspected and replaced? a. when contaminated by secretions b. at least every shift c. at least every day d. when condensate is visible

when contaminated by secretions