Test 5 (Ch. 19)
100. You obtain an SpO2 reading of 90% using an oximeter with an approximate accuracy of 5%. This could indicate a PO2 as low as what level? a. 55 mm Hg b. 60 mm Hg c. 65 mm Hg d. 70 mm Hg
ANS: A
102. An alert outpatient awaiting bronchoscopy has an 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? a. Switch sites or replace the sensor probe. b. Immediately start O2 therapy. c. Obtain an ABG. d. Cancel the bronchoscopy procedure.
ANS: A
104. What is the most common technique used to measure CO2 in respiratory gases? a. Infrared absorption b. Mass spectroscopy c. Photoacoustics d. Raman scattering
ANS: A
106. At the very beginning of exhalation, the PETCO2 normally should be at what level? a. 0 mm Hg b. 15 mm Hg c. 25 mm Hg d. 40 mm Hg
ANS: A
109. What is the normal gradient between PaCO2 and PETCO2? a. 3 to 5 mm Hg b. 5 to 10 mm Hg c. 10 to 15 mm Hg d. 15 to 20 mm Hg
ANS: A
11. Which of the following are reasons for finding an alternative site for arterial puncture? 1. Failed Allen test 2. History of peripheral vascular disease 3. Anticoagulation therapy 4. Presence of a surgical shunt a. 1, 2, and 4 only b. 2 and 4 only c. 1, 2, and 3 only d. 1, 3, and 4
ANS: A
113. During capnography monitoring of a mechanically ventilated patient, you note that the PETCO2 has dropped to 0 mm Hg. Which of the following is the most likely problem? a. Ventilator disconnection b. Tracheal intubation c. Increased cardiac output d. Hypoventilation
ANS: A
14. Which of the following patient parameters does not need to be assessed as part of arterial blood sampling? a. Blood pressure b. Temperature c. Position or activity level d. Clinical appearance
ANS: A
15. Purposes of a needle-capping device include which of the following? 1. To isolate the sample from air exposure 2. To help prevent needlestick injuries 3. To hold the excess anticoagulant a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: A
17. Which of the following Centers for Disease Control and Prevention (CDC) barrier precautions would you use when obtaining an arterial blood gas (ABG) through percutaneous puncture? 1. Gloves 2. Protective eyewear 3. Gown or apron a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: A
25. You return to a patient's room 20 min after drawing an ABG. Which of the following should you check at this time? 1. Puncture site for hematoma 2. Adequacy of distal circulation 3. Prothrombin or partial thromboplastin times a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: A
29. When performing a percutaneous needle puncture of the radial artery, you get only a small spurt of blood. Which of the following is the best action at this time? a. Slowly withdraw the needle until a pulsatile flow fills the syringe. b. Pull out entirely, use a different angle and then reinsert it. c. Slowly advance the needle until a pulsatile flow fills the syringe. d. Repeat the procedure with a fresh blood gas kit.
ANS: A
35. A practitioner forgets to ice an ABG sample and leaves it at room temperature for 45 min. Which of the following parameters can you predict will increase in this sample during that period? 1. PCO2 2. pH 3. PO2 a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3
ANS: A
54. What is the best site for capillary puncture in an infant? a. Lateral aspect of the heel's plantar surface b. Anterior curvature of the heel c. Medial aspect of the heel's plantar surface d. Posterior curvature of the heel
ANS: A
55. Capillary puncture should be performed at or through what location? 1. Edematous tissue 2. Areas with new signs of infection 3. The heal of neonates 4. Previous puncture sites a. 2 and 3 b. 4 only c. 1, 2, and 4 d. 1, 2, 3, and 4
ANS: A
61. To measure PCO2, blood gas analyzers use what electrode? a. Severinghaus b. Clark c. Sahn d. White
ANS: A
69. When inspecting an internal quality-control plot for a blood gas analyzer, you notice several data points sporadically appearing outside the 2 standard deviation (SD) range. This represents what type of analytic error? 1. Random error 2. Bias 3. Imprecision 4. Systematic error a. 1 and 3 only b. 2 and 4 only c. 1, 2, and 4 only d. 1, 2, 3, and 4
ANS: A
7. You are asked to provide continuous monitoring of the FiO2 provided by a humidified O2 delivery system using a galvanic cell analyzer. Where would you install the analyzer's sensor? a. Proximal to the heated humidifier b. On the expiratory side of the circuit c. Distal to the heated humidifier d. As close to the patient as possible
ANS: A
70. The total instrument error (inaccuracy) of a blood gas analyzer equals which of the following? a. Bias + imprecision b. Imprecision + random error c. Bias + systematic error d. Trend error + bias
ANS: A
76. The advantage that point-of-care testing has over traditional laboratory testing is that point-of-care testing: a. reduces turnaround time. b. utilizes equipment that is less expensive. c. does not require trained personnel to run the tests. d. is more accurate than traditional laboratory testing.
ANS: A
85. 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? a. Pulse oximetry (SpO2) b. Transcutaneous monitoring (PtcO2) c. Arterial puncture (PaO2) d. Intraarterial optode monitoring
ANS: A
91. What is the greatest hazard of pulse oximetry? a. False results leading to incorrect decisions b. Pressure sores at the measuring site c. Skin burns due to using incompatible probes d. Electrical shock at the measuring site
ANS: A
94. You are monitoring a nurse acquiring a capillary blood sample from an infant. The nurse immediately punctures the infant's heel with a lancet and then squeezes the puncture site to increase the flow of blood. What mistakes has the nurse made while obtaining the capillary blood sample? 1. Inadequate warming of the capillary bed 2. Squeezing of the puncture site 3. Puncture of the infant's heel 4. Use of a lancet. a. 1 and 2 only b. 3 and 4 only c. 1, 2, and 3 only d. 1, 3, and 4 only
ANS: A
103. What is the measurement of CO2 in respiratory gases called? a. Oximetry b. Capnometry c. Optometry d. Barometry
ANS: B
108. What is a normal end-tidal PETCO2 range? a. 30 to 38 mm Hg b. 35 to 43 mm Hg c. 38 to 46 mm Hg d. 42 to 50 mm Hg
ANS: B
110. What is the normal range for end-tidal CO2 as measured by capnography? a. 0% to 5% b. 5% to 6% c. 6% to 8% d. 35% to 45%
ANS: B
111. During a single-breath capnogram, the sharp downstroke and return to baseline that normally occurs after the end-tidal point indicates what? a. Exhalation of mainly dead space gas b. Inspiration of fresh respiratory gas c. Exhalation of mixed alveolar and dead space gas d. Exhalation of mainly alveolar gas
ANS: B
112. A patient being monitored by capnography exhibits a sudden rise in end-tidal CO2 levels. Which of the following are possible causes? 1. Sudden release of a tourniquet 2. Massive pulmonary embolism 3. Sudden increase in cardiac output 4. Injection of NaHCO3 a. 2 and 3 only b. 1, 3, and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4
ANS: B
13. Which of the following should be monitored during the sampling of arterial blood? 1. Blood pressure proximal to puncture site 2. Presence of pulsatile blood return 3. Presence of air bubbles or clots in sample 4. Appearance of puncture site a. 1, 2, and 3 only b. 2, 3, and 4 only c. 1, 2, 3, and 4 d. 2 and 3 only
ANS: B
16. After obtaining an arterial blood sample through percutaneous puncture using a syringe that does not have a capping safety device, what should you do? a. Remove the needle with a Kelly clamp, then plug the syringe. b. "Scoop" the needle cap up with one hand, then plug the syringe. c. Force the needle into a rubber cork or plastic stopper. d. Manually remove and bend the needle, then plug the syringe.
ANS: B
21. Which of the following describes the correct procedure for an Allen test? a. Compress both the radial and ulnar arteries, and then release the radial artery. b. Compress both the radial and ulnar arteries, and then release the ulnar artery. c. Compress both the radial and ulnar arteries, and then release both arteries at once. d. Compress the brachial artery only and observe circulation to the hand.
ANS: B
22. After obtaining an arterial blood sample, what should you do? 1. Apply pressure to the puncture site until bleeding stops. 2. Place the sample in a transport container with ice slush. 3. Check to see if the patient is getting anticoagulant therapy. 4. Mix the sample by rolling and inverting the syringe. a. 1 and 2 only b. 1, 2, and 4 only c. 3 and 4 only d. 1, 2, 3, and 4
ANS: B
24. Before performing puncture or cannulation of the radial artery, what should you do? a. Fix and tighten a tourniquet above the antecubital fossa. b. Perform the Allen test to ensure collateral circulation. c. Inject heparin into the adjoining subcutaneous tissues. d. Apply firm pressure to the arterial site for 5 min.
ANS: B
27. You are asked to calibrate an O2 analyzer. Which of the following gases would you use for this procedure? 1. 100% oxygen 2. 50% oxygen 3. 21% oxygen (room air) a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: B
28. A patient suffering from traumatic brain injury in the ICU has a PtO2 (tissue oxygen) value of 10 to 15 mm Hg, what does this indicate? a. Normal intracranial pressure b. Ischemic brain damage c. Normal cerebral perfusion d. Cerebral hyperperfusion
ANS: B
30. Which of the following indicates venous admixture during arterial puncture? 1. Need to use syringe suction. 2. Dark-colored blood. 3. Small sample volumes. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: B
31. If patient pain or anxiety occurs during arterial puncture, which of the following will probably occur? a. Hypoventilation b. Hyperventilation c. Respiratory acidosis d. Hypoxemia
ANS: B
33. Which of the following would you expect to occur if too much heparin was used in gathering an ABG sample from a patient breathing room air? a. Increase in HCO3- b. Decrease in PCO2 c. Decrease in pH d. Decrease in PO2
ANS: B
36. When analyzing an ABG sample from a patient with acute respiratory distress syndrome and refractory hypoxemia, you notice a PaO2 of 141 mm Hg and a PaCO2 of 14 mm Hg. Which of the following analytic errors should you suspect? a. Excessive time since sample collection b. Exposure of the blood sample to air c. Excessive heparin in the sample d. Sample admixture with venous blood
ANS: B
37. 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. Decreased pH 3. Increased PO2 a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: B
38. Which of the following can help avoid the problem of arterial blood sample contamination with air? 1. Discarding frothy samples 2. Fully expelling any bubbles 3. Mixing before expelling air 4. Capping syringe quickly a. 2 and 3 only b. 1, 2, and 4 only c. 1 and 4 only d. 1, 2, 3, and 4
ANS: B
4. Which of the following is false about the galvanic fuel cell O2 analyzer? a. It actually measures the PO2 and not the O2 concentration. b. It requires an external power source (alternating current line or batteries). c. It has a slower response time than the Clark electrode. d. Its fuel cells deplete and must be periodically replaced.
ANS: B
46. Before connecting the sample syringe to an adult's arterial line stopcock, what would you do? a. Flush the line and stopcock with the heparinized intravenous solution. b. Aspirate 1 to 2 ml of fluid or blood using a waste syringe. c. Align the stopcock off to the patient and on to the flush solution. d. Increase the flush-solution bag pressure by 20 to 30 mm Hg.
ANS: B
47. After obtaining an arterial blood sample from an arterial line, you would do all of the following except: a. flush the line and stopcock with the heparinized intravenous solution. b. aspirate at least 5 ml of fluid or blood (dead space or waste). c. confirm stopcock port open to intravenous bag solution and catheter. d. confirm undamped pulse pressure waveform on monitor.
ANS: B
50. A mixed venous blood sample obtained from a pulmonary artery catheter sample has a PO2 of 85 mm Hg and a hemoglobin saturation of 95%. Which of the following is likely? 1. The pulmonary artery catheter balloon was not deflated. 2. The sample was drawn from the proximal, not distal port. 3. The blood sample was withdrawn too quickly. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: B
51. All of the following are true about capillary blood gas sampling except: a. capillary sampling can be used in lieu of direct arterial access in some infants and small children. b. a capillary sample PO2 provides a fairly close estimate of actual arterial oxygenation. c. clinicians should exercise caution when using capillary samples to guide decisions. d. properly obtained capillary blood can provide estimates of arterial pH and PCO2 levels.
ANS: B
57. Before a sample of capillary blood is taken, what should you do to the site? 1. Warmed to 42° C for 10 min. 2. Squeezed lightly until blanched. 3. Cleaned with an antiseptic solution. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: B
58. A blood gas analyzer measures which of the following? 1. HCO3- 2. PCO2 3. PO2 4. pH a. 2 and 3 only b. 2, 3, and 4 only c. 2 and 4 only d. 1, 2, 3, and 4
ANS: B
60. Which blood gas analyzer electrode uses a separate reference electrode? a. O2 b. pH c. Clark d. HCO3-
ANS: B
63. What is the process of testing a new blood gas analyzer to confirm a manufacturer's claims? a. Automated calibration b. Performance validation c. Proficiency testing d. Preventive maintenance
ANS: B
64. How is the accuracy of a blood gas analyzer determined? a. Examining the repeatability of the analyzer's results b. Comparing the analyzer's measurements to known values c. Adjusting the offset (or balance) of the instrument d. Adjusting the gain (or slope) of the instrument
ANS: B
68. Statistically derived limits for internal quality control of blood gas samples are usually set at what appropriate level? a. 1 standard deviation from the mean b. 2 standard deviations from the mean c. 3 standard deviations from the mean d. 5 standard deviations from the mean
ANS: B
71. Which of the following factors contributing to imprecision (random) errors during blood gas analysis? a. Sample contamination b. Contaminated buffers c. Statistical probability d. Sample mishandling
ANS: B
72. When analyzing a blood gas control sample, you notice that the result falls outside the 2 SD range. How could you verify that this was a random error (error of imprecision)? 1. Repeat the analysis on a different analyzer. 2. Compare the control to an actual patient sample. 3. Rerun the control sample a second time. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: B
73. Which of the following factors does not contributing to bias (systematic) errors during blood gas analysis? a. Incorrect procedures b. Statistical probability c. Contaminated buffers d. Component failure
ANS: B
74. While analyzing a blood gas control sample, you notice a trending of several PCO2 values above the 2 SD range over the last six control samples run. What corrective action would you consider at this time? 1. Check the function of the PCO2 electrode. 2. Rerun the control sample a second time. 3. Repair or replace any failed components. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: B
77. Which of the following is false about transcutaneous blood gas monitoring? a. Transcutaneous blood gas monitoring provides a reasonable estimate of PaO2 and PaCO2. b. Transcutaneous blood gas monitoring is most accurate when used with older adults. c. Accurate estimates of transcutaneous blood gases are difficult in patients with shock. d. Transcutaneous blood gas monitors use heated skin electrodes to arterialize the blood.
ANS: B
80. Which of the following is not a common tissue injury to be on guard for at the site of transcutaneous blood gas electrode placement? a. Erythema b. Hematomas c. Burns or blisters d. Skin tears
ANS: B
84. What is the appropriate interval for changing the site for a transcutaneous blood gas monitor sensor? a. 1 to 2 hr b. 2 to 6 hr c. 6 to 8 hr d. 8 to 12 hr
ANS: B
86. To avoid thermal injury with transcutaneous blood gas monitor sensors, what should you do? 1. Carefully monitor the sensor temperature. 2. Apply hydrocortisone cream under the sensor. 3. Regularly rotate the sensor site. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: B
89. Which of the following will result in falsely low HbO2 readings with a pulse oximeter? a. Presence of HbCO b. Vascular dyes c. Dark skin pigmentation d. Presence of fetal hemoglobin
ANS: B
92. Pulse oximeter readings are generally unreliable at saturations below what level? a. 70% b. 80% c. 90% d. 95%
ANS: B
98. What is the most common source of error and false alarms with pulse oximetry? a. Presence of HbCO b. Patient motion artifact c. Presence of vascular dyes d. Ambient light detection
ANS: B
105. Which of the following are indications for capnography? 1. Evaluating the response to therapies affecting ventilation/perfusion ratio () relationships 2. Determining the position of an artificial airway (trachea vs. esophagus) 3. Assessing a patient's readiness for weaning from ventilatory support 4. Monitoring the integrity of the ventilatory circuit and artificial airway a. 1 and 3 only b. 2, 3, and 4 only c. 1, 2, and 4 only d. 1, 2, 3, and 4
ANS: C
114. The shape of the expired CO2 tracing of a patient is normal but instead of being zero, the baseline is elevated to approximately 12 mm Hg. Which of the following is the most likely problem? a. Patient disconnected from the system b. Obstruction of the sampling tube c. Rebreathing d. Presence of N2O
ANS: C
115. After changing the FiO2 of a patient with emphysema, how long should you wait to draw an ABG to monitor the patient's respiratory status? a. 5 to 10 min b. 10 to 20 min c. 20 to 30 min d. 30 to 40 min
ANS: C
3. How does the Clark polarographic O2 electrode function? a. It measures the magnetic properties of O2 versus N2. b. It measures the electrical potential across a Wheatstone bridge. c. It uses O2 to produce a reduction-oxidation reaction. d. It measures the comparative cooling effect on a heated wire.
ANS: C
40. Because of an extremely low PO2, you suspect that an arterial blood sample taken from a patient's brachial artery might have been contaminated with venous blood. Which of the following might help to confirm your suspicion? a. Call the laboratory resources/staff to get the latest chemistry report. b. Inspect the sample for color and consistency. c. Cross-check the sample with an SpO2 reading. d. Measure the sample's actual hemoglobin saturation.
ANS: C
42. An outpatient scheduled for an arterial blood sample enters the pulmonary lab 20 min late and out of breath, having run up four flights of stairs. What should you do? a. Postpone the blood sample until tomorrow. b. Scold the patient for being so late. c. Wait 5 min before taking the sample. d. Scold the patient for using the stairs.
ANS: C
43. A PaO2 below what value would be considered moderate hypoxemia? a. 75 mm Hg b. 65 mm Hg c. 55 mm Hg d. Depends on the FiO2
ANS: C
44. What is a normal level for CaO2? a. 12 to 15 ml/100 ml b. 14 to 16 ml/100 ml c. 18 to 20 ml/100 ml d. 16 to 22 ml/100 ml
ANS: C
49. Through which pulmonary artery catheter port would you obtain a mixed venous blood sample? a. Proximal (right atrium) port b. Catheter thermistor connector c. Distal (catheter tip) port d. Balloon inflation port
ANS: C
5. While checking a polarographic (Clark) electrode, you determine that the device fails to read 100% when exposed to pure O2. Which of the following actions would be the proper first step? a. Check the silica crystals. b. Send the device out for repair. c. Replace the analyzer's batteries. d. Change the analyzer's fuel cell.
ANS: C
52. Warming a capillary bed to 42° C has which of the following effects? 1. It constricts the underlying blood vessels. 2. It increases blood flow well above tissue needs. 3. It "arterializes" the capillary blood. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: C
53. When is capillary blood gas sampling indicated? a. There is a need for direct analysis of blood oxygenation. b. Normal noninvasive monitor readings need to be checked. c. ABG analysis is needed, but arterial access is not available. d. Continuous data on patient ventilation status are needed.
ANS: C
65. What media are used to calibrate a blood gas analyzer's gas electrodes? a. Standard pH buffer solutions b. Bloodlike control media c. Precision mixtures of O2 and CO2 d. Tonometered human blood samples
ANS: C
67. How often should blood gas calibration verification by control media take place? a. At least one level of control media should be analyzed every 8 hr. b. At least two levels of control media should be analyzed every day. c. At least two levels of control media should be analyzed every 8 hr. d. At least two levels of control media should be analyzed every hour.
ANS: C
75. What is the quality control procedure of analysis and reporting on externally provided control media with unknown values? a. Automated calibration b. Performance validation c. Proficiency testing d. Preventive maintenance
ANS: C
8. Which of the following sites are used for arterial blood sampling by percutaneous needle puncture? 1. Femoral 2. Radial 3. Brachial 4. Carotid a. 2 and 3 only b. 1 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4
ANS: C
82. To validate patient readings obtained from a transcutaneous blood gas monitor, what should you do? a. Measure and compare the PtcO2 and PtcCO2 at three or more different sites. b. Compare the monitor's readings to a concurrent pulse oximetry reading. c. Compare the monitor's readings to those obtained with a concurrent ABG sample. d. Compare the patient reading to those obtained when calibrating the sensor.
ANS: C
87. While monitoring an active infant through a transcutaneous blood gas system, you notice a rapid rise in PtcO2 from 63 to 145 mm Hg. At that same time, the (PtcCO2) drops from 35 to 7 mm Hg. What is the most appropriate action in this case? a. Perform a quick assessment of the infant's airway. b. Stabilize the infant and call for emergency assistance. c. Check the sensor for air leaks or dislodgment. d. Remove the sensor and recalibrate the instrument.
ANS: C
90. Indications for pulse oximetry include which of the following? 1. To assess changes in HbO2 during certain procedures 2. To measure abnormal Hb 3. To comply with external regulations or recommendations 4. To monitor the adequacy of HbO2 saturation a. 1 and 4 only b. 1, 2, and 4 only c. 1, 3, and 4 only d. 1, 2, 3, and 4
ANS: C
93. Under ideal conditions, pulse oximeter readings patients usually fall in what range of those obtained with invasive hemoximetry? a. 1% to 2% b. 2% to 3% c. 3% to 5% d. 5% to 7%
ANS: C
96. For continuous monitoring of adults and children, you should set a pulse oximeter's low alarm in what range? a. 80% to 85% b. 85% to 88% c. 88% to 92% d. 93% to 97%
ANS: C
97. Which of the following can cause false high readings when using a pulse oximeter? a. Fetal hemoglobin b. Intravascular dyes c. Carboxyhemoglobin d. Presence of metHb
ANS: C
1. Arteriospasm 2. Embolization 3. Infection 4. Hemorrhage a. 1, 2, and 3 only b. 2 and 3 only c. 2 and 4 only d. 1, 2, 3, and 4
ANS: D
10. Clinical indications for arterial blood analysis include which of the following? 1. Sudden, unexplained dyspnea 2. Cardiopulmonary resuscitation 3. Changes in ventilator settings 4. Chest pain a. 1 and 3 only b. 2 and 4 only c. 1, 2, and 4 only d. 1, 2, and 3 only
ANS: D
101. You obtain an SpO2 reading of 100% on a patient receiving O2 through a nonrebreathing mask. What range of PaO2 levels is possible in this patient? a. 60 to 90 mm Hg b. 90 to 100 mm Hg c. 100 to 200 mm Hg d. 100 to 600 mm Hg
ANS: D
107. During a single-breath capnogram, what does the occurrence of a plateau indicate? a. Exhalation of mainly dead space gas b. Inspiration of fresh respiratory gas c. Exhalation of mixed alveolar and dead space gas d. Exhalation of mainly alveolar gas
ANS: D
18. What size needle would you recommend to obtain an ABG sample through percutaneous puncture of an infant? a. 18 gauge b. 20 gauge c. 22 gauge d. 25 gauge
ANS: D
19. Required equipment and supplies for percutaneous arterial blood sampling of an adult include all of the following except: a. antiseptic (alcohol or Betadine). b. patient or sample label. c. 20- to 22-gauge needle. d. local anesthetic.
ANS: D
20. What chart information should be checked before performing artery puncture? 1. Patient's primary diagnosis and history 2. Presence of bleeding disorders or blood-borne infections 3. Anticoagulant or thrombolytic drug prescriptions 4. Respiratory care orders (e.g., O2 therapy) a. 1, 2, and 3 only b. 2 and 3 only c. 2, 3, and 4 only d. 1, 2, 3, and 4
ANS: D
23. How long should you wait before drawing an ABG on a chronic obstructive pulmonary disease (COPD) patient whose FiO2 has just been changed? a. 5 to 10 min b. 10 to 15 min c. 15 to 20 min d. 20 to 30 min
ANS: D
26. When performing an Allen test on the left hand of a patient, you notice that the palm, fingers, and thumb remain blanched for more than 15 sec after pressure on the ulnar artery is released. What should you do? a. Use the brachial site for sampling. b. Sample from the contralateral radial artery. c. Use the femoral site for sampling. d. Perform the Allen test on the right hand.
ANS: D
32. Most pre-analytical ABG errors can be avoided by ensuring that the sample is which of the following? 1. Properly anticoagulated. 2. Obtained anaerobically. 3. Analyzed within 15 to 30 min. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: D
34. To avoid the dilution effects caused by too much sodium heparin during ABG sampling of an adult, what should you do? 1. Ensure a sample volume greater than 2 ml. 2. Use dry heparin instead. 3. Fill the needle dead space only. 4. Use saline if dry heparin is not available. a. 1 and 4 only b. 1 and 3 only c. 2 and 4 only d. 1, 2, and 3 only
ANS: D
39. Analysis of an arterial blood sample taken from a healthy athlete reveals a pH of 7.36, a PCO2 of 45 mm Hg, and a PO2 of 43 mm Hg. Which of the following analytic errors should you suspect? a. Excessive time since sample collection b. Exposure of the blood sample to air c. Excessive heparin in the sample d. Sample admixture with venous blood
ANS: D
41. You determine that a blood gas sample that requires analysis has been sitting in ice slush for 90 min. What should you do? a. Go ahead and analyze the sample (because it was on ice). b. Warm the sample to room temperature before analysis. c. Readjust the blood gas analyzer temperature to 0° C. d. Discard the sample and notify the appropriate clinician.
ANS: D
45. To assess gas exchange at the tissues, you would obtain a blood sample from which of the following? a. Pulmonary artery (balloon-deflated) b. Peripheral artery (radial, brachial) c. Central vein (superior or inferior vena cava) d. Pulmonary artery (balloon-inflated)
ANS: D
48. A physician requests that you obtain and set up an arterial line system for invasive monitoring of blood pressure. Which of the following equipment would you gather? 1. Pressurized intravenous bag 2. Continuous flush device 3. Arterial catheter 4. Volume transducer a. 1, 3, and 4 only b. 2 and 3 only c. 2, 3, and 4 only d. 1, 2, and 3 only
ANS: D
56. Possible complications of capillary blood gas sampling include which of the following? 1. Infection 2. Hematoma 3. Hemorrhage 4. Hypotension a. 3 and 4 only b. 2 and 4 only c. 1, 3, and 4 only d. 1, 2, and 3 only
ANS: D
59. Components of a laboratory blood gas analyzer include which of the following? 1. Two-electrode measuring chamber 2. Reagent containers 3. Calibrating gas tanks 4. Waste container a. 1, 2, and 3 only b. 1 and 4 only c. 2 and 4 only d. 2, 3, and 4 only
ANS: D
6. During calibration of a Clark polarographic O2 analyzer, you cannot get the sensor to read 100% when exposed to 100% O2, even after adjusting its calibration control. The unit has new batteries. Which of the following actions would be correct? a. Use it only with low FiO2 values. b. Send the device out for repair. c. Replace the unit's batteries. d. Change the sensor or electrode.
ANS: D
62. Which of the following are true about a blood gas analyzer's waste fluids? 1. A strong disinfectant should be added to waste fluid containers. 2. Waste fluids should be handled as if they were blood samples. 3. Waste fluids should be treated as potentially infectious. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: D
66. To ensure that the output of a blood gas analyzer is both accurate and linear across the range of measured values, a calibration procedure must measure what? a. Two different parameters at the same time b. Parameters with known input values at one point c. Two different parameters at different times d. Parameters with known input values at two points
ANS: D
78. In which of the following patients would transcutaneous blood gas monitoring most likely provide inaccurate or erroneous results? a. Newborn infant with respiratory distress syndrome (RDS) b. Patient with hypoxemia c. Patient with a hyperpyrexia d. Patient in hypovolemic shock
ANS: D
79. 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 4. To monitor CO levels following hyperbaric oxygen treatment a. 3 and 4 only b. 1 and 3 only c. 2 and 4 only d. 1, 2, and 3 only
ANS: D
81. The transcutaneous blood gas electrode should not be placed on the: a. chest. b. abdomen. c. lower back. d. thigh.
ANS: D
83. 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). a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
ANS: D
88. Oximetry is the measurement of blood hemoglobin saturations using what technique? a. Electrochemical dissociation b. Photoplethysmography c. Photochemical reactions d. Spectrophotometry
ANS: D
9. 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. 4. It is the largest artery located in the upper extremities. a. 1 and 4 only b. 3 only c. 2 and 4 only d. 1, 2, and 3 only
ANS: D
95. Which of the following guidelines should you adhere to when performing pulse oximetry? 1. Mix different sensors among different devices to ensure accuracy. 2. Make sure that the sensors are the correct size and are properly applied. 3. Avoid using pulse oximetry to monitor hyperoxia in neonates. 4. Whenever possible, validate the initial SpO2 against the actual SaO2. a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only
ANS: D
99. 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? a. Sedate the patient and restrain the arms. b. Reset the low alarm limit to the 80% to 85% range. c. Use a spot check instead of continuous monitoring. d. Relocate the sensor to a more stable location.
ANS: D
1. Which of the following are true about invasive versus noninvasive monitoring? 1. Invasive procedures require insertion of a device into the body. 2. Laboratory analysis of gas exchange is usually noninvasive in nature. 3. Physiologic monitoring can be either invasive or noninvasive. 4. Invasive procedures provide more accurate data but carry greater risks. a. 2 and 4 only b. 1, 3, and 4 only c. 2 only d. 1, 2, 3, and 4
B
2. Under ideal conditions, electrochemical oxygen (O2) analyzers have approximately what degree of accuracy? a. 1% b. 2% c. 3% d. 4%
B
