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INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS

 

Egan’s Fundamentals of Respiratory Care 10th Edition By Kacmarek – Stoller – Test Bank

 

Sample  Question

Chapter 01: History of Respiratory Care

Test Bank

 

MULTIPLE CHOICE

 

  1. Which of the following is NOT an expected role of a respiratory therapist?
a. promoting lung health and wellness
b. providing patient education
c. assessing the patient’s cardiopulmonary health status
d. selling oxygen therapy devices to patients

 

 

ANS:  D

Respiratory care includes the assessment, treatment, management, control, diagnostic evaluation, education, and care of patients with deficiencies and abnormalities of the cardiopulmonary system. Respiratory care is increasingly involved in the prevention of respiratory disease, the management of patients with chronic disease, and promotion of health and wellness.

 

DIF:    Recall             REF:   p. 4                OBJ:   1

 

  1. Where are the majority of respiratory therapists employed?
a. skilled nursing facilities
b. diagnostic laboratories
c. hospitals or acute care settings
d. outpatient physician offices

 

 

ANS:  C

About 75% of all respiratory therapists work in hospitals or other acute care settings.

 

DIF:    Recall             REF:   p. 4                OBJ:   1

 

  1. Who is considered to be the “father of medicine”?
a. Hippocrates
b. Galen
c. Erasistratus
d. Aristotle

 

 

ANS:  A

The foundation of modern Western medicine was laid in ancient Greece with the development of the Hippocratic Corpus. This collection of ancient medical writings is attributed to the “father of medicine,” Hippocrates, a Greek physician who lived during the fifth and fourth centuries BC.

 

DIF:    Recall             REF:   p. 7                OBJ:   2

 

  1. In 1662, a chemist published a book that described the relationship between gas, volume, and pressure. What was the chemist’s name?
a. Sir Isaac Newton
b. Robert Boyle
c. Anthony van Leeuwenhoek
d. Nicolaus Copernicus

 

 

ANS:  B

The chemist, Robert Boyle, published what is now known as “Boyle’s law,” governing the relationship between gas volume and pressure.

 

DIF:    Recall             REF:   p. 7                OBJ:   2

 

  1. Who discovered oxygen in 1774 and described it as “dephlogisticated air”?
a. Robert Boyle
b. Jacque Charles
c. Thomas Beddoes
d. Joseph Priestley

 

 

ANS:  D

In 1774, Joseph Priestley described his discovery of oxygen, which he called “dephlogisticated air.”

 

DIF:    Recall             REF:   p. 8                OBJ:   2

 

  1. Who is credited with first describing the law of partial pressures for a gas mixture?
a. John Dalton
b. Joseph Prestley
c. Jacque Charles
d. Thomas Young

 

 

ANS:  A

John Dalton described his law of partial pressures for a gas mixture in 1801 and his atomic theory in 1808.

 

DIF:    Recall             REF:   p. 8                OBJ:   2

 

  1. Who was the first scientist in 1865 to suggest that many diseases were caused by microorganisms?
a. Thomas Young
b. Louis Pasteur
c. Henry Graham
d. Robert Koch

 

 

ANS:  B

In 1865, Louis Pasteur advanced his “germ theory” of disease, which held that many diseases are caused by microorganisms.

 

DIF:    Recall             REF:   p. 8                OBJ:   2

 

  1. Who discovered the x-ray and opened the door for the modern field of radiology?
a. John Dalton
b. William Smith
c. William Roentgen
d. Thomas Young

 

 

ANS:  C

In 1895, William Roentgen discovered the x-ray and the modern field of radiologic imaging sciences was born.

 

DIF:    Recall             REF:   p. 8                OBJ:   2

 

  1. What was the primary duty of the first inhalation therapists?
a. provide airway care
b. support oxygen therapy
c. aerosol therapy to patients
d. maintain patients on mechanical ventilation

 

 

ANS:  B

The first inhalation therapists were really just oxygen technicians.

 

DIF:    Recall             REF:   p. 8                OBJ:   3

 

  1. When did the designation “respiratory therapist” become standard?
a. 1954
b. 1964
c. 1974
d. 1984

 

 

ANS:  C

In 1974, the designation “respiratory therapist” became standard.

 

DIF:    Recall             REF:   p. 8                OBJ:   3

 

  1. Who was the first to develop the large-scale production of oxygen in 1907?
a. Robert Dalton
b. David Boyle
c. Thomas Anderson
d. Karl von Linde

 

 

ANS:  D

Large-scale production of oxygen was developed by Karl von Linde in 1907.

 

DIF:    Recall             REF:   p. 9                OBJ:   4

 

  1. When was the first Ventimask introduced that allows the precise delivery of 24%, 28%, 35%, and 40% oxygen?
a. 1945
b. 1954
c. 1960
d. 1972

 

 

ANS:  C

The Campbell Ventimask, which allowed the administration of 24%, 28%, 35%, or 40% oxygen, was introduced in 1960.

OB J: 4

DIFF: Recall

 

DIF:    Recall             REF:   p. 9                OBJ:   4

 

  1. When were aerosolized glucocorticoids for the maintenance of patients with moderate to severe asthma first introduced?
a. in the 1950s
b. in the 1960s
c. in the 1970s
d. in the 1980s

 

 

ANS:  C

The use of aerosolized glucocorticoids for the maintenance of patients with moderate to severe asthma began in the 1970s.

 

DIF:    Recall             REF:   p. 9                OBJ:   4

 

  1. Which of the following medications has NOT been delivered as an aerosol by a respiratory therapist?
a. inotropics
b. bronchodilators
c. mucolytics
d. antibiotics

 

 

ANS:  A

There has been a proliferation of medications designed for aerosol administration, including bronchodilators, mucolytics, antibiotics, and anti-inflammatory agents.

 

DIF:    Recall             REF:   p. 9                OBJ:   4

 

  1. Which two names are linked with the development of the iron lung, which was extensively used to treat the polio epidemic in the 1950s?
a. Allison and Smyth
b. Drinker and Emerson
c. Drager and Bennett
d. Byrd and Tyler

 

 

ANS:  B

The iron lung was developed by Drinker, an engineer at Harvard University. Jack H. Emerson developed a commercial version of the iron lung that was used extensively during the polio epidemics of the 1930s and 1950s.

 

DIF:    Recall             REF:   p. 9                OBJ:   5

 

  1. Which of the following was one of the first positive-pressure ventilators developed?
a. MA-1
b. Bird Mark 7
c. Dräger Pulmotor
d. Engstrom

 

 

ANS:  C

Early positive-pressure ventilators included the Dräger Pulmotor (1911), the Spiropulsator (1934), the Bennett TV-2P (1948), the Morch Piston Ventilator (1952), and the Bird Mark 7 (1958).

 

DIF:    Recall             REF:   p. 10              OBJ:   4

 

  1. When was positive end-expiratory pressure (PEEP) first introduced to treat patients with acute respiratory distress syndrome?
a. 1935
b. 1946
c. 1958
d. 1967

 

 

ANS:  D

Positive end-expiratory pressure (PEEP) was introduced for use in patients with ARDS in 1967.

 

DIF:    Recall             REF:   p. 10              OBJ:   4

 

  1. When was synchronized intermittent mandatory ventilation (SIMV) first introduced?
a. 1975
b. 1985
c. 1995
d. 2005

 

 

ANS:  A

SIMV was introduced in 1975

 

DIF:    Recall             REF:   p. 10              OBJ:   4

 

  1. Who introduced the first laryngoscope, in 1913?
a. Thomas Allen
b. Chevalier Jackson
c. Jack Emerson
d. Forrest Bird

 

 

ANS:  B

In 1913, the laryngoscope was introduced by Chevalier Jackson.

 

DIF:    Recall             REF:   p. 11              OBJ:   5

 

  1. Who introduced the use of soft rubber endotracheal tubes around 1930?
a. Davidson
b. McGill
c. Haight
d. Murphy

 

 

ANS:  B

Ivan McGill introduced the use of soft rubber endotracheal tubes.

 

DIF:    Recall             REF:   p. 11              OBJ:   5

 

  1. In 1846, who developed a water seal spirometer, which allowed accurate measurement of the patient’s vital capacity?
a. Hutchinson
b. Strohl
c. Tiffeneau
d. Davis

 

 

ANS:  A

In 1846, John Hutchinson developed a water seal spirometer, with which he measured the vital capacity.

 

DIF:    Recall             REF:   p. 11              OBJ:   5

 

  1. What was the name of the first professional organization for the field of respiratory care?
a. American Association for Inhalation Therapy
b. National Organization for Inhalation Therapy
c. Inhalation Therapy Association
d. Better Breathers Organization

 

 

ANS:  C

Founded in 1947 in Chicago, the Inhalational Therapy Association (ITA) was the first professional association for the field of respiratory care.

 

DIF:    Recall             REF:   p. 11              OBJ:   7

 

  1. In what year did the respiratory care professional organization American Association for Respiratory Therapy (ARRT) change its name to American Association for Respiratory Care (AARC)?
a. 1954
b. 1966
c. 1975
d. 1982

 

 

ANS:  D

The ITA became the American Association for Inhalation Therapists (AAIT) in 1954, the American Association for Respiratory Therapy (ARRT) in 1973, and the AARC in 1982.

 

DIF:    Recall             REF:   p. 11              OBJ:   7

 

  1. What organization has developed an examination to enable respiratory therapists to become licensed?
a. American Respiratory Care Board
b. National Board for Respiratory Care
c. American Association for Respiratory Care
d. National Organization for Respiratory Therapist

 

 

ANS:  B

During the 1980s, the AARC began a major push to introduce state licensure for respiratory care practitioners based on the National Board for Respiratory Care (NBRC) credentials.

 

DIF:    Recall             REF:   p. 12              OBJ:   6

 

  1. Today, respiratory care educational programs in the United States are accredited by what organization?
a. National Board for Respiratory Care (NBRC)
b. American Association for Respiratory Care (AARC)
c. Committee on Accreditation for Respiratory Care (CoARC)
d. Joint Review Committee for Respiratory Therapy Education (JRCRTE)

 

 

ANS:  C

Today, respiratory care educational programs in the United States are accredited by the CoARC.

 

DIF:    Recall             REF:   p. 14              OBJ:   6

 

  1. The majority of respiratory care education programs in the United States offer what degree?
a. associate’s degree
b. bachelor’s degree
c. master’s degree
d. none of the above

 

 

ANS:  A

There are approximately 300 associate, 50 baccalaureate, and 3 graduate-level degree programs in the United States.

 

DIF:    Recall             REF:   p. 14              OBJ:   8

 

  1. Which of the following is NOT predicted to be a growing trend in respiratory care for the future?
a. greater use of respiratory therapy protocols
b. increased need for patient assessment skills
c. increased involvement in smoking cessation programs
d. increased use of intravascular lines for patient monitoring

 

 

ANS:  D

Dr. David Pierson, a prominent pulmonary physician, described the future of respiratory care in 2001. Among other things, he predicted greater use of patient assessment and protocols in disease state management in all clinical settings; a more active role for respiratory therapists in palliative care; increasing emphasis on smoking cessation and prevention; early detection and intervention in COPD; and an increase in the use of respiratory therapists as coordinators and care givers for home care.

 

DIF:    Recall             REF:   p. 15              OBJ:   9

 

  1. How is the education of respiratory therapists expected to change over the next decade?
a. stay about the same
b. decrease
c. increase
d. unknown

 

 

ANS:  C

The development of the respiratory therapist as physician extender will require increasing the number of respiratory therapists with advanced levels of education.

 

DIF:    Recall             REF:   p. 17              OBJ:   8

 

  1. All of the following are true regarding the American Association of Respiratory Care (AARC), except:
a. It serves as an advocate for the profession to legislative and regulatory bodies.
b. Thousands of Respiratory Care Practitioners (RCP’s) are members.
c. It has normal affiliations with all 50 state respiratory societies.
d. It determines if graduating students are competent to practice.

 

 

ANS:  D

State licensing laws set the minimum educational requirements and the method of determining competence to practice.

 

DIF:    Recall             REF:   p. 12              OBJ:   6

 

  1. How is competency to practice Respiratory Care determined?
a. achievement of good grades in school and graduating from an approved program
b. applying for a state license
c. only by graduating from a CoARC approved program
d. obtaining a passing grade on a credentialing exam administered by the NBRC after graduation from a CoARC approved program

 

 

ANS:  D

State licensing laws set the minimum educational requirements and the method of determining competence to practice.

 

DIF:    Recall             REF:   p. 12              OBJ:   6

 

  1. Due to the aging of the majority of the population, all of the following will be the focus of the Respiratory Therapist of the future, except:
a. verifying insurance information
b. disease management and rehabilitation
c. patient and family education
d. tobacco education and smoking cessation

 

 

ANS:  A

In the future, there will be an increase in demand for respiratory care due to advances in treatment and technology, increases in the aging of the population, and increases in the number of people with asthma, COPD, and other cardiopulmonary diseases. Due to this the RT of the future will be focused on patient assessment, care plan development, protocol administration, disease management and rehabilitation, and patient and family education, to include tobacco education and smoking cessation.

 

DIF:    Application    REF:   p. 18              OBJ:   9

 

  1. According to the AARC’s “2015 and Beyond” project, all of the following are included in the seven major competencies required by Respiratory Therapists by the Year 2015 except:
a. chronic disease state management
b. bronchoscopy
c. evidence-based medicine and respiratory care protocols
d. leadership

 

 

ANS:  B

According to the AARC’s “2015 and Beyond” project, the seven major competencies required by Respiratory Therapists by the Year 2015 will be, diagnostics, chronic disease state management, evidence-based medicine and respiratory care protocols, patient assessment, leadership, emergency and critical care, and therapeutics.

 

DIF:    Recall             REF:   p. 17              OBJ:   9

Chapter 03: Patient Safety, Communication, and Record Keeping

Test Bank

 

MULTIPLE CHOICE

 

  1. Which of the following is/are a potential area of risk to patients receiving respiratory care?
a. movement or ambulation
b. electrical shock
c. fire hazards
d. all the above

 

 

ANS:  C

The key areas of potential risk are (1) patient movement and ambulation, (2) electrical hazards, and (3) fire hazards.

 

DIF:    Recall             REF:   p. 42              OBJ:   2| 3

 

  1. Lifting heavy objects is best done with which of the following techniques?
a. straight spine, bent legs
b. straight spine, straight legs
c. bent spine, bent legs
d. bent spine, straight legs

 

 

ANS:  A

Note that the correct technique calls for a straight spine and use of the leg muscles to lift the object.

 

DIF:    Application    REF:   p. 42              OBJ:   1

 

  1. Which of the following factors are most critical in determining when a patient can be ambulated?
  2. willingness of patient
  3. stability of vital signs
  4. absence of severe pain
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  A

Ambulation should begin as soon as the patient is physiologically stable and free of severe pain.

 

DIF:    Application    REF:   p. 42              OBJ:   2

 

  1. Which of the following statements is false about patient ambulation?
a. Ambulation is necessary for normal body functioning.
b. Patients must be carefully monitored during ambulation.
c. Chairs or emergency supports must available during ambulation.
d. Patients with intravenous (IV) lines should not be ambulated.

 

 

ANS:  D

Place all equipment (e.g., intravenous [IV] equipment, nasogastric tube, surgical drainage tubes) close to the patient to prevent dislodging during ambulation.

 

DIF:    Application    REF:   p. 42              OBJ:   2

 

  1. Which of the following parameters should be monitored during ambulation?
  2. skin color
  3. breathing rate and effort
  4. level of consciousness
  5. urine output
a. 1 and 2
b. 3 and 4
c. 1, 2, and 3
d. 1, 2, 3, and 4

 

 

ANS:  C

Skin color, breathing rate and effort, and level of consciousness provide clues to how well the patient is tolerating ambulation.

 

DIF:    Application    REF:   p. 43              OBJ:   2

 

  1. Which of the following terms describes the power potential behind electrical energy?
a. voltage
b. current
c. Ohms
d. resistance

 

 

ANS:  A

Voltage is the power potential behind the electrical energy.

 

DIF:    Recall             REF:   p. 44              OBJ:   3

 

  1. Which of the following is used to report electrical current?
a. Ohms
b. voltage
c. amps
d. cycles

 

 

ANS:  C

Current is the flow of electricity from a point of higher voltage to one of lower voltage and is reported in amperes (or amps).

 

DIF:    Recall             REF:   p. 44              OBJ:   3

 

  1. What is the primary factor determining the effect of an electrical shock?
a. current
b. temperature
c. resistance
d. voltage

 

 

ANS:  A

It is important to note that current represents the greatest danger to you or your patients when electrical shorts occur.

 

DIF:    Recall             REF:   p. 45              OBJ:   4

 

  1. Which of the following is/are key factor(s) determining the extent of harm caused by an electrical current?
  2. duration for which the current is applied
  3. path the current takes through the body
  4. amount of current flowing through the body
a. 1 and 2
b. 2 and 3
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

The harmful effects of current depend on (1) the amount of current flowing through the body, (2) the path it takes, and (3) the duration the current is applied.

OBJ : 4

DIFF: Application

REF : Pg: 45

 

DIF:    Application    REF:   p. 45              OBJ:   4

 

  1. If 120 Volts are applied to a system with 1,000 Ohms of resistance, what is the current?
a. 100 amps
b. 100 Ohms
c. 120 milliamps
d. 120 amps

 

 

ANS:  C

The current is now calculated as amps = 120 V/1,000 Ohms = 0.12 amps or 120 milliamps.

 

DIF:    Analysis         REF:   p. 45              OBJ:   3

 

  1. Which of the following organs is the most sensitive to the effects of electrical shock?
a. liver
b. heart
c. kidneys
d. lungs

 

 

ANS:  B

Because the heart is susceptible to any current level above 100 milliamps, the 120 milliamps represents a potentially fatal shock.

 

DIF:    Recall             REF:   p. 45              OBJ:   4

 

  1. In which of the following clinical situations is the normally high resistance of the skin bypassed?
  2. in patients with external pacemaker wires
  3. in patients with saline-filled catheters
  4. in patients with intact, dry skin
a. 2 and 3
b. 1, 2, and 3
c. 1 and 2
d. 3

 

 

ANS:  C

Current can readily flow into the body, causing damage to vital organs when the skin is bypassed via conductors such as pacemaker wires or saline-filled intravascular catheters.

 

DIF:    Application    REF:   p. 45              OBJ:   4

 

  1. When a relatively high current (usually greater than 1 mA, or 1/1000 A) is applied externally to the skin, which of the following conditions exists?
a. macroshock hazard
b. grounding hazard
c. microshock hazard
d. isolation hazard

 

 

ANS:  A

A macroshock exists when a high current (usually greater than 1 milliamp) is applied externally to the skin.

 

DIF:    Application    REF:   p. 46              OBJ:   4

 

  1. When a small, usually imperceptible current (usually less than 1 mA) is allowed to bypass the skin and follow a direct, low resistance pathway into the body, which of the following conditions exists?
a. macroshock hazard
b. grounding hazard
c. isolation hazard
d. microshock hazard

 

 

ANS:  D

A microshock exists when a small, usually imperceptible current (less than 1 milliamp) bypasses the skin and follows a direct, low-resistance path into the body.

 

DIF:    Application    REF:   p. 46              OBJ:   4

 

  1. High amperage (6 amps or more) applied externally to the skin can cause which of the following?
  2. sustained myocardial contraction
  3. respiratory paralysis
  4. skin burns
a. 1 and 2
b. 2 and 3
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

Table 3-1 summarizes the different effects of these two types of electrical shock.

 

DIF:    Recall             REF:   p. 47              OBJ:   4

 

  1. Which of the following currents passing through the chest can cause ventricular fibrillation, diaphragm dysfunction (due to severe, persistent contraction), and death?
a. 100 mA
b. 100 A
c. 100 mA
d. 10 mA

 

 

ANS:  A

Higher currents (exceeding 100 milliamps [mA]) that pass through the chest can cause ventricular fibrillation, diaphragm dysfunction (due to severe, persistent contraction), and death. Table 3-1 summarizes the different effects of these two types of electrical shock.

 

DIF:    Analysis         REF:   p. 45              OBJ:   4

 

  1. What is the primary purpose of grounding all electrical equipment used in the hospital setting?
a. to prevent the dangerous buildup of voltage in the equipment
b. to make the equipment more secure and less likely to break down
c. to avoid excessive energy costs
d. to convert electrical power from DC to AC

 

 

ANS:  A

In these cases, the third (ground) wire prevents the dangerous buildup of voltage that can occur on the metal frames of some electrical equipment.

 

DIF:    Application    REF:   p. 46              OBJ:   3

 

  1. Where do most hospital fires initially start?
a. clinical laboratory
b. kitchen
c. electrical engineering post
d. patient’s room

 

 

ANS:  B

About 90% of fires in health care facilities occur in hospitals and the most common site for the origin of the fire is the kitchen.

 

DIF:    Recall             REF:   p. 47              OBJ:   6

 

  1. Which of the following is true about fires in oxygen-enriched atmospheres?
  2. They are more difficult to put out.
  3. They burn more quickly.
  4. They burn more intensely
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

Fires in oxygen-enriched atmospheres are larger, more intense, faster burning, and more difficult to extinguish.

 

DIF:    Application    REF:   p. 47              OBJ:   7

 

  1. Which of the following conditions must be met for a fire to occur?
  2. temperature high enough for combustion
  3. presence of oxygen
  4. presence of flammable material
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

For a fire to start, three conditions must exist: (1) flammable material must be present, (2) oxygen must be present, and (3) the flammable material must be heated to or above its ignition temperature.

 

DIF:    Application    REF:   p. 48              OBJ:   7

 

  1. Which of the following statements is/are true regarding the use of oxygen?
  2. Oxygen is flammable.
  3. Oxygen accelerates the rate of combustion.
  4. Increased oxygen concentration accelerates the rate of combustion.
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

Although oxygen is nonflammable, it greatly accelerates the rate of combustion. Burning speed increases with an increase in either the concentration or partial pressure of oxygen.

 

DIF:    Recall             REF:   p. 48              OBJ:   7

 

  1. How can the risk of fire because of static electrical discharge in the presence of oxygen be minimized?
a. Use only wool or polyester fabrics in the area of use.
b. Keep oxygen concentrations well below 21%.
c. Maintain high relative humidity in the area of use.
d. Keep oxygen in high-pressure storage cylinders.

 

 

ANS:  C

The minimal risk that may be present can be further reduced by maintaining high relative humidity (greater than 60%).

 

DIF:    Application    REF:   p. 48              OBJ:   7

 

  1. In the standard approach to hospital fires, the RACE plan has been suggested. What does the letter “C” stand for in this approach?
a. capture
b. contain
c. call for help
d. collapse

 

 

ANS:  B

The third step is to contain the fire as much as possible by closing doors and turning oxygen zone valves off.

 

DIF:    Application    REF:   p. 48              OBJ:   7

 

  1. Nonverbal communication includes all of the following except:
a. gesture
b. touch
c. discussion
d. space

 

 

ANS:  C

Nonverbal communication includes gestures, facial expressions, eye movements and contact, voice tone, space, and touch.

 

DIF:    Recall             REF:   p. 49              OBJ:   9

 

  1. Which of the following components of communication is a method used to transmit messages?
a. sender
b. channel
c. receiver
d. feedback

 

 

ANS:  B

The channel of communication is the method used to transmit messages.

 

DIF:    Application    REF:   p. 49              OBJ:   9

 

  1. Which of the following is a method for communicating empathy to your patients?
  2. use of touch
  3. use of key words
  4. use of eye contact
  5. use of the authority
a. 1, 2, and 3
b. 1 and 3
c. 1, 2, 3, and 4
d. 2, 3, and 4

 

 

ANS:  A

The use of touch and proper eye contact can demonstrate genuine concern for your patient. Key words and phrases such as “I understand” can let the patient know you are listening and interested.

 

DIF:    Application    REF:   p. 50              OBJ:   9

 

  1. Which of the following factors can have an impact on the outcomes of therapeutic communication between patient and practitioner?
  2. verbal and nonverbal components of expression
  3. environmental factors (e.g., noise, privacy)
  4. values and beliefs of both patient and practitioner
  5. sensory and emotional factors (e.g., fear, pain)
a. 1, 2, and 3
b. 1 and 3
c. 1, 2, 3, and 4
d. 2, 3, and 4

 

 

ANS:  C

Many factors affect communication in the health care setting (Figure 3-11).

 

DIF:    Application    REF:   p. 50              OBJ:   9

 

  1. Basic purposes of communication include all of the following except:
a. change others’ values orientation
b. obtain or relay information
c. give instructions (teach)
d. persuade others to take action

 

 

ANS:  A

Key purposes of communication are summarized in Box 3-1.

 

DIF:    Application    REF:   p. 51              OBJ:   11

 

  1. All of the following techniques can be used to improve one’s effectiveness as a sender of messages except:
a. share information rather than telling
b. emphasize agreement over disagreement
c. eliminate threatening behavior
d. use effective nonverbal communication

 

 

ANS:  B

Others will not always agree with what you say. Do not become defensive when others disagree with you; simply try to understand their perspective and be open to their input.

 

DIF:    Application    REF:   p. 52              OBJ:   12

 

  1. All of the following techniques can be used to improve one’s listening skills except:
a. resist distractions
b. maintain composure and control emotions
c. keep an open mind (be objective)
d. judge the sender’s delivery, not the content

 

 

ANS:  D

The content of what is being said is the issue to focus on. How it is delivered is not that important. Some people are more articulate than others but the message is most important.

 

DIF:    Application    REF:   p. 52              OBJ:   12

 

  1. Maintaining eye contact, leaning toward the patient, and nodding your head are all good examples of what communication technique?
a. clarifying
b. empathizing
c. attending
d. reflecting

 

 

ANS:  C

Attending involves the use of gestures and posture that communicate one’s attentiveness. Attending also involves confirming remarks such as, “I see what you mean.”

 

DIF:    Application    REF:   p. 52              OBJ:   12

 

  1. Techniques to help ensure that understanding is taking place between the parties involved in an interaction include which of the following?
  2. clarifying
  3. paraphrasing
  4. perception checking
  5. attending
a. 1, 2, and 3
b. 1 and 3
c. 1, 2, 3, and 4
d. 2, 3, and 4

 

 

ANS:  C

All four techniques can be useful to enhance communication.

 

DIF:    Application    REF:   p. 52              OBJ:   12

 

  1. A therapist who says “Please explain that to me again” to a patient during an interview is using what interpersonal communication technique?
a. clarifying
b. paraphrasing
c. perception checking
d. reflecting feelings

 

 

ANS:  A

Requesting clarification lets the patient know you are trying to understand him or her.

 

DIF:    Recall             REF:   p. 52              OBJ:   12

 

  1. A patient’s response to an interview question is initially unclear. Which of the following responses on your part would be most appropriate?
a. “Please go on.”
b. “You seem to be anxious.”
c. “Please explain that to me again.”
d. “Yes, I think I understand.”

 

 

ANS:  C

Requesting clarification is done by asking the patient to explain his or her thought again.

 

DIF:    Application    REF:   p. 52              OBJ:   12

 

  1. A therapist who says “You seem to be anxious about your surgery” to a patient just admitted for bypass surgery is using what interpersonal communication technique?
a. clarifying
b. paraphrasing
c. perception checking
d. reflecting feelings

 

 

ANS:  D

Reflecting feelings is the process of telling patients about how you perceive their feelings. It encourages patients to discuss their feelings further.

 

DIF:    Application    REF:   p. 53              OBJ:   11

 

  1. Key barriers to effective interpersonal communication include all of the following except:
a. use of symbols or words with different meanings
b. value systems that are different or not accepted
c. similar perceptions of the problem
d. feelings of personal insecurity by one or both parties

 

 

ANS:  C

Similar perceptions of the problem promote communication and are not a barrier.

 

DIF:    Application    REF:   p. 52              OBJ:   13

 

  1. Which of the following strategies for conflict resolution represents a middle-ground strategy that combines assertiveness and cooperation?
a. avoiding
b. competing
c. compromising
d. accommodating

 

 

ANS:  C

Compromising is a middle-ground strategy that combines assertiveness and cooperation.

 

DIF:    Recall             REF:   p. 54              OBJ:   13

 

  1. What form of patient record is most designed to succinctly report data in a time-oriented format and to decrease time needed for documentation?
a. subjective, objective, assessment, and plan (SOAP) record
b. problem-oriented, medical record (POMR) record
c. flowsheet
d. progress note

 

 

ANS:  C

Flowsheets are designed to briefly report data and to decrease time spent in documentation.

 

DIF:    Recall             REF:   p. 55              OBJ:   14

 

  1. The elements of a POMR entry would include which of the following?
  2. patient’s subjective complaints and concerns
  3. objective data gathered by the health professional
  4. assessment of the subjective and objective data
  5. plan to address the identified problem(s)
a. 1, 2, and 3
b. 1 and 3
c. 1, 2, 3 and 4
d. 1, 3, and 4

 

 

ANS:  C

The POMR progress notes contain the findings (subjective and objective data), assessment, plans, and orders of the doctors, nurses, and other practitioners involved in the care of the patient. The format used is often referred to as SOAP. “S” = subjective information; “O” = objective information; “A” = assessment; “P” = plan of care.

 

DIF:    Application    REF:   p. 58              OBJ:   14

 

  1. Information about a patient’s nearest kin, physician, and initial diagnosis can be found in which section of the medical record?
a. history and physical exam
b. admission sheet
c. physician’s orders
d. consultation sheet

 

 

ANS:  B

See Box 3-3.

 

DIF:    Recall             REF:   p. 55              OBJ:   14

 

  1. To confirm a physician’s prescription for a drug that you need to give to a patient, you would go to which section of the medical record?
a. history and physical exam
b. laboratory sheet
c. physician’s orders
d. medication record

 

 

ANS:  C

See Box 3-3.

 

DIF:    Recall             REF:   p. 55              OBJ:   14

 

  1. To determine the most recent medical status of a patient whom you are about to start treating, you would go to which section of the medical record?
a. progress sheet
b. nurses’ notes
c. physician’s orders
d. history and physical exam

 

 

ANS:  A

See Box 3-3.

 

DIF:    Recall             REF:   p. 55              OBJ:   14

 

  1. To find out what drugs or intravenous fluids a patient has received recently, you would go to which section of the medical record?
a. progress sheet
b. nurses’ notes
c. physician’s orders
d. medication record

 

 

ANS:  D

See Box 3-3.

 

DIF:    Recall             REF:   p. 55              OBJ:   14

 

  1. What is a time-based record of measurement during a specialized procedure such as mechanical ventilation?
a. consultation sheet
b. specialized flowsheet
c. progress notes
d. graphic sheet

 

 

ANS:  B

See Box 3-3.

 

DIF:    Recall             REF:   p. 55              OBJ:   14

 

  1. A pulmonary specialist has been called in by an internist to examine a patient and help make a diagnosis. Where in the patient’s medical record would you look for the pulmonary specialist’s report?
a. progress sheet
b. consultation sheet
c. physician’s orders
d. history and physical exam

 

 

ANS:  B

See Box 3-3.

 

DIF:    Recall             REF:   p. 55              OBJ:   14

 

  1. To determine any recent trends in a patient’s pulse, respiration, or blood pressure, you would go to which section of the medical record?
a. progress sheet
b. nurses’ notes
c. anesthesia record
d. vital signs sheet

 

 

ANS:  D

See Box 3-3.

 

DIF:    Recall             REF:   p. 55              OBJ:   14

 

  1. To check on the results of a patient’s recent blood work, you would go to which section of the medical record?
a. vital signs sheet
b. laboratory sheet
c. flowsheet
d. progress notes

 

 

ANS:  B

See Box 3-3.

 

DIF:    Recall             REF:   p. 55              OBJ:   14

 

  1. To determine the amount of urine excreted by a patient in the last 24 hours, you would go to which section of the medical record?
a. vital signs sheet
b. laboratory sheet
c. nurses’ notes
d. intake and output (I & O) sheet

 

 

ANS:  D

See Box 3-3.

 

DIF:    Recall             REF:   p. 55              OBJ:   14

 

  1. Which of the following is the correct way to sign a medical record entry?
a. CAW, LRCP, CRT
b. CAW, Respiratory Department
c. C. White, LRCP, CRT
d. Cathy White, Therapist, Respiratory Department

 

 

ANS:  C

See Box 3-4.

 

DIF:    Application    REF:   p. 58              OBJ:   15

 

  1. Which of the following is an acceptable practice in medical recordkeeping?
a. leaving blank lines
b. erasing incorrect entries
c. using ditto marks
d. using standard abbreviations

 

 

ANS:  D

See Box 3-4.

 

DIF:    Recall             REF:   p. 58              OBJ:   15

 

  1. If you make a mistake when charting a patient treatment, what should you do?
a. Make a new entry (called “correction”) just below the mistake.
b. Erase the mistake and have your supervisor countersign it.
c. Draw a line through the mistake and write “error” above it.
d. Have your supervisor make the chart correction later.

 

 

ANS:  C

See Box 3-4.

 

DIF:    Recall             REF:   p. 58              OBJ:   15

 

  1. Which of the following are unacceptable practices in medical recordkeeping?
  2. specifying when you will return to provide patient therapy
  3. providing your own interpretation of a patient’s symptoms
  4. recording the patient’s complaints and general behavior
  5. charting several separate tasks under a single chart entry
a. 2 and 4
b. 1 and 2
c. 1 and 4
d. 1, 2, and 4

 

 

ANS:  A

See Box 3-4.

 

DIF:    Recall             REF:   p. 58              OBJ:   15

 

  1. What is the role of the RT during a disaster situation?
a. transporting the critically ill patients to safety first
b. shutting of the main oxygen supply in the hospital
c. getting themselves to safety
d. going to look for a backup generator

 

 

ANS:  A

Part of the RT’s role of disaster preparedness includes transport and transfer of the critically ill patients.

 

DIF:    Application    REF:   p. 48              OBJ:   8

 

  1. A patient who is on a ventilator is going to be transported to MRI. Which of the following is the most important piece of equipment to have available in the MRI suite?
a. a MRI compatible ventilator
b. laboratory flowsheet
c. intubation box
d. sedatives

 

 

ANS:  A

The RT needs to have an MRI-compatible ventilator available and set up in the MRI suite.

 

DIF:    Analysis         REF:   p. 49              OBJ:   8

 

  1. All health care personnel must use the “two patient identifiers” before initiating care, which include all of the following, except?
a. patient name
b. patient birth date
c. patient medical record number
d. patient room number

 

 

ANS:  D

All health care personnel must use the “two patient identifiers” before initiating care, which include patient name, birth date, and medical record number

 

DIF:    Application    REF:   p. 50              OBJ:   10

 

  1. Medical records are strictly confidential and are protected under what law?
a. HIPPA
b. HESSA
c. Record’s law
d. Patriot Act

 

 

ANS:  A

Medical records are strictly confidential and are protected under the Health Insurance and Portability Act (HIPPA).

 

DIF:    Recall             REF:   p. 54              OBJ:   15

 

  1. What was one of the Joint Commission’s (TJC) goals for 2010?
a. to improve accuracy of patient identification
b. to lessen costs
c. to enforce proper infection control
d. to have more case studies

 

 

ANS:  A

TJC’s goals for 2010 were to improve accuracy of patient identification.

 

DIF:    Recall             REF:   p. 50              OBJ:   10

 

  1. Improper storage or handling of medical gas cylinders can result in which of the following?
  2. increased risk of fire
  3. explosive releases of high pressure gas
  4. toxic effects of some gases
  5. a contained environment
a. 1, 2 and 4
b. 1 and 2
c. 1 and 4
d. 1, 2, and 3

 

 

ANS:  D

All of the above and result from improper storage and handling of medical gas cylinders.

 

DIF:    Recall             REF:   p. 49              OBJ:   8

 

  1. Which group or organizations regulates the storage of medical gases?
a. NBRC
b. National Fire Protection Association (NFPA)
c. The Joint Commission (TJC)
d. HIPPA

 

 

ANS:  B

National Fire Protection Association (NFPA) regulates the storage of medical gases. Monitoring is done by the Joint Commission.

 

DIF:    Recall             REF:   p. 49              OBJ:   8

 

  1. An RT is instructing a patient on a particular piece of equipment, and should use which scenario on educating the patient?
a. Call Back
b. Read Back
c. Teach Back
d. A short quiz

 

 

ANS:  C

A Teach Back scenario will be helpful for the RT to know if the patient understands what is being explained regarding equipment use.

 

DIF:    Application    REF:   p. 51              OBJ:   12

Chapter 11: Gas Exchange and Transport

Test Bank

 

MULTIPLE CHOICE

 

  1. On what does the movement of gases between the lungs and the body tissues mainly depend?
a. active transport
b. gaseous diffusion
c. membrane dialysis
d. membrane transport

 

 

ANS:  B

Gas movement between the lungs and tissues occurs by simple diffusion.

 

DIF:    Application    REF:   p. 249            OBJ:   1

 

  1. The lowest PO2 would normally be found in what location?
a. arterial blood
b. atmospheric air
c. cells
d. venous blood

 

 

ANS:  C

The intracellular PO2 (approximately 5 mm Hg) provides the final gradient for oxygen diffusion into the cell.

 

DIF:    Application    REF:   p. 249            OBJ:   1

 

  1. The highest PCO2 levels are found in what location?
a. arterial blood
b. atmospheric air
c. cells
d. venous blood

 

 

ANS:  C

The partial pressure of carbon dioxide (PCO2) is highest in the cells (approximately 60 mm Hg).

 

DIF:    Application    REF:   p. 249            OBJ:   1

 

  1. Which of the following are true regarding the PACO2?
  2. directly proportional to whole-body carbon dioxide production
  3. inversely proportional to alveolar ventilation (A)
  4. normally maintained at about 35 to 45 mm Hg
a. 2 and 3
b. 1, 2, and 3
c. 1 and 2
d. 1 and 3

 

 

ANS:  B

PACO2 varies directly with the body’s production of carbon dioxide (CO2) and inversely with alveolar ventilation (A). Under normal conditions it is maintained at about 35 to 45 mm Hg.

 

DIF:    Application    REF:   p. 249            OBJ:   2

 

  1. What is the approximate normal level of carbon dioxide production (CO2) for an adult?
a. 200 ml/min
b. 250 ml/min
c. 4200 ml/min
d. 6000 ml/min

 

 

ANS:  A

In a healthy individual the normal CO2 of is about 200 ml/min.

 

DIF:    Recall             REF:   p. 249            OBJ:   2

 

  1. Under what conditions will the alveolar PACO2 rise above normal?
a. if both metabolic rate and ventilation increase (e.g., through exercise)
b. if carbon dioxide production decreases relative to A
c. if A decreases relative to carbon dioxide production
d. when the patient is febrile

 

 

ANS:  C

The PACO2 will increase above this level if carbon dioxide production increases while alveolar ventilation remains constant or when alveolar ventilation decreases while CO2 remains constant.

 

DIF:    Application    REF:   p. 249            OBJ:   2

 

  1. A 70-kg male patient has a CO2 of 200 ml/min and a A of 9 L/min. From this information, what can you infer?
a. The patient’s carbon dioxide production is abnormally low.
b. The patient’s A is abnormally low.
c. The patient will have a lower than normal PACO2.
d. The patient will have a higher than normal PACO2.

 

 

ANS:  C

When the CO2 is normal while the A is elevated, the PACO2 must be lower then normal. Likewise, the PACO2 will fall if carbon dioxide production decreases or alveolar ventilation increases.

 

DIF:    Analysis         REF:   p. 249            OBJ:   2

 

  1. What is the primary determinant of the PAO2?
a. body’s CO2
b. metabolic rate of the body tissues
c. PaO2
d. PO2 in the inspired gas

 

 

ANS:  D

Many factors determine the alveolar partial pressure of oxygen (PAO2). Most important is the inspired partial pressure of oxygen, or PIO2.

 

DIF:    Application    REF:   p. 250            OBJ:   2

 

  1. The PAO2 depends on which of the following factors?
  2. ambient (atmospheric) pressure
  3. fractional concentration of inspired oxygen
  4. level of A
  5. types of fuels burned (fat, protein, carbohydrate)
a. 1, 2, and 3
b. 1 and 2
c. 3 only
d. 1, 2, 3, and 4

 

 

ANS:  D

PAO2 = FIO2 ´ (PB – 47) – PACO2 ¸ 0.8

where FIO2 is fraction of inspired oxygen, PB is barometric pressure, 47 is water vapor tension (in mm Hg) at 37° C, PACO2 is alveolar PCO2, and 0.8 is normal respiratory exchange ratio (R). As the A is the primary determinant of PACO2 any changes in A will affect the PAO2. Likewise the fuel source will determine the RQ which is normally 0.8.

 

DIF:    Analysis         REF:   p. 250            OBJ:   3

 

  1. Calculate the approximate PAO2 given the following conditions (assume R = 0.8): FIO2 = .40, PB = 770 mm Hg, PACO2 = 31 mm Hg
a. 100 mm Hg
b. 135 mm Hg
c. 250 mm Hg
d. 723 mm Hg

 

 

ANS:  C

PAO2 = FIO2 ´ (PB – 47) – PACO2 ¸ 0.8

where FIO2 is fraction of inspired oxygen, PB is barometric pressure, 47 is water vapor tension (in mm Hg) at 37° C, PACO2 is alveolar PCO2, and 0.8 is normal respiratory exchange ratio (R).

PAO2 = 0.4(770 – 47) – (31/0.8)

PAO2 = 250.45 mm Hg

 

DIF:    Analysis         REF:   p. 250            OBJ:   3

 

  1. A normal person breathing 100% oxygen at sea level would have PAO2 of about what level?
a. 149 mm Hg
b. 670 mm Hg
c. 713 mm Hg
d. 760 mm Hg

 

 

ANS:  B

If the FIO2 is 1.0, the PB is 760 mm Hg, and the PACO2 is 40 mm Hg, the alveolar partial pressure of oxygen can be estimated as follows:

PAO2 = 1 ´ (760 mm Hg – 47 ) – (40 mm Hg ¸ 0.8) = 663 mm Hg

 

DIF:    Analysis         REF:   p. 250            OBJ:   3

 

  1. Which of the following best represents the partial pressures of all gases in the normally ventilated and perfused alveolus when breathing room air at sea level?
a. PO2 = 40 mm Hg; PCO2 = 100 mm Hg; PN2 = 573 mm Hg; PH2O = 47 mm Hg
b. PO2 = 100 mm Hg; PCO2 = 40 mm Hg; PN2 = 573 mm Hg; PH2O = 47 mm Hg
c. PO2 = 100 mm Hg; PCO2 = 40 mm Hg; PN2 = 713 mm Hg; PH2O = 47 mm Hg
d. PO2 = 149 mm Hg; PCO2 = 40 mm Hg; PN2 = 573 mm Hg; PH2O = 47 mm Hg

 

 

ANS:  B

Nitrogen is inert and plays no role in gas exchange. However, nitrogen does occupy space and exert pressure. According to Dalton’s law, the partial pressure of alveolar nitrogen must equal the pressure it would exert if it alone were present. Thus, to compute the partial pressure of alveolar nitrogen, subtract the pressures exerted by all the other alveolar gases, as follows:

PAN2 = PB – (PAO2 + PACO2 + PH2O)

PAN2 = 760 mm Hg – (100 mm Hg + 40 mm Hg + 47 mm Hg)

PAN2 = 760 mm Hg – 187 mm Hg

PAN2 = 573 mm Hg

 

DIF:    Analysis         REF:   p. 251            OBJ:   2

 

  1. In a person breathing room air (and with all else being normal), if the alveolar PCO2 rises from 40 to 70 mm Hg, what would you expect?
a. PAO2 to fall by about 30 mm Hg
b. PAO2 to fall by about 40 mm Hg
c. PAO2 to rise by about 30 mm Hg
d. PAO2 to rise by about 40 mm Hg

 

 

ANS:  A

Based on the alveolar air equation, if the FIO2 remains constant, then the PAO2 must vary inversely with the PACO2.

 

DIF:    Analysis         REF:   p. 252            OBJ:   3

 

  1. Assuming a constant FIO2 and carbon dioxide production, which of the following statements are correct?
a. An increased PACO2 will result in and increased PAO2.
b. Increased FIO2 blows off carbon dioxide.
c. Increases in A decrease the PACO2 and increase the PAO2.
d. The PAO2 varies proportionally with the PACO2.

 

 

ANS:  C

With a constant carbon dioxide production, a decrease in A simultaneously raises the PACO2 and lowers the PAO2.

 

DIF:    Application    REF:   p. 252            OBJ:   4

 

  1. What is the highest PAO2 one could expect to observe in an individual breathing room air at sea level?
a. 90 to 100 mm Hg
b. 110 to 120 mm Hg
c. 640 to 670 mm Hg
d. 710 to 760 mm Hg

 

 

ANS:  B

Neural control mechanisms and the increased of work breathing prevent decreases in PACO2 much below 15 to 20 mm Hg. Thus, whenever a patient is breathing room air at sea level, the respiratory therapist should not expect to see a PaO2 any higher than 120 mm Hg during hyperventilation.

 

DIF:    Application    REF:   p. 250            OBJ:   2

 

  1. Which of the following conditions must exist for gas to move between the alveolus and pulmonary capillary?
a. adequate alveolar ventilation (VA)
b. difference in partial pressures (pressure gradient)
c. normal central nervous system (CNS) control mechanism
d. sufficient amount of blood hemoglobin (Hb)

 

 

ANS:  B

Diffusion is the process whereby gas molecules move from an area of high partial pressure to an area of low partial pressure.

 

DIF:    Application    REF:   p. 252            OBJ:   1

 

  1. Which of the following “layers” must be traversed by gases moving across the alveolar-capillary membrane?
  2. alveolar epithelial membrane
  3. capillary endothelial membrane
  4. interstitial space
  5. transbronchial radial tethering mechanisms
a. 1, 2, and 3
b. 1, 2, and 4
c. 2 and 3
d. 1, 2, 3, and 4

 

 

ANS:  A

For carbon dioxide or oxygen to move between the alveoli and the pulmonary capillary blood, the following three barriers must be penetrated: (1) alveolar epithelium, (2) interstitial space, and (3) capillary endothelium.

 

DIF:    Application    REF:   p. 252            OBJ:   1

 

  1. When is the rate of gaseous diffusion across a biological membrane decreased?
a. The diffusion distance is small.
b. The gas diffusion constant increases.
c. The partial pressure gradient is low.
d. The surface area is large.

 

 

ANS:  C

Given that the area of and distance across the alveolar-capillary membrane are relatively constant in healthy people, diffusion in the normal lung mainly depends on gas pressure gradients.

 

DIF:    Application    REF:   p. 252            OBJ:   1

 

  1. Which of the following values corresponds most closely to the normal PO2 and PCO2 in the mixed venous blood returning to the lungs from the right side of the heart?
a. PO2 = 40 mm Hg; PCO2 = 46 mm Hg
b. PO2 = 40 mm Hg; PCO2 = 100 mm Hg
c. PO2 = 100 mm Hg; PCO2 = 40 mm Hg
d. PO2 = 100 mm Hg; PCO2 = 46 mm Hg

 

 

ANS:  A

Venous blood returning to the lungs has a lower PO2 (40 mm Hg) than alveolar gas. Thus the pressure gradient for oxygen diffusion into the blood is approximately 60 mm Hg (100 mm Hg – 40 mm Hg). Therefore, as blood flows past the alveolus, it takes up oxygen, leaving the capillary with a PO2 close to 100 mm Hg. Because venous blood has a higher PCO2 than alveolar gas (46 mm Hg versus 40 mm Hg), the pressure gradient for carbon dioxide causes diffusion of carbon dioxide in the opposite direction, from the blood into the alveolus.

 

DIF:    Application    REF:   p. 253            OBJ:   6

 

  1. Which of the following gases would diffuse fastest across the alveolar-capillary membrane?
a. air
b. carbon dioxide
c. oxygen
d. nitrogen

 

 

ANS:  B

Carbon dioxide diffuses approximately 20 times faster across the alveolar-capillary membrane than does oxygen, because of its much higher solubility in plasma.

 

DIF:    Application    REF:   p. 252            OBJ:   1

 

  1. Carbon dioxide diffuses across the alveolar-capillary membrane about how many times faster than oxygen?
a. 10
b. 20
c. 30
d. 40

 

 

ANS:  B

Carbon dioxide diffuses approximately 20 times faster across the alveolar-capillary membrane than does oxygen, because of its much higher solubility in plasma.

 

DIF:    Application    REF:   p. 252            OBJ:   1

 

  1. The time available for diffusion in the lung is mainly a function of which of the following?
a. functional residual capacity (FRC)
b. inspired oxygen concentration
c. level of VA
d. rate of pulmonary blood flow

 

 

ANS:  D

The diffusion time in the lung depends on the rate of pulmonary blood flow.

 

DIF:    Application    REF:   p. 252            OBJ:   1

 

  1. What is the minimum amount of time that blood must take for pulmonary capillary transit for equilibration of oxygen to occur across the alveolar-capillary membrane?
a. 0.15 second
b. 0.25 second
c. 0.35 second
d. 0.45 second

 

 

ANS:  B

If blood flow increases, such as during heavy exercise, capillary transit time can decrease to as low as 0.25 seconds. Even this short time frame is adequate to ensure that equilibration takes place, as long as no other factors impair diffusion. However, in the presence of a diffusion limitation, rapid blood flow through the pulmonary circulation can result in inadequate oxygenation.

 

DIF:    Recall             REF:   p. 252            OBJ:   1

 

  1. What is the primary factor that maintains the pressure gradient that drives oxygen from the capillaries into the interstitial spaces and into the cells?
a. Bohr effect on the RBC
b. cellular consumption of oxygen
c. Haldane effect on the RBC
d. increased carbon dioxide in blood decreasing Hb affinity for oxygen

 

 

ANS:  B

As cellular metabolism depletes its oxygen, the intracellular PO2 drops below that of the blood entering the tissue capillary. This provides the diffusion gradient by which oxygen diffuses from the tissue capillary blood (PO2 = 100 mm Hg) to the cells (PO2 less than 40 mm Hg).

 

DIF:    Analysis         REF:   p. 252            OBJ:   2

 

  1. In order to assess the events occurring at the tissue level, especially tissue oxygenation, what parameter would you sample and measure?
a. coronary sinus blood
b. left-sided heart blood
c. systemic arterial blood
d. systemic mixed venous blood

 

 

ANS:  D

To assess tissue gas exchange, the respiratory therapist must consider mixed venous blood parameters. The use of mixed venous blood to assess tissue oxygenation also is discussed in Chapter 43.

 

DIF:    Application    REF:   p. 254            OBJ:   6

 

  1. What is the normal range of PAO2 – PaO2 for healthy young adults breathing room air?
a. 5 to 10 mm Hg
b. 10 to 20 mm Hg
c. 20 to 30 mm Hg
d. 50 to 60 mm Hg

 

 

ANS:  A

Rather than equaling the alveolar PO2, the PaO2 of healthy individuals breathing air at sea level is always approximately 5 to 10 mm Hg less than the calculated PAO2.

 

DIF:    Application    REF:   p. 253            OBJ:   4

 

  1. Breathing room air, a normal PAO2 – PaO2 of 5 to 10 mm Hg exists due to which of the following?
  2. anatomical shunts in the pulmonary and cardiac circulations
  3. normal limitations to oxygen diffusion in the lung
  4. regional differences in pulmonary ventilation and blood flow
a. 1 and 3
b. 2 and 4
c. 1, 2, and 3
d. 1 and 2

 

 

ANS:  A

Two factors account for the normal PAO2 – PaO2: (1) right-to-left shunts in the pulmonary and cardiac circulation and (2) regional differences in pulmonary ventilation and blood flow.

 

DIF:    Application    REF:   p. 253            OBJ:   4

 

  1. Which of the following would you expect to occur if ventilation to an area of the lung remained constant but perfusion to this same area decreased?
  2. The PACO2 should fall.
  3. The PAO2 should fall.
  4. The /ratio should rise.
a. 3 only
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

A decrease in pulmonary capillary blood flow will cause a fall in alveolar PCO2 and a rise in alveolar PO2) assuming minute ventilation remains the same. The will result in an area of high /.

 

DIF:    Analysis         REF:   p. 255            OBJ:   10

 

  1. Which of the following would you expect to occur if perfusion to an area of the lung remained constant, but VA to this same area decreased?
a. The PACO2 should fall.
b. The HCO3 will fall.
c. The PAO2 should fall.
d. The ventilation/perfusion ratio (/) should rise.

 

 

ANS:  C

A low / indicates that ventilation is less than normal, perfusion is greater than normal, or both. In areas with a low /, the alveolar PO2 is lower and the PCO2 is higher than normal.

 

DIF:    Analysis         REF:   p. 255            OBJ:   10

 

  1. An area of the lung has no blood flow but is normally ventilated. Which of the following statements are true about this area?
  2. The alveolar gas is like air (PO2 = 150; PCO2 = 0).
  3. The area represents alveolar dead space.
  4. The /is elevated.
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

At the extreme right of the graph, perfusion is 0 (/ = 0). Areas with ventilation but no blood flow represent alveolar dead space, as defined in Chapter 10. The makeup of gases in these areas is similar to that of inspired air (PO2 = 150 mm Hg; PCO2 = 0 mm Hg).

 

DIF:    Application    REF:   p. 255            OBJ:   10

 

  1. An area of the lung has no ventilation but is normally perfused by the pulmonary circulation. Which of the following statements are correct?
  2. Blood exiting the pulmonary capillary will have a PO2 = 40 and a PCO2 = 46.
  3. The area represents an alveolar shunt.
  4. The /is 0.
a. 2 and 3
b. 1 and 3
c. 2 only
d. 1, 2, and 3

 

 

ANS:  D

With no ventilation to remove carbon dioxide and restore fresh oxygen, the makeup of gases in these areas is like that of mixed venous blood (PO2 = 40 mm Hg; PCO2 = 46 mm Hg). The / is zero. Venous blood entering areas with / ratios of 0 cannot pick up oxygen or unload carbon dioxide and leave the lungs unchanged. For such areas to be distinguished from true anatomical shunts, exchange units with / values of 0 are called alveolar shunts. Although small anatomical shunts are normal, alveolar shunts are not.

 

DIF:    Analysis         REF:   p. 255            OBJ:   4

 

  1. Regarding pulmonary blood flow in the upright lung, which of the following statements is true?
a. The apexes receive about 20 times more blood flow than the bases.
b. The bases receive about 20 times more blood flow than the apexes.
c. The greatest blood flow is found at the apexes of the lungs.
d. The pulmonary circulation is a high-pressure system.

 

 

ANS:  B

Farther down the lung, perfusion increases linearly in proportion to the hydrostatic pressure so the lung bases receive nearly 20 times as much blood flow as do the apexes.

 

DIF:    Application    REF:   p. 255            OBJ:   4

 

  1. During normal inspiration, which of the following occurs?
a. Alveoli at the apexes expand less than those at the bases.
b. Alveoli at the apexes expand more than those at the bases.
c. Alveoli at the bases and apexes expand almost equally.
d. Alveoli at the bases expand less than those at the apexes.

 

 

ANS:  A

Like perfusion, ventilation also is increased in the lung bases, with approximately four times as much ventilation going to the bases than to the apexes of the upright lung.

 

DIF:    Application    REF:   p. 255            OBJ:   4

 

  1. What occurs in the bases of the upright lung?
a. The PAO2 is higher than normal.
b. The respiratory exchange ratio is elevated.
c. There is significant dead space under normal conditions.
d. The / is lower than the average.

 

 

ANS:  D

At the bottom of the lung, blood flow is greater than ventilation, resulting in a low / (approximately 0.66), low PO2 (89 mm Hg), and slightly higher PCO2 (42 mm Hg).

 

DIF:    Application    REF:   p. 255            OBJ:   4

 

  1. Even in healthy young subjects, regional differences in pulmonary ventilation and blood flow result in the PaO2 being lower than the PAO2. Why is this so?
a. Most blood flows through the apexes of the lung.
b. Most blood flows through areas with high /.
c. Most blood flows through the bases of the lung.
d. Most ventilation goes to the apexes of the lung.

 

 

ANS:  C

As shown in Table 11-1, because of gravity most blood flows to the lung bases, where the PO2 is lower and the PCO2 is higher than normal. After leaving the lung, this relatively large volume of blood combines with the smaller volume coming from the middle and apical regions. The result is a mixture of blood with less oxygen and more carbon dioxide than would come from an ideal gas exchange unit.

 

DIF:    Application    REF:   p. 255            OBJ:   3

 

  1. How is the vast majority of oxygen carried in the blood?
a. as bicarbonate ion (HCO3)
b. as carbamino compounds
c. chemically combined with Hb
d. in physical solution

 

 

ANS:  C

The majority of oxygen is carried in a reversible chemical combination with hemoglobin inside the RBC.

 

DIF:    Recall             REF:   p. 255            OBJ:   6

 

  1. As the amount of oxygen that dissolves in the plasma increases, what is it directly proportional to?
a. its partial pressure
b. its solubility coefficient
c. minute ventilation
d. temperature

 

 

ANS:  A

The relationship between partial pressure and dissolved oxygen is direct and linear. By applying Henry’s law, the amount of dissolved oxygen in the blood (at 37° C) can be computed with the following simple formula:

Dissolved oxygen (ml/dl) = PO2 ´ 0.003.

 

DIF:    Application    REF:   p. 255            OBJ:   6

 

  1. At body temperature, how much oxygen will physically dissolve in plasma at a PO2 of 40 mm Hg?
a. 0.12 ml/dl
b. 0.20 ml/dl
c. 0.30 ml/dl
d. 1.34 g/dl

 

 

ANS:  A

By applying Henry’s law, the amount of dissolved oxygen in the blood (at 37° C) can be computed with the following simple formula:

Dissolved oxygen (ml/dk) = PO2 ´ 0.003

 

DIF:    Analysis         REF:   p. 255            OBJ:   6

 

  1. Under normal physiologic circumstances, how many milliliters of oxygen are capable of combining with 1 g of Hb?
a. 0.003 ml
b. 0.450 ml
c. 0.820 ml
d. 1.340 ml

 

 

ANS:  D

In whole blood, each gram of hemoglobin can carry approximately 1.34 ml of oxygen.

 

DIF:    Recall             REF:   p. 255            OBJ:   6

 

  1. If the total hemoglobin content (Hb + HbO2) of a sample of blood is 20 g/dl and the oxyhemoglobin (HbO2) content is 15 g/dl, what is the HbO2 saturation?
a. 17%
b. 50%
c. 75%
d. 83%

 

 

ANS:  C

If there were a total of 20 g/dl Hb in the blood, of which 15 g was HbO2, the SaO2 would be calculated as follows:

SaO2 (%) = [15 ¸ 20] ´ 100 = 75%

 

DIF:    Analysis         REF:   p. 257            OBJ:   6

 

  1. At a PaO2 of 65 mm Hg, what is the approximate saturation of Hb with oxygen?
a. 73%
b. 80%
c. 90%
d. 97%

 

 

ANS:  C

If some abnormality reduced the PaO2 to 65 mm Hg, the SaO2 would still be approximately 90%.

 

DIF:    Application    REF:   p. 257            OBJ:   7

 

  1. Why is it necessary to keep the patient’s PaO2 greater than 60 mm Hg?
a. A level of 60 mm Hg marks the beginning of the steep part of O2Hb dissociation curve.
b. Below the 60 mm Hg level, tissue hypoxia is ensured.
c. Oxygen deprivation will cause severe cerebral vasoconstriction below 60 mm Hg.
d. The PaCO2 will start to rise precipitously if the PaO2 falls further.

 

 

ANS:  A

With a PO2 lower than 60 mm Hg, the curve steepens dramatically. Here, in the normal operating range of the tissues, even a small drop in PO2 causes a large drop in SaO2, indicating a lessening affinity for oxygen. This normal decrease in the affinity of hemoglobin for oxygen helps release large amounts of oxygen to the tissue, where the PO2 is low. This also explains why it is necessary to keep the PaO2 higher than 60 mm Hg in clinical practice.

 

DIF:    Application    REF:   p. 258            OBJ:   7

 

  1. Given the following blood parameters, compute the total oxygen content (dissolved + HbO2) of the blood in ml/dl: Hb = 18; PO2 = 40 mm Hg; SO2 = 73%.
a. 16.5 ml/dl
b. 17.7 ml/dl
c. 18.6 ml/dl
d. 19.5 ml/dl

 

 

ANS:  B

Known values are (1) PO2, (2) total hemoglobin content (g/dl), and (3) hemoglobin saturation. Given these values, the following equation can be applied:

CaO2 = (0.003 ´ PO2) + (Hbtot ´ 1.34 ´ SO2)

 

DIF:    Analysis         REF:   p. 257            OBJ:   6

 

  1. Given the following blood parameters, compute the total oxygen content (dissolved + HbO2) of the blood in ml/dl: Hb = 16; PO2 = 625 Hg; SO2 = 100%.
a. 17.8 ml/dl
b. 19.4 ml/dl
c. 21.4 ml/dl
d. 23.3 ml/dl

 

 

ANS:  D

The respiratory therapist obtains a sample of arterial blood from a patient breathing 100% oxygen. The PO2 is 625 mm Hg, Hb is 16 g/dl, and the oxygen saturation is 100%. To compute the total oxygen content, the respiratory therapist should apply the aforementioned equation as follows:

CaO2 = (0.003 ´ PaO2) + (Hbtot ´ 1.34 ´ SaO2)

CaO2 = (0.003 ml ´ 625 mm Hg) + (16 g/dl ´ 1.34 ´ 1.0)

CaO2 = (1.875 ml) + (21.44 g/dl)

CaO2 = 23.3 ml/dl

 

DIF:    Analysis         REF:   p. 257            OBJ:   6

 

  1. What is the approximate normal CaO2 – CO2 in a healthy adult at rest?
a. 5 ml/dl
b. 15 ml/dl
c. 20 ml/dl
d. 250 ml/dl

 

 

ANS:  A

As indicated in Table 11-2, the difference between the normal arterial and venous oxygen contents is approximately 5 ml/dl.

 

DIF:    Recall             REF:   p. 258            OBJ:   10

 

  1. A patient has a whole-body oxygen consumption of 320 ml/min and a measured CaO2 – CO2 of 8 ml/dl. What is the cardiac output?
a. 3.2 L/min
b. 4.0 L/min
c. 5.0 L/min
d. 7.0 L/min

 

 

ANS:  B

Fick equation:

t = O2 ¸C(a – v)O2 ´ 10

In this equation, t is cardiac output (L/min), O2 is the whole-body oxygen consumption (ml/min), and C(a –)O2 is the arteriovenous oxygen contents difference (ml/dl). The factor of 10 converts ml/dl to ml/L. Given a normal O2 of 250 ml/min and a normal C(a –)O2 of 5 ml/dl, a normal cardiac output is calculated as follows:

t = 200 ml/min ¸ 5 ml/dl ´ 10

t = 250 ml/min ¸ 5 ml/L

t = 5.0 L/min

 

DIF:    Analysis         REF:   p. 258            OBJ:   10

 

  1. According to the Fick principle, if oxygen consumption remains constant, an increase in cardiac output will manifest itself as which of the following?
a. decrease in the CaO2 – CO2
b. increase in the CaO2
c. increase in the CaO2 – CO2
d. decrease in the CO2

 

 

ANS:  A

If the cardiac output rises and oxygen consumption remains constant, the C(a –)O2 will fall proportionately.

 

DIF:    Analysis         REF:   p. 258            OBJ:   10

 

  1. According to the Bohr effect, when the pH drops (blood becomes more acidic), what happens?
  2. The affinity of Hb for oxygen decreases.
  3. The Hb saturation for a given PO2 falls.
  4. The Hb saturation for a given PO2 rises.
a. 1 and 2
b. 2 only
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  A

The impact of changes in blood pH on hemoglobin affinity for oxygen is called the Bohr effect. As shown in Figure 11-10, the Bohr effect alters the position of the HbO2 dissociation curve. A low pH (acidity) shifts the curve to the right, decreasing Hb affinity for oxygen and thus oxygen saturation.

 

DIF:    Application    REF:   p. 258-259     OBJ:   10

 

  1. Compared to normal levels, a shift in the HbO2 curve to the right has which of the following effects?
  2. The affinity of Hb for oxygen decreases.
  3. The Hb saturation for a given PO2 falls.
  4. The Hb saturation for a given PO2 rises.
a. 1 only
b. 1 and 2
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  B

As blood pH drops and the curve shifts to the right, the Hb saturation for a given PO2 falls (decreased Hb affinity for oxygen.

 

DIF:    Application    REF:   p. 259            OBJ:   10

 

  1. What role does the Bohr effect play in oxygen transport?
a. describes the affect of varying enzyme levels on Hb and oxygen affinity
b. diminishes tissue oxygenation due to electrolyte imbalances
c. enhances oxygen delivery to tissues and oxygen pickup at lungs
d. explains the affect that oxygen levels have on carbon dioxide transport

 

 

ANS:  C

The Bohr effect enhances oxygen loading in the lungs and oxygen unloading in the tissues.

 

DIF:    Application    REF:   p. 259            OBJ:   10

 

  1. What happens when the temperature of the blood rises?
  2. The Hb saturation for a given PO2 falls.
  3. The HbO2 curve shifts to the right.
  4. The affinity of Hb for oxygen increases.
a. 1 and 2
b. 1 and 3
c. 2 only
d. 1, 2, and 3

 

 

ANS:  A

Conversely, as body temperature rises, the curve shifts to the right, and the affinity of Hb for oxygen decreases.

 

DIF:    Application    REF:   p. 260            OBJ:   10

 

  1. What is the affect of an elevated intracellular 2,3-DPG concentration?
a. decreases the availability of oxygen to the tissues
b. increases the affinity of Hb for oxygen
c. increases the availability of oxygen to the tissues
d. shifts the HbO2 dissociation curve to the left

 

 

ANS:  C

Increased 2,3-DPG concentrations shift the HbO2 curve to the right, promoting oxygen unloading.

 

DIF:    Application    REF:   p. 260            OBJ:   10

 

  1. In which of the following conditions will erythrocyte concentration of 2,3-DPG be decreased?
a. anemia
b. banked blood
c. high pH
d. hypoxemia

 

 

ANS:  B

Erythrocyte concentrations of 2,3-DPG in banked blood decrease over time. After a week of storage, the 2,3-DPG level may be less than one third of the normal value.

 

DIF:    Recall             REF:   p. 260            OBJ:   10

 

  1. The oxidation of the Hb molecule’s iron ions to the ferric state (Fe3+) results in which of the following?
  2. form of anemia called sickle cell anemia
  3. formation of methemoglobin (metHb)
  4. inability of metHb to bind with oxygen
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  C

metHb is an abnormal form of the molecule in which the heme-complex normal ferrous iron ion (Fe2+) loses an electron and is oxidized to its ferric state (Fe3+). In the ferric state, the iron ion cannot combine with oxygen.

 

DIF:    Recall             REF:   p. 261            OBJ:   10

 

  1. The affinity of Hb for carbon monoxide (CO) is approximately how many times greater than its affinity for oxygen?
a. 10 to 50 times greater
b. 50 to 90 times greater
c. 100 to 190 times greater
d. 200 or greater

 

 

ANS:  D

Carboxyhemoglobin (HbCO) is the chemical combination of hemoglobin with CO. Hemoglobin’s affinity for CO is more than 200 times greater than it is for oxygen.

 

DIF:    Application    REF:   p. 261            OBJ:   10

 

  1. Which of the following does NOT increase the affinity of Hb for oxygen?
a. decreased 2,3-DPG
b. decreased PCO2
c. increased pH
d. increased temperature

 

 

ANS:  D

An increased pH results in a right shift in the oxygen-hemoglobin dissociation curve resulting in a decreased affinity.

 

DIF:    Application    REF:   p. 261            OBJ:   10

 

  1. Which of the following are true regarding fetal hemoglobin (HbF)?
a. It has a reduced level of 2,3-DPG.
b. It is replaced in the first month of life.
c. It delivers more oxygen to tissues at low PaO2 than normal Hb.
d. It has a higher P50 than normal Hb.

 

 

ANS:  C

HbF has a greater affinity for oxygen than does normal adult Hb, as manifested by a leftward shift of the HbO2 curve. Given the low PO2 values available to the fetus in utero, this leftward shift aids oxygen loading at the placenta. Because of the relatively low pH of the fetal environment, oxygen unloading at the cellular level is not greatly affected.

 

DIF:    Application    REF:   p. 262            OBJ:   10

 

  1. A patient has a P50 value of 29 mm Hg. What does this indicate?
a. decreased affinity of Hb for oxygen
b. higher than normal Hb saturation for a given PO2
c. increased affinity of Hb for oxygen
d. normal position in the HbO2

 

 

ANS:  A

Conditions that cause a decrease in Hb affinity for oxygen (a shift of the HbO2 curve to the right) increase the P50 to higher than normal. A normal P50 is 26 mm Hg.

 

DIF:    Application    REF:   p. 262            OBJ:   10

 

  1. In which of the following forms is carbon dioxide transported by the blood?
  2. chemically combined with proteins
  3. ionized as bicarbonate (HCO3)
  4. simple physical solution
a. 2 only
b. 3 only
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

Approximately 45 to 55 ml/dl of carbon dioxide is normally carried in the blood in the following three forms: (1) dissolved in physical solution, (2) chemically combined with protein, and (3) ionized as bicarbonate.

 

DIF:    Application    REF:   p. 263            OBJ:   8

 

  1. Which of the following applies to the following reaction:

Prot-NH2 + CO2  Prot-NHCOO + H+?

a. About 20% of the total blood carbon dioxide is carried in this form.
b. It is second in importance to only the bicarbonate buffer system.
c. It represents the formation of blood carbamino compounds.
d. The resulting H+ ions are buffered by reduced HCO3.

 

 

ANS:  C

A small amount of the carbon dioxide leaving the tissues combines with plasma proteins to form these carbamino compounds.

 

DIF:    Analysis         REF:   p. 263            OBJ:   8

 

  1. The largest percentage of carbon dioxide transported in the blood occurs as which of the following?
a. carbamino-Hb
b. carbonic acid (H2CO3)
c. HCO3
d. physically dissolved carbon dioxide

 

 

ANS:  C

Approximately 80% of the blood carbon dioxide is transported as bicarbonate.

 

DIF:    Recall             REF:   p. 263            OBJ:   8

 

  1. Why is the presence of carbonic anhydrase in RBCs so crucial for carbon dioxide transport?
a. forms H2CO3 which is the major buffer for carbon dioxide
b. drives the hydrolysis reaction that forms HCO3
c. forms H2CO3, which is the way the majority of carbon dioxide is transported
d. without its formation, carbon dioxide could not be excreted at the lungs

 

 

ANS:  B

Hydrolysis of carbon dioxide initially forms carbonic acid, which quickly ionizes into hydrogen and bicarbonate ions:

CO2 + H2O  H2CO3  HCO3 + H+

However, the rate of this plasma hydrolysis reaction is extremely slow, producing minimal amounts of H+ and HCO3. This reaction is greatly enhanced by an enzyme catalyst called carbonic anhydrase.

 

DIF:    Application    REF:   p. 263            OBJ:   8

 

  1. When a Hb molecule accumulates excessive amounts of HCO3, it is expelled from the cell in exchange for Cl. What is this called?
a. Bohr effect
b. Haldane effect
c. Hamburger phenomenon
d. hydrolysis phenomenon

 

 

ANS:  C

As the hydrolysis of carbon dioxide continues, HCO3 ions begin to accumulate in the erythrocyte. To maintain a concentration equilibrium across the cell membrane, some of these anions diffuse outward into the plasma. Because the erythrocyte is not freely permeable by cations, electrolytic equilibrium must be maintained by way of an inward migration of anions. This is achieved by the shifting of chloride ions (Cl) from the plasma into the erythrocyte, a process called the chloride shift, or the Hamburger phenomenon.

 

DIF:    Recall             REF:   p. 264            OBJ:   8

 

  1. When Hb saturation with oxygen is high, less carbon dioxide is carried in the blood. What is this relationship called?
a. Bohr effect
b. chloride shift
c. dissociation constant
d. Haldane effect

 

 

ANS:  D

Figure 11-14 shows that oxyhemoglobin saturation also affects the position of the carbon dioxide dissociation curve. The influence of oxyhemoglobin saturation on carbon dioxide dissociation is called the Haldane effect.

 

DIF:    Application    REF:   p. 264            OBJ:   9

 

  1. The conversion of HbO2 to deoxygenated Hb does which of the following?
  2. decreases blood carbon dioxide content
  3. enhances carbon dioxide loading on Hb
  4. helps buffer H+ ions
a. 2 and 3
b. 1 and 2
c. 3 only
d. 1, 2, and 3

 

 

ANS:  A

Figure 11-14 shows that oxyhemoglobin saturation also affects the position of the CO2 dissociation curve. The influence of oxyhemoglobin saturation on CO2 dissociation is called the Haldane effect. As previously explained, this phenomenon is a result of changes in the affinity of hemoglobin for CO2, which occur as a result of its buffering of H+ ions.

 

DIF:    Analysis         REF:   p. 264            OBJ:   9

 

  1. Which of the following statements is true regarding the Haldane effect?
a. At high SaO2 levels, carbon dioxide more readily forms carbamino compounds.
b. At high SaO2 levels, the capacity of blood to hold carbon dioxide decreases.
c. At high SaO2 levels, the capacity of blood to hold carbon dioxide increases.
d. At low SaO2 levels, the capacity of blood to hold carbon dioxide decreases.

 

 

ANS:  B

At point “a,” the high SaO2 decreases the blood’s capacity to hold carbon dioxide, thus helping unload this gas at the lungs.

 

DIF:    Application    REF:   p. 264            OBJ:   9

 

  1. Which of the following equations best describes oxygen delivery to the tissues?
a. arterial oxygen content ¸ cardiac output
b. arterial oxygen content ´ cardiac output
c. cardiac output + arterial oxygen content
d. cardiac output ´ vascular resistance

 

 

ANS:  B

Oxygen delivery (O2) to the tissues is a function of arterial oxygen content (CaO2) times cardiac output (t):

O2 = CaO2 ´ t

 

DIF:    Analysis         REF:   p. 265            OBJ:   10

 

  1. In the presence of an acutely reduced arterial oxygen content (hypoxemia), normal oxygen delivery to the tissues can be maintained by which of the following?
a. hyperventilation (increased VA)
b. increased RBC production
c. increasing the cardiac output
d. peripheral vasoconstriction

 

 

ANS:  C

Oxygen delivery (O2) to the tissues is a function of arterial oxygen content (CaO2) times cardiac output (t):

O2 = CaO2 ´ t

If arterial oxygen content falls an increased cardiac output will compensate.

 

DIF:    Analysis         REF:   p. 265            OBJ:   10

 

  1. Hypoxia is best defined as a condition in which what occurs?
a. Blood Hb levels are less than normal (15 g/dl).
b. The arterial PCO2 is greater than normal (45 mm Hg).
c. The arterial PO2 is greater than normal (100 mm Hg).
d. Tissue oxygen delivery is inadequate to meet cellular needs.

 

 

ANS:  D

When oxygen delivery falls short of cellular needs, hypoxia occurs.

 

DIF:    Application    REF:   p. 265            OBJ:   10

 

  1. Which of the following are potential causes of hypoxia?
  2. decrease in arterial PO2
  3. decrease in available Hb
  4. decrease in cardiac output
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

Hypoxia occurs if (1) the arterial blood oxygen content is decreased (hypoxemia),or (2) cardiac output, or perfusion is decreased (shock or ischemia).

 

DIF:    Application    REF:   p. 265            OBJ:   10

 

  1. An abnormal metabolic state in which the tissues are unable to utilize the oxygen made available to them best describes which of the following?
a. diffusion hypoxia
b. dysoxia
c. hemic hypoxia
d. physiologic shunt

 

 

ANS:  B

Abnormal cellular function prevents proper uptake of oxygen is called dysoxia.

 

DIF:    Application    REF:   p. 269            OBJ:   10

 

  1. A patient breathing room air at sea level has the following arterial blood gases: PaO2 = 62 mm Hg; PCO2 = 75 mm Hg. When the FIO2 is raised to 0.28, the PaO2 rises to 95 mm Hg. What is the most likely cause of the hypoxemia?
a. hypoventilation
b. impaired diffusion
c. right-to-left shunt
d. / imbalance

 

 

ANS:  A

In the case of simple hypoventilation, a rise in the alveolar PCO2 is always accompanied by a proportionate fall in alveolar PO2. The P(A – a)O2 is normal in such cases. The hypoxemia will respond readily to oxygen therapy.

 

DIF:    Application    REF:   p. 266            OBJ:   10

 

  1. What is the most common cause of hypoxemia in patients with lung disease?
a. diffusion defect
b. hypoventilation
c. right-to-left shunt
d. / mismatch

 

 

ANS:  D

Ventilation-perfusion (/) imbalances are the most common cause of hypoxemia in patients with lung disease.

 

DIF:    Application    REF:   p. 266            OBJ:   9

 

  1. A patient breathing 40% oxygen at sea level has a PaO2 of 50 mm Hg, a PCO2 of 30 mm Hg and a PAO2 – PaO2 of 250 mm Hg. When the FIO2 is raised to 0.7, the PaO2 rises to only 58 mm Hg. Hypoxemia is primarily due to which of the following?
a. hypoventilation
b. impaired diffusion
c. right-to-left shunt
d. / imbalance

 

 

ANS:  C

A / of 0 represents a special type of imbalance. When the / is 0, there is blood flow but no ventilation. The result is equivalent to a right-to-left anatomical shunt, shown at the bottom of Figure 11-15. Venous blood bypasses ventilated alveoli and mixes with freshly oxygenated arterial blood, resulting in what is called a venous admixture. Right-to-left physiologic shunting results in a more severe form of hypoxemia than does a simple /.

 

DIF:    Analysis         REF:   p. 266            OBJ:   9

 

  1. The expected PaO2 for an 80-year-old man who is otherwise in good health and breathing room air is about what level?
a. 50 mm Hg
b. 75 mm Hg
c. 80 mm Hg
d. 90 mm Hg

 

 

ANS:  B

One may estimate the expected PaO2 in older adults by using the following formula:

Expected PaO2 = 100.1 – (0.323 ´ age in years)

 

DIF:    Analysis         REF:   p. 266            OBJ:   9

 

  1. A patient with a normal PaO2 and cardiac output is exhibiting signs and symptoms of tissue hypoxia. What is the most likely cause?
a. hemoglobin deficiency
b. low ambient PO2
c. right-to-left shunt
d. hypoventilation

 

 

ANS:  A

If the blood hemoglobin is low—even when the PaO2 is normal—hypoxia can occur because of low oxygen content in the arterial blood.

 

DIF:    Analysis         REF:   p. 268            OBJ:   9

 

  1. What is the most important component in the oxygen transport system?
a. dissolved oxygen in ml/dl
b. HCO3
c. Hb
d. PaO2

 

 

ANS:  C

Progressive falls in blood hemoglobin content cause large drops in arterial oxygen content (CaO2). In fact, a 33% decrease in hemoglobin content (from 15 to 10 g/dl) reduces the CaO2 as much as would a drop in PaO2 from 100 to 40 mm Hg.

 

DIF:    Analysis         REF:   p. 255            OBJ:   9

 

  1. When oxygen uptake by the tissues is abnormally low, as occurs in certain forms of dysoxia, what would you expect to find?
a. decreased CaO2
b. decreased CvO2
c. decreased PaO2
d. increased CvO2

 

 

ANS:  D

Dysoxia is a form of hypoxia in which the cellular uptake of oxygen is abnormally decreased. The best example of dysoxia is cyanide poisoning. Cyanide disrupts the intracellular cytochrome oxidase system, thereby preventing cellular use of oxygen.

 

DIF:    Analysis         REF:   p. 269            OBJ:   9

 

  1. Which of the following would you expect to find with “oxygen debt”?
  2. accentuated in diseases such as sepsis
  3. oxygen demand exceeds oxygen delivery
  4. oxygen excess usage results in debt
a. 1, 2, and 3
b. 1 and 2
c. 2 only
d. 2 and 3

 

 

ANS:  B

Decreases in oxygen delivery result in an oxygen “debt,” when oxygen demand exceeds oxygen delivery. Under conditions of oxygen debt, oxygen consumption becomes dependent on oxygen delivery (sloped line on Figure 11-19). This in turn leads to lactic acid accumulation and metabolic acidosis. In pathologic conditions such as septic shock and adult respiratory distress syndrome (dotted line on Figure 11-19), this critical point may occur at levels of oxygen delivery considered normal.

 

DIF:    Application    REF:   p. 270            OBJ:   10

 

  1. Under which of the following conditions may carbon dioxide removal be impaired?
  2. when a /imbalance exists
  3. when the dead space ventilation/min is increased
  4. when the minute ventilation is inadequate
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

Anything that decreases alveolar ventilation can impair carbon dioxide removal. A decrease in alveolar ventilation occurs when (1) the minute ventilation is inadequate, (2) the dead space ventilation per minute is increased, or (3) a / imbalance exists.

 

DIF:    Application    REF:   p. 270            OBJ:   11

 

  1. Carbon dioxide is most commonly elevated due to significant pulmonary disease that results in small tidal volumes.
a. False
b. True

 

 

ANS:  B

Clinically, inadequate minute ventilation usually is caused by decreased tidal volumes. This occurs in restrictive conditions, such as atelectasis, neuromuscular disorders, or impeded thoracic expansion (e.g., kyphoscoliosis).

 

DIF:    Application    REF:   p. 270            OBJ:   11

 

  1. What can you assume about a patient who has a / imbalance and exhibits hypercapnia (PCO2 greater than 45 mm Hg)?
a. The central nervous system is not responding to the increased PCO2.
b. The patient cannot sustain the high E to overcome the high VD.
c. The patient is compensating for an acute metabolic alkalosis.
d. The patient is compensating for a chronic metabolic acidosis.

 

 

ANS:  B

An increase in dead space ventilation is caused by either (1) rapid, shallow breathing (an increase in anatomical dead space per minute) or (2) increased physiologic dead space (/ = 0). In either case, the proportion of wasted ventilation increases. Without compensation, this lowers alveolar ventilation per minute and impairs carbon dioxide removal.

 

DIF:    Application    REF:   p. 271            OBJ:   11

 

  1. What does / mismatch have the biggest impact on?
a. carbon dioxide elimination
b. dissolved HCO3
c. Oxygenation
d. pH

 

 

ANS:  C

/ imbalances have a greater effect on oxygenation than on carbon dioxide removal.

 

DIF:    Application    REF:   p. 271            OBJ:   11

 

  1. If blood from an area of the lung with a high / is mixed with blood perfusing an area with a low /, what will be the result?
a. CaO2 higher than the average of the two
b. CaO2 lower than the average of the two
c. PaO2 equal to the average of the two
d. PaO2 lower than the average of the two

 

 

ANS:  D

The final oxygen content, also arrived at by averaging the high and low / points, is shown as point X on the oxygen curve (Figure 11-20). Whereas the averaged value for carbon dioxide was normal, the PaO2 resulting from averaging the oxygen content of the high and low / units is well below normal (point “a” on the oxygen curve of Figure 11-20).

 

DIF:    Application    REF:   p. 271            OBJ:   10

 

  1. Which of the following statements is NOT true about the effect of / imbalances on oxygen and carbon dioxide exchange?
a. Blood leaving high / units has a high PO2 and a low PCO2.
b. Blood leaving low / units has a low PO2 and a high PCO2.
c. High / units can compensate for high PCO2 levels from low / units.
d. High / units can compensate for low PO2 levels from low / units.

 

 

ANS:  D

However, the shape of the dissociation curves dictates that a high / unit can reverse the high PCO2 but not the low PO2.

 

DIF:    Analysis         REF:   p. 271            OBJ:   11

 

  1. Under which of the following conditions can the alveolar partial pressure of carbon dioxide (PACO2) be increased?
  2. when the body increases its production of CO2 (VCO2)
  3. when the dead space ventilation/min. is increased (VD)
  4. when the minute ventilation is inadequate (VE)
  5. when the alveolar ventilation is decreased (VA)
a. 1 and 2
b. 1 and 3
c. 1, 2 and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

The alveolar partial pressure of carbon dioxide, or PACO2, varies directly with the body`s production of carbon dioxide (VCO2) and inversely with alveolar ventilation (VA). A decrease in alveolar ventilation occurs when the minute ventilation is inadequate, the dead space ventilation per minute is increased, or a / imbalance exists.

 

DIF:    Analysis         REF:   p. 249-250     OBJ:   2

 

  1. When using therapeutic agents that can cause methhemoglobinemia methHb, which of the following are important to prevent adverse effects?
a. checking the frequency of ventilation
b. frequent monitoring for methHb to weigh the risk against the benefit
c. occasional monitoring for sickle cell anemia
d. frequent monitoring for abnormal body temperature (high or low)

 

 

ANS:  B

Methemoglobin (metHb) is an abnormal form of the molecule, in which the heme-complex normal ferrous iron ion (Fe++) loses an electron and is oxidized to its ferric state (Fe+++). In the ferric state, the iron ion cannot combine with oxygen. The result is a special form of anemia called methemoglobinemia. As with HbCO, clinical abnormalities come from the associated increased affinity for oxygen and loss of oxygen-binding capacity. The most common cause of methemoglobinemia is the therapeutic use of oxidant medications such as nitric oxide, nitroglycerin, and lidocaine. When using these therapeutic agents, frequent monitoring for metHg is important to weigh the risk against the benefit.

 

DIF:    Application    REF:   p. 261            OBJ:   7

 

  1. The two major causes of dead space ventilation are:
  2. a decreased tidal volume
  3. dysoxia
  4. impaired CO2 removal
  5. increased physiologic dead space
a. 1 and 2 only
b. 1 and 3 only
c. 1 and 4 only
d. 1, 2, 3 only

 

 

ANS:  C

An increase in dead space ventilation, or VD/VT, is caused by either (1) a decreased tidal volume as with rapid, shallow breathing (an increase in anatomic dead space per minute) or (2) increased physiologic dead space as in pulmonary embolus.(V./Q. = 0). In either case, the proportion of wasted ventilation increases.

 

DIF:    Application    REF:   p. 268            OBJ:   10

 

  1. Disorders that can lead to alveolar dead space include:
  2. pulmonary emboli
  3. partial obstruction of the pulmonary vasculature
  4. destroyed pulmonary vasculature
  5. reduced cardiac output
a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 4 only
d. 1, 2, 3, and 4

 

 

ANS:  D

Alveolar dead space is that ventilation that enters into alveoli that are without any perfusion or without adequate perfusion. Disorders that can lead to alveolar dead space include pulmonary emboli, partial obstruction of the pulmonary vasculature, destroyed pulmonary vasculature (as can occur in COPD) and with reduced cardiac output.

 

DIF:    Application    REF:   p. 265            OBJ:   10

Chapter 21: Nutrition Assessment

Test Bank

 

MULTIPLE CHOICE

 

  1. What is the primary purpose of nutrition assessment?
a. to identify how much weight the patient needs to lose
b. to identify the patient’s ideal body weight
c. to develop a nutrition care plan
d. to identify the proper caloric intake for the patient

 

 

ANS:  C

The purpose of nutrition assessment is to gather data to develop a nutrition care plan that will ensure adequate nutrition for health and well-being when implemented

 

DIF:    Recall             REF:   p. 477            OBJ:   1

 

  1. Which of the following is NOT considered part of the anthropometric assessment?
a. body mass index
b. activity level
c. history of weight loss
d. triceps skinfold

 

 

ANS:  B

Box 21-1 gives an overview of the information to incorporate into a nutrition assessment.

 

DIF:    Recall             REF:   p. 477            OBJ:   1

 

  1. If your patient is 2 m in height and weighs 80 kg, what is his body mass index (BMI)?
a. 40
b. 30
c. 20
d. 15

 

 

ANS:  C

The formula used to calculate BMI is as follows for measurements in kilograms and meters:

BMI = Weight (kg)

Height (m)2

 

DIF:    Application    REF:   p. 478            OBJ:   2

 

  1. What is the normal BMI for adults?
a. 15.5 to 20.6 kg/m2
b. 18.5 to 24.9 kg/m2
c. 20.6 to 25.9 kg/m2
d. 22.5 to 26.0 kg/m2

 

 

ANS:  B

A healthy weight may be confirmed by a BMI of between 18.5 and 24.9 kg/m2 for adults or a BMI-for-age between the 10th and 85th percentiles for children.

 

DIF:    Recall             REF:   p. 478            OBJ:   2

 

  1. Obesity is defined as a BMI over what value?
a. 20 kg/m2
b. 25 kg/m2
c. 30 kg/m2
d. 35 kg/m2

 

 

ANS:  C

Obesity is defined as a BMI greater than 30 kg/m2 in the adult and greater than the 95th percentile in boys and girls aged 2 to 20 years.

 

DIF:    Recall             REF:   p. 478            OBJ:   2

 

  1. Which of the following statements is NOT true regarding kwashiorkor?
a. occurs with a long-term loss of protein
b. often causes facial and limb edema
c. child often has a pot belly
d. may occur in combination with marasmus

 

 

ANS:  A

Kwashiorkor results from the more sudden lack of protein and calories, as in the first-born infant weaned suddenly on the arrival of a new sibling, when a diet of nutrient-rich breast milk is traded for a nutrient-poor cereal-based diet. The protruding belly and edematous face and limbs, characteristics of kwashiorkor, result from a lack of circulating proteins needed to maintain fluid balance and to transport fat out of the liver.

 

DIF:    Application    REF:   p. 479            OBJ:   2

 

  1. Protein-energy malnutrition may be reflected in reduced values for each of the following except:
a. albumin levels
b. lymphocyte count
c. transferrin
d. red blood cell count

 

 

ANS:  D

Protein-energy malnutrition may be reflected in low values for albumin, transferrin, transthyretin, retinol-binding protein, and total lymphocyte count.

 

DIF:    Recall             REF:   p. 481            OBJ:   3

 

  1. Which of the following blood tests is most useful for day to day monitoring of long-term trends in the nutrition status of the patient?
a. albumin levels
b. total white blood cell count
c. hematocrit
d. serum potassium levels

 

 

ANS:  A

The general availability and stability of albumin levels from day to day make it one of the most useful tests for assessing long-term trends (Table 21-2).

 

DIF:    Recall             REF:   p. 480            OBJ:   4

 

  1. Your male patient has a creatinine excretion level of 8 mg/kg body weight/day. What does this indicate?
a. It is normal.
b. There is mild muscle wasting.
c. There is moderate muscle wasting.
d. There is severe muscle wasting.

 

 

ANS:  D

Predicted values are based on gender and height, with reference values of approximately 18 mg/kg body weight/day for women to approximately 23 mg/kg body weight/day for men. Values of 60% to 80% of predicted indicate a mild deficit of muscle mass; 40% to 60% indicate a moderate deficit, and less than 40% of predicted suggests a severe depletion of muscle mass.

 

DIF:    Application    REF:   p. 481            OBJ:   4

 

  1. Which of the following complications is LEAST likely to influence creatinine excretion?
a. sepsis
b. trauma
c. hypoxemia
d. diet

 

 

ANS:  C

Factors that influence creatinine excretion, and thus complicate interpretation of this index, include age, diet, exercise, stress, trauma, fever, and sepsis.

 

DIF:    Recall             REF:   p. 481            OBJ:   4

 

  1. What is the recommended measurement for nitrogen balance?
a. blood urea nitrogen
b. serum urea nitrogen
c. urinary nitrogen
d. urinary urea nitrogen

 

 

ANS:  C

Urinary nitrogen is the recommended value to use in determining nitrogen balance.

 

DIF:    Recall             REF:   p. 481            OBJ:   4

 

  1. What changes in lung function are associated with malnutrition?
a. reduced VC
b. increased TLC
c. increased RV
d. decreased FRC

 

 

ANS:  A

Weakness of the diaphragm and other muscles of inspiration can lead to a reduced vital capacity and peak inspiratory pressures.

 

DIF:    Recall             REF:   p. 484            OBJ:   4

 

  1. Your patient is reported to be cachexic. Which of the following physical findings would support this statement?
a. The patient’s belly is swollen.
b. The patient has facial edema.
c. The patient’s ribs protrude.
d. The patient’s hair falls out easily.

 

 

ANS:  C

Patients with persistent malnutrition will often appear very thin to the point that their ribs and bony structures of the chest are very visible. The patient is said to be cachexic in such cases.

 

DIF:    Recall             REF:   p. 482            OBJ:   5

 

  1. What is the classic measure of energy expenditure?
a. basal oxygen consumption
b. basal metabolic rate (BMR)
c. resting caloric uptake
d. resting carbon dioxide production

 

 

ANS:  B

The classic measure of energy expenditure is the BMR.

 

DIF:    Recall             REF:   p. 486            OBJ:   5

 

  1. When is the basal metabolic rate (BMR) best obtained?
a. after 10 hours of fasting
b. while walking on a treadmill
c. on rising in the morning
d. 1 hour after lunch

 

 

ANS:  A

Obtained after 10 hours of fasting, the BMR measures the number of calories (kcal) expended at rest per square meter of body surface per hour (kcal/m2/hr).

 

DIF:    Recall             REF:   p. 486            OBJ:   5

 

  1. What procedure is used to overcome the limitations associated with estimating resting energy expenditures?
a. measuring blood glucose before and after exercise
b. monitoring body temperature during heavy exercise
c. indirect calorimetry
d. the Douglas procedure

 

 

ANS:  C

To overcome the limitations of estimating formulas, energy needs can be measured at the bedside. To do so, a procedure called indirect calorimetry is used.

 

DIF:    Recall             REF:   p. 486            OBJ:   5

 

  1. Which of the following statements is FALSE regarding energy needs?
a. They vary with state of health.
b. They vary with activity level.
c. They are increased with obese patients.
d. They increase with sepsis.

 

 

ANS:  C

Of course, energy needs vary according to activity level and state of health. Energy needs of sick patients can be significantly higher than predicted normal values. Energy needs for obese individuals are less because adipose tissue uses less energy than does muscle. Energy needs should be reevaluated and adjusted whenever weight changes more than 5 to 10 lb.

 

DIF:    Recall             REF:   p. 486            OBJ:   5

 

  1. In which of the following patients would indirect calorimetry be indicated?
  2. patients who are difficult to wean from mechanical ventilation
  3. patients with morbid obesity
  4. patients with a high level of stress
a. 1
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

Specific clinical conditions supporting the need for indirect calorimetry as a tool in nutrition assessment are listed in Box 21-4.

 

DIF:    Application    REF:   p. 489            OBJ:   8

 

  1. Which of the following pieces of equipment is NOT needed to perform indirect calorimetry?
a. oxygen analyzer
b. Tissot spirometer
c. Douglas bag
d. nitrogen analyzer

 

 

ANS:  D

Indirect calorimetry can be performed with a Douglas bag, a Tissot spirometer, and CO2 and O2 gas analyzers.

 

DIF:    Recall             REF:   p. 489            OBJ:   8

 

  1. What probably represents the most significant problem while performing calorimetry on a patient being mechanically ventilated?
a. compensating for mechanical dead space
b. leaks in the circuit
c. volume compression during inspiration
d. high PEEP levels

 

 

ANS:  B

Perhaps the most significant problem in performing indirect calorimetry on mechanically ventilated patients is the presence of leaks (circuit, tracheal tube cuff, chest tubes).

 

DIF:    Recall             REF:   p. 489            OBJ:   8

 

  1. What does the RQ represent?
a. matching of respiration to perfusion
b. ratio of the moles of CO2 produced to O2 consumed
c. ratio of O2 consumed to kilograms of ideal body weight
d. ratio of calories consumed to CO2 produced

 

 

ANS:  B

The second step in metabolic assessment is to interpret the RQ. The RQ is the ratio of moles of CO2 expired to moles of O2 consumed.

 

DIF:    Recall             REF:   p. 489-490     OBJ:   10

 

  1. Which of the following has an RQ of 1.0?
a. fat
b. carbohydrates
c. protein
d. soy

 

 

ANS:  B

Carbohydrates have an RQ of 1.0, protein has an RQ of 0.82, and fat has an RQ of 0.7.

 

DIF:    Recall             REF:   p. 490            OBJ:   10

 

  1. Which of the following is associated with primary protein-energy malnutrition (PEM)?
a. poor diet due to living in a Third World country
b. anorexia
c. malabsorption
d. severe infection

 

 

ANS:  A

PEM has adverse effects on respiratory musculature and the immune response. PEM may be either primary or secondary. Primary PEM results from inadequate intake of calories and/or protein and is typically seen only in developing countries.

Secondary PEM is due to underlying illness. Illness may cause (1) decreased caloric or protein intake (e.g., anorexia, dysphagia); (2) increased nutrient losses (e.g., malabsorption or diarrhea); and/or (3) increased nutrient demands (e.g., injury or infection). As many as 50% of hospital patients may have secondary PEM.

 

DIF:    Recall             REF:   p. 491            OBJ:   3

 

  1. Which of the following diseases is/are associated with protein-energy malnutrition (PEM)?
  2. asthma
  3. emphysema
  4. cancer
a. 1
b. 1 and 2
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  C

This type of PEM usually manifests itself as a gradual wasting process, as seen in chronic diseases such as cancer and emphysema. The primary clinical sign is progressive weight loss.

 

DIF:    Recall             REF:   p. 491            OBJ:   12

 

  1. Which of the following illnesses is NOT associated with acute catabolic disease?
a. trauma
b. sepsis
c. burns
d. pulmonary embolism

 

 

ANS:  D

This type of protein-energy malnutrition typically occurs with acute catabolic disease, such as in sepsis, burns, or trauma.

 

DIF:    Recall             REF:   p. 491            OBJ:   12

 

  1. Zinc deficiencies are associated with all the following except:
a. poor blood clotting
b. impaired wound healing
c. bronchospasm
d. reduced immunity

 

 

ANS:  C

Zinc deficiencies can impair clotting, slow wound healing, and impair immunity.

 

DIF:    Recall             REF:   p. 491            OBJ:   13

 

  1. Magnesium deficiencies are associated with all the following except:
a. reduced diaphragm strength
b. neurologic abnormalities
c. cardiac abnormalities
d. liver enlargement

 

 

ANS:  C

Magnesium deficiencies can result in cardiac, vascular, neurologic, and electrolyte abnormalities (hypocalcemia, hypokalemia), as well as in decreases in respiratory muscle strength.

 

DIF:    Recall             REF:   p. 491            OBJ:   13

 

  1. Which of the following is associated with acute cardiac muscle weakness and potential cardiopulmonary failure?
a. hyperkalemia
b. hypophosphatemia
c. hypernatremia
d. low folic acid levels

 

 

ANS:  B

Severe hypophosphatemia can result in decreased muscle strength and contractility and acute cardiopulmonary failure.

 

DIF:    Recall             REF:   p. 491            OBJ:   13

 

  1. Which of the following abnormalities in the respiratory system is/are associated with malnutrition?
  2. reduced hypoxic drive
  3. reduced airway clearance
  4. loss of lung surfactant
a. 1
b. 1 and 2
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

Specific effects of malnutrition on the respiratory system are listed in Box 21-9.

 

DIF:    Recall             REF:   p. 492            OBJ:   12

 

  1. Which of the following statements is NOT true regarding malnutrition in patients with chronic obstructive pulmonary disease (COPD)?
a. Use of a nasal cannula may contribute to the problem.
b. Depression is common and may reduce appetite.
c. A high work of breathing increases caloric needs.
d. Vitamin deficiencies increased the need for oxygen.

 

 

ANS:  D

Box 21-10 summarizes the factors contributing to malnutrition in COPD patients.

 

DIF:    Application    REF:   p. 492            OBJ:   17

 

  1. Ideally, approximately what percent of a patient’s estimated calorie needs should be provided by protein?
a. 20%
b. 40%
c. 50%
d. 60%

 

 

ANS:  A

Ideally, approximately 20% of a patient’s estimated calorie needs should be provided by protein.

 

DIF:    Recall             REF:   p. 496            OBJ:   14

 

  1. What effect does high carbohydrate intake have on metabolism?
a. increases CO2 production
b. reduces oxygen consumption
c. increases caloric needs
d. reduces protein catabolism

 

 

ANS:  A

For the patient with pulmonary disease or those requiring mechanical ventilation, high carbohydrate loads can cause problems. High carbohydrate loads increase CO2 production and the RQ, resulting in increased ventilatory demand, O2 consumption, and work of breathing.

 

DIF:    Recall             REF:   p. 499            OBJ:   14

 

  1. What percent of the patient’s caloric intake should come from fat in most circumstances?
a. 10% to 15%
b. 20% to 30%
c. 30% to 40%
d. 40% to 50%

 

 

ANS:  B

Ideally, approximately 20% of a patient`s estimated calorie needs should be provided by proteins. For critically ill patients, 50% to 60% of the total daily calories can be in the form of simple carbohydrate and the remaining calories (20% to 30%) should be provided from fat.

 

DIF:    Recall             REF:   p. 496            OBJ:   14

 

  1. Which of the following situations is NOT an indication for enteral nutritional support?
a. burns over 30% of the body surface area
b. persistent inability to eat orally
c. severe pancreatitis
d. renal failure

 

 

ANS:  D

Box 21-12 provides guidelines for initiating nutrition support as recommended by the American Society for Parenteral and Enteral Nutrition (ASPEN).

 

DIF:    Recall             REF:   p. 497            OBJ:   15

 

  1. Which of the following is NOT a reason to use enteral feeding over parenteral?
a. reduced incidence of stress ulcers
b. enteral route may avoid intestinal atrophy
c. enteral causes less hypoglycemia
d. enteral is safer and cheaper

 

 

ANS:  C

Enteral feedings are the route of choice: “If the gut works, use it.” The enteral route is safer and cheaper to use than the parenteral route. Enteral feeding stimulates gut hormones, subjects nutrients to the absorptive and metabolic controls of the intestinal tract and liver, and produces less hyperglycemia (providing for better immune function) than the parenteral route. In addition, the buffering capacity of enteral feeding can improve resistance against stress ulcers. Finally, enteral feeding maintains a more normal intestinal mucosa than the parenteral route (the intestinal mucosa may undergo atrophy during parenteral nutrition).

 

DIF:    Application    REF:   p. 494            OBJ:   15

 

  1. What tube feeding method is associated with an increased risk of aspiration?
a. bolus
b. intermittent
c. continuous drip
d. pressurized

 

 

ANS:  A

There is an increased risk of aspiration associated with bolus feedings because of the rapid infusion of formula into the stomach.

 

DIF:    Recall             REF:   p. 494            OBJ:   16

 

  1. What tube feeding method must be used when the food substance is delivered beyond the pylorus?
a. bolus
b. intermittent
c. continuous drip
d. pressurized

 

 

ANS:  C

Because the small bowel lacks storage capacity, feedings delivered beyond the pylorus must be provided by the continuous drip method.

 

DIF:    Recall             REF:   p. 494            OBJ:   15

 

  1. Why raise the head of the bed during tube feedings?
a. It reduces the time needed.
b. It improves absorption.
c. It reduces the risk of aspiration.
d. It is easier for the caregiver.

 

 

ANS:  C

The two most important ways to minimize the likelihood of aspiration are (1) to raise the head of the bed at least 45 degrees and (2) to deliver the feeding beyond the pylorus using the continuous drip method.

 

DIF:    Recall             REF:   p. 494            OBJ:   16

 

  1. Which of the following metabolism issues is NOT associated with systemic inflammatory response syndrome (SIRS)?
a. hypoglycemia
b. protein catabolism
c. increased macronutrient requirement
d. triglyceride intolerance

 

 

ANS:  A

Metabolism in SIRS is characterized by increased total caloric requirements, hyperglycemia, triglyceride intolerance, increased net protein catabolism, and increased macronutrient and micronutrient requirements.

 

DIF:    Recall             REF:   p. 494            OBJ:   17

 

  1. What are the primary goals of nutritional support during mechanical ventilation?
  2. avoid loss of lean body mass
  3. avoid lung infection
  4. keep muscles of breathing strong enough for weaning
a. 1
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

During acute illness, proper nutrition helps prevent the loss of lean body mass. After the resolution of the acute phase of illness, good nutrition helps the muscles regain strength and improves the likelihood of successful ventilator weaning.

 

DIF:    Recall             REF:   p. 496            OBJ:   17

 

  1. Which of the following statements is NOT true with regard to nutritional support of the patient with advanced chronic obstructive pulmonary disease?
a. Provide low-calorie options.
b. Provide high-protein nutrition.
c. Provide small, frequent meals.
d. Provide good patient education.

 

 

ANS:  A

Given the positive link between dietary intake and knowledge of diet and health, good patient education is critical. Patients should be taught to select easy to consume calorically dense foods (Box 21-13). Emphasis should be placed on small, frequent feedings with the use of high-calorie, high-protein nutritional supplements encouraged.

 

DIF:    Recall             REF:   p. 497            OBJ:   17

 

  1. Which of the following pulmonary diseases is similar to chronic obstructive pulmonary disease with regard to metabolic abnormalities?
a. asthma
b. cystic fibrosis
c. pulmonary fibrosis
d. acute respiratory distress syndrome

 

 

ANS:  B

The same disturbance may cause pancreatic insufficiency. Metabolic problems in cystic fibrosis are similar to those in the patient with chronic obstructive pulmonary disease, with reduced intake and increased metabolic needs.

 

DIF:    Application    REF:   p. 489            OBJ:   17

 

  1. Which of the following instructions must be followed to prepare a patient for indirect calorimetry?
  2. suction the patient 30 mins before the test
  3. fasting 10 hours before test
  4. avoid physical activity 4 hours before the test
  5. 24-hour urine urea nitrogen collection
a. 1 and 2
b. 2, 3, and 4
c. 4
d. 1, 2, 3 and 4

 

 

ANS:  B

Fasting in required because if feeding in continued result will reflect the patient’s energy expenditure in response to feeing and may be high if patient is being overfed. It may also register high if there has been recent physical activity. The UUN collection is used if determination of carbohydrate, fat and protein utilization is desired.

 

DIF:    Recall             REF:   p. 489            OBJ:   9

 

  1. Which of the following tools for nutritional assessment requires the patient to maintain a daily record of food intake for a 3- or 7-day period?
a. The 24-hour recall.
b. Usual intake recall.
c. Food frequency questionnaire.
d. Food diary.

 

 

ANS:  D

Keeping a dietary history allows the patient to arrive with a history already recorded so the patient interview can reveal other dietary practices.

 

DIF:    Recall             REF:   p. 482            OBJ:   6

 

  1. All of the following are nutritional goals for the management of a cystic fibrosis patient, except:
a. Maximize nutritional intake.
b. Meet clinical and psychological needs.
c. Avoid caloric dense foods.
d. Encourage mineral and vitamin supplementation.

 

 

ANS:  C

All of the following are nutritional goals for the management of a cystic fibrosis patient, except: Rationale is: Use of calorically dense nutritional supplements consumed throughout the day have proved useful in achieving weight gain.

 

DIF:    Recall             REF:   p. 498            OBJ:   17

Chapter 31: Neonatal and Pediatric Respiratory Disorders

Test Bank

 

MULTIPLE CHOICE

 

  1. Another name for respiratory distress syndrome (RDS) is:
a. hyaline membrane disease
b. transient tachypnea of the newborn
c. type II RDS
d. persistent pulmonary hypertension

 

 

ANS:  A

Respiratory distress syndrome, or hyaline membrane disease, is a disease of prematurity.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. What are the major factors in the pathophysiology of RDS?
  2. qualitative surfactant deficiency
  3. increased alveolar surface area
  4. increased small airways compliance
  5. presence of the ductus arteriosus
a. 1 and 2
b. 1 and 3
c. 1, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  C

The major factors in the pathophysiology of RDS are qualitative surfactant deficiency, decreased alveolar surface area, increased small airways compliance, and the presence of the ductus arteriosus.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. Which of the following factors is associated with an increase in the incidence of RDS?
a. maternal heart disease
b. maternal diabetes
c. maternal asthma
d. long labor

 

 

ANS:  B

Maternal factors that impair fetal blood flow, such as abruptio placentae and maternal diabetes, also may lead to RDS.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. In preterm infants, adequate amounts of surfactant are present; however, it is trapped inside type II cells.
a. True
b. False

 

 

ANS:  A

In preterm infants adequate amounts of surfactant are present in the lung; however, the surfactant is trapped inside type II cells.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. What is the first clinical sign of RDS in the newborn infant?
a. cyanosis
b. wheezing
c. hypertension
d. tachypnea

 

 

ANS:  D

Tachypnea usually occurs first.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. Which of the following clinical signs is not consistent with the onset of RDS?
a. grunting
b. retractions
c. nasal flaring
d. cyanosis

 

 

ANS:  D

After tachypnea, worsening retractions, paradoxical breathing, and audible grunting are observed. Nasal flaring also may be seen.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. What diagnostic parameter is most often used to confirm the diagnosis of RDS?
a. arterial blood gases
b. chest radiograph
c. pulmonary function test
d. serum enzymes

 

 

ANS:  B

Definitive diagnosis of RDS usually is made with chest radiography.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. Which of the following findings on the chest radiograph is not typical for RDS?
a. hyperinflation
b. air bronchograms
c. diffuse hazy infiltrates
d. bilateral reticulogranular densities

 

 

ANS:  A

Diffuse, hazy, reticulogranular densities with the presence of air bronchograms with low lung volumes are typical of RDS. The reticulogranular pattern is caused by aeration of respiratory bronchioles and collapse of the alveoli. Air bronchograms appear as aerated, dark, major bronchi surrounded by the collapsed or consolidated lung tissue.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. Which of the following treatments is the least useful for the treatment of RDS?
a. CPAP
b. surfactant replacement therapy
c. high-frequency ventilation
d. bronchial hygiene techniques

 

 

ANS:  D

Continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) are the traditional support modes used to manage RDS. Surfactant replacement therapy and high-frequency ventilation (HFV) have been added to these traditional approaches.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. You are caring for an infant with RDS. Nasal CPAP has been used; however, the infant suddenly deteriorates and is demonstrating severe hypoxemia on an FIO2 of 0.60. What should be done next?
a. Increase the CPAP.
b. Intubate the infant and begin mechanical ventilation.
c. Switch to nasal CPAP.
d. Increase the FIO2.

 

 

ANS:  B

Mechanical ventilation with PEEP should be initiated if oxygenation does not improve with CPAP or if the patient is apneic or acidotic.

 

DIF:    Application    REF:   p. 683            OBJ:   1

 

  1. What is the maximum PIP that should be used with mechanical ventilation of larger premature infants to prevent volutrauma?
a. 25 cm H2O
b. 30 cm H2O
c. 40 cm H2O
d. 50 cm H2O

 

 

ANS:  B

For minimization of the potential for volutrauma, the PIP should be kept at less than 30 cm H2O for larger premature infants and even lower PIP for more immature infants.

 

DIF:    Recall             REF:   p. 683            OBJ:   1

 

  1. The current standard of care is delivery surfactant replacement to all infants with RDS.
a. True
b. False

 

 

ANS:  A

The current standard of care is to deliver replacement surfactant to all infants with RDS.

 

DIF:    Recall             REF:   p. 683            OBJ:   1

 

  1. In which infants is the surfactant administered as rescue?
a. infants delivered prematurely
b. infants with failure on CPAP trial
c. infants with diagnosis of RDS
d. infants with congenital heart disease

 

 

ANS:  C

Surfactant replacement therapy also is used as both prophylactic and rescue treatment (of infants who already have RDS).

 

DIF:    Recall             REF:   p. 683            OBJ:   1

 

  1. What is believed to be the cause of transient tachypnea of the newborn (TTN)?
a. persistent hypoxemia
b. immature surfactant
c. delayed clearance of fetal lung fluid
d. persistent fetal circulation

 

 

ANS:  C

The cause of TTN is unclear, but it is most likely related to delayed clearance of fetal lung liquid.

 

DIF:    Recall             REF:   p. 683-684     OBJ:   2

 

  1. Most infants with transient tachypnea are born premature.
a. True
b. False

 

 

ANS:  B

Most infants with TTN are born at term without any specific predisposing factors in common.

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. Mothers of infants with transient tachypnea tend to have longer labor intervals and a higher incidence of failure to progress in labor.
a. True
b. False

 

 

ANS:  A

Mothers of neonates who have TTN tend to have longer labor intervals and a higher incidence of failure to progress in labor.

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. What radiographic finding is common in infants with transient tachypnea?
a. low lung volumes
b. bilateral perihilar lymphadenopathy
c. hyperinflation
d. mucus plugging

 

 

ANS:  C

The chest radiographic findings, which may initially be indistinguishable from those of pneumonia, are hyperinflation, which is secondary to air-trapping, and perihilar streaking.

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. What treatment usually causes improvement in the initial treatment of transient tachypnea of the newborn?
a. mechanical ventilation with PEEP
b. oxygen with low FIO2
c. bronchodilators
d. mucolytics

 

 

ANS:  B

Infants with TTN usually respond readily to a low FIO2 by infant oxygen hood or nasal cannula

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. What treatment is indicated for infants with transient tachypnea requiring higher FIO2?
a. frequent turning of the infant
b. oxygen
c. mechanical ventilation
d. CPAP

 

 

ANS:  D

Infants requiring a higher FIO2 may benefit from CPAP.

OBJ 2

DIFF: Recall

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. What treatment may improve lung fluid clearance in the infant with transient tachypnea?
a. CPAP
b. oxygen
c. mechanical ventilation
d. frequent turning of the infant

 

 

ANS:  D

Because the retention of lung fluid may be gravity dependent, frequent changes in the infant’s position may help speed lung fluid clearance.

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. Which statements about TTN are true?
  2. TTN and neonatal pneumonia have similar clinical signs.
  3. The need for mechanical ventilation in TTN is rare.
  4. A small number of infants with TTN eventually have persistent pulmonary hypertension.
  5. Intravenous administration of antibiotics should be considered.
a. 1 and 2
b. 1 and 3
c. 1, 2, and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

Because TTN and neonatal pneumonia have similar clinical signs, intravenous administration of antibiotics should be considered for at least 3 days after appropriate culture samples are obtained. The need for mechanical ventilation is rare and probably indicates a complication. Clearing of the lungs evident on both a chest radiograph and with clinical improvement usually occurs within 24 to 48 hours. A small number of infants with TTN eventually have persistent pulmonary hypertension.

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. Meconium-stained amniotic fluid is common among infants of less than 37 weeks’ gestational age.
a. True
b. False

 

 

ANS:  B

Meconium aspiration syndrome (MAS) is a disease of term and near-term infants.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. Normally, meconium is not passed by the infant until after birth.
a. True
b. False

 

 

ANS:  A

Meconium normally is not passed until after delivery.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. What percentage of births will present with meconium-stained amniotic fluid?
a. 2%
b. 12%
c. 25%
d. 50%

 

 

ANS:  B

Amniotic fluid stained with meconium is found in approximately 12% of all births.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. Which of the following is not a problem with the typical case of meconium aspiration syndrome?
a. lung tissue damage
b. pulmonary obstruction
c. hypovolemia
d. pulmonary hypertension

 

 

ANS:  C

Meconium aspiration syndrome involves three primary problems: pulmonary obstruction, lung tissue damage, and pulmonary hypertension.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. What is associated with ball-valve obstruction in meconium aspiration syndrome?
a. volutrauma
b. atelectrauma
c. hypertension
d. hypotension

 

 

ANS:  A

Ball-valve obstruction causes air-trapping and can lead to volutrauma.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. Which of the following clinical findings is NOT usually seen in meconium aspiration syndrome?
a. tachypnea and grunting
b. irregular pulmonary densities on the chest film
c. metabolic acidosis
d. respiratory alkalosis

 

 

ANS:  D

Infants with MAS typically have gasping respirations, tachypnea, grunting, and retractions. The chest radiograph usually shows irregular pulmonary densities, which represent areas of atelectasis, and hyperlucent areas, which represent hyperinflation due to air trapping.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. Which of the following blood gas alteration is usually seen in meconium aspiration syndrome?
a. hypoxemia and respiratory acidosis
b. hypoxemia and mixed respiratory and metabolic alkalosis
c. hypoxemia and normal acid-base balance
d. hypoxemia and mixed respiratory and metabolic acidosis

 

 

ANS:  A

Arterial blood gases typically show hypoxemia with mixed respiratory and metabolic acidosis.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. Which of the following should be done early in the treatment of the non-vigorous infant with meconium aspiration syndrome?
a. suctioning
b. mask CPAP
c. antibiotics
d. vasopressors

 

 

ANS:  A

In the presence of meconium-stained amniotic fluid, once delivery is complete and if the infant is depressed and requires intubation for resuscitation, an ET tube should be inserted immediately, and suction should be applied directly to the ET tube.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. Which of the following ventilatory modalities has been associated with a lesser rate of air leak in MAS?
  2. IMV
  3. SIMV
  4. HFV
  5. CPAP
a. 1
b. 1 and 2
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  C

Evidence suggests that both HFV and synchronous intermittent mechanical ventilation decrease the risk of air leak.

 

DIF:    Recall             REF:   p. 685            OBJ:   3

 

  1. Which of the following have been implicated in the origin of bronchopulmonary dysplasia (BPD)?
  2. oxygen toxicity
  3. malnutrition
  4. mechanical ventilation
a. 1
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

Immaturity, genetics, malnutrition, oxygen toxicity, and mechanical ventilation all have been implicated in the origin of BPD.

 

DIF:    Recall             REF:   p. 685            OBJ:   4

 

  1. What factor is not associated with the new description of BPD?
a. improvements in ventilator management
b. use of surfactant
c. use of HFV
d. postnatal steroid therapy

 

 

ANS:  C

This change in the pathological characteristics of BPD is thought related to improvements in ventilator management, the use of surfactant, and processes that interrupt alveolar development (e.g., postnatal steroid therapy).

 

DIF:    Recall             REF:   p. 685            OBJ:   4

 

  1. What clinical finding is typically seen with BPD infants?
a. areas of air-trapping on the chest film
b. areas of consolidation on the chest film
c. hypoxemia and hypercapnia
d. hypocapnia

 

 

ANS:  C

Progressive vascular leakage and areas of atelectasis and emphysema develop in the lungs, and progressive pulmonary damage occurs. The chest radiograph for severe disease will show areas of atelectasis, emphysema, and fibrosis diffusely intermixed throughout the lung (Figure 31-5). Arterial blood gas measurements reveal varying degrees of hypoxemia and hypercapnia secondary to airway obstruction, air-trapping, pulmonary fibrosis, and atelectasis.

 

DIF:    Recall             REF:   p. 686            OBJ:   4

 

  1. What is the best strategy in the management of BPD?
a. adequate fluid management
b. prevention
c. aggressive mechanical ventilation
d. PEEP

 

 

ANS:  B

The best management of BPD is prevention.

 

DIF:    Recall             REF:   p. 686            OBJ:   4

 

  1. Which of the following therapies has little effect on long-term outcome such as mortality and duration of oxygen therapy in infants with BPD?
a. diuretics
b. steroids
c. antibiotics
d. bronchodilators

 

 

ANS:  B

Steroid therapy has little effect on long-term outcome such as mortality and duration of oxygen therapy.

 

DIF:    Recall             REF:   p. 687            OBJ:   4

 

  1. Which of the following is not associated with apnea episodes in premature infants?
a. Apnea lasts longer than 15 seconds.
b. Apnea is associated with cyanosis.
c. Apnea is associated with bradycardia.
d. Apnea lasts longer than 1 minute.

 

 

ANS:  D

Apneic spells are abnormal if (1) they last longer than 15 seconds or (2) they are associated with cyanosis, pallor, hypotonia, or bradycardia.

 

DIF:    Recall             REF:   p. 687            OBJ:   5

 

  1. Which of the following is NOT associated with causing apnea in premature infants?
a. gender
b. intracranial lesion
c. gastroesophageal reflux
d. impaired oxygenation

 

 

ANS:  A

Table 31-2.

 

DIF:    Recall             REF:   p. 687            OBJ:   5

 

  1. Treatment of the premature infant with apnea includes all the following except:
a. tactile stimulation
b. theophylline
c. transfusion
d. bronchial hygiene

 

 

ANS:  C

Table 31-3 outlines current treatment strategies for infants with apnea.

 

DIF:    Recall             REF:   p. 688            OBJ:   5

 

  1. Infants who have apnea of prematurity are at greater risk of SIDS than other infants.
a. True
b. False

 

 

ANS:  B

Infants who have apnea of prematurity are not at higher risk of SIDS than are other infants.

 

DIF:    Recall             REF:   p. 688            OBJ:   5

 

  1. What physiologic abnormality is believed to be the cause of persistent pulmonary hypertension in the newborn (PPHN)?
a. right-to-left shunting
b. high cardiac output
c. high pulmonary vascular resistance
d. metabolic acidosis

 

 

ANS:  C

The common denominator in PPHN is a return to fetal circulatory pathways, usually because of high PVR.

 

DIF:    Recall             REF:   p. 688            OBJ:   6

 

  1. Normally the PVR/SVR ratio is greater than 1 in the fetus.
a. True
b. False

 

 

ANS:  A

This condition produces a PVR/SVR ratio greater than 1.

 

DIF:    Recall             REF:   p. 688            OBJ:   6

 

  1. What are the three fundamental pathophysiologic events that explain PPHN?
  2. vascular spasm
  3. hypoxemia
  4. increased muscle wall thickness
  5. decreased cross-sectional area
a. 1
b. 1 and 2
c. 1 and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

There are three fundamental types of PPHN: vascular spasm, increased muscle wall thickness, and decreased cross-sectional area of pulmonary vessels.

 

DIF:    Recall             REF:   p. 688            OBJ:   6

 

  1. Which of the following factors may stimulate pulmonary vascular spasm and cause persistent pulmonary hypertension in the newborn?
  2. hypoxemia
  3. hypoglycemia
  4. hypotension
  5. pain
a. 1
b. 1 and 2
c. 1, 2, 3, and 4
d. 4

 

 

ANS:  C

Vascular spasm is an acute event that can be triggered by many different conditions, including hypoxemia, hypoglycemia, hypotension, and pain.

 

DIF:    Recall             REF:   p. 688            OBJ:   6

 

  1. Infants with persistent pulmonary hypertension usually have hypoxemia out of proportion to the lung disease detected by radiography.
a. True
b. False

 

 

ANS:  A

Hypoxemia out of proportion to the lung disease detected with chest radiography or PaCO2 measurement.

 

DIF:    Recall             REF:   p. 688            OBJ:   6

 

  1. Treatment of the infant with persistent pulmonary hypertension may include all the following except:
a. ECMO
b. high-frequency ventilation
c. nitric oxide
d. theophylline

 

 

ANS:  D

Initial therapy for PPHN is removal of the underlying cause, such as administration of oxygen for hypoxemia, surfactant for RDS, glucose for hypoglycemia, and inotropic agents for low cardiac output and systemic hypotension. If correction of the underlying problem does not correct the hypoxemia, the infant needs intubation and mechanical ventilation. Because pain and anxiety may contribute to PPHN, the infant may need sedation and, frequently, paralysis. If these measures do not improve oxygenation, the next step is HFV. This mode of ventilation allows a higher FRC without a large tidal volume. Inhaled nitric oxide is now considered the next intervention. Should all of these modalities fail to improve oxygenation, the infant may be a candidate for extracorporeal membrane oxygenation (ECMO).

 

DIF:    Recall             REF:   p. 688            OBJ:   6

 

  1. Which of the following is an example of an internal obstruction to the infant’s airway?
a. hemangiomas
b. neck mass
c. tracheoesophageal fistula
d. laryngomalacia

 

 

ANS:  D

Internal obstruction includes common problems, such as laryngomalacia, that cause obstructive apnea.

 

DIF:    Recall             REF:   p. 689            OBJ:   6

 

  1. Which of the following is the most common type of esophageal atresia?
a. esophageal atresia with a proximal fistula
b. esophageal atresia with a distal fistula
c. intact esophagus with an H fistula
d. esophageal atresia without either fistula

 

 

ANS:  B

The most common of these malformations is esophageal atresia with a distal fistula, which comprises 85% to 90% of all tracheoesophageal fistulas.

 

DIF:    Recall             REF:   p. 689            OBJ:   6

 

  1. The pathophysiologic abnormalities associated with congenital diaphragmatic hernia include all the following except:
a. malformation of the left ventricle
b. lung hypoplasia
c. pulmonary hypertension
d. unusual anatomy of the inferior vena cava

 

 

ANS:  A

The pathophysiologic mechanism is a complex combination of lung hypoplasia, including decreased alveolar count and decreased pulmonary vasculature, pulmonary hypertension, and unusual anatomy of the inferior vena cava.

 

DIF:    Recall             REF:   p. 689            OBJ:   7

 

  1. Clinical findings associated with congenital diaphragmatic hernia include all the following except:
a. severe cyanosis
b. decreased breath sounds
c. displaced heart sounds
d. hepatomegaly

 

 

ANS:  D

Physical examination may yield the following findings: scaphoid abdomen (because the abdominal contents are in the thorax), decreased breath sounds, displaced heart sounds (because the heart is pushed away from the hernia), and severe cyanosis (from lung hypoplasia and pulmonary hypertension).

 

DIF:    Recall             REF:   p. 690            OBJ:   7

 

  1. Which of the following diagnostic tools serves to confirm the diagnosis of CDH?
a. sweat test
b. fluoroscopy
c. chest radiography
d. ultrasound

 

 

ANS:  C

The diagnosis is established with chest radiography.

 

DIF:    Recall             REF:   p. 690            OBJ:   7

 

  1. The mortality rate for infants with congenital diaphragmatic hernia is usually low.
a. True
b. False

 

 

ANS:  B

Despite all these advanced therapies, the mortality for this disease is high.

 

DIF:    Recall             REF:   p. 690            OBJ:   7

 

  1. Which of the following is the most common defect of the abdominal wall?
a. inguinal hernia
b. omphalocele
c. gastroschisis
d. agenesis of abdominal muscles

 

 

ANS:  B

Large defects in the abdominal wall can cause severe respiratory compromise. The most common of these defects is omphalocele.

 

DIF:    Recall             REF:   p. 690            OBJ:   8

 

  1. Which of the following are common neuromuscular defect that affect infants?
  2. spinal muscular atrophy
  3. congenital myasthenia gravis
  4. myotonic dystrophy
  5. poliomyelitis
a. 1
b. 1, 2, and 3
c. 1 and 3
d. 1, 2, and 4

 

 

ANS:  B

Many diseases of poor neuromuscular control affect newborns. These include spinal muscular atrophy, congenital myasthenia gravis, myotonic dystrophy, and many others.

 

DIF:    Recall             REF:   p. 690            OBJ:   8

 

  1. Which of the following defects is not associated with tetralogy of Fallot?
a. ventricular septal defect
b. right ventricular hypoplasia
c. pulmonary stenosis
d. dextroposition of the aorta

 

 

ANS:  B

Tetralogy of Fallot is a defect that includes (1) obstruction of right ventricular outflow (pulmonary stenosis), (2) ventricular septal defect (a hole between the right and left ventricles), (3) dextroposition of the aorta, and (4) right ventricular hypertrophy.

 

DIF:    Recall             REF:   p. 690            OBJ:   8

 

  1. Children with tetralogy of Fallot are at risk for sudden death from arrhythmia later in life.
a. True
b. False

 

 

ANS:  A

Children with this defect are at increased risk of sudden death of arrhythmia later in life.

 

DIF:    Recall             REF:   p. 692            OBJ:   8

 

  1. Which of the following is the most likely diagnosis in the newborn with severe cyanosis at birth?
a. persistent pulmonary hypertension
b. tetralogy of Fallot
c. transposition of the great vessels
d. ventricular septal defect

 

 

ANS:  C

Transposition of the great arteries is the heart disease that most frequently causes severe cyanosis.

 

DIF:    Recall             REF:   p. 692            OBJ:   9

 

  1. Which of the following is NOT true regarding ventricular septal defects in infants?
a. are quite common
b. usually cause right-to-left shunting
c. may cause congestive heart failure
d. usually do not appear immediately after birth

 

 

ANS:  B

A simple ventricular septal defect usually causes left-to-right shunting and congestive heart failure.

 

DIF:    Recall             REF:   p. 692            OBJ:   9

 

  1. How soon after birth does the ductus typically close?
a. 1 to 2 days
b. 3 to 4 days
c. 5 to 7 days
d. 10 days

 

 

ANS:  C

Closure of the ductus normally occurs 5 to 7 days after the birth of term infants.

 

DIF:    Recall             REF:   p. 692            OBJ:   9

 

  1. In left ventricular outflow obstructions, systemic blood flow depends on patency of the ductus arteriosus.
a. True
b. False

 

 

ANS:  A

Systemic blood flow depends on patency of the ductus arteriosus.

 

DIF:    Recall             REF:   p. 693            OBJ:   9

 

  1. Most infants with hypoplastic left heart syndrome do not need to be supported with mechanical ventilation.
a. True
b. False

 

 

ANS:  B

Most infants with these defects need support with mechanical ventilation.

 

DIF:    Recall             REF:   p. 693            OBJ:   9

 

  1. In which of the following defects is heart transplantation an accepted option for treatment?
a. interrupted aortic arch
b. coarctation of the aorta
c. hypoplastic left heart syndrome
d. none of the above

 

 

ANS:  C

Hypoplastic left heart syndrome has three accepted treatments: comfort care (allowing the infant to die), a palliative surgical procedure (Norwood), and transplantation.

 

DIF:    Recall             REF:   p. 693            OBJ:   9

 

  1. Sudden infant death syndrome (SIDS) is the most common cause of death in infants under the age of 1 year.
a. True
b. False

 

 

ANS:  A

SIDS is the leading cause of death (40%) among infants younger than 1 year in the United States.

 

DIF:    Recall             REF:   p. 693            OBJ:   10

 

  1. Which of the following maternal characteristics is NOT associated with an increased frequency of SIDS?
a. younger than 20 years
b. low socioeconomic status
c. cigarette smoking
d. history of asthma

 

 

ANS:  D

Factors associated with increased frequency of SIDS are presented in Box 31-1.

 

DIF:    Recall             REF:   p. 693            OBJ:   10

 

  1. Which of the following infant characteristics is associated with an increased risk of SIDS?
a. female gender
b. preterm birth
c. high APGAR score
d. full-term birth

 

 

ANS:  B

An infant who dies of SIDS typically is a preterm African-American boy born to a poor mother younger than 20 years who received inadequate prenatal care.

 

DIF:    Recall             REF:   p. 694            OBJ:   10

 

  1. It is not difficult to differentiate death from SIDS from death by intentional suffocation.
a. True
b. False

 

 

ANS:  B

It is difficult to differentiate death of SIDS from death of intentional suffocation.

 

DIF:    Recall             REF:   p. 694            OBJ:   10

 

  1. The American Academy of Pediatrics recommends that infants be placed in either the supine or the side-lying position for the first 6 months of life to reduce the risk of SIDS.
a. True
b. False

 

 

ANS:  A

The American Academy of Pediatrics recommends that infants be placed in either the supine or the side-lying position for the first 6 months of life and reducing soft objects in the infant’s sleeping environment.

 

DIF:    Recall             REF:   p. 694            OBJ:   10

 

  1. Which of the following findings is not associated with gastroesophageal reflux (GER) disease?
a. stridor
b. apnea
c. reactive airways disease
d. syncope

 

 

ANS:  D

Respiratory problems caused by gastroesophageal reflux include reactive airways disease, aspiration pneumonia, laryngospasm, stridor, chronic cough, choking spells, and apnea.

 

DIF:    Recall             REF:   p. 694            OBJ:   11

 

  1. Which of the following are used to diagnose GER?
  2. esophageal pH testing
  3. chest radiograph
  4. upper GI contrast studies
  5. gastric scintiscanning
a. 1
b. 1, 2, and 3
c. 1 and 3
d. 1, 3, and 4

 

 

ANS:  D

GER disease can be diagnosed with esophageal pH testing, upper gastrointestinal contrast studies, and gastric scintiscanning.

 

DIF:    Recall             REF:   p. 694            OBJ:   11

 

  1. Bronchiolitis is an acute infection of the lower respiratory tract usually caused by bacterial organisms.
a. True
b. False

 

 

ANS:  B

Bronchiolitis is an acute infection of the lower respiratory tract, usually caused by the respiratory syncytial virus (RSV).

 

DIF:    Recall             REF:   p. 694            OBJ:   12

 

  1. The following diseases are commonly associated with bronchiolitis most likely to result in respiratory failure except:
a. infant with congenital heart failure
b. infant with BPD
c. child with cystic fibrosis
d. pneumonia

 

 

ANS:  D

Those most prone to respiratory failure as a consequence of bronchiolitis are very young and immunodeficient and have comorbidity, such as congenital heart disease, bronchopulmonary dysplasia, cystic fibrosis, or childhood asthma.

 

DIF:    Recall             REF:   p. 694-695     OBJ:   12

 

  1. Which of the following findings is not typical for infants with bronchiolitis?
a. stridor
b. wheezing
c. dyspnea
d. tachypnea

 

 

ANS:  A

After a few days, signs of respiratory distress develop, particularly dyspnea and tachypnea. Progressive inflammation and narrowing of the airways cause inspiratory and expiratory wheezing and increase airway resistance.

 

DIF:    Recall             REF:   p. 695            OBJ:   12

 

  1. Which of the following groups of infants should receive passive immunization for RSV?
  2. chronic lung disease
  3. infants born less than 32 weeks’ gestational age
  4. infants with congenital heart disease
  5. infants with retinopathy of prematurity
a. 1
b. 1, 2, and 3
c. 1 and 3
d. 1, 3, and 4

 

 

ANS:  B

Passive immunization is now recommended for infants younger than 2 years of age who are requiring medical therapy for chronic lung disease, infants born less than 32 weeks’ gestational age, and infants with congenital heart disease who have cardiovascular compromise.

 

DIF:    Recall             REF:   p. 695            OBJ:   12

 

  1. Which of the following therapies is considered controversial in the management of the infant with severe bronchiolitis?
a. hydration
b. oxygen
c. bronchodilator therapy
d. CPAP

 

 

ANS:  C

Because bronchiolitis and childhood asthma have similar symptoms, a trial course of bronchodilator therapy with a b-agonist may be useful if airway obstruction is relieved after administration. This practice is controversial, and practitioners should assess the efficacy of all bronchodilator therapy before continuing.

 

DIF:    Recall             REF:   p. 695            OBJ:   12

 

  1. Which of the following statements is TRUE about croup?
  2. caused by viral organism
  3. most common form of airway obstruction in children aged 6 months to 6 years
  4. causes subglottic swelling and obstruction
  5. most often caused by parainfluenza virus
a. 1 and 3
b. 2, 3, and 4
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

Croup is a viral disorder of the upper airway that normally results in subglottic swelling and obstruction. Termed laryngotracheobronchitis, viral croup is usually caused by the parainfluenza virus and is the most common form of airway obstruction in children between 6 months and 6 years of age.

 

DIF:    Recall             REF:   p. 695            OBJ:   13

 

  1. Which of the following clinical signs is NOT common with croup?
a. stridor
b. murmur
c. coughing
d. cyanosis

 

 

ANS:  B

The child typically has slow, progressive inspiratory and expiratory stridor and a barking cough. As the disease progresses, dyspnea, cyanosis, exhaustion, and agitation occur.

 

DIF:    Recall             REF:   p. 695            OBJ:   13

 

  1. Which of the following is the most common radiographic finding that suggests the presence of croup?
a. thumb sign
b. flail chest
c. sail sign
d. steeple sign

 

 

ANS:  D

Classic croup manifests on an anteroposterior radiograph as characteristic subglottic narrowing of the trachea, called the steeple sign.

 

DIF:    Recall             REF:   p. 695            OBJ:   13

 

  1. Which of the following clinical findings suggests the child with croup should be hospitalized?
  2. stridor at rest
  3. suprasternal retractions
  4. cyanosis on room air
  5. harsh breath sounds
a. 1
b. 1 and 2
c. 1, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

If there is stridor at rest (accompanied by harsh breath sounds, suprasternal retractions, and cyanosis with breathing of room air), hospitalization is indicated.

 

DIF:    Recall             REF:   p. 695            OBJ:   13

 

  1. Which of the following treatments is least likely to be needed in the treatment of the child with croup?
a. oxygen
b. mechanical ventilation
c. aerosolized racemic epinephrine
d. budesonide

 

 

ANS:  B

Progressive worsening of the clinical signs despite treatment indicates the need for intubation and mechanical ventilation.

 

DIF:    Recall             REF:   p. 695            OBJ:   13

 

  1. What modality is believed to be the cause of a decrease in the reported incidence of epiglottitis over the past decade?
a. vaccine
b. better diet
c. improved epidemiology reporting
d. better quality of air

 

 

ANS:  A

Evidence suggests that the incidence of epiglottitis is decreasing among children, probably because of the use of vaccines.

 

DIF:    Recall             REF:   p. 696            OBJ:   13

 

  1. Which of the following clinical findings is NOT typically seen in patients with epiglottitis?
a. high fever
b. stridor
c. croupy barking cough
d. drooling

 

 

ANS:  C

The patient does not have a croupy bark but instead has a muffled voice.

 

DIF:    Recall             REF:   p. 696            OBJ:   13

 

  1. Which of the following is the most common radiographic finding that suggests the presence of epiglottitis?
a. thumb sign
b. flail chest
c. sail sign
d. steeple sign

 

 

ANS:  A

Lateral neck radiographic results (Figure 31-9) indicate the epiglottis is markedly thickened and flattened (thumb sign).

 

DIF:    Recall             REF:   p. 696            OBJ:   13

 

  1. Which of the following therapies is LEAST likely to be needed in the child with epiglottitis?
a. tracheostomy
b. pressure support with low-level CPAP
c. high FIO2
d. humidity therapy

 

 

ANS:  A

Tracheostomy may be needed if the patient’s condition warrants it; however, this procedure is rarely used.

 

DIF:    Recall             REF:   p. 697            OBJ:   13

 

  1. A 2 year old boy is in severe respiratory distress. The child is drooling and has labored breathing. Stridor is heard. RR is 42 and HR is 140. What should be done next?
a. Intubate.
b. Provide 100% oxygen on non-rebreather mask.
c. Administer racemic epinephrine.
d. Place on CPAP with low PSV.

 

 

ANS:  A

The clinical picture, particularly the age, level of distress, stridor and drooling, suggest that this patient apparently has epiglottitis, a severe swelling of the tissue around the glottis. Given the potential for additional swelling and complete airway closure, this patient should be intubated for airway protection.

 

DIF:    Analysis         REF:   p. 697            OBJ:   13

 

  1. What is the likely diagnosis of a 18-month old patient in moderate respiratory distress with a one-week history of a low-grade fever and chills, barking cough, and an AP chest radiograph which shows a steeple sign?
a. pulmonary interstitial emphysema
b. bronchopulmonary dysplasia
c. epiglottis
d. croup

 

 

ANS:  D

A child typically has slow, progressive inspiratory and expiratory stridor and a barking coup. As the disease progresses, dyspnea, cyanosis, exhaustion and agitation occur.

 

DIF:    Analysis         REF:   p. 695            OBJ:   13

 

  1. Patients with cystic fibrosis often have trouble with the digestion of fats and have deficiency of the fat-soluble vitamins.
a. True
b. False

 

 

ANS:  A

These patients often have deficiencies of the fat-soluble vitamins A, D, E, and K and have large amounts of undigested fat in the stool (steatorrhea).

 

DIF:    Recall             REF:   p. 697            OBJ:   14

 

  1. What is the leading cause of death among patients with cystic fibrosis?
a. pancreatic disease
b. lung disease
c. gastrointestinal disease
d. diabetes

 

 

ANS:  B

Complications of lung disease are the leading cause of death among patients with cystic fibrosis.

 

DIF:    Recall             REF:   p. 697            OBJ:   14

 

  1. Which test is commonly used to confirm the diagnosis of cystic fibrosis?
a. sweat chloride
b. chest radiograph
c. lung diffusion capacity
d. serum enzyme levels

 

 

ANS:  A

In evaluation of a child, a sweat chloride level greater than 60 mEq/L confirms the diagnosis of cystic fibrosis.

 

DIF:    Recall             REF:   p. 697            OBJ:   14

 

  1. What therapy has been shown to reduce the incidence of bronchiectatic exacerbations in the patient with cystic fibrosis?
a. autogenic lung drainage
b. inhaled tobramycin
c. chest physical therapy
d. bronchodilator therapy

 

 

ANS:  B

When inhaled tobramycin is used twice daily every other month, there is a marked reduction in the number of bronchiectatic exacerbations.

 

DIF:    Recall             REF:   p. 698            OBJ:   14

 

  1. What therapy has been shown to reduce the rate of loss of lung function in patients with cystic fibrosis?
a. high doses of ibuprofen
b. continuous oxygen therapy
c. corticosteroids
d. inhaled DNase

 

 

ANS:  A

High doses of the antiinflammatory drug ibuprofen reduce the rate of lung function loss in patients younger than 13 years.

 

DIF:    Recall             REF:   p. 697            OBJ:   14

Chapter 51: Respiratory Care in Alternative Settings

Test Bank

 

MULTIPLE CHOICE

 

  1. Postacute care settings include all of the following except:
a. rehabilitation facilities
b. the home
c. trauma centers
d. skilled nursing facilities (SNFs)

 

 

ANS:  C

Although home care remains the most common alternative site for providing health care, a host of other postacute care settings, including subacute, rehabilitation, and SNFs, provide respiratory care to patients.

 

DIF:    Recall             REF:   p. 1306          OBJ:   1

 

  1. Which patients are better suited for subacute rather than for acute care?
  2. those who no longer need diagnostics or invasive procedures
  3. those who have a determined course of treatment
  4. those who are recovering from an acute illness
a. 2 and 3
b. 1 and 2
c. 3
d. 1, 2, and 3

 

 

ANS:  A

According to the National Association of Subacute/Post Acute Care, subacute care is a comprehensive level of inpatient care for stable patients who (1) have experienced an acute event resulting from injury, illness, or exacerbation of a disease process; (2) have a determined course of treatment; and (3) require diagnostics or invasive procedures but not those requiring acute care.

 

DIF:    Application    REF:   p. 1308          OBJ:   1

 

  1. Where is most postacute respiratory care provided?
a. skilled nursing facilities
b. the home
c. rehabilitation facilities
d. subacute care facilities

 

 

ANS:  B

Currently, most postacute respiratory care is provided in the home.

 

DIF:    Recall             REF:   p. 1308          OBJ:   1

 

  1. Under which conditions is the home NOT the best setting for providing subacute care?
  2. when the patient is unable to do self-care
  3. when adequate caregiver support is unavailable
  4. when the patient’s physician cannot make home visits
a. 2 and 3
b. 1 and 2
c. 3
d. 1, 2, and 3

 

 

ANS:  B

Home care should generally be the first choice, but when patients have multiple ailments and are unable to care for themselves, when adequate patient support is unavailable, or when the home environment is unsuitable, an alternative care site must be selected.

 

DIF:    Application    REF:   p. 1308          OBJ:   1

 

  1. Respiratory home care contributes to achieving which of the following goals?
  2. improving patients’ physical and social well-being
  3. ensuring cost-effective delivery of care
  4. supporting and maintaining patients’ lives
  5. promoting patient and family self-sufficiency
a. 2 and 4
b. 1, 2, and 3
c. 2 and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

Respiratory home care can contribute to supporting and maintaining life; improving patients’ physical, emotional, and social well-being; promoting patient and family self-sufficiency; ensuring cost-effective delivery of care; and maximizing patient comfort near the end of life.

 

DIF:    Application    REF:   p. 1308          OBJ:   1

 

  1. For which of the following categories of disorders is respiratory home care NOT considered appropriate?
a. cystic fibrosis
b. chronic neuromuscular disorders
c. acute restrictive disorders
d. pulmonary obstructive lung disease

 

 

ANS:  C

Applicable categories of disorders include chronic obstructive pulmonary disease, cystic fibrosis, chronic neuromuscular disorders, chronic restrictive conditions, and carcinomas of the lung.

 

DIF:    Recall             REF:   p. 1308          OBJ:   1

 

  1. Studies have shown that carefully selected home treatment regimens can play an important role in achieving which of the following?
  2. maintaining patients’ lives
  3. improving patients’ quality of life
  4. increasing patients’ functional performance
  5. reducing hospitalization costs
a. 2 and 4
b. 1, 2, 3, and 4
c. 3 and 4
d. 1, 2, and 3

 

 

ANS:  B

These benefits include increased longevity, improved quality of life, increased functional performance, and a reduction in the individual and societal costs associated with hospitalization.

 

DIF:    Recall             REF:   p. 1308          OBJ:   2

 

  1. From where do standards for the delivery of subacute and home health care derive?
  2. state licensing laws
  3. private sector standards
  4. federal regulations
a. 2 and 3
b. 1 and 2
c. 3
d. 1, 2, and 3

 

 

ANS:  D

Other standards are established by federal and state laws, as well as private-sector accreditation.

 

DIF:    Recall             REF:   p. 1308          OBJ:   3

 

  1. What statutory regulations ensure that skilled nursing facilities and home health agencies meet minimum health and safety requirements?
  2. The Joint Commission (formerly Joint Commission on Accreditation of Hospitals Organization [JCAHO]) accreditation standards
  3. Medicare provider certification program
  4. State health agency regulations
a. 2 and 3
b. 1 and 2
c. 3
d. 1, 2, and 3

 

 

ANS:  A

The majority of reimbursement for postacute care is through either the federal Medicare or federal/state Medicaid programs.

 

DIF:    Recall             REF:   p. 1308          OBJ:   3

 

  1. What agency is primarily responsible for voluntary accreditation of postacute care providers?
a. The Joint Commission (TJC) (formerly Joint Commission on Accreditation of Hospitals Organization [JCAHO])
b. AARC
c. CAAHEP
d. ASTM

 

 

ANS:  A

The primary organization responsible for standard setting and voluntary accreditation of postacute care providers is TJC.

 

DIF:    Recall             REF:   p. 1308-1309                                  OBJ:   3

 

  1. Patient- and resident-focused functions addressed in The Joint Commission (formerly Joint Commission on Accreditation of Hospitals Organization [JCAHO]) standards for long-term, subacute care, and home care include all of the following except:
a. patient education
b. treatment
c. rights and ethics
d. infection control

 

 

ANS:  C

The patient safety goals target for improvement, common problem areas for health care organizations such as proper patient identification, medication safety, and infection control.

 

DIF:    Recall             REF:   p. 1309          OBJ:   4

 

  1. Which of the following key features distinguish delivery of respiratory care services in alternative settings (subacute, long-term, and home care) from traditional acute care delivery?
  2. reliance on outside vendors for most lab and diagnostic testing
  3. reliance mainly on portable equipment (oxygen [O2], suction, aerosol)
  4. most work independently performed with minimal supervision
  5. heavy reliance on assessment and documentation in care planning
  6. intensive interaction with professional team and patient’s family
a. 1, 2, and 4
b. 1, 2, and 3
c. 2, 3, and 5
d. 1, 2, 3, 4, and 5

 

 

ANS:  D

Key differences involve resource availability, supervision and work schedules, documentation and assessment, and professional-patient interaction (Table 51-1).

 

DIF:    Recall             REF:   p. 1309          OBJ:   4

 

  1. Which of the following is NOT normally included as part of a good discharge plan?
a. evaluating both the patient and the discharge site
b. providing caregiver travel to and from the discharge site
c. confirming or securing financial resources
d. providing patient and caregiver education and training

 

 

ANS:  C

To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Discharge Planning for the Respiratory Care Patient. Excerpts appear on p. xx.

 

DIF:    Recall             REF:   p. 1309          OBJ:   5

 

  1. All of the following are components of the patient evaluation aspect of a good discharge plan except the patient’s:
a. socioeconomic status and neighborhood characteristics
b. (and family’s) expectations and psychosocial readiness
c. functional ability and activities of daily living (ADLs)

 

 

ANS:  A

To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Discharge Planning for the Respiratory Care Patient. Excerpts appear on p. xx.

 

DIF:    Recall             REF:   p. 1310-1311                                  OBJ:   5

 

  1. What are some desired outcomes of the discharge plan?
  2. prevent hospital readmission due to poor planning
  3. satisfactory performance of all treatments by caregivers
  4. caregivers’ ability to assess the patient and solve problems
  5. patient’s and family’s satisfaction
a. 1, 2, 3, and 4
b. 2 and 4
c. 1, 2, and 3
d. 3 and 4

 

 

ANS:  A

To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Discharge Planning for the Respiratory Care Patient. Excerpts appear on pp. 1310-1311.

 

DIF:    Recall             REF:   p. 1310-1311                                  OBJ:   5

 

  1. Which of the following is NOT normally part of the respiratory home care team?
a. respiratory care
b. durable medical equipment supplier
c. pulmonary function
d. nursing

 

 

ANS:  C

Although a physician normally initiates an order to discharge a patient to a postacute care site, many other health care professionals are involved in the discharge process. Table 51-2 identifies these key professionals, along with their major responsibilities.

 

DIF:    Recall             REF:   p. 1311          OBJ:   5

 

  1. Establishing therapeutic objectives for home care is normally the responsibility of which member of the respiratory home care team?
a. physical therapist
b. respiratory care practitioner
c. Nurse
d. Attending physician

 

 

ANS:  D

Although a physician normally initiates an order to discharge a patient to a postacute care site, many other health care professionals are involved in the discharge process. Table 51-2 identifies these key professionals, along with their major responsibilities.

 

DIF:    Recall             REF:   p. 1311          OBJ:   6

 

  1. Making necessary contacts with outside agencies that can help with home care is the responsibility of which member of the respiratory home care team?
a. attending physician
b. social services representative
c. respiratory care practitioner
d. nurse

 

 

ANS:  B

Although a physician normally initiates an order to discharge a patient to a postacute care site, many other health care professionals are involved in the discharge process. Table 51-2 identifies these key professionals, along with their major responsibilities.

 

DIF:    Recall             REF:   p. 1311          OBJ:   6

 

  1. Providing regular in-home follow-up visits and assessing the patient’s overall progress is the responsibility of which member of the respiratory home care team?
a. social services representative
b. nurse
c. attending physician
d. respiratory care practitioner

 

 

ANS:  D

Although a physician normally initiates an order to discharge a patient to a postacute care site, many other health care professionals are involved in the discharge process. Table 51-2 identifies these key professionals, along with their major responsibilities.

 

DIF:    Application    REF:   p. 1311          OBJ:   6

 

  1. Providing necessary home care equipment and supplies and handling any emergency situations involving delivery or equipment operation is the responsibility of which member of the respiratory home care team?
a. social services representative
b. respiratory care practitioner
c. nurse
d. durable medical equipment (DME) company representative

 

 

ANS:  D

Equipment support and selected clinical services for respiratory home care patients are often provided by a DME supplier.

 

DIF:    Application    REF:   p. 1312          OBJ:   6

 

  1. Durable medical equipment (DME) companies usually provide which of the following respiratory home care services?
  2. third-party insurance processing
  3. most respiratory care modalities
  4. 24-hours/7-days-a-week service
  5. home instruction and follow-up
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

These companies, both large and small, usually provide the following services: 24-hours/7-days-a-week service, third-party insurance processing, home instruction and follow-up by a respiratory therapist, and most forms of respiratory care.

 

DIF:    Recall             REF:   p. 1312          OBJ:   6

 

  1. Factors to consider when advising a patient on selection of durable medical equipment (DME) include all of the following except:
a. accreditation
b. finder’s fees
c. cost
d. availability

 

 

ANS:  B

When selecting a DME supplier, the discharge planning team, including the patient and family members, should consider the company’s accreditation status, cost and scope of services, dependability, location, personnel, past track record, and availability.

 

DIF:    Recall             REF:   p. 1312          OBJ:   6

 

  1. To determine if a home setting can support the equipment needs of a mechanically ventilated patient being considered for discharge, which of the following would you assess?
  2. available space for equipment
  3. amperage of power supply
  4. number and location of grounded outlets
  5. presence of hazardous appliances
a. 2 and 4
b. 1, 2, 3, and 4
c. 3 and 4
d. 1, 2, and 3

 

 

ANS:  B

Box 51-1 lists some key factors one should assess in planning the discharge of a respiratory care patient to the home environment.

 

DIF:    Application    REF:   p. 1312          OBJ:   6

 

  1. Key environmental factors that should be assessed in considering discharge of a patient to the home care setting include all of the following except:
a. heating and ventilation
b. humidity
c. lighting
d. airborne pollutants

 

 

ANS:  D

Box 51-1 lists some key factors one should assess in planning the discharge of a respiratory care patient to the home environment

 

DIF:    Application    REF:   p. 1312          OBJ:   6

 

  1. What is the most common respiratory home care modality?
a. aerosol therapy
b. mechanical ventilation
c. O2 therapy
d. nasal continuous positive airway pressure (CPAP)

 

 

ANS:  B

Oxygen therapy is by far the most common mode of respiratory care in postacute care settings.

 

DIF:    Recall             REF:   p. 1313          OBJ:   7

 

  1. Which of the following are acceptable indicators of hypoxemia for purposes of justifying home O2 therapy?
  2. resting PaO2 of 65 mm Hg (room air)
  3. drop in Sao2 below 89% during ambulation
  4. resting arterial SaO2 below 88% (room air)
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on pp. 1314.

 

DIF:    Recall             REF:   p. 1314          OBJ:   7

 

  1. Home O2 therapy can be justified in patients with PaO2 values greater than 55 mm Hg in all of the following conditions except:
a. cor pulmonale
b. erythrocythemia (hematocrit greater than 56%)
c. congestive heart failure
d. peripheral vascular disease

 

 

ANS:  D

To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on pp. 1314.

 

DIF:    Recall             REF:   p. 1314          OBJ:   7

 

  1. Physical hazards associated with home O2 therapy equipment include all of the following except:
a. unsecured cylinders
b. gaseous explosions
c. ungrounded equipment
d. liquid O2 burns

 

 

ANS:  B

To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on pp. 1314.

 

DIF:    Recall             REF:   p. 1314          OBJ:   7

 

  1. To determine the need for long-term home O2 therapy after initial justification, when should blood gas analysis be repeated?
a. 1 to 3 weeks after initiation
b. 1 to 3 days after initiation
c. 1 to 3 months after initiation
d. 1 to 3 years after initiation

 

 

ANS:  C

To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on pp. 1314.

 

DIF:    Application    REF:   p. 1314          OBJ:   7

 

  1. Once the need for long-term home O2 therapy has been documented, why should repeated laboratory assessment (ABG or oximetry) be conducted?
  2. to follow the course of the disease
  3. to assess changes in clinical status
  4. to facilitate changes in the prescription
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on pp. 1314.

 

DIF:    Recall             REF:   p. 1314          OBJ:   7

 

  1. CMS regulations require that prescriptions for home O2 therapy be based on:
a. documented hypoxemia
b. documented symptoms
c. written diagnosis
d. presence of cyanosis

 

 

ANS:  A

As indicated in the practice guideline, O2 prescriptions must be based on documented hypoxemia, as determined by either blood gas analysis or oximetry.

 

DIF:    Application    REF:   p. 1313          OBJ:   7

 

  1. Which of the following are acceptable methods of documenting the presence of hypoxemia in patients being considered for home O2 therapy?
  2. blood gas analysis
  3. pulse oximetry
  4. physical exam
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

As indicated in the practice guideline, O2 prescriptions must be based on documented hypoxemia, as determined by either blood gas analysis or oximetry.

 

DIF:    Recall             REF:   p. 1313          OBJ:   7

 

  1. Which of the following is FALSE about home O2 therapy?
a. A PRN (as needed) prescription for O2 is acceptable.
b. Hypoxemia can be confirmed by arterial blood gas (ABG) or oximetry.
c. A PaO2 at or below 55 mm Hg documents need.
d. An SaO2 below 88% is clinical evidence of need.

 

 

ANS:  A

As-needed O2 is no longer acceptable in the postacute care setting.

 

DIF:    Recall             REF:   p. 1313          OBJ:   7

 

  1. In addition to specifying the liter flow or concentration, which of the following must a physician include in a home O2 prescription?
  2. evidence of central cyanosis
  3. appropriate medical diagnosis
  4. laboratory evidence of hypoxemia
  5. frequency of use of O2
  6. duration of need for O2
a. 2, 3, 4, and 5
b. 1, 3, and 4
c. 3, 4, and 5
d. 1, 2 3, 4, and 5

 

 

ANS:  A

Once the need for O2 therapy is established, the physician writes a prescription. A prescription for O2 therapy in the postacute care setting must include the following elements:

  • Flow rate in liters/minute and/or concentration
  • Frequency of use in hours/day and minutes/hour (if applicable)
  • Duration of need (up to a maximum of 12 months in the home)
  • Diagnosis (severe primary lung disease, secondary conditions related to lung disease and hypoxia, related conditions or symptoms that may improve with O2)
  • Laboratory evidence (arterial blood gas [ABG] analysis or oximetry under the appropriate testing conditions). Home care companies cannot provide this testing.
  • Additional medical documentation (no acceptable alternatives to home O2 therapy).

 

DIF:    Recall             REF:   p. 1313          OBJ:   7

 

  1. Home O2 can be supplied by which of the following systems?
  2. REDOX chemical reactors
  3. liquid O2 systems
  4. O2 concentrators
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

In these settings, O2 normally is supplied from one of the following three sources: (1) compressed O2 cylinders, (2) liquid O2 systems, or (3) O2 concentrators.

 

DIF:    Recall             REF:   p. 1313          OBJ:   8

 

  1. Advantages of using compressed O2 cylinders in the home include which of the following?
  2. minimal waste or loss
  3. unlimited storage time
  4. widespread availability
  5. minimal user hazards
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 1, 2, and 4

 

 

ANS:  A

Table 51-3 summarizes the major advantages and disadvantages of each system.

 

DIF:    Application    REF:   p. 1313          OBJ:   8

 

  1. Disadvantages of using compressed O2 cylinders in the home include all of the following except:
a. high-pressure hazards
b. limited volume of O2
c. gas waste when not used
d. need for frequent deliveries

 

 

ANS:  C

Table 51-3 summarizes the major advantages and disadvantages of each system.

 

DIF:    Application    REF:   p. 1317          OBJ:   8

 

  1. What is the primary use of compressed O2 cylinders in alternative settings?
  2. ambulation (small cylinders)
  3. backup supply (large cylinders)
  4. primary supply (large cylinders)
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

The primary use of compressed O2 cylinders in alternative settings is for either ambulation (small cylinders) or as a backup to liquid or concentrator supply systems (H/K cylinders).

 

DIF:    Application    REF:   p. 1313          OBJ:   8

 

  1. A home care patient will be receiving nasal O2 at 0.5 L/min using a large compressed gas cylinder. Which of the following additional equipment would you specify for this patient?
  2. bubble humidifier
  3. pressure-reducing valve
  4. calibrated low-flow flowmeter
a. 1 and 2
b. 1, 2, and 3
c. 2 and 3
d. 1 and 3

 

 

ANS:  C

In addition to the cylinder gas, a pressure-reducing valve with flowmeter is needed to deliver O2 at the prescribed flow. Standard clinical flowmeters deliver flows up to 15 L/min; flows used in alternative settings are typically in the 0.25 to 5.0 L/min range. For this reason, the respiratory therapist should select a calibrated low-flow flowmeter whenever possible. Alternatively, a preset flow restrictor can be used.

 

DIF:    Application    REF:   p. 1313          OBJ:   8

 

  1. Which of the following would you recommend as the solution used to fill a bubble humidifier used for home O2 therapy?
a. sterile water
b. distilled water
c. 0.9% saline
d. tap water

 

 

ANS:  B

Because the mineral content of tap water may be high (hard water), water used in these humidifiers should be distilled.

 

DIF:    Application    REF:   p. 1317          OBJ:   8

 

  1. A home care patient receiving long-term O2 therapy at 5 L/min complains that her nondisposable humidifier is not bubbling properly. Upon inspection of the humidifier, you notice hard white deposits in and around the diffusing element. Which of the following would you recommend to this patient?
a. Stop using the humidifier because there is no need for it at this flow.
b. Replace the device and fill with distilled water, not tap water.
c. Increase the flow at night to help clean out the humidifier.
d. Replace the device and fill with sterile water, not tap water.

 

 

ANS:  B

Otherwise, the porous diffusing element may become occluded. Although complete blockage is unlikely, occlusion of the diffusing element can impair humidification and alter flow.

 

DIF:    Analysis         REF:   p. 1317          OBJ:   8

 

  1. One cubic foot (1 cu/ft) of liquid O2 equals how many cu/ft of gaseous O2?
a. 22.80
b. 7.48
c. 860.00
d. 3.14

 

 

ANS:  C

One cubic foot of liquid O2 equals 860 cubic feet of gas.

 

DIF:    Recall             REF:   p. 1317          OBJ:   8

 

  1. The O2 in the inner reservoir of a home liquid O2 system is maintained at what temperature?
a. –300° F
b. 212° F
c. 0° F
d. –150° F

 

 

ANS:  A

The liquid O2 is kept at approximately -300°F.

 

DIF:    Recall             REF:   p. 1317          OBJ:   8

 

  1. When not in use, vaporization in a home liquid O2 system maintains the pressure in the container at what range?
a. 10 to 15 psi
b. 45 to 55 psi
c. 80 to 90 psi
d. 20 to 25 psi

 

 

ANS:  D

When the cylinder is not in use, this vaporization maintains pressures between 20 and 25 psi.

 

DIF:    Recall             REF:   p. 1317          OBJ:   8

 

  1. When the flow-metering device of a home liquid O2 system is turned on, O2 leaves the container through a vaporizing coil, where it is heated by exposure to which of the following?
a. hot water
b. ambient air
c. electrical energy
d. ultrasound

 

 

ANS:  B

When flow is turned on, gaseous O2 passes through a vaporizing coil, where it is warmed by exposure to room temperature.

 

DIF:    Recall             REF:   p. 1317          OBJ:   8

 

  1. At normal liquid cylinder operating pressures, 1 lb of stored liquid O2 equals about how many liters of gaseous O2?
a. 860.00
b. 344.00
c. 22.80
d. 7.48

 

 

ANS:  B

At normal liquid cylinder operating pressures, 1 pound of liquid O2 equals approximately 344 L of gaseous O2.

 

DIF:    Recall             REF:   p. 1317          OBJ:   8

 

  1. The gauge reading of a 50-lb home liquid O2 system indicates that the cylinder is a third full. What is the approximate duration of flow of this system at 2 L/min?
a. 24 hours
b. 48 hours
c. 72 hours
d. 95 hours

 

 

ANS:  B

See Mini Clini Computing a Liquid Oxygen System’s Duration of Flow for an example of how you can compute a liquid O2 system’s duration of flow.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. What is the purpose of the small refillable liquid O2 tank that comes with many stationary home liquid O2 reservoirs?
a. to provide O2 to ambulatory patients outside the home
b. to serve as a backup should the primary reservoir fail
c. to collect and save gas vented by the primary reservoir
d. to provide higher flows for patients requiring high FIO2 values

 

 

ANS:  A

Many personal liquid O2 systems also come with smaller portable units (Figure 51-3). This system is ideal for the ambulatory patient who is capable of physical activity.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. Most portable home liquid O2 systems can provide low-flow O2 (2 L/min) for about how long?
a. 1 to 3 hours
b. 3 to 5 hours
c. 8 to 12 hours
d. 5 to 8 hours

 

 

ANS:  D

Most portable units come with a carrying case or small cart and can provide 5 to 8 hours of O2 at a flow of 2 L/min.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. An ambulatory home O2 therapy patient complains that the portable liquid (at 3 L/min) does not last long enough for a visit with the grandchildren. What might you recommend to overcome this limitation?
a. Decrease the flow to 2 L/min.
b. Put a couple of E cylinders in her car.
c. Use an O2-conserving device.
d. Put the large liquid unit in the car.

 

 

ANS:  C

The functional use time of portable liquid O2 units can be extended with O2-conserving devices, including the demand-flow systems.

 

DIF:    Analysis         REF:   p. 1318          OBJ:   8

 

  1. Advantages of home liquid O2 systems include all of the following except they:
a. usually include a small refillable portable subsystem
b. do not require an O2 service delivery company
c. provide large-volume O2 storage in a small space
d. are useful for rehabilitation activities (e.g., walking)

 

 

ANS:  B

Table 51-3 summarizes the major advantages and disadvantages of each system.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. Disadvantages of home liquid O2 systems include which of the following?
  2. Oxygen is lost when not used (because of venting).
  3. The low temperature of liquid O2 can be a hazard.
  4. Liquid O2 must be delivered when needed.
  5. These systems cannot drive pneumatic equipment.
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

Table 51-3 summarizes the major advantages and disadvantages of each system.

 

DIF:    Application    REF:   p. 1317          OBJ:   8

 

  1. What electrically powered device can separate the O2 in room air from N2, thereby providing an enriched flow of O2 for therapeutic use?
a. O2 concentrator
b. O2-conserving device
c. Joule-Thompson enricher
d. molecular impactor

 

 

ANS:  A

An O2 concentrator is an electrically powered device that physically separates the O2 in room air from N2.

 

DIF:    Recall             REF:   p. 1318          OBJ:   8

 

  1. Advantages of O2 concentrators for home O2 therapy include all of the following except they:
a. operate at safe low pressures
b. are cost-effective for continuous use
c. do not waste or lose any O2
d. can power most pneumatic equipment

 

 

ANS:  D

Table 51-3 summarizes the major advantages and disadvantages of each system.

 

DIF:    Application    REF:   p. 1317          OBJ:   8

 

  1. What are some disadvantages of O2 concentrators for home O2 therapy?
  2. FIO2 values decrease with increased flow.
  3. Backup O2 is required in case of electrical failure.
  4. They cannot operate high-pressure devices.
  5. Loss of electricity disrupts delivery.
a. 2 and 4
b. 1, 2, and 3
c. 2 and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

Table 51-3 summarizes the major advantages and disadvantages of each system.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. At flows between 1 and 2 L/min, a typical molecular sieve O2 concentrator provides an O2 concentration of about what level?
a. 65%
b. 75%
c. 85%
d. 95%

 

 

ANS:  D

At flows of 1 to 2 L/min, the typical molecular sieve concentrator provides between 92% and 95% O2.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. At 3 to 5 L/min output, a typical molecular sieve O2 concentrator provides O2 concentrations at what level?
a. 65% to 78%
b. 78% to 85%
c. 85% to 93%
d. >93%

 

 

ANS:  C

At 3 to 5 L/min, O2 concentrations fall to between 85% and 93%.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. To help prevent problems with home O2 therapy, you should have the patient or caregiver check all delivery equipment at least how often?
a. once a day
b. once a week
c. every other day
d. once a month

 

 

ANS:  A

To avoid problems before they occur, have the patient or caregiver check all O2 delivery equipment at least once a day.

 

DIF:    Application    REF:   p. 1319          OBJ:   8

 

  1. In setting up a home care chronic obstructive pulmonary disease patient for continuous low-flow O2 therapy through an O2 concentrator, which of the following additional equipment must you provide?
a. pressure-reducing valve
b. backup gas cylinder
c. emergency generator
d. backup concentrator

 

 

ANS:  B

You must ensure that all such systems have an emergency backup supply.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. Other than providing a backup H cylinder for a home care O2 therapy patient who uses a concentrator, what other safety measure would you take to ensure an uninterrupted supply?
a. Provide an emergency backup battery-powered concentrator.
b. Arrange for emergency transport of the patient to a hospital.
c. Notify the power company that life support equipment is in use.
d. Provide an emergency backup liquid O2 system.

 

 

ANS:  C

If a home care patient’s primary O2 supply is by concentrator, the home care respiratory therapist should notify the electric power company in writing that life support equipment is in use at that location.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. Routine in-home monthly maintenance of an O2 concentrator should include which of the following?
  2. flushing the system for 20 minutes with an inert gas
  3. confirming the FIO2 with a calibrated O2 analyzer
  4. cleaning and replacing the internal and external filters
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

In the home, O2 concentrator fractional inspired O2 concentration (FIO2) levels should be checked and confirmed as part of a routine monthly maintenance visit. Routine maintenance of these devices should include cleaning and replacing filters, checking the alarm system, and confirming the FIO2 levels using either the unit’s O2 sensor or a separate calibrated O2 analyzer.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. When visiting a home care patient receiving nasal O2 at 2 L/min through an O2 concentrator, you measure the FIO2 of the outlet gas as 0.63. Which of the following best explains this finding?
a. This FIO2 is normal at this flow.
b. The sieve pellets are exhausted.
c. The gas inlet filter must be clogged.
d. Electrical power is inadequate.

 

 

ANS:  B

If the concentration is less than the manufacturer’s specification at the given flow, the pellet canisters are probably exhausted and should be replaced.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. A home care patient with kyphoscoliosis requires intermittent positive-pressure breathing (IPPB) treatments twice per day with O2. A local charitable organization has given the family a pneumatically powered IPPB device for this purpose. Which of the following gas sources would you recommend to drive this device?
  2. liquid O2 reservoir
  3. O2 concentrator
  4. compressed gas cylinder
a. 1 and 2
b. 2 and 3
c. 3
d. 1, 2, and 3

 

 

ANS:  C

Because both concentrators and personal liquid O2 systems operate at low pressures, they cannot be used to drive equipment needing 50 psi, such as pneumatically powered ventilators and large-volume jet nebulizers.

 

DIF:    Analysis         REF:   p. 1320          OBJ:   8

 

  1. What is the most common O2 delivery system for long-term care?
a. simple mask
b. entrainment mask
c. transtracheal catheter
d. nasal cannula

 

 

ANS:  D

The most common O2 delivery system for long-term care is the nasal cannula.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. Oxygen-conserving delivery systems include which of the following?
  2. transtracheal catheter
  3. reservoir cannula or pendant
  4. pulse-dose
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

These include the transtracheal O2 catheter, the reservoir cannula, and the demand or pulse-dose O2 delivery systems.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. A home care patient using a reservoir cannula for long-term, low-flow O2 therapy objects to the cosmetic appearance of the device. Which of the following alternatives would you recommend to this patient’s physician as capable of addressing the patient’s concerns?
  2. transtracheal catheter
  3. entrainment mask
  4. pendant reservoir
a. 1
b. 2 and 3
c. 1 and 2
d. 1, 2, and 3

 

 

ANS:  A

This delivery method offers advantages of improved cosmetic appearance and lower flows to achieve the same therapeutic effect.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. Transtracheal O2 therapy (TTOT) should be considered as an option for what patients requiring long-term O2 therapy?
  2. those who remain hypoxemic with standard approaches
  3. those who do not comply well when using other devices
  4. those who exhibit complications with nasal delivery
  5. those who prefer TTOT for cosmetic reasons
  6. those who require increased mobility
a. 1, 2, and 4
b. 1, 2, and 3
c. 2, 3, and 5
d. 1, 2, 3, 4, and 5

 

 

ANS:  D

TTOT is indicated only for those patients who meet one or more of the following criteria: (1) they cannot be adequately oxygenated with standard approaches, (2) they do not comply well when using other devices, (3) they exhibit complications from nasal cannula use, (4) they prefer TTOT for cosmetic reasons, and (5) they have need for increased mobility.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. Routine removing and cleaning of a transtracheal O2 catheter should be performed by whom?
a. visiting nurse
b. respiratory care practitioner
c. physician
d. patient

 

 

ANS:  D

Key patient responsibilities include routine catheter cleaning and recognizing and troubleshooting common problems.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. A home care patient on transtracheal O2 therapy at 0.5 L/min frantically calls you, unable to reinsert the catheter after cleaning. What would you recommend?
a. Use a clean, pointed instrument to guide catheter reinsertion.
b. Put on a nasal cannula at 1 L/min and call the physician.
c. Insert the catheter into the nasal cavity about 3 to 4 inches.
d. Insert the catheter into the oral cavity.

 

 

ANS:  B

Key patient responsibilities include routine catheter cleaning and recognizing and troubleshooting common problems.

 

DIF:    Analysis         REF:   p. 1320          OBJ:   8

 

  1. To avoid product failure, transtracheal catheters and their tubing should be replaced every how often?
a. every week
b. every 3 months
c. every month
d. every 6 months

 

 

ANS:  B

Key patient responsibilities include routine catheter cleaning and recognizing and troubleshooting common problems. See Box 51-3.

 

DIF:    Application    REF:   p. 1321          OBJ:   8

 

  1. Which O2 delivery system would you recommend for an active home care patient with low FIO2 needs who desires increased mobility?
a. traditional low-flow nasal cannula supplied by O2 concentrator
b. compressor-driven humidifier with supplemental O2 through a concentrator
c. conserving device used in conjunction with a portable liquid O2 system
d. air entrainment mask driven by a large (H/K) compressed gas cylinder

 

 

ANS:  C

Patients requiring low-flow home O2 and enhanced mobility should be considered for a liquid O2 set-up with a pulsed-dose O2-conserving device.

 

DIF:    Analysis         REF:   p. 1322          OBJ:   8

 

  1. Complications associated with insertion of a transtracheal O2 catheter include all of the following except:
a. bleeding
b. pneumothorax
c. bronchospasm
d. abscess

 

 

ANS:  D

The most common complications of transtracheal O2 therapy are listed in Box 51-4.

 

DIF:    Recall             REF:   p. 1323          OBJ:   8

 

  1. You are caring for a patient who has just received a transtracheal catheter for long-term continuous home O2 therapy. Which of the following problems should you be on guard for with this patient?
  2. airway obstruction
  3. catheter clogging
  4. stoma infection
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

The most common complications of transtracheal O2 therapy are listed in Box 51-4.

 

DIF:    Application    REF:   p. 1323          OBJ:   8

 

  1. While visiting a patient who has been receiving transtracheal O2 therapy for 6 months, you note marked erythemia and swelling at the stoma site. Which of the following actions would be appropriate at this time?
a. Question the patient and family about their cleaning methods.
b. Promptly report your observations to the prescribing physician.
c. Liberally apply tincture of benzoin to the stoma site.
d. Flush the catheter and the tubing with H2O2.

 

 

ANS:  B

In particular, you should immediately report any evidence of tract tenderness, fever, excessive cough, increased dyspnea, or subcutaneous emphysema to the patient’s physician.

 

DIF:    Analysis         REF:   p. 1323          OBJ:   8

 

  1. What are some major problems with demand O2 delivery systems?
  2. They are cumbersome and unattractive.
  3. Equipment and maintenance costs are high.
  4. The device valve may have slow response times.
  5. Catheter and sensor malfunction is common.
a. 2 and 4
b. 1, 2, and 3
c. 2 and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

These and other potential problems with demand-flow O2 delivery systems are listed in Box 51-5.

 

DIF:    Application    REF:   p. 1322          OBJ:   8

 

  1. Which of the following are good candidates for home mechanical ventilation?
  2. a patient who cannot maintain adequate ventilation at night
  3. a patient who requires continuous ventilation to survive
  4. a terminally ill patient who requires ventilatory support
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 51-5 provides more detailed profiles of these patient groups.

 

DIF:    Recall             REF:   p. 1323          OBJ:   9

 

  1. Conditions in which patient need for home mechanical ventilation is generally limited to daytime or nocturnal support include all of the following except:
a. kyphoscoliosis
b. high spinal cord injuries
c. amyotrophic lateral sclerosis
d. myasthenia gravis

 

 

ANS:  B

Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 51-5 provides more detailed profiles of these patient groups.

 

DIF:    Recall             REF:   p. 1323          OBJ:   9

 

  1. Home care patients requiring continuous ventilatory support for long-term survival include which of the following?
  2. those with high spinal cord injuries
  3. those with late-stage muscular dystrophy
  4. those with bronchogenic carcinoma
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 51-5 provides more detailed profiles of these patient groups.

 

DIF:    Application    REF:   p. 1323          OBJ:   9

 

  1. Examples of terminally ill patients with short life expectancies who can receive ventilatory support in the home setting include which of the following?
  2. patients with end-stage chronic obstructive pulmonary disease
  3. patients with kyphoscoliosis
  4. patients with lung cancer
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 51-5 provides more detailed profiles of these patient groups.

 

DIF:    Application    REF:   p. 1323          OBJ:   9

 

  1. All of the following indicate that a patient is stable enough to be considered for home ventilatory support except:
a. pH = 7.34; PCO2 = 48; HCO3 = 27
b. FIO2 = 35%
c. 15 cm H2O positive end-expiratory pressure (PEEP)
d. absence of cardiac arrhythmias

 

 

ANS:  C

Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 51-5 provides more detailed profiles of these patient groups.

 

DIF:    Application    REF:   p. 1323          OBJ:   9

 

  1. Which of the following would indicate that a patient is not sufficiently stable for home mechanical ventilation?
  2. severe dyspnea while breathing on the ventilator
  3. airway secretions cleared only by suctioning
  4. frequent premature ventricular contractions
  5. use of a cuffed oral endotracheal tube
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 3, and 4

 

 

ANS:  D

In regard to assessing patient stability, Box 51-6 outlines the criteria developed by the American College of Chest Physicians (ACCP).

 

DIF:    Application    REF:   p. 1324          OBJ:   9

 

  1. Mechanical ventilation in the home setting can be provided by all of the following methods except:
a. positive pressure through an oral endotracheal tube
b. positive pressure through an intact upper airway
c. intermittent abdominal displacement methods
d. negative pressure through an intact upper airway

 

 

ANS:  A

In alternative settings, invasive ventilatory support always involves application of positive pressure ventilation by tracheotomy. Noninvasive approaches include positive and negative pressure ventilation via an intact upper airway or abdominal displacement methods.

 

DIF:    Application    REF:   p. 1324          OBJ:   9

 

  1. According to the AARC, which of the following standards should be met when considering ventilatory support outside the acute care hospital?
  2. Services must be based on the attending physician’s prescription.
  3. Those providing the support should be appropriately trained.
  4. Appropriate recording and reporting mechanisms should exist.
  5. Safe, effective, and appropriate equipment must be provided.
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

The AARC developed a Clinical Practice Guideline on Long-term Invasive Mechanical Ventilation in the Home. Excerpts appear on pp. 1325-1326.

 

DIF:    Recall             REF:   p. 1325-1326                                  OBJ:   9

 

  1. What equipment function should lay caregivers of home mechanical ventilation assess regularly?
  2. cleanliness and function of bag-valve-mask
  3. internal and external battery power levels
  4. cleanliness of filters and alarm functions
  5. accuracy of ventilator tidal volume (VT) output
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  A

The AARC developed a Clinical Practice Guideline on Long-term Invasive Mechanical Ventilation in the Home. Excerpts appear on pp. 1325-1326.

 

DIF:    Recall             REF:   p. 1325          OBJ:   9

 

  1. Patient parameters that lay caregivers of home mechanical ventilation should assess regularly include all of the following except:
a. vital signs
b. skin color or diaphoresis
c. chest excursions
d. breath sounds

 

 

ANS:  D

The AARC developed a Clinical Practice Guideline on Long-term Invasive Mechanical Ventilation in the Home. Excerpts appear on pp. 1325-1326.

 

DIF:    Application    REF:   p. 1325          OBJ:   9

 

  1. Which of the following are prerequisites to successful home-based mechanical ventilation?
  2. presence of adequate professional support
  3. willingness of family to accept responsibility
  4. patient’s condition, especially stability
  5. overall viability of the home care plan
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

For home ventilatory support to be successful, several prerequisites must be met. These include the following:

  • willingness of family to accept responsibility
  • adequacy of family and professional support
  • overall viability of the home care plan
  • stability of patient
  • adequacy of home setting

 

DIF:    Recall             REF:   p. 1324          OBJ:   9

 

  1. What is the first step in discharging a patient from an acute care facility who will require home-based mechanical ventilation?
a. Patient and family education and training are initiated.
b. The family is consulted about the feasibility.
c. All equipment and necessary supplies are readied.
d. The physician writes appropriate orders and sets objectives.

 

 

ANS:  B

Basic steps in the discharge process for a ventilator-dependent patient include the following:

  1. Family is consulted regarding feasibility.
  2. Physician writes appropriate orders.
  3. Discharge planner coordinates efforts of team members and discharge plan is formulated.
  4. Physician and other team members discuss plan with family and/or caregivers.
  5. Education and training are initiated and completed.
  6. Patient and family are prepared for discharge.
  7. Home layout is assessed with necessary changes made.
  8. Equipment and supplies are readied.
  9. Discharge planner meets with team and makes final preparations.
  10. Patient is discharged (with trial period, if necessary).
  11. Local power company is notified regarding the presence of life support equipment; appropriate backup power (battery or compressed gas source) is made available.
  12. Ongoing and follow-up care provided by visiting nurse, respiratory therapist, and other health care professionals (as necessary).

 

DIF:    Application    REF:   p. 1324          OBJ:   10

 

  1. You have been asked to organize a patient and family education program as part of a discharge plan for a patient requiring home ventilatory support. Which of the following areas would you be sure to cover?
  2. equipment operation and disinfection
  3. patient assessment and monitoring
  4. airway management and clearance
  5. emergency procedures
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

Essential skills that must be taught include the following:

  • simple patient assessment
  • airway management, including tracheostomy and stoma care, cuff care, suctioning, changing tubes/ties
  • chest physical therapy techniques, including percussion, vibration, coughing
  • medication administration, including oral and aerosol
  • patient movement and ambulation
  • equipment operation and maintenance
  • equipment troubleshooting
  • ceaning and disinfection
  • emergency procedures

 

DIF:    Recall             REF:   p. 1324          OBJ:   10

 

  1. Emergency situations that home mechanical ventilation caregivers must be trained to recognize and manage include all of the following except:
a. ventilator or power failure
b. tension pneumothorax
c. artificial airway obstruction
d. ventilator circuit problems

 

 

ANS:  B

Emergency situations that caregivers must be trained to recognize and properly deal with include ventilator or power failure, ventilator circuit problems, airway emergencies, and cardiac arrest.

 

DIF:    Recall             REF:   p. 1324          OBJ:   10

 

  1. You have been asked to organize a patient and family education program as part of a discharge plan for a patient requiring home ventilatory support. Which of the following methods would be best for training the family in the operation of the ventilator chosen?
a. Put the patient on the selected device while still hospitalized.
b. Set up and review the ventilator after the patient gets home.
c. Take the family into a back room and show them a ventilator.
d. Give the family the operating manual for the ventilator.

 

 

ANS:  A

Ideally, the patient should have a trial period on the actual home ventilator before discharge.

 

DIF:    Application    REF:   p. 1327          OBJ:   10

 

  1. In the early stages after a patient requiring mechanical ventilation is discharged to the home, how often should patient follow-up by a respiratory care practitioner occur?
a. every week
b. biweekly
c. every month
d. every day

 

 

ANS:  D

In the early stages after discharge, patient follow-up by a respiratory therapist will likely occur every day.

 

DIF:    Recall             REF:   p. 1327          OBJ:   10

 

  1. Which of the following conditions is an indication for application of noninvasive ventilation (NIV)?
a. The patient requires low concentrations of supplemental O2.
b. The patient cannot swallow without the risk of aspiration.
c. The patient’s peak cough flows are less than 3 L/sec.
d. Because of facial trauma, an airtight mask seal is impossible.

 

 

ANS:  A

Any individual requiring mechanical ventilation can be supported with NIV if:

  1. The patient is mentally competent, cooperative, and not using heavy sedation or narcotics.
  2. Supplemental O2 therapy is unnecessary or minimal.
  3. SaO2 can be maintained above 90% by aggressive airway clearance techniques.
  4. Bulbar muscle function is adequate for swallowing without potentially dangerous aspiration.
  5. No history exists of substance abuse or uncontrollable seizures.
  6. Unassisted or manually assisted peak expiratory flows during coughing exceed 3 L/sec.
  7. No conditions are present that interfere with NIV interfaces (e.g., facial trauma, inadequate bite for mouthpiece, presence of nasogastric tube, or facial hair that can hamper airtight seal).

 

DIF:    Application    REF:   p. 1327          OBJ:   11

 

  1. Which of the following can benefit most from intermittent use of noninvasive ventilation?
a. a patient with muscular dystrophy
b. a patient with pulmonary edema
c. a high cervical spine injury patient
d. a chronic obstructive pulmonary disease patient in respiratory failure

 

 

ANS:  A

Type 2 patients generally require only intermittent or nocturnal support. Examples of patients in this category include those with chronic neuromuscular and chest wall diseases, such as muscular dystrophy and kyphoscoliosis.

 

DIF:    Application    REF:   p. 1327          OBJ:   11

 

  1. Relative contraindications for using noninvasive ventilation (NIV) include all of the following except:
a. severe upper airway dysfunction
b. copious secretions that require suctioning
c. FIO2 requirements exceeding 40%
d. absence of respiratory muscle activity

 

 

ANS:  D

Relative contraindications to NIV include severe upper airway dysfunction, copious secretions that cannot be cleared by spontaneous or assisted cough, or O2 concentration requirements exceeding 40%.

 

DIF:    Recall             REF:   p. 1327          OBJ:   11

 

  1. For which of the following groups would you recommend long-term negative pressure ventilation in an alternative setting?
  2. patients who cannot or will not use noninvasive positive pressure ventilation
  3. patients who need frequent airway access for suctioning
  4. patients with severe nasal congestion or obstruction
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

Nonetheless, negative pressure ventilation may be appropriate in those patients who are unable to use or who have failed noninvasive positive pressure ventilation trials. Negative pressure ventilation may also be considered for patients who require frequent airway access for suctioning or those with severe nasal congestion.

 

DIF:    Recall             REF:   p. 1327          OBJ:   11

 

  1. In addition to a ventilator, which of the following equipment or supplies would you recommend for a home care patient receiving long-term invasive positive-pressure ventilation?
  2. self-inflating bag-valve-mask
  3. portable suction system
  4. portable DC defibrillator
  5. tracheal tubes and care kits
  6. disposable circuits and catheters
a. 2, 3, 4, and 5
b. 1, 3, and 4
c. 1, 2, 4, and 5
d. 1, 2, 3, 4, and 5

 

 

ANS:  C

Box 51-7 lists the essential equipment and supplies needed for ventilator-dependent patients in alternative settings.

 

DIF:    Application    REF:   p. 1328          OBJ:   12

 

  1. In which of the following situations would you recommend that more than one ventilator be provided for a home care patient?
  2. if the patient cannot maintain spontaneous ventilation for at least 1 hour
  3. if the patient’s care plan requires mechanical ventilation during mobility
  4. if a replacement ventilator cannot be secured within 2 hours
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

A second back-up ventilator should be provided for patients who cannot maintain spontaneous ventilation for more than 4 consecutive hours, for patients living in an area where a replacement ventilator cannot be secured within 2 hours, and for patients whose care plan requires mechanical ventilation during mobility.

 

DIF:    Application    REF:   p. 1327          OBJ:   12

 

  1. Which of the following strategies would you recommend for a patient with a tracheotomy who requires home ventilatory support?
a. positive-pressure ventilation
b. noninvasive positive-pressure ventilation
c. abdominal displacement ventilation
d. negative-pressure ventilation

 

 

ANS:  A

If invasive ventilation by tracheostomy is the selected approach, the best choice is a positive-pressure ventilator.

 

DIF:    Application    REF:   p. 1327          OBJ:   12

 

  1. Which of the following strategies would you recommend for a cooperative patient with an intact upper airway who requires home ventilatory support?
a. invasive positive-pressure ventilation
b. noninvasive positive-pressure ventilation
c. abdominal displacement ventilation
d. negative-pressure ventilation

 

 

ANS:  B

For patients with an intact upper airway, a device capable of noninvasive positive-pressure ventilation is the first choice.

 

DIF:    Application    REF:   p. 1328          OBJ:   12

 

  1. Absolute contraindications for using noninvasive positive-pressure ventilation include all of the following except:
a. hemodynamic instability
b. uncooperative patient
c. copious secretions
d. need for airway protection

 

 

ANS:  C

Box 51-8 lists the absolute contraindications against using noninvasive positive-pressure ventilation.

 

DIF:    Application    REF:   p. 1328          OBJ:   11

 

  1. Which of the following strategies would you recommend for a hemodynamically unstable patient with an intact upper airway who requires home ventilatory support?
a. invasive positive-pressure ventilation
b. noninvasive positive-pressure ventilation
c. abdominal displacement ventilation
d. negative-pressure ventilation

 

 

ANS:  D

In patients with an intact upper airway for whom noninvasive positive-pressure ventilation is contraindicated or unsuccessful, a negative pressure ventilator should be considered.

 

DIF:    Application    REF:   p. 1328          OBJ:   11

 

  1. Characteristics common to most positive-pressure ventilation designed for use in the home setting include all of the following except:
a. volume-cycling to end inspiration
b. high-pressure pneumatic power source
c. backup internal power supply
d. rotary piston drive mechanism

 

 

ANS:  B

Table 51-6 lists the essential, recommended, and optional features of positive-pressure ventilators used in alternative care settings.

 

DIF:    Application    REF:   p. 1328          OBJ:   12

 

  1. Essential features of positive-pressure ventilators that are used in alternative care settings on patients with intact ventilatory drive and respiratory muscles include all of the following except:
a. mandatory minimum rate
b. flow or inspiratory time control
c. breath-triggering mechanism
d. spontaneous breathe mode

 

 

ANS:  D

Table 51-6 lists the essential, recommended, and optional features of positive-pressure ventilators used in alternative care settings.

 

DIF:    Application    REF:   p. 1328          OBJ:   12

 

  1. All of the following are advantages of pressure-limited ventilators used in alternative settings except they:
a. are responsive to changing flow demands
b. can deliver higher volumes and pressures
c. are lightweight and less expensive
d. can compensate for small leaks

 

 

ANS:  B

Table 51-7 compares the advantages and disadvantages of current-generation portable volume-cycled and pressure-limited ventilators for use in alternative settings.

 

DIF:    Recall             REF:   p. 1328-1329                                  OBJ:   12

 

  1. For which home care patients requiring mechanical ventilation would you recommend a portable volume-cycled ventilator rather than a pressure-limited device?
  2. those with a neuromuscular or neurologic disorder
  3. those who cannot sustain any spontaneous breathing
  4. those with chronic obstructive pulmonary disease
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

Those with neuromuscular or neurologic disorders often favor the consistent high inflations provided by volume ventilation, which enhance coughing and phonation. In addition, the alarm capabilities and internal battery backup provided with current portable volume ventilators make them the best choice for patients who cannot sustain any spontaneous breathing.

 

DIF:    Application    REF:   p. 1329          OBJ:   12

 

  1. A home care patient receiving continuous noninvasive positive-pressure ventilation through a nasal mask complains of pressure sores over the nasal bridge. Which of the following actions could help to alleviate this problem?
  2. artificial skin
  3. forehead spacer
  4. reduce strap tension
  5. try nasal pillows
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

Table 51-7 summarizes some of the common problems associated with noninvasive positive-pressure ventilation interfaces and how to correct them.

 

DIF:    Application    REF:   p. 1330          OBJ:   12

 

  1. Which of the following alarm systems is needed for postacute care patients who require only intermittent pressure-limited noninvasive positive-pressure ventilation?
a. high-pressure alarm
b. loss of power alarm
c. low-pressure alarm
d. low-exhaled-volume alarm

 

 

ANS:  B

All positive-pressure ventilators used in alternative settings must have an alarm to indicate loss of power (pneumatic and/or electrical).

 

DIF:    Application    REF:   p. 1329          OBJ:   12

 

  1. Types of negative-pressure ventilators used in postacute care include all of the following except:
a. iron lung (tank ventilator)
b. chest cuirass (shell ventilator)
c. body wrap or pneumosuit
d. abdominal displacement device

 

 

ANS:  D

With the increased popularity of noninvasive positive-pressure ventilation and continued extensive use of invasive ventilation, negative-pressure ventilators are rarely used today for ventilatory support in postacute care settings. The original negative-pressure ventilator was the “iron lung,” popularized by postpolio patients needing ventilator assistance. For practical reasons, the cumbersome iron lung was essentially replaced by the chest cuirass and wrap or “pneumosuit.”

The chest cuirass (a rigid shell) and wrap-type systems (nylon fabric surrounding a semicylindrical tent-like support) are simply enclosures that allow application of negative pressure to the thorax. Thus, these devices require a separate electrically powered negative-pressure generator. An example of a negative-pressure generator used to power cuirass or wrap-type systems is the Respironics NEV-100.

 

DIF:    Application    REF:   p. 1330          OBJ:   12

 

  1. Which of the following negative-pressure ventilation systems require a separate negative pressure generator?
  2. body wrap
  3. iron lung
  4. chest cuirass
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

With the increased popularity of noninvasive positive-pressure ventilators and continued extensive use of invasive ventilation, negative-pressure ventilators are rarely used today for ventilatory support in postacute care settings. The original negative-pressure ventilator was the “iron lung,” popularized by postpolio patients needing ventilator assistance. For practical reasons, the cumbersome iron lung was essentially replaced by the chest cuirass and wrap or “pneumosuit.”

The chest cuirass (a rigid shell) and wrap-type systems (nylon fabric surrounding a semicylindrical tent-like support) are simply enclosures that allow application of negative pressure to the thorax. Thus, these devices require a separate electrically powered negative-pressure generator. An example of a negative-pressure generator used to power cuirass or wrap-type systems is the Respironics NEV-100.

 

DIF:    Application    REF:   p. 1330          OBJ:   12

 

  1. You are conducting a routine visit to a ventilator-dependent patient in a home care setting. Which of the following would you be sure to perform while on this visit?
  2. Carefully assess patient’s status.
  3. Administer prescribed respiratory therapy.
  4. Check and clean equipment (as needed).
  5. Complete all appropriate documentation.
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

Routine follow-up visits by a respiratory therapist help ensure the success of patient management within the home. Equipment must be checked and cleaned as necessary. The patient’s status should be carefully assessed and appropriate recommendations for change should be made to the primary or prescribing physician. Any prescribed respiratory therapy should be administered during the visit and all necessary supply items left with the patient’s caregivers. After each visit, a report form must be completed and kept on record as part of the documentation process.

 

DIF:    Application    REF:   p. 1330          OBJ:   12

 

  1. What is the major potential problem in the application of bland aerosol therapy in the home care setting?
a. overhydration
b. electrical shock
c. mechanical failure
d. Infection

 

 

ANS:  D

The potential problem is infection from contaminated equipment.

 

DIF:    Application    REF:   p. 1331          OBJ:   12

 

  1. Which of the following are first-line aerosol drug delivery systems for home care patients?
  2. small-volume nebulizer
  3. dry powder inhaler
  4. metered-dose inhaler
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

Most pulmonary drug agents are available in either metered-dose inhaler or dry powder inhaler form.

 

DIF:    Application    REF:   p. 1331          OBJ:   12

 

  1. Routine tracheostomy care for a home care patient can be provided by whom?
  2. respiratory care practitioner
  3. trained family member
  4. visiting nurse
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

Tracheostomy care can be provided by any trained caregiver.

 

DIF:    Application    REF:   p. 1331          OBJ:   12

 

  1. Which of the following personnel should be allowed to change a tracheostomy tube on a home care patient?
  2. trained family member
  3. respiratory care practitioner
  4. visiting nurse
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

Tube changes should only be performed by the patient’s nurse, physician, or respiratory therapist.

 

DIF:    Recall             REF:   p. 1331          OBJ:   12

 

  1. Which of the following are components of a portable home suction unit?
  2. electric suction pump
  3. suction tubing
  4. collection bottle
  5. DISS vacuum connector
a. 2 and 4
b. 1, 3, and 4
c. 1, 2, and 3
d. 1, 2, 3, and 4

 

 

ANS:  C

In most postacute care settings, tracheobronchial suctioning is accomplished using a portable electrically powered suction pump with collection bottle and suction tubing.

 

DIF:    Recall             REF:   p. 1331          OBJ:   12

 

  1. In order to control the cost of suction supplies for a home care patient, which of the following is an acceptable strategy?
a. Wash catheters in detergent and hot water between uses.
b. Use one catheter per day, and place it in disinfectant between uses.
c. Save used catheters for resterilization through the autoclave.
d. Wash catheters in soap and cold water when not in use.

 

 

ANS:  B

To prevent bacterial growth, catheters are placed in a disinfecting solution such as hydrogen peroxide or 2.5% acetic acid between suctioning attempts.

 

DIF:    Application    REF:   p. 1331          OBJ:   14

 

  1. All of the following secretion clearance methods could be considered for a home care patient who lives alone except:
a. forced expiratory technique
b. positive end-expiratory pressure mask therapy
c. active cycle of breathing
d. postural drainage, percussion, and vibration

 

 

ANS:  D

Patients can be taught to independently apply coughing, forced exhalation, active cycle of breathing, and autogenic drainage methods. Caregiver assistance will be required with traditional postural drainage, percussion and vibration, and directed or assisted cough.

 

DIF:    Application    REF:   p. 1331          OBJ:   12

 

  1. Which of the following evidence would support Medicare reimbursement for adult nasal CPAP equipment to treat sleep apnea?
a. history of loud snoring while sleeping and marked obesity
b. polysomnograph confirming sleep apnea
c. 6-hour sleep video demonstrating major sleep disturbances
d. clinical lab evaluation showing erythrocytosis and hypercapnia

 

 

ANS:  B

For Medicare reimbursement of home nasal CPAP equipment, the sleep apnea diagnosis must be confirmed by polysomnography.

 

DIF:    Application    REF:   p. 1331          OBJ:   12

 

  1. Components of a typical adult home nasal CPAP apparatus include all of the following except:
a. CPAP pressure valve
b. flow-generating device
c. high-pressure gas source
d. form-fitting nasal mask

 

 

ANS:  C

A typical nasal CPAP apparatus consists of a flow-generator or blower, one-way valve or reservoir bag, patient interface (e.g., nasal mask, nasal pillows), and PEEP/CPAP valve (Figure 51-9).

 

DIF:    Application    REF:   p. 1332          OBJ:   12

 

  1. What is the most common way to determine the proper CPAP level for an individual patient?
a. Assess the apnea-hypopnea index at different CPAP levels during a sleep study.
b. Have the patient keep a log of sleep problems at different CPAP levels.
c. Measure and record the patient’s SpO2 continuously throughout sleep.
d. Have the patient’s spouse keep a log of sleep problems at different CPAP levels.

 

 

ANS:  A

The proper CPAP level for a given patient is determined by one of several methods. The most common method is to conduct the sleep study, titrating different levels of CPAP.

 

DIF:    Application    REF:   p. 1332          OBJ:   12

 

  1. Which of the following methods can eliminate the need for conducting a separate sleep study to adjust a patient’s CPAP level?
  2. Use an auto-adjusting CPAP system.
  3. Use SpO2 values to titrate the CPAP level.
  4. Use a patient sleep log or diary.
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

Recently, CPAP units have been developed that automatically adjust the airway pressure in response to apnea, hypopnea, airflow limitation, or snoring. This auto-CPAP may result in lower effective pressures and better patient compliance, while eliminating the need for sleep-study titration.

Alternatively, CPAP may be titrated against pulse oximetry data (Figure 51-10). In this case, the goal is to use the lowest CPAP pressure that will prevent arterial desaturation (SpO2 less than 90%).

 

DIF:    Application    REF:   p. 1332          OBJ:   12

 

  1. Common problems encountered when using adult nasal CPAP to treat sleep apnea include all of the following except:
a. nasal discomfort
b. barotrauma
c. conjunctivitis
d. skin irritation

 

 

ANS:  B

Patient problems associated with nasal CPAP include reversible upper airway obstruction, skin irritation, conjunctivitis, epistaxis, and nasal discomfort (dryness, burning, and congestion.

 

DIF:    Recall             REF:   p. 1332          OBJ:   12

 

  1. Which of the following procedures can help to minimize skin irritation in home care patients using nasal CPAP?
  2. Replace the mask every 3 months.
  3. Adjust the mask straps.
  4. Clean the mask daily.
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

Adjusting the straps (while maintaining a good mask seal) can help prevent irritation. In addition, the patient interface should be cleaned daily to remove dirt and facial oils. Even with proper care, most interfaces such as masks harden over time, causing problems with irritation and leaks. For this reason, masks and nasal pillows should be replaced approximately every 3 to 6 months, or sooner if leakage or discomfort occur.

 

DIF:    Application    REF:   p. 1332          OBJ:   12

 

  1. Which of the following would you consider recommending for a home care patient receiving nasal CPAP who complains of severe nasal dryness?
  2. room vaporizer
  3. heat-moisture exchanger (HME)
  4. in-line humidifier
  5. saline nasal spray
a. 2 and 4
b. 1, 3, and 4
c. 1, 2 and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

Methods used to overcome excessive drying include in-line humidifiers, room vaporizers, HMEs, chin straps (to decrease loss of upper airway moisture), and saline nasal sprays.

 

DIF:    Application    REF:   p. 1332          OBJ:   12

 

  1. After fitting a home care patient with a CPAP nasal mask, you set the prescribed pressure and turn on the flow generator. At this point, the mask pressure reading is 0 cm H2O. What is the most likely cause of this problem?
a. patient asynchrony
b. too high a flow
c. jammed CPAP valve
d. large system leak

 

 

ANS:  D

Methods used to overcome excessive drying include in-line humidifiers, room vaporizers, heat-moisture exchangers, chin straps (to decrease loss of upper airway moisture), and saline nasal sprays.

 

DIF:    Analysis         REF:   p. 1332          OBJ:   12

 

  1. Which of the following groups of hospitalized infants are frequently set up on apnea monitors?
a. those at risk for respiratory syncytial virus
b. those at risk for sudden infant death syndrome (SIDS)
c. those at risk for epiglottitis
d. those at risk for pneumonia

 

 

ANS:  B

Hospitalized infants at risk for SIDS are frequently set up on apnea monitors.

 

DIF:    Recall             REF:   p. 1334          OBJ:   12

 

  1. During what phase of subacute or long-term care management does the respiratory care practitioner establish short- and long-term rehabilitation goals for the patients?
a. ongoing assessment
b. screening
c. treatment planning
d. discharge

 

 

ANS:  C

A typical treatment plan would include patient demographics, assessment information, short- and long-term goals reflective of overall rehabilitation potential, and measures to be used to achieve such goals.

 

DIF:    Recall             REF:   p. 1335          OBJ:   3

 

  1. All of the following are included in a respiratory care practitioner’s weekly summary of a subacute or long-term care resident’s progress except:
a. complete course of respiratory therapy
b. changes in respiratory status
c. explanation of any patient education
d. recommendations for additional therapy

 

 

ANS:  A

The weekly summary provides a synopsis of residents’ progress, including any changes in their respiratory status, results of any additional tests, explanation of any patient education, and recommendations for additional therapy.

 

DIF:    Application    REF:   p. 1335          OBJ:   13

 

  1. For patients receiving home respiratory care, follow-up evaluation by a home care team member should occur at least how often?
a. daily
b. biweekly
c. monthly
d. as needed

 

 

ANS:  C

For patients receiving respiratory care at home, follow-up by a home care team member should occur at least monthly, particularly patients on hi-tech equipment such as apnea monitors.

 

DIF:    Recall             REF:   p. 1330          OBJ:   13

 

  1. Which of the following factors would you consider in determining the frequency of follow-up visits needed by a home care patient?
  2. level of self-care the patient is able to provide
  3. type and complexity of home care equipment used
  4. patient’s condition and therapeutic objectives
  5. level of family or caregiver support available
a. 1, 2, 3, and 4
b. 2 and 4
c. 1 and 3
d. 3 and 4

 

 

ANS:  A

Factors to consider when deciding on the frequency of home visits include the following:

  • the patient’s condition and therapeutic needs (objectives)
  • the level of family or caregiver support available
  • the type and complexity of home care equipment
  • the overall home environment
  • the ability of the patient to provide self-care

 

DIF:    Application    REF:   p. 1335          OBJ:   13

 

  1. Which of the following functions should a respiratory care practitioner perform when making a home care visit?
  2. Identify any problem areas or concerns of the patient.
  3. Assess the equipment (operation, cleanliness, supply needs).
  4. Determine the patient’s compliance with the therapy.
  5. Assess the patient (including pre- and post-treatment measures).
a. 1, 2, and 3
b. 1, 2, 3, and 4
c. 1 and 3
d. 3 and 4

 

 

ANS:  B

When a visit is made by a respiratory therapist, a number of functions must be performed. These include the following:

  • Patient assessment (objective and subjective data), including pretreatment and posttreatment measurements of pulse, respiratory rate, blood pressure, and expiratory flows (FEV1, PEFR)
  • Patient’s compliance with prescribed respiratory home care
  • Equipment assessment (operation, cleanliness, and need for related supplies)
  • Identification of any problem areas or patient concerns
  • Statement related to patient goals and therapeutic plan

 

DIF:    Application    REF:   p. 1335          OBJ:   13

 

  1. After making a home care visit, to whom should you forward copies of your written report?
  2. patient’s physician
  3. patient’s family
  4. home care agency
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  D

Copies should be sent to the patient’s physician, the home care referral source, and any other member of the team requiring this information.

 

DIF:    Recall             REF:   p. 1335          OBJ:   13

 

  1. Basic principles of infection control in the home care setting include which of the following?
  2. Avoid visits by friends with respiratory infections.
  3. Have caregivers follow proper hand-washing techniques.
  4. Incinerate all disposable equipment and supplies.
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

In regard to infection control, the ARCF and applicable AARC clinical practice guidelines mandate proper handwashing technique by all caregivers. In addition, visits to the patient by friends or relatives with respiratory infections are discouraged.

 

DIF:    Application    REF:   p. 1336          OBJ:   14

 

  1. What is the correct order of steps to recommend to the home caregivers who are responsible for cleaning nondisposable respiratory care equipment?
  2. Soak in warm soapy water.
  3. Wash in cool water.
  4. Scrub equipment.
  5. Disassemble equipment.
  6. Rinse and drain excess water.
a. 1, 3, 4, 5, 2
b. 2, 3, 1, 4, 5
c. 1, 2, 3, 4, 5
d. 4, 2, 1, 3, 5

 

 

ANS:  D

In terms of cleaning, the ARCF and AARC recommend that all equipment be completely disassembled and washed first in water, followed by a soak in warm soapy water for several minutes, with equipment scrubbed as needed to remove any remaining organic material. Following this step, the equipment must be thoroughly rinsed to remove any residual soap and drained of excess water. Air drying on a clean surface or rack is recommended to minimize recontamination.

 

DIF:    Application    REF:   p. 1336          OBJ:   14

 

  1. Which of the following agents is recommended by the American Respiratory Care Foundation for disinfection of respiratory home care equipment?
a. activated glutaraldehyde
b. 70% ethyl alcohol solution
c. sodium hypochlorite solution
d. quaternary ammonium compound

 

 

ANS:  A

High-level disinfection with glutaraldehyde is initially recommended.

 

DIF:    Application    REF:   p. 1336          OBJ:   14

 

  1. While visiting a home care patient who uses a multidose vial of an expensive bronchodilator, you notice that the expiration date for this medication has passed. Which of the following actions would you recommend at this time?
a. Mix the remaining medication with a fresh batch.
b. Dispose of the medication as recommended by the manufacturer.
c. Dilute the remaining medication with saline.
d. Use the remaining medication until it is gone.

 

 

ANS:  B

It is further recommended that manufacturers’ guidelines for the proper handling of specific medications be strictly followed.

 

DIF:    Application    REF:   p. 1336          OBJ:   12

 

  1. Which of the following is an additional goal of home care of the terminally ill patient near the end of life?
a. prolong life
b. maximize comfort and well-being
c. maximize equipment use
d. minimize medication use

 

 

ANS:  B

Although the primary goal of home care involves minimizing a patient’s dependence on institutional care, an additional goal is to maximize the comfort and well-being of the terminally ill patient near the end of life.

 

DIF:    Recall             REF:   p. 1336          OBJ:   12

Chapter 51: Respiratory Care in Alternative Settings

Test Bank

 

MULTIPLE CHOICE

 

  1. Postacute care settings include all of the following except:
a. rehabilitation facilities
b. the home
c. trauma centers
d. skilled nursing facilities (SNFs)

 

 

ANS:  C

Although home care remains the most common alternative site for providing health care, a host of other postacute care settings, including subacute, rehabilitation, and SNFs, provide respiratory care to patients.

 

DIF:    Recall             REF:   p. 1306          OBJ:   1

 

  1. Which patients are better suited for subacute rather than for acute care?
  2. those who no longer need diagnostics or invasive procedures
  3. those who have a determined course of treatment
  4. those who are recovering from an acute illness
a. 2 and 3
b. 1 and 2
c. 3
d. 1, 2, and 3

 

 

ANS:  A

According to the National Association of Subacute/Post Acute Care, subacute care is a comprehensive level of inpatient care for stable patients who (1) have experienced an acute event resulting from injury, illness, or exacerbation of a disease process; (2) have a determined course of treatment; and (3) require diagnostics or invasive procedures but not those requiring acute care.

 

DIF:    Application    REF:   p. 1308          OBJ:   1

 

  1. Where is most postacute respiratory care provided?
a. skilled nursing facilities
b. the home
c. rehabilitation facilities
d. subacute care facilities

 

 

ANS:  B

Currently, most postacute respiratory care is provided in the home.

 

DIF:    Recall             REF:   p. 1308          OBJ:   1

 

  1. Under which conditions is the home NOT the best setting for providing subacute care?
  2. when the patient is unable to do self-care
  3. when adequate caregiver support is unavailable
  4. when the patient’s physician cannot make home visits
a. 2 and 3
b. 1 and 2
c. 3
d. 1, 2, and 3

 

 

ANS:  B

Home care should generally be the first choice, but when patients have multiple ailments and are unable to care for themselves, when adequate patient support is unavailable, or when the home environment is unsuitable, an alternative care site must be selected.

 

DIF:    Application    REF:   p. 1308          OBJ:   1

 

  1. Respiratory home care contributes to achieving which of the following goals?
  2. improving patients’ physical and social well-being
  3. ensuring cost-effective delivery of care
  4. supporting and maintaining patients’ lives
  5. promoting patient and family self-sufficiency
a. 2 and 4
b. 1, 2, and 3
c. 2 and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

Respiratory home care can contribute to supporting and maintaining life; improving patients’ physical, emotional, and social well-being; promoting patient and family self-sufficiency; ensuring cost-effective delivery of care; and maximizing patient comfort near the end of life.

 

DIF:    Application    REF:   p. 1308          OBJ:   1

 

  1. For which of the following categories of disorders is respiratory home care NOT considered appropriate?
a. cystic fibrosis
b. chronic neuromuscular disorders
c. acute restrictive disorders
d. pulmonary obstructive lung disease

 

 

ANS:  C

Applicable categories of disorders include chronic obstructive pulmonary disease, cystic fibrosis, chronic neuromuscular disorders, chronic restrictive conditions, and carcinomas of the lung.

 

DIF:    Recall             REF:   p. 1308          OBJ:   1

 

  1. Studies have shown that carefully selected home treatment regimens can play an important role in achieving which of the following?
  2. maintaining patients’ lives
  3. improving patients’ quality of life
  4. increasing patients’ functional performance
  5. reducing hospitalization costs
a. 2 and 4
b. 1, 2, 3, and 4
c. 3 and 4
d. 1, 2, and 3

 

 

ANS:  B

These benefits include increased longevity, improved quality of life, increased functional performance, and a reduction in the individual and societal costs associated with hospitalization.

 

DIF:    Recall             REF:   p. 1308          OBJ:   2

 

  1. From where do standards for the delivery of subacute and home health care derive?
  2. state licensing laws
  3. private sector standards
  4. federal regulations
a. 2 and 3
b. 1 and 2
c. 3
d. 1, 2, and 3

 

 

ANS:  D

Other standards are established by federal and state laws, as well as private-sector accreditation.

 

DIF:    Recall             REF:   p. 1308          OBJ:   3

 

  1. What statutory regulations ensure that skilled nursing facilities and home health agencies meet minimum health and safety requirements?
  2. The Joint Commission (formerly Joint Commission on Accreditation of Hospitals Organization [JCAHO]) accreditation standards
  3. Medicare provider certification program
  4. State health agency regulations
a. 2 and 3
b. 1 and 2
c. 3
d. 1, 2, and 3

 

 

ANS:  A

The majority of reimbursement for postacute care is through either the federal Medicare or federal/state Medicaid programs.

 

DIF:    Recall             REF:   p. 1308          OBJ:   3

 

  1. What agency is primarily responsible for voluntary accreditation of postacute care providers?
a. The Joint Commission (TJC) (formerly Joint Commission on Accreditation of Hospitals Organization [JCAHO])
b. AARC
c. CAAHEP
d. ASTM

 

 

ANS:  A

The primary organization responsible for standard setting and voluntary accreditation of postacute care providers is TJC.

 

DIF:    Recall             REF:   p. 1308-1309                                  OBJ:   3

 

  1. Patient- and resident-focused functions addressed in The Joint Commission (formerly Joint Commission on Accreditation of Hospitals Organization [JCAHO]) standards for long-term, subacute care, and home care include all of the following except:
a. patient education
b. treatment
c. rights and ethics
d. infection control

 

 

ANS:  C

The patient safety goals target for improvement, common problem areas for health care organizations such as proper patient identification, medication safety, and infection control.

 

DIF:    Recall             REF:   p. 1309          OBJ:   4

 

  1. Which of the following key features distinguish delivery of respiratory care services in alternative settings (subacute, long-term, and home care) from traditional acute care delivery?
  2. reliance on outside vendors for most lab and diagnostic testing
  3. reliance mainly on portable equipment (oxygen [O2], suction, aerosol)
  4. most work independently performed with minimal supervision
  5. heavy reliance on assessment and documentation in care planning
  6. intensive interaction with professional team and patient’s family
a. 1, 2, and 4
b. 1, 2, and 3
c. 2, 3, and 5
d. 1, 2, 3, 4, and 5

 

 

ANS:  D

Key differences involve resource availability, supervision and work schedules, documentation and assessment, and professional-patient interaction (Table 51-1).

 

DIF:    Recall             REF:   p. 1309          OBJ:   4

 

  1. Which of the following is NOT normally included as part of a good discharge plan?
a. evaluating both the patient and the discharge site
b. providing caregiver travel to and from the discharge site
c. confirming or securing financial resources
d. providing patient and caregiver education and training

 

 

ANS:  C

To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Discharge Planning for the Respiratory Care Patient. Excerpts appear on p. xx.

 

DIF:    Recall             REF:   p. 1309          OBJ:   5

 

  1. All of the following are components of the patient evaluation aspect of a good discharge plan except the patient’s:
a. socioeconomic status and neighborhood characteristics
b. (and family’s) expectations and psychosocial readiness
c. functional ability and activities of daily living (ADLs)

 

 

ANS:  A

To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Discharge Planning for the Respiratory Care Patient. Excerpts appear on p. xx.

 

DIF:    Recall             REF:   p. 1310-1311                                  OBJ:   5

 

  1. What are some desired outcomes of the discharge plan?
  2. prevent hospital readmission due to poor planning
  3. satisfactory performance of all treatments by caregivers
  4. caregivers’ ability to assess the patient and solve problems
  5. patient’s and family’s satisfaction
a. 1, 2, 3, and 4
b. 2 and 4
c. 1, 2, and 3
d. 3 and 4

 

 

ANS:  A

To guide practitioners in providing quality care, the AARC has published Clinical Practice Guideline: Discharge Planning for the Respiratory Care Patient. Excerpts appear on pp. 1310-1311.

 

DIF:    Recall             REF:   p. 1310-1311                                  OBJ:   5

 

  1. Which of the following is NOT normally part of the respiratory home care team?
a. respiratory care
b. durable medical equipment supplier
c. pulmonary function
d. nursing

 

 

ANS:  C

Although a physician normally initiates an order to discharge a patient to a postacute care site, many other health care professionals are involved in the discharge process. Table 51-2 identifies these key professionals, along with their major responsibilities.

 

DIF:    Recall             REF:   p. 1311          OBJ:   5

 

  1. Establishing therapeutic objectives for home care is normally the responsibility of which member of the respiratory home care team?
a. physical therapist
b. respiratory care practitioner
c. Nurse
d. Attending physician

 

 

ANS:  D

Although a physician normally initiates an order to discharge a patient to a postacute care site, many other health care professionals are involved in the discharge process. Table 51-2 identifies these key professionals, along with their major responsibilities.

 

DIF:    Recall             REF:   p. 1311          OBJ:   6

 

  1. Making necessary contacts with outside agencies that can help with home care is the responsibility of which member of the respiratory home care team?
a. attending physician
b. social services representative
c. respiratory care practitioner
d. nurse

 

 

ANS:  B

Although a physician normally initiates an order to discharge a patient to a postacute care site, many other health care professionals are involved in the discharge process. Table 51-2 identifies these key professionals, along with their major responsibilities.

 

DIF:    Recall             REF:   p. 1311          OBJ:   6

 

  1. Providing regular in-home follow-up visits and assessing the patient’s overall progress is the responsibility of which member of the respiratory home care team?
a. social services representative
b. nurse
c. attending physician
d. respiratory care practitioner

 

 

ANS:  D

Although a physician normally initiates an order to discharge a patient to a postacute care site, many other health care professionals are involved in the discharge process. Table 51-2 identifies these key professionals, along with their major responsibilities.

 

DIF:    Application    REF:   p. 1311          OBJ:   6

 

  1. Providing necessary home care equipment and supplies and handling any emergency situations involving delivery or equipment operation is the responsibility of which member of the respiratory home care team?
a. social services representative
b. respiratory care practitioner
c. nurse
d. durable medical equipment (DME) company representative

 

 

ANS:  D

Equipment support and selected clinical services for respiratory home care patients are often provided by a DME supplier.

 

DIF:    Application    REF:   p. 1312          OBJ:   6

 

  1. Durable medical equipment (DME) companies usually provide which of the following respiratory home care services?
  2. third-party insurance processing
  3. most respiratory care modalities
  4. 24-hours/7-days-a-week service
  5. home instruction and follow-up
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

These companies, both large and small, usually provide the following services: 24-hours/7-days-a-week service, third-party insurance processing, home instruction and follow-up by a respiratory therapist, and most forms of respiratory care.

 

DIF:    Recall             REF:   p. 1312          OBJ:   6

 

  1. Factors to consider when advising a patient on selection of durable medical equipment (DME) include all of the following except:
a. accreditation
b. finder’s fees
c. cost
d. availability

 

 

ANS:  B

When selecting a DME supplier, the discharge planning team, including the patient and family members, should consider the company’s accreditation status, cost and scope of services, dependability, location, personnel, past track record, and availability.

 

DIF:    Recall             REF:   p. 1312          OBJ:   6

 

  1. To determine if a home setting can support the equipment needs of a mechanically ventilated patient being considered for discharge, which of the following would you assess?
  2. available space for equipment
  3. amperage of power supply
  4. number and location of grounded outlets
  5. presence of hazardous appliances
a. 2 and 4
b. 1, 2, 3, and 4
c. 3 and 4
d. 1, 2, and 3

 

 

ANS:  B

Box 51-1 lists some key factors one should assess in planning the discharge of a respiratory care patient to the home environment.

 

DIF:    Application    REF:   p. 1312          OBJ:   6

 

  1. Key environmental factors that should be assessed in considering discharge of a patient to the home care setting include all of the following except:
a. heating and ventilation
b. humidity
c. lighting
d. airborne pollutants

 

 

ANS:  D

Box 51-1 lists some key factors one should assess in planning the discharge of a respiratory care patient to the home environment

 

DIF:    Application    REF:   p. 1312          OBJ:   6

 

  1. What is the most common respiratory home care modality?
a. aerosol therapy
b. mechanical ventilation
c. O2 therapy
d. nasal continuous positive airway pressure (CPAP)

 

 

ANS:  B

Oxygen therapy is by far the most common mode of respiratory care in postacute care settings.

 

DIF:    Recall             REF:   p. 1313          OBJ:   7

 

  1. Which of the following are acceptable indicators of hypoxemia for purposes of justifying home O2 therapy?
  2. resting PaO2 of 65 mm Hg (room air)
  3. drop in Sao2 below 89% during ambulation
  4. resting arterial SaO2 below 88% (room air)
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on pp. 1314.

 

DIF:    Recall             REF:   p. 1314          OBJ:   7

 

  1. Home O2 therapy can be justified in patients with PaO2 values greater than 55 mm Hg in all of the following conditions except:
a. cor pulmonale
b. erythrocythemia (hematocrit greater than 56%)
c. congestive heart failure
d. peripheral vascular disease

 

 

ANS:  D

To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on pp. 1314.

 

DIF:    Recall             REF:   p. 1314          OBJ:   7

 

  1. Physical hazards associated with home O2 therapy equipment include all of the following except:
a. unsecured cylinders
b. gaseous explosions
c. ungrounded equipment
d. liquid O2 burns

 

 

ANS:  B

To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on pp. 1314.

 

DIF:    Recall             REF:   p. 1314          OBJ:   7

 

  1. To determine the need for long-term home O2 therapy after initial justification, when should blood gas analysis be repeated?
a. 1 to 3 weeks after initiation
b. 1 to 3 days after initiation
c. 1 to 3 months after initiation
d. 1 to 3 years after initiation

 

 

ANS:  C

To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on pp. 1314.

 

DIF:    Application    REF:   p. 1314          OBJ:   7

 

  1. Once the need for long-term home O2 therapy has been documented, why should repeated laboratory assessment (ABG or oximetry) be conducted?
  2. to follow the course of the disease
  3. to assess changes in clinical status
  4. to facilitate changes in the prescription
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

To guide practitioners in providing quality care, the AARC has published a Clinical Practice Guideline on Oxygen Therapy in the Home or Extended Care Facility. Excerpts appear on pp. 1314.

 

DIF:    Recall             REF:   p. 1314          OBJ:   7

 

  1. CMS regulations require that prescriptions for home O2 therapy be based on:
a. documented hypoxemia
b. documented symptoms
c. written diagnosis
d. presence of cyanosis

 

 

ANS:  A

As indicated in the practice guideline, O2 prescriptions must be based on documented hypoxemia, as determined by either blood gas analysis or oximetry.

 

DIF:    Application    REF:   p. 1313          OBJ:   7

 

  1. Which of the following are acceptable methods of documenting the presence of hypoxemia in patients being considered for home O2 therapy?
  2. blood gas analysis
  3. pulse oximetry
  4. physical exam
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

As indicated in the practice guideline, O2 prescriptions must be based on documented hypoxemia, as determined by either blood gas analysis or oximetry.

 

DIF:    Recall             REF:   p. 1313          OBJ:   7

 

  1. Which of the following is FALSE about home O2 therapy?
a. A PRN (as needed) prescription for O2 is acceptable.
b. Hypoxemia can be confirmed by arterial blood gas (ABG) or oximetry.
c. A PaO2 at or below 55 mm Hg documents need.
d. An SaO2 below 88% is clinical evidence of need.

 

 

ANS:  A

As-needed O2 is no longer acceptable in the postacute care setting.

 

DIF:    Recall             REF:   p. 1313          OBJ:   7

 

  1. In addition to specifying the liter flow or concentration, which of the following must a physician include in a home O2 prescription?
  2. evidence of central cyanosis
  3. appropriate medical diagnosis
  4. laboratory evidence of hypoxemia
  5. frequency of use of O2
  6. duration of need for O2
a. 2, 3, 4, and 5
b. 1, 3, and 4
c. 3, 4, and 5
d. 1, 2 3, 4, and 5

 

 

ANS:  A

Once the need for O2 therapy is established, the physician writes a prescription. A prescription for O2 therapy in the postacute care setting must include the following elements:

  • Flow rate in liters/minute and/or concentration
  • Frequency of use in hours/day and minutes/hour (if applicable)
  • Duration of need (up to a maximum of 12 months in the home)
  • Diagnosis (severe primary lung disease, secondary conditions related to lung disease and hypoxia, related conditions or symptoms that may improve with O2)
  • Laboratory evidence (arterial blood gas [ABG] analysis or oximetry under the appropriate testing conditions). Home care companies cannot provide this testing.
  • Additional medical documentation (no acceptable alternatives to home O2 therapy).

 

DIF:    Recall             REF:   p. 1313          OBJ:   7

 

  1. Home O2 can be supplied by which of the following systems?
  2. REDOX chemical reactors
  3. liquid O2 systems
  4. O2 concentrators
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

In these settings, O2 normally is supplied from one of the following three sources: (1) compressed O2 cylinders, (2) liquid O2 systems, or (3) O2 concentrators.

 

DIF:    Recall             REF:   p. 1313          OBJ:   8

 

  1. Advantages of using compressed O2 cylinders in the home include which of the following?
  2. minimal waste or loss
  3. unlimited storage time
  4. widespread availability
  5. minimal user hazards
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 1, 2, and 4

 

 

ANS:  A

Table 51-3 summarizes the major advantages and disadvantages of each system.

 

DIF:    Application    REF:   p. 1313          OBJ:   8

 

  1. Disadvantages of using compressed O2 cylinders in the home include all of the following except:
a. high-pressure hazards
b. limited volume of O2
c. gas waste when not used
d. need for frequent deliveries

 

 

ANS:  C

Table 51-3 summarizes the major advantages and disadvantages of each system.

 

DIF:    Application    REF:   p. 1317          OBJ:   8

 

  1. What is the primary use of compressed O2 cylinders in alternative settings?
  2. ambulation (small cylinders)
  3. backup supply (large cylinders)
  4. primary supply (large cylinders)
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

The primary use of compressed O2 cylinders in alternative settings is for either ambulation (small cylinders) or as a backup to liquid or concentrator supply systems (H/K cylinders).

 

DIF:    Application    REF:   p. 1313          OBJ:   8

 

  1. A home care patient will be receiving nasal O2 at 0.5 L/min using a large compressed gas cylinder. Which of the following additional equipment would you specify for this patient?
  2. bubble humidifier
  3. pressure-reducing valve
  4. calibrated low-flow flowmeter
a. 1 and 2
b. 1, 2, and 3
c. 2 and 3
d. 1 and 3

 

 

ANS:  C

In addition to the cylinder gas, a pressure-reducing valve with flowmeter is needed to deliver O2 at the prescribed flow. Standard clinical flowmeters deliver flows up to 15 L/min; flows used in alternative settings are typically in the 0.25 to 5.0 L/min range. For this reason, the respiratory therapist should select a calibrated low-flow flowmeter whenever possible. Alternatively, a preset flow restrictor can be used.

 

DIF:    Application    REF:   p. 1313          OBJ:   8

 

  1. Which of the following would you recommend as the solution used to fill a bubble humidifier used for home O2 therapy?
a. sterile water
b. distilled water
c. 0.9% saline
d. tap water

 

 

ANS:  B

Because the mineral content of tap water may be high (hard water), water used in these humidifiers should be distilled.

 

DIF:    Application    REF:   p. 1317          OBJ:   8

 

  1. A home care patient receiving long-term O2 therapy at 5 L/min complains that her nondisposable humidifier is not bubbling properly. Upon inspection of the humidifier, you notice hard white deposits in and around the diffusing element. Which of the following would you recommend to this patient?
a. Stop using the humidifier because there is no need for it at this flow.
b. Replace the device and fill with distilled water, not tap water.
c. Increase the flow at night to help clean out the humidifier.
d. Replace the device and fill with sterile water, not tap water.

 

 

ANS:  B

Otherwise, the porous diffusing element may become occluded. Although complete blockage is unlikely, occlusion of the diffusing element can impair humidification and alter flow.

 

DIF:    Analysis         REF:   p. 1317          OBJ:   8

 

  1. One cubic foot (1 cu/ft) of liquid O2 equals how many cu/ft of gaseous O2?
a. 22.80
b. 7.48
c. 860.00
d. 3.14

 

 

ANS:  C

One cubic foot of liquid O2 equals 860 cubic feet of gas.

 

DIF:    Recall             REF:   p. 1317          OBJ:   8

 

  1. The O2 in the inner reservoir of a home liquid O2 system is maintained at what temperature?
a. –300° F
b. 212° F
c. 0° F
d. –150° F

 

 

ANS:  A

The liquid O2 is kept at approximately -300°F.

 

DIF:    Recall             REF:   p. 1317          OBJ:   8

 

  1. When not in use, vaporization in a home liquid O2 system maintains the pressure in the container at what range?
a. 10 to 15 psi
b. 45 to 55 psi
c. 80 to 90 psi
d. 20 to 25 psi

 

 

ANS:  D

When the cylinder is not in use, this vaporization maintains pressures between 20 and 25 psi.

 

DIF:    Recall             REF:   p. 1317          OBJ:   8

 

  1. When the flow-metering device of a home liquid O2 system is turned on, O2 leaves the container through a vaporizing coil, where it is heated by exposure to which of the following?
a. hot water
b. ambient air
c. electrical energy
d. ultrasound

 

 

ANS:  B

When flow is turned on, gaseous O2 passes through a vaporizing coil, where it is warmed by exposure to room temperature.

 

DIF:    Recall             REF:   p. 1317          OBJ:   8

 

  1. At normal liquid cylinder operating pressures, 1 lb of stored liquid O2 equals about how many liters of gaseous O2?
a. 860.00
b. 344.00
c. 22.80
d. 7.48

 

 

ANS:  B

At normal liquid cylinder operating pressures, 1 pound of liquid O2 equals approximately 344 L of gaseous O2.

 

DIF:    Recall             REF:   p. 1317          OBJ:   8

 

  1. The gauge reading of a 50-lb home liquid O2 system indicates that the cylinder is a third full. What is the approximate duration of flow of this system at 2 L/min?
a. 24 hours
b. 48 hours
c. 72 hours
d. 95 hours

 

 

ANS:  B

See Mini Clini Computing a Liquid Oxygen System’s Duration of Flow for an example of how you can compute a liquid O2 system’s duration of flow.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. What is the purpose of the small refillable liquid O2 tank that comes with many stationary home liquid O2 reservoirs?
a. to provide O2 to ambulatory patients outside the home
b. to serve as a backup should the primary reservoir fail
c. to collect and save gas vented by the primary reservoir
d. to provide higher flows for patients requiring high FIO2 values

 

 

ANS:  A

Many personal liquid O2 systems also come with smaller portable units (Figure 51-3). This system is ideal for the ambulatory patient who is capable of physical activity.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. Most portable home liquid O2 systems can provide low-flow O2 (2 L/min) for about how long?
a. 1 to 3 hours
b. 3 to 5 hours
c. 8 to 12 hours
d. 5 to 8 hours

 

 

ANS:  D

Most portable units come with a carrying case or small cart and can provide 5 to 8 hours of O2 at a flow of 2 L/min.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. An ambulatory home O2 therapy patient complains that the portable liquid (at 3 L/min) does not last long enough for a visit with the grandchildren. What might you recommend to overcome this limitation?
a. Decrease the flow to 2 L/min.
b. Put a couple of E cylinders in her car.
c. Use an O2-conserving device.
d. Put the large liquid unit in the car.

 

 

ANS:  C

The functional use time of portable liquid O2 units can be extended with O2-conserving devices, including the demand-flow systems.

 

DIF:    Analysis         REF:   p. 1318          OBJ:   8

 

  1. Advantages of home liquid O2 systems include all of the following except they:
a. usually include a small refillable portable subsystem
b. do not require an O2 service delivery company
c. provide large-volume O2 storage in a small space
d. are useful for rehabilitation activities (e.g., walking)

 

 

ANS:  B

Table 51-3 summarizes the major advantages and disadvantages of each system.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. Disadvantages of home liquid O2 systems include which of the following?
  2. Oxygen is lost when not used (because of venting).
  3. The low temperature of liquid O2 can be a hazard.
  4. Liquid O2 must be delivered when needed.
  5. These systems cannot drive pneumatic equipment.
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

Table 51-3 summarizes the major advantages and disadvantages of each system.

 

DIF:    Application    REF:   p. 1317          OBJ:   8

 

  1. What electrically powered device can separate the O2 in room air from N2, thereby providing an enriched flow of O2 for therapeutic use?
a. O2 concentrator
b. O2-conserving device
c. Joule-Thompson enricher
d. molecular impactor

 

 

ANS:  A

An O2 concentrator is an electrically powered device that physically separates the O2 in room air from N2.

 

DIF:    Recall             REF:   p. 1318          OBJ:   8

 

  1. Advantages of O2 concentrators for home O2 therapy include all of the following except they:
a. operate at safe low pressures
b. are cost-effective for continuous use
c. do not waste or lose any O2
d. can power most pneumatic equipment

 

 

ANS:  D

Table 51-3 summarizes the major advantages and disadvantages of each system.

 

DIF:    Application    REF:   p. 1317          OBJ:   8

 

  1. What are some disadvantages of O2 concentrators for home O2 therapy?
  2. FIO2 values decrease with increased flow.
  3. Backup O2 is required in case of electrical failure.
  4. They cannot operate high-pressure devices.
  5. Loss of electricity disrupts delivery.
a. 2 and 4
b. 1, 2, and 3
c. 2 and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

Table 51-3 summarizes the major advantages and disadvantages of each system.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. At flows between 1 and 2 L/min, a typical molecular sieve O2 concentrator provides an O2 concentration of about what level?
a. 65%
b. 75%
c. 85%
d. 95%

 

 

ANS:  D

At flows of 1 to 2 L/min, the typical molecular sieve concentrator provides between 92% and 95% O2.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. At 3 to 5 L/min output, a typical molecular sieve O2 concentrator provides O2 concentrations at what level?
a. 65% to 78%
b. 78% to 85%
c. 85% to 93%
d. >93%

 

 

ANS:  C

At 3 to 5 L/min, O2 concentrations fall to between 85% and 93%.

 

DIF:    Application    REF:   p. 1318          OBJ:   8

 

  1. To help prevent problems with home O2 therapy, you should have the patient or caregiver check all delivery equipment at least how often?
a. once a day
b. once a week
c. every other day
d. once a month

 

 

ANS:  A

To avoid problems before they occur, have the patient or caregiver check all O2 delivery equipment at least once a day.

 

DIF:    Application    REF:   p. 1319          OBJ:   8

 

  1. In setting up a home care chronic obstructive pulmonary disease patient for continuous low-flow O2 therapy through an O2 concentrator, which of the following additional equipment must you provide?
a. pressure-reducing valve
b. backup gas cylinder
c. emergency generator
d. backup concentrator

 

 

ANS:  B

You must ensure that all such systems have an emergency backup supply.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. Other than providing a backup H cylinder for a home care O2 therapy patient who uses a concentrator, what other safety measure would you take to ensure an uninterrupted supply?
a. Provide an emergency backup battery-powered concentrator.
b. Arrange for emergency transport of the patient to a hospital.
c. Notify the power company that life support equipment is in use.
d. Provide an emergency backup liquid O2 system.

 

 

ANS:  C

If a home care patient’s primary O2 supply is by concentrator, the home care respiratory therapist should notify the electric power company in writing that life support equipment is in use at that location.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. Routine in-home monthly maintenance of an O2 concentrator should include which of the following?
  2. flushing the system for 20 minutes with an inert gas
  3. confirming the FIO2 with a calibrated O2 analyzer
  4. cleaning and replacing the internal and external filters
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

In the home, O2 concentrator fractional inspired O2 concentration (FIO2) levels should be checked and confirmed as part of a routine monthly maintenance visit. Routine maintenance of these devices should include cleaning and replacing filters, checking the alarm system, and confirming the FIO2 levels using either the unit’s O2 sensor or a separate calibrated O2 analyzer.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. When visiting a home care patient receiving nasal O2 at 2 L/min through an O2 concentrator, you measure the FIO2 of the outlet gas as 0.63. Which of the following best explains this finding?
a. This FIO2 is normal at this flow.
b. The sieve pellets are exhausted.
c. The gas inlet filter must be clogged.
d. Electrical power is inadequate.

 

 

ANS:  B

If the concentration is less than the manufacturer’s specification at the given flow, the pellet canisters are probably exhausted and should be replaced.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. A home care patient with kyphoscoliosis requires intermittent positive-pressure breathing (IPPB) treatments twice per day with O2. A local charitable organization has given the family a pneumatically powered IPPB device for this purpose. Which of the following gas sources would you recommend to drive this device?
  2. liquid O2 reservoir
  3. O2 concentrator
  4. compressed gas cylinder
a. 1 and 2
b. 2 and 3
c. 3
d. 1, 2, and 3

 

 

ANS:  C

Because both concentrators and personal liquid O2 systems operate at low pressures, they cannot be used to drive equipment needing 50 psi, such as pneumatically powered ventilators and large-volume jet nebulizers.

 

DIF:    Analysis         REF:   p. 1320          OBJ:   8

 

  1. What is the most common O2 delivery system for long-term care?
a. simple mask
b. entrainment mask
c. transtracheal catheter
d. nasal cannula

 

 

ANS:  D

The most common O2 delivery system for long-term care is the nasal cannula.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. Oxygen-conserving delivery systems include which of the following?
  2. transtracheal catheter
  3. reservoir cannula or pendant
  4. pulse-dose
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

These include the transtracheal O2 catheter, the reservoir cannula, and the demand or pulse-dose O2 delivery systems.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. A home care patient using a reservoir cannula for long-term, low-flow O2 therapy objects to the cosmetic appearance of the device. Which of the following alternatives would you recommend to this patient’s physician as capable of addressing the patient’s concerns?
  2. transtracheal catheter
  3. entrainment mask
  4. pendant reservoir
a. 1
b. 2 and 3
c. 1 and 2
d. 1, 2, and 3

 

 

ANS:  A

This delivery method offers advantages of improved cosmetic appearance and lower flows to achieve the same therapeutic effect.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. Transtracheal O2 therapy (TTOT) should be considered as an option for what patients requiring long-term O2 therapy?
  2. those who remain hypoxemic with standard approaches
  3. those who do not comply well when using other devices
  4. those who exhibit complications with nasal delivery
  5. those who prefer TTOT for cosmetic reasons
  6. those who require increased mobility
a. 1, 2, and 4
b. 1, 2, and 3
c. 2, 3, and 5
d. 1, 2, 3, 4, and 5

 

 

ANS:  D

TTOT is indicated only for those patients who meet one or more of the following criteria: (1) they cannot be adequately oxygenated with standard approaches, (2) they do not comply well when using other devices, (3) they exhibit complications from nasal cannula use, (4) they prefer TTOT for cosmetic reasons, and (5) they have need for increased mobility.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. Routine removing and cleaning of a transtracheal O2 catheter should be performed by whom?
a. visiting nurse
b. respiratory care practitioner
c. physician
d. patient

 

 

ANS:  D

Key patient responsibilities include routine catheter cleaning and recognizing and troubleshooting common problems.

 

DIF:    Application    REF:   p. 1320          OBJ:   8

 

  1. A home care patient on transtracheal O2 therapy at 0.5 L/min frantically calls you, unable to reinsert the catheter after cleaning. What would you recommend?
a. Use a clean, pointed instrument to guide catheter reinsertion.
b. Put on a nasal cannula at 1 L/min and call the physician.
c. Insert the catheter into the nasal cavity about 3 to 4 inches.
d. Insert the catheter into the oral cavity.

 

 

ANS:  B

Key patient responsibilities include routine catheter cleaning and recognizing and troubleshooting common problems.

 

DIF:    Analysis         REF:   p. 1320          OBJ:   8

 

  1. To avoid product failure, transtracheal catheters and their tubing should be replaced every how often?
a. every week
b. every 3 months
c. every month
d. every 6 months

 

 

ANS:  B

Key patient responsibilities include routine catheter cleaning and recognizing and troubleshooting common problems. See Box 51-3.

 

DIF:    Application    REF:   p. 1321          OBJ:   8

 

  1. Which O2 delivery system would you recommend for an active home care patient with low FIO2 needs who desires increased mobility?
a. traditional low-flow nasal cannula supplied by O2 concentrator
b. compressor-driven humidifier with supplemental O2 through a concentrator
c. conserving device used in conjunction with a portable liquid O2 system
d. air entrainment mask driven by a large (H/K) compressed gas cylinder

 

 

ANS:  C

Patients requiring low-flow home O2 and enhanced mobility should be considered for a liquid O2 set-up with a pulsed-dose O2-conserving device.

 

DIF:    Analysis         REF:   p. 1322          OBJ:   8

 

  1. Complications associated with insertion of a transtracheal O2 catheter include all of the following except:
a. bleeding
b. pneumothorax
c. bronchospasm
d. abscess

 

 

ANS:  D

The most common complications of transtracheal O2 therapy are listed in Box 51-4.

 

DIF:    Recall             REF:   p. 1323          OBJ:   8

 

  1. You are caring for a patient who has just received a transtracheal catheter for long-term continuous home O2 therapy. Which of the following problems should you be on guard for with this patient?
  2. airway obstruction
  3. catheter clogging
  4. stoma infection
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

The most common complications of transtracheal O2 therapy are listed in Box 51-4.

 

DIF:    Application    REF:   p. 1323          OBJ:   8

 

  1. While visiting a patient who has been receiving transtracheal O2 therapy for 6 months, you note marked erythemia and swelling at the stoma site. Which of the following actions would be appropriate at this time?
a. Question the patient and family about their cleaning methods.
b. Promptly report your observations to the prescribing physician.
c. Liberally apply tincture of benzoin to the stoma site.
d. Flush the catheter and the tubing with H2O2.

 

 

ANS:  B

In particular, you should immediately report any evidence of tract tenderness, fever, excessive cough, increased dyspnea, or subcutaneous emphysema to the patient’s physician.

 

DIF:    Analysis         REF:   p. 1323          OBJ:   8

 

  1. What are some major problems with demand O2 delivery systems?
  2. They are cumbersome and unattractive.
  3. Equipment and maintenance costs are high.
  4. The device valve may have slow response times.
  5. Catheter and sensor malfunction is common.
a. 2 and 4
b. 1, 2, and 3
c. 2 and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

These and other potential problems with demand-flow O2 delivery systems are listed in Box 51-5.

 

DIF:    Application    REF:   p. 1322          OBJ:   8

 

  1. Which of the following are good candidates for home mechanical ventilation?
  2. a patient who cannot maintain adequate ventilation at night
  3. a patient who requires continuous ventilation to survive
  4. a terminally ill patient who requires ventilatory support
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 51-5 provides more detailed profiles of these patient groups.

 

DIF:    Recall             REF:   p. 1323          OBJ:   9

 

  1. Conditions in which patient need for home mechanical ventilation is generally limited to daytime or nocturnal support include all of the following except:
a. kyphoscoliosis
b. high spinal cord injuries
c. amyotrophic lateral sclerosis
d. myasthenia gravis

 

 

ANS:  B

Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 51-5 provides more detailed profiles of these patient groups.

 

DIF:    Recall             REF:   p. 1323          OBJ:   9

 

  1. Home care patients requiring continuous ventilatory support for long-term survival include which of the following?
  2. those with high spinal cord injuries
  3. those with late-stage muscular dystrophy
  4. those with bronchogenic carcinoma
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 51-5 provides more detailed profiles of these patient groups.

 

DIF:    Application    REF:   p. 1323          OBJ:   9

 

  1. Examples of terminally ill patients with short life expectancies who can receive ventilatory support in the home setting include which of the following?
  2. patients with end-stage chronic obstructive pulmonary disease
  3. patients with kyphoscoliosis
  4. patients with lung cancer
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 51-5 provides more detailed profiles of these patient groups.

 

DIF:    Application    REF:   p. 1323          OBJ:   9

 

  1. All of the following indicate that a patient is stable enough to be considered for home ventilatory support except:
a. pH = 7.34; PCO2 = 48; HCO3 = 27
b. FIO2 = 35%
c. 15 cm H2O positive end-expiratory pressure (PEEP)
d. absence of cardiac arrhythmias

 

 

ANS:  C

Good candidates for home mechanical ventilation include (1) patients unable to maintain adequate ventilation over prolonged periods (noninvasive nocturnal or intermittent use in particular), (2) patients requiring continuous mechanical ventilation for long-term survival, and (3) patients who are terminally ill with short life expectancies. Table 51-5 provides more detailed profiles of these patient groups.

 

DIF:    Application    REF:   p. 1323          OBJ:   9

 

  1. Which of the following would indicate that a patient is not sufficiently stable for home mechanical ventilation?
  2. severe dyspnea while breathing on the ventilator
  3. airway secretions cleared only by suctioning
  4. frequent premature ventricular contractions
  5. use of a cuffed oral endotracheal tube
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 3, and 4

 

 

ANS:  D

In regard to assessing patient stability, Box 51-6 outlines the criteria developed by the American College of Chest Physicians (ACCP).

 

DIF:    Application    REF:   p. 1324          OBJ:   9

 

  1. Mechanical ventilation in the home setting can be provided by all of the following methods except:
a. positive pressure through an oral endotracheal tube
b. positive pressure through an intact upper airway
c. intermittent abdominal displacement methods
d. negative pressure through an intact upper airway

 

 

ANS:  A

In alternative settings, invasive ventilatory support always involves application of positive pressure ventilation by tracheotomy. Noninvasive approaches include positive and negative pressure ventilation via an intact upper airway or abdominal displacement methods.

 

DIF:    Application    REF:   p. 1324          OBJ:   9

 

  1. According to the AARC, which of the following standards should be met when considering ventilatory support outside the acute care hospital?
  2. Services must be based on the attending physician’s prescription.
  3. Those providing the support should be appropriately trained.
  4. Appropriate recording and reporting mechanisms should exist.
  5. Safe, effective, and appropriate equipment must be provided.
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

The AARC developed a Clinical Practice Guideline on Long-term Invasive Mechanical Ventilation in the Home. Excerpts appear on pp. 1325-1326.

 

DIF:    Recall             REF:   p. 1325-1326                                  OBJ:   9

 

  1. What equipment function should lay caregivers of home mechanical ventilation assess regularly?
  2. cleanliness and function of bag-valve-mask
  3. internal and external battery power levels
  4. cleanliness of filters and alarm functions
  5. accuracy of ventilator tidal volume (VT) output
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  A

The AARC developed a Clinical Practice Guideline on Long-term Invasive Mechanical Ventilation in the Home. Excerpts appear on pp. 1325-1326.

 

DIF:    Recall             REF:   p. 1325          OBJ:   9

 

  1. Patient parameters that lay caregivers of home mechanical ventilation should assess regularly include all of the following except:
a. vital signs
b. skin color or diaphoresis
c. chest excursions
d. breath sounds

 

 

ANS:  D

The AARC developed a Clinical Practice Guideline on Long-term Invasive Mechanical Ventilation in the Home. Excerpts appear on pp. 1325-1326.

 

DIF:    Application    REF:   p. 1325          OBJ:   9

 

  1. Which of the following are prerequisites to successful home-based mechanical ventilation?
  2. presence of adequate professional support
  3. willingness of family to accept responsibility
  4. patient’s condition, especially stability
  5. overall viability of the home care plan
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

For home ventilatory support to be successful, several prerequisites must be met. These include the following:

  • willingness of family to accept responsibility
  • adequacy of family and professional support
  • overall viability of the home care plan
  • stability of patient
  • adequacy of home setting

 

DIF:    Recall             REF:   p. 1324          OBJ:   9

 

  1. What is the first step in discharging a patient from an acute care facility who will require home-based mechanical ventilation?
a. Patient and family education and training are initiated.
b. The family is consulted about the feasibility.
c. All equipment and necessary supplies are readied.
d. The physician writes appropriate orders and sets objectives.

 

 

ANS:  B

Basic steps in the discharge process for a ventilator-dependent patient include the following:

  1. Family is consulted regarding feasibility.
  2. Physician writes appropriate orders.
  3. Discharge planner coordinates efforts of team members and discharge plan is formulated.
  4. Physician and other team members discuss plan with family and/or caregivers.
  5. Education and training are initiated and completed.
  6. Patient and family are prepared for discharge.
  7. Home layout is assessed with necessary changes made.
  8. Equipment and supplies are readied.
  9. Discharge planner meets with team and makes final preparations.
  10. Patient is discharged (with trial period, if necessary).
  11. Local power company is notified regarding the presence of life support equipment; appropriate backup power (battery or compressed gas source) is made available.
  12. Ongoing and follow-up care provided by visiting nurse, respiratory therapist, and other health care professionals (as necessary).

 

DIF:    Application    REF:   p. 1324          OBJ:   10

 

  1. You have been asked to organize a patient and family education program as part of a discharge plan for a patient requiring home ventilatory support. Which of the following areas would you be sure to cover?
  2. equipment operation and disinfection
  3. patient assessment and monitoring
  4. airway management and clearance
  5. emergency procedures
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

Essential skills that must be taught include the following:

  • simple patient assessment
  • airway management, including tracheostomy and stoma care, cuff care, suctioning, changing tubes/ties
  • chest physical therapy techniques, including percussion, vibration, coughing
  • medication administration, including oral and aerosol
  • patient movement and ambulation
  • equipment operation and maintenance
  • equipment troubleshooting
  • ceaning and disinfection
  • emergency procedures

 

DIF:    Recall             REF:   p. 1324          OBJ:   10

 

  1. Emergency situations that home mechanical ventilation caregivers must be trained to recognize and manage include all of the following except:
a. ventilator or power failure
b. tension pneumothorax
c. artificial airway obstruction
d. ventilator circuit problems

 

 

ANS:  B

Emergency situations that caregivers must be trained to recognize and properly deal with include ventilator or power failure, ventilator circuit problems, airway emergencies, and cardiac arrest.

 

DIF:    Recall             REF:   p. 1324          OBJ:   10

 

  1. You have been asked to organize a patient and family education program as part of a discharge plan for a patient requiring home ventilatory support. Which of the following methods would be best for training the family in the operation of the ventilator chosen?
a. Put the patient on the selected device while still hospitalized.
b. Set up and review the ventilator after the patient gets home.
c. Take the family into a back room and show them a ventilator.
d. Give the family the operating manual for the ventilator.

 

 

ANS:  A

Ideally, the patient should have a trial period on the actual home ventilator before discharge.

 

DIF:    Application    REF:   p. 1327          OBJ:   10

 

  1. In the early stages after a patient requiring mechanical ventilation is discharged to the home, how often should patient follow-up by a respiratory care practitioner occur?
a. every week
b. biweekly
c. every month
d. every day

 

 

ANS:  D

In the early stages after discharge, patient follow-up by a respiratory therapist will likely occur every day.

 

DIF:    Recall             REF:   p. 1327          OBJ:   10

 

  1. Which of the following conditions is an indication for application of noninvasive ventilation (NIV)?
a. The patient requires low concentrations of supplemental O2.
b. The patient cannot swallow without the risk of aspiration.
c. The patient’s peak cough flows are less than 3 L/sec.
d. Because of facial trauma, an airtight mask seal is impossible.

 

 

ANS:  A

Any individual requiring mechanical ventilation can be supported with NIV if:

  1. The patient is mentally competent, cooperative, and not using heavy sedation or narcotics.
  2. Supplemental O2 therapy is unnecessary or minimal.
  3. SaO2 can be maintained above 90% by aggressive airway clearance techniques.
  4. Bulbar muscle function is adequate for swallowing without potentially dangerous aspiration.
  5. No history exists of substance abuse or uncontrollable seizures.
  6. Unassisted or manually assisted peak expiratory flows during coughing exceed 3 L/sec.
  7. No conditions are present that interfere with NIV interfaces (e.g., facial trauma, inadequate bite for mouthpiece, presence of nasogastric tube, or facial hair that can hamper airtight seal).

 

DIF:    Application    REF:   p. 1327          OBJ:   11

 

  1. Which of the following can benefit most from intermittent use of noninvasive ventilation?
a. a patient with muscular dystrophy
b. a patient with pulmonary edema
c. a high cervical spine injury patient
d. a chronic obstructive pulmonary disease patient in respiratory failure

 

 

ANS:  A

Type 2 patients generally require only intermittent or nocturnal support. Examples of patients in this category include those with chronic neuromuscular and chest wall diseases, such as muscular dystrophy and kyphoscoliosis.

 

DIF:    Application    REF:   p. 1327          OBJ:   11

 

  1. Relative contraindications for using noninvasive ventilation (NIV) include all of the following except:
a. severe upper airway dysfunction
b. copious secretions that require suctioning
c. FIO2 requirements exceeding 40%
d. absence of respiratory muscle activity

 

 

ANS:  D

Relative contraindications to NIV include severe upper airway dysfunction, copious secretions that cannot be cleared by spontaneous or assisted cough, or O2 concentration requirements exceeding 40%.

 

DIF:    Recall             REF:   p. 1327          OBJ:   11

 

  1. For which of the following groups would you recommend long-term negative pressure ventilation in an alternative setting?
  2. patients who cannot or will not use noninvasive positive pressure ventilation
  3. patients who need frequent airway access for suctioning
  4. patients with severe nasal congestion or obstruction
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

Nonetheless, negative pressure ventilation may be appropriate in those patients who are unable to use or who have failed noninvasive positive pressure ventilation trials. Negative pressure ventilation may also be considered for patients who require frequent airway access for suctioning or those with severe nasal congestion.

 

DIF:    Recall             REF:   p. 1327          OBJ:   11

 

  1. In addition to a ventilator, which of the following equipment or supplies would you recommend for a home care patient receiving long-term invasive positive-pressure ventilation?
  2. self-inflating bag-valve-mask
  3. portable suction system
  4. portable DC defibrillator
  5. tracheal tubes and care kits
  6. disposable circuits and catheters
a. 2, 3, 4, and 5
b. 1, 3, and 4
c. 1, 2, 4, and 5
d. 1, 2, 3, 4, and 5

 

 

ANS:  C

Box 51-7 lists the essential equipment and supplies needed for ventilator-dependent patients in alternative settings.

 

DIF:    Application    REF:   p. 1328          OBJ:   12

 

  1. In which of the following situations would you recommend that more than one ventilator be provided for a home care patient?
  2. if the patient cannot maintain spontaneous ventilation for at least 1 hour
  3. if the patient’s care plan requires mechanical ventilation during mobility
  4. if a replacement ventilator cannot be secured within 2 hours
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

A second back-up ventilator should be provided for patients who cannot maintain spontaneous ventilation for more than 4 consecutive hours, for patients living in an area where a replacement ventilator cannot be secured within 2 hours, and for patients whose care plan requires mechanical ventilation during mobility.

 

DIF:    Application    REF:   p. 1327          OBJ:   12

 

  1. Which of the following strategies would you recommend for a patient with a tracheotomy who requires home ventilatory support?
a. positive-pressure ventilation
b. noninvasive positive-pressure ventilation
c. abdominal displacement ventilation
d. negative-pressure ventilation

 

 

ANS:  A

If invasive ventilation by tracheostomy is the selected approach, the best choice is a positive-pressure ventilator.

 

DIF:    Application    REF:   p. 1327          OBJ:   12

 

  1. Which of the following strategies would you recommend for a cooperative patient with an intact upper airway who requires home ventilatory support?
a. invasive positive-pressure ventilation
b. noninvasive positive-pressure ventilation
c. abdominal displacement ventilation
d. negative-pressure ventilation

 

 

ANS:  B

For patients with an intact upper airway, a device capable of noninvasive positive-pressure ventilation is the first choice.

 

DIF:    Application    REF:   p. 1328          OBJ:   12

 

  1. Absolute contraindications for using noninvasive positive-pressure ventilation include all of the following except:
a. hemodynamic instability
b. uncooperative patient
c. copious secretions
d. need for airway protection

 

 

ANS:  C

Box 51-8 lists the absolute contraindications against using noninvasive positive-pressure ventilation.

 

DIF:    Application    REF:   p. 1328          OBJ:   11

 

  1. Which of the following strategies would you recommend for a hemodynamically unstable patient with an intact upper airway who requires home ventilatory support?
a. invasive positive-pressure ventilation
b. noninvasive positive-pressure ventilation
c. abdominal displacement ventilation
d. negative-pressure ventilation

 

 

ANS:  D

In patients with an intact upper airway for whom noninvasive positive-pressure ventilation is contraindicated or unsuccessful, a negative pressure ventilator should be considered.

 

DIF:    Application    REF:   p. 1328          OBJ:   11

 

  1. Characteristics common to most positive-pressure ventilation designed for use in the home setting include all of the following except:
a. volume-cycling to end inspiration
b. high-pressure pneumatic power source
c. backup internal power supply
d. rotary piston drive mechanism

 

 

ANS:  B

Table 51-6 lists the essential, recommended, and optional features of positive-pressure ventilators used in alternative care settings.

 

DIF:    Application    REF:   p. 1328          OBJ:   12

 

  1. Essential features of positive-pressure ventilators that are used in alternative care settings on patients with intact ventilatory drive and respiratory muscles include all of the following except:
a. mandatory minimum rate
b. flow or inspiratory time control
c. breath-triggering mechanism
d. spontaneous breathe mode

 

 

ANS:  D

Table 51-6 lists the essential, recommended, and optional features of positive-pressure ventilators used in alternative care settings.

 

DIF:    Application    REF:   p. 1328          OBJ:   12

 

  1. All of the following are advantages of pressure-limited ventilators used in alternative settings except they:
a. are responsive to changing flow demands
b. can deliver higher volumes and pressures
c. are lightweight and less expensive
d. can compensate for small leaks

 

 

ANS:  B

Table 51-7 compares the advantages and disadvantages of current-generation portable volume-cycled and pressure-limited ventilators for use in alternative settings.

 

DIF:    Recall             REF:   p. 1328-1329                                  OBJ:   12

 

  1. For which home care patients requiring mechanical ventilation would you recommend a portable volume-cycled ventilator rather than a pressure-limited device?
  2. those with a neuromuscular or neurologic disorder
  3. those who cannot sustain any spontaneous breathing
  4. those with chronic obstructive pulmonary disease
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

Those with neuromuscular or neurologic disorders often favor the consistent high inflations provided by volume ventilation, which enhance coughing and phonation. In addition, the alarm capabilities and internal battery backup provided with current portable volume ventilators make them the best choice for patients who cannot sustain any spontaneous breathing.

 

DIF:    Application    REF:   p. 1329          OBJ:   12

 

  1. A home care patient receiving continuous noninvasive positive-pressure ventilation through a nasal mask complains of pressure sores over the nasal bridge. Which of the following actions could help to alleviate this problem?
  2. artificial skin
  3. forehead spacer
  4. reduce strap tension
  5. try nasal pillows
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

Table 51-7 summarizes some of the common problems associated with noninvasive positive-pressure ventilation interfaces and how to correct them.

 

DIF:    Application    REF:   p. 1330          OBJ:   12

 

  1. Which of the following alarm systems is needed for postacute care patients who require only intermittent pressure-limited noninvasive positive-pressure ventilation?
a. high-pressure alarm
b. loss of power alarm
c. low-pressure alarm
d. low-exhaled-volume alarm

 

 

ANS:  B

All positive-pressure ventilators used in alternative settings must have an alarm to indicate loss of power (pneumatic and/or electrical).

 

DIF:    Application    REF:   p. 1329          OBJ:   12

 

  1. Types of negative-pressure ventilators used in postacute care include all of the following except:
a. iron lung (tank ventilator)
b. chest cuirass (shell ventilator)
c. body wrap or pneumosuit
d. abdominal displacement device

 

 

ANS:  D

With the increased popularity of noninvasive positive-pressure ventilation and continued extensive use of invasive ventilation, negative-pressure ventilators are rarely used today for ventilatory support in postacute care settings. The original negative-pressure ventilator was the “iron lung,” popularized by postpolio patients needing ventilator assistance. For practical reasons, the cumbersome iron lung was essentially replaced by the chest cuirass and wrap or “pneumosuit.”

The chest cuirass (a rigid shell) and wrap-type systems (nylon fabric surrounding a semicylindrical tent-like support) are simply enclosures that allow application of negative pressure to the thorax. Thus, these devices require a separate electrically powered negative-pressure generator. An example of a negative-pressure generator used to power cuirass or wrap-type systems is the Respironics NEV-100.

 

DIF:    Application    REF:   p. 1330          OBJ:   12

 

  1. Which of the following negative-pressure ventilation systems require a separate negative pressure generator?
  2. body wrap
  3. iron lung
  4. chest cuirass
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

With the increased popularity of noninvasive positive-pressure ventilators and continued extensive use of invasive ventilation, negative-pressure ventilators are rarely used today for ventilatory support in postacute care settings. The original negative-pressure ventilator was the “iron lung,” popularized by postpolio patients needing ventilator assistance. For practical reasons, the cumbersome iron lung was essentially replaced by the chest cuirass and wrap or “pneumosuit.”

The chest cuirass (a rigid shell) and wrap-type systems (nylon fabric surrounding a semicylindrical tent-like support) are simply enclosures that allow application of negative pressure to the thorax. Thus, these devices require a separate electrically powered negative-pressure generator. An example of a negative-pressure generator used to power cuirass or wrap-type systems is the Respironics NEV-100.

 

DIF:    Application    REF:   p. 1330          OBJ:   12

 

  1. You are conducting a routine visit to a ventilator-dependent patient in a home care setting. Which of the following would you be sure to perform while on this visit?
  2. Carefully assess patient’s status.
  3. Administer prescribed respiratory therapy.
  4. Check and clean equipment (as needed).
  5. Complete all appropriate documentation.
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

Routine follow-up visits by a respiratory therapist help ensure the success of patient management within the home. Equipment must be checked and cleaned as necessary. The patient’s status should be carefully assessed and appropriate recommendations for change should be made to the primary or prescribing physician. Any prescribed respiratory therapy should be administered during the visit and all necessary supply items left with the patient’s caregivers. After each visit, a report form must be completed and kept on record as part of the documentation process.

 

DIF:    Application    REF:   p. 1330          OBJ:   12

 

  1. What is the major potential problem in the application of bland aerosol therapy in the home care setting?
a. overhydration
b. electrical shock
c. mechanical failure
d. Infection

 

 

ANS:  D

The potential problem is infection from contaminated equipment.

 

DIF:    Application    REF:   p. 1331          OBJ:   12

 

  1. Which of the following are first-line aerosol drug delivery systems for home care patients?
  2. small-volume nebulizer
  3. dry powder inhaler
  4. metered-dose inhaler
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

Most pulmonary drug agents are available in either metered-dose inhaler or dry powder inhaler form.

 

DIF:    Application    REF:   p. 1331          OBJ:   12

 

  1. Routine tracheostomy care for a home care patient can be provided by whom?
  2. respiratory care practitioner
  3. trained family member
  4. visiting nurse
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

Tracheostomy care can be provided by any trained caregiver.

 

DIF:    Application    REF:   p. 1331          OBJ:   12

 

  1. Which of the following personnel should be allowed to change a tracheostomy tube on a home care patient?
  2. trained family member
  3. respiratory care practitioner
  4. visiting nurse
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

Tube changes should only be performed by the patient’s nurse, physician, or respiratory therapist.

 

DIF:    Recall             REF:   p. 1331          OBJ:   12

 

  1. Which of the following are components of a portable home suction unit?
  2. electric suction pump
  3. suction tubing
  4. collection bottle
  5. DISS vacuum connector
a. 2 and 4
b. 1, 3, and 4
c. 1, 2, and 3
d. 1, 2, 3, and 4

 

 

ANS:  C

In most postacute care settings, tracheobronchial suctioning is accomplished using a portable electrically powered suction pump with collection bottle and suction tubing.

 

DIF:    Recall             REF:   p. 1331          OBJ:   12

 

  1. In order to control the cost of suction supplies for a home care patient, which of the following is an acceptable strategy?
a. Wash catheters in detergent and hot water between uses.
b. Use one catheter per day, and place it in disinfectant between uses.
c. Save used catheters for resterilization through the autoclave.
d. Wash catheters in soap and cold water when not in use.

 

 

ANS:  B

To prevent bacterial growth, catheters are placed in a disinfecting solution such as hydrogen peroxide or 2.5% acetic acid between suctioning attempts.

 

DIF:    Application    REF:   p. 1331          OBJ:   14

 

  1. All of the following secretion clearance methods could be considered for a home care patient who lives alone except:
a. forced expiratory technique
b. positive end-expiratory pressure mask therapy
c. active cycle of breathing
d. postural drainage, percussion, and vibration

 

 

ANS:  D

Patients can be taught to independently apply coughing, forced exhalation, active cycle of breathing, and autogenic drainage methods. Caregiver assistance will be required with traditional postural drainage, percussion and vibration, and directed or assisted cough.

 

DIF:    Application    REF:   p. 1331          OBJ:   12

 

  1. Which of the following evidence would support Medicare reimbursement for adult nasal CPAP equipment to treat sleep apnea?
a. history of loud snoring while sleeping and marked obesity
b. polysomnograph confirming sleep apnea
c. 6-hour sleep video demonstrating major sleep disturbances
d. clinical lab evaluation showing erythrocytosis and hypercapnia

 

 

ANS:  B

For Medicare reimbursement of home nasal CPAP equipment, the sleep apnea diagnosis must be confirmed by polysomnography.

 

DIF:    Application    REF:   p. 1331          OBJ:   12

 

  1. Components of a typical adult home nasal CPAP apparatus include all of the following except:
a. CPAP pressure valve
b. flow-generating device
c. high-pressure gas source
d. form-fitting nasal mask

 

 

ANS:  C

A typical nasal CPAP apparatus consists of a flow-generator or blower, one-way valve or reservoir bag, patient interface (e.g., nasal mask, nasal pillows), and PEEP/CPAP valve (Figure 51-9).

 

DIF:    Application    REF:   p. 1332          OBJ:   12

 

  1. What is the most common way to determine the proper CPAP level for an individual patient?
a. Assess the apnea-hypopnea index at different CPAP levels during a sleep study.
b. Have the patient keep a log of sleep problems at different CPAP levels.
c. Measure and record the patient’s SpO2 continuously throughout sleep.
d. Have the patient’s spouse keep a log of sleep problems at different CPAP levels.

 

 

ANS:  A

The proper CPAP level for a given patient is determined by one of several methods. The most common method is to conduct the sleep study, titrating different levels of CPAP.

 

DIF:    Application    REF:   p. 1332          OBJ:   12

 

  1. Which of the following methods can eliminate the need for conducting a separate sleep study to adjust a patient’s CPAP level?
  2. Use an auto-adjusting CPAP system.
  3. Use SpO2 values to titrate the CPAP level.
  4. Use a patient sleep log or diary.
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

Recently, CPAP units have been developed that automatically adjust the airway pressure in response to apnea, hypopnea, airflow limitation, or snoring. This auto-CPAP may result in lower effective pressures and better patient compliance, while eliminating the need for sleep-study titration.

Alternatively, CPAP may be titrated against pulse oximetry data (Figure 51-10). In this case, the goal is to use the lowest CPAP pressure that will prevent arterial desaturation (SpO2 less than 90%).

 

DIF:    Application    REF:   p. 1332          OBJ:   12

 

  1. Common problems encountered when using adult nasal CPAP to treat sleep apnea include all of the following except:
a. nasal discomfort
b. barotrauma
c. conjunctivitis
d. skin irritation

 

 

ANS:  B

Patient problems associated with nasal CPAP include reversible upper airway obstruction, skin irritation, conjunctivitis, epistaxis, and nasal discomfort (dryness, burning, and congestion.

 

DIF:    Recall             REF:   p. 1332          OBJ:   12

 

  1. Which of the following procedures can help to minimize skin irritation in home care patients using nasal CPAP?
  2. Replace the mask every 3 months.
  3. Adjust the mask straps.
  4. Clean the mask daily.
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

Adjusting the straps (while maintaining a good mask seal) can help prevent irritation. In addition, the patient interface should be cleaned daily to remove dirt and facial oils. Even with proper care, most interfaces such as masks harden over time, causing problems with irritation and leaks. For this reason, masks and nasal pillows should be replaced approximately every 3 to 6 months, or sooner if leakage or discomfort occur.

 

DIF:    Application    REF:   p. 1332          OBJ:   12

 

  1. Which of the following would you consider recommending for a home care patient receiving nasal CPAP who complains of severe nasal dryness?
  2. room vaporizer
  3. heat-moisture exchanger (HME)
  4. in-line humidifier
  5. saline nasal spray
a. 2 and 4
b. 1, 3, and 4
c. 1, 2 and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

Methods used to overcome excessive drying include in-line humidifiers, room vaporizers, HMEs, chin straps (to decrease loss of upper airway moisture), and saline nasal sprays.

 

DIF:    Application    REF:   p. 1332          OBJ:   12

 

  1. After fitting a home care patient with a CPAP nasal mask, you set the prescribed pressure and turn on the flow generator. At this point, the mask pressure reading is 0 cm H2O. What is the most likely cause of this problem?
a. patient asynchrony
b. too high a flow
c. jammed CPAP valve
d. large system leak

 

 

ANS:  D

Methods used to overcome excessive drying include in-line humidifiers, room vaporizers, heat-moisture exchangers, chin straps (to decrease loss of upper airway moisture), and saline nasal sprays.

 

DIF:    Analysis         REF:   p. 1332          OBJ:   12

 

  1. Which of the following groups of hospitalized infants are frequently set up on apnea monitors?
a. those at risk for respiratory syncytial virus
b. those at risk for sudden infant death syndrome (SIDS)
c. those at risk for epiglottitis
d. those at risk for pneumonia

 

 

ANS:  B

Hospitalized infants at risk for SIDS are frequently set up on apnea monitors.

 

DIF:    Recall             REF:   p. 1334          OBJ:   12

 

  1. During what phase of subacute or long-term care management does the respiratory care practitioner establish short- and long-term rehabilitation goals for the patients?
a. ongoing assessment
b. screening
c. treatment planning
d. discharge

 

 

ANS:  C

A typical treatment plan would include patient demographics, assessment information, short- and long-term goals reflective of overall rehabilitation potential, and measures to be used to achieve such goals.

 

DIF:    Recall             REF:   p. 1335          OBJ:   3

 

  1. All of the following are included in a respiratory care practitioner’s weekly summary of a subacute or long-term care resident’s progress except:
a. complete course of respiratory therapy
b. changes in respiratory status
c. explanation of any patient education
d. recommendations for additional therapy

 

 

ANS:  A

The weekly summary provides a synopsis of residents’ progress, including any changes in their respiratory status, results of any additional tests, explanation of any patient education, and recommendations for additional therapy.

 

DIF:    Application    REF:   p. 1335          OBJ:   13

 

  1. For patients receiving home respiratory care, follow-up evaluation by a home care team member should occur at least how often?
a. daily
b. biweekly
c. monthly
d. as needed

 

 

ANS:  C

For patients receiving respiratory care at home, follow-up by a home care team member should occur at least monthly, particularly patients on hi-tech equipment such as apnea monitors.

 

DIF:    Recall             REF:   p. 1330          OBJ:   13

 

  1. Which of the following factors would you consider in determining the frequency of follow-up visits needed by a home care patient?
  2. level of self-care the patient is able to provide
  3. type and complexity of home care equipment used
  4. patient’s condition and therapeutic objectives
  5. level of family or caregiver support available
a. 1, 2, 3, and 4
b. 2 and 4
c. 1 and 3
d. 3 and 4

 

 

ANS:  A

Factors to consider when deciding on the frequency of home visits include the following:

  • the patient’s condition and therapeutic needs (objectives)
  • the level of family or caregiver support available
  • the type and complexity of home care equipment
  • the overall home environment
  • the ability of the patient to provide self-care

 

DIF:    Application    REF:   p. 1335          OBJ:   13

 

  1. Which of the following functions should a respiratory care practitioner perform when making a home care visit?
  2. Identify any problem areas or concerns of the patient.
  3. Assess the equipment (operation, cleanliness, supply needs).
  4. Determine the patient’s compliance with the therapy.
  5. Assess the patient (including pre- and post-treatment measures).
a. 1, 2, and 3
b. 1, 2, 3, and 4
c. 1 and 3
d. 3 and 4

 

 

ANS:  B

When a visit is made by a respiratory therapist, a number of functions must be performed. These include the following:

  • Patient assessment (objective and subjective data), including pretreatment and posttreatment measurements of pulse, respiratory rate, blood pressure, and expiratory flows (FEV1, PEFR)
  • Patient’s compliance with prescribed respiratory home care
  • Equipment assessment (operation, cleanliness, and need for related supplies)
  • Identification of any problem areas or patient concerns
  • Statement related to patient goals and therapeutic plan

 

DIF:    Application    REF:   p. 1335          OBJ:   13

 

  1. After making a home care visit, to whom should you forward copies of your written report?
  2. patient’s physician
  3. patient’s family
  4. home care agency
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  D

Copies should be sent to the patient’s physician, the home care referral source, and any other member of the team requiring this information.

 

DIF:    Recall             REF:   p. 1335          OBJ:   13

 

  1. Basic principles of infection control in the home care setting include which of the following?
  2. Avoid visits by friends with respiratory infections.
  3. Have caregivers follow proper hand-washing techniques.
  4. Incinerate all disposable equipment and supplies.
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

In regard to infection control, the ARCF and applicable AARC clinical practice guidelines mandate proper handwashing technique by all caregivers. In addition, visits to the patient by friends or relatives with respiratory infections are discouraged.

 

DIF:    Application    REF:   p. 1336          OBJ:   14

 

  1. What is the correct order of steps to recommend to the home caregivers who are responsible for cleaning nondisposable respiratory care equipment?
  2. Soak in warm soapy water.
  3. Wash in cool water.
  4. Scrub equipment.
  5. Disassemble equipment.
  6. Rinse and drain excess water.
a. 1, 3, 4, 5, 2
b. 2, 3, 1, 4, 5
c. 1, 2, 3, 4, 5
d. 4, 2, 1, 3, 5

 

 

ANS:  D

In terms of cleaning, the ARCF and AARC recommend that all equipment be completely disassembled and washed first in water, followed by a soak in warm soapy water for several minutes, with equipment scrubbed as needed to remove any remaining organic material. Following this step, the equipment must be thoroughly rinsed to remove any residual soap and drained of excess water. Air drying on a clean surface or rack is recommended to minimize recontamination.

 

DIF:    Application    REF:   p. 1336          OBJ:   14

 

  1. Which of the following agents is recommended by the American Respiratory Care Foundation for disinfection of respiratory home care equipment?
a. activated glutaraldehyde
b. 70% ethyl alcohol solution
c. sodium hypochlorite solution
d. quaternary ammonium compound

 

 

ANS:  A

High-level disinfection with glutaraldehyde is initially recommended.

 

DIF:    Application    REF:   p. 1336          OBJ:   14

 

  1. While visiting a home care patient who uses a multidose vial of an expensive bronchodilator, you notice that the expiration date for this medication has passed. Which of the following actions would you recommend at this time?
a. Mix the remaining medication with a fresh batch.
b. Dispose of the medication as recommended by the manufacturer.
c. Dilute the remaining medication with saline.
d. Use the remaining medication until it is gone.

 

 

ANS:  B

It is further recommended that manufacturers’ guidelines for the proper handling of specific medications be strictly followed.

 

DIF:    Application    REF:   p. 1336          OBJ:   12

 

  1. Which of the following is an additional goal of home care of the terminally ill patient near the end of life?
a. prolong life
b. maximize comfort and well-being
c. maximize equipment use
d. minimize medication use

 

 

ANS:  B

Although the primary goal of home care involves minimizing a patient’s dependence on institutional care, an additional goal is to maximize the comfort and well-being of the terminally ill patient near the end of life.

 

DIF:    Recall             REF:   p. 1336          OBJ:   12