Sample Chapter

INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS

 

Test Bank For Egan’s Fundamentals of Respiratory Care-10th Edition by Robert M. Kacmarek- James K. Stoller

 

 

 

SAMPLE QUESTIONS

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 17: Interpreting the Electrocardiogram

Test Bank

 

MULTIPLE CHOICE

 

  1. The electrocardiogram (ECG) is primarily used to evaluate the patient with symptoms suggestive of acute myocardial disease.
a. True
b. False

 

 

ANS:  A

The ECG is used primarily to evaluate the patient with an acute clinical condition suggestive of myocardial disease.

 

DIF:    Recall             REF:   p. 368            OBJ:   1

 

  1. Your patient has a normal ECG reading. What does this finding tell you about the patient’s likelihood of having a myocardial infarction in the immediate future?
a. less than a 10% chance
b. less than a 30 % chance
c. less than 50% chance
d. no predictive value

 

 

ANS:  D

The resting ECG has no value as a predictor of future heart attacks.

 

DIF:    Application    REF:   p. 368            OBJ:   1

 

  1. Valvular defects in the heart can be detected with a 12-lead ECG.
a. True
b. False

 

 

ANS:  B

Certain abnormalities, such as valvular defects, cannot be identified directly by the ECG.

 

DIF:    Recall             REF:   p. 368            OBJ:   1

 

  1. What term is used to define the ability of certain cardiac cells to depolarize without stimulation?
a. automaticity
b. polarization
c. contraction
d. repolarization

 

 

ANS:  A

The ability of these cells to depolarize without stimulations is known as automaticity.

 

DIF:    Recall             REF:   p. 369            OBJ:   2

 

  1. What structure normally paces the healthy heart?
a. atrioventricular (AV) node
b. sinoatrial (SA) node
c. bundle of His
d. Purkinje fibers

 

 

ANS:  B

Normally, the SA node, which is located in the upper portion of the right atrium, has the greatest degree of automaticity and therefore paces the heart.

 

DIF:    Recall             REF:   p. 369            OBJ:   3

 

  1. What structure serves as the backup pacemaker for the heart?
a. atrioventricular (AV) node
b. sinoatrial (SA) node
c. bundle of His
d. Purkinje fibers

 

 

ANS:  A

After leaving the atria, the impulse moves to the AV node, located in the intraventricular septum in the inferior aspect of the right atrium (Figure 17-2). The AV node is the “backup” pacemaker because it has the second greatest degree of automaticity in the healthy heart.

 

DIF:    Recall             REF:   p. 369            OBJ:   3

 

  1. Why is the electrical impulse temporarily delayed at the atrioventricular (AV) node?
a. to allow complete emptying of the ventricles
b. to allow more sodium buildup in the myocardial cells
c. to allow better filling of the ventricles
d. to allow complete filling of the atria

 

 

ANS:  C

The impulse is temporarily delayed at the AV node in order to allow the ventricles time to fill with blood. That brief delay also limits the rate of the ventricular stimulation during excessively fast atrial rhythms that, if passed to the ventricles, would lead to inadequate cardiac output.

 

DIF:    Recall             REF:   p. 36              OBJ:   3

 

  1. At what part of the cardiac conduction system does the electrical impulse travel most rapidly?
a. bundle of His
b. bundle branches
c. intraatrial pathways
d. Purkinje fibers

 

 

ANS:  D

The impulse travels the most rapidly in the Purkinje fibers, which is essential if contraction of the ventricles is to occur in a coordinated fashion.

 

DIF:    Recall             REF:   p. 369            OBJ:   3

 

  1. What is the normal maximum length of the P wave?
a. 1 mm
b. 3 mm
c. 5 mm
d. 7 mm

 

 

ANS:  B

Atrial hypertrophy may cause the P wave to enlarge to a height and length beyond the normal parameters.

 

DIF:    Recall             REF:   p. 371            OBJ:   3

 

  1. Which of the following waves represents depolarization of the ventricles?
a. P wave
b. QRS wave
c. T wave
d. U wave

 

 

ANS:  B

The wave of depolarization occurring over the ventricles is seen as the QRS complex on the ECG tracing.

 

DIF:    Recall             REF:   p. 372            OBJ:   3

 

  1. What is the width of the normal QRS complex?
a. not wider than 1 mm
b. not wider than 3 mm
c. not wider than 5 mm
d. not wider than 7 mm

 

 

ANS:  B

The normal QRS complex is not wider than 3 mm (0.12 second) because of the rapid movement of the impulse through the ventricles by the bundle branches and Purkinje fibers.

 

DIF:    Recall             REF:   p. 371            OBJ:   3

 

  1. Which of the following waves represents repolarization of the ventricles?
a. P
b. QRS
c. T
d. U

 

 

ANS:  C

The wave of repolarization occurring in the ventricles immediately after depolarization is the T wave.

 

DIF:    Recall             REF:   p. 371            OBJ:   3

 

  1. What is the normal period of time for the PR interval?
a. not longer than 0.20 second
b. not longer than 0.30 second
c. not longer than 0.45 second
d. not longer than 0.50 second

 

 

ANS:  A

Normally, the PR interval represents a period no longer than 0.20 second.

 

DIF:    Recall             REF:   p. 371            OBJ:   3

 

  1. What is implied by an abnormally prolonged PR interval?
a. atrioventricular block
b. bundle-branch block
c. myocardial infarction
d. valvular detachment

 

 

ANS:  A

PR intervals longer than 0.20 second suggest that the impulse is abnormally delayed at the AV node and a “block” is present.

 

DIF:    Recall             REF:   p. 371            OBJ:   3

 

  1. Which of the following ECG abnormalities is most life threatening?
a. narrow QRS complex
b. shortened PR interval
c. elevated ST segment
d. peak P waves

 

 

ANS:  C

Because this represents a potentially life-threatening arrhythmia, abnormal ST segments must be identified as soon as possible.

 

DIF:    Recall             REF:   p. 372            OBJ:   3

 

  1. Which of the following axis placements represents right-axis deviation?
a. +60
b. +90
c. +120
d. +190

 

 

ANS:  C

Normally, the mean QRS axis (vector) points leftward (patient’s left) and downward, between 0 and +90 degrees in the frontal plane (Figure 17-5).

 

DIF:    Recall             REF:   p. 373            OBJ:   3

 

  1. What condition is often associated with right-axis deviation?
a. cor pulmonale
b. congestive heart failure (CHF)
c. mitral valve prolapse
d. left ventricular hypertrophy

 

 

ANS:  A

This is commonly seen in patients with chronic obstructive pulmonary disease with cor pulmonale.

 

DIF:    Recall             REF:   p. 374            OBJ:   3

 

  1. What parameter is measured on the vertical axis of the ECG paper?
a. time
b. voltage
c. cardiac contraction rate
d. blood flow

 

 

ANS:  B

ECG paper is made up of grid-like boxes that define time on the horizontal axis and voltage on the vertical axis.

 

DIF:    Recall             REF:   p. 372            OBJ:   3

 

  1. The QRS of an ECG falls on a dark vertical line of the ECG paper. Subsequent QRS complexes fall on every other dark line (10 mm apart). What is the ventricular rate?
a. 300/min
b. 200/min
c. 150/min
d. 100/min

 

 

ANS:  C

You can count the number of large boxes between two successive complexes and divide this number into 300 to obtain the heart rate.

 

DIF:    Recall             REF:   p. 373            OBJ:   4

 

  1. What is suggested by inverted T waves on the ECG?
a. atrial enlargement
b. myocardial ischemia
c. ventricular hypertrophy
d. dextrocardia

 

 

ANS:  B

Inverted T waves suggest ischemia of the heart muscle, and abnormal configuration of the T wave occurs with electrolyte abnormalities such as hyperkalemia.

 

DIF:    Recall             REF:   p. 373            OBJ:   4

 

  1. Which of the following clinical conditions is not associated with tachycardia?
a. anxiety
b. hypoxemia
c. pain
d. hypothermia

 

 

ANS:  D

Most often, sinus tachycardia is caused by anxiety, pain, fever, hypovolemia, or hypoxemia.

 

DIF:    Recall             REF:   p. 374            OBJ:   4

 

  1. Which of the following medications is used to treat sinus bradycardia?
a. atropine
b. digitalis
c. propranol
d. lidocaine

 

 

ANS:  A

Numerous medications, such as atropine, are available to stimulate the heart rate when clinical bradycardia symptoms occur.

 

DIF:    Recall             REF:   p. 374            OBJ:   4

 

  1. The ECG you are looking at has one P wave for every QRS complex and the PR interval is 0.30 second. What is your interpretation?
a. first-degree heart block
b. right-axis deviation
c. third-degree heart block
d. atrial hypertrophy

 

 

ANS:  A

In first-degree heart block, the PR interval is longer than 0.20 second. In addition, there is one P wave before each QRS complex.

 

DIF:    Application    REF:   p. 374            OBJ:   4

 

  1. What type of medications may lead to first-degree heart block?
a. bronchodilators
b. corticosteroids
c. b-blockers
d. xanthines

 

 

ANS:  C

First-degree heart block is common following a myocardial infarction that damages the atrioventricular node, or it may be a complication of certain medications such as digoxin or b-blockers.

 

DIF:    Recall             REF:   p. 374            OBJ:   4

 

  1. Which of the following criteria applies to third-degree block?
a. There is no relationship between the P waves and the QRS complexes.
b. The PR interval becomes progressively longer.
c. The ventricular rate is twice that of the atrial rate.
d. The QRS complex is inverted compared to the P wave.

 

 

ANS:  A

This arrhythmia can be recognized when it is established that there is no relationship between the P waves and the QRS complexes.

 

DIF:    Recall             REF:   p. 376            OBJ:   4

 

  1. For which of the following arrhythmias would an electronic pacemaker be indicated?
a. first-degree block
b. sinus tachycardia
c. third-degree block
d. ventricular fibrillation

 

 

ANS:  C

In almost all cases, treatment usually includes medication to speed up the ventricles and a temporary external pacemaker until a permanent pacemaker can be surgically placed.

 

DIF:    Recall             REF:   p. 377            OBJ:   4

 

  1. On inspection of an ECG rhythm strip from an adult patient, you notice the following: regular sawtoothlike waves occurring at a rate of 280/min and a regular ventricular rhythm occurring at a rate of about 140/min. What is the most likely interpretation?
a. atrial fibrillation
b. atrial flutter
c. ventricular tachycardia
d. ventricular fibrillation

 

 

ANS:  B

Atrial flutter is the rapid depolarization of the atria resulting from an ectopic focus that depolarizes at a rate of 250 to 350 times per minute. Typically, only one ectopic focus is causing the arrhythmia, which results in each P wave appearing similar. The result is a characteristic sawtooth pattern.

 

DIF:    Recall             REF:   p. 377            OBJ:   4

 

  1. Atrial flutter is considered to be a life-threatening arrhythmia.
a. True
b. False

 

 

ANS:  B

This arrhythmia is not considered life threatening, but it may lead to atrial fibrillation if untreated.

 

DIF:    Recall             REF:   p. 377            OBJ:   4

 

  1. What is a possible serious complication associated with atrial fibrillation?
a. pulmonary edema
b. atrial thrombi
c. cardiac tamponade
d. cardiac standstill

 

 

ANS:  B

Atrial fibrillation can lead to thrombi formation in the atria caused by the stagnation of blood.

 

DIF:    Recall             REF:   p. 377            OBJ:   4

 

  1. Sources for the electrical impulse that triggers cardiac contraction that lie outside the sinoatrial node are referred to as ectopic foci.
a. True
b. False

 

 

ANS:  A

Sources for the impulse outside the sinoatrial node are called ectopic foci.

 

DIF:    Recall             REF:   p. 378            OBJ:   4

 

  1. Which of the following is NOT a common characteristic of a premature ventricular complex (PVC)?
a. no P wave prior to the QRS complex
b. widened QRS complex
c. bizarre QRS complex
d. narrow QRS

 

 

ANS:  D

PVCs are easy to recognize because they cause a unique and bizarre QRS complex, which is much wider than normal (Figure 17-16). The QRS complex of a PVC is wider than normal, because the ectopic focus is using channels outside the normal conduction system to move the impulse throughout the myocardium. PVCs have no P wave preceding them and may occur as a singular event or, more commonly, as a temporary run of PVCs.

 

DIF:    Recall             REF:   p. 378            OBJ:   4

 

  1. An occasional premature ventricular complex (PVC) is not of major concern.
a. True
b. False

 

 

ANS:  A

Occasional PVCs are not of major concern and may occur as a result of stress, caffeine intake, nicotine use, or electrolyte imbalance

 

DIF:    Recall             REF:   p. 378            OBJ:   4

 

  1. What medication is most useful for the treatment of premature ventricular contractions?
a. digoxin
b. atropine
c. lidocaine
d. digitalis

 

 

ANS:  C

Antiarrhythmic medications (such as lidocaine) may offer a temporary solution until the underlying cause can be identified and treated.

 

DIF:    Recall             REF:   p. 378            OBJ:   4

 

  1. Which of the following is NOT a common cause of ventricular tachycardia?
a. myocardial infarction
b. coronary artery disease
c. hypertensive heart disease
d. pericarditis

 

 

ANS:  D

Myocardial infarction, coronary artery disease, and hypertensive heart disease are the most common causes.

 

DIF:    Recall             REF:   p. 378            OBJ:   4

 

  1. Sinus bradycardia is always a sign of an abnormality of the heart?
a. True
b. False

 

 

ANS:  B

If sinus bradycardia causes the patient’s blood pressure to drop significantly or causes symptoms such as fatigue, lightheadedness, or syncope, then it can represent a major clinical problem. But, a well-conditioned athlete and individuals on certain medications can have a low resting heart rate below 60 bpm, with no heart abnormality.

 

DIF:    Recall             REF:   p. 374            OBJ:   4

 

  1. While a patient is receiving an albuterol treatment, the nurse performs an ECG. The ECG shows the patient’s heart rate had increased from 98 to 120 beats/minute with narrow QRS complexes proceeded by a P wave. What is the appropriate course of treatment for this patient?
a. atropine
b. activate the rapid response team
c. lidocaine
d. discontinue the treatment

 

 

ANS:  D

The patient is experiencing sinus tachycardia. Most often, sinus tachycardia is caused by anxiety, pain, fever, hypovolemia, or hypoxemia. It may also be a side effect of certain medications such as beta agonist bronchodilators. Treatment for sinus tachycardia typically involves eliminating the underlying cause.

 

DIF:    Analysis         REF:   p. 378            OBJ:   4

 

  1. A patient taking an ECG shows a regular sawtooth pattern with thirty P-waves within a six second interval (30 large boxes). What course of treatment should this patient receive for this arrhythmia?
  2. calcium channel blockers
  3. digoxin
  4. cardioversion
  5. defibrillation
a. 1, 2, and 3
b. 2 and 4
c. 3 only
d. 1, 2, 3, and 4

 

 

ANS:  A

First, the patient’s heart atrial heart rate must be calculated: 30 P-waves X 10 = 300beats/min. Looking at the patient’s atrial heart rate and the sawtooth pattern displayed on the ECG, the patient is demonstrating atrial flutter. Treatment for atrial flutter is to provide medication (digoxin, beta blockers or calcium channel blockers), allow the arrhythmia to significantly slow down, and then cardioversion is recommended.

 

DIF:    Analysis         REF:   p. 379            OBJ:   4

 

  1. An unconscious patient is bought in by EMS into an ER trauma room. Patient has no detectable pulse and the ECG baseline waveform shows grossly irregular fluctuations with a zigzag pattern. What is the course of action to treat this patient?
  2. rapid defibrillation
  3. cardiopulmonary resuscitation
  4. administration of oxygen
  5. administration of an antiarrhythmic medication
a. 1, 2, and 3
b. 2 and 4
c. 3 only
d. 1, 2, 3, and 4

 

 

ANS:  D

Ventricular fibrillation (VF) is the most life-threatening arrhythmia and is defined as erratic quivering of the ventricular muscle mass. It causes the cardiac output to drop to zero; the patient becomes unconscious and represents a true medical emergency. The electrocardiographic tracing of ventricular fibrillation shows grossly irregular fluctuations with a zigzag pattern. Treatment calls for rapid defibrillation, cardiopulmonary resuscitation, and administration of oxygen and antiarrhythmic medications, as well as treatment of the underlying cause of the ischemia. Survivors of VF usually receive an internal cardioverter-defibrillator (ICD).

 

DIF:    Analysis         REF:   p. 379            OBJ:   4

 

  1. A patient who has been diagnosed with myocardial infarction is getting an ECG. The ECG trace shows a series of nonconducted P waves followed by a P wave that is conducted to the ventricles. The ratio of non-conducted to conducted P waves is fixed at 4:1. What plan for treatment should this patient receive?
  2. rapid defibrillation
  3. atropine
  4. cardioversion
  5. pacemaker
a. 1, 2, and 3
b. 2 and 4
c. 3 only
d. 1, 2, 3, and 4

 

 

ANS:  B

Second-degree heart block comes in two different types. Type I (Wenckebach or Mobitz type I) block is a relatively benign and often transient arrhythmia. Second-degree heart block type II (Mobitz type II) is less common and is more often the result of serious problems such as MI or ischemia. Type II heart block is seen as a series of nonconducted P waves followed by a P wave that is conducted to the ventricles. Sometimes the ratio of non-conducted to conducted P waves is fixed at 3:1 or 4:1. The PR interval for the conducted impulses is consistent.

Type II second-degree heart block requires treatment in most cases, because the resulting reduction in ventricular rate causes a drop in blood pressure. Medications such as atropine will provide a better cardiac output until a pacemaker can be inserted. Because type II may progress to third-degree heart block without warning, a pacemaker is indicated even if the patient is asymptomatic.

 

DIF:    Analysis         REF:   p. 380            OBJ:   4

 

Chapter 35: Humidity and Bland Aerosol Therapy

Test Bank

 

MULTIPLE CHOICE

 

  1. What is the point in the respiratory track where inspired gas reaches body temperature, ambient pressure, saturated (BTPS) conditions?
a. point of thermal equilibrium
b. hygroscopic saturation boundary
c. thermal inversion boundary
d. isothermic saturation boundary

 

 

ANS:  D

As inspired gas moves into the lungs, it achieves BTPS conditions (body temperature, 37° C; barometric pressure; saturated with water vapor [100% relative humidity at 37° C]). This point, normally approximately 5 cm below the carina, is called the isothermic saturation boundary.

 

DIF:    Recall             REF:   p. 819            OBJ:   1

 

  1. Which of the following is FALSE about the isothermic saturation boundary (ISB)?
a. Below the ISB, temperature and relative humidity remain constant.
b. Above the ISB, temperature and humidity increase during exhalation.
c. The ISB is normally located just below the larynx (vocal cords).
d. Above the ISB, temperature and humidity decrease during inspiration.

 

 

ANS:  C

This point, normally approximately 5 cm below the carina, is called the isothermic saturation boundary (ISB). Above the ISB, temperature and humidity decrease during inspiration and increase during exhalation.

 

DIF:    Recall             REF:   p. 819            OBJ:   1

 

  1. Which of the following factors cause the isothermic saturation boundary (ISB) to shift farther down into the airways?
  2. decreased ambient temperature
  3. increased tidal volume (VT)
  4. endotracheal intubation
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

The ISB shifts distally when a person breathes through the mouth rather than the nose; when he or she breathes cold, dry air; when the upper airway is bypassed (breathing through an artificial tracheal airway); or when the minute ventilation is higher than normal.

 

DIF:    Recall             REF:   p. 819            OBJ:   1

 

  1. What is the primary goal of humidity therapy?
a. decrease airway reactivity to cold
b. maintain normal physiologic conditions
c. deliver drugs to the airway
d. reduce upper airway inflammation

 

 

ANS:  B

The primary goal of humidification is to maintain normal physiological conditions in the lower airways.

 

DIF:    Recall             REF:   p. 819            OBJ:   3

 

  1. Indications for warming inspired gases include all of the following except:
a. treating a patient whose airways are reactive to cold
b. providing humidification when the upper airway is bypassed
c. treating a patient with a low body temperature (hypothermia)
d. reducing upper airway inflammation or swelling

 

 

ANS:  D

See Box 35-1.

 

DIF:    Recall             REF:   p. 820            OBJ:   2

 

  1. Administration of dry gases at flows exceeding 4 L/min can cause which of the following?
  2. structural damage
  3. heat loss
  4. water loss
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

Administration of dry medical gases at flows greater than 4 L/min to the upper airway causes immediate heat and water loss and, if prolonged, causes structural damage to the epithelium.

 

DIF:    Recall             REF:   p. 820            OBJ:   2

 

  1. Inhalation of dry gases can do which of the following?
  2. increase viscosity of secretions
  3. impair mucociliary motility
  4. increase airway irritability
a. 1 and 2
b. 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

As the airway is exposed to relatively cold, dry air, ciliary motility is reduced, airways become more irritable, mucous production increases, and pulmonary secretions become inspissated (thickened due to dehydration).

 

DIF:    Recall             REF:   p. 820            OBJ:   2

 

  1. Which of the following inspired conditions should be maintained when delivering medical gases to the nose or mouth?
a. 50% relative humidity (RH) at 20° to 22° C
b. 100% RH at 20° to 22° C
c. 80% RH at 28° to 32° C
d. 100% RH at 32° to 35° C

 

 

ANS:  A

See Table 35-1.

 

DIF:    Recall             REF:   p. 821            OBJ:   3

 

  1. Which of the following inspired conditions should be maintained when delivering medical gases to the hypopharynx, as when administering oxygen by nasal catheter?
a. 50% relative humidity (RH) at 20° to 22° C
b. 100% RH at 20° to 22° C
c. 95% RH at 29° to 32° C
d. 100% RH at 32° to 35° C

 

 

ANS:  C

See Table 35-1.

 

DIF:    Recall             REF:   p. 821            OBJ:   3

 

  1. Which of the following inspired conditions should be maintained when delivering medical gases directly into the trachea through an endotracheal tube or a tracheotomy tube?
a. 50% relative humidity (RH) at 20° to 22° C
b. 100% RH at 37° to 42° C
c. 95% RH at 29° to 32° C
d. 100% RH at 32° to 35° C

 

 

ANS:  D

See Table 35-1.

 

DIF:    Recall             REF:   p. 821            OBJ:   3

 

  1. Clinical indications for delivering cool humidified gas include which of the following?
  2. post-extubation edema
  3. upper airway inflammation
  4. croup (laryngotracheal bronchitis)
  5. epiglottitis
a. 2, 3, and 4
b. 1, 2, and 3
c. 1, 2, 3, and 4
d. 2 and 3

 

 

ANS:  C

The delivery of cool humidified gas is used to treat upper airway inflammation resulting from croup, epiglottitis, and post-extubation edema.

 

DIF:    Recall             REF:   p. 821            OBJ:   3

 

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

 

 

ANS:  B

A humidifier is a device that adds molecular water to gas.

 

DIF:    Recall             REF:   p. 821            OBJ:   4

 

  1. Factors affecting a humidifier’s performance include all of the following except:
a. surface area
b. temperature
c. time of contact
d. outlet size

 

 

ANS:  D

The following four variables affect the quality of a humidifier’s performance: (1) temperature, (2) surface area, (3) time of contact, and (4) thermal mass.

 

DIF:    Recall             REF:   p. 821            OBJ:   5

 

  1. What is the most important factor determining a humidifier’s performance?
a. surface area
b. temperature
c. time of contact
d. gas flow

 

 

ANS:  B

Temperature is an important factor affecting humidifier performance.

 

DIF:    Recall             REF:   p. 821            OBJ:   5

 

  1. The greater the temperature of the gas, the:
a. more water vapor it can hold
b. less water vapor it can hold
c. less efficient the humidifier is
d. more water vapor is lost

 

 

ANS:  A

The greater the temperature of a gas, the more water vapor it can hold (increased capacity).

 

DIF:    Recall             REF:   p. 821            OBJ:   5

 

  1. Gas leaving an unheated humidifier at 10° C and 100% relative humidity (absolute humidity = 9.4 mg/L) would provide what relative humidity at body temperature?
a. about 100%
b. about 60%
c. about 40%
d. about 20%

 

 

ANS:  D

Although the humidifier fully saturates the gas, the low operating temperature limits total water vapor capacity to approximately 9.4 mg/L water vapor, equivalent to approximately 21% of body humidity.

 

DIF:    Recall             REF:   p. 821            OBJ:   6

 

  1. What is the simplest way to increase the humidity output of a humidifier?
a. Increase the time that the gas and the water are in contact.
b. Increase the surface area between the water and the gas.
c. Decrease the water vapor pressure of the gas.
d. Increase the temperature of either the water or the gas.

 

 

ANS:  D

Simply heating the humidifier to 40° C (Figure 35-3, right) increases its output to 51 mg/L, which is more than adequate to meet BTPS conditions.

 

DIF:    Recall             REF:   p. 821            OBJ:   6

 

  1. Which of the following is a common way to increase the surface area ratio of humidifiers?
  2. Generate a water droplet aerosol.
  3. Expose the gas to a saturated wick.
  4. Use a bubble or diffusion head.
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

More space-efficient ways to increase the water/gas surface-area ratio include bubble diffusion, aerosol, and “wick” technologies.

 

DIF:    Recall             REF:   p. 821            OBJ:   6

 

  1. All of the following are TRUE about humidification and contact time except:
a. The longer a gas is exposed to water, the greater is the amount of evaporation.
b. The rate of gas flow through a humidifier determines contact time.
c. Low flows decrease and high flows increase relative humidity output.
d. Bubble humidifier contact time depends on the water column depth.

 

 

ANS:  C

In passover and wick-type humidifiers, the flow rate of gas through the humidifier is inversely related to contact time, with high flow rates reducing the time available for evaporation to occur.

 

DIF:    Recall             REF:   p. 821            OBJ:   6

 

  1. Which of the following types of humidifiers are used in clinical practice?
  2. heat-moisture exchanger
  3. passover humidifier
  4. bubble humidifier
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

Active humidifiers typically include: (1) bubble humidifiers, (2) passover humidifiers, (3) nebulizers of bland aerosols and (4) vaporizers. Passive humidifiers refer to typical heat and moisture exchangers (HMEs).

 

DIF:    Recall             REF:   p. 822            OBJ:   6

 

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

 

 

ANS:  B

Unheated bubble humidifiers are commonly used with oronasal oxygen delivery systems (see Chapter 38) to raise the water vapor content of the gas to ambient levels.

 

DIF:    Recall             REF:   p. 822            OBJ:   6

 

  1. What is the goal of using an unheated bubble humidifier with oronasal oxygen delivery systems?
a. Raise the humidity of the gas to ambient levels.
b. Fully saturate the inspired gas to body temperature, ambient pressure, saturated (BTPS) conditions.
c. Cool the gas down to below room temperature.
d. Fully saturate the inspired gas to ambient temperature, ambient pressure, saturated (ATPS) conditions.

 

 

ANS:  A

Unheated bubble humidifiers are commonly used with oronasal oxygen delivery systems (see Chapter 38) the goal is to raise the water vapor content of the gas to ambient levels.

 

DIF:    Recall             REF:   p. 822            OBJ:   6

 

  1. What is the typical water vapor output of an unheated bubble humidifier?
a. 5 to 10 mg/L
b. 10 to 15 mg/L
c. 15 to 20 mg/L
d. 20 to 25 mg/L

 

 

ANS:  C

As indicated in Table 35-2, unheated bubble humidifiers can provide absolute humidity levels between approximately 15 and 20 mg/L.

 

DIF:    Recall             REF:   p. 822            OBJ:   6

 

  1. Increasing the flow through an unheated bubble humidifier has which of the following effects?
a. decreasing the water vapor content
b. decreasing the relative humidity
c. increasing the water vapor content
d. increasing the relative humidity

 

 

ANS:  A

As gas flow increases, these devices become less efficient as the reservoir cools and contact time is reduced.

 

DIF:    Recall             REF:   p. 822            OBJ:   6

 

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

 

 

ANS:  D

Unheated bubble humidifiers are of limited effectiveness at flow rates higher than 10 L/min.

 

DIF:    Recall             REF:   p. 822            OBJ:   6

 

  1. Why should you NOT heat the reservoirs of a bubble humidifier used with an oronasal oxygen delivery system?
a. Condensate will obstruct the delivery tubing.
b. Heating will melt the reservoir or cause a fire.
c. Heating will absorb the extra water vapor.
d. Heating will causes too much aerosol impaction.

 

 

ANS:  A

Heating the reservoirs of these units can increase humidity content but is not recommended because the resulting condensate tends to obstruct the small-bore delivery tubing to which they connect.

 

DIF:    Recall             REF:   p. 823            OBJ:   6

 

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

 

 

ANS:  A

The relief valve on a bubble humidifier serves to warn of flow-path obstruction and to prevent bursting of the humidifier bottle.

 

DIF:    Recall             REF:   p. 823            OBJ:   6

 

  1. To protect against obstructed or kinked tubing, simple bubble humidifiers incorporate which of the following?
a. HEPA outlet filter
b. pressure relief valve
c. automatic hygrometer
d. electronic alarm system

 

 

ANS:  B

Bubble humidifiers incorporate a simple pressure-relief valve, or pop-off.

 

DIF:    Recall             REF:   p. 823            OBJ:   6

 

  1. The typical pressure pop-off incorporated into most simple bubble humidifiers releases pressure above which of the following?
a. 760 mm Hg
b. 10 cm H2O
c. 250 kPa
d. 2 psig

 

 

ANS:  D

Typically, the pop-off is either a gravity or spring-loaded valve that releases pressures above 2 psi.

 

DIF:    Recall             REF:   p. 823            OBJ:   6

 

  1. When checking an oxygen delivery system that incorporates a bubble humidifier running at 6 L/min, you occlude the delivery tubing, and the humidifier pressure relief immediately pops off. What does this indicate?
a. malfunctioning humidifier
b. normal, leak-free system
c. malfunctioning flowmeter
d. leak in the delivery tubing

 

 

ANS:  B

If the system is obstructed at or near the patient interface and the pop-off sounds, the system is leak free.

 

DIF:    Recall             REF:   p. 823            OBJ:   6

 

  1. At high flow rates, what do some bubble humidifiers produce?
a. additional heat
b. microorganisms
c. low pressures
d. aerosol particles

 

 

ANS:  D

At high flow rates, bubble humidifiers can produce aerosols.

 

DIF:    Recall             REF:   p. 823            OBJ:   6

 

  1. What are some types of passover humidifiers?
  2. simple reservoir
  3. membrane
  4. wick
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

There are three common types of passover humidifiers: (1) the simple reservoir type, (2) the wick type, and (3) the membrane type.

 

DIF:    Recall             REF:   p. 823            OBJ:   6

 

  1. A design that increases surface area and enhances evaporation by incorporating an absorbent material partially submerged in a water reservoir that is surrounded by a heating element best describes what type of humidifier?
a. bubble
b. wick
c. cascade
d. hygroscopic

 

 

ANS:  B

Typically a wick is placed upright with the gravity-dependent end in a heated water reservoir.

 

DIF:    Recall             REF:   p. 823            OBJ:   6

 

  1. All of the following are TRUE regarding a membrane-type humidifier except:
a. Water and gas are separated by a hydrophobic membrane.
b. The membrane is permeable to water vapor but not to liquid water.
c. As with other passover humidifiers, there is no bubbling action.
d. A small layer of liquid water remains on both sides of the membrane.

 

 

ANS:  D

A membrane-type humidifier separates the water from the gas stream by means of a hydrophobic membrane (Figure 35-4). Water vapor molecules can easily pass through this membrane, but liquid water (and pathogens) cannot. As with the wick-type humidifier, bubbling does not occur. Moreover, if a membrane-type humidifier were to be inspected while it was in use, no liquid water would be seen in the humidifier chamber.

 

DIF:    Recall             REF:   p. 823            OBJ:   6

 

  1. Advantages of passover humidifiers include all of the following except:
a. They add minimal flow resistance to breathing circuits.
b. They do not require heating to maintain body temperature, ambient pressure, saturated (BTPS) conditions.
c. They do not generate any bacteria-spreading microaerosol.
d. They can maintain water vapor saturation at high flows.

 

 

ANS:  B

Compared with bubble humidifiers, passover humidifiers offer several advantages. First, unlike bubble devices, they can maintain saturation at high flow rates. Second, they add little or no flow resistance to spontaneous breathing circuits. Third, they do not generate any aerosols, and thus pose a minimal risk for spreading infection.

 

DIF:    Recall             REF:   p. 824            OBJ:   6

 

  1. Which type of humidifier “traps” the patient’s body heat and expired water vapor to raise the humidity of inspired gas?
a. membrane
b. bubble
c. heat-moisture exchanger
d. passover

 

 

ANS:  C

Like the nose, a heat-moisture exchanger captures exhaled heat and moisture and uses it to heat and humidify the next inspiration.

 

DIF:    Recall             REF:   p. 824            OBJ:   6

 

  1. Heat-moisture exchangers (HMEs) are mainly used to do what?
a. warm and humidify gases delivered to the trachea via ventilator circuits
b. humidify therapeutic gases delivered at high flows to the lower airway
c. provide extra humidity for a patient with thick or retained secretions
d. warm and humidify dry therapeutic gases delivered to the upper airway

 

 

ANS:  A

Traditionally, HME use has been limited to providing humidification to patients receiving invasive ventilatory support via endotracheal or tracheostomy tubes.

 

DIF:    Recall             REF:   p. 824            OBJ:   3

 

  1. Which of the following are types of heat-moisture exchangers (HMEs)?
  2. simple condenser
  3. hygroscopic condenser
  4. hydrophobic condenser
a. 1 and 2
b. 2 and 3
c. 1, 2, and 3
d. 3

 

 

ANS:  C

There are three basic types of HMEs: (1) simple condenser humidifiers, (2) hygroscopic condenser humidifiers, and (3) hydrophobic condenser humidifiers.

 

DIF:    Recall             REF:   p. 824            OBJ:   6

 

  1. Which of the following best describes the performance of a typical hygroscopic condenser HME?
a. 40 mg/L water vapor exhaled; 27 mg/L returned
b. 40 mg/L water vapor exhaled; 20 mg/L returned
c. 27 mg/L water vapor exhaled; 40 mg/L returned
d. 44 mg/L water vapor exhaled; 37 mg/L returned

 

 

ANS:  A

These devices typically achieve approximately 70% efficiency (40 mg/L exhaled, 27 mg/L returned).

 

DIF:    Recall             REF:   p. 824            OBJ:   6

 

  1. A heat-moisture exchangers has an efficiency rating of 80%. What does this mean?
a. Of the exhaled water vapor, 80% returns to the patient on inspiration.
b. The inspired temperature is 80% of the expired temperature.
c. Of the exhaled water vapor, 20% returns to the patient on inspiration.
d. The device provides 80% relative humidity at body temperature.

 

 

ANS:  A

These devices typically achieve approximately 70% efficiency (40 mg/L exhaled, 27 mg/L returned).

 

DIF:    Analysis         REF:   p. 824            OBJ:   6

 

  1. An ideal heat-moisture exchanger (HME) should have an efficiency rating of at least which of the following?
a. 30%
b. 50%
c. 70%
d. 90%

 

 

ANS:  D

The ideal HME should operate at 70% efficiency or better.

 

DIF:    Recall             REF:   p. 825            OBJ:   6

 

  1. All of the following are features of an ideal heat-moisture exchanger (HME) except:
a. high compliance
b. minimal dead space
c. 70% or higher efficiency
d. minimal flow resistance

 

 

ANS:  A

The ideal HME should operate at 70% efficiency or better (providing at least 30 mg/L water vapor); use standard connections; have a low compliance; and add minimal weight, dead space, and flow resistance to a breathing circuit.

 

DIF:    Recall             REF:   p. 825            OBJ:   6

 

  1. All of the following are true of heat-moisture exchangers (HMEs) except:
a. Moisture output falls at high volumes and rates of breathing.
b. High inspiratory flows and high FIO2 values can decrease HME efficiency.
c. In-use HMEs have little effect on flow resistance to breathing.
d. HMEs reduce bacterial colonization of ventilator circuits.

 

 

ANS:  C

As shown in Table 35-3, the moisture output of HMEs tends to fall at high volumes and rates of breathing. In addition, high inspiratory flows and high FIO2 levels can decrease HME efficiency. Flow resistance through the HME also is important. When an HME is dry, resistance across most devices is minimal. However, because of water absorption, HME flow resistance increases after several hours’ use. For some patients, the increased resistance imposed by the HME may not be well tolerated, particularly if the underlying lung disease already causes increased work of breathing. Because HMEs eliminate the problem of breathing-circuit condensation, many consider these devices (especially hydrophobic filter HMEs) to be helpful in preventing nosocomial infections.

 

DIF:    Recall             REF:   p. 825            OBJ:   6

 

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

 

 

ANS:  A

Heated humidifiers are used mainly for patients with bypassed upper airways and/or for those receiving mechanical ventilatory support.

 

DIF:    Application    REF:   p. 826            OBJ:   6

 

  1. Which of the following methods are used to heat the gas delivered by a heated humidifier system?
  2. using a wraparound heater (yoke or collar)
  3. placing a heating element in-line with gas flow
  4. using a reservoir immersion heater
  5. placing a “hot plate” at humidifier base
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

Six types of heating elements are common: (1) a “hot plate” element at the base of the humidifier; (2) a “wraparound” type that surrounds the humidifier chamber; (3) a yolk, or collar, element that sits between the water reservoir and the gas outlet; (4) an immersion-type heater, with the element actually placed in the water reservoir; (5) a heated wire in the inspiratory limb warming a saturated wick or hollow fiber, and (6) a thin film, high surface area broiler.

 

DIF:    Recall             REF:   p. 827            OBJ:   6

 

  1. Which of the following is false about a simple heated humidifier (one that does not incorporate a servo-control mechanism)?
a. The controller regulates the heating element’s electric power.
b. The controller monitors the temperature of the heating element.
c. The controller varies current to achieve a set airway temperature.
d. The patient’s airway does affect the controller.

 

 

ANS:  D

Humidifier heating systems also have a controller that regulates the element’s electric power. In the simplest systems, the controller monitors the heating element, varying the delivered current to match either a preset or an adjustable temperature. In these systems, the patient’s airway temperature has no effect on the controller.

 

DIF:    Recall             REF:   p. 827            OBJ:   6

 

  1. Characteristics of a servo-controlled heated humidifier include all of the following except:
a. monitors heater temperature
b. adjusts heater power automatically
c. provides automatic heater shutdown
d. includes temperature safety alarms

 

 

ANS:  A

Conversely, a servo-controlled heating system monitors temperature at or near the patient’s airway using a thermistor probe. The controller then adjusts heater power to achieve the desired airway temperature. Both types of controller units usually incorporate alarms and alarm-activated heater shutdown. Box 35-4 outlines key features of modern heated humidification systems.

 

DIF:    Recall             REF:   p. 827            OBJ:   6

 

  1. A heated humidifier should trigger both auditory and visual alarms and interrupt power to the heater when the delivered temperature exceeds which of the following?
a. 25° C
b. 30° C
c. 35° C
d. 40° C

 

 

ANS:  D

See Box 35-4.

 

DIF:    Recall             REF:   p. 828            OBJ:   6

 

  1. What should happen when the remote temperature sensor of a heated humidifier becomes disconnected or fails?
  2. Power to the heater should be interrupted.
  3. Auditory and visual alarms should trigger.
  4. The unit’s outlet valve should lock closed.
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

See Box 35-4.

 

DIF:    Recall             REF:   p. 828            OBJ:   6

 

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

 

 

ANS:  D

See Box 35-4.

 

DIF:    Recall             REF:   p. 828            OBJ:   6

 

  1. The temperature of gas delivered to a patient’s airway by a servo-controlled heated humidifier should not vary by more than how much?
a. 2° C
b. 4° C
c. 6° C
d. 8° C

 

 

ANS:  A

See Box 35-4.

 

DIF:    Recall             REF:   p. 828            OBJ:   6

 

  1. Which of the following are necessary features to look for in selecting a heated humidifier?
  2. water level readily visible
  3. over-temperature protection
  4. auditory and visual alarms
  5. minimal temperature overshoot
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

See Box 35-4.

 

DIF:    Recall             REF:   p. 828            OBJ:   6

 

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

 

 

ANS:  D

See Rule of Thumb p. 827.

 

DIF:    Recall             REF:   p. 827            OBJ:   7

 

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

 

 

ANS:  A

See Rule of Thumb p. 827.

 

DIF:    Recall             REF:   p. 827            OBJ:   8

 

  1. What are some potential problems with manually refilled heated humidifier reservoirs?
  2. cross-contamination and infection
  3. variable compliance or delivered volume
  4. delivery of dry and/or hot gases
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

Unfortunately, the use of manually refilled reservoirs requires a momentary interruption of humidifier operation and mechanical ventilation. Moreover, because the system must be “opened” for refilling, cross contamination can occur. Water levels in manually filled systems are constantly changing, so that changes in the humidifier fill volume alter the gas compression factor and thus the delivered volume during mechanical ventilation.

 

DIF:    Recall             REF:   p. 827            OBJ:   7

 

  1. Which of the following automatic feed systems are used to regulate water levels when using a humidifier with a continuous feed system?
  2. leveling reservoirs
  3. flotation controls
  4. optical sensors
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

The simplest type of automatic feed system is the level-compensated reservoir (Figure 35-8). In these systems, an external reservoir is aligned horizontally with the humidifier, maintaining relatively consistent water levels between the reservoir and the humidifier chamber. In flotation-type systems, a float rises and falls with the water level. As the water level falls below a preset value, the float opens the feed valve; as the water rises back to the set fill level, the float closes the feed valve. An optical sensor can also be used to sense water level, driving a solenoid valve to allow refilling of the humidifier reservoir.

 

DIF:    Recall             REF:   p. 828            OBJ:   7

 

  1. All of the following are contraindications for heat-moisture exchangers except:
a. presence of thick, copious, or bloody secretions
b. presence of a large leak around artificial airway
c. when a patient is suffering from hyperpyrexia
d. when a patient’s minute ventilation exceeds 10 L/min

 

 

ANS:  C

The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts appear on p. 830.

 

DIF:    Recall             REF:   p. 830            OBJ:   7

 

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

 

 

ANS:  D

The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 35-1

 

DIF:    Recall             REF:   p. 830            OBJ:   7

 

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

 

 

ANS:  C

The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 35-1.

 

DIF:    Recall             REF:   p. 830            OBJ:   7

 

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

 

 

ANS:  B

The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 35-1.

 

DIF:    Recall             REF:   p. 830            OBJ:   7

 

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

 

 

ANS:  D

The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 35-1.

 

DIF:    Application    REF:   p. 830            OBJ:   7

 

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

 

 

ANS:  B

The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 35-1.

 

DIF:    Recall             REF:   p. 830            OBJ:   7

 

  1. During routine use on an intubated patient, a heated humidifier should deliver inspired gas at which of the following?
a. temperature of 33 ± 2° C, with a minimum of 30 mg/L of water vapor
b. temperature of 37 ± 2° C, with a minimum of 44 mg/L of water vapor
c. temperature of 20 ± 2° C, with a minimum of 10 mg/L of water vapor
d. temperature of 30 ± 2° C, with a minimum of 24 mg/L of water vapor

 

 

ANS:  A

The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 35-1.

 

DIF:    Recall             REF:   p. 830            OBJ:   8

 

  1. Which of the following are the proper temperature alarm settings for a heated humidifier used during mechanical ventilation?

High   Low

a.
b.
c.
d.

 

 

ANS:  B

The AARC has published Clinical Practice Guideline: Humidification During Mechanical Ventilation. Excerpts are in CPG 35-1.

 

DIF:    Recall             REF:   p. 830            OBJ:   8

 

  1. The amount of condensation occurring in a heated, humidified gas delivery system depends on which of the following?
  2. length, diameter, and mass of the circuit
  3. temperature differential along the circuit
  4. ambient temperature
  5. rate of gas flow through the circuit
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

Factors influencing the amount of condensation include (1) the temperature difference across the system (humidifier to airway), (2) the ambient temperature, (3) the gas flow, (4) the set airway temperature, and (5) the length, diameter, and thermal mass of the breathing circuit.

 

DIF:    Recall             REF:   p. 831            OBJ:   9

 

  1. Which of the following is FALSE about heated humidifier condensate?
a. It can block or obstruct the delivery circuit.
b. It must be treated as contaminated waste.
c. It requires that circuits be drained frequently.
d. It poses minimal infection risk.

 

 

ANS:  D

Condensation can disrupt or occlude gas flow through the circuit, potentially altering FIO2 and/or ventilator function. Moreover, condensate can work its way toward the patient and be aspirated. For these reasons, circuits must be positioned to drain condensate away from the patient and must be checked often, and excess condensate must be drained from heated humidifier breathing circuits on a regular basis. Typically, patients contaminate ventilator circuits within hours, and condensate is colonized with bacteria and thus poses an infection risk. To avoid problems in this area, health care personnel should treat all breathing-circuit condensate as infectious waste.

 

DIF:    Recall             REF:   p. 831            OBJ:   9

 

  1. Which of the following barrier precautions should be used when heated humidifier circuits are changed or removed?
  2. wearing gloves
  3. wearing goggles
  4. 5-minute hand scrub
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

See Rule of Thumb p. 832.

 

DIF:    Recall             REF:   p. 832            OBJ:   9

 

  1. Which of the following are acceptable means to help minimize the problems caused by condensation in heated humidifier circuits?
  2. installing water traps in the circuit
  3. using a heated wire circuit
  4. setting heater temperature to 25° to 28° C
a. 1, 2, and 3
b. 2 and 3
c. 1 and 2
d. 1 and 3

 

 

ANS:  C

One common method is to place water traps at low points in the circuit (both the inspiratory and expiratory limbs of ventilator circuits). The most common approach uses wire heating elements inserted into the ventilator circuit.

 

DIF:    Recall             REF:   p. 832            OBJ:   9

 

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

 

 

ANS:  D

One common method is to place water traps at low points in the circuit (both the inspiratory and expiratory limbs of ventilator circuits).

 

DIF:    Recall             REF:   p. 832            OBJ:   9

 

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

 

 

ANS:  A

To minimize this risk, place nebulizers in a superior position, so that any condensate travels downstream from the nebulizer.

 

DIF:    Recall             REF:   p. 832            OBJ:   9

 

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

 

 

ANS:  A

When heated-wire circuits are used, the humidifier heats gas to a lower temperature (32° to 40° C) than it does with conventional circuits (45° to 50° C). The reduction in condensate in the tubing results in less water use, reduced need for drainage, and less infection risk for both patient and healthcare workers.

 

DIF:    Recall             REF:   p. 832            OBJ:   9

 

  1. All of the following reduce the risk of nosocomial infection when using heated humidification systems except:
a. use of wick or membrane humidifiers
b. use of heated-wire delivery circuits
c. high humidifier reservoir temperatures
d. frequent changing of delivery circuits

 

 

ANS:  D

It is now known that frequent ventilator-circuit changes actually increase the risk of nosocomial pneumonia.

 

DIF:    Recall             REF:   p. 833            OBJ:   9

 

  1. What is the most reliable indicator that the gas delivered by a servo-controlled heated-wire humidifier system is fully saturated at the airway?
a. observing no visible condensate anywhere in the delivery tubing
b. confirming an airway temperature between 32° and 35° C
c. observing a few drops of condensate at or near the patient’s airway
d. observing condensate over the full length of the delivery tubing

 

 

ANS:  C

To ensure that the inspired gas is being properly conditioned, clinicians should always adjust the temperature differential to the point that a few drops of condensation form near the patient wye. Lacking direct measurement of humidity, observation of this minimal condensate is the most reliable indicator that the gas is fully saturated at the specified temperature.

 

DIF:    Recall             REF:   p. 834            OBJ:   9

 

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

 

 

ANS:  A

To ensure that the inspired gas is being properly conditioned, clinicians should always adjust the temperature differential to the point that a few drops of condensation form near the patient wye. Lacking direct measurement of humidity, observation of this minimal condensate is the most reliable indicator that the gas is fully saturated at the specified temperature.

 

DIF:    Application    REF:   p. 834            OBJ:   9

 

  1. When checking a patient attached to a servo-controlled heated-wire humidifier breathing circuit, you notice no visible condensate anywhere in the tubing. Based on this observation, you can conclude that the relative humidity of the delivered gas is which of the following?
a. less than 25%
b. 25% to 90%
c. 90% to 100%
d. less than 100%

 

 

ANS:  D

If condensate cannot be seen, there is no way of knowing the level of relative humidity without direct measurement—it could be anywhere between 99% and 0%!

 

DIF:    Application    REF:   p. 834            OBJ:   8

 

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

 

 

ANS:  A

Lacking direct measurement of humidity, observation of this minimal condensate is the most reliable indicator that the gas is fully saturated at the specified temperature.

 

DIF:    Recall             REF:   p. 834            OBJ:   9

 

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

 

 

ANS:  A

The AARC has published Clinical Practice Guideline: Bland Aerosol Administration. Excerpts are in CPG 35-2.

 

DIF:    Recall             REF:   p. 835            OBJ:   10

 

  1. For which of the following patients would you NOT recommend bland aerosol therapy administration?
  2. patient with a history of airway hyperresponsiveness
  3. patient with a bypassed upper airway
  4. patient with active bronchoconstriction
a. 1, 2, and 3
b. 2 and 3
c. 1 and 2
d. 1 and 3

 

 

ANS:  D

The AARC has published Clinical Practice Guideline: Bland Aerosol Administration. Excerpts are in CPG 35-2.

 

DIF:    Recall             REF:   p. 835            OBJ:   10

 

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

 

 

ANS:  D

The AARC has published Clinical Practice Guideline: Bland Aerosol Administration. Excerpts are in CPG 35-2.

 

DIF:    Recall             REF:   p. 835            OBJ:   13

 

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

 

 

ANS:  B

The AARC has published Clinical Practice Guideline: Bland Aerosol Administration. Excerpts are in CPG 35-2.

 

DIF:    Recall             REF:   p. 835            OBJ:   13

 

  1. For which of the following patients might you recommend administration of a hypertonic saline aerosol?
  2. acquired immune deficiency syndrome (AIDS) patient with severe pneumonia symptoms
  3. patient with a bypassed upper airway
  4. patient suspected of having tuberculosis
a. 1, 2, and 3
b. 2 and 3
c. 1 and 2
d. 1 and 3

 

 

ANS:  D

The AARC has published Clinical Practice Guideline: Bland Aerosol Administration. Excerpts are in CPG 35-2.

 

DIF:    Application    REF:   p. 835            OBJ:   13

 

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

 

 

ANS:  B

The AARC has published Clinical Practice Guideline: Bland Aerosol Administration. Excerpts are in CPG 35-2.

 

DIF:    Recall             REF:   p. 835            OBJ:   13

 

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

 

 

ANS:  C

The large-volume jet nebulizer is the most common device used to generate bland aerosols.

 

DIF:    Recall             REF:   p. 835            OBJ:   11

 

  1. All of the following are true regarding large-volume jet nebulizers except:
a. A variable air-entrainment port allows air mixing and different FIO2 values.
b. Liquid particles are generated by mechanical vibration energy.
c. They are pneumatically powered and attach directly to a flowmeter.
d. Baffling causes impaction or removal of large, unstable particles.

 

 

ANS:  B

As depicted in Figure 35-14, these devices are pneumatically powered, attaching directly to a flow meter and compressed gas source. Liquid particle aerosols are generated by passing gas at a high velocity through a small “jet” orifice. The resulting low pressure at the jet draws fluid from the reservoir up to the top of a siphon tube, where it is sheared off and shattered into liquid particles. The large, unstable particles fall out of suspension or impact on the internal surfaces of the device, including the fluid surface (baffling). The remaining small particles leave the nebulizer through the outlet port, carried in the gas stream. A variable air-entrainment port allows air mixing to increase flow rates and to alter FIO2 levels.

 

DIF:    Recall             REF:   p. 834            OBJ:   11

 

  1. What is the total water output of unheated large-volume jet nebulizers?
a. 10 to 16 mg H2O/L
b. 16 to 25 mg H2O/L
c. 26 to 35 mg H2O/L
d. 33 to 55 mg H2O/L

 

 

ANS:  C

Depending on the design, input flow, and air-entrainment setting, the total water output of unheated large-volume jet nebulizers varies between 26 and 35 mg H2O/L.

 

DIF:    Recall             REF:   p. 836            OBJ:   11

 

  1. What is the total water output of heated large-volume jet nebulizers?
a. 16 to 25 mg H2O/L
b. 26 to 35 mg H2O/L
c. 33 to 55 mg H2O/L
d. 56 to 75 mg H2O/L

 

 

ANS:  C

When heated, output increases to between 33 and 55 mg H2O/L, mainly because of increased vapor capacity.

 

DIF:    Recall             REF:   p. 836            OBJ:   11

 

  1. Which of the following nebulizers uses a piezoelectric transducer to generate liquid particle aerosols?
a. hydrodynamic nebulizer
b. ultrasonic nebulizer
c. jet nebulizer
d. centrifugal nebulizer

 

 

ANS:  B

An ultrasonic nebulizer is an electrically powered device that uses a piezoelectric crystal to generate aerosol.

 

DIF:    Recall             REF:   p. 836            OBJ:   12

 

  1. Which of the following principles is used by the ultrasonic nebulizer to produce aerosol droplets?
a. evaporative cooling
b. mechanical baffling
c. fractional distillation
d. high-frequency vibrations

 

 

ANS:  D

This crystal transducer converts radio waves into high-frequency mechanical vibrations (sound).

 

DIF:    Recall             REF:   p. 836            OBJ:   12

 

  1. Which of the following are components of an ultrasonic nebulizer?
  2. air-entrainment orifice
  3. radiofrequency generator
  4. nebulizer chamber
  5. piezoelectric transducer
  6. blower or fan
a. 1, 3, and 4
b. 2, 3, 4, and 5
c. 1, 2, 3, 4, and 5
d. 3, 4, and 5

 

 

ANS:  B

See Figure 35-15.

 

DIF:    Recall             REF:   p. 836            OBJ:   12

 

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

 

 

ANS:  C

The frequency at which the crystal vibrates, preset by the manufacturer, determines aerosol particle size.

 

DIF:    Recall             REF:   p. 836            OBJ:   12

 

  1. Which of the following mean mass aerodynamic diameter (MMAD) aerosol suspensions is produced by an ultrasonic nebulizer operated at 1.25 MHz?
a. 1 to 2 mm
b. 6 to 10 mm
c. 4 to 6 mm
d. less than 1 mm

 

 

ANS:  C

A nebulizer operating at 1.25 MHz produces an aerosol with an MMAD of between 4 and 6 mm.

 

DIF:    Recall             REF:   p. 836            OBJ:   12

 

  1. The aerosol output (in mg/L) of an ultrasonic nebulizer depends mainly on which of the following?
a. signal amplitude
b. chamber baffling
c. source current
d. signal frequency

 

 

ANS:  A

Amplitude affects water output.

 

DIF:    Recall             REF:   p. 836            OBJ:   12

 

  1. To produce the highest possible density aerosol from an ultrasonic nebulizer, how would you set the controls?

Amplitude      Flow

a.
b.
c.
d.

 

 

ANS:  B

See Rule of Thumb p. 837.

 

DIF:    Recall             REF:   p. 837            OBJ:   12

 

  1. For which of the following patients might you recommend bland aerosol therapy via an ultrasonic nebulizer (USN)?
  2. patient with upper airway edema
  3. patient with a bypassed upper airway
  4. patient who must provide a sputum specimen
a. 1, 2, and 3
b. 2 and 3
c. 2
d. 3

 

 

ANS:  D

Exceptions include the use of the USN for sputum induction where the high output (1 to 5 ml/min) and aerosol density seems to yield higher quantity and quality of sputum specimens for analysis, but at some cost increased airway reactivity.

 

DIF:    Application    REF:   p. 837            OBJ:   12

 

  1. How often would you recommend that a home care patient disinfect a home ultrasonic room humidifier?
a. per manufacturer’s specifications, or at least every day
b. per manufacturer’s specifications, or at least every 3 days
c. per manufacturer’s specifications, or at least every 6 days
d. per manufacturer’s specifications, or at least every 2 weeks

 

 

ANS:  C

In the absence of a manufacturer’s recommendation, these units should undergo appropriate disinfection at least every 6 days.

 

DIF:    Application    REF:   p. 837            OBJ:   13

 

  1. A physician orders bland water aerosol administration to a patient with an intact upper airway. Which of the following airway appliances could you use to meet this goal?
  2. simple oxygen mask
  3. face tent
  4. T-tube
  5. aerosol mask
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 2, 3, and 4

 

 

ANS:  A

Airway appliances used to deliver bland aerosol therapy include the aerosol mask, face tent, T-tube, and tracheostomy mask.

 

DIF:    Application    REF:   p. 837            OBJ:   12

 

  1. A physician orders bland water aerosol administration to a patient with a tracheostomy. Which of the following airway devices could you use to meet this goal?
  2. tracheostomy mask
  3. face tent
  4. T-tube
  5. aerosol mask
a. 2 and 4
b. 1, 2, and 3
c. 1 and 3
d. 2, 3, and 4

 

 

ANS:  C

The T-tube is used for patients who are orally or nasally intubated or who have a tracheostomy. The tracheostomy mask is used solely for patients who have a tracheostomy.

 

DIF:    Application    REF:   p. 837            OBJ:   12

 

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

 

 

ANS:  A

Infants and small children may not readily tolerate direct airway appliances such as masks, so enclosures such as mist tents and aerosol hoods are used to deliver bland aerosol therapy to these patients.

 

DIF:    Application    REF:   p. 837            OBJ:   12

 

  1. What are some problems common to mist tents?
  2. heat retention
  3. CO2 buildup
  4. hypothermia
a. 1, 2, and 3
b. 1 and 2
c. 2 and 3
d. 1 and 3

 

 

ANS:  B

Any body enclosure poses two problems: CO2 build-up and heat retention.

 

DIF:    Recall             REF:   p. 838            OBJ:   13

 

  1. All mist tents prevent CO2 buildup by what process?
a. recirculating the gas
b. providing high gas flows
c. using CO2 absorbers
d. cooling the gas

 

 

ANS:  B

CO2 build-up can be reduced by providing sufficiently high gas flow rates.

 

DIF:    Recall             REF:   p. 838            OBJ:   13

 

  1. Which of the following measures can help to ensure a good sputum sample?
a. using an ultrasonic nebulizer instead of a jet nebulizer
b. using a 5% saline solution instead of a 3% concentration
c. having the patient rinse the mouth or blow the nose before induction
d. using the lowest possible aerosol density (high flow and low output)

 

 

ANS:  C

To ensure a good sputum sample, every effort must be made to separate saliva from true respiratory tract secretions. In some cases, protocols include having patients brush their teeth and tongue surface thoroughly and rinse their mouths before sputum induction.

 

DIF:    Recall             REF:   p. 838            OBJ:   14

 

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

 

 

ANS:  D

See Box 35-5.

 

DIF:    Recall             REF:   p. 838            OBJ:   14

 

  1. To minimize problems with environmental safety when aerosol therapy is prescribed for immunosuppressed patients or those with tuberculosis, what precautions should you follow?
  2. those for tuberculosis exposure
  3. Centers for Disease Control and Prevention (CDC) standards and contact precautions
  4. CDC standards and airborne precautions
a. 1, 2, and 3
b. 1 and 2
c. 2 and 3
d. 1 and 3

 

 

ANS:  A

To minimize problems in this area, all clinicians should strictly follow CDC standards and airborne precautions, including those specified for control of exposure to tuberculosis.

 

DIF:    Application    REF:   p. 839            OBJ:   13

 

  1. Causes of inadequate mist production with pneumatically powered jet nebulizers include all of the following except:
a. inadequate input flow
b. siphon tube obstruction
c. jet orifice misalignment
d. tripped circuit breaker

 

 

ANS:  D

With pneumatically powered jet nebulizers, poor mist production can be caused by inadequate input flow of driving gas, siphon tube obstruction, or jet orifice misalignment.

 

DIF:    Recall             REF:   p. 839            OBJ:   13

 

  1. An ultrasonic nebulizer is not putting out any mist. After confirming (a) a good electrical power supply (cord, plug, and circuit breakers are in good working order), (b) that carrier gas is actually flowing through the device, and (c) that the output control is set at maximum, what should you do?
a. Take the unit out of service and send it to engineering for repair.
b. Inspect the couplant chamber to confirm cleanliness and fill level.
c. Disassemble the radiofrequency generator and test for electrical leakage.
d. Hook it up the chamber inlet to a flowmeter set at 10 L/min or higher.

 

 

ANS:  B

If there is still no visible mist output, the clinician should inspect the couplant chamber to confirm proper fill level and the absence of any visible dirt or debris.

 

DIF:    Application    REF:   p. 839            OBJ:   13

 

  1. The risk of overhydration with continuous delivery of bland water aerosols is greatest among which patient group?
  2. patients with fluid or electrolyte imbalances
  3. patients with fever and infection
  4. infants and small children
a. 1, 2, and 3
b. 1 and 2
c. 2 and 3
d. 1 and 3

 

 

ANS:  D

The risk of overhydration is highest for infants, small children, and those with preexisting fluid or electrolyte imbalances.

 

DIF:    Recall             REF:   p. 839            OBJ:   13

 

  1. After administering a 30-minute bland water aerosol treatment to a dehydrated elderly patient with chronic bronchitis, you note increased wheezing and a general decrease in the intensity of breath sounds. Which of the following has probably occurred?
a. Reactive bronchospasm has occurred and worsened airway obstruction.
b. Inspissated secretions have swollen and worsened airway obstruction.
c. Nothing; this is a normal response to bland aerosol therapy.
d. The patient is developing atelectasis due to overhydration.

 

 

ANS:  B

In addition to overhydration of the patient, inspissated pulmonary secretions also can swell after high-density aerosol therapy, worsening airway obstruction.

 

DIF:    Analysis         REF:   p. 839            OBJ:   13

 

  1. A patient with chronic obstructive pulmonary disease (COPD) is receiving heated water aerosol treatments through a jet nebulizer four times daily as a supplement to other bronchial hygiene measures designed to aid in mobilizing retained secretions. After each session, you notice the presence of moderate wheezing. Which of the following recommendations would you make to the physician?
a. Discontinue the heated water aerosol treatments.
b. Consider prior treatment with a bronchodilator.
c. Switch to a higher-density aerosol (e.g., ultrasonic).
d. Discontinue the other bronchial hygiene measures.

 

 

ANS:  B

If the physician still requests bland aerosol therapy for such a patient, pretreatment with a bronchodilator may be needed.

 

DIF:    Application    REF:   p. 839            OBJ:   15

 

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

 

 

ANS:  A

The best way to avoid this problem and further minimize infection risks is to use heated passover humidification instead of nebulization.

 

DIF:    Application    REF:   p. 839            OBJ:   15

 

  1. Key considerations in selecting or recommending humidity or bland aerosol therapy for a patient include which of the following?
  2. required gas flow
  3. presence of an artificial tracheal airway
  4. character of pulmonary secretions
  5. need for or duration of mechanical ventilation
  6. presence of heat-moisture exchanger (HME) contraindications
a. 2, 3, and 4
b. 1, 2, and 3
c. 3, 4, and 5
d. 1, 2, 3, 4, and 5

 

 

ANS:  D

Key considerations include (1) gas flow, (2) presence or absence of an artificial tracheal airway, (3) character of the pulmonary secretions, (4) need for and expected duration of mechanical ventilation, and (5) contraindications to using an HME.

 

DIF:    Recall             REF:   p. 839            OBJ:   15

 

  1. In general, to deliver oxygen to the upper airway, a bubble humidifier is required only when the gas flow exceeds which of the following?
a. 1 L/min
b. 2 L/min
c. 3 L/min
d. 4 L/min

 

 

ANS:  D

Regarding delivery of oxygen to the upper airway, the American College of Chest Physicians advises against using a bubble humidifier at flow rates of 4 L/min or less.

 

DIF:    Recall             REF:   p. 839            OBJ:   15

 

  1. A patient receiving nasal oxygen at 3 L/min complains of nasal dryness and irritation. Which of the following actions would be appropriate?
a. recommending that the flow be decreased to 2 L/min
b. adding a humidifier to the delivery system
c. recommending that the flow be increased to 4 L/min
d. switching to a simple mask at 3 L/min

 

 

ANS:  B

For the occasional patient who complains of nasal dryness or irritation when receiving low-flow oxygen, a humidifier should be added to the delivery system.

 

DIF:    Application    REF:   p. 839-840     OBJ:   15