Student Review Questions, Chapter 25, Respiratory Care Modalities
1.
Of the following oxygen administration devices, which has the advantage of providing
high oxygen concentration?
*Non-rebreather mask
Venturi mask
Catheter
.
Face tent
The non-rebreather mask provides high oxygen concentration but it is usually poor
fitting. The Venturi mask provides low levels of supplemental oxygen. The catheter is
an inexpensive device that provides a variable fraction of inspired oxygen and may cause
gastric distention. A face tent provides a fairly accurate fraction of inspired oxygen, but
is bulky and uncomfortable. It would not be the device of choice to provide high oxygen
concentration.
2.
Which of the following ranges of water pressure identifies the amount of pressure within
the endotracheal tube cuff that is believed to prevent both injury and aspiration?
10 to15 mm Hg
30 to 35 mm Hg
0 to 5 mm Hg
*20 to 25 mm Hg
Usually the pressure is maintained at less than 25 cm water pressure to prevent injury and
at more than 20 cm water pressure to prevent aspiration. A measure of 10 to 15 mm Hg
of water pressure would indicate that the cuff is underinflated. A measure of 30 to 35
mm Hg of water pressure would indicate that the cuff is overinflated. A measure of 0 to
5 mm Hg of water pressure would indicate that the cuff is underinflated.
3.
When performing endotracheal suctioning, the nurse applies suctioning while
withdrawing and gently rotating the catheter 360 degrees for which of the following time
periods?
0 to 5 seconds
*10 to 15 seconds
30 to 35 seconds
20 to 25 seconds
In general, the nurse should apply suction no longer than 10 to15 seconds because
hypoxia and dysrhythmias may develop, leading to cardiac arrest. Applying suction for
30 to 35 seconds is hazardous and may result in the patient's developing hypoxia, which
can lead to dysrhythmias and, ultimately, cardiac arrest. Applying suction for 20 to 25
seconds is hazardous and may result in the patient's developing hypoxia, which can lead
to dysrhythmias and, ultimately, cardiac arrest. Applying suction for 0 to 5 seconds
would provide too little time for effective suctioning of secretions.
4.
In general, chest drainage tubes are not used for the patient undergoing
lobectomy.
*pneumonectomy.
wedge resection.
segmentectomy.
Usually, no drains are used for the pneumonectomy patient because the accumulation of
fluid in the empty hemothorax prevents mediastinal shift. With lobectomy, two chest
tubes are usually inserted for drainage, the upper tube for air and the lower tube for fluid.
With wedge resection, the pleural cavity usually is drained because of the possibility of
an air or blood leak. With segmentectomy, drains are usually used because of the
possibility of an air or blood leak.
5.
Which of the following is the most reliable and accurate method for delivering precise
concentrations of oxygen through noninvasive means?
Nasal cannula
*Venturi mask
T-piece
Partial-rebreathing mask
The Venturi mask is the most reliable and accurate method for delivering a precise
concentration of oxygen through noninvasive means. Nasal cannula, T-piece, and partialrebreathing masks are not the most reliable and accurate methods of oxygen
administration.
6.
Which type of oxygen therapy includes the administration of oxygen at pressure greater
than 1 atmosphere?
Low-flow systems
*Hyperbaric
High-flow systems
Transtracheal
Hyperbaric oxygen therapy is the administration of oxygen at pressures greater than 1
atmosphere. As a result, the amount of oxygen dissolved in plasma is increased, which
increases oxygen levels in the tissues. Low-flow systems contribute partially to the
inspired gas the patient breathes, which means that the patient breathes some room air
along with the oxygen. High-flow systems are indicated for patients who require a
constant and precise amount of oxygen. During transtracheal oxygenation, patients
achieve adequate oxygenation at lower rates, making this method less expensive and
more efficient.
7.
Which of the following is a correct endotracheal tube cuff pressure?
13 mm Hg
*17 mm Hg
21 mm Hg
25 mm Hg
Cuff pressures should be checked with a calibrated aneroid manometer device every 6 to
8 hours to maintain cuff pressures between 15 and 20 mm Hg. The other values are not
within the normal range for adequate cuff pressure.
8.
Which type of ventilator has a present volume of air to be delivered with each
inspiration?
Negative-pressure
*Volume-controlled
Time-cycled
Pressure-cycled
With volume-controlled ventilation, the volume of air to be delivered with each
inspiration is present. Negative pressure ventilators exert a negative pressure on the
external chest. Time-cycled ventilators terminate or control inspiration after a preset
time. When the pressure-cycled ventilator cycles on, it delivers a flow of air (inspiration)
until it reaches a present pressure, and then cycles off, and expiration occurs passively.
9.
Which of the following statements would not be considered an appropriate intervention
for a patient with an ET tube?
Cuff is deflated prior to tube removal
*Routine cuff deflation is recommended
Cuff pressures should be checked every 6 to 8 hours
Humidified oxygen should always be introduced through the tube
Routine cuff deflation is not recommended because of the increased risk for aspiration
and hypoxia. The cuff is deflated before the endotracheal tube is removed. Cuff
pressures should be checked every 6 to 8 hours. Humidified oxygen should always be
introduced through the tube.
10.
Which of the following is a potential complication of a low pressure in the ET cuff?
Tracheal bleeding
*Aspiration pneumonia
Tracheal ischemia
Pressure necrosis
Low pressure in the cuff can increase the risk for aspiration pneumonia. High cuff
pressure can cause tracheal bleeding, ischemia, and pressure necrosis.
11.
Which ventilator mode provides a combination of mechanically assisted breaths and
spontaneous breaths?
*Intermittent mandatory ventilation (IMV)
Assist-control
Synchronized intermittent mandatory ventilation (SIMV)
Pressure support
Intermittent mandatory ventilation (IMV) provides a combination of mechanically
assisted breaths and spontaneous breaths. Assist-control ventilation provides full
ventilator support by delivering a preset tidal volume and respiratory rate. SIMV delivers
a preset tidal volume and number of breaths per minute. Between ventilator-delivered
breaths, the patient can breathe spontaneously with no assistance from the ventilator for
those extra breaths. Pressure support ventilation assists SIMV by applying a pressure
plateau to the airway throughout the patient-triggered inspiration to decrease resistance
within the tracheal tube and ventilator tubing.
12.
Which ventilator mode provides full ventilatory support by delivering a present tidal
volume and respiratory rate?
IMV
SIMV
*Assist-control
Pressure support
Assist-control ventilation provides full ventilator support by delivering a preset tidal
volume and respiratory rate. Intermittent mandatory ventilation (IMV) provides a
combination of mechanically assisted breaths and spontaneous breaths. SIMV delivers a
preset tidal volume and number of breaths per minute. Between ventilator-delivered
breaths, the patient can breathe spontaneously with no assistance from the ventilator for
those extra breaths.
13.
Arterial blood gases should be obtained at which timeframe following the initiation of
continuous mechanical ventilation?
10 minutes
15 minutes
*20 minutes
25 minutes
ABGs should be obtained to measure carbon dioxide partial pressure (PaCO2), pH, and
PaO2 after 20 minutes of continuous mechanical ventilation.
14.
Which of the following would indicate a decrease in pressure with mechanical
ventilation?
Kinked tubing
*Increase in compliance
Decrease in lung compliance
Plugged airway tube
A decrease in pressure in the mechanical ventilator may be caused by an increase in
compliance. Kinked tubing and decreasing lung compliance, and a plugged airway tube
cause an increase in peak airway pressure.
15.
Which of the following is an adverse reaction that would require termination of the
weaning process from the ventilator?
*Blood pressure increase of 20 mm Hg
PaO2 greater than 60 mmHg with a FiO2 less than 40%
Heart rate less than 100
Vital capacity of 12 mL/kg
Criteria for termination of the weaning process includes: heart rate increase of 20 beats
per minute, and systolic blood pressure increase of 20 mm Hg. A normal vital capacity is
10 to 15 mL/kg.
16.
Constant bubbling in the water seal of a chest drainage system indicates which of the
following problems?
*Air leak
Tidaling
Tension pneumothorax
Increased drainage
The nurse needs to observe for air leaks in the drainage system; they are indicated by
constant bubbling in the water seal chamber, or by the air leak indicator in dry systems
with a one-way valve. Tidaling is fluctuation of the water level in the water seal that
shows effective connection between the pleural cavity and the drainage chamber and
indicates that the drainage system remains patent.