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

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

 

Chapter 02: Quality and Evidence-Based Respiratory Care

Test Bank

 

MULTIPLE CHOICE

 

  1. Quality in the practice of respiratory care encompasses which of the following?
a. personnel performing care
b. equipment used
c. method or manner in which care is provided
d. level of experience of respiratory care providers
e. all of the above

 

 

ANS:  E

Quality, as applied to the practice of respiratory care, is multidimensional. It encompasses the personnel who perform respiratory care, the equipment used, and the method or manner in which care is provided.

 

DIF:    Recall             REF:   p. 20              OBJ:   1

 

  1. Who is professionally responsible for the clinical function of the respiratory care department?
a. shift supervisor
b. department head
c. medical director
d. clinical supervisor
e. senior pulmonologist

 

 

ANS:  C

The medical director of respiratory care is professionally responsible for the clinical function of the department and provides oversight of the clinical care that is delivered (Box 2-1).

 

DIF:    Recall             REF:   p. 21              OBJ:   1

 

  1. What is the most essential aspect of providing quality respiratory care?
a. Care being provided is indicated.
b. Care is delivered competently and appropriately.
c. Patient is appropriately evaluated by physician before care is initiated.
d. A and B.
e. A, B, and C.

 

 

ANS:  D

The medical director of respiratory care is professionally responsible for the clinical function of the department and provides oversight of the clinical care that is delivered (Box 2-1).

 

DIF:    Recall             REF:   p. 21              OBJ:   2

 

  1. The medical director of respiratory care is responsible for all the following except:
a. supervision of ongoing quality assurance activities
b. supervision of respiratory therapists performing pulmonary function testing
c. participation in the selection and promotion of technical staff
d. medical direction of the in-service and educational programs
e. establishment of safety and equipment effectiveness standards

 

 

ANS:  E

Perhaps the most essential aspect of providing quality respiratory care is to ensure that the care being provided is indicated and that it is delivered competently and appropriately.

 

DIF:    Recall             REF:   p. 21              OBJ:   1

 

  1. What is the chief reason that respiratory care protocols were developed and are currently being used in hospitals throughout North America?
a. enhance proper allocation of respiratory care services
b. decrease patient care costs to hospitals and insurance companies
c. expand patient care skills among respiratory care providers
d. enhance efficiency of respiratory care personnel in providing patient care
e. justify reasons for increasing patient care costs

 

 

ANS:  A

Misallocation has led to the use of respiratory care protocols that are implemented by respiratory therapists (as described under “Methods for Enhancing the Quality of Respiratory Care”).

 

DIF:    Application    REF:   p. 21              OBJ:   1

 

  1. Which of the following factors is important in determining the quality of care delivered by a respiratory therapist?
a. education
b. experience
c. training
d. all the above
e. none of the above

 

 

ANS:  D

The quality of respiratory therapists depends primarily on their training, education, experience, and professionalism.

 

DIF:    Recall             REF:   p. 21              OBJ:   1

 

  1. For the CRT credential, what does the letter “T” stand for?
a. therapist
b. technician
c. trainee
d. teacher
e. none of the above

 

 

ANS:  A

Currently, there are two levels of general practice credentialing in respiratory care: (1) certified respiratory therapists (CRTs) and (2) registered respiratory therapists (RRTs).

 

DIF:    Recall             REF:   p. 21              OBJ:   1

 

  1. Respiratory care education programs are reviewed by which committee to ensure quality?
a. Committee for Accreditation of Respiratory Care
b. American Association for Respiratory Care Education
c. Joint Review Committee Respiratory Care Education
d. Respiratory Care Education Committee
e. none of the above

 

 

ANS:  A

Respiratory care education programs are reviewed by the Committee on Accreditation for Respiratory Care (CoARC).

 

DIF:    Recall             REF:   p. 22              OBJ:   1

 

  1. The word “credentialing” in general refers to what?
a. recognition of an individual in the profession
b. licensure by a state or national organization
c. successful completion of entry-level board examination
d. voluntary certification by state agency
e. not used in the field of respiratory care

 

 

ANS:  A

“Credentialing” is a general term that refers to the recognition of individuals in particular occupations or professions.

 

DIF:    Recall             REF:   p. 23              OBJ:   1

 

  1. What term is used to describe the process in which a government agency gives an individual permission to practice an occupation?
a. certification
b. licensure
c. registry
d. credentialing
e. none of the above

 

 

ANS:  B

Licensure is the process in which a government agency gives an individual permission to practice an occupation.

 

DIF:    Recall             REF:   p. 23              OBJ:   1

 

  1. What agency is responsible for ensuring quality in respiratory care through voluntary certification and registration?
a. JRCRTE
b. CoARC
c. NBRC
d. AARC
e. CAAHE

 

 

ANS:  C

The primary method of ensuring quality in respiratory care is voluntary certification or registration conducted by the National Board for Respiratory Care (NBRC).

 

DIF:    Recall             REF:   p. 23              OBJ:   1

 

  1. What organization is responsible for credentialing respiratory therapists?
a. AARC
b. ATS
c. NBRC
d. ACCP
e. all the above

 

 

ANS:  C

The primary method of ensuring quality in respiratory care is voluntary certification or registration conducted by the National Board for Respiratory Care (NBRC).

 

DIF:    Recall             REF:   p. 23              OBJ:   1

 

  1. Which of the following is/are characteristics of a respiratory care professional?
a. participates in continuing education activities
b. obtains professional credentials
c. adheres to a code of ethics
d. completes an accredited education program
e. all of the above

 

 

ANS:  E

A professional is characterized as an individual conforming to the technical and ethical standards of a profession. Respiratory therapists demonstrate their professionalism by maintaining the highest practice standards, by engaging in ongoing learning, by conducting research to advance the quality of respiratory care, and by participating in organized activities through professional societies such as the American Association for Respiratory Care and associated state societies. Box 2-3 lists the professional attributes of a respiratory therapist.

 

DIF:    Recall             REF:   p. 24              OBJ:   1

 

  1. HIPAA was established in 1996 to set standards related to sharing confidential health history information about patients. What does the letter “P” stand for?
a. privacy
b. portability
c. patient
d. protection
e. people

 

 

ANS:  B

HIPAA is the Health Insurance Portability and Accountability Act.

 

DIF:    Recall             REF:   p. 26              OBJ:   1

 

  1. Responsibility for the technical direction of a respiratory care department lies with whom?
a. medical director
b. department manager
c. hospital administrator
d. shift supervisor
e. hospital biomedical engineering department

 

 

ANS:  B

Technical direction is often the responsibility of the manager of a respiratory care department, who must make sure the equipment and the associated protocols and procedures have sufficient quality to ensure the safety, health, and welfare of the patient using the equipment.

 

DIF:    Recall             REF:   p. 24              OBJ:   1

 

  1. The responsibilities of a respiratory care department manager include all of the following except:
a. check that medical devices function at an appropriate and safe level
b. develop respiratory care protocols and procedures
c. regulate medications delivered by respiratory care staff
d. maintain knowledge of changes in medications and delivery devices
e. evaluate new devices and methods for effectiveness commensurate with cost

 

 

ANS:  C

Those responsible for technical direction must be certain that these new devices, methods, and strategies not only are effective but also deliver a benefit commensurate with the cost.

 

DIF:    Recall             REF:   p. 24              OBJ:   2

 

  1. Which of the following is a key element of a respiratory care protocol program?
a. strong and committed medical direction
b. collaborative environment among health care providers
c. responsiveness to address and correct problems
d. capable therapists
e. all of the above

 

 

ANS:  E

The success of a respiratory care protocol program requires several key elements including active and committed medical direction, capable respiratory therapists, collaboration with physicians and nurses, careful monitoring, and a responsive hospital environment. (Box 2-5).

 

DIF:    Recall             REF:   p. 27              OBJ:   2

 

  1. Which of the following is an essential element of a comprehensive protocol program?
a. carefully structured assessment tool and care plan form
b. active quality monitoring
c. comprehensive delineation of boundaries between respiratory care, nursing, and physician personnel
d. both B and C
e. none of the above

 

 

ANS:  A

A carefully structured assessment tool and care plan form (Figures 2-3 and 2-4) are essential elements for a comprehensive protocol program.

 

DIF:    Application    REF:   p. 28              OBJ:   2

 

  1. What voluntary accrediting agency monitors quality in respiratory care departments?
a. JRCRTE
b. AARC
c. FDA
d. The Joint Commission
e. AMA

 

 

ANS:  D

The Joint Commission requires a hospital service to have a quality assurance plan to provide a system for controlling quality.

 

DIF:    Recall             REF:   p. 31              OBJ:   1

 

  1. Current Joint Commission standards for accreditation emphasize which of the following?
a. continual quality improvement
b. therapist-driven protocols
c. license and registration of health care providers
d. health, welfare, and safety of patients using respiratory care equipment
e. development of continuing education programs for health care providers

 

 

ANS:  A

Current Joint Commission standards for accreditation emphasize organization-wide efforts for continuous quality improvement (CQI).

 

DIF:    Application    REF:   p. 31              OBJ:   1

 

  1. To monitor correctness of respiratory care plans, which of the following should be used?
a. nursing care plans
b. physician progress notes
c. care plan auditors and case study exercises
d. daily patient rounds with medical director
e. regular multidisciplinary patient rounds

 

 

ANS:  C

Specific methods to monitor the quality of respiratory care protocol programs include conducting care plan audits in real time and ensuring practitioner training by using case study exercises.

 

DIF:    Application    REF:   p. 33              OBJ:   2

 

  1. Respiratory care plans may be monitored by which of the following?
a. experienced care plan auditors
b. computerized case study exercises
c. patient scenarios
d. comparison of therapist’s patient assessment with the department’s “gold standard” assessment
e. all of the above

 

 

ANS:  E

The assessment sheets and the care plans are then compared with the “gold standard,” or correct assessments and care plans as determined by the consensus of the education coordinator and the supervisors.

 

DIF:    Recall             REF:   p. 33              OBJ:   3

 

  1. What system has the federal government developed to evaluate the quality of care given to Medicare beneficiaries?
a. hospital restructuring and design
b. patient-focused care
c. peer review organizations (PROs)
d. protocols
e. case study reviews

 

 

ANS:  C

In addition to the voluntary accreditation process that health care organizations use to help ensure that patients are receiving quality care, the federal government has established an elaborate system of PROs to evaluate the quality and appropriateness of care given to Medicare beneficiaries.

 

DIF:    Recall             REF:   p. 33              OBJ:   2

 

  1. Hospital restructuring and redesign have involved all of the following except:
a. cross-training employees and using unlicensed assistive staff
b. nursing unit having its own admitting and medical laboratory facilities
c. downsizing and decentralizing high-budget, labor-intensive departments
d. deploying respiratory care personnel to individual nursing units
e. training multiskilled assistive personnel to perform basic patient care

 

 

ANS:  B

Approaches for restructuring commonly include cross-training employees, using unlicensed assistive staff, and decentralizing services by bringing them directly to the patient.

 

DIF:    Application    REF:   p. 33              OBJ:   3

 

  1. The effectiveness of the patient-focused care model has been limited by which one of the following?
a. requirement that each nursing unit has its own admitting, x-ray unit, medical laboratory, pharmacy, and physical therapy facilities
b. reduction of the number of health care providers for patients
c. expense of relocating radiology, pharmacy, and laboratory services to nursing units
d. assignment of cross-trained personnel to specific units
e. expense of training multiskilled personnel to perform patient care

 

 

ANS:  C

The obvious challenges of the patient-focused care model (e.g., decentralizing equipment, extensive cross-training, etc.) explain its very limited adoption.

 

DIF:    Application    REF:   p. 33              OBJ:   2

 

  1. What is one advantage that has been shown of respiratory care protocols?
a. increase in the number of procedures performed by respiratory care providers
b. decrease in the overordering of respiratory care services
c. decrease in the cost savings to respiratory care departments
d. decrease in the cost of performing each respiratory care procedure
e. decrease in the demand for qualified respiratory care providers

 

 

ANS:  B

Most studies show a significant decrease in overordering respiratory care services.

 

DIF:    Application    REF:   p. 35              OBJ:   2

 

  1. What term is used in current healthcare that refers to an organized strategy of delivering care to a large group of individuals?
a. patient-focused care
b. protocol-based medicine
c. disease management
d. evidence-based medicine

 

 

ANS:  C

Disease management refers to an organized strategy of delivering care to a large group of individuals with chronic disease in order to improve outcomes and reduce cost.

 

DIF:    Recall             REF:   p. 36              OBJ:   4

 

  1. Treatment based on careful review of available literature is known as:
a. evidence-based medicine
b. protocol-based medicine
c. review-based medicine
d. team health care

 

 

ANS:  A

Evidence-based medicine refers to an approach to determining optimal clinical management based on several practices.

 

DIF:    Recall             REF:   p. 36              OBJ:   5

 

  1. What term is used to describe the work done by a researcher who reviews numerous studies on a single topic and gives more weight to the more rigorous ones before making recommendations?
a. state-of-the-art paper
b. meta-analysis
c. alpha review
d. apical review
e. none of the above

 

 

ANS:  B

Meta-analyses assess the quality of available evidence and gives weight to better-designed, more rigorous studies.

 

DIF:    Recall             REF:   p. 38              OBJ:   5

 

  1. How are competencies being used to monitor the quality of respiratory care?
a. They focus on cost saving strategies.
b. They are used to check the skill and knowledge of respiratory through the use of clinical simulations.
c. They are used to educate therapist on new treatments and procedures.
d. They are used to review protocols

 

 

ANS:  B

The purpose of competencies is to check for having suitable and sufficient skills, knowledge and experience for specific tasks.

 

DIF:    Recall             REF:   p. 31              OBJ:   3

 

  1. Which organization is an emerging model of health care providers that work to meet quality and care targets, receive and disburse payments?
a. NBRC
b. CDC
c. ACO
d. The Joint Commission

 

 

ANS:  C

Accountable care organizations (ACOs) is an emerging group of health care providers that work to enhance the quality of care, receive payments, and lessen costs.

 

DIF:    Recall             REF:   p. 33              OBJ:   2

 

  1. What is/are the essential components comprise disease management programs?
a. an integrated healthcare system that can provide a full range of a patient’s needs
b. a knowledge regarding prevention, diagnosis, and treatment of diseases
c. a commitment to CQI
d. a sophisticated clinical and administrative information system that helps assess patterns in the clinical practice
e. all of the above

 

 

ANS:  E

All of the above are the essential components for a disease management team to be successful at meeting the clinical needs of the patients and hospital.

 

DIF:    Recall             REF:   p. 33              OBJ:   4

 

  1. What is a cohort study?
a. comparing the clinical outcomes from two different groups
b. single patient study
c. a literature-based review
d. collection of patients with similar clinical situations

 

 

ANS:  A

Cohort studies, which compare the clinical outcomes in two compared groups (or cohorts), generally have greater scientific rigor than case studies or case series and consist of two broad types of study designs: observational cohort studies and randomized controlled trials.

 

DIF:    Recall             REF:   p. 36              OBJ:   5

 

  1. What are the key outcomes that are looked at in different types of studies?
a. patient survival
b. discharge from ICU
c. organ system failure
d. all of the above

 

 

ANS:  D

All three are important key out comes that are evaluated and compared when looking at study results.

 

DIF:    Recall             REF:   p. 37              OBJ:   5

Chapter 04: Principles of Infection Prevention and Control

Test Bank

 

MULTIPLE CHOICE

 

  1. About how many people die each year in the United States from hospital-acquired infections (HAIs)?
a. 5,000
b. 25,000
c. 99,000
d. 250,000

 

 

ANS:  C

HAIs account for an estimated 1.7 million infections; $4.5 billion in costs, and 99,000 excess deaths annually.

 

DIF:    Recall             REF:   p. 62              OBJ:   1

 

  1. Approximately what percent of patients receiving mechanical ventilation develop pneumonia as a complication?
a. 1%
b. 10%
c. 15%
d. 25%

 

 

ANS:  D

Approximately 25% of patients undergoing mechanical ventilation develop pneumonia.

 

DIF:    Recall             REF:   p. 62              OBJ:   1

 

  1. Which of the following is considered the primary source of infection in the health care setting?
a. medical equipment
b. humans
c. food and water
d. carpet

 

 

ANS:  B

Humans (patients, personnel, or visitors) are the primary source for infectious agents in the health care setting

 

DIF:    Recall             REF:   p. 62              OBJ:   1

 

  1. How do endotracheal tubes increase the risk of infection?
a. impeding local host defenses
b. providing surfaces for biofilms to develop
c. by reducing neutrophil effectiveness
d. both A and B

 

 

ANS:  D

Endotracheal tubes allow pathogens to increase the risk of infection by impeding local host defenses and providing biofilms that may facilitate adherence of pathogens.

 

DIF:    Application    REF:   p. 62              OBJ:   5

 

  1. All of the following factors increase the risk of surgical patients for developing postoperative pneumonia except:
a. obesity
b. prolonged intubation
c. history of smoking
d. strong cough

 

 

ANS:  D

Patients at highest risk include elderly persons, the severely obese, those with chronic obstructive pulmonary disease (COPD) or a history of smoking, and those having an artificial airway in place for long periods. Strong cough mechanism actually helps to prevent atelectasis and pneumonia

 

DIF:    Recall             REF:   p. 63              OBJ:   4

 

  1. What is the most common route of pathogen transmission in the hospital setting?
a. indirect contact
b. droplet transmission
c. airborne transmission
d. surgical transmission

 

 

ANS:  A

Indirect contact transmission is the most frequent mode of transmission in the health care environment

 

DIF:    Recall             REF:   p. 63              OBJ:   3

 

  1. Which of the following is an example of indirect contact transmission involving fomites?
a. use of a sterile needle on a pneumonia patient
b. use of a dirty nebulizer on another patient
c. drinking tap water
d. inhaling tuberculosis pathogens in the emergency department

 

 

ANS:  B

Instruments that have been inadequately cleaned between patients before disinfection or sterilization are an example of indirect contact transmission involving fomites.

 

DIF:    Application    REF:   p. 63              OBJ:   3

 

  1. If you are caring for a patient who is suspected of having SARS, at what distance from the patient is it recommended to wear an effective filtration mask?
a. 6 feet
b. 10 feet
c. 12 feet
d. 15 feet

 

 

ANS:  A

Current HICPAC guidelines state it may be prudent to don a mask when within 6 feet of the patient or upon entry into the room of a patient who is on droplet isolation.

 

DIF:    Application    REF:   p. 63              OBJ:   9

 

  1. Which of the following diseases is transmitted primarily by airborne transmission?
a. tuberculosis
b. measles
c. smallpox
d. all the above

 

 

ANS:  D

The pathogens transmitted by the airborne route include Mycobacterium tuberculosis, varicella-zoster virus (chickenpox), and rubeola virus (measles). Airborne transmission of variola (smallpox) has been documented and airborne transmission of SARS, monkeypox, and the viral hemorrhagic fever virus has been reported, although not proved conclusively.

 

DIF:    Recall             REF:   p. 64              OBJ:   3

 

  1. What techniques are used by most hospitals to reduce host susceptibility to infection?
a. immunization
b. chemoprophylaxis
c. surveillance
d. both A and B

 

 

ANS:  D

Hospital efforts to decrease host susceptibility focus mainly on employee immunization and chemoprophylaxis.

OBJ 6

DIFF: Recall

 

DIF:    Recall             REF:   p. 64              OBJ:   6

 

  1. What vaccination does OSHA require hospital employers to provide?
a. tuberculosis
b. smallpox
c. hepatitis B
d. Streptococcus pneumoniae

 

 

ANS:  C

OSHA mandates that employers offer hepatitis B vaccination.

 

DIF:    Recall             REF:   p. 64              OBJ:   6

 

  1. Exposure to which of the following organisms calls for postexposure chemoprophylaxis?
a. N. meningitides
b. B. pertussis
c. B. anthracis
d. All of the above

 

 

ANS:  D

Post exposure chemoprophylaxis is recommended under defined circumstances for B. pertussis (whooping cough), N. meningitides (meningococcal meningitis), B. anthracis (anthrax), influenza virus, human immunodeficiency virus, and group A streptococci.

 

DIF:    Recall             REF:   p. 64-65         OBJ:   9

 

  1. What is the first step in equipment processing for reuse on another patient?
a. drying the equipment
b. cleaning the equipment
c. disinfecting the equipment
d. sterilizing the equipment

 

 

ANS:  B

Cleaning is the first step in all equipment processing.

 

DIF:    Recall             REF:   p. 72              OBJ:   8

 

  1. Which of the following statements is NOT true regarding the use of soaps to clean equipment?
a. Soaps act by lowering the surface tension.
b. Soaps work poorly in hard water.
c. Soaps have good bactericidal activity.
d. Soaps can help remove organic material.

 

 

ANS:  C

Soaps act by lowering surface tension and forming an emulsion with organic matter. Unfortunately, soaps have little bactericidal activity and work poorly in hard water. A detergent refers to a substance (usually a chemical agent but sometimes a physical one) applied to inanimate objects that destroys disease-causing pathogens but not spores.

 

DIF:    Application    REF:   p. 72-73         OBJ:   7

 

  1. What should be used to wipe down the surface of devices that cannot be immersed in water?
a. 70% ethyl alcohol
b. warm soapy water
c. strong detergent
d. bleach

 

 

ANS:  A

The surface of the device should be disinfected using a 70% ethyl alcohol solution or the equivalent.

 

DIF:    Recall             REF:   p. 79              OBJ:   7

 

  1. Which of the following organisms is NOT destroyed by a disinfection agent?
a. gram-negative cocci
b. bacterial spores
c. gram-positive rods
d. viruses

 

 

ANS:  B

Disinfection describes a process that destroys the vegetative form of all pathogenic organisms on an inanimate object except bacterial spores.

 

DIF:    Recall             REF:   p. 73              OBJ:   7

 

  1. What solution should be used to disinfect the surfaces of the room of a patient who was infected with C. difficile?
a. 70% ethyl alcohol
b. 5.25% sodium hypochlorite
c. 1% sodium benzoate
d. 5% iodine solution

 

 

ANS:  B

Because C. difficile may form spores that are resistant to commonly used surface disinfectants, the CDC recommends the use of 1:10 dilution of 5.25% sodium hypochlorite (household bleach) and water for routine environmental disinfection in the rooms of patients with C. difficile.

 

DIF:    Recall             REF:   p. 73              OBJ:   7

 

  1. Which of the following statements is NOT true regarding the use of alcohol disinfectants?
a. Their activity drops when diluted below 50% concentration.
b. Alcohols are good for surface cleaning of stethoscope bells and diaphragms.
c. They can damage rubber tubing.
d. They are considered sporicidal.

 

 

ANS:  D

Alcohol disinfectants in the health care setting refer to either ethyl alcohol or isopropyl alcohol. Neither is considered a high-level disinfectant as a single agent, they are not sporicidal, and they do not penetrate protein-rich materials. Their activity drops when diluted below 50% concentration. Alcohols are inactivated by protein and can damage rubber, plastics, and the shellac mounting of lensed instruments. Alcohol wipes are a good choice for disinfecting small surfaces, such as medication vial tops. Alcohols are also useful as surface disinfectants for stethoscopes, ventilators, and manual ventilation bags.

 

DIF:    Recall             REF:   p. 73              OBJ:   7

 

  1. Which of the following statements is NOT true regarding the use of phenolics as a disinfectant?
a. They are bactericidal.
b. They are fungicidal.
c. They are ineffective on surfaces shortly after application.
d. They cause tissue irritation.

 

 

ANS:  C

Phenolics are not sporicidal but are bactericidal, fungicidal, and tuberculocidal at their recommended use dilution (see Table 4-3). Phenolics retain their activity in the presence of organic matter and can remain effective on surfaces long after application.

 

DIF:    Recall             REF:   p. 73              OBJ:   7

 

  1. Which of the following characteristics is true for iodophors as disinfectants?
a. water soluble
b. nonstaining
c. less irritating to tissue
d. all of the above

 

 

ANS:  D

Unlike iodine tinctures, iodophors are water soluble, nonstaining, and less irritating to tissue. Iodophors are bactericidal, virucidal, and tuberculocidal.

 

DIF:    Recall             REF:   p. 73              OBJ:   7

 

  1. Which of the following statements is NOT true regarding the use of glutaraldehyde?
a. It is a true sterilizing agent when used properly.
b. It can retain activity up to 90 days once activated.
c. It is not used for disinfection on surfaces due to cost.
d. It can cause significant tissue inflammation in workers who use it.

 

 

ANS:  B

Glutaraldehyde (saturated dialdehyde) is a commonly used high-level disinfectant/sterilant. When aqueous solutions of 2% glutaraldehyde are alkalized (“activated”) to a pH between 7.5 and 8.5, glutaraldehyde can kill vegetative bacteria, M. tuberculosis, fungi, viruses, and spores in less than 10 minutes (see Table 4-3). This sporicidal activity qualifies glutaraldehyde as a true sterilizing agent.

 

DIF:    Recall             REF:   p. 74              OBJ:   7

 

  1. What is the recommended dilution level of bleach according to the CDC for cleaning up blood spills?
a. 1:1
b. 1:5
c. 1:10
d. 1:20

 

 

ANS:  C

The CDC recommends a 1:10 dilution of bleach (or an Environmental Protection Agency [EPA]-registered disinfectant) to disinfect blood spills.

 

DIF:    Recall             REF:   p. 77-78         OBJ:   7

 

  1. What is the most common, efficient, and easiest sterilization method?
a. ETO
b. flash sterilization
c. steam sterilization
d. use of hydrochlorofluorcarbon

 

 

ANS:  C

Moist heat in the form of steam under pressure is the most common, efficient, and easiest sterilization method.

 

DIF:    Recall             REF:   p. 74              OBJ:   7

 

  1. Which of the following statements is NOT true regarding the use of ETO for sterilization?
a. It is harmless to rubber and plastics.
b. It will penetrate prewrapping.
c. Acute exposure is of little consequence.
d. It is useful for equipment that cannot be autoclaved.

 

 

ANS:  C

Unfortunately, acute exposure to ETO gas can cause airway inflammation, nausea, diarrhea, headache, dizziness, and even convulsions.

 

DIF:    Recall             REF:   p. 75              OBJ:   7

 

  1. Which of the following is the most common source of patient infections?
a. large-volume nebulizers
b. small-volume nebulizers
c. internal circuits of a ventilator
d. oxygen therapy devices

 

 

ANS:  A

Large-volume nebulizers are the worst offenders.

 

DIF:    Recall             REF:   p. 76              OBJ:   4

 

  1. Which of the following steps for disinfection of a bronchoscope is NOT true?
a. The first step is cleaning the scope.
b. Disinfection is done by immersion in a liquid disinfectant.
c. The device is stored lying flat to promote drying.
d. Drying techniques can include forced air.

 

 

ANS:  C

Store in a manner so that the bronchoscope is vertical to prevent recontamination and facilitate drying.

 

DIF:    Recall             REF:   p. 72              OBJ:   7

 

  1. Which of the following organisms has been associated with health care–associated infections in patients using a poorly disinfected bronchoscope?
a. M. tuberculosis
b. Pseudomonas aeruginosa
c. Klebsiella
d. both A and B

 

 

ANS:  D

Health care–associated infections associated with bronchoscopes have been most commonly reported with M. tuberculosis, nontuberculosis mycobacterium, and P. aeruginosa.

 

DIF:    Recall             REF:   p. 79              OBJ:   4| 5

 

  1. Which of the following statements is/are true regarding the use of disposable respiratory care equipment?
a. Recent research supports their use as a cost-effective measure.
b. Many quality issues exist.
c. Reusing the equipment is often done.
d. All of the above are true.

 

 

ANS:  D

Three major issues are involved in using disposables: cost, quality, and reuse.

 

DIF:    Recall             REF:   p. 80              OBJ:   8

 

  1. Which of the following is NOT a category under Expanded Precautions?
a. Contact Precautions
b. Droplet Precautions
c. Standard Precautions
d. Airborne Infection Isolation

 

 

ANS:  C

There are four categories of Expanded Precautions: Contact Precautions, Droplet Precautions, Airborne Infection Isolation, and Protective Environment.

 

DIF:    Recall             REF:   p. 69              OBJ:   8

 

  1. What is the minimum recommended time for handwashing in the health care environment?
a. 5 seconds
b. 15 seconds
c. 30 seconds
d. 60 seconds

 

 

ANS:  B

Hand hygiene includes handwashing with both plain or antiseptic-containing soap and water for at least 15 seconds.

 

DIF:    Recall             REF:   p. 65              OBJ:   6

 

  1. Which of the following statements is NOT true regarding the use of sterile gloves in the hospital setting?
a. They should be worn for all invasive procedures.
b. They should not be used as a substitute for handwashing.
c. The same pair can be used on numerous patients if noninvasive procedures are done.
d. They may have small invisible defects that cause contamination of the user’s hands.

 

 

ANS:  C

Gloves should be changed, regardless of use, between each patient contact.

 

DIF:    Recall             REF:   p. 66              OBJ:   6

 

  1. Which of the following is NOT one of the five key recommended components of an infection control program in the hospital setting?
a. development
b. surveillance
c. investigation
d. reporting

 

 

ANS:  A

The five key recommended components of an infection control program are surveillance, investigation, prevention, control, and reporting.

 

DIF:    Recall             REF:   p. 81              OBJ:   6

 

  1. Which of the following diseases is transmitted through direct contact?
a. HIV
b. pertussis
c. hepatitis B
d. hepatitis C

 

 

ANS:  A

The only one of those diseases that is transmitted through direct contact is HIV. Hepatitis B and C and both indirect contact, and pertussis is through droplet transmission.

 

DIF:    Recall             REF:   p. 63              OBJ:   4

 

  1. Which of the following diseases travels through droplet mode?
a. influenza
b. small pox
c. pertussis
d. both A and C

 

 

ANS:  D

Influenza and Pertussis BOTH travel through droplet mode. Small pox travels airborne thorugh droplet nuclei.

 

DIF:    Recall             REF:   p. 63              OBJ:   4

 

  1. What is a Prevention Bundle?
a. The use of multiple evidence based best practices to prevent device related infection
b. Recent research supports the use of cost-effective measurements.
c. An ongoing process of monitoring patients and personnel for the acquisition of infection in the healthcare setting
d. All of the above

 

 

ANS:  A

Prevention Bundle is the use of multiple evidence-based best practices to prevent device related infection.

 

DIF:    Recall             REF:   p. 69              OBJ:   6

 

  1. Besides humans, what is another source of infectious agents in a health care setting?
a. ventilator-associated pneumonia (VAP)
b. catheter-related bloodstream infections
c. catheter-associated urinary tract infections (UTI)
d. all of the above

 

 

ANS:  D

All of the above can be infectious agents in a health care setting. This is why it is important to use medical devices for the least amount of time necessary.

 

DIF:    Application    REF:   p. 81              OBJ:   5

 

  1. Small volume nebulizers produce bacterial aerosols that have been commonly associated with which of the following diseases?
a. Pseudomonas aeruginosa
b. measles
c. small pox
d. nosocomial pneumonia

 

 

ANS:  D

Small volume nebulizers produce bacterial aerosols that have been associated with nosocomial pneumonia.

 

DIF:    Application    REF:   p. 70              OBJ:   5

 

  1. What is the purpose of an inspiratory HEPA filter in a ventilator circuit?
a. The purpose is to serve as a heated thermistor that prevents condensation from forming in the circuits.
b. It prevents pathogens from being expelled into the surroundings.
c. When placed between the ventilator and the circuit, it can eliminate bacteria
d. None of the above

 

 

ANS:  C

The purpose of an inspiratory HEPA filter, when it is placed between the ventilator and the external circuit, is to eliminate bacteria from the driving gas and prevent retrograde contamination back into the ventilator.

 

DIF:    Application    REF:   p. 70              OBJ:   8

 

  1. The unit residence asked you to reduce the risk of contamination caused by condensation in the circuit of a mechanically ventilated patient. Which of the following would help to reduce or eliminate condensation in this patient’s circuit?
a. using a heat and moisture exchange (HME)
b. by draining the circuit on a daily basis
c. by not using any form of heater at all
d. by lowering the temperature in the heater

 

 

ANS:  A

By replacing an active humidification system by a passive humidification one (HME), there will be less condensation in the circuit because no water is being used to heat and moisten the air, but instead the patient’s own body heat is used. Draining the circuit daily, not using heat, or lowering the heater temperature are not acceptable and may place the patient at risk of infection caused by inspisated secretions among other consequences.

 

DIF:    Analysis         REF:   p. 76              OBJ:   6

Chapter 12: Solutions, Body Fluids, and Electrolytes

Test Bank

 

MULTIPLE CHOICE

 

  1. What is a uniform distribution of large molecules that attract and hold water?
a. colloid
b. mixture
c. solution
d. suspension

 

 

ANS:  A

Colloids (sometimes called dispersions or gels) consist of large molecules that attract and hold water

 

DIF:    Application    REF:   p. 273            OBJ:   1

 

  1. The combination of red blood cells in plasma is a good example of what?
a. colloid
b. mixture
c. solution
d. suspension

 

 

ANS:  D

Red blood cells in plasma are an example of a suspension.

 

DIF:    Application    REF:   p. 273            OBJ:   1

 

  1. What is a stable mixture of two or more evenly dispersed substances?
a. colloid
b. mixture
c. solution
d. suspension

 

 

ANS:  C

A solution is a stable mixture of two or more substances in a single phase. One substance is evenly dispersed throughout the other.

 

DIF:    Application    REF:   p. 273            OBJ:   1

 

  1. The ease with which a gas dissolves into a solvent is at least partially determined by which of the following?
a. gas conductivity
b. gas temperature
c. level of 2,3-DPG
d. solvent conductivity

 

 

ANS:  B

The ease with which a solute dissolves in a solvent is its solubility, which is influenced by five factors:

  1. Nature of the solute. The ease with which substances go into a solution in a given solvent depends on the forces of the solute-solute molecules and varies widely.
  2. Nature of the solvent. A solvent’s ability to dissolve a solute depends on the bonds of the solvent-solvent molecules, and also varies widely.
  3. Temperature. Solubility of most solids increases with increased temperature. However, the solubility of gases varies inversely with temperature.
  4. Pressure. The solubility of solids and liquids is not greatly affected by pressure. The solubility of gases in liquids, however, varies directly with pressure.
  5. Concentration. The concentration of a solute or available solvent will have an effect of how much of the substance goes into solution.

 

DIF:    Application    REF:   p. 273            OBJ:   2

 

  1. Which of the following is NOT true regarding solubility?
a. Gas solubility varies directly with pressure.
b. Gas solubility varies directly with temperature.
c. Solvents vary in their ability to dissolve substances.
d. The solubility of solids increases with temperature.

 

 

ANS:  A

The ease with which a solute dissolves in a solvent is its solubility, which is influenced by five factors:

  1. Nature of the solute. The ease with which substances go into a solution in a given solvent depends on the forces of the solute-solute molecules and varies widely.
  2. Nature of the solvent. A solvent’s ability to dissolve a solute depends on the bonds of the solvent-solvent molecules, and also varies widely.
  3. Temperature. Solubility of most solids increases with increased temperature. However, the solubility of gases varies inversely with temperature.
  4. Pressure. The solubility of solids and liquids is not greatly affected by pressure. The solubility of gases in liquids, however, varies directly with pressure.
  5. Concentration. The concentration of a solute or available solvent will have an effect of how much of the substance goes into solution.

 

DIF:    Application    REF:   p. 273            OBJ:   2

 

  1. Gas transport in the body is most affected by changes in which of the following variables?
a. ambient pressure
b. inspired gas temperature
c. oxygen’s solubility coefficient
d. water vapor pressure of inspired gases

 

 

ANS:  A

The partial pressure of the dissolved gas is the product of its coefficient of solubility and the partial pressure of the gas to which the liquid is exposed. Oxygen and carbon dioxide transport can change significantly with changes in body temperature or the pressure to which the body is exposed.

 

DIF:    Application    REF:   p. 273            OBJ:   2

 

  1. A solution holding the maximum amount of solute in a given volume at a constant temperature is said to be what?
a. hypertonic
b. hypotonic
c. saturated
d. supersaturated

 

 

ANS:  C

A saturated solution has the maximal amount of solute that can be held in a given volume of a solvent at a constant temperature.

 

DIF:    Application    REF:   p. 273            OBJ:   2

 

  1. The most important physiological characteristic of solutions is their ability to exert pressure.
a. True
b. False

 

 

ANS:  A

The most important physiologic characteristic of solutions is their ability to exert pressure.

 

DIF:    Application    REF:   p. 274            OBJ:   1

 

  1. What is the attractive force of solute particles in a concentrated solution?
a. diffusion pressure
b. gas pressure
c. hydrostatic pressure
d. osmotic pressure

 

 

ANS:  D

Osmotic pressure is the force produced by solvent particles under certain conditions.

If a solution is placed on one side of a semipermeable membrane and pure solvent on the other, solvent molecules will move through the membrane into the solution. The force driving solvent molecules through the membrane is osmotic pressure (Figure 12-2, A).

 

DIF:    Recall             REF:   p. 274            OBJ:   3

 

  1. What is the effect of osmotic pressure on solutions of different solute concentrations, separated by a semipermeable membrane?
a. causes a net loss of fluid
b. equal distribution of solvent
c. has no effect in this situation
d. redistribution of the solute

 

 

ANS:  B

Osmotic pressure tries to distribute solvent molecules so that the same concentration exists on both sides of the membrane.

 

DIF:    Application    REF:   p. 274            OBJ:   3

 

  1. If a 60% solution (A) were exposed to a 10% solution (B) across a semipermeable membrane, what would be the strength of each solution following equilibrium?
a. solution A 10%/solution B 60%
b. solution A 35%/solution B 35%
c. solution A 50%/solution B 20%
d. solution A 60%/solution B 10%

 

 

ANS:  B

Osmotic pressure can also be visualized as an attractive force of solute particles in a concentrated solution. If 100 ml of a 50% solution is placed on one side of a membrane and 100 ml of a 30% solution is placed on the other side, solvent molecules will move from the dilute to the concentrated side (Figure 12-2, D and E). The particles in the concentrated solution attract solvent molecules from the dilute solution until equilibrium occurs. Equilibrium exists when the concentrations (i.e., ratio of solute to solvent) in both compartments are equal (40% in Figure 12-2).

 

DIF:    Application    REF:   p. 274            OBJ:   3

 

  1. Which of the following is true regarding osmotic pressure?
a. Osmotic pressure depends on the number of particles in solution.
b. Osmotic pressure varies inversely with temperature.
c. Osmotic pressure is highest in dilute solutions.
d. Osmotic pressure varies inversely with tonicity.

 

 

ANS:  A

Osmotic pressure depends on the number of particles in solution but not on their charge or identity. A 2% solution has twice the osmotic pressure of a 1% solution under similar pressures. For a given amount of solute, osmotic pressure is inversely proportional to the volume of solvent. Osmotic pressure varies directly with temperature, increasing by 1/273 for each 1° C.

 

DIF:    Application    REF:   p. 274            OBJ:   3

 

  1. Which of the following is an isotonic solution?
a. 0.09% NaCl
b. 0.90% NaCl
c. 9.00% NaCl
d. 19.0% NaCl

 

 

ANS:  B

Average body cellular fluid has a tonicity equal to a 0.9% solution of sodium chloride (NaCl; sometimes referred to as physiologic saline). Solutions with similar tonicity are called isotonic.

 

DIF:    Recall             REF:   p. 275            OBJ:   3

 

  1. A 3% NaCl solution is called what?
a. hypertonic
b. hypotonic
c. isotonic
d. normotonic

 

 

ANS:  B

Those solutions with more tonicity are hypertonic, and those solutions with less tonicity are hypotonic.

 

DIF:    Application    REF:   p. 275            OBJ:   3

 

  1. If your objective were to draw water out of cells or tissues, you would expose them to what type of solution?
a. hypertonic
b. hypotonic
c. isotonic
d. normotonic

 

 

ANS:  A

Hypertonic solutions draw water out of cells.

 

DIF:    Application    REF:   p. 275            OBJ:   3

 

  1. Which of the following is termed a physiologic solution?
a. isotonic
b. noncovalent
c. nonpolar covalent
d. polar electrovalent

 

 

ANS:  C

In electrochemical terms, there are three basic types of physiologic solutions. Depending on the solute, solutions are ionic (electrovalent), polar covalent, or nonpolar covalent.

 

DIF:    Recall             REF:   p. 275            OBJ:   5

 

  1. Positive ions are referred to as what?
a. anions
b. cations
c. covalents
d. electrolytes

 

 

ANS:  B

If an electrode is placed in such a solution, positive ions migrate to the negative pole of the electrode. These ions are called cations.

 

DIF:    Recall             REF:   p. 275            OBJ:   5

 

  1. In which of the following solutions do the molecules of solute remain intact?
a. electrolytic
b. electrovalent
c. nonpolar covalent
d. polar covalent

 

 

ANS:  C

In nonpolar covalent solutions, molecules of solute remain intact and do not carry electrical charges; these solutions are referred to as nonelectrolytes.

 

DIF:    Application    REF:   p. 275            OBJ:   5

 

  1. How is the gram-equivalent (gEq) weight of a substance computed?
a. dividing its gram atomic weight by its valence
b. dividing its valence by its gram atomic weight
c. multiplying its atomic number times its atomic weight
d. multiplying its gram atomic weight times its valence

 

 

ANS:  A

Gram equivalent weight values. A gEq of a substance is calculated as its gram atomic (formula) weight divided by its valence. The valence signs (+ or –) are disregarded.

 

DIF:    Analysis         REF:   p. 276            OBJ:   1

 

  1. What is the gEq weight of an acid?
a. amount of the acid containing 1 mol of replaceable H+ ions
b. amount of the acid containing 1 mol of replaceable OH ions
c. gram atomic weight of the acid times its valence
d. milligrams of acid per deciliter (dl) of normal solution

 

 

ANS:  A

The gram equivalent weight of an acid may be calculated by dividing its gram formula weight by the number of hydrogen atoms in its formula, as shown in the following reaction:

The single H+ of hydrochloric acid (HCl) is replaced by Na+. One mole of HCl has 1 mole of replaceable hydrogen. By definition, the gEq of HCl must be the same as its gram formula weight, or 36.5 g.

 

DIF:    Application    REF:   p. 276            OBJ:   1

 

  1. A serum value of 140 mEq/L of Na is equivalent to how many mg/dl?
a. 14 mg/dl
b. 70 mg/dl
c. 280 mg/dl
d. 322 mg/dl

 

 

ANS:  D

For example, to convert a serum Na+ value of 322 mg/dl to mEq/L, the equation is used as follows:

 

DIF:    Analysis         REF:   p. 276            OBJ:   1

 

  1. In which of the following types of solutions is the relationship of solute to solvent expressed as a proportion?
a. normal
b. percent
c. ratio
d. weight/volume

 

 

ANS:  C

Ratio solution. The amount of solute to solvent is expressed as a proportion.

 

DIF:    Application    REF:   p. 277            OBJ:   4

 

  1. You prepare a solution by dissolving 5 g of glucose in 100 ml of solution. What type of solution are you making?
a. normal
b. percent
c. ratio
d. weight/volume

 

 

ANS:  D

It is defined as weight of solute per volume of solution. This method is sometimes erroneously described as a percent solution. W/V solutions are commonly expressed in grams of solute per 100 ml of solution. For example, 5 g of glucose dissolved in 100 ml of solution is properly called a 5% solution.

 

DIF:    Application    REF:   p. 280            OBJ:   4

 

  1. You prepare a solution by combining 5 g of glucose with 95 g of water. What type of solution are you making?
a. normal
b. percent
c. ratio
d. weight/volume

 

 

ANS:  B

Percent solution. A percent solution is weight of solute per weight of solution. Five grams of glucose dissolved in 95 g of water is a true percent solution. The glucose is 5% of the total solution weight of 100 g.

 

DIF:    Application    REF:   p. 278            OBJ:   4

 

  1. What type of solution could have 1 mol of solute per L of solution?
a. molal
b. molar
c. normal
d. weight/volume

 

 

ANS:  B

Molar solution. A molar solution has 1 mole of solute per liter of solution, or 1 mmol/ml of solution. Solute is measured into a container, and solvent is added to produce the solution volume desired.

 

DIF:    Application    REF:   p. 278            OBJ:   1

 

  1. What type of solution could have 1 gEq of solute per L of solution?
a. molal
b. molar
c. normal
d. weight/volume

 

 

ANS:  C

Normal solution. A normal solution has 1 gEq of solute per liter of solution, or 1 mEq/ml of solution.

 

DIF:    Application    REF:   p. 278            OBJ:   1

 

  1. You add 50 ml of water to 150 ml of a 6% solution. What is the new concentration?
a. 3.0%
b. 4.5%
c. 7.5%
d. 12.0%

 

 

ANS:  B

If 50 ml of water is added to 150 ml of a 3% (0.03) solution, the new concentration is calculated by rearranging the dilution equation to find C2 as follows:

 

DIF:    Analysis         REF:   p. 278            OBJ:   4

 

  1. What is a characteristic of an acid?
a. absorbs H+ ions
b. accepts a proton
c. is a proton donor
d. produces OH ions

 

 

ANS:  C

Another definition of an acid is that of Brönsted-Lowry, in which an acid is any compound that is a proton (H+) donor.

 

DIF:    Recall             REF:   p. 279            OBJ:   5

 

  1. Supply the definition for a base substance.
a. compound that will donate a H+ ion
b. any compound that will accept a proton
c. only substances that contain a hydroxyl group
d. substances that contain Na+ ions

 

 

ANS:  B

The Brönsted-Lowry definition of a base is any compound that accepts a proton.

 

DIF:    Recall             REF:   p. 279            OBJ:   5

 

  1. Which of following is NOT a nonhydroxide base?
a. ammonia
b. carbonates
c. certain proteins
d. ammonium

 

 

ANS:  D

Nonhydroxide bases. Ammonia and carbonates are good examples of nonhydroxide bases. Proteins, with their amino groups, also can serve as nonhydroxide bases.

 

DIF:    Recall             REF:   p. 279            OBJ:   5

 

  1. Where does ammonia play its most important role as a base buffer?
a. kidney
b. liver
c. lung
d. vasculature

 

 

ANS:  A

Ammonia plays an important role in renal excretion of acid.

 

DIF:    Recall             REF:   p. 279            OBJ:   5

 

  1. Which of the following is a facet of blood proteins?
a. Blood proteins are composed of amino acids held together by fatty acids.
b. Deoxygenated hemoglobin (Hb) is unable to accept H+ ions.
c. In an alkaline environment, blood proteins can act as bases.
d. The imidazole group on amino acids is the key binding site for other amino acids.

 

 

ANS:  C

Protein bases. Proteins are composed of amino acids bound together by peptide links. Physiologic reactions in the body occur in a mildly alkaline environment. This allows proteins to act as H+ receptors, or bases. Cellular and blood proteins acting as bases are transcribed as prot. The imidazole group of the amino acid histidine is an example of an H+ acceptor on a protein molecule (Figure 12-4). The ability of proteins to accept hydrogen ions limits H+ activity in solution, which is called buffering. The ability of hemoglobin to accept (i.e., buffer) H+ ions depends on its oxygenation state. Deoxygenated (reduced) hemoglobin is a stronger base (i.e., a better H+ acceptor) than oxygenated hemoglobin.

 

DIF:    Application    REF:   p. 279            OBJ:   6

 

  1. Pick the correct statement as it relates to hemoglobin and acid-base buffering.
a. Deoxygenated hemoglobin acts as an acid at the tissue level.
b. Deoxygenated hemoglobin is a fairly strong base.
c. Hemoglobin contributes more H+ in the face of increased histidine.
d. In an alkaline environment, hemoglobin becomes an ineffective base.

 

 

ANS:  B

The ability of proteins to accept hydrogen ions limits H+ activity in solution, which is called buffering. The ability of hemoglobin to accept (i.e., buffer) H+ ions depends on its oxygenation state. Deoxygenated (reduced) hemoglobin is a stronger base (i.e., a better H+ acceptor) than oxygenated hemoglobin.

 

DIF:    Application    REF:   p. 280            OBJ:   6

 

  1. What is the relation between pure water and acid-base balance?
a. A solution with an OH concentration greater than that of water acts as an acid.
b. Pure water is slightly acidic solution.
c. The concentrations of both H+ and OH ions are equal.
d. The H+ concentration of water can be designated as 1 nmol/L.

 

 

ANS:  C

The concentration of both H+ and OH in pure water is 107 mol/L.

 

DIF:    Application    REF:   p. 280            OBJ:   7

 

  1. How is pH defined?
a. log of the dissociation constant of the weak acid in a solution
b. negative logarithm of the H+ ion concentration of a solution
c. point at which an electrolyte solution is exactly 50% dissociated
d. ratio of a solution’s weak acid concentration to its conjugate base pair

 

 

ANS:  B

pH is the negative logarithm of the [H+] used as a positive number.

 

DIF:    Application    REF:   p. 280            OBJ:   7

 

  1. Which of the following describes an aspect of pH?
a. Any solution with a pH of 7 is neutral.
b. A pH of 7 describes an acidotic solution.
c. A pH change from 7 to 8 equals a 2-fold increase in H+ ion concentration.
d. The pH is the log of the OH ion concentration.

 

 

ANS:  A

In this scheme, any solution with a pH of 7.00 is neutral, corresponding to the [H+] of pure water.

 

DIF:    Application    REF:   p. 281            OBJ:   7

 

  1. If a patient’s pH were to drop from 7.40 to 7.10, the H+ concentration will increase by how much?
a. ´2
b. ´3
c. ´5
d. ´10

 

 

ANS:  A

Similarly, a change in pH of 0.3 unit equals a 2-fold change in [H+].

 

DIF:    Analysis         REF:   p. 281            OBJ:   7

 

  1. Which of the following are true regarding water in the human body?
  2. The more fatty tissue there is, the greater is the percentage of body water.
  3. Total body water depends on an individual’s weight and sex.
  4. Water constitutes about 45% to 80% of an individual’s body weight.
  5. Water content is highest in the aged.
a. 1 and 2
b. 2 and 4
c. 3 and 4
d. 2 and 3

 

 

ANS:  D

Water is a major component of the body. It makes up 45% to 80% of an individual’s body weight, depending on that person’s weight, gender, and age. Leanness is associated with higher body water content. Obese individuals have a lower percentage of body water (as much as 30% less) than do normal-weight individuals. Men have a slightly higher percentage of total body water than women have. Total percentage of body water in infants and children is substantially greater than it is in adults. In the newborn, water accounts for 80% of the total body weight.

 

DIF:    Application    REF:   p. 281            OBJ:   8

 

  1. Intracellular water represents about what proportion of total body water?
a.
b.
c.
d.

 

 

ANS:  D

Intracellular water accounts for approximately two thirds of the total body water, and extracellular water accounts for the remaining third.

 

DIF:    Recall             REF:   p. 281            OBJ:   8

 

  1. What is the smallest fluid subcompartment of extracellular water?
a. interstitial
b. intraorganelle
c. intravascular
d. transcellular

 

 

ANS:  D

Extracellular water is found in three subcompartments: (1) intravascular water (plasma), (2) interstitial water, and (3) transcellular fluid. Intravascular water makes up approximately 5% of the body weight. Interstitial water is water in the tissues between the cells. It makes up approximately 15% of the body weight. Transcellular fluid is quite small in proportion to plasma and interstitial fluid.

 

DIF:    Application    REF:   p. 281            OBJ:   8

 

  1. Which of the following is NOT a major extracellular electrolyte?
a. Cl
b. HCO3
c. K+
d. Na+

 

 

ANS:  C

Sodium (Na+), chloride (Cl), and bicarbonate (HCO3) are predominantly extracellular electrolytes.

 

DIF:    Recall             REF:   p. 282            OBJ:   8

 

  1. What are the main intracellular electrolytes?
  2. K+
  3. Na+
  4. Phosphate
  5. Sulfate
a. 1, 3, and 4
b. 2, 3, and 4
c. 1 and 2
d. 1, 2, 3, and 4

 

 

ANS:  A

Potassium (K+), magnesium (Mg2+), phosphate (PO43–), sulfate (SO42–), and protein constitute the main intracellular electrolytes.

 

DIF:    Recall             REF:   p. 282            OBJ:   8

 

  1. Which of the following is FALSE regarding body fluids and electrolytes?
a. Interstitial fluid contains substantially more protein than does plasma.
b. Intravascular and interstitial fluid have similar electrolyte compositions.
c. Osmotic pressure helps to determine fluid distribution between compartments.
d. Proteins account for the high colloid osmotic pressure of plasma.

 

 

ANS:  A

Intravascular and interstitial fluids have similar electrolyte compositions. However, plasma contains substantially more protein than interstitial fluid. Proteins, chiefly albumin, account for the high osmotic pressure of plasma. Osmotic pressure is an important determinant of fluid distribution between vascular and interstitial compartments.

 

DIF:    Application    REF:   p. 282            OBJ:   8

 

  1. What maintains the volume and composition of body fluids?
  2. filtration and reabsorption of sodium by the kidneys
  3. regulation of water balance by vasopressin (ADH)
  4. gastrointestinal filtration and excretion of chloride
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  A

The kidneys maintain the volume and composition of body fluids by two related mechanisms. First, filtration and reabsorption of sodium adjust urinary sodium excretion to match changes in dietary intake. Second, water excretion is regulated by secretion of antidiuretic hormone (ADH, or vasopressin).

 

DIF:    Application    REF:   p. 282            OBJ:   8

 

  1. Water can be lost from the body through what organ systems?
  2. gastrointestinal tract
  3. liver
  4. lungs
  5. skin
a. 1, 2, and 3
b. 1, 3, and 4
c. 2 and 4
d. 1, 2, 3, and 4

 

 

ANS:  B

Water may be lost from the body through the skin, lungs, kidneys, and gastrointestinal tract.

 

DIF:    Application    REF:   p. 282            OBJ:   9

 

  1. Insensible water loss occurs through what organs?
  2. gastrointestinal tract
  3. kidneys
  4. lungs
  5. skin
a. 3 and 4
b. 1, 2, and 4
c. 2 and 3
d. 2 and 4

 

 

ANS:  A

Water loss can be insensible, such as vaporization of water from the skin and lungs.

 

DIF:    Application    REF:   p. 282            OBJ:   9

 

  1. An adult’s insensible water loss averages what level?
a. 300 ml/day
b. 500 ml/day
c. 700 ml/day
d. 900 ml/day

 

 

ANS:  D

See Table 12-4.

 

DIF:    Recall             REF:   p. 282            OBJ:   9

 

  1. An adult’s insensible water through the lungs averages what level?
a. 100 ml/day
b. 200 ml/day
c. 300 ml/day
d. 400 ml/day

 

 

ANS:  B

See Table 12-4.

 

DIF:    Recall             REF:   p. 282            OBJ:   9

 

  1. What is the average urine output in a healthy adult?
a. 600 to 800 ml/day
b. 800 to 1000 ml/day
c. 1000 to 1200 ml/day
d. 1200 to 1400 ml/day

 

 

ANS:  C

See Table 12-4.

 

DIF:    Recall             REF:   p. 282            OBJ:   9

 

  1. Which of the following is FALSE regarding water balance and the gastrointestinal tract?
a. The gastrointestinal tract processes some 8 to 10 L of fluid per day.
b. The large intestine reclaims more than 98% of the daily gastrointestinal fluid volume.
c. Vomiting and diarrhea can cause large gastrointestinal tract fluid losses.
d. The gastrointestinal tract is responsible for the most sensible fluid loss.

 

 

ANS:  D

The gastrointestinal tract manufactures 8 to 10 L of fluid per day. More than 98% of this volume is reclaimed in the large intestine. In patients who are vomiting or have diarrhea, water losses through the gastrointestinal tract can be considerable. Individuals with severe burns or open wounds can also lose large quantities of water.

 

DIF:    Application    REF:   p. 282            OBJ:   9

 

  1. Patients with what condition are prone to evaporative water loss through the lungs?
  2. artificial airways
  3. hypothermia
  4. increased ventilation
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  B

Patients with increased ventilation also have increased water losses through increased evaporation from the respiratory tract. Patients with artificial airways are prone to evaporative water loss if inspired air is not adequately humidified. Artificial airways bypass the normal heat and water exchange processes of the nose.

 

DIF:    Application    REF:   p. 282            OBJ:   9

 

  1. Pick the statement that best describes the relationship between infants and their body fluids?
a. Fluid loss or lack of intake depletes infants of water slower than it does adults.
b. Infants have proportionately less body water than do adults.
c. Infants’ higher metabolic rates necessitate greater urinary excretion compared with adults.
d. Under normal circumstances, infants’ water loses are three times those of adults.

 

 

ANS:  C

Infants have a greater proportion of body water than do adults, particularly in the extracellular compartments (Table 12-3). Water loss in infants may be twice that of adults. Infants also have a greater body surface area (in proportion to body volume) than adults, making their basal heat production twice as high. Higher metabolic rates in infants necessitate greater urinary excretion. Infants turn over approximately half of their extracellular fluid volume daily; adults turn over approximately one seventh. Fluid loss or lack of intake can rapidly deplete an infant of water.

 

DIF:    Application    REF:   p. 282-283     OBJ:   9

 

  1. By what process is water replenished?
  2. absorption
  3. ingestion
  4. metabolism
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  C

Water is replenished in two major ways: ingestion and metabolism.

 

DIF:    Application    REF:   p. 283            OBJ:   9

 

  1. During recovery from a serious surgery or trauma, how much water is likely to be produced in a 24-hour period by the catabolism of fat and proteins?
a. 300 ml
b. 500 ml
c. 750 ml
d. 1000 ml

 

 

ANS:  D

Recovery after surgery or trauma may be similar to starvation. Under such conditions, approximately 500 mg of protein and a similar amount of fat are metabolized. This yields approximately 1 L of water/day.

 

DIF:    Recall             REF:   p. 283            OBJ:   9

 

  1. What best describes an aspect of the movement of fluid and solutes between the capillaries and the interstitial space?
a. At the tissue level, osmotic pressure tends to draw water into the interstitial space.
b. Electrolytes move freely across the capillary wall into the interstitium.
c. The capillary and interstitial hydrostatic pressures are approximately equal.
d. The interstitial fluid has a relatively high protein concentration.

 

 

ANS:  B

The first stage of homeostasis is fluid exchange between systemic capillaries and interstitial fluid by passive diffusion. Capillary walls are permeable to crystalline electrolytes. This allows equilibrium between the two extracellular compartments to occur quickly.

 

DIF:    Application    REF:   p. 283            OBJ:   10

 

  1. What is the net effect of the hydrostatic pressure gradient between the capillary and interstitial space?
a. It tends to push water into the capillaries.
b. It tends to push water into the interstitial spaces.
c. The pressure gradient is zero so fluid movement is due to osmosis.
d. It tends to push water into the cells.

 

 

ANS:  B

Movement of fluid and solutes from capillary blood to interstitial spaces is enhanced by the difference in hydrostatic pressure between compartments. Hydrostatic pressure difference depends on blood pressure, blood volume, and the vertical distance of the capillary from the heart (i.e., the effects of gravity). Hydrostatic pressure tends to cause fluid to leak out of capillaries into the interstitial spaces.

 

DIF:    Application    REF:   p. 283            OBJ:   10

 

  1. What establishes the capillary colloidal osmotic pressure?
a. presence of electrolytes in plasma
b. presence of plasma proteins in blood
c. presence of RBCs in whole blood
d. presence of WBCs in whole blood

 

 

ANS:  B

Proteins such as albumin are too large to pass through the pores of the capillary. Instead, these proteins remain in the intravascular compartment and exert osmotic pressure, which draws water and small solute molecules back into the capillaries. This plasma colloid osmotic pressure is also sometimes called oncotic pressure.

Because these large proteins are negatively charged, they attract (but do not bind) an equivalent amount of cations to the intravascular compartment. These cations have the effect of increasing osmotic pressure within the capillary (Donnan effect).

 

DIF:    Application    REF:   p. 283            OBJ:   10

 

  1. What does the Donnan effect describe?
a. how Cl exchanges for HCO3 in RBCs at the tissue level
b. how proteins attract cations, which increase capillary osmotic pressure.
c. relationship between colloidal osmotic pressure and fluid movement at tissue
d. relationship between osmotic and hydrostatic pressure at the capillary

 

 

ANS:  B                    DIF:    Application    REF:   p. 283            OBJ:   10

 

  1. Describe the normal pressures or flows at the arterial end of the capillary.
a. Electrolytes move from the interstitium into the capillary.
b. Hydrostatic pressure is approximately 24 mm Hg.
c. Osmotic pressure is approximately 30 mm Hg.
d. Plasma minus the proteins flows into the interstitium.

 

 

ANS:  D

For example, in a typical capillary, blood pressure is approximately 30 mm Hg at the arterial end and approximately 20 mm Hg at the venous end (Figure 12-6). Colloid osmotic pressure of the intravascular fluid remains constant at approximately 25 mm Hg. Hydrostatic pressure along the capillary continually decreases. At the arterial end, hydrostatic pressure normally exceeds osmotic pressure and water flows out of the vascular space into the interstitial space.

 

DIF:    Application    REF:   p. 283            OBJ:   10

 

  1. Under normal circumstances, a small amount of fluid is filtered from the capillary in excess of that which is absorbed. What prevents edema from occurring under these conditions?
a. The lymphatic system absorbs it and returns it to the circulatory system.
b. Tissue cells absorb this fluid and use it in the metabolic process.
c. Wandering macrophages use this excess fluid in hydrolyzing invaders.
d. Waste products dilute this, maintaining eutonic conditions.

 

 

ANS:  A

This slight outward excess is balanced by fluid return through the lymphatic circulation.

 

DIF:    Application    REF:   p. 283            OBJ:   10

 

  1. According to the Starling equilibrium equation, which of the following will NOT facilitate fluid filtration from the capillaries into the interstitial space?
a. high capillary hydrostatic pressure
b. high capillary permeability
c. low capillary osmotic pressure
d. low interstitial osmotic pressure

 

 

ANS:  D

These relationships may be expressed by the Starling equilibrium equation:

 

 

DIF:    Analysis         REF:   p. 283            OBJ:   10

 

  1. Which of the following factors contributes to reabsorption of tissue fluid in dependent regions of the body?
a. hydrostatic pressure of 100 mm Hg.
b. low capillary permeability
c. low interstitial osmotic pressure
d. pumping action of skeletal muscles

 

 

ANS:  D

Because of hydrostatic effects, capillary pressure in the feet can be as high as 100 mm Hg when an individual is standing. Reabsorption of tissue fluid can be accomplished although hydrostatic pressure greatly exceeds colloidal osmotic pressure. Three factors favor reabsorption under these circumstances. First, high intravascular hydrostatic pressure is somewhat balanced by a proportionally greater interstitial pressure. Second, the “pumping” action of the skeletal muscles surrounding leg veins lowers venous pressures. Third, lymph flow back to the thorax is enhanced by a similar mechanism. This facilitates clearance of excess interstitial fluid.

 

DIF:    Application    REF:   p. 283            OBJ:   10

 

  1. The alveolar interstitial region of the lungs remains relatively “dry” primarily because of what?
a. low capillary hydrostatic pressure
b. low capillary osmotic pressure
c. low capillary permeability
d. low interstitial osmotic pressure

 

 

ANS:  A

To minimize interstitial fluid in the alveolar-capillary region, the hydrostatic pressure difference must be kept low. The pulmonary circulation is in fact a low-pressure system. The mean pulmonary vascular pressures are approximately one sixth of those in the systemic circulation. Colloid osmotic pressure exceeds hydrostatic forces across the entire length of the pulmonary capillaries in healthy individuals.

 

DIF:    Application    REF:   p. 283            OBJ:   10

 

  1. What is a common cause for pulmonary edema due to increased hydrostatic pressure?
a. alveolar-capillary damage
b. chronic liver disease
c. failing left ventricle
d. failing right ventricle

 

 

ANS:  C

In the lungs, edema caused by increased hydrostatic pressure often is a result of back pressure from a failing left ventricle.

 

DIF:    Application    REF:   p. 284            OBJ:   10

 

  1. What is a normal range for serum sodium?
a. 3.5 to 4.8 mEq/L
b. 67.0 to 75.0 mEq/L
c. 98.0 to 105.0 mEq/L
d. 136.0 to 145.0 mEq/L

 

 

ANS:  D

The normal serum concentration of sodium ranges from 136 to 145 mEq/L.

 

DIF:    Recall             REF:   p. 285            OBJ:   11

 

  1. Na+ reabsorption in the kidneys is governed mainly by the level of what hormone?
a. ADH
b. aldosterone
c. angiotensin
d. insulin

 

 

ANS:  B

Sodium reabsorption in the kidneys is governed mainly by the level of aldosterone, which is secreted by the adrenal cortex.

 

DIF:    Application    REF:   p. 285            OBJ:   11

 

  1. Which of the following would NOT cause an abnormal loss of Na+ (hyponatremia)?
a. ascites
b. excessive sweating or fever
c. use of certain diuretics
d. steroid therapy

 

 

ANS:  D

Abnormal losses of sodium can lead to hyponatremia and may occur for a number of reasons, as shown in Table 12-5.

 

DIF:    Application    REF:   p. 285            OBJ:   11

 

  1. What is the most prominent anion in the body?
a. Cl
b. HCO3
c. phosphate
d. sulfate

 

 

ANS:  A

Chloride is the most prominent anion in the body.

 

DIF:    Recall             REF:   p. 286            OBJ:   11

 

  1. What is a normal range for serum Cl?
a. 3.5 to 4.8 mEq/L
b. 98.0 to 106.0 mEq/L
c. 137.0 to147.0 mEq/L
d. 150.0 to 220.0 mEq/L

 

 

ANS:  B

Normal serum levels of chloride (Cl) range between 98 and 106 mEq/L.

 

DIF:    Recall             REF:   p. 286            OBJ:   11

 

  1. Which of the following correctly describes a facet of chloride?
a. A loss of Cl is equivalent to a gain in acid.
b. Cl is usually excreted with H+ as HCl.
c. Cl levels vary inversely with HCO3 levels.
d. Cl plays a key role in acid-base buffering.

 

 

ANS:  C

The concentration of extracellular chloride is inversely proportional to that of the other major anion, bicarbonate (HCO3).

 

DIF:    Recall             REF:   p. 286            OBJ:   11

 

  1. What can cause hypochloremia?
  2. diuretics
  3. gastrointestinal loss
  4. metabolic acidosis
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  A

Abnormal chloride levels may occur for a variety of reasons (see Table 12-5).

 

DIF:    Recall             REF:   p. 285            OBJ:   11

 

  1. Which of the following describe roles played by HCO3?
  2. HCO3 levels vary directly with Cl levels.
  3. It is the primary vehicle for blood carbon dioxide transport.
  4. It plays a key role in acid-base homeostasis.
a. 1, 2, and 3
b. 1 and 3
c. 2 only
d. 2 and 3

 

 

ANS:  D

HCO3 plays an important role in acid-base homeostasis and is the strong base in the bicarbonate-carbonic acid buffer pair. HCO3 is the primary means for transporting carbon dioxide from the tissues to the lungs. The ratio of HCO3 to carbonic acid in healthy individuals is maintained near 20:1.

 

DIF:    Application    REF:   p. 286            OBJ:   11

 

  1. What is the role of kidneys when a patient experiences acute respiratory alkalosis?
a. Cl shift enhances the body’s compensatory mechanisms.
b. HCO3 is eliminated in the urine.
c. It dumps Cl so as to retain HCO3.
d. The Hamburger phenomenon occurs.

 

 

ANS:  B

In respiratory acidosis, the kidneys retain or produce HCO3 to buffer the additional acid caused by CO2 retention. In respiratory alkalosis, the opposite occurs. A reciprocal relationship exists between Cl and HCO3 concentrations. Bicarbonate retention is associated with chloride excretion.

 

DIF:    Application    REF:   p. 286            OBJ:   11

 

  1. What cation is the most prominent in the intracellular compartment?
a. Ca2+
b. K+
c. Li+
d. Na+

 

 

ANS:  B

Potassium is the main cation of the intracellular compartment.

 

DIF:    Recall             REF:   p. 286            OBJ:   1

 

  1. What is a normal K+ blood level?
a. 3.5 to 5.0 mEq/L.
b. 7.8 to 10.2 mEq/L
c. 22 to 26 mEq/L
d. 35 to 42 mEq/L

 

 

ANS:  A

Serum K+ concentration normally ranges between only 3.5 and 5.0 mEq/L.

 

DIF:    Recall             REF:   p. 286            OBJ:   1

 

  1. Which patients are prone to K+ depletion and hypokalemia?
  2. postsurgical patients
  3. those with renal disease
  4. trauma victims
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

Patients who have undergone surgery, have sustained trauma, or have renal disease often have greater K+ losses.

 

DIF:    Application    REF:   p. 287            OBJ:   11

 

  1. Which answer best describes the relationship between K+ movement and acid-base balance?
a. Excess extracellular H+ ions are exchanged for intracellular K+.
b. Extracellular acidosis results in serum hypokalemia.
c. Low-K+ diets are required following nasogastric suctioning.
d. When the extracellular pH rises, K+ moves out of the cells.

 

 

ANS:  A

Serum K+ concentration is determined primarily by the pH of extracellular fluid and the size of the intracellular K+ pool. In extracellular acidosis, excess H+ ions are exchanged for intracellular K+. Movement of K+ from intracellular to extracellular spaces may produce dangerous levels of hyperkalemia.

 

DIF:    Application    REF:   p. 287            OBJ:   11

 

  1. What affect do metabolic acidosis and aldosterone have in common?
a. They both result in renal loss of K+.
b. There is a loss of HCO3 and Cl in the renal tubules.
c. There is retention of CO2 and Cl.
d. They both cause renal retention of HCO3.

 

 

ANS:  A

Renal excretion of K+ is controlled by aldosterone levels. Aldosterone inhibits the enzyme responsible for K+ transport in the distal renal tubular cells of the kidney. Metabolic acidosis also inhibits the transport system.

 

DIF:    Application    REF:   p. 287            OBJ:   11

 

  1. Hypokalemia disturbs cellular function in ALL but one of the following systems. Which one does it NOT affect?
a. gastrointestinal
b. hepatic
c. neuromuscular
d. renal

 

 

ANS:  B

Hypokalemia (reduced serum potassium) disturbs cellular function in a number of organ systems. These include the gastrointestinal, neuromuscular, renal, and cardiovascular systems.

 

DIF:    Recall             REF:   p. 285            OBJ:   11

 

  1. What is the most common cause of hyperkalemia?
a. cardiac arrest
b. metabolic alkalosis
c. renal failure
d. respiratory acidosis

 

 

ANS:  C

Hyperkalemia (elevated serum potassium) is most common in renal insufficiency.

 

DIF:    Recall             REF:   p. 285            OBJ:   11

 

  1. Which of the following drugs can be used to temporarily lower K+ in severe hyperkalemia?
a. corticosteroids
b. insulin
c. K-sparing diuretics
d. nonsteroidal antiinflammatory drugs

 

 

ANS:  B

Temporary measures for reducing serum K+ levels include administration of insulin, calcium gluconate, sodium salts, or large volumes of hypertonic glucose.

 

DIF:    Recall             REF:   p. 287            OBJ:   11

 

  1. What is the normal serum calcium concentration?
a. 4.5 to 5.3 mg/dl.
b. 8.7 to 10.4 mg/dl
c. 98.0 to 105.0 mg/dl
d. 137 to 147 mg/dl

 

 

ANS:  B

The normal serum calcium is 8.7 to 10.4 mg/dl, or about 4.5 to 5.25 mEq/L.

 

DIF:    Recall             REF:   p. 287            OBJ:   11

 

  1. Which of the following describes serum Ca2+?
a. About 30% of the serum Ca2+ is ionized and combined with plasma anions.
b. Acidemia decreases the serum levels of ionized Ca2+.
c. More than half of the serum Ca2+ is nonionized and bound to plasma albumin.
d. Serum Ca2+ is present in three forms: ionized, protein bound, and complex.

 

 

ANS:  D

Calcium is present in the blood in the following three forms: ionized, protein bound, and complex. Approximately 50% of serum calcium is ionized (Ca2+) and is physiologically active. An additional 10% forms calcium anion complexes. The remaining 40% is bound to plasma proteins, primarily albumen. Ionized calcium is physiologically active in processes such as enzyme activity, blood clotting, neuromuscular irritability, and bone calcification. Acidemia increases, and alkalemia decreases, the concentration of Ca2+ in the serum.

 

DIF:    Application    REF:   p. 287            OBJ:   11

 

  1. Clinical symptoms of hyponatremia would NOT include which of the following?
a. headache
b. bradycardia
c. lassitude
d. weakness

 

 

ANS:  B

Symptoms of hyponatremia include: weakness, lassitude, apathy, headache, orthostatic hypotension, and tachycardia.

 

DIF:    Application    REF:   p. 287            OBJ:   11

 

  1. Clinical signs of hypokalemia would NOT include which of the following?
a. convulsions
b. electrocardiogram abnormalities
c. muscle weakness
d. paralysis

 

 

ANS:  A

Symptoms of hypokalemia include: muscle weakness, paralysis, ECG abnormalities, supraventricular arrhythmias, circulatory failure, and cardiac arrest.

 

DIF:    Application    REF:   p. 285            OBJ:   11

 

  1. Signs and symptoms of hyperkalemia would NOT include which of the following?
a. cardiac arrest
b. electrocardiogram abnormalities
c. metabolic alkalosis
d. ventricular arrhythmias

 

 

ANS:  C

Symptoms of hyperkalemia include: ECG changes, ventricular arrhythmias, and cardiac arrest.

 

DIF:    Application    REF:   p. 285            OBJ:   11

 

  1. Clinical manifestations of hypocalcemia would NOT include which of the following?
a. abdominal cramps
b. depressed tendon reflexes
c. electrocardiogram abnormalities
d. muscular twitching and spasm

 

 

ANS:  B

Symptoms of hypocalcemia include: hyperactive tendon reflexes, muscle twitching, spasm, abdominal cramps, ECG changes, and convulsions.

 

DIF:    Application    REF:   p. 285            OBJ:   11

 

  1. Symptoms of hypercalcemia would include which of the following?
a. depression
b. diarrhea
c. hyperactive tendon reflexes
d. muscle fasciculation

 

 

ANS:  A

Symptoms of hypercalcemia include: fatigue, depression, muscle weakness, anorexia, nausea, vomiting, and constipation.

 

DIF:    Application    REF:   p. 285            OBJ:   11

 

  1. What is hypercalcemia most often associated with?
a. hyperparathyroidism
b. kidney failure
c. pancreatitis
d. trauma

 

 

ANS:  A

Hypercalcemia (increased levels of calcium) can result from numerous disorders. The most common causes are hyperparathyroidism (increased intestinal calcium absorption) and in malignancies (e.g., multiple myeloma, lung cancer).

Normal values for serum Mg2+ range from 1.7 to 2.1 mg/dl (1.3 to 2.1 mEq/L) in healthy adults.

 

DIF:    Recall             REF:   p. 285            OBJ:   11

 

  1. What are normal values for serum Mg2+?
a. 1.3 to 2.1 mEq/L.
b. 3.5 to 4.8 mEq/L
c. 9.0 to 10.5 mEq/L
d. 98.0 to 105.0 mEq/L

 

 

ANS:  A                    DIF:    Recall            REF:   p. 287            OBJ:   11

 

  1. Where is most of the Mg2+ found in the body?
a. bound to phosphate
b. bound to proteins
c. in the cells
d. ionized

 

 

ANS:  C

Most (99%) of the magnesium in the body is intracellular. Of the small portion in extracellular spaces, 80% is ionized or bound to other ions (e.g. phosphate) with the remaining 20% bound to proteins.

 

DIF:    Recall             REF:   p. 287            OBJ:   11

 

  1. What is the normal range for serum phosphate?
a. 1.2 to 2.3 mEq/L.
b. 3.5 to 5.8 mEq/L
c. 9.0 to 10.5 mEq/L
d. 98.0 to 106.0 mEq/L

 

 

ANS:  A

Only about 1% of the total body phosphorus is available as free serum compounds, so the serum level (1.2 to 2.3 mEq/L) does not necessarily reflect total body content.

 

DIF:    Recall             REF:   p. 288            OBJ:   11

 

  1. Which of the following is FALSE about phosphate?
a. Organic phosphate is the primary extracellular cation.
b. Inorganic phosphate plays a primary role in energy metabolism.
c. Phosphate is the main urinary buffer for titratable acid excretion.
d. Serum phosphate levels range from 1.2 to 2.3 mEq/L.

 

 

ANS:  A

Organic phosphate (HPO42–) is the main anion within cells. Inorganic phosphate plays a primary role in the metabolism of cellular energy, being the source from which adenosine triphosphate is synthesized. In acid-base homeostasis, phosphate is the main urinary buffer for titratable acid excretion.

 

DIF:    Application    REF:   p. 288            OBJ:   11

 

  1. The ease with which a solute dissolves into a solvent is at least partially determined by which of the following?
a. pressure of a solid
b. solute concentration
c. level of 2,3-DPG
d. solvent conductivity

 

 

ANS:  B

The ease with which a solute dissolves in a solvent is its solubility, which is influenced by five factors:

  1. Nature of the solute. The ease with which substances go into a solution in a given solvent depends on the forces of the solute-solute molecules and varies widely.
  2. Nature of the solvent. A solvent’s ability to dissolve a solute depends on the bonds of the solvent-solvent molecules, and also varies widely.
  3. Temperature. Solubility of most solids increases with increased temperature. However, the solubility of gases varies inversely with temperature.
  4. Pressure. The solubility of solids and liquids is not greatly affected by pressure. The solubility of gases in liquids, however, varies directly with pressure.
  5. Concentration. The concentration of a solute or available solvent will have an effect of how much of the substance goes into solution.

 

DIF:    Application    REF:   p. 273            OBJ:   2

 

  1. Osmolality is defined as:
a. the ratio of solute to solvent
b. the ratio of solvent to solute
c. the ability of cell walls to be semipermeable
d. the attractive force of the solute within the solution

 

 

ANS:  A

Osmolality is defined as the ratio of solute to solvent. In physiology the solvent is water. Osmotic pressure depends on the number of particles in solution but not on their charge or identity.

 

DIF:    Application    REF:   p. 275            OBJ:   3

 

  1. Starling Forces, or fluid movement due to filtration across the wall of a capillary is dependent upon:
  2. hydrostatic & oncotic pressure gradients across the capillary
  3. hydraulic (hydrostatic) in the vessel
  4. colloid osmotic pressure (COP) in the vessel
  5. colloid osmotic pressure (COP) in the tissue space
a. 1 and 4
b. 1, 2, and 4
c. 2 and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

Ernst Starling was a 19th century British physiologist who studied fluid transport across membranes. His hypothesis states that the fluid movement due to filtration across the wall of a capillary is dependent upon both the hydrostatic and oncotic pressure gradients across the capillary. The driving force for fluid filtration across the wall of the capillary is determined by four separate pressures: hydraulic (hyrdrostatic), and colloid osmotic pressure (COP) both within the vessel and in the tissue space respectively.

 

DIF:    Application    REF:   p. 283            OBJ:   1

 

  1. The most common causes of acute hyponatremia include:
  2. postoperative iatrogenic causes
  3. not drinking enough water
  4. self-induced due to water intoxication
  5. not eating enough foods containing sodium
a. 1 and 3
b. 2 and 3
c. 1, 2, and 4
d. 1, 2, 3 and 4

 

 

ANS:  A

Hyponatremia can lead to cerebral edema due to a change in osmotic pressure. The two most common causes for acute hyponatremia are postoperative iatrogenic and self-induced due to water intoxication.

 

DIF:    Application    REF:   p. 285            OBJ:   11

 

  1. Hyponatremia can lead to which of the following problems?
  2. impaired cognitive function
  3. negative effects on gait stability
  4. renal insufficiency
  5. cerebral edema
a. 1 and 3
b. 2 and 3
c. 1, 2, and 4
d. 1, 2, 3 and 4

 

 

ANS:  C

Once considered to be benign, mild hyponatremia has been shown in recent studies to have a significant impact on a patient`s cognitive function as well as his or her gait stability, it is thought to be a contributing factor in falls. Hyponatremia can lead to cerebral edema due to a change in osmotic pressure.

 

DIF:    Application    REF:   p. 285            OBJ:   11

Chapter 22: Pulmonary Infections

Test Bank

 

MULTIPLE CHOICE

 

  1. Which of the following is true concerning pneumonia?
a. Patients with community-acquired pneumonia most often require hospitalization.
b. Community-acquired pneumonias are most often antibiotic-resistant strains.
c. Pneumonia is the number one cause of death in the United States.
d. Pneumonia is the sixth leading cause of death in the United States.

 

 

ANS:  D

Pneumonia is the seventh leading cause of death in the United States and the most common cause of infection-related mortality.

 

DIF:    Application    REF:   p. 506            OBJ:   2

 

  1. A patient comes into the emergency department presenting with signs and symptoms of pneumonia. While taking the patient’s history, it is determined that 2 months ago the patient spent 3 days in the hospital for acute angina. Since then the patient has been stable on medication. What type of pneumonia is this patient most likely to have?
a. CAP
b. HAP
c. HCAP
d. VAP

 

 

ANS:  C

HCAP is defined as pneumonia occurring in any patient hospitalized for 2 or more days in the past 90 days in an acute care setting or who, in the past 30 days, has resided in a long-term care or nursing facility, attended a hospital or hemodialysis clinic, or who has received intravenous antibiotics, chemotherapy or wound care.

 

DIF:    Application    REF:   p. 506            OBJ:   2

 

  1. Which of the following types of pneumonia suggests that the patient acquired it through inhalation of infectious particles?
a. cytomegalovirus
b. Haemophilus influenzae
c. histoplasmosis
d. Staphylococcus

 

 

ANS:  C

Six pathogenetic mechanisms may contribute to the development of pneumonia (Table 22-2). Histoplasmosis is one of those caused by inhalation of infectious particles.

 

DIF:    Recall             REF:   p. 507            OBJ:   2

 

  1. Via what route is tuberculosis spread?
a. direct contact
b. fecal-oral route
c. fomite
d. inhaled particles

 

 

ANS:  D

Tuberculosis is acquired by inhalation of infectious particles is the basis for a policy whereby patients with suspected or proven tuberculosis who are coughing are placed in respiratory isolation, thereby minimizing the risk of disease transmission within the hospital setting.

 

DIF:    Recall             REF:   p. 507            OBJ:   2

 

  1. Which group of patients is most likely to develop pneumonia subsequent to large volume aspiration?
a. acute respiratory distress syndrome
b. alcohol toxicity
c. diabetes mellitus
d. obstructive sleep apnea

 

 

ANS:  B

Certain patient populations are at risk of large-volume aspiration, such as those with impaired gag reflexes from narcotic use, alcohol intoxication, or prior stroke.

 

DIF:    Recall             REF:   p. 507            OBJ:   3

 

  1. What mechanism has been found to be useful in minimizing the development of pneumonia associated with intubated patients?
a. elevation of the head of the bed
b. frequent suctioning through the endotracheal tube
c. maintaining the patient on severe fluid restriction
d. use of tracheal gas insufflation

 

 

ANS:  A

In intubated patients, chronic aspiration of colonized secretions through a tracheal cuff has been linked to the subsequent occurrence of pneumonia, which has led to the development of novel strategies to prevent hospital-acquired pneumonia, such as continuous suctioning of subglottic secretions in mechanically ventilated patients and elevation of the head of the bed.

 

DIF:    Recall             REF:   p. 507            OBJ:   3

 

  1. Which of the following mechanisms is an uncommon route for the spread of pneumonia?
a. aspiration of infectious particles
b. inhalation of infectious particles
c. through the bloodstream

 

 

ANS:  C

The spread of infection through the bloodstream from a remote site is called hematogenous dissemination. This is an uncommon cause of pneumonia, which may occur in patients with right-sided bacterial endocarditis in whom fragments of an infected heart valve break off, embolize through the pulmonary arteries to the lungs, and produce either pneumonia or septic pulmonary infarcts.

 

DIF:    Recall             REF:   p. 507            OBJ:   3

 

  1. Which of the following types of pneumonia suggests that the patient acquired it because of the reactivation of a latent infection, often in the setting of immunosuppression?
a. cytomegalovirus
b. Haemophilus influenzae
c. histoplasmosis
d. Staphylococcus

 

 

ANS:  A

Cytomegalovirus pneumonia is an example of a latent infection that can reactivate during chronic immunosuppression, especially in solid organ and bone marrow transplant recipients.

 

DIF:    Recall             REF:   p. 508            OBJ:   3

 

  1. What is the most common identified cause of community-acquired pneumonia?
a. Haemophilus influenzae
b. Legionella pneumophila
c. Staphylococcus aureus
d. Streptococcus pneumoniae

 

 

ANS:  D

In most studies, S. pneumoniae, also called pneumococcus, has been the most commonly identified cause of community-acquired pneumonia, accounting for 20% to 75% of cases (Table 22-3).

 

DIF:    Recall             REF:   p. 508            OBJ:   4

 

  1. Which of the following represents an example of atypical community-acquired pneumonia?
a. Haemophilus influenzae
b. Legionella pneumophila
c. Staphylococcus aureus
d. Streptococcus pneumoniae

 

 

ANS:  B

Legionella species, Chlamydophilia pneumoniae, and Mycoplasma pneumoniae together account for 10% to 20% of cases. These latter organisms, called atypical pathogens, vary in frequency in recent reports, depending on the age of the patient population, the season of the year, and geographical locale.

 

DIF:    Recall             REF:   p. 508            OBJ:   4

 

  1. What has been found to be a common cause of pneumonia in HIV-positive patients?
a. Klebsiella
b. Pneumocystis jiroveci
c. Staphylococcus
d. Streptococcus pneumoniae

 

 

ANS:  B

In urban settings that have a high incidence of endemic HIV infection, P. jiroveci may be a more common cause of community-acquired pneumonia and, according to one report, may account for up to 13% of cases.

 

DIF:    Recall             REF:   p. 508            OBJ:   4

 

  1. In what percentage of patients with pneumonia has NO microbial agent been isolated?
a. up to 40%
b. up to 50%
c. up to 60%
d. up to 70%

 

 

ANS:  B

In most published series, no microbiological diagnosis is established in up to 50% of patients.

 

DIF:    Recall             REF:   p. 508            OBJ:   4

 

  1. Which of the following would be the more common route for nosocomial pathogens to be transmitted?
a. directly patient to patient
b. fecal-oral route
c. aerosol route
d. via the health care worker

 

 

ANS:  D

Nosocomial pathogens capable of producing hospital-acquired pneumonia can be transmitted directly from one patient to another, as in the case of tuberculosis. However, transmission from health care workers (including respiratory therapists [RTs]), contaminated equipment, or fomites (objects capable of transmitting infection through physical contact with them) is more common, especially for gram-negative bacilli, S. aureus, and viruses.

 

DIF:    Recall             REF:   p. 509            OBJ:   4

 

  1. What term is used to describe objects capable of transmitting infection through physical contact with them?
a. consolidates
b. contaminants
c. fomites
d. nanospecs

 

 

ANS:  C

Fomites are objects capable of transmitting infection through physical contact with them.

 

DIF:    Recall             REF:   p. 509            OBJ:   4

 

  1. In what type of pneumonia is diarrhea a common symptom?
a. cytomegalovirus
b. Klebsiella
c. pneumococcal
d. staphylococcal

 

 

ANS:  C

The occurrence of concomitant diarrhea, once considered indicative of legionellosis, is now known to be common in pneumococcal and Mycoplasma pneumonia.

 

DIF:    Recall             REF:   p. 509            OBJ:   5

 

  1. A patient presents with high fever, teeth-chattering chills, pleuritic pain, and a cough producing rust-colored sputum. What pathogen should be suspected?
a. Chlamydia pneumoniae
b. Legionella pneumoniae
c. Mycoplasma pneumoniae
d. Pneumococcal pneumoniae

 

 

ANS:  D

In patients presenting with high fever, teeth-chattering chills, pleuritic pain, and a cough producing rust-colored sputum, pneumococcal pneumonia is the most likely diagnosis.

 

DIF:    Recall             REF:   p. 509            OBJ:   5

 

  1. Which of the following symptoms is typical for pneumococcal pneumonia?
a. foul-smelling sputum
b. low-grade fever
c. minimal sputum production
d. pleuritic chest pain

 

 

ANS:  D

In patients presenting with high fever, teeth-chattering chills, pleuritic pain, and a cough producing rust-colored sputum, pneumococcal pneumonia is the most likely diagnosis.

 

DIF:    Recall             REF:   p. 509            OBJ:   5

 

  1. Your patient has community-acquired bacterial pneumonia. Which of the following symptoms are common with this type of pneumonia?
  2. cough with purulent sputum
  3. diarrhea
  4. high fever
  5. shaking chills
a. 1, 2, and 3
b. 2 and 4
c. 3
d. 1, 2, 3, and 4

 

 

ANS:  D

In patients presenting with high fever, teeth-chattering chills, pleuritic pain, and a cough producing rust-colored sputum, pneumococcal pneumonia is the most likely diagnosis. Diarrhea is also a common finding.

 

DIF:    Application    REF:   p. 509            OBJ:   5

 

  1. A patient presents with pneumonia accompanied by foul-smelling breath, an absent gag reflex, or recent loss of consciousness. What should be suspected?
a. aspiration pneumonia
b. Chlamydia pneumonia
c. pneumococcal pneumonia
d. tuberculosis

 

 

ANS:  A

Patients with pneumonia accompanied by foul-smelling breath, an absent gag reflex, or recent loss of consciousness are most likely to have a mixed aerobic and anaerobic infection as a consequence of aspiration.

 

DIF:    Application    REF:   p. 509            OBJ:   5

 

  1. What organism is likely to be responsible for pneumonia that is community acquired and produces a hoarse voice in the patient?
a. Chlamydia pneumoniae
b. Haemophilus influenzae
c. Legionella
d. Mycoplasma

 

 

ANS:  A

Community-acquired pneumonia accompanied by hoarseness suggests that the culprit is C. pneumoniae.

 

DIF:    Recall             REF:   p. 509            OBJ:   5

 

  1. An elderly patient comes in with failure to thrive, shortness of breath, confusion, and worsening congestive heart failure. What is most likely the patient’s primary problem?
a. an atypical pneumonia
b. aspiration pneumonia
c. community-acquired pneumonia
d. tuberculosis

 

 

ANS:  C

The clinical presentation of community-acquired pneumonia in elderly patients deserves special mention because it may be subtle. Older individuals with pneumonia may not have a fever or cough and may simply present with shortness of breath, confusion, worsening congestive heart failure (CHF), or failure to thrive.

 

DIF:    Application    REF:   p. 509-510     OBJ:   5

 

  1. What clinical finding should raise your suspicion that a patient has developed hospital-acquired pneumonia?
a. a new fever
b. digital clubbing
c. diplopia
d. pedal edema

 

 

ANS:  A

HCAP, HAP, and VAP usually present with a new onset of fever in hospitalized or institutionalized patients.

 

DIF:    Recall             REF:   p. 510            OBJ:   3

 

  1. What finding is usually used to confirm the diagnosis of pneumonia?
a. development of central cyanosis
b. new cough or new characteristic to the cough
c. new fever
d. new infiltrate on chest radiograph

 

 

ANS:  D

In patients with a compatible clinical syndrome, the diagnosis of community-acquired pneumonia is established by the presence of a new pulmonary infiltrate on the chest radiograph.

 

DIF:    Recall             REF:   p. 510            OBJ:   5

 

  1. Which of the following clinical conditions are often associated with a normal chest radiograph in the patient with pneumonia?
  2. dehydration
  3. early infection
  4. Klebsiella pneumonia
  5. Pneumocystis jiroveci infection
a. 1, 2, and 4
b. 2 and 3
c. 1
d. 1, 2, 3, and 4

 

 

ANS:  A

A normal chest x-ray film does not exclude the diagnosis of pneumonia. The chest radiograph may be normal in patients with early infection, dehydration, or P. jiroveci infection.

 

DIF:    Recall             REF:   p. 510            OBJ:   6

 

  1. What finding on the chest radiograph is typical for a viral pneumonia?
a. interstitial infiltrates
b. lobar consolidation
c. patchy infiltrate surrounding one bronchus or several bronchi
d. pleural effusion

 

 

ANS:  A

Interstitial infiltrates, especially if diffuse, suggest viral disease, P. jiroveci, or miliary tuberculosis in patients with community-acquired pneumonia.

 

DIF:    Recall             REF:   p. 510            OBJ:   6

 

  1. What type of lung infection is most commonly associated with cavitating lesions on the chest radiograph?
a. community-acquired pneumonia
b. reactivation tuberculosis
c. Staphylococcus aureus
d. viral pneumonias

 

 

ANS:  B

Cavitary infiltrates are seen in reactivation pulmonary tuberculosis; fungal pneumonias, such as histoplasmosis and blastomycosis; nocardiosis; pyogenic lung abscess; and rarely, P. jiroveci pneumonia.

 

DIF:    Recall             REF:   p. 510            OBJ:   6

 

  1. What type of severe lung infection may result in the development of small lung cavities called pneumatoceles?
a. community-acquired pneumonia
b. Legionella pneumoniae
c. Staphylococcus aureus
d. viral pneumonia

 

 

ANS:  C

Patients with severe staphylococcal or gram-negative pneumonias may develop small cavities called pneumatoceles.

 

DIF:    Recall             REF:   p. 510            OBJ:   6

 

  1. Rapidly spreading multilobar consolidation is typical for what type of pneumonia?
a. Klebsiella
b. Legionella
c. Pneumocystis jiroveci
d. Viral

 

 

ANS:  B

Legionellosis should be seriously considered in sicker patients with pneumonia of a single lobe, which quickly spreads to involve multiple lobes over 24 to 48 hours.

 

DIF:    Recall             REF:   p. 510            OBJ:   6

 

  1. The chest radiograph is often of little help in the diagnosis of nosocomial pneumonia in mechanically ventilated patients in the ICU because these individuals often have other reasons for radiographic abnormalities.
a. True
b. False

 

 

ANS:  A

The chest radiograph is often less helpful in the diagnosis of VAP because mechanically ventilated patients often have other reasons for radiographic abnormalities, such as ARDS, CHF, pulmonary thromboembolism, alveolar hemorrhage, or atelectasis.

 

DIF:    Recall             REF:   p. 511            OBJ:   6

 

  1. What organism is associated with the highest mortality rate for patients with pneumonia?
a. Klebsiella
b. Legionella
c. Pseudomonas aeruginosa
d. Staphylococcus aureus

 

 

ANS:  C

Mortality varies according to the infecting agent and was highest for P. aeruginosa (61.1%), Klebsiella species (35.7%), Escherichia coli (35.3%), and S. aureus (31.8%). Mortality rates for more common pathogens were lower but still substantial and included Legionella species (14.7%), S. pneumoniae (12.3%), C. pneumoniae (9.8%), and M. pneumoniae (1.4%).

 

DIF:    Recall             REF:   p. 511            OBJ:   7

 

  1. Which of the following clinical findings is NOT associated with an increased risk of death in the patient with pneumonia?
a. kidney disease
b. heart rate of 130 beats/min
c. respiratory alkalosis
d. systolic blood pressure of 85 mm Hg

 

 

ANS:  C

Points are assigned for the presence of a number of variables, and cumulative point scores are used to stratify patients into one of five different risk groups with predictable mortality rates (Table 22-5). Of the above only C is NOT associated with increased risk of death.

 

DIF:    Recall             REF:   p. 512            OBJ:   7

 

  1. Which of the following would be associated with a fatal outcome in a patient with pneumonia who is mechanically ventilated?
a. heart rate of 110 beats/min
b. multisystem organ failure
c. presence of purulent sputum
d. respiratory alkalosis

 

 

ANS:  B

In mechanically ventilated patients, factors associated with fatal outcome include the following:

  • Infection with high-risk organisms such as P. aeruginosa, Acinetobacter species, and Stenotrophomonas maltophilia
  • Multisystem organ failure
  • Nonsurgical diagnosis
  • Therapy with antacids or H2-receptor antagonists
  • Transfer from another hospital or ward
  • Renal failure
  • Prolonged mechanical ventilation
  • Coma or shock
  • Inappropriate antibiotic therapy
  • Hospitalization in a noncardiac ICU

 

DIF:    Recall             REF:   p. 512            OBJ:   7

 

  1. Which of the following would interfere with the collection of a good sputum sample for Gram stain?
  2. contamination of the sample with oral secretions
  3. lack of productive cough
  4. prior antibiotic therapy
  5. rinsing with mouthwash prior to sputum collection
a. 1, 2, and 3
b. 2 and 4
c. 3
d. 1, 2, 3, and 4

 

 

ANS:  A

Factors that contribute to a poor Gram stain specimen include: lack a productive cough, prior antibiotic therapy, and contamination by oral secretions as specimens contaminated with oropharyngeal epithelial cells are unsatisfactory for analysis.

 

DIF:    Recall             REF:   p. 513            OBJ:   8

 

  1. What would be important to perform in order to obtain a good sputum sample that is to be used to detect the pathogen causing community-acquired pneumonia?
a. Ensure that antibiotic treatment was instituted at least 24 hours earlier.
b. Have patient sit in the semirecumbent position to obtain sample.
c. Have patient spit into sample container.
d. Patient should rinse mouth prior to sample collection.

 

 

ANS:  D

The RT has an important role in the collection of an appropriate specimen of expectorated sputum. Patients should be advised to rid the mouth of contaminating saliva, either by rinsing with water or by spitting, and then to expectorate a specimen from deep within the tracheobronchial tree into a collection container. Prompt transportation to the laboratory is essential and improves the diagnostic yield from culture.

 

DIF:    Recall             REF:   p. 514            OBJ:   8

 

  1. Which of the following organisms have been found to colonize the oropharynx of healthy individuals?
a. Coccidioides immitis
b. Haemophilus influenzae
c. Histoplasma capsulatum
d. Mycobacterium

 

 

ANS:  B

In routine sputum culture, the isolation of bacteria, such as S. pneumoniae and H. influenzae, must be interpreted within the context of the Gram stain because these organisms can colonize the oropharynx, and their presence in culture may not signify true lower respiratory tract infection.

 

DIF:    Recall             REF:   p. 514            OBJ:   8

 

  1. In the patient suspected of having tuberculosis, what finding on Gram stain would result in the initiation of antituberculosis medications?
a. acid-fast bacilli
b. gram-negative rods
c. pleomorphic cocci
d. presence of gram-negative cocci

 

 

ANS:  A

In patients with suspected tuberculosis, the finding of acid-fact bacilli in stained specimens of sputum often prompts initiation of antituberculous therapy, because culture isolation of M. tuberculosis may take up to 6 weeks.

 

DIF:    Recall             REF:   p. 514            OBJ:   8

 

  1. Which of the following organisms that cause pneumonia is most likely to result in a positive blood culture?
a. Chlamydia pneumoniae
b. Haemophilus influenzae
c. Mycoplasma pneumoniae
d. Pneumocystis jiroveci

 

 

ANS:  B

Blood cultures should be obtained in hospitalized patients with community-acquired pneumonia and may be helpful in establishing the diagnosis in patients with typical bacterial pathogens. Blood cultures are positive in approximately 30% of patients with pneumococcal pneumonia and in up to 70% of those with H. influenzae pneumonia.

 

DIF:    Recall             REF:   p. 514            OBJ:   9

 

  1. What percent of patients with community-acquired pneumonia have a parapneumonic pleural effusion?
a. 5% to 10%
b. 20% to 35%
c. 30% to 50%
d. 50% to 75%

 

 

ANS:  C

Parapneumonic pleural effusions are common and occur in 30% to 50% of cases of community-acquired pneumonia.

 

DIF:    Recall             REF:   p. 514            OBJ:   9

 

  1. A 35-year-old man is admitted to the hospital and has been confirmed to have pneumococcal pneumonia. What test would it be wise to order at this time?
a. bronchial biopsy
b. CBC and electrolytes
c. HIV
d. sputum culture and sensitivity

 

 

ANS:  C

Because pneumococcal and H. influenzae pneumonia occur with higher frequency in patients with HIV than they do in the average population, an HIV test is recommended for patients with community-acquired pneumonia who are between the ages of 15 and 54 years. HIV testing also is recommended for other individuals who engage in behaviors that put them at risk for HIV.

 

DIF:    Application    REF:   p. 515            OBJ:   9

 

  1. An intubated, mechanically ventilated patient is suspected of developing nosocomial pneumonia. The pulmonologist decides to perform a bronchoscopy. Which bronchoscopy findings would be consistent with pneumonia?
  2. alveolar collapse
  3. distal purulent secretions
  4. persistent secretions surging from distal bronchi during exhalation
  5. P/F ratio less than 50
a. 2, 3, and 4
b. 1 and 3
c. 2
d. 1, 2, 3, and 4

 

 

ANS:  A

Direct visualization by bronchoscopy of the lower airway in ventilated patients is sometimes helpful in supporting the diagnosis of VAP. In one recent study, the presence of distal, purulent secretions; persistence of secretions surging from distal bronchi during exhalation; and a decrease in the PaO2/FIO2 ratio of less than 50 were independently associated with the presence of pneumonia.

 

DIF:    Application    REF:   p. 515            OBJ:   9

 

  1. What diagnostic procedure might be done by a lone respiratory therapist in order to determine the presence of ventilator-associated pneumonia?
a. bronchial biopsy
b. mini bronchoalveolar lavage
c. protected specimen brush
d. transthoracic ultrathin needle aspiration

 

 

ANS:  B

Recently, mini-BAL performed by RTs has been advocated for diagnosing VAP. In one study, results obtained using this technique were comparable with those obtained by bronchoscopy using PSB.

 

DIF:    Recall             REF:   p. 516            OBJ:   9

 

  1. What timeline has been established to initiate antibiotic treatment in patients with pneumonia who are admitted to the hospital that will result in improved survival?
a. 2 hours or less
b. 4 hours or less
c. 6 hours or less
d. 8 hours or less

 

 

ANS:  B

Therapy initiated within 4 hours of hospital admission has been associated with improved survival.

 

DIF:    Recall             REF:   p. 516            OBJ:   10

 

  1. For a patient with pneumonia with coexisting cardiopulmonary disease, according to the ATS guidelines, what single antibiotic could be given as empiric treatment?
a. intravenous b-lactam
b. intravenous doxycycline
c. intravenous fluoroquinolone
d. intravenous macrolide

 

 

ANS:  C

For higher-risk patients with these comorbidities, acceptable alternatives include an IV beta-lactam plus an IV or oral macrolide or doxycycline; alternatively, a parenteral fluoroquinolone may be used alone.

 

DIF:    Recall             REF:   p. 509            OBJ:   10

 

  1. ATS guidelines suggest using which of the following antibiotics if methicillin-resistant S. aureus is a concern?
a. cefazolin
b. doxycycline
c. penicillin
d. vancomycin

 

 

ANS:  D

Vancomycin is another alternative, although the ATS guidelines suggest avoiding vancomycin unless methicillin-resistant S. aureus is a concern.

 

DIF:    Recall             REF:   p. 518            OBJ:   10

 

  1. What antibiotic is the drug of choice for the patient with nonresistant S. pneumoniae?
a. ampicillin
b. azithromycin
c. penicillin
d. vancomycin

 

 

ANS:  C

For isolates of S. pneumoniae susceptible to penicillin, penicillin remains the preferred agent.

 

DIF:    Recall             REF:   p. 517            OBJ:   10

 

  1. What is the drug of choice for the patient with Pneumocystis jiroveci pneumonia?
a. ampicillin
b. doxycycline
c. erythromycin
d. trimethoprim-sulfamethoxazole

 

 

ANS:  D

Trimethoprim-sulfamethoxazole (TMP-SMX) is the drug of choice for P. jiroveci pneumonia.

 

DIF:    Recall             REF:   p. 519            OBJ:   10

 

  1. If an HIV-infected patient has an adverse reaction to the treatment of choice for Pneumocystis jiroveci pneumonia, what treatment should be instituted?
a. amphotericin B
b. pentamidine
c. trimethoprim-sulfamethoxazole
d. vancomycin

 

 

ANS:  B

Up to 50% of HIV-infected patients will develop fever or a rash while taking TMP-SMX. Pentamidine is an acceptable alternative.

 

DIF:    Application    REF:   p. 518            OBJ:   10

 

  1. What might be indicated by failure of the patient’s temperature to normalize 4 or 5 days after the start of antibiotic therapy?
  2. closed-space infection
  3. drug fever
  4. missed pathogen
a. 1 and 2
b. 2 and 3
c. 1
d. 1, 2, and 3

 

 

ANS:  D

Failure of the patient’s temperature to normalize within 4 or 5 days suggests the following possibilities: a missed pathogen, a metastatic or closed-space infection (e.g., empyema), drug fever, or the presence of an obstructing endobronchial lesion.

 

DIF:    Application    REF:   p. 518            OBJ:   10

 

  1. A 45-year-old patient diagnosed with pneumonia has received appropriate antibiotic therapy. Radiographic resolution is most often seen within what time period?
a. 1 week
b. 1 month
c. 6 months
d. 1 year

 

 

ANS:  B

Within 1 month, radiographic resolution occurs in 90% of individuals younger than the age of 50 years.

 

DIF:    Recall             REF:   p. 518            OBJ:   6

 

  1. Which of the following organisms is associated with a poor prognosis in the patient with ventilator-related pneumonia despite optimal therapy?
a. C. pneumoniae
b. Klebsiella
c. P. aeruginosa
d. S. pneumoniae

 

 

ANS:  C

Some organisms, such as P. aeruginosa and Acinetobacter species, are associated with a poor prognosis in ventilator-associated pneumonia, despite optimal therapy. The mortality rate for these organisms may approach 90%, despite appropriate treatment.

 

DIF:    Recall             REF:   p. 519            OBJ:   4

 

  1. Which of the following individuals should be immunized against influenza?
  2. 65-year-old individual
  3. respiratory therapist
  4. individual with chronic heart disease
  5. individual with glaucoma
a. 1, 2, and 3
b. 2 and 4
c. 1 and 3
d. 1, 2, 3, and 4

 

 

ANS:  A

Immunization for community-acquired pneumonia is indicated for individuals: older than the age of 60 years, with chronic lung or heart disease, or for whom the morbidity of influenza may be substantial. Health care workers, including RTs, should be immunized annually to prevent transmission of influenza to patients.

 

DIF:    Recall             REF:   p. 519            OBJ:   11

 

  1. Pneumococcal vaccines are indicated for which of the following individuals?
  2. 65-year-old individual
  3. respiratory therapist
  4. individual with chronic heart disease
  5. individual with glaucoma
a. 1, 2, and 3
b. 2 and 4
c. 1 and 2
d. 1, 2, 3, and 4

 

 

ANS:  C

Pneumococcal vaccination is indicated for all individuals older than the age of 65 years and for those older than the age of 2 years who have functional or anatomical asplenia. Vaccination is also indicated in patients with chronic illnesses such as CHF, chronic lung disease, chronic liver disease, alcoholism, cerebrospinal fluid leaks, or conditions characterized by impaired immunity. Routine pneumococcal vaccination of all health care workers is not currently recommended, unless they possess one of the specific indications for vaccination outlined previously.

 

DIF:    Recall             REF:   p. 519            OBJ:   11

 

  1. What is an often-neglected but very important component of preventing transmission of pathogens between patients, particularly those who are ventilated?
a. adequate antibiotic therapy
b. brushing of teeth
c. hand washing
d. use of negative-pressure rooms

 

 

ANS:  C

Handwashing is an important but frequently neglected measure that can reduce transmission of nosocomial bacteria from one patient to another. It is especially important for RTs who may be caring for several ventilated patients in the ICU.

 

DIF:    Recall             REF:   p. 520            OBJ:   11

 

  1. Would a patient being fed through a jejunostomy tube be more likely to develop nosocomial pneumonia than if he were fed totally via the parenteral route?
a. no, less likely
b. risks are almost the same
c. yes, more likely

 

 

ANS:  A

In patients requiring nutritional support, the use of enteral feeding by means of jejunostomy has been associated with a lower risk of nosocomial pneumonia than that associated with the use of total parenteral nutrition.

 

DIF:    Application    REF:   p. 520            OBJ:   11

 

  1. Which of the following are common laboratory findings found in adults with suspected Community-Acquired Pneumonia?
  2. acidemia (arterial pH < 7.35)
  3. proteinuria
  4. azotemia
  5. hyponatremia
a. 1, 2, and 3
b. 2 and 4
c. 1 and 3
d. 1, 3, and 4

 

 

ANS:  D

Table 22.5 lists some of the laboratory and radiographic findings to help in the diagnosis of Community-Acquired Pneumonia. Some of these findings are Acidemia (arterial pH <7.35), Azotemia (BUN >30mg/dl), Hyponatremia (sodium <130 mmol/L), Hypoxia (Pao2 < 60mmHg), Hyperglycemia (glucose >250mg/dl), Anemia (Hematocrit <30%) and Pleural effusion. Proteinuria is not common in CAP.

 

DIF:    Recall             REF:   p. 512            OBJ:   5

 

  1. All of the following are extra-pulmonary manifestations for TB, except:
a. hectic fever
b. hepatomegaly
c. bronchioectasis
d. weight loss

 

 

ANS:  C

Pulmonary complications tuberculosis include tuberculous empyema, bronchiectasis, extensive pulmonary parenchymal destruction, spontaneous pneumothorax, and massive hemoptysis from rupture of a Rasmussen aneurysm in the wall of a cavity. Extra-pulmonary complications may include hectic fever, wasting, and hepatosplenomegaly (enlargement of the liver and spleen). Laboratory testing may demonstrate pancytopenia (decreased cell counts in white blood cells, red blood cells, and platelets) and advanced immunodeficiency.

 

DIF:    Recall             REF:   p. 521            OBJ:   10

 

  1. A 26 year-old seasonal worker from South America came to the ER with a history of a dry, hacking blood-tinged cough, fever, chills and loss of appetite. The chest x-ray showed cavitary lesion in the right upper lobe. After a week in the hospital the sputum culture shows the present of acid-fast stained organisms. Which of the following medications would you recommend for this patient at this time?
  2. ceftizoxime
  3. isoniazid
  4. rifampin
  5. ethambutol
a. 1
b. 2 and 4
c. 1, 2 and 3
d. 2, 3, and 4

 

 

ANS:  D

Isoniazid, rifampin, pyrazinamide, and ethambutol are first-line antituberculous medications. Pending antimicrobial susceptibility results, treatment with four drugs at the outset is recommended. In those with drug-susceptible pulmonary tuberculosis, a number of 6- to 9-month treatment regimens have been shown to be effective as outlined in the ATS/CDC/IDSA guidelines.

 

DIF:    Analysis         REF:   p. 522            OBJ:   10

Chapter 32: Airway Pharmacology

Test Bank

 

MULTIPLE CHOICE

 

  1. Which of the following phases constitute the course of drug action from dose to effect?
  2. drug administration
  3. pharmacognosy
  4. pharmacokinetic
  5. pharmacodynamic
a. 1, 2, and 3
b. 1, 3, and 4
c. 2, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  B

Three phases constitute the course of drug action from dose to effect: the drug administration, pharmacokinetic, and pharmacodynamic phases.

 

DIF:    Recall             REF:   p. 708            OBJ:   1

 

  1. Which of the following devices are most commonly used to deliver aerosols by the inhalation route?
  2. dry powder inhaler
  3. metered dose inhaler
  4. small-volume nebulizer
  5. slip-stream nebulizer
a. 1 and 3
b. 2 and 4
c. 1, 2, and 3
d. 1, 2, 3, and 4

 

 

ANS:  C

The most commonly used devices to administer orally or nasally inhaled aerosols are the metered-dose inhaler, the small-volume nebulizer, and the dry-powder inhaler.

 

DIF:    Recall             REF:   p. 708            OBJ:   1

 

  1. Which one or more of the following devices is NOT used in combination with metered dose inhaler (MDI) therapy to reduce the need for hand-breathing coordination and oropharyngeal impaction of aerosolized drugs?
a. nonvalved spacer devices
b. one-way spacer
c. holding chambers
d. drying chambers

 

 

ANS:  D

Reservoir devices, including both holding chambers with one-way inspiratory valves and simple, nonvalved spacer devices, are often added to an MDI to reduce the need for complex hand-breathing coordination and to reduce oropharyngeal impaction of the aerosol drug.

 

DIF:    Recall             REF:   p. 708            OBJ:   1

 

  1. Which of the following is NOT an advantage for the treatment of the respiratory tract with inhaled aerosols?
a. Doses are usually smaller.
b. Onset of drug action is rapid.
c. Delivered dose is consistent with each administration.
d. Systemic side effects are often fewer and less severe.

 

 

ANS:  C

The advantages for treatment of the respiratory tract with inhaled aerosols are as follows:

  • Aerosol doses are usually smaller than doses for systemic administration.
  • Onset of drug action is rapid.
  • Delivery is targeted to the organ requiring treatment.
  • Systemic side effects are often fewer and less severe.

 

DIF:    Recall             REF:   p. 708            OBJ:   1

 

  1. Which phase describes the time course and disposition of a drug in the body based on its absorption, distribution, metabolism, and elimination?
a. pharmaceutical
b. pharmacognosy
c. pharmacokinetic
d. pharmacodynamic

 

 

ANS:  C

The pharmacokinetic phase of drug action describes the time course and disposition of a drug in the body based on its absorption, distribution, metabolism, and elimination.

 

DIF:    Recall             REF:   p. 708            OBJ:   1

 

  1. Which of the following methods limits the systemic distribution of an inhaled aerosolized drug?
a. use of a fully ionized drug
b. use of a partially ionized drug
c. use of metabolites
d. use of the generic form of the drug

 

 

ANS:  A

One method of limiting distribution of inhaled aerosols is use of a fully ionized drug rather than a nonionized agent.

 

DIF:    Recall             REF:   p. 708            OBJ:   1

 

  1. Which of the following anticholinergics is poorly ionized?
a. atropine
b. ipratropium bromide
c. tiotropium bromide
d. oxitropium bromide

 

 

ANS:  A

Atropine is poorly ionized and diffuses well, distributing throughout the body.

 

DIF:    Recall             REF:   p. 708            OBJ:   1

 

  1. Which of the following lung availability/total systemic availability (L/T) ratios is consistent with an efficient aerosol delivery?
a. 0.46
b. 0.23
c. 0.1
d. 0.6

 

 

ANS:  D

The L/T ratio quantifies the efficiency of aerosol delivery to the lung.

 

DIF:    Application    REF:   p. 708            OBJ:   1

 

  1. Which phase describes the mechanism of drug action by which a drug causes its effects within the body through drug–receptor interactions?
a. pharmaceutical
b. pharmacognosy
c. pharmacokinetic
d. pharmacodynamic

 

 

ANS:  D

The pharmacodynamic phase describes the mechanisms of drug action by which a drug molecule causes its effects in the body.

 

DIF:    Recall             REF:   p. 708            OBJ:   1

 

  1. Pharmacologic control of the airway is mediated by receptors found on all of the following structures, except:
a. smooth muscle
b. secretory cells
c. blood vessels
d. alveolar epithelium

 

 

ANS:  D

Pharmacologic control of the airway is mediated by receptors found on airway smooth muscle, secretory cells, bronchial epithelium, and pulmonary and bronchial blood vessels.

 

DIF:    Recall             REF:   p. 708            OBJ:   1

 

  1. Which of the following is the usual neurotransmitter in the sympathetic system?
a. atropine
b. acetylcholine
c. norepinephrine
d. dopamine

 

 

ANS:  C

The usual neurotransmitter in the sympathetic system is norepinephrine, which is similar to epinephrine, also known as Adrenalin.

 

DIF:    Recall             REF:   p. 708-709     OBJ:   1

 

  1. Which of the following terms is used to describe a drug that stimulates a receptor responding to norepinephrine?
a. sympatholytic
b. anticholinergic
c. cholinergic
d. adrenergic

 

 

ANS:  D

Adrenergic (adrenomimetic) refers to a drug that stimulates a receptor responding to norepinephrine or epinephrine.

 

DIF:    Recall             REF:   p. 709            OBJ:   1

 

  1. When stimulated, which of the following receptors cause bronchoconstriction?
a. M3
b. M2
c. a1
d. b2

 

 

ANS:  A

See Table 32-1.

 

DIF:    Recall             REF:   p. 709            OBJ:   1

 

  1. Which of the following comprises the largest single group of drugs among aerosolized agents used for inhalation?
a. inhaled corticosteroids
b. adrenergic bronchodilators
c. mucus-controlling agents
d. anticholinergic bronchodilators

 

 

ANS:  B

The adrenergic bronchodilators represent the largest single group of drugs among the aerosolized agents used for oral inhalation.

 

DIF:    Recall             REF:   p. 709            OBJ:   2

 

  1. Proventil and Ventolin are brand names for which of the following b-adrenergic bronchodilators?
a. albuterol
b. isoetharine
c. terbutaline
d. metaproterenol

 

 

ANS:  A

See Table 32-2.

 

DIF:    Recall             REF:   p. 710            OBJ:   4

 

  1. Foradil is a brand name for which of the following b-adrenergic bronchodilators?
a. albuterol
b. isoetharine
c. terbutaline
d. formoterol

 

 

ANS:  D

See Table 32-2.

 

DIF:    Recall             REF:   p. 710            OBJ:   4

 

  1. A metered-dose inhaler of salmeterol delivers which of the following?
a. 131 mg/puff
b. 90 mg/puff
c. 65 mg/puff
d. 25 mg/puff

 

 

ANS:  D

See Table 32-2.

 

DIF:    Recall             REF:   p. 710            OBJ:   4

 

  1. What is the dosage for salmeterol MDI?
a. 2 puffs every 4 to 6 hours
b. 1 to 2 puffs four times daily
c. 2 puffs three times daily
d. 2 puffs every 12 hours

 

 

ANS:  D

See Table 32-2.

 

DIF:    Recall             REF:   p. 710            OBJ:   4

 

  1. Which of the following is an indication for use of an adrenergic bronchodilator?
a. treatment of excessive, viscous mucus secretions
b. antiinflammatory treatment of mild to moderate persistent asthma
c. treatment of reversible airflow obstruction
d. prophylactic management of asthma

 

 

ANS:  C

The general indication for use of an adrenergic bronchodilator is the presence of reversible airflow obstruction.

 

DIF:    Recall             REF:   p. 710            OBJ:   3

 

  1. Adrenergic bronchodilators improve flow rates for all the following diseases except:
a. asthma
b. acute bronchitis
c. chronic bronchitis
d. pulmonary fibrosis

 

 

ANS:  D

The most common use of these agents clinically is to improve flow rates in asthma (including exercise-induced asthma), acute and chronic bronchitis, emphysema, bronchiectasis, cystic fibrosis, and other obstructive airway states.

 

DIF:    Recall             REF:   p. 710            OBJ:   5

 

  1. Short-acting adrenergic bronchodilators are considered what type of agent according to the National Asthma Education and Prevention Program?
a. antiinflammatory
b. rescue
c. controller
d. mucolytic

 

 

ANS:  B

Short-acting agents are termed “rescue” agents in the 1997 National Asthma Education and Prevention Program Expert Panel II (NAEPP EPR II) guidelines.

 

DIF:    Recall             REF:   p. 710            OBJ:   2

 

  1. What is the name of the enzyme responsible for the short duration of action of catecholamine bronchodilators?
a. catechol O-methyltransferase (COMT)
b. epinephrine dismutase
c. EDTA
d. hyaluronidase

 

 

ANS:  A

Catecholamines are metabolized rapidly by the enzyme COMT, which causes a short duration of action.

 

DIF:    Recall             REF:   p. 710            OBJ:   2

 

  1. Which of the following short-acting catecholamines are used for their strong a1-vasoconstricting effects to reduce swelling in the nose and larynx and to control bleeding during bronchoscopic biopsy?
a. isoproterenol
b. isoetharine
c. dobutamine
d. racemic epinephrine

 

 

ANS:  D

Because of their strong a1 activity and vasoconstricting effect, epinephrine and the synthetic racemic epinephrine are used to reduce swelling in the nose (nasal decongestant) and larynx (croup, epiglottitis) and to control bleeding during bronchoscopic biopsy.

 

DIF:    Recall             REF:   p. 710            OBJ:   2

 

  1. What is the average duration of action of the short-acting noncatecholamine agents?
a. 1 to 2 hours
b. 2 to 4 hours
c. 4 to 6 hours
d. 6 to 8 hours

 

 

ANS:  C

Because their duration of action is approximately 4 to 6 hours, these drugs were more suited to maintenance therapy than catecholamines and could be taken on a four-times-daily schedule.

 

DIF:    Recall             REF:   p. 712            OBJ:   3

 

  1. Which of the following is NOT a short-acting noncatecholamine bronchodilator?
a. pirbuterol
b. terbutaline
c. albuterol
d. salmeterol

 

 

ANS:  D

The release of salmeterol offered the first long-acting adrenergic bronchodilator in the United States.

 

DIF:    Recall             REF:   p. 710            OBJ:   2

 

  1. Long-acting adrenergic bronchodilators such as salmeterol (Serevent) are not well suited for relief of acute airflow obstruction because it takes about how long for their peak effect to occur?
a. 1 to 3 hours
b. 3 to 5 hours
c. 5 to 7 hours
d. longer than 12 hours

 

 

ANS:  B

Salmeterol is not well suited for relief of acute airflow obstruction or bronchospasm because its onset is longer than 20 minutes, with a peak effect occurring by 3 to 5 hours.

 

DIF:    Recall             REF:   p. 710            OBJ:   3

 

  1. What is the brand name of the (R)-isomer of formoterol?
a. Foradil
b. Survanta
c. Brovana
d. Tornalate

 

 

ANS:  C

Arformoterol (Brovana), the single (R)-isomer of formoterol, is the newest long-acting b-agonist on the market.

 

DIF:    Recall             REF:   p. 710            OBJ:   4

 

  1. Which of the following is NOT a side effect of newer, more b2-selective bronchodilators?
a. tremor
b. insomnia
c. nervousness
d. bradycardia

 

 

ANS:  D

The newer, more b2-selective agents are safe and typically cause tremor as the main side effect. Other common side effects with the inhaled agents include headache, insomnia, and nervousness.

 

DIF:    Recall             REF:   p. 715            OBJ:   3

 

  1. What are some potential adverse effects with use of adrenergic bronchodilators?
  2. hypokalemia
  3. dizziness
  4. worsening ventilation/perfusion ratio ()
  5. bradycardia
a. 1 and 4
b. 2 and 3
c. 1, 2, and 3
d. 1, 2, 3, and 4

 

 

ANS:  C

Potential adverse effects with use of adrenergic bronchodilators include the following:

  • clorofluorocarbon (CFC) propellant-induced bronchospasm
  • dizziness
  • hypokalemia
  • loss of bronchoprotection
  • nausea
  • tolerance (tachyphylaxis)
  • worsening ventilation/perfusion ratio (decrease in PaO2)

 

DIF:    Recall             REF:   p. 715            OBJ:   3

 

  1. Which of the following are assessment features for evaluating patient response to bronchodilator therapy?
  2. reversibility of airflow obstruction
  3. changes in flow rates using a peak flowmeter or portable spirometry
  4. changes in vital signs
  5. changes in ventilation and oxygenation
  6. the patient’s subjective reaction to treatment
a. 2, 3, and 4
b. 2, 3, and 5
c. 1, 2, 3, and 5
d. 1, 2, 3, 4, and 5

 

 

ANS:  D

Assessment of therapy with adrenergic bronchodilators should be based on the indication(s) for the aerosol agent (presence of reversible airflow due to primary bronchospasm or other obstruction secondary to an inflammatory response and/or secretions, either acute or chronic). With all aerosol drug therapy, basic vital signs (respiratory rate and pattern, pulse, breath sounds) should be assessed before and after treatment, especially for initial drug use, as well as the patient’s subjective reaction (complaints of breathing difficulty).

 

DIF:    Recall             REF:   p. 715            OBJ:   6

 

  1. What amount of ipratropium bromide (Atrovent) is delivered by metered-dose inhaler?
a. 10 mg/puff
b. 15 mg/puff
c. 17 mg/puff
d. 90 mg/puff

 

 

ANS:  C

See Table 32-3.

 

DIF:    Recall             REF:   p. 715            OBJ:   4

 

  1. What is the dosage for ipratropium bromide (Atrovent)?
a. 2 puffs four times daily
b. 2 puffs three times daily
c. 2 puffs twice daily
d. 2 puffs every 12 hours

 

 

ANS:  A

See Table 32-3.

 

DIF:    Recall             REF:   p. 715            OBJ:   4

 

  1. What is the duration of action for ipratropium bromide?
a. 4 to 6 hours
b. 6 to 8 hours
c. 8 to 10 hours
d. 12 hours

 

 

ANS:  A

See Table 32-3.

 

DIF:    Recall             REF:   p. 715            OBJ:   3

 

  1. What is the duration of action for the formulation of ipratropium bromide plus albuterol sulfate (DuoNeb)?
a. 4 to 6 hours
b. 6 to 8 hours
c. 8 to 10 hours
d. 12 hours

 

 

ANS:  A

See Table 32-3.

 

DIF:    Recall             REF:   p. 715            OBJ:   4

 

  1. Ipratropium bromide (Atrovent) is indicated for maintenance treatment of the following diseases, except:
a. chronic bronchitis
b. emphysema
c. asthma
d. chronic obstructive pulmonary disease (COPD)

 

 

ANS:  C

Ipratropium and tiotropium are indicated as bronchodilators for maintenance treatment in COPD, including chronic bronchitis and emphysema.

 

DIF:    Recall             REF:   p. 715            OBJ:   3

 

  1. What are some common side effects seen with ipratropium bromide (Atrovent)?
a. tachycardia
b. blood pressure increase
c. cough and dry mouth
d. tolerance

 

 

ANS:  C

See Box 32-2.

 

DIF:    Recall             REF:   p. 716            OBJ:   3

 

  1. Ipratropium bromide should be used with precaution in all of the following diseases/conditions except:
a. prostatic hypertrophy
b. urinary retention
c. kidney stones
d. glaucoma

 

 

ANS:  C

Although ipratropium is not contraindicated in subjects with prostatic hypertrophy, urinary retention, or glaucoma, the drug should be used with precaution and adequate evaluation for possible systemic side effects in these subjects.

 

DIF:    Recall             REF:   p. 716            OBJ:   3

 

  1. Which of the following mucus-controlling agents is NOT currently approved for inhalation in the United States?
a. tryptase
b. dornase alfa
c. acetylcysteine
d. Mucomyst

 

 

ANS:  A

The two agents currently approved in the United States for oral inhalation with an effect on mucus are acetylcysteine (Mucomyst) and dornase alfa.

 

DIF:    Recall             REF:   p. 717            OBJ:   2

 

  1. Acetylcysteine (Mucomyst) is indicated in all of the following diseases except:
a. acute tracheobronchitis
b. bronchiectasis
c. chronic obstructive pulmonary disease (COPD)
d. asthma

 

 

ANS:  D

Diseases of excessive viscous mucus secretions and poor airway clearance include COPD, acute tracheobronchitis, and bronchiectasis.

 

DIF:    Recall             REF:   p. 717            OBJ:   3

 

  1. Which of the following are indications for the use of acetylcysteine (Mucomyst)?
  2. treatment of acetaminophen overdose
  3. treatment of excessive, viscous mucus secretions
  4. treatment of aspirin overdose
  5. treatment of purulent mucus secretions by breaking up DNA
a. 1 and 2
b. 2 and 4
c. 1, 2, and 3
d. 1, 2, 3, and 4

 

 

ANS:  A

Acetylcysteine is indicated for treatment to reduce accumulation of airway secretions. It is also used to treat or prevent the liver damage that can occur when a patient takes an overdose of acetaminophen.

 

DIF:    Recall             REF:   p. 717            OBJ:   3

 

  1. Acetylcysteine (Mucomyst) lowers the viscosity of mucus by means of which of the following?
a. breaking down DNA
b. increasing the osmolarity of the mucus and pulling water into it
c. changing the pH of the mucus, causing it to break down
d. substituting its sulfhydryl group for disulfide bonds and breaking a portion of the bond forming the gel structure

 

 

ANS:  D

Acetylcysteine acts as a classic mucolytic to reduce the viscosity of mucus by substituting its own sulfhydryl group for the disulfide group in mucus, thereby breaking a portion of the bond forming the gel structure.

 

DIF:    Recall             REF:   p. 717            OBJ:   3

 

  1. Which of the following prophylactic therapies is recommended to reduce the irritant effect of acetylcysteine?
a. administration of anticholinergics
b. administration of dornase alfa
c. administration of corticosteroids
d. administration of adrenergic bronchodilator

 

 

ANS:  D

Pretreatment with an adrenergic bronchodilator, allowing adequate time for a bronchodilatory effect to be produced, can prevent or reduce airway resistance with acetylcysteine.

 

DIF:    Recall             REF:   p. 717            OBJ:   3

 

  1. When administering acetylcysteine (Mucomyst), the respiratory therapist should be particularly focused on which of the following potential adverse effects?
  2. incompatibility with certain antibiotics when administered together
  3. nausea
  4. bronchospasm
  5. airway obstruction due to rapid liquefaction of mucus
a. 2 and 3
b. 1, 2, and 3
c. 2, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

Other side effects that can occur include the following:

  • airway obstruction due to rapid liquefaction of secretions
  • disagreeable odor due to hydrogen sulfide
  • incompatibility with certain antibiotics (sodium ampicillin, amphotericin B, erythromycin, tetracyclines, and aminoglycosides) if mixed in solution
  • increased concentration and toxicity of nebulizer solution toward end of treatment
  • nausea and rhinorrhea
  • stomatitis
  • reactivity of acetylcysteine with rubber, copper, iron, and cork

 

DIF:    Application    REF:   p. 717-718     OBJ:   3

 

  1. Which of the following are indications for aerosolized administration of dornase alfa?
  2. presence of nonpurulent mucoid secretions
  3. management of cystic fibrosis
  4. reduction of the frequency of exacerbations due to respiratory infection
  5. management of bronchospasm
a. 2 and 3 only
b. 1, 2, and 3
c. 2, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  A

Dornase alfa is indicated in the management of cystic fibrosis to reduce the frequency of respiratory infections requiring parenteral antibiotics and to improve pulmonary function of these patients.

 

DIF:    Recall             REF:   p. 718            OBJ:   3

 

  1. Which of the following are side effects of dornase alfa administration?
  2. allergic reactions due to antibody production in the patient against dornase alfa
  3. chest pain
  4. rash
  5. laryngitis
a. 1, 2, and 3
b. 1, 3, and 4
c. 2, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  C

Common side effects associated with dornase alfa have included pharyngitis and voice alteration, laryngitis, rash, chest pain, and conjunctivitis.

 

DIF:    Recall             REF:   p. 718            OBJ:   3

 

  1. Bland aerosols are better classified as:
a. mucolytics
b. secretagogues
c. expectorants
d. mucoactive therapy

 

 

ANS:  C

Bland aerosols are therefore more properly considered expectorants rather than mucolytic agents.

 

DIF:    Recall             REF:   p. 718            OBJ:   2

 

  1. Which of the following should be assessed during the administration of mucolytic agents?
  2. breathing pattern and rate
  3. monitoring peak flow changes
  4. patient’s reaction to treatment
  5. monitoring for presence of hydrogen sulfide (a rotten egg odor), which means that the acetylcysteine (Mucomyst) is no longer active
a. 1 and 3
b. 1, 2, and 3
c. 2, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  B

During treatment and short term:

  • Instruct and then verify correct use of aerosol nebulization system, including cleaning.
  • Assess therapy based on indication for drug: mucolysis and improved clearance of secretions.
  • Monitor airflow changes or adverse effects such as a decrease in FEV1.
  • Assess breathing pattern and rate.
  • Assess patient’s subjective reaction to treatment (changes in breathing effort or pattern).
  • Discontinue therapy if patient experiences adverse reactions.

 

DIF:    Application    REF:   p. 719            OBJ:   6

 

  1. Which of the following FEV1 values indicates severe compromise of expiratory airflow that may contraindicate the use of mucoactive therapy?
a. less than 65%
b. less than 55%
c. less than 35%
d. less than 25%

 

 

ANS:  D

Generally, if the FEV1 is less than 25% of predicted, it becomes difficult to mobilize and expectorate secretions.

 

DIF:    Recall             REF:   p. 719            OBJ:   3

 

  1. The National Asthma Education and Prevention Program guidelines advocate the use of oral administration of corticosteroids for which of the following?
a. acute asthma exacerbations
b. maintenance of severe persistent asthma
c. maintenance of moderate to severe persistent asthma
d. maintenance of mild to moderate persistent asthma

 

 

ANS:  D

The primary use of orally inhaled corticosteroids is for antiinflammatory maintenance therapy of persistent asthma.

 

DIF:    Recall             REF:   p. 719            OBJ:   5

 

  1. Which of the following is NOT an available formulation strength for fluticasone propionate (Flovent) by metered-dose inhaler?
a. 44 mg/puff
b. 110 mg/puff
c. 220 mg/puff
d. 250 mg/puff

 

 

ANS:  D

See Table 32-5.

 

DIF:    Recall             REF:   p. 720            OBJ:   4

 

  1. Which of the following are TRUE regarding glucocorticoids?
  2. They work through activation of intracellular receptors.
  3. Relief is immediate.
  4. Daily compliance is essential to controlling inflammation in asthma.
  5. They work in a similar fashion to adrenergic bronchodilators.
a. 1 and 3
b. 1, 3, and 4
c. 2, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  A

Because steroid action involves modification of cell transcription, full antiinflammatory effects require hours to days. It is important for patients to understand that inhalation of an aerosolized steroid will not provide immediate relief as with an adrenergic bronchodilator. However, daily compliance with the inhaled medication is essential to controlling the inflammation of asthma.

 

DIF:    Recall             REF:   p. 719            OBJ:   3

 

  1. Aerosolized delivery of corticosteroids usually does not manifest in adrenal suppression compared to systemic use as long as the daily dose in adults is kept below what level?
a. 800 mg
b. 1000 mg
c. 1200 mg
d. 1400 mg

 

 

ANS:  A

The systemic effect of adrenal suppression is not usually seen with inhaled doses less than 800 mg per day in adults or less than 400 mg per day in children.

 

DIF:    Recall             REF:   p. 721            OBJ:   4

 

  1. Which of the following inhaled corticosteroids is a prodrug?
a. ciclesonide
b. flunisolide
c. budesonide
d. triamcinolone

 

 

ANS:  A

Ciclesonide, a prodrug, is given as an inactive compound and is converted to an active metabolite, desisobutyryl-ciclesonide (des-CIC), by intracellular enzymes.

 

DIF:    Recall             REF:   p. 721            OBJ:   2

 

  1. Which of the following is NOT considered part of the assessment of severity of symptoms recommended by the NAEPP and GOLD guidelines to modify level or dosage of corticosteroids?
a. number of exacerbations
b. missed work or school days
c. pulmonary function
d. use of anticholinergics

 

 

ANS:  D

Assess severity of symptoms (coughing, wheezing, nocturnal awakenings, symptoms during exertion; use of rescue bronchodilator; number of exacerbations, missed work/school days; and pulmonary function), and modify level or dosage as recommended by NAEPP and GOLD guidelines.

 

DIF:    Recall             REF:   p. 721-722     OBJ:   3

 

  1. Which of the following are considered nonsteroidal antiasthma drugs?
  2. cromolyn-like agents
  3. leukotriene modifiers
  4. anti-IgE agents
  5. anti-IgA agents
a. 1 and 3
b. 1, 2, and 3
c. 2, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  B

Nonsteroidal antiinflammatory agents include the cromolyn-like agents (cromolyn sodium, nedocromil sodium); the antileukotrienes, also termed leukotriene modifiers (zafirlukast, zileuton, and montelukast); and a new class, monoclonal antibodies or anti-IgE agents (omalizumab).

 

DIF:    Recall             REF:   p. 723            OBJ:   2

 

  1. Which of the following are considered to be “quick relief” agents in treating asthma?
  2. methylxanthines
  3. ipratropium
  4. systemic corticosteroids (oral or intravenous)
  5. short-acting inhaled b2-agonists
  6. long-acting inhaled b2-agonists
  7. leukotriene antagonists
a. 2, 3, and 4
b. 2, 5 and 6
c. 1, 3, 5, and 6
d. 1, 2, 3, and 4

 

 

ANS:  D

See Box 32-4.

 

DIF:    Recall             REF:   p. 722            OBJ:   2

 

  1. How does cromolyn sodium work?
a. produces antiinflammatory enzymes within cells
b. inhibits degranulation of mast cells
c. prevents arachidonic acid formation from activation of mast cell membrane phospholipase A2
d. provides leukotriene inhibition

 

 

ANS:  B

Cromolyn sodium acts by inhibiting the degranulation of mast cells in response to allergic and nonallergic stimuli.

 

DIF:    Recall             REF:   p. 722            OBJ:   3

 

  1. Which of the following are mechanisms of action for nedocromil sodium?
  2. mast cell activity inhibition
  3. C-fiber sensory nerve inhibition
  4. eosinophil activation
  5. airway epithelial cell activation
a. 1 and 2
b. 1, 2, and 3
c. 1, 24, and IV
d. 1, 2, 3, and 4

 

 

ANS:  D

Nedocromil sodium acts by inhibiting the activity of a variety of cells, including mast cells, eosinophils, airway epithelial cells, and sensory neurons called C-fibers

 

DIF:    Recall             REF:   p. 723            OBJ:   3

 

  1. Zileuton belongs to which of the following categories?
a. cromolyn-like agents
b. leukotriene modifiers
c. anti-IgE agents
d. anti-IgA agents

 

 

ANS:  B

Zileuton inhibits the 5-lipoxygenase enzyme that catalyzes the formation of leukotrienes from arachidonic acid, as also shown in Figure 32-8.

 

DIF:    Recall             REF:   p. 723            OBJ:   2

 

  1. Which of the following is NOT considered an aerosolized antiinfective agent?
a. pentamidine
b. ribavirin
c. tobramycin
d. amikacin

 

 

ANS:  D

Pentamidine, ribavirin, inhaled tobramycin, and zanamivir are antiinfective agents. They are briefly outlined in the chapter text.

 

DIF:    Recall             REF:   p. 725            OBJ:   2

 

  1. Pentamidine is indicated for the treatment of which of the following diseases?
a. Pneumocystis jiroveci
b. tuberculosis
c. HIV infection
d. pneumococcal pneumonia

 

 

ANS:  A

Pentamidine isethionate is an antiprotozoal agent that has been used in the treatment of opportunistic pneumonia caused by Pneumocystis carinii (PCP).

 

DIF:    Recall             REF:   p. 724            OBJ:   3

 

  1. When administering aerosolized pentamidine, what should the respiratory care practitioner do?
  2. Use a nebulizer that produces particles in the 1- to 2-mm mean mass aerodynamic diameter (MMAD) range.
  3. Use a nebulizer system with one-way valves and scavenging expiratory filters.
  4. Provide isolation and an environmental containment system.
  5. Screen patients for human immunodeficiency virus (HIV).
a. 1 and 2
b. 2 and 4
c. 1, 2, and 3
d. 1, 2, 3, and 4

 

 

ANS:  C

When administering aerosolized pentamidine, isolation, an environmental containment system (e.g., a booth or negative pressure room), and personnel barrier protection should be provided. Subjects should be screened for tuberculosis. The drug is given using a nebulizer system with one-way valves and scavenging expiratory filters (e.g., the Respirgard). This reduces environmental contamination. Nebulizer systems capable of producing an MMAD of 1 to 2 mm for peripheral lung deposition may reduce coughing.

 

DIF:    Application    REF:   p. 724            OBJ:   5

 

  1. Which of the following is TRUE about the use of ribavirin?
  2. It is used as an antiviral agent against respiratory syncytial virus.
  3. It is delivered via a Respirgard unit.
  4. Adverse effects include skin rash, conjunctivitis, and eyelid erythema.
  5. It can occlude endotracheal tube and ventilator exhalation valves.
a. 1 and 2
b. 3 and 4
c. 1, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  C

Administration of the aerosol requires use of a special large-reservoir nebulizer called the small particle aerosol generator (SPAG).

 

DIF:    Recall             REF:   p. 724            OBJ:   5

 

  1. Which of the following is true about the use of tobramycin?
  2. It is primarily used by patients with cystic fibrosis.
  3. It is intended to manage chronic infections with Pseudomonas aeruginosa.
  4. It is prevents deterioration of lung function due to recurrent infections.
  5. It has very good lung bioavailability.
  6. It is associated with a high rate of bacterial resistance.
a. 1 and 2
b. 3 and 5
c. 1, 2, 3, and 5
d. 1, 2, 4, and 5

 

 

ANS:  C

Patients with cystic fibrosis (CF) have chronic respiratory infection with Pseudomonas aeruginosa, as well as other microorganisms. Such chronic infection causes recurrent acute respiratory infections and deterioration of lung function. With the exception of the quinoline derivatives such as ciprofloxacin, antibiotics such as the aminoglycosides (e.g., tobramycin), which are effective against Pseudomonas organisms, have poor lung bioavailability when taken orally. Consequently, such antibiotics must be given either intravenously or by inhalation. The aminoglycoside, tobramycin, has been approved for inhaled administration and is intended to manage chronic infection with P. aeruginosa in CF. Goals of therapy are to treat or prevent early colonization with P. aeruginosa and maintain present lung function or reduce the rate of deterioration. The emergence of bacterial resistance was not seen in clinical trials with inhaled tobramycin.

 

DIF:    Recall             REF:   p. 726            OBJ:   5

 

  1. Side effects associated with parenteral administration of aminoglycosides include all of the following, except:
a. ototoxicity
b. voice alteration
c. nephrotoxicity
d. deafness

 

 

ANS:  B

See Box 32-5.

 

DIF:    Recall             REF:   p. 726            OBJ:   3

 

  1. Inhaled zanamivir is indicated for which of the following treatment of uncomplicated respiratory illness?
a. pharyngitis
b. croup
c. epiglottitis
d. influenza

 

 

ANS:  D

Inhaled zanamivir is indicated for the treatment of uncomplicated acute illness due to influenza virus in adults and children 5 years of age or older, who have been symptomatic for no longer than 2 days.

 

DIF:    Recall             REF:   p. 727            OBJ:   5

 

  1. What is the mechanism behind nitric oxide (INOmax)?
a. It dilates pulmonary arterial vascular beds and affects platelet aggregation.
b. It inhibits the degranulation of mast cells.
c. It inhibits the 5-lipoxygenase enzyme that catalyzes the formation of leukotrienes from arachidonic acid.
d. It relaxes vascular smooth muscle by binding to the heme group of cystolic guanylate, activating guanylate cyclase, increasing cyclic GMP.

 

 

ANS:  D

When inhaled, nitric oxide produces pulmonary vasodilation, reducing pulmonary artery pressure and improve  mismatching.

 

DIF:    Recall             REF:   p. 728            OBJ:   3

 

  1. Which of the following inhalational agents have been approved by the Food and Drug Administration for the treatment of pulmonary hypertension?
  2. Epoprostenol
  3. nitric oxide
  4. Iloprost
  5. alprostadil
a. 2
b. 2 and 3
c. 1, 2, 3, and 4
d. 2 and 4

 

 

ANS:  B

Currently only two agents, nitric oxide gas and iloprost, are Food and Drug Administration approved for inhalation.

 

DIF:    Recall             REF:   p. 728            OBJ:   5

 

  1. Which of the following is a contraindication for the use of nitric oxide?
a. neonates older than 34 weeks
b. hypoxic respiratory failure
c. right-to-left shunt dependence
d. pulmonary hypertension

 

 

ANS:  C

Nitric oxide is contraindicated in neonates with dependent right-to-left shunts.

 

DIF:    Recall             REF:   p. 728            OBJ:   3

 

  1. Which of the following nebulizers is used to nebulize iloprost?
a. Hudson
b. Pari
c. I-neb
d. Respirgard

 

 

ANS:  C

Iloprost inhalation is administered with the I-neb.

 

DIF:    Recall             REF:   p. 728            OBJ:   5

 

  1. A 45-year old man has a history of heart failure and is diagnosed with pulmonary arterial hypertension. Initially, he is prescribed treprostinil (Tyvaso) 3 breathes (18µg) per treatment session via the Tyvaso Inhalation System. Upon first administration, the patient feels nauseated, throat irritation, muscle pain, and experiences flushing. What is the best next course of action?
a. Continue medication administration with the addition of pain relievers.
b. Stop medication administration and continue to the next treatment session.
c. Reduce dose to 1 to 2 breaths per session and then gradually increase to 3.
d. Change medication administration.

 

 

ANS:  C

The initial dose for Tyvaso is 3 breathes (18µg) per treatment session. If not tolerated, the dose may be reduced to 1 to 2 breathes per session and then increased to 3. Tyvaso should be increased by 3 breathes every 1 to 2 weeks until 9 breathes (54 µg) per treatment session is reached.

 

DIF:    Analysis         REF:   p. 729            OBJ:   6

Chapter 42: Mechanical Ventilators

Test Bank

 

MULTIPLE CHOICE

 

  1. Which of the following major categories of ventilator function are useful in classifying ventilators?
  2. control scheme
  3. power conversion
  4. ventilator output
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

To understand mechanical ventilators, we must first understand their four basic functions:

  • input power
  • power transmission and conversion
  • control system
  • output (pressure, volume, and flow waveforms)

 

DIF:    Recall             REF:   p. 1007          OBJ:   1

 

  1. A ventilator can derive its input power from which of the following sources?
  2. alternating current (AC) electricity
  3. battery
  4. pneumatic
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

The power source for a ventilator is either electrical energy (Energy = Volts ´ Amperes ´ Time) or compressed gas (Energy = Pressure ´ Volume).

 

DIF:    Recall             REF:   p. 1007          OBJ:   1

 

  1. For which of the following uses might you consider the use of a purely pneumatically powered ventilator?
  2. as a backup to electrically powered ventilators
  3. when electrical device cannot be used (e.g., magnetic resonance imaging)
  4. during certain types of patient transport
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

These devices are ideal in situations where electrical power is unavailable (e.g., during certain types of patient transport) or as a backup to electrically powered ventilators in case of power failures. They are also particularly useful where electrical power is undesirable, as near magnetic resonance imaging equipment.

 

DIF:    Application    REF:   p. 1007          OBJ:   2

 

  1. Primary drive mechanisms used by modern ventilators include which of the following?
  2. compressed gas or reducing valve
  3. hydraulic or fluidic compressor
  4. electrical motor or compressor
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  B

Drive mechanisms can be either (1) a direct application of compressed gas via a pressure reducing valve or (2) an indirect application via an electric motor or compressor.

 

DIF:    Recall             REF:   p. 1007          OBJ:   2

 

  1. Types of output control valves used in modern ventilators include all of the following except:
a. pneumatic diaphragm valve
b. proportional valve
c. electromagnetic poppet or plunger
d. linear screw valve

 

 

ANS:  D

Commonly used output control valves include the pneumatic diaphragm, electromagnetic poppet/plunger valve, and the proportional valve. Descriptions of these devices can be found in respiratory care equipment textbooks.

 

DIF:    Recall             REF:   p. 1007          OBJ:   2

 

  1. Which of the following equations best describes the pressure (P) necessary to drive gas into the airway and inflate the lungs?
a. P = (Elastance ´ Volume) + (Resistance ´ Flow)
b. P = (Elastance – Volume) + (Resistance ÷ Flow)
c. P = (Volume + Compliance) + (Resistance ÷ Flow)
d. P = (Volume ÷ Compliance) – (Resistance ´ Flow)

 

 

ANS:  A

Pvent + Pmus = (E ´ V) + (R ´ V).

 

DIF:    Application    REF:   p. 1008          OBJ:   2

 

  1. How would a ventilatory support device that uses pressure regulators, needle valves, and balloon valves to regulate most or all of the parameters of ventilation be classified?
a. mechanically controlled
b. electronically controlled
c. fluidically controlled
d. pneumatically controlled

 

 

ANS:  D

Pneumatic control is provided using gas-powered pressure regulators, needle valves, jet entrainment devices, and balloon valves.

 

DIF:    Recall             REF:   p. 1011          OBJ:   2

 

  1. Which of the following types of ventilators would you select for use during an MRI procedure?
  2. electronically controlled
  3. pneumatically controlled
  4. fluidically controlled
  5. electrically controlled
a. 1 and 4
b. 2 and 3
c. 1, 2, and 4
d. 1, 2, 3, and 4

 

 

ANS:  B

Some transport ventilators use pneumatic control systems. The Ohmeda Logic-07 is an example. Fluidic control mechanisms have no moving parts. In addition, fluidic circuits are immune to failure from surrounding electromagnetic interference, as can occur around MRI equipment.

 

DIF:    Application    REF:   p. 1011          OBJ:   2

 

  1. Which of the following ventilators is controlled by fluidic logic systems?
a. Siemens 300
b. Sechrist IV-100B
c. Bird 8400ST
d. Bear 1000

 

 

ANS:  B

Fluidic logic-controlled ventilators, such as the Bio-Med MVP-10 and Sechrist IV-100B, also use pressurized gas to regulate the parameters of ventilation.

 

DIF:    Recall             REF:   p. 1011          OBJ:   2

 

  1. According to the equation of motion of the respiratory system, a ventilator can control all of the following variables except:
a. volume
b. resistance
c. pressure
d. flow

 

 

ANS:  B

There are only three variables in the equation of motion that a ventilator can control: pressure, volume, and flow.

 

DIF:    Recall             REF:   p. 1017          OBJ:   2

 

  1. If the pressure waveform of a ventilator remains the same when a patient’s lung mechanics change, then what is the ventilator?
a. volume controller
b. pressure controller
c. time controller
d. flow controller

 

 

ANS:  B

If the ventilator controls pressure, the pressure waveform will remain consistent but volume and flow will vary with changes in respiratory system mechanics.

 

DIF:    Application    REF:   p. 1019          OBJ:   2

 

  1. Which of the following are characteristic of a ventilator that functions as a true volume controller?
  2. Its pressure waveform changes with changes in lung mechanics.
  3. It measures and uses volume to control the volume waveform.
  4. Its volume waveform stays constant with changes in lung mechanics.
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

If the ventilator controls volume, the volume and flow waveforms will remain consistent, but pressure will vary with changes in respiratory mechanics. To qualify as a true volume controller, a ventilator must measure volume and use this signal to control the volume waveform.

 

DIF:    Recall             REF:   p. 1019          OBJ:   2

 

  1. During volume control ventilation, the clinician has control over which of the following?
  2. pressure waveform
  3. volume waveform
  4. flow waveform
a. 1 or 2
b. 2 or 3
c. 2
d. 1, 2, and 3

 

 

ANS:  B

Volume can be controlled directly by the displacement of a device such as a piston or bellows. Volume can be controlled indirectly by controlling flow.

 

DIF:    Recall             REF:   p. 1019          OBJ:   2

 

  1. Which of the following is true of the relationship between flow and volume?
  2. Volume is the integral of flow.
  3. Volume is the derivative of flow.
  4. Flow is the derivative of volume.
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  B

This follows from the fact that volume and flow are inverse functions of time (i.e., volume is the integral of flow and flow is the derivative of volume).

 

DIF:    Application    REF:   p. 1019          OBJ:   2

 

  1. A ventilator’s pressure waveform changes when a patient’s lung mechanics change, but its volume waveform remains the same. The device does not directly control the delivered volume. What is this ventilator?
a. volume controller
b. pressure controller
c. time controller
d. flow controller

 

 

ANS:  D

If the ventilator controls flow, the flow and volume waveforms will remain consistent, but pressure will vary with changes in respiratory mechanics. Flow can be controlled directly using something as simple as a flow meter or as complex as a proportional solenoid valve. Flow can be controlled indirectly by controlling volume.

 

DIF:    Recall             REF:   p. 1019          OBJ:   2

 

  1. The volume waveform generated by a ventilator remains the same against changing lung mechanics. Which of the following parameters might this device be controlling?
  2. volume
  3. flow
  4. pressure
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  A

If the ventilator controls flow, the flow and volume waveforms will remain consistent, but pressure will vary with changes in respiratory mechanics. Flow can be controlled directly using something as simple as a flow meter or as complex as a proportional solenoid valve. Flow can be controlled indirectly by controlling volume.

 

DIF:    Application    REF:   p. 1019          OBJ:   2

 

  1. Which of the following ventilators is the simplest example of a true flow controller?
a. Newport Wave
b. Bear 1
c. Emerson 3-PV
d. Sechrist

 

 

ANS:  D

Infant ventilators, such as the Sechrist, are the simplest examples of flow controllers

 

DIF:    Recall             REF:   p. 1019          OBJ:   2

 

  1. A complete ventilatory cycle or breath consists of which of the following phases?

 

  1. expiration
  2. initiation of inspiration
  3. inspiration
  4. end of inspiration
a. 1 and 4
b. 2 and 3
c. 1, 2, and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

A complete ventilatory cycle or breath consists of four phases: the initiation of inspiration, inspiration itself, the end of inspiration, and expiration.

 

DIF:    Recall             REF:   p. 1019          OBJ:   2

 

  1. During mechanical ventilation, what variable causes a breath to begin?
a. limit
b. cycle
c. trigger
d. baseline

 

 

ANS:  C

The variable causing a breath to begin is the trigger variable.

 

DIF:    Recall             REF:   p. 1015          OBJ:   2

 

  1. During mechanical ventilation, what variable causes a breath to end?
a. limit
b. cycle
c. trigger
d. baseline

 

 

ANS:  B

The variable causing a breath to end is the cycle variable.

 

DIF:    Recall             REF:   p. 1015          OBJ:   2

 

  1. To describe what happens during the expiratory phase of mechanical ventilation, you must know the value of which variable?
a. limit
b. cycle
c. trigger
d. baseline

 

 

ANS:  D

To describe what happens during expiration, we must know what baseline variable is in effect.

 

DIF:    Recall             REF:   p. 1017          OBJ:   2

 

  1. If a ventilator, not the patient, initiates a breath, what is the trigger variable?
a. time
b. pressure
c. flow
d. volume

 

 

ANS:  A

If the machine initiates the breath, the trigger variable is time.

 

DIF:    Recall             REF:   p. 1013          OBJ:   2

 

  1. If a patient initiates a ventilator breath, the trigger variable could be all of the following except:
a. pressure
b. flow
c. time
d. volume

 

 

ANS:  C

If the patient initiates the breath, pressure, flow, or volume may serve as the trigger variable.

 

DIF:    Recall             REF:   p. 1013          OBJ:   2

 

  1. A patient receiving time-triggered continuous mechanical ventilation at a preset rate of 10/min stops breathing. Which of the following will occur?
a. The high-pressure limit alarm will sound (if properly set).
b. The patient will continue to receive 10 breaths/min.
c. The low tidal volume (VT) alarm will sound (if properly set).
d. Ventilation will drop to zero and the apnea alarm will sound.

 

 

ANS:  B

When triggering by time, a ventilator initiates a breath according to a predetermined time interval, without regard to patient effort.

 

DIF:    Application    REF:   p. 1013          OBJ:   2

 

  1. Pure time-triggered ventilation is the same as what type of ventilation?
a. assist
b. intermittent mandatory ventilation
c. assist and control
d. proportional assist

 

 

ANS:  B

Currently, time triggering is most commonly seen when using the IMV mode (intermittent mandatory ventilation).

 

DIF:    Recall             REF:   p. 1013          OBJ:   2

 

  1. A volume-cycled ventilator has a rate knob for setting the controlled frequency of breathing. If this control is set to 12/min, which of the following other settings will determine the inspiratory and expiratory times?
  2. FIO2
  3. flow
  4. volume
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  C

When a rate control is used, inspiratory and expiratory times will vary according to other control settings, such as flow and volume.

 

DIF:    Application    REF:   p. 1013          OBJ:   2

 

  1. When you adjust the pressure drop necessary to trigger a breath on a ventilator, what are you adjusting on the machine?
a. sensitivity
b. pressure limit
c. mode setting
d. positive end-expiratory pressure (PEEP) level

 

 

ANS:  A

Pressure triggering occurs when a patient’s inspiratory effort causes a drop in pressure within the breathing circuit. When this pressure drop reaches the pressure sensing mechanism, the ventilator triggers on and begins gas delivery. On most ventilators, you can adjust the pressure drop needed to trigger a breath. The trigger level is often called the sensitivity.

 

DIF:    Recall             REF:   p. 1013          OBJ:   2

 

  1. When using pressure as the trigger variable, where do you typically set the trigger level?
a. 0.5 to 1.5 cm H2O below the baseline expiratory pressure
b. 0.5 to 1.5 cm H2O above the baseline expiratory pressure
c. 2.0 to 3.5 cm H2O below the baseline expiratory pressure
d. 2.0 to 3.5 cm H2O above the baseline expiratory pressure

 

 

ANS:  A

Typically, you set the trigger level 0.5 to 1.5 cm H2O below the baseline expiratory pressure.

 

DIF:    Recall             REF:   p. 1014          OBJ:   2

 

  1. Which of the following is false about the application of flow triggering on a mechanical ventilator?
a. The ventilator measures both input and output flow.
b. Between patient breaths, input flow exceeds output flow.
c. A relative drop in output flow triggers the machine to turn on.
d. Gas flows continuously through the ventilator circuit.

 

 

ANS:  B

The ventilator measures the flow coming out of the main flow control valve and also the flow through the exhalation valve. Between breaths, these two flows are equal (assuming there are no leaks in the patient circuit). When the patient makes an inspiratory effort, the flow through the exhalation valve falls below the flow from the output valve. The difference between these two flows is the flow trigger variable.

 

DIF:    Recall             REF:   p. 1014          OBJ:   2

 

  1. A physician requests that you switch from pressure-triggering a patient to flow-triggering. Which of the following new settings would be appropriate?
a. Base flow = 0 L/min; trigger at 2 L/min
b. Base flow = 10 L/min; trigger at –2 cm H2O
c. Base flow = 10 L/min; trigger at 2 L/min
d. Base flow = 0 L/min; trigger at 10 cm H2O

 

 

ANS:  C

For example, if you set the base continuous flow at 10 L/min and the trigger at 2 L/min, the ventilator will trigger when the output flow falls to 8 L/min or less.

 

DIF:    Analysis         REF:   p. 1014          OBJ:   2

 

  1. Compared to using pressure as the trigger variable, what is the major advantage of flow-triggering?
a. decreased work of breathing
b. improved minute ventilation (VE)
c. decreased physiologic dead space
d. improved arterial oxygenation

 

 

ANS:  A

When compared with pressure, using flow as the trigger variable decreases a patient’s work of breathing.

 

DIF:    Recall             REF:   p. 1014          OBJ:   2

 

  1. What ventilatory variable reaches and maintains a preset level before inspiration ends?
a. limit
b. cycle
c. trigger
d. baseline

 

 

ANS:  A

A limit variable is one that can reach and maintain a preset level before inspiration ends but does not terminate inspiration.

 

DIF:    Recall             REF:   p. 1015          OBJ:   2

 

  1. Which of the following parameters can serve as the cycle variable during ventilatory support?
  2. volume
  3. pressure
  4. flow
  5. time
a. 1 and 4
b. 2 and 3
c. 1, 2, and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

The cycle variable can be pressure, volume, flow, or time.

 

DIF:    Application    REF:   p. 1015          OBJ:   2

 

  1. A volume-cycled ventilator provides gas under positive pressure during inspiration until what point?
a. A preselected volume of gas is received by the patient.
b. An adjustable, preselected airway pressure is reached.
c. The inspiratory time equals or exceeds the expiratory time.
d. A preselected volume of gas is expelled from the device.

 

 

ANS:  D

When a ventilator is set to volume-cycle, it delivers flow until a preselected volume has been expelled from the device.

 

DIF:    Application    REF:   p. 1015          OBJ:   3

 

  1. Flow serves as a limit variable whenever a ventilator controls what?
a. pressure
b. flow
c. time
d. volume

 

 

ANS:  B

When a ventilator is set to flow cycle, it delivers flow until a preset level is met and then flow stops and expiration begins.

 

DIF:    Recall             REF:   p. 1016          OBJ:   3

 

  1. You observe that a ventilator reaches a preset pressure early in inspiration but holds it for a specific time, after which inspiration ends. What mode of ventilatory support is in force?
a. time cycled
b. pressure limited
c. pressure cycled
d. volume limited

 

 

ANS:  A

Time cycling occurs when the inspiratory time has elapsed.

 

DIF:    Analysis         REF:   p. 1016          OBJ:   3

 

  1. A time-cycled constant flow generator is set up with a flow of 35 L/min and an inspiratory time of 1.7 seconds. What is the approximate VT?
a. 750 ml (0.75 L)
b. 1000 ml (1.00 L)
c. 1900 ml (1.90 L)
d. 1200 ml (1.20 L)

 

 

ANS:  B

If it is used, it may be set directly, or it may occur indirectly if the set inspiratory time is longer than the inspiratory flow time (determined by the set tidal volume and flow; time = volume/flow).

 

DIF:    Application    REF:   p. 1017          OBJ:   3

 

  1. What is the name of a breath where a patient is able to change the inspiratory time?
a. patient cycled
b. patient triggered
c. machine triggered
d. machine cycled

 

 

ANS:  A

For the breath to be patient cycled, the patient must be able to change the inspiratory time, such as by making either inspiratory or expiratory efforts. If this is not possible, then the breath is, by definition, machine cycled.

 

DIF:    Recall             REF:   p. 1017          OBJ:   3

 

  1. In which of the following modes inspiration ends when flow decays to some preset value?
a. intermittent mandatory ventilation
b. pressure support ventilation
c. continuous mandatory ventilation
d. airway pressure release ventilation

 

 

ANS:  B

Another example of patient cycling is the pressure support mode. Here, inspiration ends when flow decays to some preset value (i.e., flow cycling).

 

DIF:    Recall             REF:   p. 1017          OBJ:   3

 

  1. What parameter serves as the baseline variable on all modern ventilators?
a. pressure
b. flow
c. time
d. volume

 

 

ANS:  A

Although pressure, volume, or flow could serve as the baseline variable, pressure control is the most practical and is implemented by all modern ventilators.

 

DIF:    Recall             REF:   p. 1017          OBJ:   3

 

  1. What is the default baseline value during mechanical ventilation?
a. positive end-expiratory pressure (PEEP)
b. zero end-expiratory pressure (ZEEP)
c. negative end-expiratory pressure (NEEP)
d. continuous positive airway pressure (CPAP)

 

 

ANS:  B

ZEEP is the default baseline value during positive-pressure ventilation, meaning that it is normally in effect unless purposely changed.

 

DIF:    Recall             REF:   p. 1017          OBJ:   3

 

  1. What is the application of pressure above atmospheric at the airway throughout expiration during mechanical ventilation?
a. positive end-expiratory pressure (PEEP)
b. pressure support ventilation
c. continuous mandatory ventilation (CMV)
d. continuous positive airway pressure (CPAP)

 

 

ANS:  A

PEEP is the application of pressure above atmospheric pressure at the airway throughout expiration.

 

DIF:    Recall             REF:   p. 1017          OBJ:   3

 

  1. What is the primary physiological effect of positive end-expiratory pressure (PEEP)?
a. increase the functional residual capacity (FRC)
b. increase the inspiratory reserve volume (IRV)
c. decrease the compliance of the lung (CL)
d. increase the length of expiration

 

 

ANS:  A

PEEP elevates a patient’s FRC and can help improve oxygenation by preventing collapse of alveolar units that are made unstable by lack of surfactant or disease.

 

DIF:    Recall             REF:   p. 1017          OBJ:   3

 

  1. During mechanical ventilation, a spontaneous breath is defined as one that:
a. initiated and terminated by the machine
b. begun by the patient and ended by the machine
c. initiated and terminated by the patient
d. begun by the machine and ended by the patient

 

 

ANS:  C

A spontaneous breath is a breath for which the patient decides the start time and the tidal volume. That is, the patient both triggers and cycles the breath.

 

DIF:    Recall             REF:   p. 1019          OBJ:   3

 

  1. During mechanical ventilation, a mandatory breath is defined as one that is:
a. initiated or terminated by the machine
b. initiated and terminated by the machine
c. initiated and terminated by the patient
d. begun according to a preset time interval

 

 

ANS:  A

A mandatory breath is a breath for which the machine sets the start time and/or the tidal volume. That is, the machine triggers and/or cycles the breath.

 

DIF:    Recall             REF:   p. 1019          OBJ:   3

 

  1. While observing a patient receiving ventilatory support, you notice that all delivered breaths are initiated or terminated by the machine. Which of the following modes of ventilatory support is in force?
a. intermittent mandatory ventilation
b. partial ventilatory support
c. continuous mandatory ventilation
d. continuous spontaneous ventilation

 

 

ANS:  C

In continuous mandatory ventilation, all breaths are mandatory.

 

DIF:    Application    REF:   p. 1021          OBJ:   3

 

  1. While observing a patient receiving ventilatory support, you notice that some delivered breaths are begun or ended by the machine, whereas others are begun and ended by the patient. Which of the following modes of ventilatory support is in force?
a. intermittent mandatory ventilation (IMV)
b. pressure support ventilation
c. continuous mandatory ventilation (CMV)
d. airway pressure release ventilation

 

 

ANS:  A

In IMV, breaths can be either mandatory or spontaneous.

 

DIF:    Application    REF:   p. 1021          OBJ:   3

 

  1. A mode that allows spontaneously breathing patients to breathe at a positive-pressure level, but drops briefly to a reduced pressure level for CO2 elimination during each breathing cycle is also known as:
a. intermittent mandatory ventilation
b. airway pressure release ventilation
c. continuous mandatory ventilation (CMV)
d. continuous spontaneous ventilation

 

 

ANS:  B

At this level of description, we can avoid the cumbersome verbal ad hoc definition for airway pressure release ventilation such as “a mode that allows spontaneously breathing patients to breathe at a positive-pressure level, but drops briefly to a reduced pressure level for CO2 elimination during each breathing cycle.”

 

DIF:    Recall             REF:   p. 1021          OBJ:   3

 

  1. Which of the following ventilator control systems is NOT considered closed loop?
a. orientation based
b. servo
c. adaptive
d. optimal

 

 

ANS:  A

The basic concept of closed-loop control has evolved into at least seven different ventilator control systems.

 

DIF:    Recall             REF:   p. 1021          OBJ:   3

 

  1. Which of the closed-loop controllers is used by all ventilators?
a. setpoint
b. auto setpoint
c. adaptive
d. servo

 

 

ANS:  A

Most ventilators use at least setpoint control.

 

DIF:    Recall             REF:   p. 1023          OBJ:   3

 

  1. Which of the following modes is a good example of adaptive control?
a. intermittent mandatory ventilation
b. airway pressure release ventilation
c. continuous mandatory ventilation (CMV)
d. pressure-regulated volume control (PRVC)

 

 

ANS:  D

One of the first examples of a mode using adaptive control was PRVC on the Siemens Servo 300 ventilator.

 

DIF:    Recall             REF:   p. 1023          OBJ:   3

 

  1. A ventilator that controls pressure and delivers a rectangular pressure waveform will also exhibit what waveform?
a. exponential (rise) volume
b. rectangular flow
c. ascending ramp pressure
d. sinusoidal flow

 

 

ANS:  A

See Figure 42-11.

 

DIF:    Recall             REF:   p. 1022          OBJ:   3

 

  1. A ventilator that controls flow and delivers a rectangular flow waveform will also exhibit what waveform?
a. exponential (rise) volume
b. rectangular pressure
c. ascending ramp pressure
d. descending ramp volume

 

 

ANS:  C

See Figure 42-11.

 

DIF:    Recall             REF:   p. 1022          OBJ:   3

 

  1. Peak airway pressure is highest with what waveform?
a. sinusoidal flow
b. rectangular flow
c. ascending ramp flow
d. descending ramp flow

 

 

ANS:  C

See Figure 42-11.

 

DIF:    Recall             REF:   p. 1022          OBJ:   3

 

  1. Mean airway pressure is lowest with what waveform?
a. sinusoidal flow
b. rectangular flow
c. ascending ramp flow
d. descending ramp flow

 

 

ANS:  C

See Figure 42-11.

 

DIF:    Recall             REF:   p. 1022          OBJ:   3

 

  1. Mean airway pressure is highest with what waveform?
a. rectangular flow
b. rectangular pressure
c. ascending ramp flow
d. sinusoidal flow

 

 

ANS:  B

See Figure 42-11.

 

DIF:    Recall             REF:   p. 1022          OBJ:   3

 

  1. During volume-targeted ventilation, which of the following settings determine the machine-delivered minute volume?
  2. volume
  3. flow
  4. rate
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  B

See Table 42-1.

 

DIF:    Application    REF:   p. 1013          OBJ:   3

 

  1. During volume-targeted ventilation, which of the following settings determine the inspiratory time?
  2. volume
  3. flow
  4. rate
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  A

See Table 42-1.

 

DIF:    Recall             REF:   p. 1013          OBJ:   3

 

  1. During volume-targeted ventilation, which of the following settings determine the expiratory time?
  2. volume
  3. flow
  4. rate
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

See Table 42-1.

 

DIF:    Recall             REF:   p. 1013          OBJ:   3

 

  1. During volume-targeted ventilation, which of the following settings determine the total cycle time?
  2. volume
  3. flow
  4. rate
a. 1 and 2
b. 2 and 3
c. 3 only
d. 1, 2, and 3

 

 

ANS:  C

See Table 42-1.

 

DIF:    Recall             REF:   p. 1013          OBJ:   3

 

  1. During volume-targeted ventilation, which of the following settings determine I:E ratio?
  2. volume
  3. flow
  4. rate
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

See Table 42-1.

 

DIF:    Application    REF:   p. 1013          OBJ:   3

 

  1. A patient receiving continuous mandatory ventilation in the control mode has an inspiratory time of 1.5 seconds and an expiratory time of 2.5 seconds. What is the frequency of breathing?
a. 10/min
b. 12/min
c. 15/min
d. 18/min

 

 

ANS:  C

See Table 42-1.

 

DIF:    Application    REF:   p. 1013          OBJ:   3

 

  1. A patient is receiving continuous mandatory ventilation in the control mode at a rate of 15/min. The expiratory time is 2.9 seconds. What is the inspiratory time?
a. 1.1 seconds
b. 1.3 seconds
c. 1.5 seconds
d. 1.7 seconds

 

 

ANS:  A

See Table 42-1.

 

DIF:    Application    REF:   p. 1013          OBJ:   3

 

  1. A patient is receiving continuous mandatory ventilation in the control mode at a rate of 10/min. The inspiratory time control is set at 40%. What is the inspiratory time?
a. 1.60 seconds
b. 1.85 seconds
c. 2.40 seconds
d. 3.50 seconds

 

 

ANS:  C

See Table 42-1.

 

DIF:    Application    REF:   p. 1013          OBJ:   3

 

  1. A patient is receiving continuous mandatory ventilation in the control mode at a rate of 12/min. The inspiratory time control is set at 33%. What is the expiratory time?
a. 1.65 seconds
b. 2.45 seconds
c. 3.35 seconds
d. 3.85 seconds

 

 

ANS:  C

See Table 42-1.

 

DIF:    Application    REF:   p. 1013          OBJ:   3

 

  1. A patient is receiving continuous mandatory ventilation in the control mode at a rate of 15/min. The inspiratory time is 0.8 second. What is the expiratory time?
a. 3.2 seconds
b. 2.8 seconds
c. 2.4 seconds
d. 4.2 seconds

 

 

ANS:  A

See Table 42-1.

 

DIF:    Application    REF:   p. 1013          OBJ:   3

 

  1. A patient is receiving continuous mandatory ventilation in the control mode at a rate of 20/min. The inspiratory time is 0.75 second. What is the percentage inspiratory time?
a. 20%
b. 25%
c. 30%
d. 33%

 

 

ANS:  B

See Table 42-1.

 

DIF:    Application    REF:   p. 1013          OBJ:   3

 

  1. A patient is receiving continuous mandatory ventilation in the control mode at a rate of 10/min. The inspiratory time control is set at 25%. What is the I:E ratio?
a. 1:3
b. 1:2
c. 1:4
d. 1:1

 

 

ANS:  A

See Table 42-1.

 

DIF:    Application    REF:   p. 1013          OBJ:   3

 

  1. A patient is receiving continuous mandatory ventilation through a constant flow generator in the control mode at a rate of 20/min with a VT of 750 mL. The inspiratory time is 1 second. What is the flow?
a. 15 L/min
b. 30 L/min
c. 45 L/min
d. 60 L/min

 

 

ANS:  C

See Table 42-1.

 

DIF:    Application    REF:   p. 1013          OBJ:   3

 

  1. During pressure-targeted ventilation, which of the following settings determine VT?
  2. pressure difference
  3. inspiratory time
  4. time constant
a. 1 and 2
b. 2 and 3
c. 3 only
d. 1, 2, and 3

 

 

ANS:  D

See Table 42-1.

 

DIF:    Recall             REF:   p. 1013          OBJ:   3

 

  1. In which of the following situations is volume-controlled ventilation sometimes used?
  2. when a precise PaCO2 has to be maintained (some closed-head injuries)
  3. when more even distribution of ventilation is required
  4. when ventilating patients with severe, refractory hypoxemia
  5. when ventilating patients with unstable or changing ventilatory drives
a. 1 and 2
b. 3 and 4
c. 1, 2, and 3
d. 1, 3, and 4

 

 

ANS:  A

Volume-controlled continuous mandatory ventilation is indicated when a precise minute ventilation or blood gas parameter, such as PaCO2, is therapeutically essential to the care of patients with normal lung mechanics. Theoretically, volume control (with a constant inspiratory flow) results in a more even distribution of ventilation (compared to pressure control) among lung units with different time constants where the units have equal resistances but unequal compliances (e.g., acute respiratory distress syndrome [ARDS]).

 

DIF:    Recall             REF:   p. 1019          OBJ:   3

 

  1. In which of the following situations is pressure-controlled ventilation sometimes used?
  2. when a precise PaCO2 has to be maintained (some closed-head injuries)
  3. when more even distribution of ventilation is required
  4. when ventilating patients with severe, refractory hypoxemia
  5. when tidal volume in unstable due to leaks
a. 1 and 2
b. 3 and 4
c. 1, 2, and 3
d. 1, 3, and 4

 

 

ANS:  B

Pressure-controlled continuous mandatory ventilation is indicated when adequate oxygenation has been difficult to achieve in other modes of ventilation. The instability of tidal volume caused by airway leaks can be minimized by using pressure-controlled ventilation rather than volume controlled ventilation.

 

DIF:    Recall             REF:   p. 1019          OBJ:   3

 

  1. Which of the following is the primary parameter used to alter the breath size in pressure controlled?
a. positive inspiratory pressure (PIP)- positive end-expiratory pressure (PEEP)
b. continuous positive airway pressure (CPAP)
c. tidal volume
d. flow

 

 

ANS:  A

Because tidal volume is not directly controlled, the pressure gradient (PIP – PEEP) is the primary parameter used to alter the breath size and hence carbon dioxide tensions.

 

DIF:    Recall             REF:   p. 1013          OBJ:   3

 

  1. Spontaneous breath modes include all of the following except:
a. pressure support ventilation (PSV)
b. continuous positive airway pressure (CPAP)
c. bilevel CPAP (BiPAP)
d. continuous mandatory ventilation assist-control

 

 

ANS:  D

CPAP, PSV, automatic tube compensation, and proportional assist ventilation are continuous spontaneous breath modes.

 

DIF:    Recall             REF:   p. 1018          OBJ:   3

 

  1. What is the mode of ventilatory support in which patient’s inspiratory efforts are augmented with a set amount of positive airway pressure?
a. intermittent mandatory ventilation
b. continuous mandatory ventilation (CMV)
c. pressure support ventilation (PSV)
d. positive end-expiratory pressure (PEEP)

 

 

ANS:  C

PSV is a form of PC-CSV that assists the patient’s inspiratory efforts.

 

DIF:    Recall             REF:   p. 1016          OBJ:   3

 

  1. The respiratory therapist has been called to transport a patient from the emergency department to obtain a CT scan, which of the following types of ventilator should he therapist chose to transport the patient?
a. electric
b. apneuistic
c. pneumatic
d. electronic

 

 

ANS:  C

For patient transport you must use either a pneumatically powered ventilator or one that can run solely on batteries. Always take along a manually powered bag-valve mask and for long transports be sure to have back-up power available (extra cylinders or batteries).

 

DIF:    Application    REF:   p. 1007          OBJ:   2

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