Mosbys Respiratory Care Equipment 9th Edition By J.M. Cairo – Test Bank

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Mosbys Respiratory Care Equipment 9th Edition By J.M. Cairo – Test Bank

Chapter 02: Principles of Infection Control

 

MULTIPLE CHOICE

 

  1. A 78-year-old man is going to be discharged today after having abdominal surgery several days ago. The nurse notices that the patient has a temperature of 101.5° F and has some tan secretions in his suture area. A specimen is sent to the laboratory. The results show the presence of gram-positive cocci. The statement that might explain this condition is which of the following?
a. The antibiotic was ineffective.
b. The patient was not compliant with therapy.
c. It is normal to have secretions at the suture site.
d. A health care-associated infection should be considered.

 

 

ANS:  D

No antibiotic was mentioned in the scenario. There is no history of the patient receiving any medication for this problem, so compliance is not an issue with this situation. It is not normal to have secretions at a suture site.

 

PTS:   1                    REF:   Page 41

 

  1. A nosocomial infection is best defined as a:
a. respiratory system–borne pathogen. c. bacterial or viral organism.
b. hospital-acquired pathogen. d. blood-borne pathogen.

 

 

ANS:  B

A nosocomial infection is one that is acquired in a hospital setting. Respiratory system–borne pathogens and blood-borne pathogens can be acquired in the community.

 

PTS:   1                    REF:   Page 28

 

  1. Infectious diseases are not usually caused by:
a. ticks. c. viruses.
b. bacteria. d. algae.

 

 

ANS:  D

Algae do not cause infectious diseases. Infectious diseases can be caused by ticks, bacteria, and viruses.

 

PTS:   1                    REF:   Page 32, Table 2-3

 

  1. Clinical microbiology is concerned with _____ the organism.
  2. identifying
  3. controlling
  4. isolating
  5. eradication of
a. 1 and 4 c. 1, 2, and 4
b. 2 and 3 d. 1, 2, and 3

 

 

ANS:  D

Clinical microbiology addresses the identification, isolation, and control of pathogens, not their eradication.

 

PTS:   1                    REF:   Page 28

 

  1. A prokaryotic, one-celled organism that ranges in size from 0.5 µm to 50 µm is usually classified as which of the following?
a. Virus c. Bacterium
b. Protozoan d. Retrovirus

 

 

ANS:  C

This is the definition of a bacterium.

 

PTS:   1                    REF:   Page 28

 

  1. When speaking about the morphology of bacteria, one is referring to its:
a. size. c. function.
b. shape. d. movement.

 

 

ANS:  B

There are three ways to classify bacteria: by its shape, by staining, and by its metabolic characteristics. Size, function, and movement are not characteristics used to classify bacteria.

 

PTS:   1                    REF:   Page 28

 

  1. Which of the following is a bacterium?
a. Herpes simplex c. Pseudomonas aeruginosa
b. Pneumocystis carinii d. Candida albicans

 

 

ANS:  C

Pneumocystis carinii is a protozoan, herpes is a virus, and Candida albicans is a fungus.

 

PTS:   1                    REF:   Page 29

 

  1. A sputum specimen is received in the microbiology laboratory. Gram staining and a microscopic examination reveal a paired, spherical, purple-stained organism. It can be reasonably assumed that this organism is which of the following?
a. Gram-negative bacilli c. Gram-positive diplococci
b. Gram-negative staphylococci d. Gram-positive bacilli

 

 

ANS:  C

Diplococci are spherically shaped bacteria that occur in pairs; gram-positive organisms appear blue or violet. Gram-negative organisms have a red appearance from the counterstain. Staphylococci are cocci that occur in irregular clusters. Bacilli are rodlike organisms.

 

PTS:   1                    REF:   Pages 28-29

 

  1. The word vibrio refers to:
a. The many shapes bacteria can assume
b. The erratic movement of bacteria
c. Comma-shaped morphology
d. Spirochete helical shape

 

 

ANS:  C

Vibrio refers to comma-shaped bacteria.

 

PTS:   1                    REF:   Page 28, Figure 2-1

 

  1. An organism that appears reddish-pink after Gram staining is usually called:
a. gram-negative. c. non–acid-fast.
b. gram-positive. d. acid-fast.

 

 

ANS:  A

Gram-positive organisms stain blue or violet, whereas gram-negative organisms appear red from a counterstain of red dye safranin. Acid-fast is a different test.

 

PTS:   1                    REF:   Pages 28-29

 

  1. Which of the following is a gram-negative pathogen?
a. Bacillus anthracis c. Pseudomonas aeruginosa
b. Staphylococcus aureus d. Clostridium botulinum

 

 

ANS:  C

Bacillus anthracis, Staphylococcus aureus, and Clostridium botulinum are gram-positive pathogens.

 

PTS:   1                    REF:   Page 29

 

  1. Which of the following is spread by direct contact?
a. Measles c. Staphylococcus
b. Hepatitis B d. Histoplasmosis

 

 

ANS:  C

Staphylococcus is spread by direct contact. Measles are spread by droplets; hepatitis B, by indirect contact; and histoplasmosis, by airborne dust.

 

PTS:   1                    REF:   Page 32, Table 2-3

 

  1. The Ziehl-Neelsen stain is useful in identifying which family of microorganisms?
a. Streptococci c. Staphylococci
b. Mycobacterium d. Pseudomonas

 

 

ANS:  B

The Ziehl-Neelsen stain is also called the acid-fast stain and is used to identify Mycobacterium species such as Mycobacterium tuberculosis. This stain is not used to identify streptococci, staphylococci, or Pseudomonas.

 

PTS:   1                    REF:   Page 29

 

  1. Which of the following is typically associated with tuberculosis?
a. Mycobacterium c. Clostridium
b. Pseudomonas d. Bordetella

 

 

ANS:  A

Mycobacterium tuberculosis is the organism responsible for pulmonary, spinal, and miliary tuberculosis.

 

PTS:   1                    REF:   Page 29

 

  1. Bacteria that require oxygen for growth are typically known as:
a. aerobes. c. anaerobes.
b. airborne. d. autotrophs.

 

 

ANS:  A

Aerobes require oxygen for life. Airborne refers to the method of transmission of infectious diseases. Anaerobes can grow and live without oxygen, and autotrophs require simple inorganic nutrients to sustain themselves.

 

PTS:   1                    REF:   Page 29

 

  1. Which of the following is true concerning facultative anaerobes?
a. They have limited oxygen tolerance.
b. They require complex nutrients to exist.
c. They cannot live in oxygen environments.
d. They require simple inorganic nutrients to exist.

 

 

ANS:  A

Facultative anaerobes have limited oxygen tolerance. Heterotrophs require complex nutrients to exist. Autotrophs require simple inorganic nutrients to exist. Only anaerobes cannot live in oxygen environments.

 

PTS:   1                    REF:   Page 29

 

  1. To survive adverse conditions, such as excessive heat and dryness, bacteria might do which of the following?
a. Store excess water in special sporelike structures
b. Form large colonies in a short period of time
c. Speed up their enzymatic processes
d. Form endospores

 

 

ANS:  D

Certain bacteria form endospores under adverse conditions such as dryness, heat, and poor nutrition. Bacteria do not undergo any of the other processes mentioned.

 

PTS:   1                    REF:   Page 29

 

  1. Ventilator-associated pneumonia is commonly caused by which of the following?
a. Escherichia coli c. Enterobacteriaceae
b. Bacillus anthracis d. Corynebacterium diphtheriae

 

 

ANS:  C

Ventilator-associated pneumonia is most commonly caused by Pseudomonas  aeruginosa, Staphylococcus aureus, Enterobacteriaceae, Haemophilus influenzae, and Streptococcus spp.

 

PTS:   1                    REF:   Page 32, Box 2-1

 

  1. A virus can be described as a parasite with which of the following traits?
a. Nucleic acid core c. Size of less than 20 nm
b. Carbohydrate sheath d. Ability to produce spores

 

 

ANS:  A

Viruses have a nucleic acid core surrounded by a protein sheath; viruses range from 20 nm to 200 nm. They do not produce spores.

 

PTS:   1                    REF:   Page 29

 

  1. Viruses are usually described as nonliving because they:
a. do not have a cell wall.
b. are unable to self-replicate.
c. must create endospores to survive.
d. cannot live without another living organism.

 

 

ANS:  B

Viruses must invade a living organism to replicate. This is the reason that they are described as nonliving. They do have a wall-like structure that is made of protein. They do not create endospores and are able to live outside a host; however, they cannot replicate outside of a host.

 

PTS:   1                    REF:   Page 29

 

  1. Which of the following is a virus that has a respiratory route of transmission?
a. Polio c. Coronavirus
b. Hepatitis d. Herpes simplex

 

 

ANS:  C

Coronavirus has a respiratory route of transmission; for polio, the route of transmission is through the gut. Hepatitis is transmitted through body fluids and blood, and herpes simplex has several routes of transmission, including oral, genital, and ocular.

 

PTS:   1                    REF:   Page 31, Table 2-2

 

  1. Chlamydia species are classified as:
a. viruses. c. protozoa.
b. bacteria. d. intracellular parasites.

 

 

ANS:  D

Chlamydia species have complex structures that resemble those of bacteria and they act like viruses in that they require a living host to replicate, but they are actually intracellular parasites. Protozoa are unicellular eukaryotes.

 

PTS:   1                    REF:   Page 29

 

  1. Which of the following is the type of organism that causes malaria and trypanosomiasis?
a. Virus c. Protozoa
b. Parasite d. Bacteria

 

 

ANS:  C

Protozoan infections include amebiasis, malaria, trypanosomiasis, and Pneumocystis pneumonia.

 

PTS:   1                    REF:   Page 29

 

  1. Which of the following is the protozoan organism that is associated with pneumonia in immune-compromised patients?
a. Schistosoma c. Pneumocystis
b. Shigella d. Rickettsiae

 

 

ANS:  C

Pneumocystis pneumonia is common in immunocompromised patients—particularly those infected with human immunodeficiency virus. Pneumocystis is a protozoan. Schistosoma is a blood fluke. Shigella is a gram-negative, non–spore-forming, rod-shaped bacteria. Rickettsiae are intracellular parasites that resemble bacteria.

 

PTS:   1                    REF:   Page 31

 

  1. Airborne droplet nuclei are responsible for the transmission of:
a. legionellosis. c. staphylococcus.
b. histoplasmosis. d. tuberculosis.

 

 

ANS:  D

Tuberculosis is transmitted by droplet nuclei. Legionellosis is transmitted by airborne aerosols; histoplasmosis, by airborne dust; and staphylococcus, by direct contact.

 

PTS:   1                    REF:   Page 32, Table 2-3

 

  1. A budding unicellular organism revealed in the microscopic examination of sputum is most likely:
a. yeast. c. Rickettsia.
b. Bacillus. d. Clostridium.

 

 

ANS:  A

Yeast reproduces by budding. Bacteria reproduce either by binary fission or conjugation. Rickettsia reproduces by binary fission.

 

PTS:   1                    REF:   Page 30

 

  1. All of the following organisms can be transmitted via the respiratory tract, except:
a. hepatitis. c. varicella.
b. influenza. d. parainfluenza.

 

 

ANS:  A

Hepatitis is transmitted through blood and body fluids.

 

PTS:   1                    REF:   Page 32, Table 2-3

 

  1. Which of the following is the least likely mode of transmission for a nosocomial infection?
a. Airborne c. Vector-borne
b. Through fomites d. Direct contact

 

 

ANS:  C

The transmission of infections by vectors is rarely associated with nosocomial infections. In the hospital, instruments and equipment (through fomites) are common sources of hospital-acquired infections. Direct contact is also a common way to transmit nosocomial infections.

 

PTS:   1                    REF:   Page 31

 

  1. The spread of diseases requires all of the following, except:
a. pathogen source. c. mode of transmission.
b. immunosuppression. d. susceptible host.

 

 

ANS:  B

Immunosuppression is not a requirement for the transmission of an infectious disease. However, a pathogen source, mode of transmission, and susceptible host must be present. A susceptible host does not have to be immunosuppressed to be considered susceptible. The host could have had surgery, be intubated, or have an indwelling catheter to be susceptible.

 

PTS:   1                    REF:   Page 28

 

  1. You are visiting a country that has been plagued by heavy rains and flooding. The population is suffering from widespread disease. Which of the following is the most likely cause of the disease?
a. Cholera c. Legionella
b. Influenza d. Salmonellosis

 

 

ANS:  A

Cholera is a waterborne infectious disease. With excessive rains and flooding, this waterborne bacterium might flourish. Legionella is spread by aerosols. Salmonellosis is a food-borne infectious disease. Influenza is spread through the respiratory tract.

 

PTS:   1                    REF:   Page 32, Table 2-3

 

  1. The skin and mucosal tissue can prevent the spread of infectious agents by acting as _____ barriers.
a. immunologic c. epidermal
b. mechanical d. soft

 

 

ANS:  B

The skin and mucous membranes are mechanical barriers to infection, meaning that they physically prohibit the transfer of infectious organisms into a host.

 

PTS:   1                    REF:   Page 32

 

  1. Which of the following is a common pathogen that could cause a disruption of normal flora in a patient receiving antibiotic therapy?
a. Clostridium difficile c. Enterobacteriaceae spp.
b. Pneumocystis carinii d. Pseudomonas  aeruginosa

 

 

ANS:  A

Clostridium difficile are the bacteria that cause the disruption of normal flora in the gastrointestinal tract caused by antibiotic therapy. Pneumocystis carinii are the protozoa that cause pneumonia in immunocompromised patients with human immunodeficiency virus. Enterobacteriaceae spp. are the bacteria that can cause hypogammaglobulinemia in patients with multiple myeloma.

 

PTS:   1                    REF:   Page 33, Table 2-4

 

  1. Transmission of an infectious agent by flies would fall into which mode of disease transfer?
a. Vector-borne c. Contact
b. Airborne d. Indirect

 

 

ANS:  A

Insects are the transmission agents in vector-borne infectious diseases. Airborne, indirect, and contact transmission are not accomplished via insects.

 

PTS:   1                    REF:   Page 29

 

  1. Which of the following are the two primary human barriers to infection in the health care setting?
a. Disinfection and sterilization
b. Immunologic and mechanical
c. Disinfection and pasteurization
d. Hand-washing and personal protective equipment

 

 

ANS:  B

Human barriers to infection include the mechanical barriers of the skin and mucous membranes and the person’s immune system. The others are preventative measures that reduce the spread of infection in health care settings.

 

PTS:   1                    REF:   Page 32

 

  1. An agent that destroys pathogenic microorganisms on inanimate objects only is best described as a:
a. virucide. c. bactericide.
b. germicide. d. disinfectant.

 

 

ANS:  D

A disinfectant describes agents that destroy pathogenic microorganisms on inanimate objects only. Germicide is a general term used to describe agents that destroy pathogenic microorganisms on living tissue and inanimate objects. A bactericide destroys all pathogenic bacteria. A virucide destroys viruses only.

 

PTS:   1                    REF:   Pages 32-33

 

  1. Sterilization differs from pasteurization in that sterilization destroys:
a. bacteria and fungi only. c. all microbes.
b. only bacteria. d. only viruses.

 

 

ANS:  C

Bactericides destroy only pathogenic bacteria. Fungicides kill fungi, and virucides kill viruses. Sterilization kills all microbes including spores, whereas pasteurization is a disinfection process that removes most pathogenic microorganisms except bacterial endospores.

 

PTS:   1                    REF:   Page 32

 

  1. All of the following are factors that affect disinfection and sterilization, except:
a. shape of the pathogen. c. resistance of the pathogen.
b. number of organisms. d. strength of the germicide.

 

 

ANS:  A

The shape of the organism does not make a difference in how disinfection and sterilization work. The number, location, and innate resistance of the microorganisms; the concentration and potency of the germicide; the duration of exposure; and the physical and chemical environment in which the germicide is used are all factors that affect disinfection and sterilization.

 

PTS:   1                    REF:   Page 32

 

  1. Which of the following are true about the amount of time required to kill microbes?
  2. Time decreases as the strength of the germicide decreases.
  3. Time is directly proportional to the number of pathogens.
  4. Time increases as the microbial population increases.
  5. Time varies with the resistance of the organism.
a. 2, 3, and 4 c. 1 and 3
b. 3 and 4 d. 2 and 3

 

 

ANS:  A

The number of pathogens and their resistance affect the amount of time it takes to kill microbes. Increased strength of a germicide will decrease the amount of time to kill the microbes.

 

PTS:   1                    REF:   Page 33

 

  1. Which of the following medical states increase patient susceptibility to nosocomial infection?
a. Hypoglycemia c. Hyperbilirubinemia
b. Altered B cells d. Hypogammaglobulinemia

 

 

ANS:  D

Hypogammaglobulinemia is the only answer that describes a condition that increases susceptibility to nosocomial infections.

 

PTS:   1                    REF:   Page 33, Table 2-4

 

  1. A patient’s susceptibility to Pseudomonas aeruginosa is increased by:
a. organ transplantation. c. antibiotic therapy.
b. multiple myeloma. d. oncochemotherapy.

 

 

ANS:  D

Organ transplantation increases a patient’s susceptibility to toxoplasmosis. Multiple myeloma increases a patient’s susceptibility to Haemophilus influenzae. Antibiotic therapy increases a patient’s susceptibility to Clostridium difficile. Oncochemotherapy increases a patient’s susceptibility to Pseudomonas aeruginosa and Candida.

 

PTS:   1                    REF:   Page 33, Table 2-4

 

  1. After a ventilator is cleaned and ready for use, it should be stored in:
a. the hallway near the freight elevators.
b. the back of the preparation area.
c. the back of the clean-up area.
d. a separate “clean room.”

 

 

ANS:  D

A separate “clean room” is necessary so that dirty and clean equipment remain separate. Hallways, prep areas, and clean-up areas are not ideal places to store clean equipment.

 

PTS:   1                    REF:   Page 34

 

  1. In general, germicides are most effective in which of the following environments?
a. Lower acidity c. Lower temperatures
b. Lower alkalinity d. Higher temperatures

 

 

ANS:  D

Higher temperatures increase the activity of most germicides. Higher alkalinity also improves the antimicrobial activity of some disinfectants. Lower temperatures and acidity do not improve the action of germicides.

 

PTS:   1                    REF:   Page 33

 

  1. Under normal conditions, high-level disinfectants can kill all of the following organisms, except:
a. fungal buds. c. gram-positive bacteria.
b. bacterial spores. d. gram-negative bacteria.

 

 

ANS:  B

Bacterial spores are not killed by high-level disinfectants unless they are exposed to the disinfectant for an extended time. Fungi and all bacteria are killed by high-level disinfectants.

 

PTS:   1                    REF:   Page 33

 

  1. Flash pasteurization exposes equipment to which of the following?
a. Water bath at 72° C for 15 minutes c. Moist heat at 72° C for 15 minutes
b. Water bath at 63° C for 30 minutes d. Moist heat at 72° C for 15 seconds

 

 

ANS:  D

There are only two methods for pasteurization: the flash process and the batch process. The flash process requires moist heat at 72° C for 15 seconds, and the batch process requires a water bath at 63° C for 30 minutes.

 

PTS:   1                    REF:   Page 36

 

  1. Quaternary ammonium salts are routinely used to sanitize:
a. ventilator tubing. c. walls and furniture.
b. ventilator surfaces. d. critical respiratory care equipment.

 

 

ANS:  C

Quats are bactericidal, fungicidal, and virucidal toward lipophilic viruses. They are not sporicidal, tuberculocidal, or virucidal toward hydrophilic viruses. They are used to sanitize noncritical surfaces like walls and furniture. Most ventilator tubing is disposable and is therefore not cleaned and disinfected.

 

PTS:   1                    REF:   Page 36

 

  1. Alcohols such as ethyl and isopropyl are unable to kill:
a. fungi. c. bacteria.
b. viruses. d. bacterial spores.

 

 

ANS:  D

Ethyl and isopropyl alcohols are bactericides, fungicides, and virucides, but they do not kill bacterial spores.

 

PTS:   1                    REF:   Page 36

 

  1. The ability of alcohols to act as an effective disinfectant decreases significantly when their concentration drops below:
a. 30%. c. 70%.
b. 50%. d. 90%.

 

 

ANS:  B

Below 50% concentration, the ability of alcohols to disinfect decreases significantly.

 

PTS:   1                    REF:   Page 36

 

  1. The respiratory therapist is in a contact isolation room with a patient. The stethoscope for use with this patient is located within the patient’s room. Which of the following is the most appropriate solution for disinfecting this stethoscope?
a. Acetic acid c. Glutaraldehyde
b. Ethylene oxide d. Isopropyl alcohol

 

 

ANS:  D

Alcohols are used to disinfect equipment such as thermometers, stethoscopes, and fiberoptic endoscopes; in addition, they are used to clean the surfaces of mechanical ventilators and preparation areas. Acetic acid is the disinfectant of choice with home respiratory care equipment and is not often used in the hospital setting. Glutaraldehyde is a respiratory irritant and would not be appropriate for use in patient care areas. Ethylene oxide cannot be used at the bedside because it requires specialized equipment and takes several steps to prepare it for disinfectant use.

 

PTS:   1                    REF:   Page 36

 

  1. Phenolic compounds are generally diluted to what concentration?
a. 0.04% to 0.05% c. 40% to 50%
b. 0.4% to 5.0% d. 4% to 5%

 

 

ANS:  B

Phenolic compounds are diluted to a 0.4% to 5% solution to provide a low to intermediate level of disinfection.

 

PTS:   1                    REF:   Page 35, Table 2-5

 

  1. Bacterial spores can be inactivated by exposure to:
a. 10 hours of iodophors.
b. 8 hours of glutaraldehyde.
c. 30 minutes of isopropyl alcohol.
d. 6 hours of quaternary ammonium compounds.

 

 

ANS:  B

Glutaraldehyde is sporicidal and has an exposure time of 6 to 8 hours. Iodophors are bactericidal, tuberculocidal, fungicidal, and virucidal, but they are not effective against bacterial spores. Alcohols are bactericidal, fungicidal, and virucidal, but they do not kill bacterial spores. Quaternary ammonium compounds are not sporicidal.

 

PTS:   1                    REF:   Page 35

 

  1. A residue will remain on equipment exposed to:
a. formaldehyde. c. hydrogen peroxide.
b. isopropyl alcohol. d. quaternary ammonium compounds.

 

 

ANS:  A

Formaldehyde will leave a residue on equipment. The other agents listed in these choices will not.

 

PTS:   1                    REF:   Page 35, Table 2-5

 

  1. Which of the following disinfectants/sterilizing agents is a respiratory irritant?
a. Phenolic c. Formaldehyde
b. Iodophors d. Isopropyl alcohol

 

 

ANS:  C

Formaldehyde is a respiratory irritant. The other agents listed are not.

 

PTS:   1                    REF:   Page 35, Table 2-5

 

  1. A typical high-level disinfectant can kill organisms—but not spores—in what time period?
a. 24 hours c. 12 to 18 hours
b. 1 to 2 hours d. Less than 45 minutes

 

 

ANS:  D

High-level disinfectant agents are typically chemical sterilants that are used at reduced exposure times, usually less than 45 minutes. They kill bacteria, fungi, and viruses in this period of time. However, spores are not killed unless the chemical is used for an extended period of time.

 

PTS:   1                    REF:   Page 35

 

  1. In batch pasteurization, equipment is placed in a water bath heated to ____ for 30 minutes.
a. 63° C c. 163° C
b. 72° C d. 175° C

 

 

ANS:  A

Batch pasteurization requires the equipment to be exposed to a water bath at 63° C for 30 minutes. Flash pasteurization requires equipment to be exposed to moist heat at 72° C for 15 seconds.

 

PTS:   1                    REF:   Page 36

 

  1. Acid glutaraldehyde is tuberculocidal with a minimum exposure time of _____ minutes.
a. 10 c. 30
b. 20 d. 40

 

 

ANS:  B

Acid glutaraldehyde is bactericidal, fungicidal, and virucidal with a 10-minute exposure time. However, exposure time must be extended to 20 minutes for it to become tuberculocidal.

 

PTS:   1                    REF:   Page 37

 

  1. The statement “A disinfectant’s potency increases as its concentration increases” is not true for:
a. phenols. c. iodophors.
b. alcohols. d. glutaraldehydes.

 

 

ANS:  C

Iodophors are the only exception to this statement.

 

PTS:   1                    REF:   Page 37

 

  1. During a home care visit, the respiratory therapist is instructing the patient and family member on the use of the patient’s equipment. Which of the following household items should the respiratory therapist inform the patient to use to decontaminate the equipment?
a. Alcohol c. Bleach
b. Vinegar d. Lye

 

 

ANS:  B

White household vinegar is used extensively as a method for decontaminating home care respiratory equipment. One part 5% white household vinegar and three parts water should be used. Bleach and lye are too dangerous for the patient to use and are respiratory irritants. Prolonged and repeated use of alcohol can cause swelling and hardening of rubber and plastic tubes.

 

PTS:   1                    REF:   Page 36

 

  1. An oxygen atom can be added to acetic acid to form an excellent disinfectant with sterilization capabilities. This disinfecting agent is:
a. peroxide. c. peracetic acid.
b. peroxidic acid. d. acetic peroxide.

 

 

ANS:  C

Peracetic acid is an excellent disinfectant with sterilization capabilities. It kills microbes by denaturing proteins, disrupting cell wall permeability, and oxidizing cellular metabolites. Its shortcoming is that it can corrode brass, iron, copper, and steel.

 

PTS:   1                    REF:   Page 35

 

  1. Carbolic acid is:
a. an acetic acid derivative. c. the basis for phenol derivatives.
b. a common disinfectant. d. the only form of acid glutaraldehyde.

 

 

ANS:  C

Carbolic acid is the prototype 6-carbon aromatic compound. It was first used as a germicide by Lister in his pioneering work on antiseptic surgery.

 

PTS:   1                    REF:   Page 36

 

  1. The Centers for Disease Control and Prevention recommends that blood spills be cleaned with:
a. ethanol. c. sodium hypochlorite.
b. peracetic acid. d. alkaline glutaraldehyde.

 

 

ANS:  C

The Centers for Disease Control and Prevention recommends that a 1:10 dilution of sodium hypochlorite be used to clean blood spills.

 

PTS:   1                    REF:   Page 37

 

  1. A 1.25% solution of acetic acid has been shown to be an effective bactericidal agent against:
a. Staphylococcus aureus c. Micobacterium tuberculosis
b. Pseudomonas aeruginosa d. Streptococcus pneumoniae

 

 

ANS:  B

Pseudomonas aeruginosa is killed by 1.25% acetic acid or one part 5% white household vinegar and three parts water. Pseudomonas aeruginosa transmission is through indirect contact via fomites, such as those on clothing, surgical bandages, and especially equipment. It is the most common respiratory pathogen in patients with cystic fibrosis and is encountered in patients with chronic obstructive pulmonary disease.

 

PTS:   1                    REF:   Page 36

 

  1. Which of the following indicates the minimum time a tracheostomy inner cannula should be soaked in 3% hydrogen peroxide to be an effective disinfectant during a patient’s tracheostomy care?
a. 1 minute c. 10 minutes
b. 5 minutes d. 15 minutes

 

 

ANS:  C

Commercially available 3% solutions of hydrogen peroxide are effective disinfectants of bacteria (including Mycobacteria sp.), fungi, and viruses and are active within 10 minutes at room temperature. To be effective against spores, the solution would need to be at 50° C and the equipment would need to be soaked for at least 20 minutes.

 

PTS:   1                    REF:   Page 37

 

  1. The Centers for Disease Control and Prevention recommends a _____ dilution of bleach to water to clean up blood spills.
a. 1:1 c. 1:10
b. 1:2 d. 1:100

 

 

ANS:  C

The Centers for Disease Control and Prevention recommends that a 1:10 dilution of sodium hypochlorite be used to clean up blood spills.

 

PTS:   1                    REF:   Page 37

 

  1. Which type of germicide requires activation with bicarbonate?
a. 5% acetic acid c. 3% hydrogen peroxide
b. 2% alkaline glutaraldehyde d. 10% sodium hypochlorite

 

 

ANS:  B

Only alkaline glutaraldehyde requires activation with a bicarbonate solution. This yields a solution with a pH of 7.5 to 8.5.

 

PTS:   1                    REF:   Page 37

 

  1. Commercial-grade hydrogen peroxide is an effective disinfectant at room temperature after how many minutes?
a. 5 c. 30
b. 10 d. 60

 

 

ANS:  B

Commercially available 3% solutions of hydrogen peroxide are effective disinfectants of bacteria (including Mycobacteria sp.), fungi, and viruses and are active within 10 minutes at room temperature.

 

PTS:   1                    REF:   Page 37

 

  1. Which of the following physical properties are required for an autoclave to sterilize biohazardous material?
  2. Dry heat
  3. A vacuum
  4. 100% humidity
  5. Increased air pressure
a. 2 and 3 c. 1, 2, and 4
b. 1 and 3 d. 2, 3, and 4

 

 

ANS:  D

Air is evacuated, moisture is added (100% humidity), and the pressure inside the autoclave is raised to 15 to 20 lb-force per square inch gauge (psig). Air is evacuated from the chamber because residual air prolongs the penetration time of steam, thus increasing the total autoclave cycle time. Pressure is used to raise the temperature of the steam, which is critical because the amount of time required to achieve sterilization depends on the temperature inside of the autoclave. Dry heat is not used during autoclaving.

 

PTS:   1                    REF:   Page 38

 

  1. Dry-heat sterilization involves a 1-hour to 2-hour exposure at approximately:
a. 100° C. c. 170° C.
b. 132° C. d. 200° C.

 

 

ANS:  C

Dry heat is another effective method of heat sterilization. Its use is limited to items that are not heat-sensitive. Temperatures must be maintained between 160° C and 180° C for 1 to 2 hours for sterilization.

 

PTS:   1                    REF:   Page 38

 

  1. At high altitudes, sterilization by boiling must be prolonged primarily because of which of the following?
a. Increased oxygen content c. Increased normal boiling point
b. Reduced oxygen content d. Reduced normal boiling point

 

 

ANS:  D

Because water boils at a lower temperature at high altitudes, exposure time must be prolonged during this form of sterilization at high elevations.

 

PTS:   1                    REF:   Page 38

 

  1. Which of the following should routinely be used to ensure proper function and quality control of an autoclave?
  2. Pressure-sensitive tape
  3. Biologic indicators
  4. Chemical indicators
  5. Heat-sensitive tape
a. 2 c. 1, 2, and 3
b. 2 and 4 d. 1, 2, and 4

 

 

ANS:  B

Because the process of autoclaving depends on several factors, heat-sensitive tape and biologic indicators are routinely used to ensure quality control during the process. Heat-sensitive tape that is used for packaging materials for autoclaving changes color when it is exposed to a given temperature for a prescribed amount of time. The most common biologic indicators for autoclaving are strips of paper that are impregnated with Bacillus stearothermophilus spores. These strips should be used weekly (at a minimum) to ensure that the autoclave is working properly. Biologic indicators are also used for ethylene oxide sterilization.

 

PTS:   1                    REF:   Page 38

 

  1. According to the classification of infection-risk devices described by Spaulding, ventilator tubing is considered:
a. critical. c. semicritical.
b. noncritical. d. highly critical.

 

 

ANS:  C

Ventilator tubing comes in contact with intact mucous membranes and is considered semicritical. Critical items are those that are introduced into sterile tissue or the vascular system. Noncritical items come in contact with intact skin. Noncritical items include face masks, ventilators, stethoscopes, and blood pressure cuffs. Highly critical is not a descriptor that Spaulding used.

 

PTS:   1                    REF:   Page 39

 

  1. According to the classification described by Spaulding, which of the following items of medical equipment fall into the category of noncritical infection risk?
a. Scalpels c. Ventilator tubing
b. Ventilators d. Manual resuscitators

 

 

ANS:  B

Noncritical items come in contact with intact skin. These items include face masks, ventilators, stethoscopes, and blood pressure cuffs. Scalpels are introduced into sterile tissue and are considered critical items. Ventilator tubing and manual resuscitators come in contact with intact mucous membranes and are considered semicritical.

 

PTS:   1                    REF:   Page 40

 

  1. Which of these precautions must be followed in the treatment of a patient with an influenza infection?
  2. Contact
  3. Droplet
  4. Airborne
  5. Standard
a. 1 and 3 c. 1, 2, and 4
b. 2 and 4 d. 2, 3, and 4

 

 

ANS:  B

Standard precautions need to be used for all patients. Droplet precautions are used for patients known or suspected to have serious illnesses transmitted by large-particle droplets. Influenza is a serious viral infection spread by droplet transmission. Contact isolation is used for patients known or suspected to have serious illnesses easily transmitted by direct patient contact or by contact with items in the patient’s environment. Airborne precautions should be used for patients who are known or suspected to have illnesses transmitted by airborne droplet nuclei, such as measles, varicella, or tuberculosis.

 

PTS:   1                    REF:   Page 42, Box 2-6

 

  1. Which of the following is the most important infection control procedure for anyone who has direct patient contact?
a. Sterile latex gloves c. Hand hygiene
b. Disposal of sharps d. Face masks

 

 

ANS:  C

Hand-washing is the most important prevention strategy to protect health care workers from being infected through contact with infected patients. It also reduces the risk of health care workers transmitting infectious microorganisms from one patient to another or from a contaminated site to a clean site on the same patient. Sterile gloves are worn during invasive procedures. Disposal of sharps is important when any sharps (e.g., needles) are used. Face masks need to be worn when there is a possibility of blood or body fluid being splashed or sprayed, such as during an arterial blood gas stick.

 

PTS:   1                    REF:   Page 43

 

  1. Which of the following illnesses requires airborne precautions?
a. Measles c. Herpes simplex virus
b. Clostridium difficile d. Mycoplasma pneumoniae

 

 

ANS:  A

Airborne precautions should be used for patients who are known to have or who are suspected of having illnesses transmitted by airborne droplet nuclei, such as measles, varicella, or tuberculosis. Clostridium difficile and the herpes simplex virus require contact isolation, because they are transmitted by direct patient contact or by contact with items in the patient’s environment. Mycoplasma pneumoniae requires droplet precautions because it is spread by droplet transmission.

 

PTS:   1                    REF:   Page 42, Box 2-6

 

  1. Droplet isolation precautions call for all of the following, except:
a. face masks. c. protective eyewear.
b. latex gloves. d. special air-handling.

 

 

ANS:  D

Droplet precautions include masks, gloves, and protective eyewear but not special air-handling.

 

PTS:   1                    REF:   Page 45

 

  1. Which isolation precaution requires the patient to be placed in a private isolation room?
a. Droplet c. Airborne
b. Contact d. Universal

 

 

ANS:  C

Airborne precautions have two major components: (1) placement of the infected patient in an area with appropriate air-handling and ventilation and (2) use of respiratory protective equipment by health care workers and visitors entering the patient’s room. In cases in which an infected patient must be transported, the patient should wear a surgical mask to minimize dispersal of droplet nuclei. Current standards require that infected patients be placed in a private, negative-pressure isolation room. Negative air pressure within the room should be monitored relative to other areas of the hospital. Severe acute respiratory syndrome, measles, chicken pox (primary varicella zoster virus), and tuberculosis are illnesses that require airborne precautions.

 

PTS:   1                    REF:   Page 45

 

  1. In preparation for an arterial blood gas puncture on a noninfectious patient in the pulmonary laboratory, which of the following items of protective apparel should be used?
  2. Gown
  3. Gloves
  4. Shoe covers
  5. Eye protection
a. 1 and 2 c. 2, 3, and 4
b. 2 and 4 d. 1, 2, 3, and 4

 

 

ANS:  B

The least amount of protective apparel that should be worn when drawing an arterial blood gas includes gloves and eye protection. In the case of a patient in isolation, a gown should be worn if there is a chance of splashing blood. Shoe covers are not necessary in areas outside of the operating rooms.

 

PTS:   1                    REF:   Page 44

 

  1. The below figure represents which of the following bacteria?

 

a. Bacillus c. Streptococcus
b. Diplococcus d. Staphylococcus

 

 

ANS:  D

Cocci that occur in irregular clusters are called staphylococci. A bacillus is rod-shaped; a diplococcus is paired, sphere-shaped bacteria; and a streptococcus is a chain of cocci.

 

PTS:   1                    REF:   Page 28

 

  1. Which of the following figure represents a spirochete?

 

a. A c. C
b. B d. D

 

 

ANS:  C

Bacteria that are spiral are called spirochetes. The others are designated as follows: (A) streptococci, (B) diplococci, and (D) vibrio.

 

PTS:   1                    REF:   Page 28

 

  1. A Gram stain leaves the following organism violet. Which pathogen could this be?
a. Escherichia coli c. Staphylococcus aureus
b. Bacillus anthracis d. Streptococcus pneumoniae

 

 

ANS:  D

Streptococcus pneumoniae are gram-negative spheres that occur in chains.  Escherichia coli are gram-negative and rod-shaped. Bacillus anthracis are gram-positive and rod-shaped. Staphylococus aureus are gram-positive spheres that occur in irregular clusters.

 

PTS:   1                    REF:   Page 28

 

  1. Which of the following is a commonly encountered gram-negative, facultative anaerobic bacillus bacteria?
a. Escherichia coli c. Neisseria meningitidis
b. Clostridium tetani d. Haemophilus parainfluenzae

 

 

ANS:  A

Escherichia coli are gram-negative, rod-shaped facultative anaerobes. Clostridium are gram-positive, rod-shaped anaerobes. Neisseria meningitidis are gram-positive aerobes that occur in chains. Haemophilus parainfluenzae are gram-negative, rod-shaped aerobes.

 

PTS:   1                    REF:   Page 30, Table 2-1

 

  1. Which of the following viruses will cause bronchiolitis?
a. Influenza c. Herpes zoster
b. Rhinovirus d. Respiratory syncytial

 

 

ANS:  D

Respiratory syncytial virus causes bronchiolitis. Influenza virus can cause tracheobronchitis and pneumonia. Rhinovirus causes rhinitis and pharyngitis. Herpes zoster causes vesicles on ectodermal tissues.

 

PTS:   1                    REF:   Page 31, Table 2-2

 

  1. What is the route of transmission for hepatitis?
a. Gut c. Body fluids
b. Genitalia d. Respiratory tract

 

 

ANS:  C

The transmission route for hepatitis is blood and body fluids. The transmission route for coxsackievirus and polio is the gut. Herpes simplex can be transmitted through the genitals. The respiratory tract is the transmission route for influenza, mumps, measles, parainfluenza, respiratory syncytial virus, adenoviruses, rhinoviruses, varicella, and rubella.

 

PTS:   1                    REF:   Page 31, Table 2-2

 

  1. The definition “an aerobic, gram-negative, rodlike bacteria” describes:
a. Bacillus anthracis. c. Clostridium botulinum.
b. Bordetella pertussis. d. Mycobacterium tuberculosis.

 

 

ANS:  B

Bordetella pertussis is gram-negative, aerobic, and rod-shaped. Bacillus anthracis is gram-positive, aerobic, and rod-shaped. Clostridium botulinum is gram-positive, anaerobic, and rodlike. Mycobacterium tuberculosis is gram-positive, aerobic, and rodlike.

 

PTS:   1                    REF:   Page 31, Table 2-2

 

  1. Legionellosis is transmitted by which of the following modes?
a. Mosquitoes c. Airborne aerosol
b. Airborne dust d. Waterborne vehicle

 

 

ANS:  C

The transmission mode for legionellosis is through airborne aerosols. Mosquitoes transmit malaria. Airborne dust transmits histoplasmosis. Water transmits shigellosis and cholera.

 

PTS:   1                    REF:   Page 32

 

  1. Hepatitis B is spread by which type of transmission?
a. Droplet nuclei c. Indirect contact
b. Direct contact d. Food-borne vehicle

 

 

ANS:  C

Hepatitis B is spread by indirect contact. Tuberculosis and diphtheria are spread by droplet nuclei. Hepatitis A, venereal disease, human immunodeficiency virus, staphylococcus, and enteric bacteria are spread by direct contact. Salmonellosis and hepatitis A are spread through food.

 

PTS:   1                    REF:   Page 32, Table 2-3

 

  1. Opportunistic fungal infections are typically caused by which of the following?
a. Pneumocystis carinii c. Histoplasma capsulatum
b. Aspergillus fumigatus d. Haemophilus haemolyticus

 

 

ANS:  B

Aspergillus fumigatus causes opportunistic fungal infections. Pneumocystis carinii is an opportunistic protozoan that causes pneumonia in immunocompromised patients. Histoplasma capsulatum can cause fungal infections in otherwise healthy individuals. Haemophilus haemolyticus is usually nonpathogenic, but on rare occasions it can cause subacute endocarditis.

 

PTS:   1                    REF:   Page 30

 

  1. Human immunodeficiency virus is transmitted by which of the following routes?
a. Direct contact c. Indirect contact
b. Droplet contact d. Airborne aerosol

 

 

ANS:  A

Human immunodeficiency virus is transmitted by direct contact. Tuberculosis and diphtheria are spread by droplet nuclei. Hepatitis B is spread by indirect contact. Legionellosis is spread by airborne aerosols.

 

PTS:   1                    REF:   Page 32, Table 2-3

 

  1. Safe needle practice calls for which of the following?
a. Needles should not be recapped.
b. Recap the needle with two hands.
c. Gloves are not necessary when drawing blood.
d. Dispose of the needle in a hazardous waste bag.

 

 

ANS:  A

Needles should not be recapped. When it is necessary to recap a syringe, both hands should never be used; instead, use the one-hand “scoop” technique or a mechanical device to recap syringe needles safely. Gloves should always be worn when using a needle to draw blood. Needles must be disposed of in a biohazard sharps (i.e., hard plastic) container.

 

PTS:   1                    REF:   Page 44

 

  1. Endotracheal intubation increases a patient’s susceptibility to which of the following common pathogens?
a. Pneumocystis carinii c. Staphylococcus aureus
b. Neisseria meningitidis d. Streptococcus pneumoniae

 

 

ANS:  C

Endotracheal intubation increases a patient’s susceptibility to Staphylococcus aureus, as well as Pseudomonas aeruginosa, Enterobacteriaceae species, and Candida. Pneumocystis carinii is common in patients with acquired immunodeficiency syndrome. Patients with systemic lupus erythematosus, liver failure, or vasculitis are susceptible to Neisseria meningitidis and Streptococcus pneumoniae.

 

PTS:   1                    REF:   Page 33, Table 2-4

 

  1. Patients undergoing corticosteroid therapy have an increased risk of nosocomial infection from which of the following common pathogens?
a. Candida albicans c. Streptococcus pneumoniae
b. Enterobacteriaceae sp. d. Staphylococus epidermidis

 

 

ANS:  A

Corticosteroid therapy disrupts the normal flora of the oral cavity, leaving the patient at risk for the development of Candida albicans, which is otherwise known as thrush.

 

PTS:   1                    REF:   Page 33, Table 2-4

 

  1. An adult is brought to the emergency department with third-degree burns over 40% of his body. This patient now has an increased susceptibility to which of the following organisms?
a. Streptococcus pneumoniae c. Candida albicans
b. Pseudomonas aeruginosa d. Clostridium difficile

 

 

ANS:  B

The skin and mucosal barrier have been disrupted by the burns; therefore, this patient is susceptible to Pseudomonas aeruginosa. Pseudomonas aeruginosa is one of several pathogens that can affect hospitalized patients. Patients with systemic lupus erythematosus, liver failure, or vasculitis are susceptible to Streptococcus pneumoniae. Oncochemotherapy and antibiotic therapy increase a patient’s susceptibility to Candida albicans and Clostridium difficile.

 

PTS:   1                    REF:   Page 33, Table 2-4

 

  1. A 65-year-old male is intubated and placed on a mechanical ventilator after a motor vehicle accident. Thirty-six hours later he develops infiltrates on the chest radiograph. Which of the following actions may have been able to prevent this from occurring?
  2. Elevation of the head of the bed 20 to 30 degrees
  3. Aspiration of subglottic secretions
  4. Changing ventilator circuit every 24 hours
  5. Stress ulcer prophylaxis
  6. Avoid the use of sedatives
a. 1 only c. 1, 2, 4, and 5
b. 1, 3, and 5 d. 1, 2, 3, 4, and 5

 

 

ANS:  C

The information indicates that the patient has ventilator-associated pneumonia; ventilator-associated pneumonia must be suspected anytime intubation develops shortly after endotracheal intubation. There are many actions that can be taken to prevent its development. Current standards state that the ventilator circuit should be changed only when it is grossly contaminated.

 

PTS:   1                    REF:   Page 32

 

  1. A home care patient is being instructed on the use of a hand-held nebulizer. Which of the following would be the recommended method of disinfection for the nebulizer?
a. Alkaline glutaraldehyde
b. One part household vinegar and three parts water
c. Pasteurization
d. Autoclave

 

 

ANS:  B

Acetic acid is the agent of choice to disinfect home care equipment due to its low cost and effectiveness. Alkaline glutaraldehyde requires a use of a hood for protection from fumes. Pasteurization and autoclave both require specialized equipment.

 

REF Pages 2-34, 2-36, and 2-38

 

PTS:   1                    REF:   Page 41, Box 2-4

 

  1. Which of the following conditions require the use of NIOSH-approved respiratory protective devices?
  2. Severe Acute Respiratory Distress Syndrome
  3. Tuberculosis
  4. Influenza
  5. Smallpox
a. 1 only c. 1, 2, and 4
b. 1 and 3 d. 1, 2, 3, and 4

 

 

ANS:  D

These conditions are all associated with droplet nuclei and require the use of an N-95 respirator.

 

PTS:   1                    REF:   Page 44

 

Chapter 04: Administering Medical Gases: Regulators, Flowmeters, and

 

MULTIPLE CHOICE

 

  1. What device helps reduce high-pressure gases from cylinders or bulk storage units to a lower working pressure?
a. Regulator c. Bourdon gauge
b. Kinetic tube d. Thorpe tube

 

 

ANS:  A

The regulator is the only device in which pressure is regulated. The other devices relate to flow.

 

PTS:   1                    REF:   Page 84

 

  1. The chamber located above the diaphragm of a single-stage regulator is which of the following?
a. Lower chamber c. High-pressure chamber
b. Pressure-relief valve d. Adjustable regulator

 

 

ANS:  C

The high-pressure chamber is located above the diaphragm and contains a valve stem that will close the inlet when the pressure reaches its setting.

 

PTS:   1                    REF:   Page 84

 

  1. The gas flow into the high-pressure side regulator is dependent on what two opposing forces?
  2. Gas pressure above the diaphragm
  3. Gas pressure at the diaphragm
  4. Spring tension below the diaphragm
  5. Spring tension above the diaphragm
a. 1 and 3 c. 2 and 4
b. 2 and 3 d. 1 and 4

 

 

ANS:  A

When the force offered by the high-pressure gas above the diaphragm equals the force offered by spring tension, the diaphragm is straight and the inlet valve is closed.

 

PTS:   1                    REF:   Page 84

 

  1. Delivered pressures on common adjustable regulators are between _____ and ____ pounds per square inch gauge (psig).
a. 0; 50 c. 50; 100
b. 0; 100 d. 50; 200

 

 

ANS:  B

Most adjustable regulators can be set to deliver pressure between 0 and 100 psig.

 

PTS:   1                    REF:   Page 84

 

  1. Which regulator supports the theory that gas pressure is gradually reduced as gas flows from a high-pressure source through a series of stages to the outlet?
a. Single-stage regulator c. Preset regulator
b. Flowmeter d. Multistage regulator

 

 

ANS:  D

Gas from a compressed cylinder (e.g., 2200 psig) enters the first stage of a two-stage regulator, and the gas pressure is reduced to an intermediate pressure (e.g., 700 psig). This lower pressure gas then enters into the second stage of the regulator, where the gas pressure is further reduced to the desired working pressure (e.g., 50 psig) before the gas reaches the outlet.

 

PTS:   1                    REF:   Page 85

 

  1. Which device is more precise in terms of controlling gas pressure?
a. Bourdon flowmeter c. Multistage regulator
b. Thorpe tube flowmeter d. Flow restrictors

 

 

ANS:  C

Multistage regulators can control gas pressure with more precision than single-stage regulators because the pressure is gradually reduced.

 

PTS:   1                    REF:   Page 85

 

  1. The most commonly used flowmeter in respiratory care is which of the following?
a. Thorpe tube flowmeter c. Flow restrictor
b. Bourdon gauge d. Reducing valve

 

 

ANS:  A

Thorpe tubes are the most commonly used flowmeters in respiratory care.

 

PTS:   1                    REF:   Page 86

 

  1. The problem most often encountered with a Thorpe tube flowmeter is:
a. patient outlet becomes occluded.
b. gas leaks caused by faulty valve seats.
c. a cracked tube.
d. prolonged heat exposure.

 

 

ANS:  B

This problem is usually detected when the flowmeter is turned off completely, but gas can be heard continuing to flow from the flowmeter outlet; in this case, the flowmeter should be replaced. This problem can also occur because of constant wear and tear.

 

PTS:   1                    REF:   Page 87

 

  1. Pressure-compensated flowmeters provide which of the following?
a. Inaccurate estimates of flow c. Back pressure
b. Accurate estimates of flow d. A means to estimate leaks

 

 

ANS:  B

On pressure-compensated flowmeters, the needle valve controlling gas flow out of the flowmeter is located distal to the Thorpe tube. This arrangement allows the pressure in the indicator tube to be maintained at the source gas pressure, which ensures an accurate estimate of flow.

 

PTS:   1                    REF:   Page 86

 

  1. A float that jumps and falls to zero when the needle valve is closed and is attached to a bulk system is indicative of a _____ flowmeter.
a. crack in the c. non-compensated
b. Bourdon d. pressure-compensated

 

 

ANS:  D

This floating movement occurs because the source gas must pass through the indicator tube before it reaches the needle valve.

 

PTS:   1                    REF:   Page 86

 

  1. Which device uses the following principle? As the driving pressure is increased, the flow from the flowmeter outlet increases.
a. Compensated Thorpe tube flowmeter
b. Fixed-orifice flowmeter
c. Bourdon flowmeter
d. Non-compensated pressure flowmeter

 

 

ANS:  C

A Bourdon flowmeter is actually a reducing valve that controls the pressure gradient across an outlet with a fixed orifice.

 

PTS:   1                    REF:   Page 87

 

  1. What is (are) the type(s) of flow restrictor(s)?
  2. Fixed-orifice
  3. Adjustable, multiple-orifices
  4. Compensated orifice
  5. Non-compensated orifice
a. 1 c. 1, 2, 3, and 4
b. 2 d. 1 and 2

 

 

ANS:  D

There are two types of flow restrictors: fixed-orifice and adjustable, multiple-orifice models. The adjustable, multiple-orifice flow restrictor uses a series of calibrated openings in a disk that can be adjusted to deliver different flows.

 

PTS:   1                    REF:   Page 87

 

  1. The characteristic(s) of low-flow devices is (are):
  2. fractional inspired oxygen (FIO2) from 0.22 to 0.60.
  3. make use of a nasal cannula.
  4. make use of a Venturi mask.
  5. make use of a transtracheal catheter.
a. 1, 2, and 4 c. 1
b. 1 and 4 d. 1, 2, 3, and 4

 

 

ANS:  A

All of the choices are low-flow devices except for a Venturi mask. A Venturi mask is an air-entrainment device, all of which are considered to be high-flow devices. Therefore, Venturi masks deliver a precise FIO2.

 

PTS:   1                    REF:   Page 98

 

  1. A patient with chronic bronchitis comes to your emergency department; she is discovered to have a pulse oximetry oxygen saturation (SpO2) of 78% with room air. On the basis of these data, which oxygen-delivery device would you use with the patient?
a. 6-L nasal cannula c. Simple mask
b. Transtracheal catheter d. Venturi mask

 

 

ANS:  D

A patient with chronic obstructive pulmonary disease requires a precise FIO2 because of carbon dioxide (CO2) retention issues. The only precise FIO2 device is a Venturi mask, which is considered a high-flow device.

 

PTS:   1                    REF:   Pages 98-99

 

  1. High-flow devices include which of the following?
  2. Nasal cannula
  3. Venturi mask
  4. Mask with reservoir bag
  5. Oxygen hoods
a. 1 and 2 c. 3 and 4
b. 2 and 3 d. 2 and 4

 

 

ANS:  D

High-flow devices are also called fixed-performance devices because they provide oxygen at flow rates high enough to completely satisfy a patient’s inspiratory demands. These high-flow oxygen-delivery devices include air-entrainment masks (Venturi masks), incubators, oxygen tents, oxygen hoods, and high-volume aerosol devices.

 

PTS:   1                    REF:   Page 90

 

  1. Which of the following are disadvantages of the nasal cannula?
  2. Pressure necrosis
  3. Drying nasal mucosa
  4. FIO2 not precise
  5. Claustrophobia
a. 1 and 4 c. 1, 2, and 3
b. 1 and 2 d. 2 and 3

 

 

ANS:  C

With straight prongs, oxygen flow is directed toward the superior aspects of the nasal cavity, thus promoting turbulent flow; with curved prongs, oxygen entering the nose is directed across the nasal turbinate, thus enhancing laminar flow as the gas flows through the nasal cavity. Thus, both types of prongs can cause the aforementioned disadvantages.

 

PTS:   1                    REF:   Page 93

 

  1. If the air-entrainment port on a Venturi mask is occluded, which of the following will happen?
  2. A decrease in flow
  3. A decrease in FIO2
  4. An increase in flow
  5. An increase in FIO2
a. 1 and 2 c. 1 and 4
b. 1 and 3 d. None of the choices

 

 

ANS:  C

Partial obstruction of oxygen flow downstream of the jet orifice or partial obstruction of the entrainment ports will decrease the amount of room air entrained, thus raising the FIO2 of the delivered gas.

 

PTS:   1                    REF:   Page 98

 

  1. In theory, a nasal cannula can deliver what amount of FIO2 to a patient?
a. 0.24 to 0.60 c. 0.24 to 1.00
b. 0.24 to 0.36 d. 0.24 to 0.44

 

 

ANS:  D

The FIO2 levels delivered by a nasal cannula vary with the flow rate setting. Generally, the FIO2 increases by about 4% for each liter of flow increase beginning with 1 L/min delivering approximately 24% oxygen.

 

PTS:   1                    REF:   Page 93, Table 4-1

 

  1. O2-induced hypoventilation is more likely to occur with which oxygen-delivery device?
a. Simple mask c. Venturi mask
b. Nasal cannula d. Large-volume nebulizer

 

 

ANS:  A

Excessive amounts of oxygen can cause a patient with chronically elevated CO2 levels to hypoventilate because the oxygen can knock out the patient’s hypoxic drive. The oxygen concentration delivered can vary significantly and may cause ventilatory depression in patients with chronically elevated partial pressure of arterial CO2 (PaCO2) levels.

 

PTS:   1                    REF:   Page 89, Clinical Practice Guideline 4-1

 

  1. A nasal cannula that delivers 5 L/min translates to what approximate FIO2?
a. 36% c. 40%
b. 28% d. 44%

 

 

ANS:  C

The FIO2 increases approximately 4% for each liter of flow increase. If we begin with 20%, then 5 L/min ´ 4 = 20. And 20 + 20% = 40%.

 

PTS:   1                    REF:   Page 93, Table 4-1

 

  1. What liter flow is approximately 32% on a nasal cannula?
a. 2 c. 4
b. 3 d. 5

 

 

ANS:  B

For this calculation, zero flow is 20%. Therefore, 32% – 20% = 12%. If each liter represents 4% oxygen, then 12/4 = 3 L/min.

 

PTS:   1                    REF:   Page 93, Table 4-1

 

  1. If a Venturi mask is set at 28% and the liter flow is set above the set liter flow prescribed on the device, what FIO2 is being delivered?
a. 28%
b. 32%
c. 100%
d. 80%

 

 

ANS:  A

The flow of oxygen to the nozzle is constant, so an obstruction will increase the FIO2 but not the flow.

 

PTS:   1                    REF:   Page 99, Table 4-2

 

  1. Which of the following influences the FIO2 delivered to the patient by nasal

cannula?

  1. Work of breathing
  2. Tidal volume
  3. Respiratory rate
  4. Humidification
a. 4 c. 1 and 3
b. 1, 2, and 3 d. 1, 2, 3, and 4

 

 

ANS:  B

All physiologic aspects play a role in the amount of FIO2 delivered to a patient regardless of whether breathing is predominantly occurring through the nose or the mouth.

 

PTS:   1                    REF:   Page 100

 

  1. Upon arrival to the emergency department, a patient is found to have an SpO2 of 75% on a nonrebreathing mask. You notice that the nonrebreathing mask is hooked to a bubble humidifier. The humidifier bottle is whistling and is expanded. What is your next action as the respiratory therapist?
a. Change the bubble humidifier; it’s defective.
b. Check for kinks in tubing.
c. Remove the nonrebreathing mask from the humidifier and run off of O2.
d. Place a Venturi mask on the patient.

 

 

ANS:  C

The humidity bottle is not designed for high flows. When it is set to a high flow, the humidity bottle expands and whistles; in turn there is a greater likelihood that the oxygen flowmeter will pop off from the pressure source.

 

PTS:   1                    REF:   Page 94

 

  1. A patient with pulmonary fibrosis comes to the emergency department with an SpO2 of 87% and a respiratory rate of 28 breaths/min. The patient is unsure whether her transtracheal catheter is working properly; what is your first action?
a. Intubate her. c. Place a nasal cannula on her.
b. Examine her for a mucus plug. d. Place a lavage catheter.

 

 

ANS:  C

The therapist should think to place the patient on O2 to maintain her oxygenation status. Once the oxygen is running and the patient is breathing well, the therapist can examine the catheter for obstructions.

 

PTS:   1                    REF:   Page 91

 

  1. The benefits of a transtracheal catheter include which of the following?
  2. Lower flows are needed to obtain higher SpO2
  3. The ability for the patient to eventually wean off of O2.
  4. Improved self-image of the patient.
  5. Oxygen cost savings of up to 60%.
a. 2 and 4 c. 1, 3, and 4
b. 1 and 3 d. 1, 2, 3, and 4

 

 

ANS:  C

The guiding principle for transtracheal oxygen is that the oxygen is delivered directly into the trachea, which provides the patient with adequate oxygen while reducing the amount of oxygen used. This reduces dilution with room air on inspiration. Consequently, lower oxygen flows from the source gas are required to achieve the desired arterial oxygen saturation (SaO2) with a cost savings of up to 60%.

 

PTS:   1                    REF:   Page 94

 

  1. Complications of transtracheal oxygen catheters are:
a. subcutaneous emphysema. c. infection.
b. mucus-plugging. d. all of the above.

 

 

ANS:  D

These risks can be minimized with proper care, including saline instillation and periodic clearing of the catheter lumen with a guide wire or cleaning rod.

 

PTS:   1                    REF:   Page 94

 

  1. Patients exposed to FIO2 greater than or equal to 50% are at risk for which of the following?
  2. Chronic obstructive pulmonary disease
  3. O2 toxicity
  4. Permanent lung damage
  5. Atelectasis
a. 1 and 2 c. 2, 3, and 4
b. 2 and 4 d. None of the choices

 

 

ANS:  C

Oxygen is considered a type of medication. If a patient is exposed to large amounts for a long period of time, all of the aforementioned can occur except for chronic obstructive pulmonary disease, which is considered a disease process not a complication.

 

PTS:   1                    REF:   Page 89, Clinical Practice Guideline 4-1

 

  1. In a pulse-demand oxygen-delivery system, the _____ replaces the flowmeter.
a. Pendant c. Pressure-relief valve
b. Demand valve d. Flow valve

 

 

ANS:  B

The demand valve connects directly to the oxygen source (50 psig), therefore replacing the flowmeter that is used with continuous-flow cannulas. Note that demand systems can function as pulsed or continuous-flow sources of oxygen. Settings allow the operator to select the equivalent of 1 to 5 L/min of oxygen flow from a conventional flowmeter.

 

PTS:   1                    REF:   Page 96

 

  1. Types of reservoir cannulas include which of the following?
  2. Mustache
  3. Pulse demand
  4. Pendant
  5. High flow
a. 1 and 2 c. 1, 3, and 4
b. 2 and 3 d. 2, 3, and 4

 

 

ANS:  C

The two types of reservoir nasal cannulas are the mustache and the pendant. The high-flow nasal cannula can provide heated, humidified oxygen at flows varying between 5 and 40 L/min.

 

PTS:   1                    REF:   Page 90

 

  1. Partial rebreathing masks deliver what FIO2 at what liter flow?
a. 0.35 to 0.50 at 4-5 L c. 0.50 to 0.80 at 6-8 L
b. 0.40 to 0.60 at 6-8 L d. 0 50 to 1.00 at 12-15 L

 

 

ANS:  B

A partial rebreathing mask can deliver an FIO2 of 0.40 to 0.60 with oxygen flows of 6 to 8 L/min. The actual percentage of oxygen delivered is also influenced by the patient’s ventilatory pattern.

 

PTS:   1                    REF:   Page 97

 

  1. Which of the following are O2-conserving devices?
  2. Transtracheal oxygen catheters
  3. Reservoir cannulas
  4. Pulse-demand oxygen-delivery systems
  5. E size cylinder O2 tanks
a. 1, 2, and 4 c. 1, 3, and 4
b. 1, 2, and 3 d. 1, 2, 3, and 4

 

 

ANS:  B

Transtracheal oxygen catheters, reservoir cannulas, and pulse-demand oxygen-delivery systems are recent developments that have significantly improved the delivery of oxygen therapy, especially with regard to conserving oxygen supplies during long-term oxygen therapy.

 

PTS:   1                    REF:   Page 90, Clinical Practice Guideline 4-2

 

  1. The transtracheal oxygen catheter is a guiding principle in which oxygen is delivered directly into the trachea and does which of the following?
a. Provides the patient with adequate oxygen
b. Reduces the amount of oxygen used
c. Provides an overall oxygen savings of 54% to 59%
d. All of the above

 

 

ANS:  D

That is, the direct delivery of oxygen into the trachea reduces dilution with room air on inspiration because the upper airways (the anatomic reservoir) are filled with oxygen.

 

PTS:   1                    REF:   Page 94

 

  1. Which of the following are advantages of transtracheal catheters?
  2. Increase patient mobility
  3. Improve patient compliance because of an enhanced cosmetic appearance
  4. Increase the amounts of nasal irritation
  5. Heighten the risk for mucus plugging
a. 1, 2, and 3 c. 1 and 2
b. 2 and 3 d. 1, 2, 3, and 4

 

 

ANS:  C

Not only do transtracheal catheters produce an overall oxygen savings, they improve patient compliance with oxygen therapy because of cosmetic appearance. Transtracheal catheters are relatively inconspicuous. It is also found that patients with transtracheal catheters have increased mobility.

 

PTS:   1                    REF:   Page 94

 

  1. The statement that is true concerning reservoir cannulas is which of the following?
a. The mustache cannula can hold about 40 mL of gas.
b. The pendant cannula can reduce oxygen supply use by 75%.
c. Patients prefer the mustache cannula to the pendant cannula.
d. Pendant cannulas can be concealed by the patient’s clothing.

 

 

ANS:  D

Studies indicate that mustache and pendant systems may reduce oxygen supply use by 50%. Many patients feel that mustache cannulas are heavier, larger, and more obvious. Pendant cannulas can be concealed by the patient’s clothing.

 

PTS:   1                    REF:   Page 96

 

  1. The main goal of a pulse-demand oxygen-delivery system is which of the following?
  2. To provide oxygen only during expiration
  3. To provide oxygen only during inspiration
  4. To deliver oxygen to the patient only after a sufficient inspiratory effort is made and the demand valve opens
  5. To deliver oxygen at a preset flow rate and close during inspiration to conserve oxygen
a. 1 and 3 c. 2 and 3
b. 2 and 4 d. 1 and 4

 

 

ANS:  C

Pulse-demand oxygen-delivery systems deliver oxygen to the patient on demand only during inspiration. Oxygen is delivered to the patient only after a sufficient inspiratory effort is made and the demand valve opens. The demand valve closes during exhalation to conserve oxygen.

 

PTS:   1                    REF:   Page 96

 

  1. A simple mask can deliver what percentage of FIO2 at how many liters/minute?
a. 0.24 to 0.44 at 1-6 L/min c. 0.40 to 0.60 at 10-15 L/min
b. 0.35 to 0.50 at 5-10 L/min d. 0.50 to 0.80 at 5-10 L/min

 

 

ANS:  B

The simple mask can deliver a higher concentration than a nasal cannula because of the volume of the mask itself. That volume serves as an extension of the anatomic reservoir. The simple mask is generally said to be able to deliver 0.35 to 0.50 at oxygen flows of 5 to 10 L/min.

 

PTS:   1                    REF:   Page 93

 

  1. The FIO2 that is actually delivered to the patient through an oxygen mask depends on which of the following?
  2. Flow of the oxygen to the mask
  3. Presence of a reservoir bag
  4. Humidity of the gas
  5. Density of the gas
a. 1 and 2 c. 1 and 4
b. 2 and 3 d. 3 and 4

 

 

ANS:  A

The flow of oxygen to a reservoir mask determines the FIO2, as do the patient’s breathing pattern and the presence or absence of a reservoir bag. Those masks with a reservoir bag will have a higher FIO2 than those without a reservoir bag.

 

PTS:   1                    REF:   Pages 93-94

 

  1. Which of the following devices could cause CO2 retention?
  2. Simple mask
  3. Aerosol face mask
  4. Nonrebreathing mask
  5. Air-entrainment mask
a. 1 and 3 c. 2 and 3
b. 1 and 2 d. 3 and 4

 

 

ANS:  A

Carbon dioxide rebreathing can occur if the oxygen flow to a simple or nonrebreathing mask is not sufficient to wash out the patient’s exhaled gases. The flow of oxygen to a reservoir mask determines the FIO2, as do the patient’s breathing pattern and the presence or absence of a reservoir bag. Those masks with a reservoir bag will have a higher FIO2 than those without a reservoir bag.

 

PTS:   1                    REF:   Page 97

 

  1. In a typical adult partial rebreathing mask, the reservoir bag has an approximate volume capacity of _____ mL?
a. 150-300 c. 400-600
b. 300-500 d. 500-700

 

 

ANS:  B

A typical partial rebreathing mask has a reservoir bag with a volume capacity of 300 to 500 mL.

 

PTS:   1                    REF:   Page 97

 

  1. Which of the following O2 devices has 2 one-way valves and the second valve is at the exhalation ports, which prevents room air from entering the mask during inhalation?
a. Nonrebreathing mask c. Aerosol tracheostomy collar mask
b. Partial rebreathing mask d. Simple mask

 

 

ANS:  A

The first set of valves is a one-way valve located between the reservoir bag and the base of the mask. This valve allows gas flow to enter the mask from the reservoir bag when the patient inhales and prevents gas flow from the mask flowing back into the reservoir bag during the patient’s exhalation. The second set of valves is at the exhalation ports. The one-way valves placed there prevent room air from entering the mask during inhalation. They also allow the patient’s exhaled gases to exit the mask during exhalation.

 

PTS:   1                    REF:   Pages 97-98

 

  1. Theoretically, a nonrebreathing mask can deliver 100% oxygen, assuming that the mask fits appropriately on the patient’s face and is the only source of gas being inhaled by the patient. However, in actual practice, the disposable nonrebreathing mask can deliver what percentage of FIO2?
a. 0.30-0.50 c. 0.60-0.80
b. 0.40-0.60 d. 0.24-0.50

 

 

ANS:  C

The discrepancy between disposable nonrebreathing masks and the original Boothby-Lovelace-Bulbulian masks is primarily related to the fact that manufacturers usually supply disposable masks with one of the exhalation valves removed.

 

PTS:   1                    REF:   Page 98

 

  1. The concentration of oxygen delivered to the patient with an air-entrainment mask depends on which of the following?
  2. Flow of the oxygen exiting the jet nozzle
  3. Size of the jet nozzle outlet
  4. Size of the entrainment port
  5. Size of the Venturi mask
a. 1, 2, and 3 c. 1, 2, and 4
b. 2, 3, and 4 d. 3 and 4

 

 

ANS:  A

Oxygen flowing through the jet nozzle of an air-entrainment device “drags” in room air through the entrainment ports as a result of viscous, shearing forces between the gas exiting the jet nozzle outlet and the surrounding ambient air. The concentration of oxygen delivered to the patient, therefore, depends on the flow of oxygen exiting the jet nozzle, the size of the jet nozzle outlet, and the size of the entrainment ports.

 

PTS:   1                    REF:   Page 98

 

  1. The total flow for a 35% air-entrainment mask running at 10 L/min is _____ L/min.
a. 43 c. 60
b. 53 d. 65

 

 

ANS:  B

100% O2 – 35% FIO2 = 65%. 20% air – 35% FIO2 = 15. Ratio: 15:65 = 1:4.3. For every 1 L/min of O2, there is 4.3 L/min of air being entrained. 1 + 4.3 = 5.3 ´ 10 = 53 L/min total flow.

 

PTS:   1                    REF:   Page 99, Figure 4-21

 

  1. How many liters/minute of air is being entrained for a 35% air-entrainment mask running at 10 L/min?
a. 43 L/min c. 60 L/min
b. 53 L/min d. 65 L/min

 

 

ANS:  A

Refer to question 44. Air: 4.3 ´ 10 L/min = 43 L/min of air being entrained.

 

PTS:   1                    REF:   Page 99, Figure 4-21

 

  1. The oxygen/air ratio for the 35% air-entrainment mask is:
a. 1:4.3. c. 1:6.0.
b. 1:5.3. d. 1:6.5.

 

 

ANS:  A

Refer to question 44.

 

PTS:   1                    REF:   Page 99, Figure 4-21

 

  1. The total flow for a 50% air-entrainment mask running at 8 L/min is _____ L/min.
a. 18 c. 25
b. 22 d. 30

 

 

ANS:  B

100% O2 – 50% = 50%. 20% air – 50% FIO2 = 30. 30:50 = 1:1.7. For every 1 L/min of O2, there is 1.7 L/min of air being entrained. 1 + 1.7 = 2.7 ´ 8 = 21.6 L/min total flow.

 

PTS:   1                    REF:   Page 99, Figure 4-21

 

  1. How many liters/minute of air is being entrained for a 50% air-entrainment mask running at 8 L/min?
a. 10 c. 14
b. 12 d. 20

 

 

ANS:  C

Refer to question 47. 1.7 ´ 8 = 13.6 L/min of air being entrained.

 

PTS:   1                    REF:   Page 99, Figure 4-21

 

  1. A 22-year-old with asthma comes to the emergency department in respiratory distress. The patient has acute shortness of breath (SOB); is febrile, tachypneic, and tachycardic; and has an SpO2 of 88% on a nasal cannula that delivers 2 L/min. Which of the following actions should the respiratory therapist take at this time?
a. Teach the patient to breathe through pursed lips.
b. Place a simple mask on the patient.
c. Remove the cannula and place a 0.35 air-entrainment mask on the patient.
d. Place a high-flow cannula at 15 L/min on the patient.

 

 

ANS:  C

A patient with asthma benefits from a precise preset FIO2. With a simple mask, there is a greater likelihood of the patient retaining CO2, which is not helpful for those with asthma. Breathing through pursed lips is beneficial to people with asthma; however, it is not the first course of action. Finally, a high-flow cannula at 15 L/min is too much FIO2 for the patient at this time.

 

PTS:   1                    REF:   Page 98

 

  1. Which of the following O2 devices is appropriate for patients with chronic obstructive pulmonary disease who are hypoxemic?
a. Simple mask c. Partial rebreathing mask
b. Nasal cannula d. Air-entrainment mask

 

 

ANS:  D

Air-entrainment masks are excellent for providing oxygen therapy to hypoxemic patients with chronic obstructive pulmonary disease who typically require a fixed FIO2 between 0.24 and 0.35. The total flow of gas delivered (oxygen plus air) by such masks for lower FIO2 levels is usually sufficient to meet the peak inspiratory flow requirements for these patients.

 

PTS:   1                    REF:   Page 98

 

  1. With oxygen hoods, FIO2 must be measured by using what type of device?
a. Incubator c. Heater
b. Pulse oximeter d. Analyzer

 

 

ANS:  D

Oxygen hoods must be measured intermittently or monitored continuously with an oxygen analyzer.

 

PTS:   1                    REF:   Page 100

 

  1. Current incubators are designed to allow all of the following, except:
a. Variable control of environmental temperature
b. Variable control of environmental humidity
c. Control of FIO2 concentration
d. Control of barometric pressure

 

 

ANS:  D

The temperature and humidity of the gas within the incubator are regulated by a servo-controlled mechanism connected to a fan that circulates environmental gas over heating coils and a blow-by humidifier. Supplemental oxygen can be provided by connecting a heated humidifier directly to the incubator.

 

PTS:   1                    REF:   Page 100

 

  1. An oxygen _____ compresses air and oxygen from a high-pressure source into a chamber where the pressure of the two gases is equalized, usually at 50 psi.
a. blender c. hood
b. tent d. delivery devices

 

 

ANS:  A

An oxygen blender is attached to both a high-pressure compressed air source and a high-pressure oxygen source of equal pressure (approximately 50 psig).

 

PTS:   1                    REF:   Page 101

 

  1. It is important to filter the gas before it enters the blender housing; otherwise, a malfunction will occur. Which of the following can cause a malfunction?
  2. Moisture
  3. Particulate matter
  4. High amounts of FIO2
  5. Low amounts of FIO2
a. 1 and 3 c. 1 and 4
b. 1 and 2 d. 2 and 3

 

 

ANS:  B

Because moisture and particulate matter introduced into the blender by the source gases can cause the blender to malfunction, it is important to filter the gas before it enters the blender housing.

 

PTS:   1                    REF:   Pages 101-102

 

  1. _____ therapy exposes patients to a pressure greater than atmospheric pressure while they breathe 100% oxygen, either continuously or intermittently.
a. Aerosol oxygen c. Bronchial hygiene
b. Hyperbaric oxygen d. Nitric oxide

 

 

ANS:  B

Hyperbaric oxygen therapy exposes patients to a pressure greater than atmospheric pressure while they breathe 100% oxygen, either continuously or intermittently.

 

PTS:   1                    REF:   Page 102

 

  1. What types of patients are treated with hyperbaric oxygen therapy?
  2. Deep sea diving patients with decompression sickness
  3. Those with thermal injuries
  4. Patients with carbon monoxide poisoning
  5. Those with refractory osteomyelitis
a. 1, 2, and 3 c. 2, 3, and 4
b. 1, 2, and 4 d. 1, 2, 3, and 4

 

 

ANS:  D

Decompression sickness arises from the generation of nitrogen bubbles in the vascular system and tissues in volumes sufficient to interfere with the function of an organ. The cause of gas bubble formation is the rapid decompression during ascent from diving when the speed of decompression exceeds the ability of the gas-saturated tissues to vent the gases by simple diffusion. For this type of patient, hyperbaric oxygen will reduce the size of the bubbles. For thermal injuries, hyperbaric oxygen limits the progression of the burn injury, reduces swelling, and may reduce the need for surgical intervention. For CO poisoning, hyperbaric oxygen promotes the dissociation of carboxyhemoglobin more than just oxygen alone. For refractory osteomyelitis, hyperbaric oxygen provides periodic elevation of bone and tissue oxygen tension from hypoxic levels to normal or supranormal levels, which promotes collagen production by fibroblasts.

 

PTS:   1                    REF:   Page 105, Box 4-1

 

  1. Exposure to elevated barometric pressure during hyperbaric oxygen therapy can directly affect a number of physiologic parameters, including which of the following?
  2. Arterial and alveolar partial pressure for oxygen
  3. Temperature of the gases being breathed
  4. Work of breathing
  5. Lung volumes
a. 1 and 2 c. 2, 3, and 4
b. 1 and 4 d. 1, 2, 3, and 4

 

 

ANS:  D

The effect of increased ambient pressure on the partial pressure of alveolar oxygen (PAO2) can be explained by Dalton’s law, which states that the total pressure of a gas mixture, such as air, equals the sum of the partial pressures of each of the constituent gases in the mixture. According to Gay-Lussac’s law, if the volume of a gas remains constant, there is a direct relationship between the absolute pressure of a gas and its temperature. It is reasonable to suggest that if the volume of a hyperbaric chamber remains constant, then increasing the pressure would raise the temperature inside of the chamber.

 

PTS:   1                    REF:   Page 102

 

  1. ______ law states that if the temperature of a gas remains constant, the volume of a gas is inversely related to its pressure.
a. Henry’s c. Dalton’s
b. Boyle’s d. Laplace’s

 

 

ANS:  B

Boyle’s law states that if the temperature of a gas remains constant, the volume of a gas is inversely related to its pressure. Therefore, as pressure is exerted on a container, the gas volume within the container decreases.

 

PTS:   1                    REF:   Page 102

 

  1. Dalton’s law states that:
a. The total pressure of a gas mixture equals the sum of the partial pressure of each constituent gas in the mixture.
b. The pressure within a liquid sphere is influenced by the surface tension forces of the liquid and the size of the sphere.
c. There is a direct relationship between the absolute pressure of a gas and its temperature.
d. The volume of a gas is inversely related to its pressure.

 

 

ANS:  A

Dalton’s law states that the sum of the partial pressures of a gas mixture equals the total pressure of the system. Laplace’s law states that the pressure within a liquid sphere is influenced by the surface tension forces of the liquid and the size of the sphere. Gay-Lussac demonstrated that if the volume of a gas is held constant, the gas pressure rises as the absolute temperature of the gas increases. Boyle’s law states that when the temperature is held constant, the volume that a gas occupies is inversely proportional to the absolute pressure exerted on it.

 

PTS:   1                    REF:   Page 102

 

  1. A patient is receiving 0.30 FIO2 with a barometric pressure at 750 mm Hg. The partial pressure of carbon dioxide (PCO2) for this patient is 70 mm Hg; the partial pressure of arterial oxygen (PaO2) is 60 mm Hg. The PAO2 for this patient is _____ mm Hg.
a. 100.2 c. 160.0
b. 123.4 d. 181.7

 

 

ANS:  B

Formula: PAO2 = (Barometric pressure [PB] – pressure of water vapor [PH2O]) FIO2 – PaCO2 (1.25).

PAO2 = (750 mm Hg – 47) 0.30 – 70 (1.25).

PAO2 = 210.9 – 87.5.

PAO2 = 123.4 mm Hg.

 

PTS:   1                    REF:   Page 103

 

  1. A patient is receiving 0.60 FIO2 with a barometric pressure of 755 mm Hg. PCO2 is 56 mm Hg and PaO2 65 mm Hg. The PAO2 for this patient is _____ mm Hg.
a. 265.6 c. 354.8
b. 300.9 d. 404.0

 

 

ANS:  C

Formula: PAO2 = (PB – PH2O) FIO2 – PaCO2 (1.25).

PAO2 = (755 – 47) 0.60 – 56 (1.25).

PAO2 = 424.8 – 70.

PAO2 = 354.8 mm Hg.

 

PTS:   1                    REF:   Page 103

 

  1. A patient is receiving 0.80 FIO2 with a barometric pressure at 760 mm Hg. PCO2 is at 68; PaO2 is 55. The PAO2 for this patient is _____ mm Hg.
a. 395.6 c. 510.9
b. 485.4 d. 550.0

 

 

ANS:  B

Formula: PAO2 = (PB – PH2O) FIO2 – PaCO2 (1.25).

PAO2 = (760 – 47) 0.80 – 68 (1.25).

PAO2 = 570.4 – 85.

PAO2 = 485.4 mm Hg.

 

PTS:   1                    REF:   Page 103

 

  1. As the barometric pressure increases, there is an increase in the density of the gas being breathed. The increase in gas density in turn causes a(n):
a. Decrease in work of breathing c. Increase in work of breathing
b. Increase in FIO2 d. Decrease in FIO2

 

 

ANS:  C

The increase in gas density results in increased work of breathing, which is not noticeable and can easily be accommodated in healthy subjects. In patients with reduced lung reserves, however, this increased work can present problems and necessitate ventilatory support.

 

PTS:   1                    REF:   Page 103

 

  1. Intermittent air-breathing is used in hyperbaric chambers to prevent which of the following?
a. Hyperventilation c. Hypoventilation
b. Oxygen toxicity d. Hypertension

 

 

ANS:  B

Hyperbaric oxygenation is achieved by having the patient breathe oxygen by mask or through a specially designed hood while being exposed to elevated barometric pressures in the compressed-air chamber. Treatment schedules are tailored to the specific needs of the patient. Generally, patients are placed on schedules in which intermittent air-breathing periods of 5 minutes or more are programmed approximately every 20 minutes to prevent oxygen toxicity to the patient.

 

PTS:   1                    REF:   Page 102

 

  1. Which types of devices/techniques should be used to monitor the oxygenation status of patients undergoing hyperbaric oxygen therapy?
  2. Transcutaneous monitoring
  3. Arterial blood gas monitoring
  4. End-tidal CO2 monitoring
  5. Spirometer
a. 1 and 2 c. 2 and 3
b. 1 and 4 d. 3 and 4

 

 

ANS:  A

Transcutaneous monitoring has proven to be valuable in the assessment of the overall oxygenation status of a patient undergoing hyperbaric therapy. Arterial blood gas monitoring can provide information on the oxygenation status of patients receiving hyperbaric therapy and can also give an indication of their ventilatory status.

 

PTS:   1                    REF:   Page 104

 

  1. Contraindications for hyperbaric oxygen therapy consist of all of the following, except:
a. Pneumothorax c. Upper respiratory infection
b. Obstructive bronchial diseases d. Skin grafting

 

 

ANS:  D

If pneumothorax occurs during hyperbaric treatment, chest tubes should be immediately inserted; failure to treat pneumothorax can have dire consequences. Gas-trapping can result in barotraumas for those with obstructive bronchial diseases. Similarly, patients who have upper respiratory infections and nasal congestion are usually unable to clear their ears during compression and decompression and thus are prone to eardrum rupture during treatment.

 

PTS:   1                    REF:   Page 105, Box 4-2

 

  1. Which type of therapy has been used to successfully treat persistent pulmonary hypertension in newborns?
a. Helium-oxygen (heliox) c. Bronchial hygiene
b. Nitric oxide d. Carbon dioxide–nitrogen (carbogen)

 

 

ANS:  B

Nitric oxide has been shown to be a potent pulmonary vasodilator.

 

PTS:   1                    REF:   Page 105

 

  1. The therapeutic dose of nitric oxide is _____ ppm.
a. 2-80 c. 40-150
b. 25-115 d. 30-60

 

 

ANS:  A

The therapeutic dose of nitric oxide is 2 to 80 ppm.

 

PTS:   1                    REF:   Page 105

 

  1. Heliox has been used on a limited basis to treat patients with which of the following?
a. Hyperventilation c. Airway obstructions
b. Thermal burns d. Upper respiratory infections

 

 

ANS:  C

Specifically, heliox has been used to manage asthmatic patients with acute respiratory failure, to treat postextubation stridor in pediatric trauma patients, as an adjunct in the treatment of pediatric patients with refractory croup, to administer anesthetic gases to patients via small-diameter endotracheal tubes, and to provide ventilatory support for patients with severe airway obstruction caused by chronic bronchitis and emphysema.

 

PTS:   1                    REF:   Page 106

 

  1. An 18-year-old with severe asthma is brought into the emergency department on an nonrebreathing mask; he is in acute respiratory distress. He has been given multiple rounds of bronchodilators and corticosteroids and is still in distress, with an SpO2 of 85% on the nonrebreathing mask. What therapy should the respiratory care practitioner suggest to the physician at this time?
a. Nitric oxide therapy c. Carbogen therapy
b. Heliox therapy d. Hyperbaric therapy

 

 

ANS:  B

Heliox mixtures have been used on a limited basis to treat patients with airway obstruction, specifically in the management of asthmatic patients with acute respiratory failure.

 

PTS:   1                    REF:   Page 106

 

  1. A patient is placed on a 70:30 heliox mixture at a flow of 8 L/min. The actual flow rate going to the patient is ____ L/min.
a. 11.2 c. 14.4
b. 12.8 d. 16.2

 

 

ANS:  B

Conversion for 70:30 = 1.6 ´ 8 L/min = 12.8 L/min.

 

PTS:   1                    REF:   Page 107, Table 4-3

 

  1. A pediatric patient with refractory croup is placed on heliox 80:20 at a flow of 10 L/min. The actual flow going to the patient is _____ L/min.
a. 14 c. 18
b. 16 d. 20

 

 

ANS:  C

Conversion for 80:20 = 1.8 ´ 10 L/min = 18 L/min.

 

PTS:   1                    REF:   Page 107, Table 4-3

 

  1. The benefits of breathing heliox are related to its lower density in comparison with pure oxygen or air. The lower density does which of the following?
  2. Promotes laminar flow
  3. Increases the amount of turbulent flow
  4. Reduces the amount of turbulent flow
  5. Decreases the laminar flow
a. 1 and 2 c. 2 and 4
b. 1 and 3 d. 3 and 4

 

 

ANS:  B

This relationship is important to remember when administering heliox because the actual flow rate of gas delivered will be greater than the set flow.

 

PTS:   1                    REF:   Page 106

 

  1. What type of oxygen device is used to administer heliox to a non-intubated patient?
a. Nasal cannula c. Simple mask
b. High-flow cannula d. Nonrebreathing mask

 

 

ANS:  D

For non-intubated patients, a well-fitted nonrebreathing mask attached to a reservoir bag should be used. The flow rate of gas should be high enough to prevent the reservoir bag from collapsing during inspiration. Nasal cannulas are ineffective for delivering heliox because of leakage; instead, nonrebreathing masks are the most effective.

 

PTS:   1                    REF:   Page 106

 

  1. A 55-year-old man comes to the emergency department on a nonrebreathing mask with an SpO2 of 88%. The patient was found unconscious in a running car in the garage. Carbon monoxide poisoning is a concern at this time. What should the respiratory care practitioner recommend to the physician at this time?
a. Place a nasal cannula at 6 L/min on the patient.
b. Begin the patient on heliox therapy 80%:20%.
c. Place the patient on carbogen therapy 5%:95%.
d. Set the patient up on an air-entrainment device at 0.50 FIO2.

 

 

ANS:  C

Carbogen is used to treat hiccups and carbon monoxide poisoning; furthermore, it is used as a stimulant/depressant of ventilation and to prevent the complete washout of CO2 during cardiopulmonary bypass.

 

PTS:   1                    REF:   Page 107, Table 4-3

 

  1. To prevent an adverse reaction, it is essential to monitor which of the following when administering carbogen to a patient?
  2. Heart rate
  3. Blood pressure
  4. Respirations
  5. The patient’s mental status
a. 1, 2, and 3 c. 2, 3, and 4
b. 1, 2, and 4 d. 1, 2, 3, and 4

 

 

ANS:  D

Pulse, arterial blood pressure, and minute volume normally increase as the patient breathes carbogen, but the rapidity and level of these changes depend on the concentration of the mixture.

 

PTS:   1                    REF:   Page 107, Table 4-3

 

  1. According to the American Association for Respiratory Care (AARC) Clinical Practice Guideline (2002 Revision & Update), which of the following are considered precautions or complications of oxygen therapy?
  2. A PaO2 >60 mm Hg in spontaneously breathing patients with chronic PaCO2 levels
  3. With FIO2 >0.50 and the risk of oxygen toxicity or absorption atelectasis occurring
  4. During laser bronchoscopy and high levels of oxygen
  5. Acute myocardial infarction
a. 1, 2, and 4 c. 2, 3, and 4
b. 1, 2, and 3 d. 1, 2, 3, and 4

 

 

ANS:  B

See the AARC Clinical Practice Guideline: Oxygen Therapy for Adults in the Acute Care Facility—2002 Revision and Update, Clinical Practice Guideline 4-1.

 

PTS:   1                    REF:   Page 89, Clinical Practice Guideline 4-1

 

  1. All oxygen-delivery systems should be checked how often according to the AARC Clinical Practice Guideline (2002 Revision & Update)?
a. At least once a day c. Every 48 hours
b. Twice a week d. Once a month

 

 

ANS:  A

See the AARC Clinical Practice Guideline: Oxygen Therapy for Adults in the Acute Care Facility—2002 Revision and Update, Clinical Practice Guideline 4-1.

 

PTS:   1                    REF:   Page 89, Clinical Practice Guideline 4-1

 

  1. What criteria must a patient meet for home oxygen therapy, according to AARC Clinical Practice Guidelines (2002 Revision)?
  2. PaO2 <55 mm Hg
  3. SpO2 <88% room air at rest
  4. SpO2 <88% room air with exertion
  5. PaO2 >60 mm Hg
a. 1, 2, and 4 c. 1, 2, and 3
b. 2, 3, and 4 d. 2 and 3

 

 

ANS:  C

See the AARC Clinical Practice Guideline: Oxygen Therapy for Adults in the Acute Care Facility—2002 Revision and Update, Clinical Practice Guideline 4-1.

 

PTS:   1                    REF:   Page 89, Clinical Practice Guideline 4-1

 

  1. Retinopathy of prematurity often occurs in neonates because of which of the following?
a. Increased amounts of FIO2
b. Low amounts of FIO2
c. Improper placement of the oxygen-delivery device
d. Hyperventilation

 

 

ANS:  A

The origin of retinopathy of prematurity, especially with regard to the role of oxygen, is controversial. Nonetheless, care should be taken when supplemental oxygen is provided to preterm infants (<37 weeks’ gestation). It is suggested that oxygen supplementation should not result in a PaO2 >80 mm Hg.

 

PTS:   1                    REF:   Page 91, Clinical Practice Guideline 4-3

 

  1. For a neonate on an oxygen hood, where is the best placement of an oxygen analyzer to measure the correct FIO2?
a. Above the patient’s head c. On the side near either arm
b. At the nose and mouth d. The rear of the hood

 

 

ANS:  B

Neonates are obligate nose-breathers, so the mouth and nose are the most accurate location, because it is the area closest to the nares.

 

PTS:   1                    REF:   Page 93

 

  1. What is the percentage of FIO2 for a patient on 3 L/min delivered through a nasal cannula?
a. 32% c. 44%
b. 40% d. 50%

 

 

ANS:  A

3 L/min ´ 4 = 12 L/min + 20 = 32% FIO2. The flow is multiplied by 4 because for every 1 L/min of oxygen flowing to a nasal cannula the FIO2 increases by 4%. The 20 is the number that the flow multiplied by 4 is added to, in order to get the approximate FIO2.

 

PTS:   1                    REF:   Page 93, Table 4-1

 

  1. Which of the following are disadvantages of delivering oxygen by reservoir masks?
  2. Rebreathing CO2
  3. The patient cannot eat
  4. Increased risk of aspirations
  5. Claustrophobia/discomfort
a. 2, 3, and 3 c. 1, 3, and 4
b. 2, 3, and 4 d. 1, 2, 3, and 4

 

 

ANS:  D

Oxygen masks are confining and may not be well-tolerated by some patients. Furthermore, they must be removed during eating, drinking, and facial and airway care. Patients often report that these oxygen masks cause skin irritation, especially when they are tightly fitted. Finally, both aspiration of vomitus and rebreathing of CO2 are more likely when a mask is being used.

 

PTS:   1                    REF:   Pages 96-97

 

  1. Which of the following are advantages of nasal cannula use?
  2. They are cost-effective.
  3. They deliver precise FIO2.
  4. The patient can eat, speak, and drink with the cannula in place.
  5. Pressure necrosis will not occur.
a. 1 and 2 c. 2 and 3
b. 1 and 3 d. 3 and 4

 

 

ANS:  B

Nasal cannulas are inexpensive and allow the patient to eat, drink, and speak while receiving oxygen. Nasal cannulas cannot deliver precise oxygen concentrations, and pressure necrosis is possible because of the pressure points where the tubing holds the cannula in place touch the patient’s face and ears.

 

PTS:   1                    REF:   Page 97

 

  1. Which of the following are the potential harmful effects of excessive amounts of oxygen therapy?
  2. Persistent pulmonary hypertension
  3. Oxygen-induced hypoventilation
  4. Absorption atelectasis
  5. Retinopathy or prematurity
a. 1, 2, and 3 c. 2, 3, and 4
b. 1, 2, and 4 d. 1, 2, 3, and 4

 

 

ANS:  C

Oxygen is considered a type of medication. If exposed to large amounts of oxygen for a long period of time, a patient can experience lung damage because oxygen can be toxic if given in high doses.

 

PTS:   1

REF:   Page 89, Clinical Practice Guideline 4-1 | Page 91, Clinical Practice Guideline 4-3

 

  1. When a closed Thorpe tube flowmeter is attached to a 50-psi oxygen source, the indicator float jumps up then quickly falls to zero. This flowmeter is:
a. broken. c. compensated for back pressure.
b. a Bourdon gauge flowmeter. d. uncompensated for back pressure.

 

 

ANS:  C

A flowmeter can be determined to be pressure-compensated if the following test is performed: With the needle valve closed, the flowmeter is plugged into a high-pressure gas source. If the float in the indicator tube jumps and then falls to zero, the flowmeter is pressure-compensated. The float movement occurs because the source gas must pass through the indicator tube before it reaches the needle valve.

 

PTS:   1                    REF:   Page 86

 

  1. What type of oxygen-delivery device does the following image illustrate?

 

 

 

a. Simple mask c. Air-entrainment mask
b. Nonrebreathing mask d. Aerosol mask

 

 

ANS:  B

See also Figure 4-19.

 

PTS:   1                    REF:   Page 97

 

  1. What type of oxygen-delivery device does the following image illustrate?

 

 

a. Simple mask c. Air-entrainment mask
b. Nonrebreathing mask d. Partial rebreathing mask

 

 

ANS:  C

See Figure 4-20.

 

PTS:   1                    REF:   Page 98, Figure 4-20

 

  1. ______ law states that the degree to which a gas enters into a physical solution in body fluids is directly proportional to the partial pressure of gas to which the fluid is exposed?
a. Dalton’s c. Gay-Lussac’s
b. Henry’s d. Boyle’s

 

 

ANS:  B

Henry’s law is used to explain the changes in the PaO2 that occur with exposure to elevated ambient pressure. The law states that the degree to which a gas enters into physical solution in body fluids is directly proportional to the partial pressure of gas to which the fluid is exposed.

 

PTS:   1                    REF:   Page 103

 

  1. A 6-year-old patient with asthma has a sudden onset of SOB and wheezing. He presents to the emergency department with a heart rate of 82 beats/min, respiratory rate of 28 breaths/minute, and an SpO2 of 87% on room air. Which of the following actions should the respiratory care practitioner take at this time?
  2. Place the patient on oxygen therapy.
  3. Intubate the patient.
  4. Administer a bronchodilator.
  5. Administer nitric oxide therapy.
a. 1 and 3 c. 2 and 4
b. 1 and 4 d. 3 and 4

 

 

ANS:  A

Immediate relief for the patient at this time can be provided by a bronchodilator to help open up the airways and by oxygen to improve the patient’s oxygenation status. Intubation and nitric oxide therapy can both be administered to people with asthma; however, these approaches are taken when the others do not work for the patient and depend on the severity of the patient’s condition.

 

PTS:   1                    REF:   Page 89

 

  1. A 60-year-old man with a 90 pack-years smoking history arrives in the emergency department on a nonrebreathing mask with an SpO2 of 88%. The arterial blood gas results at this time indicate a pH of 7.38, PCO2 of 58, and partial pressure of oxygen (PO2) of 54. Which action should the respiratory therapist take at this time?
a. Keep the nonrebreathing mask on the patient.
b. Administer an 80:20 heliox concentration.
c. Place a nasal cannula set at 6 L/min.
d. Place an air-entrainment mask on the patient that delivers 0.40 FIO2.

 

 

ANS:  D

An air-entrainment device is the best delivery device for a patient with chronic obstructive pulmonary disease because of its ability to provide a precise FIO2. The other choices have a greater likelihood of causing CO2 retention and knocking out the patient’s hypoxic drive.

 

PTS:   1                    REF:   Page 98

 

  1. A home care patient calls to inform the respiratory therapist that his transtracheal catheter accidentally fell out last night and that he was unable to reinsert it. The patient should be told to:
a. insert a dilating or stenting device.
b. continue attempts to reinsert the catheter.
c. use a nasal cannula and call his physician as soon as possible.
d. use a nasal cannula until another transtracheal catheter is delivered to the home.

 

 

ANS:  D

Without the transtracheal catheter in place, this patient is not receiving any supplemental oxygen. To avoid hypoxemia, the patient must use a back-up delivery device. The most appropriate device in this situation would be a nasal cannula. The patient must call the physician for follow-up immediately.

 

PTS:   1                    REF:   Page 95

 

  1. The partial pressure of alveolar oxygen (PAO2) when the atmospheric pressure is 3 atmospheric pressure (atm), the PACO2 is 40 mm Hg, and the FIO2 is 0.80 is _____ mm Hg.
a. 2280 c. 1736
b. 1784 d. 1500

 

 

ANS:  C

PAO2 = (Pbar – PH2O) FIO2 – PaCO2 ÷ 0.8; Pbar = 3 atm ´ 760 = 2280 mm Hg.

PAO2 = (2280 – 47)0.8 – 40 ÷ 0.8.

PAO2 = 1786.4 – 50 = 1736.4 mm Hg.

 

PTS:   1                    REF:   Page 103

 

  1. A 45-year-old man had a deep sea diving accident recently and developed air emboli. Which type of therapy should the therapist recommend at this time?
a. Nitric oxide therapy c. Hyperbaric therapy
b. Heliox therapy d. Aerosol therapy

 

 

ANS:  C

Hyperbaric oxygen therapy exposes patients to a pressure greater than atmospheric pressure while they breathe 100% oxygen either continuously or intermittently. The effects on lung volume can be explained by Boyle’s law, which states that if the temperature of a gas remains constant, the volume of a gas is inversely related to its pressure. That is, as the pressure exerted on the container increase, the gas volume decreases. Thus when a person is exposed to elevated pressures, the gas volume contained in any body cavity tends to be compressed.

 

PTS:   1                    REF:   Page 105, Box 4-1

 

  1. A patient has a 0.40 air-entrainment mask on and is not tolerating it well at this time because of claustrophobia. A nasal cannula is placed on the patient. What liter flow should be set to match the appropriate FIO2?
a. 2 c. 4
b. 3 d. 5

 

 

ANS:  D

5 L/min ´ 4 = 20. 20 + 20 = 0.40 FIO2.

 

PTS:   1                    REF:   Page 98

 

  1. A patient is receiving supplemental oxygen via a 30% air-entrainment mask set at 8 L/min. The respiratory therapist must increase the supplemental oxygen to 40%. To maintain the same total output, the flow rate must be increased to _____ L/min.
a. 10 c. 16
b. 14 d. 18

 

 

ANS:  D

The output for the 30% air-entrainment mask set at 8 L/min is 72 L/min, because 30% has nine total parts multiplied by 8 L/min, which equals 72 L/min. The total output for 40% should, therefore, be 72 L/min. There are four total parts in 40% multiplied by an unknown flow that equals 72 L/min. 4X = 72. X is equal to 18 L/min.

 

PTS:   1                    REF:   Page 98

 

  1. A patient is receiving supplemental oxygen at a flow of 4 L/min. Assessment reveals that there is clouding of the mask. What step should be taken to resolve this situation?
a. Change to a nasal cannula at 2 L/min.
b. Increase the flow to 5 L/min.
c. Change to a 50% air-entrainment mask.
d. Increase the flow to 10% L/min.

 

 

ANS:  B

The clouding of the mask shows there is CO2 retention in the mask. The minimum flow for a simple mask is 5 L/min. The other options would result in significant changes in the delivered FIO2.

 

REF Page 4-21

 

PTS:   1                    REF:   Page 98

 

  1. A patient is being administered supplemental oxygen with a 40% air-entrainment mask being powered with a flow of 6 L/min. The manufacturer recommends a flow of 4 L/min. Which of the following will occur with this change?
  2. There will be an increase in the delivered FIO2.
  3. There will be an increase in the total flow.
  4. There will be a decrease in the total flow.
  5. There will be no change in the FIO2.
a. 1, 2 c. 3, 4
b. 2, 4 d. 1, 3

 

 

ANS:  B

The total flow from an air-entrainment mask will increase as the oxygen flow rate is increased. As long as the air:oxygen ratio is not changed, there will be no changes in the delivered FIO2.

 

REF Figure 4-21

 

PTS:   1                    REF:   Page 99

 

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