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This study guide contains several practice questions about Airway Management in Mechanical Ventilation.

So if that’s what you’re looking for, then you’ve come to the right place. It’s important to remember that as a Respiratory Therapist, ventilation and gas exchange are the most important things for us to keep in mind. And in order to maintain it properly, the patient must have a patent airway.

This is why this section is very important for Respiratory Therapy students. It’s critical that you know have to manage the patient’s airway properly, not only for your classes and for the board exams but also for in real-life situation when you start seeing patients on your own. So are you ready to dive in?

Airway Management Practice Questions:

1. When is an artificial airway required?
When the patient’s natural airway can no longer perform its proper functions.

2. What are the contraindications of an artificial airway?
When the patient desires to be a DNR or Do Not Resuscitate.

3. What are the possible complications of an artificial airway?
Trauma to the nose, mouth, tongue, pharynx, larynx, vocal cords, trachea, esophagus, spine, eyes and teeth. Aspiration or infection.

4. What does a pharyngeal airway do?
It prevents airway obstruction by keeping the tongue pulled forward and away from the posterior pharynx.

5. Do nasal pharyngeal airways always enter the trachea?
No

6. Which artificial airway is best for suctioning?
Nasal Pharyngeal Airway.

7. What artificial airway can be used as a bite block?
Oral Pharyngeal airway.

8. Which artificial airway is mainly used in emergency life support?
Pharyngeal airway.

9. What is an Endotracheal tube?
An artificial airway that is placed in the trachea in order to support mechanical ventilation.

10. What is intubation?
The process of placing an artificial airway into the trachea.

11. Do pharyngeal airways extend only into the pharynx?
Yes

12. What is orotracheal intubation?
When the tube passes through the mouth into the trachea, as opposed to being passed through the nose.

13. What is nasotracheal intubation?
When the ET tube passes through the nose into the trachea, as opposed to being passed through the mouth.

14. What are two types of tracheal airways?
Endotracheal tubes and Tracheostomy tubes.

15. Are tracheostomy tubes inserted surgically?
Yes

16. What is the purpose of the angle of the bevel on the ET tube?
It minimizes mucosal trauma during insertion.

17. What is the purpose of inflating the cuff of the ET tube?
It protects from aspiration and helps provide positive pressure ventilation.

18. What are the three areas of skill for Respiratory Therapists in airway management?
(1) Insert and maintain artificial airways. (2) Be proficient in airway clearance. (3) Assist physicians in performing procedures related to airway management.

19. What are the two categories of airways?
Pharyngeal airways and Tracheal airways

20. What are the two types of pharyngeal airways?
Oropharyngeal airways (OPA) and Nasopharyngeal airways (NPA)

21. What are Oropharyngeal airways made of?
Metal, plastic, or rubber

22. What are the indications of an oropharyngeal airway?
(1) Prevent airway obstruction by the tongue, (2) To be used as a bite block, (3) To increase the effectiveness of bag/mask ventilation.

23. What is a contraindication of an oropharyngeal airway?
A conscious patient with a gag reflex.

24. What are some complications of the oropharyngeal airway?
Laryngospasm/cough, vomiting/aspiration (do not tape in place), airway obstruction, lip or tongue damage, dental damage.

25. How is the oropharyngeal airway sized?
From the angle of the jaw to the corner of the mouth

26. What are the most common oropharyngeal airway sizes for the adult airway?
80 and 90

27. The nasopharyngeal airway (NPA) is also known as the?
Nasal trumpet

28. The nasopharyngeal airway is inserted where?
Into the nose and rests behind the tongue just above the epiglottis

29. What are the indications of the nasopharyngeal airway?
(1) increase effectiveness of bag/mask ventilation, (2) aid with suctioning and bronchoscopy, (3) management of facial anomalies, (4) eliminates the risk of oral damage.

30. What are the complications of using a nasopharyngeal airway?
Laryngospasm/cough, nosebleeds, sinus infections, damage to turbinates

31. The nasopharyngeal airway is tolerated best by a?
Conscious patient

32. What are the steps for placing a nasopharyngeal airway?
(1) Head tilt, (2) H2O soluble lube, (3) Slowly advance the airway, (4) It should rest above the epiglottis, (5) You can observe the correct placement with a tongue depressor.

33. What are some indications of tracheal intubation?
(1) To bypass an upper airway obstruction. (2) To protect the airway from aspiration. (3) To apply positive pressure ventilation. (4) To aid clearance of secretions. (5) To deliver high oxygen concentrations.

34. Can you instill drugs down an ET tube?
Yes; generally the dose is 2X the normal dose

35. What drugs can be instilled down the ET tube?
Remember NAVEL: Narcan, Atropine, Valium/Versed, Epinephrine, and Lidocaine

36. What are the advantages of oral intubation?
(1) Faster, easier, less traumatic, more comfortable. (2) Larger tubes can be tolerated. (3) Easier suctioning. (4) Less airflow resistance. (5) Decreased work of breathing. (6) Decreased risk of the tube kinking. (7) Avoids nasal and paranasal complications.

37. What are the disadvantages of oral intubation?
Greater risk of self-extubation, Greater risk of mainstem intubation, Risk of tube occlusion from biting, Risk of injury to the oral structures, Greater risk of retching, vomiting, and aspiration.

38. What is the preferred method of intubation during CPR?
Oral

39. How is the ET Tube size measured?
It’s measured in millimeters on the inside diameter.

40. What do the centimeter markings on the ET tube indicate?
They indicate the placement of the tube.

41. What is the purpose of using a stylet during intubation?
It gives the tube more rigidity.

42. What are the advantages of nasal intubation?
Greater comfort, less salivation, improved swallowing, more communication, no need for oral care, helps to avoid occlusion from biting, less damage to oral structures, better stabilization, reduced risk of mainstem intubation, does not require muscle relaxants or sedatives.

43. What are the disadvantages of nasal intubation?
Nasal/paranasal complications, It is more difficult to perform, Spontaneous breathing is required for the procedure, A smaller tube is necessary, Increased difficulty suctioning, Increased airflow resistance, Increased work of breathing, Difficulty passing the bronchoscope.

44. What is the name of the curved laryngoscope blade?
Macintosh

45. Would you want to use the Macintosh blade for neonates?
No

46. Where is the Macintosh blade designed to fit?
Into the vallecula so that it indirectly picks up the epiglottis

47. What is the name of the straight laryngoscope blade?
Miller

48. Where is the Miller blade designed to fit?
Into the epiglottis.

49. Which laryngoscope blade is best for neonates?
Miller (straight blade)

50. What is the purpose of the Murphey’s eye?
It allows for collateral ventilation.

51. What are the supplies needed for oral intubation?
Oxygen flowmeter and tubing, manual resuscitator, suction setup, oropharyngeal airway, laryngoscope, endotracheal tubes, stylet, stethoscope, tape, 10 cc syringe, towels for positioning, gloves, gowns, masks, eyewear, CO2 detector.

52. Where should the tip of the endotracheal tube rest?
It should rest 2 – 4 cm above the carina.

53. What should the tube depth of the ET tube be for the adults?
21 – 23 cm at the lip

54. How long should you hyperinflate and hyperoxygenate the patient for the oral intubation procedure?
2 to 3 minutes

55. What is an extra piece of equipment you may need for nasal intubation?
Magill forceps for direct visualization only.

56. What position should the patient be in for nasal intubation?
Direct – supine blind (fowlers position)

57. How do you confirm placement of the airway?
Auscultation, observation of chest movement, PetCO2, Esophageal detection device, light wand, fiberoptic laryngoscopy, CO2 detector.

58. What is the most accurate way to confirm placement after intubation?
Fiberoptic laryngoscopy

59. Should you use a chest x-ray to confirm tube placement after an intubation?
No, it should only be used to determine the position of the tube.

60. When should you consider a tracheostomy?
When the ET tube will be inserted for longer than 7 days.

61. What are the indications of a tracheotomy?
Prolonged intubation to overcome upper airway obstruction trauma/surgery

62. What are the advantages of the tracheotomy?
More comfortable, less tube movement, better communication, lower airway resistance, easier suctioning, easier to replace than an ET tube.

63. What are the disadvantages of the tracheotomy?
Requires a surgical procedure, hemorrhage, possible subcutaneous emphysema, possible pneumothorax, possible pneumomediastinum, leaves a permanent scar.

64. When is an uncuffed tracheostomy tube used?
When there is no major concern about aspiration or being able to protect the airway.

65. What is the fenestrated tracheostomy tube?
It can help facilitate speech, it can be cuffed or uncuffed, the inner cannula must also be fenestrated.

66. What are the complications of intubation post-extubation?
Sore throat, stridor, odynophagia, pulmonary aspiration, poor cough.

67. What is the number one complication post-extubation?
Hoarseness

68. How do you prevent airway trauma?
Use sedation when necessary. Use nasal tubes vs. oral tubes when possible. Use correct sizing tubes. Avoid changing tubes. Avoid unnecessary coughing or efforts to talk. Limit cuff pressure.

69. What is the process of airway maintenance?
(1) Securing the tube and maintain proper placement. (2) Provide cuff care. (3) Aid secretion clearance. (4) Ensure humidification. (5) Minimize the possibility of infection. (6) Provide for patient communication. (7) Troubleshoot emergencies.

70. What do you need in order to secure the ET tube?
Tape, Velcro attachments, harness, bite block.

71. What do you need in order to secure the tracheostomy?
Velcro attachments, ties.

72. You should always record what values for positioning on the ET tube?
Size of the tube and positioning in cm

73. Unplanned extubations occur in what percentage of intubated patients?
It occurs in 2 – 13% of patients. The #1 contributing factor is a lack of secure placement.

74. What is the ideal method for securing an ET tube?
It allows minimal tube movement, is comfortable for the patient, allows for oral hygiene, preserves skin integrity, easy to apply, requires minimal maintenance.

75. When maintaining cuff pressure, it is important to?
Keep the cuff pressure below tracheal capillary perfusion pressure.

76. What is the normal cuff pressure range?
20 – 30 cmH2O

77. How can you measure cuff pressure?
If you have not got a pressure manometer you can use the minimal leak technique or minimal occluding volume technique to inflate the cuff.

78. What are some emergency airway situations?
Tube obstruction, cuff leak, accidental extubation.

79. What are examples of a tube obstruction?
Kinking or biting, herniation of the cuff over the tube, jamming the of tube opening against the tracheal wall, mucus plugging.

80. What are clinical signs of an airway emergency?
Various degrees of respiratory distress. Changes in breath sounds. Air movement through the mouth.

81. How do you fix kinking of the ET Tube?
Reposition the head/neck

82. How do you fix biting of the ET Tube?
Use an oropharyngeal airway or bite block

83. What should you do in the case of a herniated cuff?
Deflate/re-inflate, then try to pass a suction catheter to determine if cuff is herniated.

84. What should you do in the case of the tip of the tube is on the tracheal wall?
Reposition the airway and head/neck

85. What should you do if there is a mucus plug?
Lavage, try to pass a suction catheter, then resort to extubation.

86. What should you always do prior to extubation?
Suction the patient

87. What is extubation?
The removal of the endotracheal tube.

88. What are some indications for extubation?
The patient can: Keep their upper airway patent. Protect their lower airway from aspiration. Clear secretions from their lower respiratory tract. Breathe without mechanical ventilation.

89. What are the percentages of extubation failures?
5-15% of cases are failures.

90. A practitioner who extubates should also be able to do which of the following?
Intubate

91. What can be used to maintain a trach stoma?
A tracheal button

92. How is the Laryngeal mask airway (LMA) inserted?
Blind

93. How is the Esophageal obturator (EOA) inserted?
It is inserted into the esophagus and mainly is used by EMTs. It is difficult to obtain proper mask fit and ventilation. You should always intubate prior to removal of an EOA.

94. How does the ET tube exchanger work?
It is inserted through the ET tube. Then the ET tube is withdrawn and removed. A new ET tube can be slipped over the tube exchanger and threaded down into the proper location.

95. What are the supplies needed for tracheostomy care?
Suction supplies, oxygen therapy, hydrogen peroxide, sterile dressings and ties, sterile water, new inner cannula or supplies to clean the reusable one.

96. What can you give to reduce inflammation post-extubation?
Decadron

97. What should the patient’s FiO2 be in order to process with extubation?
40% or less

98. What are the 6 aspects of airway maintenance?
(1) Natural airway. (2) Artificial Airways. (3) General consideration of airways. (4) Nasal and oral (pharyngeal airways). (5) Tracheostomy. (6) Airway clearance.

99. What are the causes/types of obstructions in a natural airway?
(1) soft/tissues (tongue) obstruction. (2) Foreign body. (3) Supra-glottic, sub-glottic swelling/edema. (4) Very thick secretions. (often described as inspissated).

100. What are the signs of a complete obstruction in a natural airway?
(1) Paradoxical chest movement. (2) Inability to vocalize and no air movement sound at all. (3) Marked use of accessory muscles. (4) Marked nasal flaring, retractions etc. (5) Severe/marked anxiety, agitation.

101. How do you establish patency in a natural airway?
(1) Modified Jaw thrust. (2) Head-tilt/chin-lift.

102. What is the modified jaw thrust?
It is modified to avoid head-extension and is good for suspected neck trauma patients. It is done by pushing the mandibular process to extend the jaw and open the airway.

103. How do you perform the head-tilt/chin-lift maneuver?
It is done by lifting up on the front edge of the jaw with one hand while pushing the forehead upward. You should not use this when there is a suspecting neck fracture (no hyperextension of the head).

104. What is the procedure for an extubation?
(1) Clear the airway by suctioning below and above the airway. (2) Explain the procedure to the patient. (3) Remove the air from the cuff. (4) Have the patient inhale and hold. Remove the tube while the patient is holding maximum inspiration. (5) Instruct the patient to cough and expectorate. You can facilitate with a suction device if needed.

105. What is the purpose of suctioning while an artificial airway is in place?
To remove secretions, promote expectoration of secretions (cough), or to collect a specimen.

106. What is the suctioning procedure while an artificial airway is in place?
Pre-oxygenate the patient with 100% oxygen before and after suctioning for 1 – 3 minutes. The procedure should be sterile. Suction no longer than 15 seconds. Stop suctioning if any signs of distress become present.

107. What are hazards of suctioning during an artificial airway?
Bleeding/trauma to the mucosa, so be gentle and use lubricant. Cardiac changes can occur due to vagal reflex (bradycardia) and hypotension from vagal nerve stimulation. Tachycardia due to hypoxemia. Use sterile technique.

108. How do we determine the size of an oropharyngeal airway?
The length should be equal to the distance from the angle of the jaw to the tip of chin to past corner of the mouth.

109. How do we determine the size of a nasopharyngeal airway?
The outside diameter of airway should be equal to the inside diameter of the patient’s external nares. The length of the airway is from tip of the earlobe to center of nostrils.

110. How do you insert a nasopharyngeal airway?
It should be inserted opposite of its anatomic shape (upside down) to the back of the throat and then rotate into its correct position.

110. How do you insert an oropharyngeal airway?
It should be inserted the way it’s anatomically shaped using a water-soluble lubricant.

111. What is the Minimal Occluding Volume (MOV)?
A technique used to inflate the cuff to 20 – 25 mmHg/25 – 30 cmH20. Listen for an air leak as the cuff is inflated during positive pressure ventilation. Stop inflating at the minimum volume necessary to eliminate air leak via tracheostomy or ET Tube.

112. What is the Minimal Leak Technique (MLT)?
Slowly inject air into the cuff during positive pressure inspiration until the leak stops. A small amount of air is removed to allow a slight leak during peak inspiration. Remove the small amount to prevent aspiration.

113. How do you troubleshoot a laryngoscope?
If the light doesn’t work, tighten bulb, check the handle attachment, change the blade, or change the batteries.

114. What are the normal blade sizes?
Adult: Size 3, Pediatric Size: 2, Term Infant: Size 1, Pre-Term: Size 0.

115. Describe a stylet?
It is used to aid in oral intubations only. It shapes the tube for easier insertion. The end is to be recessed 1 cm above ET tube.

116. Describe Magill forceps?
They are used to aid in a nasal intubation. They are inserted in the mouth to lift the tube into the trachea.

117. What are the normal ET tube markings?
For an oral Intubation: 21 – 25 cm mark at the lip. For a nasal Intubation: 26 – 29 cm mark at the nares.

118. What is the Double Lumen Tube (Carlen’s Tube)?
An ET tube with two independent lumens of different lengths. The longer tube is inserted in either the left or right mainstem bronchus. The shorter tube is placed in the trachea above the carina. Each Lumen can ventilate one lung separately or they can be connected via wye and share the ventilation source.

119. What is the Laryngeal Mask Airway (LMA)?
It is positioned directly over the opening into the trachea (hypopharynx). You can even intubate through the LMA. Do not remove the LMA until the patient is intubated.

120. Identify three methods to determine the correct position of an ET tube?
(1) Inspection – look for bilateral chest expansion during inspiration. (2) Auscultation of the patient’s breath sounds. They should be heard on both sides of the chest. (3) Chest X-ray – the radiopaque line on the endotracheal tube can be easily visualized to assess tube placement.

121. How can a respiratory therapist maintain airway patency?
Suctioning

122. Name two types of Laryngoscope blades commonly used to intubate adult patients and describe how each is used?
For the laryngoscope handle, always hold in left hand, check the battery for light source. For a curved/Macintosh blade, it fits into vallecula and indirectly raises the epiglottis. For the straight/Miller blade, it fits directly under the epiglottis and is the preferred blade for infant intubations.

123. What steps should the respiratory therapist take if the light on the Laryngoscope blade does not work?
Tighten the bulb, Check the handle attachment, Change the blades, Check the Batteries.

124. What size laryngoscope blade commonly used for an adult patient?
Size 3

125. What size laryngoscope blade is commonly used for a term infant?
Size 1

126. What is the approximate endotracheal tube sizes for a pre-term infant?
2.5 – 3.0 mm

127. What is the approximate endotracheal tube sizes for a full-term infant?
3.0 – 3.5 mm

128. What is the appropriate endotracheal tube sizes for adult males and females?
Males: 8.0 to 9.0mm; Females: 7.0 to 8.0 mm.

129. A patient receiving mechanical ventilation is being transported to radiology for a CT scan. The respiratory therapist is arranging equipment when the low volume alarm begins to sound. She also notes that the oral endotracheal tube is taped at the 28 cm mark. Where should the tube actually be located?
Between 21 cm – 25 cm

130. Why should the ET tube be removed at peak inspiration?
To prevent vocal cord damage

131. What should you do if the patient self-extubates?
Alert the physician. Re-intubate the patient.

132. Identify a possible complication of extubation and how to manage it?
For mild distress/stridor and a sore throat, you should provide humidity, oxygen and/or racemic epinephrine as necessary.

133. Tracheostomy is preferred over endotracheal tube intubation in what instance?
It is the preferred method of providing an airway for patients who require long-term ventilation.

134. List two possible immediate complications of the tracheostomy procedure?
Bleeding is a major hazard, and you also have to watch for a Pneumothorax.

135. List two possible late complications of the tracheostomy procedure?
Infection and Hemorrhage

136. Under what circumstances should the tracheostomy tube cuff be inflated?
If should be inflated if the patient is eating, or if they are on positive pressure ventilation.

137. What does it mean if the therapist recommends a fenestrated tracheostomy tube?
It is used for weaning and temporary mechanical ventilation with an inner cannula.

138. Briefly, describe the features of a standard tracheostomy tube?
It’s often white and made of plastic. It may have an inner cannula for easy cleaning. Also, it has a soft cuff.

139. When using a tracheal speaking valve, the tracheostomy tube cuff must be?
The cuff must be deflated.

140. The most commonly used airway for ventilating a patient with a manual resuscitator is:
a. Nasopharyngeal airway
b. Oropharyngeal airway
c. Nasal trumpet
d. Tracheostomy tube

141. A nasopharyngeal airway is also commonly called a?
Nasal Trumpet

142. What does LMA stand for?
a. Laryngoscopic manual airway
b. Loss of major airway
c. Laryngeal mask airway
d. Laryngeal manual airway

142. Oropharyngeal airways are indicated for ______________ patients.
Unconscious

143. Can incorrect placement of an oropharyngeal airway (OPA) push the tongue further back into the pharynx worsening the obstruction?
Why yes, yes it can.

144. When encountering resistance upon insertion of a nasopharyngeal airway (NPA) in the right nare, you should:
a. Lubricate the airway with lots of petroleum jelly and try again
b. Try the left nare
c. Twist and push harder
d. Ask the nurse to do it

145. The most common airway maneuver used to ventilate an apneic patient during CPR is which of the following?
a. Triple airway maneuver
b. Jaw thrust
c. Head-tilt/chin-lift
d. Heimlich maneuver

146. What is the proper way to estimate the appropriate length of a nasal airway?
Measure from the patient’s earlobe to the tip of the nose

147. When is the jaw thrust technique indicated to help maintain an open airway?
a. When foreign body obstruction is present
b. After trauma to the head
c. In cases of suspected neck injury
d. During most CPR efforts

148. Should a laryngeal mask airway be used for short-term ventilation of an unconscious patient?
Yes, yes it should.

149. An unconscious patient begins gagging during your attempt to insert an oropharyngeal airway. The correct action to take at this time would be to:
Insert a nasal airway

150. Which of the following is a hazard of the insertion of an oropharyngeal airway?
a. Nosebleed
b. Vomiting
c. Pain upon insertion
d. Increased airway resistance

151. What is the position of a correctly sized properly inserted oropharyngeal airway?
The distal tip should be at the base of tongue, the flange should be outside the teeth.

152. What is a tracheotomy?
It’s an incision into the trachea and the procedure for establishing access to the trachea.

153. What is a stoma?
It’s a hole in the trachea without the tube in place.

154. What are some complications of a tracheostomy?
Bleeding, pneumothorax, air embolism, and subcutaneous emphysema. Some late complications: infection, hemorrhage, tracheal stenosis.

155. What is a Passy-Muir speaking valve?
It’s a one-way valve that attaches to the 15 mm adaptor and allows for speech and secretion management. It allows air to enter only during inspiration. The blue-colored ones are used with ventilators. The white ones are for spontaneously breathing patients.

156. What is the tracheostomy button used for?
It’s used to aid in weaning from the trach tube. It keeps the stoma open. It extends from the skin to just inside of the tracheal wall.

157. What does the tracheostomy button look like?
It’s a short, soft hollow tube which fits in stoma in place of the tracheostomy tube.

158. When will you need to do a tracheostomy change out?
When the patient needs a new one, when the patient’s condition is unstable, when there is edema around the site that may make change difficult.

159. What are the methods for weaning from tracheostomy tube?
Tracheostomy buttons, fenestrated tubes, progressively smaller tracheostomy tubes.

160. What is the laryngeal mask airway?
A hollow tube with a spoon shaped mask. The mask has a cuff attached to the end of it, which inflates to permit the area around the tracheal glottis and epiglottis to be sealed. It sits on the esophageal sphincter.

161. What is the biggest problem with an LMA?
Regurgitation during insertion

162. What is one the most common causes of airway obstruction?
Tube obstruction

163. How do you know there is an obstruction in the tune?
Peak airway pressure on ventilator increase.

164. When will you need to remove the entire airway and replace it?
If all the other methods are not working.

165. Which airway is preferred during an emergency?
Oral

166. Why would a tracheostomy be preferred?
Stability, long-term ventilation greater than 7 days

167. What are some complications for a tracheostomy?
Infection, pneumothorax, bleeding, granuloma, hemorrhage.

168. What should you do when weaning a tracheostomy patient?
Remove the inner cannula, deflate the cuff, and cap the tracheostomy.

Final Thoughts

So there you have it! That wraps up our study guide for Airway Management. I hope these practice questions were helpful to you. No matter where you are in your journey to becoming a Respiratory Therapist, whether still in school or already preparing to the TMC Exam, if you learned this study guide, it will help you tremendously. Thanks again and I will see you in the next post. Be sure to check out our recommended reading below.

If you want an even more detailed review of Airway Management in Mechanical Ventilation, especially focused on what you MUST know for the TMC Exam, be sure to check out our fully comprehensive TMC Study Guide. It covers everything you need to know, from top to bottom, in order to pass the TMC Exam.