Mechanical Ventilation Chapter 50 & 51 Practice Questions:

 

1. Know what patients with chronic pulmonary disorders have difficulty with coping with: They have difficulty coping with the physiologic limitations of their diseases, and these physiologic limitations may lead to psychosocial problems.

2. Know the definition of rehabilitation: The restoration of the individual to the fullest medical, mental, emotional, social, and vocational potential of which he or she is capable.

3. Know the overall and general goals of pulmonary rehabilitation: to control and alleviate symptoms, restore functional capabilities as much as possible, and improve the quality of life.

4. Know how a patient accomplishes physical reconditioning: Physical Reconditioning involves strengthening essential muscle groups, improving overall O2 use, and enhancing the body’s cardiovascular response to physical activity.

5. Know the common goals for pulmonary rehabilitation programs: to improve functionality for the patient’s activities of daily living.

6. Know what the first step is in evaluating patients for a pulmonary rehabilitation program: Complete Patient History

7. A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following test regimens would you recommend in order to ascertain the patient’s cardiopulmonary status? I. Cardiopulmonary exercise evaluation, II. Pulmonary function testing

8. Know which pulmonary function tests would be performed in the preliminary evaluation: Pulmonary function testing includes assessment of pulmonary ventilation, lung volume determinations, diffusing capacity (DLCO), and spirometry before and after bronchodilator use.

9. A cardiopulmonary exercise evaluation is conducted on a patient before participation in pulmonary rehabilitation for what purpose? 1. to quantify the patient’s baseline exercise capacity, 2. to develop an exercise prescription (including target heart rate), 3. to determine how much desaturation occurs with exercise

10. What are some relative contraindications for cardiopulmonary exercise testing? I. Severe pulmonary hypertension or cor pulmonale, II. Known electrolyte disturbances (e.g., hypokalemia), III. SaO2 or SpO2 less than 85% breathing room air IV. Untreated or unstable asthma

11. Which of the following patients are NOT good candidates for pulmonary rehabilitation? I. Unstable cardiovascular patients who require monitoring. III. Patients with malignant neoplasms involving the lungs.

12. To increase the likelihood that positive patient results are lasting, what must pulmonary rehabilitation programs provide?: Periodic follow-up and reinforcement

13. Know what are the four components of physical reconditioning: 1. Cardio (ie. timed walking), 2. Lower Extremity circuit training, 3. Upper Extremity circuit training, 4. Ventilatory muscle training

14. Which of the following exercises are useful for reconditioning the lower extremities of patients undergoing pulmonary rehabilitation? I. Walking on a flat surface for a specified period of time. II. Walking on a treadmill for a specified distance or time. III. Pedaling a stationary bicycle for a specified distance.

15. Know how a flow-resistive breathing device works: Performing a NIF on the patient will help give you an idea of where they should start with resistance. Using the device: patient breaths slowly through it (10-12 BPM), Inspiratory pressure should be less than 30% (more negative) on their NIF, otherwise, change resistance. What is true about the flow-resistor breathing exerciser? Exhaled gas flows unimpeded out a one-way valve, Resistance is created by a variable-size orifice.

16. Know which type of health care professional would have a session on relaxation and stress management: clinical psychologist

17. Know which type of health care professional would have a session on recreation and vocational counseling: occupational therapist

18. What topics would be covered in a rehabilitation education session on respiratory home care?: self-administration of therapy, care of home equipment, safe use of home care equipment

19. What is the ideal class size for a pulmonary rehabilitation program?: 3-10

20. Know the advantages of having a manageable class size for a pulmonary rehabilitation program: Keeping the class size manageable facilitates vital group interaction processes and allows for more individualized attention. The factors help sustain motivation, reducing the likelihood of participant attrition.

21. Know what emergency equipment is needed in a pulmonary rehabilitation center: To deal with incidents of hypoxemia, dyspnea, or airway hyperreactivity during physical reconditioning activities, which of the following should be available in the rehabilitation area?: II. Bronchodilator agents, III. Emergency oxygen.

22. Minimum equipment requirements for the physical reconditioning component of a pulmonary rehabilitation program include which of the following? I. Inspiratory resistive breathing devices. II. Rowing machines or upper extremity ergometers. III. Pulse oximeters (for pulse rate/SaO2). IV. Stationary bicycles.

23. Which of the following are differences between cardiac and pulmonary rehabilitation? I. Cardiac patients are typically younger. III. Reimbursement is easier to obtain with cardiac rehabilitation. IV. Breathing exercises are not essential to cardiac patients.

24. Know what clinician(s) are involved in the cardiac rehabilitation program facilitation and administration: I. Nurse Specialist, II. Cardiologist.

25. What is the level of involvement of the respiratory therapist in cardiac rehabilitation?: Significantly less than in pulmonary rehabilitation

26. Which of the following is NOT a factor affecting the cost of a pulmonary rehabilitation program? Patient health insurance

27. What educational topics covered in a typical pulmonary rehabilitation program are most suitable for presentation by an RCP?: methods of relaxation and stress management, recreation and vocational counseling, diaphragmatic and pursed-lip breathing techniques, respirator structure, function, and disease.

28. Post-acute care settings do NOT include what?: Trauma Centers

29. What patients are better suited for subacute rather than for acute care? Those who have a determined course of treatment, and Those who are recovering from an acute illness.

30. Know where is the majority of post-acute respiratory care provided: The Home



31. Know what are the goals of respiratory home care: Improving patients’ physical and social well-being, Ensuring cost-effective delivery of care, Supporting and maintaining patients’ lives, Promoting patient and family self-sufficiency.

32. Know where do the standards for the delivery of subacute and home health care derive from: State licensing laws, Private sector standards, Federal regulations

33. Know what agency is responsible for voluntary accreditation of post-acute care providers: JCAHO

34. What is NOT normally included as part of a good discharge plan?: confirming or securing financial resources

35. What is NOT normally part of the respiratory home care team?: Pulmonary function testing

36. Know who is responsible for establishing therapeutic objectives for home care: Physician

37. Know who is responsible for providing home care equipment and supplies: DME supplier of home care company

38. Know what home care services do durable medical equipment (DME) companies provide: DME companies usually provide what respiratory home care services?: 3rd party insurance processing –most respiratory care modalities –24/7 service –home instruction and follow-up

39. Know what is the most common respiratory home care modality: O2 Therapy

40. Know what are the acceptable indicators of hypoxemia for purposes of justifying home O2 therapy: resting PaO2 of 65mm Hg on room air, drop in SaO2 below 89% during ambulation, resting arterial SaO2 below 88% on room air

41. Know what are the physical hazards associated with home O2 therapy equipment: Gaseous explosions

42. When should an ABG be repeated to determine the need for long-term home O2 therapy: 1-3 months after initiation

43. Know what are the acceptable methods of documenting the presence of hypoxemia in patients being considered for home O2 therapy: blood gas analysis & pulse oximetry

44. Know if home O2 therapy can be ordered as needed (PRN): No, PRN O2 therapy is unacceptable

45. In addition to specifying the liter flow or concentration, what must a physician include in a home O2 prescription? appropriate medical dx, lab evidence of hypoxemia, frequency of use of O2, duration of need for O2.

46. Know what type of systems home O2 can be supplied by: liquid O2 systems, O2 concentrators

47. Know the advantages and disadvantages of using compressed O2 cylinders, liquid O2, O2 concentrators: each modality is better in different situations.

48. Know what are the primary uses of compressed O2 cylinders in alternative settings: Ambulation, Backup supply

49. Know what solution you would recommend to fill a bubble humidifier used for home O2 therapy: Distilled Water

50. Know what one cubic foot (1 cu/ft.) of liquid O2 would equal how many cu/ft. of gaseous O2: 860.0

51. Know what is the temperature of O2 in the inner reservoir of a home liquid O2 system: -300 degrees F

52. Know what 1 lb. of stored liquid O2 would equal how many liters of gaseous O2 at the normal liquid cylinder operating pressure: 344.0

53. Know what is the purpose of the small refillable liquid O2 tank that is included with the stationary home liquid O2 reservoir: Provide O2 to ambulatory patients outside the home

54. When visiting a home care patient receiving nasal O2 at 2LPM through an O2 concentrator, you measure the FiO2 of the outlet gas as 0.63. What does this finding mean?: The sieve pellets are exhausted

55. Know what other safety measures would you take other than providing a backup tank for a home O2 therapy patient who uses a concentrator: Notify the power company that life support equipment is in use

56. Know what is the most common O2 delivery system for long-term care: Nasal cannula

57. Know what are some examples of oxygen-conserving delivery systems: trans-tracheal catheter, reservoir cannula or pendant, pulse dose

58. Know what are the indications for using a trans-tracheal oxygen therapy: (1) cannot be adequately oxygenated with standard approaches, (2) do not comply well when using other devices, (3) exhibit complications from nasal cannula use, (4) prefer TTOT for cosmetic reasons, and (5) have need for increased mobility.

59. Know what type of patients are good candidates for home mechanical ventilation: The patient must be medically stable, have a secure artificial airway, be adequately oxygenated at less than an FIO2 40%, and be able to maintain adequate ventilation on standard ventilator settings.

60. Know what type of ventilation strategy would you recommend for a patient with a tracheotomy who requires home ventilatory support: Positive-pressure ventilation

61. Know who can provide routine tracheostomy care for a home care patient: I. Respiratory care practitioner, II. Trained family member, III. Visiting nurse.

62. Know what evidence would support Medicare reimbursement for adult nasal CPAP equipment to treat sleep apnea: Polysomnograph confirming sleep apnea

63. Know what are the basic principles of infection control in the home care setting: 1) proper handwashing technique by all caregivers, 2) discouraging visits to the patient from friends or relatives with respiratory infections, 3) proper cleaning and disinfection of all permanent equipment, 4) NOT recycling disposable or single-patient use equipment on multiple patients.

64. What should be monitored during a cardiopulmonary exercise evaluation? RR, HbO2, ECG, and BP

65. What exercises are useful for reconditioning the upper extremities of patients undergoing pulmonary rehabilitation?: Rowing machine, Arm ergometer, Free hand weights