1. Prior to intubation in an emergency, injection of air into the pilot line fails to inflate the cuff. You should
A. check the cuff for leaks
B. check the valve on the pilot line
C. replace the endotracheal tube
D. inspect the pilot line for patency
A cuff that fails to inflate when injected with air has a large leak. The faulty ET tube should be replaced and the new tube tested in the same manner.
The correct answer is: replace the endotracheal tube
2. A 15-year-old with cystic fibrosis is receiving pressure control SIMV with pressure support due to a severe bilateral pneumonia. The pulmonologist asks you to administer aerosolized dornase alfa (Pulmozyme, DNase) in-line with the ventilator. Which of these devices would you select to administer this therapy?
A. dry powder inhaler (DPI)
B. vibrating mesh nebulizer
C. metered dose inhaler (MPI)
D. small volume nebulizer
Pulmozyme is available only as a liquid (ampule) preparation for single use and thus cannot be administered by either MDI or DPI. Pulmozyme normally is administered by FDA-approved jet nebulizers. However, in-line jet nebulization during mechanical ventilation can alter ventilator response (especially with spontaneous breathing) and cause inaccurate flow/volume measurement. For this reason, many clinicians are using vibrating mesh nebulizers for in-line ventilator drug aerosol therapy. ese devices do not add any flow to the circuit and thus do not affect ventilator function.
The correct answer is: vibrating mesh nebulizer
3. Which of the following conditions will cause a DECREASE in the FIO2 delivered to a patient receiving oxygen at 4 L/min via a nasal cannula?
A. decrease in patient inspiratory flow
B. increase in patient inspiratory time
C. increase in patient minute ventilation
D. decrease in patient tidal volume
With a low-flow device like a nasal cannula, the larger the tidal volume, the higher the inspiratory flow, the less the inspiratory time, or the greater the minute ventilation, the greater will be the amount of air diluting the O2 and the lower the FIO2. Conversely, with all else constant, the greater the input O2 flow during inhalation, the less air dilution occurs, and the higher the FIO2.
The correct answer is: increase in patient minute ventilation
4. You notice that a disposable nebulizer is delivering large water droplets down the large bore tube. To correct this problem, you should
A. add a heating collar to the nebulizer
B. replace the nebulizer
C. add water to the nebulizer
D. dismantle and clean the nebulizer
Nebulizers should deliver fine aerosol mists, not large water droplets. This situation indicates malfunction of the device. Since disposable devices cannot be disassembled and repaired, the unit should be replaced.
The correct answer is: replace the nebulizer
5. Shortly after you replace a jet nebulizer and tubing on a patient who has a tracheostomy, the SpO2 drops from 98% to 90%. Aerosol is visible throughout inspiration and expiration in the tracheostomy collar. Which of the following should you do first to resolve the situation?
A. Decrease the input flow to the nebulizer
B. Ask the patient to breath slower and deeper
C. Check the entrainment setting on the nebulizer
D. Obtain an arterial blood gas sample for analysis
In general, when troubleshooting oxygenation issues the first step always should be to check the O2 source and confirm that the proper FIO2 is being delivered. Because aerosol is visible throughout inspiration and expiration, the flow is adequate to meet patient needs and thus assure a stable FIO2. Given adequate flow, the only good explanation is that the FIO2 setting on the new nebulizer was not checked and is providing a lower O2 concentration than the prior setup. To correct the problem, readjust the entrainment setting to match the prescribed value.
The correct answer is: Check the entrainment setting on the nebulizer
6. Which of the following would you expect to occur AFTER an unheated bubble diffusion humidifier is set-up and operating?
A. the reservoir will be warmer than room temperature
B. the reservoir will be cooler than room temperature
C. the reservoir temperature will equal room temperature
D. water will condense on the inside of the delivery tubing
In all humidifiers, heat is lost due to evaporative cooling. is cooling lowers the temperature of the gas and its ability to carry water vapor. In unheated humidifiers, as water vaporizes into the gas, heat is lost and both the gas and the water are cooled. Thus, gas leaving the device is warmed by room conditions, the relative humidity drops, and no condensation occurs.
The correct answer is: the reservoir will be cooler than room temperature
7. During computerized setup of a ventilator, you are prompted to enter a circuit compliance factor. This information is needed to:
A. calibrate the flow sensors
B. complete the automated leak test
C. calibrate the pressure transducer
D. compensate for compressed volume loss
All disposable breathing circuits should come labeled with a compliance factor. This factor is required during computerized ventilator setup to program the device to compensate for compressed volume loss.
The correct answer is: compensate for compressed volume loss
8. A bubble humidifier is connected to a flowmeter set and running at 5 L/min. When you obstruct the outlet of the small-bore delivery tubing, the pressure pop-off does NOT sound. Which of the following is the most likely cause of this observation?
A. excessive flow through the humidifier
B. a leak in the humidifier/delivery system
C. diameter of delivery tubing is too small
D. the flowmeter is not pressure compensated
The pressure pop-off on a bubble humidifier normally sounds when the pressure in system exceeds a preset limit, e.g. 2 psi. Pressure in the system rises only when there is an obstruction to flow DISTAL to the downtube or bubble-diffuser. If the pop-off does not sound when you obstruct flow, either (1) there is no inlet flow, (2) there is a leak in the humidifier/ delivery system, or (3) the pop-off is malfunctioning.
The correct answer is: a leak in the humidifier/delivery system
9. Which of the following analyzers would you select if your objective were to continuously measure changes in the FIO2 in a ventilator circuit with the fastest possible response time?
A. physical (paramagnetic) analyzer
B. thermal conductivity analyzer
C. galvanic fuel cell analyzer
D. polarographic (Clark) analyzer
Only the polarographic and galvanic fuel cell analyzers can provide continuous sampling and measurement under dynamic conditions (as in ventilator circuits). However, with its current flow maintained solely by the chemical reaction itself, the galvanic fuel cell has a comparatively slow response time.
The correct answer is: polarographic (Clark) analyzer
10. To maximize the duration of flow/runtime outside the home, liquid portable O2 systems:
A. hold about three liters of liquid oxygen
B. can be refilled from a liquid O2 base unit
C. incorporate a pulse-dose delivery system
D. include a battery-powered contents indicator
Liquid portable O2 systems are used in conjunction with a home-based stationary unit, from which they are refilled. Because refilling requires a return to the base unit, it does not extend runtime outside the home. When full the typical unit holds 1-liter of liquid O2 and provides 3-4 hours continuous flow at a typical low flow setting of ‘2.’ A 3 liter unit would triple this duration of flow but would weigh over 12 lbs. and not be readily transportable. us the best way to maximize portable unit runtime is to incorporate a pulse dosing system that delivers small boluses of O2 only during inspiration.
The correct answer is: incorporate a pulse-dose delivery system
This is only a sample from Module 4. To see the remainder of Questions and Answers, check out the TMC Test Bank.
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1001 Questions and Answers You Might See on the Board Exam