Chapter 5

Question 1

List 5 indications for bronchoscopy?

Answer 1

1. Removal of foreign bodies
2. Removal of mucous plugs
3. Atelectasis that affects a lobe or entire
   lung
4. Pulmonary hemorrhage
5. When tracheal intubation is difficult as a
   result of upper airway trauma, obesity,
   tumors, or spinal deformity.

Question 2

List 8 complications of bronchoscopy

Answer 2

1. Hypoxemia
2. Laryngospasm
3. Brochospasm
4. Arrythmias
5. Hemorrhage
6. Respiratory depression
7. Hypotension
8. Pneumothorax

Question 3

Name 1 medication that is used to achieve
conscious sedation before surgery?

Answer 3

Versed

Question 4

What is the purpose of administering atropine
before a bronchoscopy?

Answer 4

To dry out the airway to aid in visualization
during the procedure.

Question 5

How should the bronchoscope be cleaned after
the procedure?

Answer 5

Sterilized in Cidex for 3-10 hours

Question 6

What is the purpose of inserting a chest tube?

Answer 6

To drain substances that accumulate in the
pleural space.

Question 7

If the water in the water seal bottle is not
fluctuating, what should be suspected?

Answer 7

Obstruction of the tube

Question 8

If a chest tube becomes obstructed what may
occur?

Answer 8

Tension pneumothorax

Question 9

If an air leak from a chest tube is suspected,
what should be done first?

Answer 9

Chest tube should be clamped to identify the
source of the leak.

Question 10

How much negative pressure is generally
required to help evacuate fluid from the pleural
space?

Answer 10

-20 cmH2O

Question 11

Which of the following diagnostic techniques is
utilized to obtain biopsies for peripheral lung
lesions.

Answer 11

Electromagnetic navigational bronchoscopy
(ENB)

Question 12

Which of the diagnostic technique is often used
to detect a DVT?

Answer 12

Ultrasound

Question 13

What size needle is used to perform a
thoracentesis?

Answer 13

25-27 (for lidocaine)
16-20 (for procedure)

Question 14

What is another medication used for a
conscious sedation?

Answer 14

Valium

Question 15

Lidocaine can be used as what 2 things?

Answer 15

Lubricant & anesthetic

Question 16

What are some complications of bronchoscopy?

Answer 16

1. Hypoxemia
2. Laryngospasm
3. Arrhythmias
4. Hemorrhage
5. Respiratory depression
6. Hypotension
7. Pneumothorax

Question 17

What are the responsibilities of the therapist
before bronchoscopy?

Answer 17

1. Prepare patient and explain procedure
2. Administer aerosolized local anesthetic to
   patients upper airway
3. Conduct patient monitoring throughout
   procedure
4. Collect sputum sample and tissue samples
   that the physician has obtained and
   prepare them for laboratory analysis
5. Clean the bronchoscope properly after the
   procedure

Question 18

ENB can successfully diagnose of
peripheral lesions

Answer 18

75-77%

Question 19

A pneumothorax is a complication in
approximately of patients?

Answer 19

3.5%

Question 20

EBUS is a technique that is much more accurate
for the diagnosis of ?

Answer 20

Lung tumors (approximately 98%)

Question 21

Complications of EBUS include?

Answer 21

pneumothorax
pneumomediastinum
bacteremia

Question 22

What is BAL?

Answer 22

Approximately 100mL of normal saline through
the bronchscope’s suction channel to the
affected area.

Question 23

The tip of the bronchoscope is positioned into a
and the saline instilled in five
separate times.

Answer 23

Fourth generation bronchus; 20mL increments

Question 24

BAL is contradicted in?

Answer 24

Hypoxemic patients
patients with reduced pulmonary function
patients with cardiovascular disease
patients with serious electrolyte abnormalities

Question 25

To help evacuate air (pneumothorax) from the
pleural space, the chest tube is usually inserted
where?

Answer 25

Second, third, or fourth intercostal space

Question 26

To remove fluid the tube is placed where?

Answer 26

sixth or seventh intercostal space

Question 27

what is the one bottle set up?

Answer 27

The bottle is both a water seal container and a
collection container.

Question 28

What is the two bottle system?

Answer 28

The bottle closest to the patient collects the
drainage, while the second bottle provides the
water seal.

Question 29

What is a three bottle system?

Answer 29

A suction source may be attached to the vent of
the third bottle to maintain a desire, constant
pressure

Question 30

What is the most common chest tube drainage
system?

Answer 30

The three chambered system

Question 31

What is tidaling?

Answer 31

The water level in the water seal bottle fluctuates
with changes in pleural pressure that occur with
normal breathing.

Question 32

What can obstruct a chest tube?

Answer 32

Blood clots or kinks

Question 33

Occasional excessive or persistent bubbling in
the water seal bottle indicates what?

Answer 33

Air leaks in the system or patient

Question 34

The absence of bubbling indicates what?
What is this a sign of?

Answer 34

No air being removed from the plural space
Patient improvement

Question 35

Clamping of the tube must be done with caution
in patients with plural air leaks because what
can occur?

Answer 35

Tension pneumothorax

Question 36

What are some complications of a
thoracentesis?

Answer 36

bleeding
Infection
Pneumothorax
Pulmonary edema (caused by removing fluid
too quickly?

Question 37

CT scan is used to detect what?

Answer 37

Bony abnormalities
Soft tissue abnormalities
Pleural abnormalities
Parenchymal lung disease
Pulmonary embolism
Aortic dissection

Question 38

MRI is used to detect what?

Answer 38

soft tissue abnormality
Bone marrow pathology
Plerual disease
Diaphragmatic disease
Mediastinal abnormalities
Congenital heart disease

Question 39

What are some disadvantages of MRI?

Answer 39

2. Motion artifact caused by respiratory and
   cardiac motion that can obscure images
3. Contraindicated in patients with
   pacemakers
4. Because of the strength of the MRI
   magnets, most ventilators cannot be used
   near an MRI