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Egan's CH 36 > Egan 36 > Flashcards

Egan 36 Flashcards

1
Q 
1.	What is the primary indication for tracheal suctioning?
a.
Presence of pneumonia
b.
Presence of atelectasis
c.
Ineffective coughing
d.
Retention of secretions
A

ANS: D
Excerpts from the AARC guideline (CPG 36-1) include indications, contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring.

DIF: Recall REF: p. 741 OBJ: 1

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2
Q 
2.	What is the most common complication of suctioning?
a.
Hypoxemia
b.
Hypotension
c.
Arrhythmias
d.
Infection
A

ANS: A
Excerpts from the AARC guideline (CPG 36-1) include indications, contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring.

DIF: Recall REF: p. 741 OBJ: 1

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3
Q
  1. Complications of tracheal suctioning include which of the following?
  2. Bronchospasm
  3. Hyperinflation
  4. Mucosal trauma
  5. Elevated intracranial pressure
    a.
    1 and 3 only
    b.
    1, 2, and 3 only
    c.
    3 and 4 only
    d.
    1, 3, and 4 only
A

ANS: D
Complications of tracheal suctioning include bronchospasm, mucosal trauma, and elevated intracranial pressures.

DIF: Recall REF: p. 741 OBJ: 1

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4
Q 
4.	How often should patients be suctioned?
a.
At least once every 2 to 3 hr
b.
Whenever they are moved or ambulated
c.
When physical findings support the need
d.
Whenever the charge nurse requests it
A

ANS: C
A patient should never be suctioned according to a preset schedule.

DIF: Recall REF: p. 742 OBJ: 1

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5
Q 
5.	What is the normal range of negative pressure to use when suctioning an adult patient?
a.
–100 to –120 mm Hg
b.
–80 to –100 mm Hg
c.
–60 to –80 mm Hg
d.
–20 to –30 mm Hg
A

ANS: A
The suction pressure should be set at the lowest effective level. Negative pressures of 80 to 100 mm Hg in neonates and less than 150 mm Hg in adults are generally recommended

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6
Q 
6.	What is the normal range of negative pressure to use when suctioning children?
a.
–60 to –80 mm Hg
b.
–80 to –100 mm Hg
c.
–100 to –120 mm Hg
d.
–120 to –150 mm Hg
A

ANS: C
The suction pressure should be set at the lowest effective level. Negative pressures of 80 to 100 mm Hg in neonates and less than 150 mm Hg in adults are generally recommended.

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7
Q 
7.	You are about to suction a 10-year-old patient who has a 6-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter that you would use in this case?
a.
6 Fr
b.
8 Fr
c.
10 Fr
d.
14 Fr
A

ANS: C
See Rule of Thumb 36-1.

DIF: Application REF: p. 742 OBJ: 1

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8
Q 
8.	You are about to suction a female patient who has an 8-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter you would use in this case?
a.
8 Fr
b.
10 Fr
c.
12 Fr
d.
14 Fr
A

ANS: D

See Rule of Thumb 36-1.

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9
Q

To prevent hypoxemia when suctioning a patient, the respiratory care practitioner should initially do which of the following?
a.
Manually ventilate the patient with a resuscitator.
b.
Preoxygenate the patient with 100% oxygen.
c.
Give the patient a bronchodilator treatment.
d.
Have the patient hyperventilate for 2 min.

A

ANS: B

First, preoxygenation helps minimize the incidence of hypoxemia during suctioning.

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10
Q
  1. To maintain positive end expiratory pressure (PEEP) and high FiO2 when suctioning a mechanically ventilated patient, what would you recommend?
    a.
    Limit suction time to no more than 5 sec.
    b.
    Use a closed-system multiuse suction catheter.
    c.
    Limit suctioning to once an hour.
    d.
    Use the smallest possible catheter.
A

ANS: B
Basic indications for the use of closed suction catheters can be found in Box 36-2.

DIF: Application REF: p. 743 OBJ: 1

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11
Q 
11.	Total application time for endotracheal suction in adults should not exceed which of the following?
a.
20 to 25 sec
b.
15 to 20 sec
c.
10 to 15 sec
d.
3 to 5 sec
A

ANS: C
Keep total suction time to less than 10 to 15 sec.

DIF: Recall REF: p. 743 OBJ: 1

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12
Q
  1. While suctioning a patient, you observe an abrupt change in the electrocardiogram waveform being displayed on the cardiac monitor. Which of the following actions would be most appropriate?
    a.
    Change to a smaller catheter and repeat the procedure.
    b.
    Stop suctioning and immediately administer oxygen.
    c.
    Stop suctioning and report your findings to the nurse.
    d.
    Decrease the amount of negative pressure being used.
A

ANS: B
If any major change is seen in the heart rate or rhythm, immediately stop suctioning and administer oxygen to the patient, providing manual ventilation as needed.

DIF: Analysis REF: p. 744 OBJ: 1

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13
Q
  1. Which of the following methods can help to reduce the likelihood of atelectasis due to tracheal suctioning?
  2. Limit the amount of negative pressure used.
  3. Hyperinflate the patient before and after the procedure.
  4. Suction for as short a period of time as possible.
    a.
    1 and 2 only
    b.
    1 and 3 only
    c.
    2 and 3 only
    d.
    1, 2, and 3
A

ANS: D
Atelectasis can be caused by removal of too much air from the lungs. You can avoid this complication by (1) limiting the amount of negative pressure used, (2) keeping the duration of suctioning as short as possible, and (3) providing hyperinflation before and after the procedure.

DIF: Recall REF: p. 744 OBJ: 1

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14
Q
  1. Which of the following can help to minimize the likelihood of mucosal trauma during suctioning?
  2. Use as large a catheter as possible.
  3. Rotate the catheter while withdrawing.
  4. Use as rigid a catheter as possible.
  5. Limit the amount of negative pressure.
    a.
    1 and 2 only
    b.
    2 and 4 only
    c.
    3 and 4 only
    d.
    1, 2, and 4 only
A

ANS: B
To avoid this problem, limit the amount of negative pressure used and always rotate the catheter while withdrawing.

DIF: Recall REF: p. 744 OBJ: 1

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15
Q
  1. Absolute contraindication for nasotracheal suctioning includes which of the following?
  2. Epiglottitis
  3. Croup
  4. Irritable airway
    a.
    1 and 2 only
    b.
    1 and 3 only
    c.
    2 and 3 only
    d.
    1, 2, and 3
A

ANS: A
Excerpts from the AARC guideline (CPG 36-2) include indications, contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring.

DIF: Recall REF: p. 741 OBJ: 1

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16
Q
  1. Which of the following equipment is needed to perform nasotracheal suctioning?
  2. Suction kit (catheter, gloves, basin, etc.)
  3. Laryngoscope with MacIntosh and Miller blades
  4. Oxygen delivery system (mask and manual resuscitator)
  5. Bottle of sterile water or saline solution
    a.
    1 and 3 only
    b.
    1, 3, and 4 only
    c.
    2 and 4 only
    d.
    2, 3, and 4 only
A

ANS: B
See Box 36-1.

DIF: Recall REF: p. 742 OBJ: 1

17
Q
  1. After repeated nasotracheal suctioning over 2 days, a patient with retained secretions develops minor bleeding through the nose. Which of the following actions would you recommend?
    a.
    Perform a tracheotomy for better access to the lower airway.
    b.
    Discontinue nasotracheal suctioning for 48 hr and reassess.
    c.
    Stop the bleeding and use a nasopharyngeal airway for access.
    d.
    Orally intubate the patient for better access to the lower airway.
A

ANS: C
Placement of a nasopharyngeal airway can help minimize nasal trauma when repeated access is needed.

DIF: Application REF: p. 744 OBJ: 1

18
Q
  1. Before the suctioning of a patient, auscultation reveals coarse breath sounds during both inspiration and expiration. After suctioning, the coarseness disappears, but expiratory wheezing is heard over both lung fields. What is most likely the problem?
    a.
    Secretions are still present and the patient should be suctioned again.
    b.
    The patient has hyperactive airways and has developed bronchospasm.
    c.
    A pneumothorax has developed and the patient needs a chest tube.
    d.
    The patient has developed a mucous plug and should undergo bronchoscopy.
A

ANS: B
The bronchospastic response may be particularly strong in patients with hyperactive airway disease. These patients should be assessed for the development of wheezes associated with suctioning.

DIF: Analysis REF: p. 746 OBJ: 1

19
Q
  1. What general condition requires airway management?
  2. Airway compromise
  3. Respiratory failure
  4. Need to protect the airway
    a.
    1 and 2 only
    b.
    1 and 3 only
    c.
    2 and 3 only
    d.
    1, 2, and 3
A

ANS: D
Excerpts from the AARC guideline (CPG 36-3) include indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring.

DIF: Recall REF: pp. 747-748 OBJ: 3

20
Q
  1. Which of the following conditions require emergency tracheal intubation?
  2. Upper airway or laryngeal edema
  3. Loss of protective reflexes
  4. Cardiopulmonary arrest
  5. Traumatic upper airway obstruction
    a.
    1 and 4 only
    b.
    3 and 4 only
    c.
    1, 2, and 3 only
    d.
    1, 2, 3, and 4
A

ANS: D
Excerpts from the AARC guideline (CPG 36-3) include indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring.

DIF: Recall REF: pp. 747-748 OBJ: 3

21
Q
  1. Which of the following autonomic or protective neural responses represent potential hazards of emergency airway management?
  2. Hypotension
  3. Bradycardia
  4. Cardiac arrhythmias
  5. Laryngospasm
    a.
    1, 2, and 3 only
    b.
    1 and 4 only
    c.
    3 and 4 only
    d.
    1, 2, 3, and 4
A

ANS: D
Excerpts from the AARC guideline (CPG 36-3) include indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring.

DIF: Recall REF: pp. 747-748 OBJ: 4

22
Q
  1. Which of the following indicate an inability to adequately protect the airway?
  2. Wheezing
  3. Coma
  4. Lack of gag reflex
  5. Inability to cough
    a.
    1 and 3 only
    b.
    1, 2, and 3 only
    c.
    3 and 4 only
    d.
    2, 3, and 4 only
A

ANS: D
Excerpts from the AARC guideline (CPG 36-3) include indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring.

DIF: Recall REF: pp. 747-748 OBJ: 4ANS:

23
Q
  1. Which of the following types of artificial airways are inserted through the larynx?
  2. Pharyngeal airways
  3. Tracheostomy tubes
  4. Nasotracheal tubes
  5. Orotracheal tubes
    a.
    1 and 4 only
    b.
    1, 2, and 3 only
    c.
    3 and 4 only
    d.
    1, 2, 3, and 4
A

ANS: C
The two basic types of tracheal airways are endotracheal (translaryngeal) tubes and tracheostomy tubes. Endotracheal tubes are inserted through either the mouth or nose (orotracheal or nasotracheal), through the larynx, and into the trachea.

DIF: Recall REF: p. 749 OBJ: 3

24
Q
  1. Compared with the nasal route, the advantages of oral intubation include which of the following?
  2. Reduced risk of kinking
  3. Less retching and gagging
  4. Easier suctioning
  5. Less traumatic insertion
    a.
    1 and 3 only
    b.
    1, 2, and 3 only
    c.
    1, 2, 3, and 4
    d.
    1, 3, and 4 only
A

ANS: D
A summary of the advantages and disadvantages of each of these three approaches appears in Table 36-1.

DIF: Recall REF: p. 750 OBJ: 3

25
Q
  1. Compared with the oral route, the advantages of nasal intubation include which of the following?
  2. Reduced risk of kinking
  3. Less retching and gagging
  4. Less accidental extubation
  5. Greater long-term comfort
    a.
    1 and 3 only
    b.
    1, 2, and 3 only
    c.
    3 and 4 only
    d.
    2, 3, and 4 only
A

ANS: D
A summary of the advantages and disadvantages of each of these three approaches appears in Table 36-1.

DIF: Recall REF: p. 750 OBJ: 3

Egan's CH 36 (1 decks)

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