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special proc for final Flashcards

1
Q 
Therapy for fiberoptic bronchoscopy include which of the following
1.  Inspect airways
2.  Retrieve foreign bodies
3.  obtain specimens for analysis
4.  Aid ET intubation
A.  2 and 4
B.  3 and 4
C.  1, 2, and 3
D.  1, 2, 3, and 4
A

D. all of the listed

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2
Q

In which of the following conditions should fiberoptic bronchoscopy not be performed?

  1. uncorrected bleeding disorders
  2. presence of lung abscess
  3. refractory hypoxemia
  4. unstable hemodynamic status
    a. 2 and 3
    b. 2 and 4
    c. 1, 3, and 4
    d. 1, 2, 3, and 4
A

c. uncorrected bleeding disorders
refractory hypoxemia
unstable hemodynamic status

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3
Q 
Complications of fiberoptic bronchoscopy include all of the following except:
A,  hypocapnia
B.  infection
C.  hypotension
D.  hypoxemia
A

A. hypocapnia

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4
Q 
Key points to consider in planning fiberoptic bronchoscopy include which of the following:
1.  equipment preparation
2.  premedication
3.  airway preparation
4.  monitoring
A.  2 and 4
B.  3 and 4
C.  1, 2, and 3
d.  1, 2, 3, and 4
A

D. all items listed

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5
Q

Which of the following are appropriate orders before and elective fiberoptic bronchoscopy procedure scheduled for next morning?

  1. have patient take nothing by mouth after midnight
  2. establish vascular access
  3. premedicate with benzodiazepine
    a. 1 and 2
    b. 1 and 3
    c. 2 and 3
    d. 1, 2, and 3
A

D. all items listed

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6
Q

For which of the following reasons is atropine often used during fiberoptic bronchoscopy?

  1. to dry the patients airway
  2. to decrease vagal response
  3. to provide topical anesthesia
    a. 1 and 2
    b. 1 and 3
    c. 2 and 3
    d. 1, 2, and 3
A

A. 1 and 2:
Dry airway
Decrease vagal respons

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7
Q

During fiberoptic bronchoscopy a patient receiving IV fentanyl exhibits respiratory depression. Which is the best action?
A. Increase O2 flow rate and continue to monitor
B. immediately administer naloxone (narcan)
C. decrease O2 flow and continue monitoring
D. immediately administer neostigmine or prostigmine

A

B. Immediately administer naloxone (Narcan)

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8
Q 
Equipment required for patient monitoring during fiberoptic bronchoscopy includes all the following except:
a.  Pulse ox
B.  O2 cannula
C.  ECG monitor
D.  Capnometer
A

D. Capnometer

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9
Q 
Goals of airway preparation before bronchoscopy include:
1.  decrease cough and gagging
2.  decrease pain
3.  prevent bleeding
A.  1 and 2
b.  1 and 3
C.  2 and 3
D.  1, 2, and 3
A

D. all items

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10
Q 
Which of the following is used to prevent bleeding during bronchoscopy?
A.  Phenylephrine
B.  Dopamine
C.  Cocaine HCL
D.  Naloxone
A

A. Phenylephrine

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11
Q 
Lower airway anesthesia can be achieved by which of these routes?
1.  bronchoscopic instillation
2.  IV administration
3.  Nebulization
A.  1 and 2
B.  1 and 3
C.  2 and 3
D.  1, 2 and 3
A

B. 1 and 3

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12
Q 
During fiberoptic bronch a patients SPO2 drops from 91 to 87% which action is best?
1.  apply suction through scopes open channel
2.  give O2 via scope open channel
3.  increase cannula or mask o2 flow
A.  1 and 2
B.  2 and 3
C.  1 and 3
D.  1, 2, and 3
A

B. 2 and 3

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13
Q

A patient exhibits persistent mild hypoxemia after bronch, what is best?
a. continue O2 therapy & reassess in 4 hrs
b. administer benzodiazepine
C. administer racemic epinephrine
d. have patient refrain from eating or drinking

A

A. continue O2 therapy & reassess in 4 hrs

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14
Q

To avoid risk of aspiration after bronch what is best to do?
A. place in supine trendelenburg for 2 hrs
B. remain in sitting position and NPO until sensation returns
C. give aerosolized lidocaine by nebulizer
d. continuously monitor via pulse ox

A

B. remain sitting and NPO

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15
Q 
The most common cause of pleural effusion is?
A.  pneumothorax
B.  CHF
C.  Cor pulmonale
D.  COPD
A

B. CHF

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16
Q 
A problem that occurs from rupture of thoracic duct includes:
A.  Pneumothorax
B.  Chylothorax
C.  Hydrothorax
D.  Pulmonary edema
A

B. chylothorax

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17
Q 
The most common cause of a hemothorax is?
A.  Rupture of thoracic duct
B.  Chest trauma
C.  CHF
D.  Cardiogenic pulmonary edema
A

B. chest trauma

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18
Q 
What anatomical location is most likely to show a small pleural effusion in upright chest xray?
A.  Apices of lung
B.  Base of lung
C.  Costophrenic angles
D.  posterior lower lobe
A

C. Costophrenic angles

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19
Q

T or F: Exudative have more protein & inflammatory cells than transudative

A

True

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20
Q

T or F: the correct order of the thoracentesis procedure is

  1. Obtain consent
  2. puncture site is disinfected
  3. correctly position patient
  4. dr performs chest percussion to determine correct site
A

True

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21
Q

Correct instructions to give a patient before a thoracentesis include:
1. Take a deep breath and hold
2. Do not take a deep breath
3. Exhale normally and pause breathing for 15 sec
4. Inhale to full Vt and pause with normal exhale
A. 1, 3
B. 2, 3
C. 4 only
D. 1 only

A

B. 2 and 3

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22
Q 
Which items do not belong in thoracentesis tray?
1.  50 ml syringe
2.  70% isopropyl alcohol
3   2% Lidocaine!
4.  5 mL syringe with 21G
and 25 G needles
5.  17G thoracic needle
6.  arterial clamps
7.  hemostats
8.  trocars
9.  4x4 gauze
10.  rib separators
11.  3 way stopcock
12.  Water soluble lubricant
A

6, arterial clamps

  1. trocars
  2. rib separators
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23
Q

Complications of thoracentesis include:

  1. hypotension
  2. hypertension
  3. tachypnea
  4. intrathoracic bleeding
  5. hemoptysis
  6. pain
  7. reexpansion of pulmonary edema
  8. bradycardia
  9. seeding of needle with tumor cells
  10. Cardiac infarction
  11. inability to clot
A 
1, 4, 5, 6, 7, 8, 9
hypotension
intrathoracic bleeding
hemoptysis
pain
reexpansionn of pulmonary edema
bradycardia
seeding of needle with tumor
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24
Q

T or F: A chest xray is routinely performed post procedure to check for development of pneumothorax.

A

True

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25
Q 
What is the maximum amount of fluid that can be removed to prevent hypovolemic shock
A.  500 mll
B.  250 ml
C.  1200 ml
D.  1500 ml
A

C. 1200 ml

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26
Q

T or F: there are no contraindications for thoracentesis only potential risks.

A

False: coagulation disorders is a contraindication

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27
Q

This type of fluid is often associated with CHF, it is a clear serous fluid
A. transudate
B. exudate
C. both a & b

A

A. transudate

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28
Q

This type of fluid is cloudy and opaque and often associated with infection?
A. transudate
B. exudate
C. both a and b

A

B. exudate

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29
Q

This type of fluid is often thick, purulent, may not change position with gravity and may contain chyle?
A. transudate
B. exudate
C. both a & B

A

B. exudate

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30
Q 
What lung problem is V/Q scanning used to detect?
A.  asthma
B.  pulmonary embolism
C.  pneumonia
D.  lung cancer
A

B. pulmonary embolism

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31
Q 
Which of the following will result in the most radiopaque shows on xray?
A.  aorta
B.  heart
C.  lungs
D.  ribs
A

D. ribs

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32
Q 
The right heart shadow is not visible on chest xray.  Which of the following pathologies can explain this?
A.  right middle lobe pneumonia
b.  right lung pneumothorax
c.  bilateral emphysema
d.  bleb in right lower lobe
A

a. right middle lobe pneumonia

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33
Q

In which situation is obtaining xray least useful?

a. following intubation
b. following placement of central venous pressure line
c. when static pressure drops by 2 cm H2O during CMV
d. when patients oxygenation status declined for no known reason

A

C. when pressure drops

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34
Q

In what pulmonary condition does chest xray lag behind the clinical status of patient?

a. pulmonary embolism
b. emphysema
c. pneumonia
d. CHF

A

C. pneumonia

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35
Q

Which xray view of the chest allows physician to read best quality:

a. anteroposterior
b. posteranterior (pa)
c. lateral
d. lordotic

A

b. PA

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36
Q

Your patient just had an AP xray. When you view film what may be a consideration?

a. lungs may appear smaller than they really are
b. the heart may appear less dense than it really is
c. ribs may appear more horizontal
d. heart may be larger than it really is

A

d. heart may be larger than It really is

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37
Q

In standard PA xray, what proportion of the chest width should the shadow not exceed?

a. 33%
b. 40%
c. 50%
d. 65%

A

C. 50%

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38
Q 
What term best defines high density images on chest xray?
A.  radiodense
B.  translucent
c.  radiopaque
d.  opacity
A

c. radiopaque

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39
Q

To minimize magnification, how far should the patient be from film source?

40
Q

Which xray has the least amount of magnification
A. AP view
B. PA view
C. Cubital lateral

A

B. PA view

41
Q 
A patient who is standing upright with his back to xray, his anterior thorax is pressed against metal cassette containing film and arms positioned out of the way is being filmed in what view?
A.  AP view
B.  PA view
C.  left lateral view
D. lateral decubitus view
A

B. PA view

42
Q 
Which of the following provides less cardiac magnification & sharper view of left lower lobe?
A.  AP view
B.  PA view
C.  left lateral view
D. lateral decubitus view
A

C left lateral view

43
Q 
Which of the following views is used to see whether free fluid is present in the chest in the left pleural region?
A.  AP view
B.  PA view
C.  lateral view
D. lateral decubitus view
A

d. lateral decubitus view

44
Q

Which of the following is most helpful in finding a pneumothorax?
A. inspiratory film
B. expiratory film

A

B. expiratory

45
Q 
Which view is best to dileating mediastinal lesion from overlying structures?
A.  oblique view
B.  Lateral decubitus view
C.  PA view
D.  Left lateral view
A

A. oblique

46
Q

How many ribs present on film indicate a good inspiratory effort?

47
Q

What is useful to see if pulmonary infiltrate is present and in contact with lung border?

A

Silhouette sign

48
Q 
What is useful to determine if an abnormality is within lung?
A.  silhouette
B.  Kurly C
C.  Air bronchograms
D.  honeycombing
A

C. bronchograms

49
Q 
With hyperinflation which would you expect to increase?
1.  lung volumes
2.  lung capacities
3.  Vt
A.  1 and 3
B.  1 and 2
C.  2 and 3
D.  1, 2, and 3
50
Q

Common findings with CHF include:

  1. pedal edema
  2. hepatamegaly
  3. venous distention
    a. 1 and 2
    b. 1 and 3
    c. 2 and 3
    d. 1, 2 and 3
A

D. all listed

51
Q

T or F: chest xrays do depend on type of fluid in pleural space in order to be viewed.

52
Q

In a chest tube, which department causes continuous bubbling?

A

suction control department

53
Q 
Functions of the water seal include:
1.  control suction pressure
2.  allow removal of air & prevent it from moving back
3.  allow air to escape to atmosphere
A.  1 and 2
B.  1 and 3
C.  2 and 3
D.  1, 2, and 3
A

D. all items listed

54
Q 
What would you expect to see if there is air evacuating pleura?
A.  bubbling in suction control
B.  Bubbling in pressure department
C.  bubbling in water seal compartment
D. all of the above
A

C. bubbling in water seal compartment

55
Q

How do you increase suction?

A

Add more water to bottle 3

56
Q

What would cause there to be no fluctuations in water seal bottle?

A

obstruction in chest tube

57
Q

If you pinch off chest tube & bubbling continues what could be the cause?

A

Leaks in the connection

58
Q 
Which of the following can affect PetCo2?
1.  water on sensor
2.  inspired O2 %
3.  Patients breathing pattern
4.  Deadspace & Vt
A.  1 and 2
B.  2 and 3
C.  1, 3, 4
D.  1, 2, 3, and 4
A

C. 1, 3, and 4

59
Q

What is the trend speed of capnograph?

60
Q

What is the real time speed of capnograph?

A

12.5 mm/min

61
Q

T or F: On bipap vision when you adjust the frequency you will change the size of Vt

62
Q

T or F: During spontaneous breathing inspiratory time setting will cycle to exhale if breath too long

A

False; does not function

63
Q 
If you increase IPAP the following will happen:
1.  increase in Vt
2.  increase in ventilation
3.  increase in mechanical dead space
4.  decrease in PaCO2
A.  1 and 2
B.  1, 2 and 3
C.  1, 2, 4
D.  1, 2, 3, and 4
A

C. 1, 2 and 4

64
Q 
If you decrease your EPAP which of the following may happen:
1.  decrease in FRC
2.  decrease in PaO2
3.  increase in Vt
4.  decrease of mechanical dead space
A.  1, 2, 3
B.  1, and 2
c.  1, 3, 4
D.  1, 2, 3, 4
A

a. 1, 2, 3

65
Q

Which improves Vt the most
A. Full face mask
B.. Total face mask
C. nasal face mask

A

A. full face mask

66
Q 
What physiological effect does increase in epap have?
A.  Increase in FRC
B.  Decrease in FRC
C.  Increase in deadspace ventilation
D.  increased Vt
A

A. increase in FRC

67
Q

What is most common complication of bipap?

68
Q

Which is the least likely to indicate need for NPPV in acute care?

a. dyspnea
b. high paco2
c. use of accessory muscles in breathing
d. JVD

69
Q

T or F: the pressure port on bipap vision will power the SVN

70
Q

T or F: The blue cap that sits on patient mask is removed before application for patient safety

71
Q 
Which piece of equipment is inadequate for weaning parameters:
A stopwatch
B.  OEM weaning manifold with red cap
C  pressure manometer
D.  respirometer
A

C. pressure manometer

72
Q 
What would be ok to omit from weaning parameter test?
A.  FEV1
B.  PIF
C.  PEF
D.  VC
73
Q

T or F; A respirometer is used with bacteria filter because it cannot be sterilized.

74
Q

To clean respirometer what can you use?
A. hydrogen peroxide
B. glutaralehyde cidex
C. disinfectant solution

A

B. glutaralhyde cidex

75
Q

T or F: a chest tube should be directed towards the base of the lung when used to drain a pneumothorax?

76
Q

During transporation of patient with chest tube drainage system it is pulled off the drainage tubing and cracked open. What would you do?
A. immediately begin bag/mask
B. Hold distal end of tubing few cm below surface of a bottle of sterile water or saline
C. apply new chest tube
d. immediately call for assistance

A

B. hold distal end below surface of bottle of sterile water

77
Q 
The purpose of chest tube in patient with blunt chest trauma that caused bleeding and pneumothorax include?
1. measure rate of bleeding
2.  evacuate blood from pleural space 
3.  improve ventilation
A.  1 and 2
B.  1 and 3
C.  2 and 3
D.  1, 2 and 3
A

D. 1, 2 and 3

78
Q

T or F; A bronch should not be performed on patients with refractory hypoxemia

79
Q 
When you increase your EPAP the following happens?
1.  increased FRC
2.  increased MAP
3.  increased PaO2
4.  increase in Vt
A.  1 and 2
B.  1, 2 and 4
C.  1, 2 and 3
D.  1, 2, 3 and 4
A

B. 1, 2 and 4

Vt does not increase with increase in epap; it decreases

80
Q 
How do you decrease your increase ventilation?
1.  increase Vt
2. decrease PaCO2
3.  increase IPAP
4.  Increase EPAP
A.  1 and 2
B.  1, 2, 3
C.  1, 2, 4
D.  1, 2, 3, and 4
A

B. Increase MV by increasing VT with increased IPAP and decreased PaCO2

81
Q 
How can you increase PaCO2?
1.  increase IPAP
2.  decrease IPAP
3.  increase EPAP
4.  decrease EPAP
A.  1, 3
B.  2, 3
C.  1, 4
D.  1 only
E.  2 only
A

E. decrease IPAP

82
Q

What setting may improve synchrony?

83
Q

T or F: to determine if mask cpap is successful you want to see a decrease in rr below 25 and SpO2 above 90%

A

False; SpO2 above 92%

84
Q

T or F: It is ok to use mask cpap on chest trauma patient if they can protect airway

85
Q 
The main indication for mask cpap is?
A.  reversal of post surgery atelectasis
b.  cardiogenic pulmonary edema
C.  COPD
D.  hypercapnic respiratory failure
A

B. cardiogenic pulm edema

86
Q

Mask cpap will:
A. increase FRC
B. Prevent collapse of alveoli
C. stabilize chest wall during flail chest
D. can be used during hypoxemia if they can ventilate
E. all of the above

A

E. all of the above

87
Q

Mask CPAP requires a pf ratio in what range?

A

above 100 and below 250

88
Q

T or F: system pressure should decrease no more than 1-2 cm at inspiration to illustrate adequate flow

89
Q

T or F: Gastric insufflation is a hazard of mask cpap

90
Q

What are the 2 types of CPAP

A

Downs flow generator

Free standing CPAP system

91
Q

Which type is lightweight & portable?

A

Downs Flow

92
Q 
In a downs flow generator what controls FIO2?
A.  Entrained air
B.  one way valve
C.  Flow generated
D.  Needle valves
A

D. needle valves

93
Q

T or F: In the free standing CPAP system one disadvantage is that adjustments are not independent.

A

False; this happens in Downs flow generator

94
Q

T or F: in the downs flow generator it can be affected by backpressure

95
Q

T or F: an aerosol bag must accompany the free standing cpap as a reservoir chamber.

A

False; water trap must be solid as peep cannot stabilize

Capnography (2 decks)

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