Special Procedures - Test Your Knowledge (Workbook)

Question 1

A 53 year old male patient is in the ICU for pneumonia secondary to pneumocystis jiroveci. The physician is performing a flexible bronchoscopy procedure. During the procedure, the physician reports that there is localized hemorrhaging at the biopsy site. The pulmonary function technologist should recommend

A. a saline lavage
B. administration of epinephrine
C. insertion of a fogarty catheter
D. compression at the biopsy site

Answer 1

B. administration of epinephrine

*page D-7

saline lavage and time, and compression of biopsy site are also good choices, but epinephrine should be chosen for “serious” bleeding.

Question 2

The technologist has obtained a blood gas from a patient. After obtaining the sample, the technologist begins calibration of the pulmonary function equipment and the blood sample is left at the patient’s bedside. Thirty minutes later, the technologist runs the blood sample and obtains the following results:

pH 7.48
PaCO2 25 torr
PaO2 100 torr
HCO3 25 mEq/L

Based on this information, the technologist should expect that the sample

A. values will be inaccurate
B. needs to be re-drawn
C. analysis time has no effect on the results
D. will require heating before analysis

Answer 2

A. values will be inaccurate

Question 3

A patient is currently enrolled in a 6 week smoking cessation program through the local hospital. the technologist can monitor abstinence of cigarette smoking in the participant by utilizing which of the following?

A. pulse oximetry
B. FECO levels
C. capnography
D. NIOX testing

Answer 3

B. FECO levels

“fraction of expired carbon monoxide” levels

*page D-37

Exhaled CO levels are a good way to monitor compliance.

Carboxyhemoglobin measurement (COHb) is another good method.

Cotinine levels (byproduct of the breakdown of nicotine) in the urine are another method detectable up to 4 days after smoking.

Pulse oximetry, capnography, and NIOX testing do not measure CO or cotinine.

Question 4

All of the following could cause a capnograph reading to change from 32 to 22 torr EXCEPT

A. hypovolemia
B. cardiac compressions
C. pulmonary embolism
D. hyperventilation

Answer 4

B. cardiac compressions

No information available in the study guide to support this answer.

Hypovolemia (low blood volume) decreases diffusion. PE would decrease diffusion via shunting. Hyperventilation would decrease CO2 concentration.

By process of elimination, you can conclude B may be the best answer.

Question 5

A patient has participated in a smoking cessation program for the past four weeks. At the weekly scheduled meeting, the patient complains that he is still experiencing strong cravings for cigarettes despite the group counseling and behavioral modification techniques he has been practicing. The technologist should recommend the administration of

A. Zyban
B. Chantix
C. Ativan
D. Valium

Answer 5

B. Chantix

*page D-37

Varenicline (Chantix) is used to treat nicotine addiction. It reduces cravings and can help patient’s quit smoking.

Zyban is an antidepressant
Ativan and Valium are anxiolytics.

Question 6

Which of the following is/are considered medical waste products?

1. unit dose medication vials
2. culture dishes
3. human blood
4. ?? (no option given in workbook) error

A. 2 and 3 only
B. 1 and 2 only
C. 3 and 4 only
D. 1 and 4 only

Answer 6

A. 2 and 3 only

*page D-40

Medical waste is defined as biohazardous or sharps waste.

Culture dishes and human blood are listed as biohazardous waste.

Question 7

A technologist is performing daily MIP and MEP measurements on each patient in the ICU that is being mechanically ventilated. Which of the following is the best method for preventing cross contamination while utilizing the same manometer for each patient?

A. handwashing before and after the procedure
B. rinsing the manometer with water in between patients
C. wiping the manometer with alcohol
D. use of one-way valves to prevent re-breathing

Answer 7

D. use of one-way valves to prevent re-breathing.

*page D-40 (top of page)

“…equipment used with multiple patients should have one-way valves or personal sampling chambers to prevent cross infection.”

Question 8

All of the following are considered routes of transmission of infections EXCEPT

A. airborne droplet nuclei
B. respiratory droplets
C. indirect contact
D. patient room placement.

Answer 8

D. patient room placement

*page D-39

Routes of transmission:

contact (direct and indirect)
respiratory droplets
airborne droplet nuclei

Question 9

A technologist is reviewing the current smoking cessation program for the hospital. Which of the following strategies should be included for all patients to ensure that the hospital has a comprehensive program?

1. nicotine replacement therapy
2. patient education
3. oxygen therapy
4. stress reduction

A. 1, 3, and 4 only
B. 2 and 3 only
C. 2, 3, and 4 only
D. 1, 2, and 4 only

Answer 9

D. 1, 2, and 4 only

*page D-37

All of the choices are valid, but option 3 is only recommended if indicated (not necessary)

All of the choices except D include option 3. They should all be eliminated.

*remember to recommend group counseling/support and nicotine replacement therapy when asked about the best methods to help a patient quit smoking.

Question 10

What is the correct interpretation of the following arterial blood gas:

pH 7.28
PaCO2 32 torr
PaO2 90 torr
HCO3 15 mEq/L

A. acute respiratory acidosis
B. partially compensated metabolic acidosis
C. chronic metabolic alkalosis
D. acute respiratory alkalosis

Answer 10

B. partially compensated metabolic acidosis

If you need help, use the ABG ninja website to practice blood gas interpretation.

Question 11

Which of the following should the technologist administer to a patient to control coughing?

A. cetacaine
B. midazolam
C. lorazepam
D. ipratropium

Answer 11

A. cetacaine

*page D-8

“-caine” is a local anaesthetic. it will suppress a cough.

“-lam” and “-pam” are sedatives.

ipratropium is an anti-cholinergic.

Question 12

A modified Allen’s Test should be performed before

A. capillary blood sampling
B. venipuncture
C. radial artery puncture
D. rigid bronchoscopy

Answer 12

C. radial artery puncture

*page D-10

“The modified Allen’s Test is used to assess the collateral circulation in the hand prior to drawing a radial ABG.”

Question 13

The pulmonary function technologist notes the following information in the patient’s chart:

pH 7.48
PaCO2 25 torr
PaO2 100 torr
HCO3 25 mEq/L

Heart rate 120
Respiratory rate 25
Blood pressure 130/85
FiO2 40%

What is the patient’s PAO2?

A. 200 torr
B. 255 torr
C. 280 torr
D. 315 torr

Answer 13

B. 255 torr

The question is asking you to perform the alveolar air equation to determine PAO2.

PAO2 = (FiO2 x 7) - PaCO2, and the resulting value is the best possible PAO2 for the patient. (the answer will be close or exactly the same, but cannot be higher)

Question 14

The technologist notes the following information in the patient’s chart:

pH 7.48
PaCO2 25 torr
PaO2 100 torr
HCO3 25 mEq/L

Heart rate 120
Respiratory rate 25
Blood pressure 130/85
FiO2 40%

What is the patient’s A-aDO2?

A. 155 torr
B. 230 torr
C. 300 torr
D. 355 torr

Answer 14

A. 155 torr

The question is asking for the patients A-a gradient.

To find the answer you need PAO2 (from the AA equation) as well as PaCO2 and PaO2 from an ABG. both are given.

PAO2 = (FiO2 x 7) - PaCO2

result is 255.

A - a = answer

255 - 100 = 155

Question 15

A patient being monitored with pulse oximetry has an SpO2 of 85%. What is the patient’s estimated PaO2?

A. 55 torr
B. 60 torr
C. 85 torr
D. 100 torr

Answer 15

A. 55 torr

*page D-20

40, 50, 60 rule. The typical difference between SpO2 and PaO2 is 30.

Question 16

What is the most appropriate process to disinfect an oximeter probe after patient use?

A. soak in alkaline glutaraldehyde
B. pasteurization
C. expose to ethylene oxide
D. wipe with alcohol

Answer 16

D. wipe with alcohol

*page D-31

“clean probe with alcohol swab to disinfect. Do not submerge in any solution.”

Question 17

The attending physician suspects a patient has been exposed to carbon monoxide gas. The most accurate method to confirm the diagnosis is by

A. arterial blood gas analysis
B. hemoximetry
C. overnight pulse oximetry
D. bronchoscopy

Answer 17

B. hemoximetry

*page D-32

“Co-oximetry” and “hemoximetry” are the same. They are used to diagnose carbon monoxide poisoning.

Associate co-oximetry/hemoximetry with carbon monoxide and COHb.

Question 18

What is the normal range for ETCO2?

A. 3-5%
B. 8-11%
C. 20-30%
D. 35-45%

Answer 18

A. 3-5%

*page D-34

“ETCO2 can also be displayed as a %. Normal value is 3-5%.”

Normal PETCO2 is 30 torr. Expressed as a percent, normal is 3-5%.

Question 19

What is the primary cause of nosocomial infection?

A. droplet nuclei
B. airborne pathogens
C. contaminated equipment
D. poor handwashing technique

Answer 19

D. poor handwashing technique

*page D-38

Question 20

All of the following are benefits of pulmonary rehabilitation EXCEPT

A. decreased frequency of hospitalizations
B. improved appetite
C. decreased ability to perform ADL
D. improved diaphragmatic breathing

Answer 20

C. decreased ability to perform ADL

All of the options except C are listed on page D-42 of the study guide.

Choice C is not beneficial to the patient.

Note: “decreased frenquency of hospitalizations” should be a primary objective of pulmonary rehabilitation.