Respiratory Final Exam

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1

Which agency is responsible for the regulations that govern the manufacture, storage and transport of compressed gases?

a. bureau of medical gases

b. compressed gas association CGA

c. U.S department of transportation DOT

d. U.S food and drug administration

c. DOT

2

Which agency designed the safety systems for outlet connections of cylinder valves?

a. CGA

b. Z-79 commitee

c. FDA

d. ANSI

A

3

Which of the following agencies makes recommendations for medical air supply?

a. International safety organization

b. NFPA

c. CGA

d. Bureau of medical devices

B. NFPA

4

Safety systems for medical gases are recommended and provided by the?

CGA

5

The color codes for cylinders are prescribed by the

A. U.S National Formulary

b. CGA

c. FAA

d. American standard association

A. U.S national formulary

6

Which agency sets purity standards for medical gases?

a. CGA

b. DOT

c. FDA

d. ISO

C

7

You are walking your patient with an oxygen cylinder with a thorpe tube flowmeter set at 2 LPM. The tubing is causing 10 psi of backpressure. What flow is the patient actually getting from the flowmeter?

a. 2 lpm

b. <2 lpm

c. 4 lpm

d. 6 lpm

A

8

You are walking your patient with an oxygen cylinder with a Bourdon flowmeter set at 5 LPM. The tubing is causing 10 psi of backpressure. What flow is the patient actually getting from the flowmeter?

a. 2 lpm

b. 5 lpm

c. 8 lpm

d. 10 lpm

A

9

According to the AARC CPG, which of the following are considered precautions or complications of oxygen therapy?

I. PaO2>60 mmHg in spontaneously breathing patients with chronically elevated PaCO2

II. With a FiO2 >0.5 there is a risk of oxygen toxicity and/or absorption atelectasis

III. During laser bronchoscopy

IV. Acute myocardial infarction

a. I,II,IV

b. II,III,IV

c.I,II,III

d. I,II,III,IV

C

10

Upon arrival to the ED, the RRT finds a patient to have a SpO2 of 80% on a NRM. The RRT notices that the NRM is attached to a bubble humidifier. The humidifier bottle is whistling and looks expanded. What action should the RRT take?

a. change the bubble humidifier, it is defective

b. remove the NRM from the buble humidifier and run the mask with oxygen

c. check for kinks in the oxygen tubing

d/ place the patient on a NC

B

11

The most accurate way to provide a variety of FiO2's is through a

a. oxygen tent

b. oxygen hood

c. venti mask

d. blender

D

12

A patient is on a 35% venti mask. The patient needs to eat. What liter nasal cannula should the RRT provide for the patient?

a. 2 LPM

b. 4 LPM

c. 5 LPM

d. 6 LPM

B

13

To ensure a stable FiO2 under varying patient demands, what must an O2 delivery system do?

a. have a reservoir system at least equal to the Vt

b. provide all the gas needed by the patient during inspiration

c. maintain flows that are just below the patients peak demands

d. be able to deliver any concentration drom 21-100%

B

14

You notice that the air intake ports surrounding the jet of a 35% air-entrainment mask are partially obstructed by the patients bedding. which of the following would you expect?

I. decrease in the devices total flow output

II. increase in the percent oxygen delivered by the device

III. decrease in the percent oxygen delivered by the device

IV. increase in roomm air en-trained by the patient

a. I,III,IV

b. III and IV

c. I and II

d. I, II, IV

D

15

Specific clinical objectives of oxygen therapy include which of the following:

I. decrease the symptoms caused by chronic hypoxemia

II. decrease the workload hypoxemia imposes on the heart and lungs

III. correct documented arterial hypoxemia

a. I and II

b. I and III

c. II and III

d. I, II, III

D

16

Potential uses for inhaled NO include all of the following except:

a. acute respiratory distress syndrome

b. status asthmaticus

c. primary pulmonary hypertension

d. persistent pulmonary hypertension of the newborn

B

17

The following are the indications for home oxygen when the patient is breathing room air:

I. PaO2 < 55 mmHg

II. PaO2 > 55 mmHg

III. SaO2 > 88 %

IV. SaO2 < 88%

V. PaO2 of 56-59 mmHg with erythrocythemia

a. II,III,V

b. I, IV, V

c. I and IV

d. II and III

B

18

Which of the following is false about multi place hyperbaric oxygenation chambers?

a. air locks allow entra and egress of caregivers

b. the chamber is filled with 100% O2

c. pressure of 6 ATA or more can be applied

d. care can be provided directly within the chamber.

B

19

A physician wants a stable FiO2 of 0.5 for a newborn infant with severe hypoxemia. Which of the following systems would you select?

a. O2 hood with blender with cool large volume nebulizer

b. pediatric venti mask

c. O2 hood with blender and heated humidifier

d. incubator with O2 set at 10 LPM

C

20

Which of the following is classified as a nonflammable gas that does not support combustion?

a. oxygen

b. carbon dioxide

c. helium

d. nitric oxide

B

21

Medical gas cylinders are color coded for easy identification. E cylinders of carbon dioxide are painted:

a. yellow

b. green

c. black

d. Gray

D

22

A respiratory therapist is having trouble attaching a regulator to an E cylinder, one possible cause might be:

a. The outlet threads of the cylinder do not match the threads of the regulator

b. the regulator diaphragm is jammed

c. the pin positions of the regulator are not the same as those on the cylinder

d. the cylinder has not been cracked

C

23

Bulk liquid oxygen supplies should not be closer than _______ to public sidewalks.

a. 2 ft

b. 4 ft

c. 7 ft

d. 10 ft

D

24

Calculate the duration of the liquid oxygen supply if the liquid supply weighs 30 pounds and the oxygen demand is 4 LPM.

a. 10 hours

b. 23 hours

c. 35 hours

d. 43 hours

D

25

Calculate the duration of oxygen flow from an H cylinder containing 1200 psi of oxygen when the flow to a nasal cannula is 4 LPM

a. 9 hours, 42 mins

b. 12 hours, 15 mins

c. 15 hours, 42 mina

d. 16 hours, 10 mins

C

26

Large Piston air compressors used in bulk supply systems typically can provide working pressures of:

a. 50 psi

b. 75 psi

c. 100 psi

d. 120 psi

A

27

Alternating supply systems for medical gases that are used in hospitals should include a reserve supply for oxygen in case the primary system fails. How much reserve oxygen should be available?

a. an average 8 hr supply

b. an average days supply

c. an average 3 days supply

d. an average weeks supply

B

28

Oxygen concentrators that use semipermeable membranes usually can provide what percentage of oxygen at flows of 1-10 LPM?

a. 24%

b. 40%

c. 60%

d. 100%

B

29

The percentage of oxygen delivery provided by molecular seive O2 concentrators depends on which of the following factors?

1. the size of the concentrator

2. the rate of gas flow

3. the temperature of the refrigeration unit

4. the age of the sieve beds

a. 2 only

b. 1 and 4 only

c. 1,2, and 3

d. 1, 2, and 4

B

30

The pressure inside of a cylinder increases dramatically when the cylinder is exposed to extremely high temperatures. What prevents cylinders with frangible disks from exploding when exposed to extremely high temperatures.

a. The frangible disk ruptures from the increased pressure, allowing gas to escape from the cylinder.

b. The cylinder stem blows off when the tempt reaches 93.3%

c. The stem diaphragm ruptures, allowing gas to escape

d. The frangible disk melts when the tempt reaches 37.8%

A

31

A respiratory therapist is checking cylinder markings to determine whether any of the cylinders need to be tested. The labeling reads as follows:

9 83%

6 94%

This information indicates:

a. the cylinder is due for retesting

b. the time between the test dates shown exceeds recommendations

c. the cylinder is made of aluminum

d. the owner of the cylinder

B

32

Before using an H cylinder of oxygen, a respiratory therapist opens it, and gas at high pressure comes out of the cylinder outlet. which of the following statements are true?

a. this was an accident and should not be repeated

b. allowing gas to escape from the cylinder lets the therapist smell the gas to ensure that it is O2

c. this action clears debris from the connector

d. this action should be performed after a regulator is attached to the cylinder outlet

C

33

A respiratory therapist is helping design a new hospital wing. Which of the following agencies should be contacted so that the piping system of oxygen and air is correctly installed.

a. NFPA

b. FDA

c. HHS

d. DOT

A

34

What is point of care testing?

Testing that is done at the patients location by the use of portable devices/

35

PetCo2

measures the concentration of exhale CO2 at the end tidal phase.

36

SaO2%

Measures that oxygen saturation level in hemoglobin of arterial blood

37

SpO2%

measures the percentage of Hb molecules that are bound to oxygen by pulse oximeter

38

SaCO%

measures the saturation of carboxyhemoglobin in arterial blood.

39

PtcO2

measures transcutaneous arterial oxygen level

40

VO2

measures oxygen consumption

41

VCO2

Measures CO2 production

42

What is the principle by which oxi-meters work?

Spectrophotometry. Oxyhemoglobin absorb more infrared light. Deoxyhemoglonin absorb more red light.

43

What temperature range is acceptable for heating trans-cutaneous electrodes?

42-45 degrees celcius

44

What two analyzers are used to measure NO and NO2

Chemiluminescence monitoring

Electrochemical monitoring

45

What are two hazards of mainstream capnography?

1. increased possibility of dislodgement

2. Increased dead space

46

What is the method of choice for measuring exhaled carbon dioxide in the ICU?

Infrared

47

Sanz electrodes measure:

PH

48

Clark electrodes measure:

PO2

49

Stowe-Severing Haus electrodes measure:

PCO2

50

You are the RRT who is assessing the PetCO2 during a code. The monitor is sudden;y reading 35 mmHg and has been for several minutes. What does this indicate?

A return of spontaneous circulation

51

What 3 things are usually measured by a pulse oximeter?

Arterial SO2

Pulse rate

Perfusion index

52

What 5 values are measured with a co-oximeter?

O2Hb

HbCO

metHb

HbF

SulfHb

53

What is the method of choice for measuring exhaled carbon dioxide in the ICU?

Infrared capnography

54

How much lower is an end tidal CO2 level compared to an arterial CO2 value and what time normal end tidal value should be

PetCo2 is 4-6 mmHg lower than PaCO2.

Normal PetCo2 is 29-51 mmHg

55

Know what ABG values reflect oxygenation and which represent ventilation

Oxygenation: PaO2, SaO2

Ventilation: PaCO2, pH

56

Using end tidal CO2 monitoring, know how to diagnose a pulmonary embolism

If there is a dramatic increase in patients PeCO2-PaCO2 then there may be a pulmonary embolism

57

Using end tidal CO2 monitoring, know what the results mean in relation to CPR

<10 mmHg during CPR indicated that the quality of chest compressions needs improvement. High quality chest compression are achieved when the ETCO2 value is at least 10-29 mmHG

58

Know what each of the following measure:

pulse ox

wright spirometer

NIF meter

peak flow meter

  • Pulse ox measures oxygen saturation
  • Peak flow evaluates an asthmatic patient expiratory pressure
  • NIF (MIP) measures a patient's neuromuscular strength (the diaphragm)
  • Wright spirometer measure the minute ventilation and vital capacity
59

The humidity deficit of a patient with an endotracheal tube and a heated humidifier with a heated wire circuit set at BTPS is approximately _______ H20/L

0

60

This device is used to generate and disperse small particles of water to provide additional water content.

a humidifier

b. inhaler

c. nebulizer

d. respirator

C

61

Which of the following inspired conditions should be maintained when delivering medical gases directly into the trachea through an endotracheal tube or a tracheostomy tube?

a. 50% RH at 20 to 22

b. 100% RH at 37 to 47

c. 95% RH at 29 to 32

d. 100 % RH at 32 to 35

D

62

Which of the following factors cause the isothermic saturation boundary to shift further down into the airways?

I, decreased ambient tempt

II. increased tidal volume

III. endotracheal intubation

a. I and II

b. II and III

c.I,II, and III

C

63

What are some potential problems with manually refilled heated humidifier reservoirs?

I. cross contamination

II. variable compliance or delivered volume

III. delivery of dry and or hot gases

a. I and II

b. II and III

c. I only

d. I, II, and III

D

64

Which of the following are beneficial effects of using a holding chamber with a metered dose inhaler?

I. reduction in oropharyngeal aerosol deposition

II. decrease in need for hand breath coordination

III. elimination of medication waste

a. I and II

b. I and III

c. II and III

d. I, II and III

A

65

When absolute humidity is constant and the temperature of the gas is increased, the:

a. relative humidity decreases

b. capacity decreases

c. water content increases

d. relative humidity increases

A

66

Which of the following devices can be used to deliver continuous bland aerosol?

I. Face tent

II. Simple mask

III. NRM

IV, Tracheostomy collar

a. I only

b. I and IV

c. II and III

d. II, III, IV

...

67

Indications for warming inspired gases include all of the following except:

a. treating a patient whose airways are reactive to cold

b. providing humidification when the upper airway is bypassed

c. treating a patient with a low body tempt (Hypothermia)

d. reducing upper airway inflammation or swelling

D

68

Inhalation of dry gases can do which of the following?

I. increase viscosity of secretion

II. impair mucociliary motility

III. increase airway irritability

a. I and II

b. III only

c. I , II and III

d. i and III

C

69

According to the AARC CPG hazards and complications of bland aerosol therapy include all of the following except:

a. bronchospasm

b. overhydration

c. infection

d. hemoconcentration

D

70

A physician wants to deliver a therapeutic aerosol to the central and lower airways. To help ensure max deposition in this area, you would select an aerosol generator with an MMAD in what range?

a. 5-20

b. 2 to 5

c. 1 to 3

d. less than 1

B

71

A physician wants to deliver a therapeutic aerosol to the lung parenchyma. To help ensure max deposition in this area, you would select an aerosol generator with an MMAD in what range?

a. 5-20

b. 2 to 5

c. 1 to 3

d. less than 1

C

72

A device that adds molecular water to gas is called a(n):

a. Humidifier

b. inhaler

c. nebulizer

d. respirator

A