Description

INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS

 

 

Mosbys Respiratory Care Equipment 9th Edition By J.M. Cairo – Test Bank

 

 

Sample  Questions

 

Chapter 03: Manufacture, Storage, and Transport of Medical Gases

 

MULTIPLE CHOICE

 

  1. Which of the following gases support combustion?

Air

Oxygen

Helium

Carbon Dioxide

 

a. 2 only c. 2, 3
b. 1, 2 d. 1, 3, 4

 

 

ANS:  B

Oxygen and air support combustion.  Helium and carbon dioxide are not flammable

 

PTS:   1                    REF:   Page 57, Table 3-2

 

  1. Which of the following gases is the least dense?
a. Carbon dioxide c. Helium
b. Nitrous oxide d. Air

 

 

ANS:  C

Helium is the second-lightest element, with a density of 0.165 kg/m3 at 21.1° C and 1 atmospheric pressure (atm). Oxygen is slightly heavier than air, with a density of 1.326 kg/m3 at 21.1° C and 760 mm Hg.

 

PTS:   1                    REF:   Page 57, Table 3-3

 

  1. Which gas has been used successfully in the treatment of pulmonary hypertension of the newborn?
a. Oxygen c. Nitrous oxide
b. Nitric oxide d. Helium-oxygen mixture

 

 

ANS:  B

At very low concentrations (2 to 80 parts per million) combined with oxygen, nitric oxide has been used to successfully treat persistent pulmonary hypertension of the newborn. Nitrous oxide is used as a central nervous system depressant (anesthetic). Helium-oxygen mixtures decrease the work of breathing by decreasing turbulent airflow.

 

PTS:   1                    REF:   Page 56

 

  1. In high concentrations, which of the following gases is a potent anesthetic?
a. Nitric oxide c. Carbon dioxide
b. Nitrous oxide d. Helium-oxygen mixture

 

 

ANS:  B

The major use for nitrous oxide is a central nervous system depressant. As such, it is a potent anesthetic when administered in high concentrations. At very low concentrations (2 to 80 parts per million) combined with oxygen, nitric oxide has been used successfully to treat persistent pulmonary hypertension of the newborn. Carbon dioxide is nonflammable, but it supports combustion. Helium-oxygen mixtures decrease the work of breathing by decreasing turbulent airflow.

 

PTS:   1                    REF:   Page 56

 

  1. Which of the following gases is used to decrease the work of breathing associated with severe airway obstruction?
a. Nitric oxide c. Helium-oxygen mixture
b. Nitrous oxide d. Carbon dioxide–oxygen mixture

 

 

ANS:  C

A helium-oxygen mixture decreases the work of breathing by decreasing turbulent airflow.

 

PTS:   1                    REF:   Page 56

 

  1. Chemical pneumonitis and pulmonary edema can be caused by which of the following?
a. Nitrous oxide
b. Carbon dioxide
c. Excess amounts of nitric oxide
d. A combination of nitric oxide and nitrogen dioxide

 

 

ANS:  D

Nitric oxide and nitrogen dioxide combine to form a potent irritant that can cause chemical pneumonitis and pulmonary edema. Nitrous oxide, which is nicknamed laughing gas, can cause brain damage or death if inhaled without a sufficient oxygen supply.

 

PTS:   1                    REF:   Page 56

 

  1. Carbon dioxide can be obtained by which of the following methods?
a. Heating uranium ore
b. Combustion of natural gas
c. Fractional distillation of liquid air
d. Oxidizing ammonia at high temperatures

 

 

ANS:  B

Unrefined carbon dioxide can be obtained from the combustion of coal, natural gas, or other carbonaceous fuels. Helium can be obtained by heating uranium ore. The two methods most commonly used to prepare oxygen are the fractional distillation of liquid air and the physical separation of atmospheric air. Nitric oxide can be prepared by oxidizing ammonia at high temperatures (i.e., 500° C and above).

 

PTS:   1                    REF:   Page 55

 

  1. Which agency is responsible for the regulations that govern the manufacture, storage, and transport of compressed gases?
a. Bureau of Medical Devices
b. Compressed Gas Association (CGA)
c. U.S. Department of Transportation (DOT)
d. U.S. Food and Drug Administration (FDA)

 

 

ANS:  C

Metal cylinders have been used for storing compressed gases since 1888. Federal regulations issued by the DOT require that all cylinders used to store and transport compressed gases conform to specifications. The FDA sets purity standards for medical gas. The CGA provides standards and safety systems for compressed gas systems.

 

PTS:   1                    REF:   Page 57

 

  1. Which agency sets purity standards for medical gases?
a. CGA
b. DOT
c. FDA
d. International Standards Organization (ISO)

 

 

ANS:  C

The FDA sets purity standards for medical gas. The DOT governs the manufacture, storage, and transport of compressed gases. The CGA sets standards and provides safety systems for compressed gas systems. The ISO is an international agency that sets standards for technology.

 

PTS:   1                    REF:   Page 55, Box 3-2

 

  1. Safety systems for medical gases are recommended and provided by:
a. DOT.
b. CGA.
c. FDA.
d. National Fire Protection Association (NFPA).

 

 

ANS:  B

The CGA sets standards and provides safety systems for compressed gas systems. The FDA sets purity standards for medical gas. The DOT regulates the manufacture, storage, and transport of compressed gases. The NFPA is an independent agency that provides information on fire protection and safety.

 

PTS:   1                    REF:   Page 54, Box 3-2

 

  1. A cylinder has “DOT 3AA 2015” stamped on it. What does the 3AA stand for?
a. Ownership mark c. Non–heat-treated carbon-steel
b. Manufacturer’s mark d. Heat-treated, high-strength steel

 

 

ANS:  D

3AA stands for heat-treated, high-strength steel. Type 3A cylinders are made of carbon-steel (non–heat-treated).

 

PTS:   1                    REF:   Page 57

 

  1. A cylinder has “DOT 3AL 2015” stamped on it. What does the 3AL stand for?
a. Manufacturer’s initials
b. Constructed of heat-treated, high-strength steel
c. Required to undergo hydrostatic testing every 3 years
d. Constructed of specially prescribed seamless aluminum alloys

 

 

ANS:  D

3AL means that the cylinder is constructed of specially prescribed seamless aluminum alloys and must be examined every 5 years to test its expansion characteristics. Type 3AA is constructed of heat-treated, high-strength steel.

 

PTS:   1                    REF:   Page 57

 

  1. Which type of cylinder is produced from non–heat-treated carbon-steel?
a. 3 c. 3AA
b. 3A d. 3AAA

 

 

ANS:  B

3AA means heat-treated, high-strength steel; 3 and 3AAA are not applicable.

 

PTS:   1                    REF:   Page 56

 

  1. If the maximum filling pressure is marked as 2050 lb-force per square inch gauge (psig), this cylinder is capable of holding _____ psig.
a. 1845 c. 2255
b. 2050 d. 2460

 

 

ANS:  C

Compressed gas cylinders should be capable of holding up to 10% more than the maximum filling pressure as marked. 10% ´ 2050 = 205 + 2050 = 2255 psig.

 

PTS:   1                    REF:   Page 57

 

  1. An asterisk following the reexamination date on a cylinder indicates that the cylinder:
a. has passed the test. c. must be retested every 10 years.
b. must be retested every 5 years. d. has been sold to another company.

 

 

ANS:  C

An asterisk after the reexamination date on the cylinder markings (see Figure 3-4) indicates that the cylinder must be retested every 10 years.

 

PTS:   1                    REF:   Page 57

 

  1. Which size cylinder would be most appropriate for use during patient transport?
a. H c. M
b. G d. E

 

 

ANS:  D

Size “E” cylinders are used for emergencies and for transport. The other cylinders are too large to be used for transport.

 

PTS:   1                    REF:   Page 60

 

  1. Which of the following is not marked on a cylinder?
a. Ownership marks
b. Method of production
c. Serial number of the cylinder
d. Type of material used to construct the cylinder

 

 

ANS:  B

The method of production is not required to be on the cylinder. All the other options are a requirement.

 

PTS:   1                    REF:   Pages 60-61

 

  1. A plus sign after an examination date indicates that the cylinder:
a. may be retested in 5 years.
b. may be retested in 10 years.
c. has been sold to another company.
d. has complied with the requirements of the test.

 

 

ANS:  D

The plus sign means that the cylinder has complied with the requirements of the test. An asterisk following the reexamination date on the cylinder markings indicates that the cylinder must be retested every 10 years.

 

PTS:   1                    REF:   Page 61

 

  1. The color codes for cylinders are prescribed by the:
a. U.S. National Formulary. c. FDA.
b. CGA. d. American Standards Association.

 

 

ANS:  A

The U.S. National Formulary sets the color-code standards.

 

PTS:   1                    REF:   Page 61

 

  1. What is the cylinder color for nitrous oxide?
a. Red c. Brown
b. Black and white d. Light blue

 

 

ANS:  D

Nitrous oxide is light blue. Ethylene is red. Compressed air is black and white. Helium is brown. See Table 3-4.

 

PTS:   1                    REF:   Page 61, Table 3-4

 

  1. What is the international color code for compressed air?
a. Gray c. Yellow
b. Black d. Black and white

 

 

ANS:  D

The international color code for compressed air is black and white. Yellow is the color set by the U.S. National Formulary.

 

PTS:   1                    REF:   Page 61

 

  1. Which of the following appear(s) on the labels of gas cylinders?
  2. Chemical symbol of the contents
  3. Precautionary measures for the gas
  4. Specific hazards related to use of the gas
  5. Volume of the cylinder marked in liters at 70° F
a. 1 c. 1, 2, and 3
b. 1 and 4 d. 1, 2, 3, and 4

 

 

ANS:  D

The CGA and the American Standards Association specify that all labels should include the chemical symbol of the contents, precautionary measures, specific hazards related to the gas, and the volume of the cylinder marked in liters at 70° F.

 

PTS:   1                    REF:   Page 62

 

  1. Which agency sets standards for the purity of medical gases?
a. U.S. National Formulary c. FDA
b. CGA d. American Standards Association

 

 

ANS:  C

Only the FDA sets the purity standards for medical gases.

 

PTS:   1                    REF:   Page 62

 

  1. A 97% purity standard is required for which of the following gases?
a. Ethylene c. Nitric oxide
b. Nitrogen d. Nitrous oxide

 

 

ANS:  D

See Table 3-4.

 

PTS:   1                    REF:   Page 61, Table 3-4

 

  1. What is the purity standard for oxygen?
a. 99% c. 97%
b. 98% d. 95%

 

 

ANS:  A

See Table 3-4.

 

PTS:   1                    REF:   Page 61, Table 3-5

 

  1. Which of the following statement(s) is (are) true about cylinder valves?
  2. Diaphragm valves can withstand pressure greater than 1500 psig.
  3. Direct-acting valves are used for pressure less than 1500 psig.
  4. Diaphragm valves should be used with flammable gases.
  5. Leakage cannot occur with direct-acting valves.
a. 3 c. 2 and 3
b. 1 d. 1 and 4

 

 

ANS:  A

Diaphragm valves can withstand pressures less than 1500 psig and should be used with flammable gases because they do not allow leaks. A direct-acting valve contains two washers and a Teflon packing to prevent gas leakage around the threads.

 

PTS:   1                    REF:   Page 63

 

  1. Which of the following statement(s) is (are) not true about cylinder valves?
  2. Diaphragm valves cannot withstand pressure greater than 1500 psig.
  3. Direct-acting valves are used for pressure greater than 1500 psig.
  4. Diaphragm valves should not be used with anesthetic gases.
  5. Stem leakage can occur with direct-acting valves.
a. 3 c. 1 and 4
b. 2 and 4 d. 1, 2, and 3

 

 

ANS:  A

Diaphragm valves are ideal for situations in which no gas leaks can be allowed, such as with flammable anesthetics.

 

PTS:   1                    REF:   Page 63

 

  1. Which of the following statement(s) is (are) true about diaphragm type of valves?
  2. A partial rotation of a diaphragm type of valve will not open the stem.
  3. The valve seat in a diaphragm type of valve does not turn.
  4. The diaphragm type of valve contains two fiber washers.
  5. The diaphragm type of valve uses a threaded stem.
a. 2 c. 3 and 4
b. 1 and 4 d. 2 and 4

 

 

ANS:  D

The valve seat does not turn and is therefore resistant to scoring; it also uses a threaded stem in place of the packing found on the direct-acting valves. The direct-acting valve has two fiber washers.

 

PTS:   1                    REF:   Page 63

 

  1. The diaphragms of a diaphragm type of valve are made of:
  2. steel.
  3. copper.
  4. aluminum.
  5. chrome-molybdenum.
a. 2 c. 3 and 4
b. 2 and 3 d. 1 and 2

 

 

ANS:  D

The diaphragm type of valve has two diaphragms, one made of steel and one made of copper. Aluminum and chrome-molybdenum are metals that are used in the construction of cylinders.

 

PTS:   1                    REF:   Page 63

 

  1. Wood’s metal is used to make:
a. gas cylinders.
b. fusible-plug pressure-relief valves.
c. rupture-disk pressure-relief valves.
d. spring-loaded pressure-relief devices.

 

 

ANS:  B

Fusible-plug pressure-relief valves are made of a metal alloy that melts when the temperature of the gas in the tank exceeds a predetermined temperature. This is called Wood’s metal.

 

PTS:   1                    REF:   Page 64

 

  1. Which type of valve operates on the principle that as the pressure in a cylinder increases, the temperature of the gas increases?
a. Direct-acting valves c. Rupture-disk pressure-relief valves
b. Fusible-plug pressure-relief valves d. Spring-loaded pressure-relief valves

 

 

ANS:  B

Fusible-plug pressure-relief valves operate on the principle that as the pressure in a tank increases, the temperature of the gas increases, causing the plug to melt. Spring-loaded devices are designed to release excessive cylinder pressure and reseal, preventing further release of gas from the cylinder after the cause of the excessive pressure is removed. The rupture-disk will buckle when the pressure inside the cylinder exceeds a certain predetermined limit. Direct-acting valves are not pressure-relief valves; instead, they are controlling devices that seal the contents of a compressed cylinder until it is ready for use.

 

PTS:   1                    REF:   Page 58, Box 3-2

 

  1. Which agency designed the safety systems for outlet connections of cylinder valves?
a. Z-79 Committee
b. CGA
c. FDA
d. American National Standards Institute (ANSI)

 

 

ANS:  B

The CGA designed the safety systems for outlet connections of cylinders. The Z-79 Committee establishes standards for anesthetic and ventilatory devices. The FDA sets purity standards. ANSI is a private nonprofit organization that coordinates the voluntary development of national standards in the United States.

 

PTS:   1                    REF:   Page 64

 

  1. Medical gas cylinder valve outlets always have connections that are _____-handed and _____.
a. right; external c. left; external
b. right; internal d. left; internal

 

 

ANS:  A

External and right-handed is the standard for medical gas cylinder valve outlets.

 

PTS:   1                    REF:   Page 66

 

  1. Which safety system is used with small cylinders, sizes “A” through “E”?
a. Pin Index Safety System
b. Diameter Index Safety System
c. Direct-Acting Valve Safety System
d. American Standard Index Safety System

 

 

ANS:  A

Small cylinders (i.e., sizes “A” to “E”) with post type of valves use a different American Standard indexing system called the Pin Index Safety System.

 

PTS:   1                    REF:   Page 65, Figure 3-8

 

  1. The cylinder outlet diameter for a “G” size oxygen cylinder is _____ inches.
a. 0.830 c. 0.960
b. 0.903 d. 0.965

 

 

ANS:  B

See Figure 3-8.

 

PTS:   1                    REF:   Page 65, Figure 3-8

 

  1. A nitrous oxide “H” size cylinder cannot be attached to oxygen equipment because the nitrous oxide cylinder has which of the following?
  2. A different outlet size
  3. A different thread type
  4. An outer threading system
  5. Internal threading; and oxygen has an external threading
a. 1, 2, 3, and 4 c. 2 and 3
b. 2, 3, and 4 d. 1 and 2

 

 

ANS:  D

See Figure 3-8.

 

PTS:   1                    REF:   Page 65, Figure 3-8

 

  1. Which of the following types of threading does a compressed air cylinder have?
  2. Right-handed
  3. Left-handed
  4. Internal
  5. External
a. 2 and 3 c. 2 and 4
b. 1 and 4 d. 1 and 3

 

 

ANS:  B

See Figure 3-8.

 

PTS:   1                    REF:   Page 66, Figure 3-9

 

  1. What are the pin positions for an “E” size oxygen cylinder?
a. 2 and 4 c. 2 and 6
b. 2 and 5 d. 3 and 5

 

 

ANS:  B

See Figure 3-9.

 

PTS:   1                    REF:   Page 66, Figure 3-9

 

  1. What are the pin positions for an “E” size compressed air cylinder?
a. 1 and 5 c. 2 and 5
b. 1 and 6 d. 3 and 5

 

 

ANS:  A

See Figure 3-9.

 

PTS:   1                    REF:   Page 66, Box 3-4

 

  1. Which of the following procedures should be followed in setting up a compressed gas cylinder at a patient’s bedside?
  2. Inspect the cylinder and valve for dirt, debris, and oil.
  3. Make sure the cylinder is properly secured.
  4. Tighten the regulator with a pipe wrench.
  5. Open the cylinder valve completely.
a. 3 and 4 c. 1, 2, 3, and 4
b. 1 and 2 d. 1, 2, and 4

 

 

ANS:  B

See Box 3-4.

 

PTS:   1                    REF:   Page 66, Box 3-4

 

  1. The best position for the cylinder valve when it is being used is:
a. completely open.
b. two turns toward the left.
c. one turn, open toward the right.
d. one half-turn back from completely open.

 

 

ANS:  D

See Box 3-4.

 

PTS:   1                    REF:   Page 67

 

  1. After connecting an oxygen regulator to an “H” cylinder and turning the direct-acting valve on, the respiratory therapist attempts to turn on the flow of oxygen. The desired gas flow is not achieved. Which of the following is (are) the most likely problem(s)?
  2. The therapist is using the wrong regulator.
  3. The pressure in the cylinder is inadequate.
  4. The regulator outlet is obstructed.
  5. There is a leak in the connection between the cylinder outlet and the regulator.
a. 1 c. 2 and 3
b. 2 and 4 d. 1, 2, and 4

 

 

ANS:  C

Failure to achieve a desired gas flow from a cylinder regulator can result from inadequate pressure or from an obstruction at the regulator outlet. There would be a hissing noise if there was a leak. Safety systems prevent the wrong regulator from fitting an oxygen cylinder.

 

PTS:   1                    REF:   Page 67

 

  1. An “E” size cylinder is turned on, and the flowmeter is off. Which of the following is (are) the most likely cause(s) of a hissing sound?
  2. A cracked flowmeter
  3. Inadequate pressure in the cylinder
  4. An obstruction at the regulator outlet
  5. A leak in the connection between the yoke and the cylinder opening
a. 2 c. 1 and 3
b. 1 and 2 d. 1 and 4

 

 

ANS:  D

A hissing noise means that there is a leak somewhere in the system. Typically, that will occur between the yoke and the cylinder opening or if there is a crack in the flowmeter. Inadequate pressure or an obstruction would not cause a hissing sound.

 

PTS:   1                    REF:   Page 67

 

  1. A full “H” size cylinder is used to provide oxygen to an air-entrainment mask at 6 L/min. If the cylinder is replaced at 500 psig, how long will it last?
a. 5 hours c. 10 hours 50 minutes
b. 10 hours 20 minutes d. 15 hours 23 minutes

 

 

ANS:  D

Amount of time left in cylinder = (cylinder pressure ´ cylinder factor)/flow rate of gas (liters/minute). H cylinder factor = 3.14. Full-size “H” cylinder = 2265 psig. If the cylinder is changed at 500 psi, then 2265 – 500 = 1765 (1765 psi will be used). (3.14 ´ 1765)/6 L/min = 923.7 minutes/60 = 15 hours (0.39 ´ 60) = 15 hours 23 minutes.

 

PTS:   1                    REF:   Page 67, Box 3-5

 

  1. An “E” size cylinder with 1600 psig is used to provide oxygen to a simple mask running at 5 L/min during a transport. The cylinder will last:
a. 8 hours. c. 68 minutes.
b. 56 minutes. d. 89 minutes.

 

 

ANS:  D

Amount of time left in cylinder = (cylinder pressure ´ cylinder factor)/flow rate of gas (liters/minute). “E” size factor = 0.28. A simple mask should run at a minimum of 5 L/min. Therefore, (1600 ´ 0.28)/5 L/min = 448/5 = 89.6 minutes.

 

PTS:   1                    REF:   Page 67, Box 3-5

 

  1. An “E” size oxygen cylinder with 2000 psig in it is being used at 4 L/min. How much will be used in 45 minutes?
a. 26.2 psig c. 180 psig
b. 140 psig d. 643 psig

 

 

ANS:  D

Amount of time left in cylinder = (cylinder pressure ´ cylinder factor)/flow rate of gas (liters/minute). (2000 ´ 0.28)/4 = 140 minutes to use up 2000 psig. Therefore, 2000 psig/140 min = X psig/1 minute X = 14.3 psig/min ´ 45 minutes = 642.8 psig.

 

PTS:   1                    REF:   Page 67, Box 3-5

 

  1. A “G” size oxygen cylinder with 1450 psig is being used at 5 L/min. This cylinder will be empty in approximately _____ hour(s) and _____ minutes.
a. 1; 30 c. 11; 30
b. 2; 39 d. 15; 16

 

 

ANS:  C

Amount of time left in cylinder = (cylinder pressure ´ cylinder factor)/flow rate of gas (liters/minute). “G” size cylinder factor = 2.41. Amount of time = (1450 ´ 2.41)/5 = 698.9 minutes/60 = 11 hours 39 minutes.

 

PTS:   1                    REF:   Page 67, Box 3-5

 

  1. The K cylinder at a patient’s bedside contains 1300 psig and is using 7 L/min. It will take approximately _____ hours to use 800 psig.
a. 3.7 c. 6
b. 9.7 d. 4

 

 

ANS:  C

Amount of time left in cylinder = (cylinder pressure ´ cylinder factor)/flow rate of gas (liters/minute). K factor = 3.14. Time to use 800 psi = (800 ´ 3.14)/7 = 358.8 min/60 = 5 hours 59 minutes.

 

PTS:   1                    REF:   Page 57, Box 3-5

 

  1. The E cylinder on a crash cart contains 900 psig. How long would the cylinder last if used at 10 L/min?
a. 1 hour c. 3 hours 36 minutes
b. 25 minutes d. 4 hours 42 minutes

 

 

ANS:  B

Amount of time left in cylinder = (cylinder pressure ´ cylinder factor)/flow rate of gas (liters/minute). E factor = 0.28. Time to use 900 psig = (900 ´ 0.28)/10 = 25 minutes.

 

PTS:   1                    REF:   Page 67, Box 3-5

 

  1. A “G” size cylinder with 2000 psig is used for 6 hours at 5 L/min. How much gas was used during this time?
a. 2000 psig c. 573 psig
b. 750 psig d. 107 psig

 

 

ANS:  B

Amount of time left in cylinder = (cylinder pressure ´ cylinder factor)/flow rate of gas (liters/minute). G factor = 2.41. Time to use 2000 psig = (2000 ´ 2.42)/5 = 964 minutes/60 = 16 hours. 2000 psig /16 hours = X psig/6 hours. X = 750 psig will be used in 6 hours at 5 L/min.

 

PTS:   1                    REF:   Page 67, Box 3-5

 

  1. Which of the following statements is (are) true with regard to liquid bulk systems?
  2. Liquefied oxygen occupies a fraction of the space required for the storage of gaseous oxygen.
  3. The CGA regulates the construction of liquid oxygen systems.
  4. A bulk oxygen system contains more than 40,000 ft of oxygen.
  5. The working pressure of a liquid bulk oxygen system is 50 psig.
a. 2 c. 1 and 3
b. 3 and 4 d. 1 and 4

 

 

ANS:  D

See Box 3-6.

 

PTS:   1                    REF:   Page 68, Box 3-6

 

  1. The function of the vaporizer of a liquid bulk oxygen system is to:
a. act as a pressure release.
b. reduce the pressure to 50 psig.
c. convert liquid oxygen to gaseous oxygen.
d. allow heat to be released into the environment.

 

 

ANS:  C

The reservoir stores a mixture of liquid and gaseous oxygen. The vaporizer acts as a heat exchanger where heat is absorbed from the environment and used to warm the liquid oxygen to room temperature, thus forming gaseous oxygen.

 

PTS:   1                    REF:   Page 67

 

  1. The gas above liquid oxygen is maintained:
a. between its freezing point and its critical temperature.
b. between its boiling point and its critical temperature.
c. at its critical pressure.
d. at its boiling point.

 

 

ANS:  B

The pressure-release valve allows some of the gas on top of the liquid to escape if the contents are warmed too much. This release of gas allows the gas within the container to expand, thus lowering the temperature. This maintains the gas under pressure between its boiling point and its critical temperature so that the majority of the reservoir’s contents will be maintained in the liquid state.

 

PTS:   1                    REF:   Page 67

 

  1. The application of Gay-Lussac’s law in a bulk liquid oxygen system:
a. accounts for the conversion of the liquid oxygen to gaseous oxygen.
b. allows the reservoir contents to be maintained in the liquid state.
c. keeps the liquid oxygen above its critical temperature.
d. allows the gas to be maintained at 50 psig.

 

 

ANS:  B

According to Gay-Lussac’s law, if the volume of a gas remains constant, there is a direct relationship between the absolute pressure of a gas and its temperature. This release of gas allows the gas within the container to expand, thus lowering the temperature.

 

PTS:   1                    REF:   Page 67

 

  1. Which of the following are components of a bulk liquid oxygen system?
  2. 3AA container
  3. Insulated reservoir
  4. Pressure-release valve
  5. A heater for the liquid oxygen
a. 2 and 3 c. 2 and 4
b. 1 and 3 d. 1 and 4

 

 

ANS:  A

A bulk liquid oxygen system consists of an insulated reservoir, a vaporizer with associated tubing attached to the reservoir, a pressure-reducing valve, and an appropriate pressure-release valve.

 

PTS:   1                    REF:   Page 67

 

  1. The NFPA requires bulk oxygen systems to be located:
  2. 10 feet from flammable gas storage.
  3. 10 feet from public sidewalks.
  4. 5 feet from the property line.
  5. 5 feet from congested areas.
a. 1 and 4 c. 2, 3, and 4
b. 2 and 3 d. 1, 2, 3, and 4

 

 

ANS:  B

See Box 3-6.

 

PTS:   1                    REF:   Page 70, Figure 3-11

 

  1. According to the NFPA, for a nonambulatory patient, the minimum distance from a bulk oxygen supply is _____ feet.
a. 5 c. 25
b. 10 d. 50

 

 

ANS:  D

See Figure 3-11.

 

PTS:   1                    REF:   Page 70, Figure 3-11

 

  1. One liter of liquid oxygen weighs _____ oz.
a. 25 c. 86
b. 40 d. 860

 

 

ANS:  B

One liter of oxygen weighs 2.5 lb. 2.5 lb ´ 16 oz/lb = 40 oz.

 

PTS:   1                    REF:   Page 69

 

  1. A home care patient inquires about how long her portable liquid oxygen system, currently weighing 30 lb, will last if she uses 3 L/min. The manufacturer says the weight of an empty container is 8 lb. Her system will last for _____ day(s) and _____ hours.
a. 1; 18 c. 4; 21
b. 2; 9 d. 8; 12

 

 

ANS:  A

First subtract 8 lb from 30 lb = 22 lb. Convert 22 lb/2.5 lb/L = 8.8 L. 8.8 L ´ 860 (liter of liquid oxygen multiplied by 860 equals the liters of gaseous oxygen) = 7568 L. Then divide by liter flow. 7568/3 L/min = 2522 min = 1 day 18 hours.

 

PTS:   1                    REF:   Page 70, Box 3-7

 

  1. If a portable liquid oxygen reservoir is set to deliver 6 L/min and the current reservoir weight is 38 lb, it will take _____ hours for the reservoir to empty if the weight of an empty container is 10 lb.
a. 5 c. 27
b. 23 d. 36

 

 

ANS:  C

Subtract 10 lb from 38 lb = 28 lb. Convert 28 lb/2.5 lb/L = 11.2 lb. 11.2 lb ´ 860 = 9632 L. Then divide by liter flow: 9632 L/6 L/min = 1605 minutes, or 27 hours.

 

PTS:   1                    REF:   Page 70, Box 3-7

 

  1. Approximately how long will a liquid oxygen reservoir last when supplying 3 L/min to your patient? The current reservoir weight is 20 lb, and the weight of an empty reservoir is 10 lb.
a. 19 hours c. 46 hours
b. 38 hours d. 119 hours

 

 

ANS:  A

Subtract 10 lb from 20 lb = 10 lb. Convert 10 lb/2.5 lb/L= 4 L. 4 ´ 860 = 3440 L. Then divide by the flow 3440 L/3 L/min = 1146 minutes, or 19 hours.

 

PTS:   1                    REF:   Page 70

 

  1. During your home care visit on Monday morning, you weigh the patient’s portable liquid oxygen reservoir. The liquid oxygen weighs 18 lb, and the patient is using 2 L/min. When should you schedule a visit to fill up the reservoir?
a. The next Monday c. Thursday afternoon
b. Wednesday morning d. Friday afternoon

 

 

ANS:  B

18 lb/2.5 lb/L=7.2 L. 7.2 L ´ 860 = 6192 L/2 L/min = 3096 minutes, or 51 hours 36 minutes, which is 2 days 3 hours 36 minutes. So it would have to be filled on Wednesday.

 

PTS:   1                    REF:   Page 70, Box 3-7

 

  1. Which of the following types of compressor can accommodate a mechanical ventilator?
  2. Diaphragm
  3. Liquid air
  4. Rotary
  5. Piston
a. 1 c. 3 and 4
b. 2 and 4 d. 1, 3, and 4

 

 

ANS:  C

Rotary compressors use a rotating vane to compress air from an intake valve. As the rotating vane turns, gas is drawn into the cylinder through a one-way valve (Figure 3-16). The rotor turns, which causes the gas to be compressed as the oval-shaped cylinder becomes smaller. The compressed gas is then forced out of the compressor through another one-way outflow valve. Low-pressure rotary compressors are used in ventilators such as the Bennett MA-1. Piston compressors use the action of a motor-driven piston to compress atmospheric air. The piston is seated within a cylinder casing and is sealed to it with a carbon or Teflon ring. Figure 3-14 illustrates the operational principle of a typical piston air compressor used to power a mechanical ventilator.

 

PTS:   1                    REF:   Page 73

 

  1. Which of the following is (are) a small nebulizer compressor(s)?
  2. Diaphragm
  3. Liquid air
  4. Rotary
  5. Piston
a. 4 c. 1 and 2
b. 1 d. 1, 3, and 4

 

 

ANS:  B

A flexible diaphragm is attached to a piston to compress gas. As the piston moves down, the diaphragm is bent outward and gas is drawn through a one-way valve into the cylinder. Upward movement of the piston forces the gas out of the cylinder through a separate one-way outflow valve. Examples of diaphragm compressors are the Air Shields Diapump and the DeVilbiss small nebulizer compressor.

 

PTS:   1                    REF:   Page 73

 

  1. Which of the following agencies makes recommendations for medical air supply?
a. ISO c. CGA
b. NFPA d. Bureau of Medical Devices

 

 

ANS:  B

See Box 3-8.

 

PTS:   1                    REF:   Page 72, Box 3-8

 

  1. Which of the following statements about medical air supplies are false?
  2. The air intake port must be located indoors.
  3. The source of medical air must be from the outside atmosphere.
  4. Most hospital bulk air supply systems use two compressors.
  5. Backflow through the compressors that are cycled off must be prevented manually.
a. 1 and 4 c. 2 and 3
b. 1, 2, and 3 d. 3 and 4

 

 

ANS:  A

See Box 3-8.

 

PTS:   1                    REF:   Page 72, Box 3-8

 

  1. Which of the following type(s) of air compressors is (are) used in bulk supply systems?
  2. Piston
  3. Rotary
  4. Liquid air
  5. Diaphragm
a. 1 and 4 c. 1 and 2
b. 1 and 3 d. 2

 

 

ANS:  C

To power a bulk air supply, either a piston or a rotary compressor is necessary. Liquid air is not used as a source for bulk supply. A diaphragm air compressor could not keep up with the requirements of a bulk system.

 

PTS:   1                    REF:   Page 54, Box 3-2

 

  1. The NFPA requires that bulk oxygen systems be at least how many feet from parked vehicles?
a. 5 c. 15
b. 10 d. 20

 

 

ANS:  B

See Figure 3-11.

 

PTS:   1                    REF:   Page 70, Figure 3-11

 

  1. If the working pressure of a bulk oxygen system is 45 psig, all pressure-relief valves should be set at _____ psig.
a. 45 c. 67
b. 50 d. 80

 

 

ANS:  C

All pressure-relief valves are set 50% higher than the system working pressure (e.g., set at 75 psi for a 50-psi system pressure).

 

PTS:   1                    REF:   Page 74

 

  1. In the event of a fire in a hospital, which of the following might be necessary?
  2. Provide supplemental oxygen to patients who require it.
  3. Shut off oxygen zone valves to the affected area.
  4. Shut off the main oxygen valve.
  5. Check oxygen line pressure.
a. 3 c. 2 and 4
b. 1 and 2 d. 3 and 4

 

 

ANS:  B

In case of fire, affected zones can be isolated, thus preventing the problem from spreading to other areas of the hospital. And always remember patient safety in terms of applying the appropriate oxygen to each patient.

 

PTS:   1                    REF:   Page 74

 

  1. Which of the following are safety features incorporated into a medical gas piping system?
  2. Zone valves
  3. Riser valves
  4. Pressure-relief valves
  5. In-line oxygen analyzers
a. 3 and 4 c. 1 and 4
b. 1 and 3 d. 1, 2, and 3

 

 

ANS:  D

See Figure 3-17.

 

PTS:   1                    REF:   Page 75

 

  1. Which safety system(s) is (are) found at station outlets of a medical gas piping system?
  2. Diameter Index Safety System (DISS)
  3. American Standard Safety System (ASSS)
  4. Pin Index Safety System
  5. Quick Connect
a. 1 c. 2 and 3
b. 1 and 4 d. 2 and 4

 

 

ANS:  B

Station outlets are designed with safety systems that prevent the connection of incompatible devices. Two safety systems are currently available: the DISS and Quick-Connect adapters.

 

PTS:   1                    REF:   Page 76

 

  1. The type of station outlet connection that uses noninterchangeable thread fittings to connect gas-powered devices to station outlets is known as:
a. regulator. c. Pin Index Safety System.
b. quick-connect adapter. d. DISS.

 

 

ANS:  D

Figure 3-20 shows an outlet that uses DISS. This system, which was designed by the CGA, uses noninterchangeable thread fittings to connect gas-powered devices to station outlets.

 

PTS:   1                    REF:   Page 78

 

  1. Which of the following statements are true concerning station outlets?
  2. Check valves are safety valves that close automatically when an adapter is disengaged from the outlet.
  3. Station outlets do not have ASSS connections.
  4. Quick-connect adapters use noninterchangeable thread fittings.
  5. Check valves must hold a minimum of 200 psig.
a. 3 and 4 c. 2 and 4
b. 1, 3, and 4 d. 1 and 2

 

 

ANS:  D

Station outlets have safety valves that close automatically when an adapter is disengaged from the outlet (i.e., quick-connect adapters). The quick-connect adapters and the DISS are the two safety systems that can be at a station outlet.

 

PTS:   1                    REF:   Page 76

 

  1. What percentage of oxygen does a typical molecular sieve concentrator provide when it is running at 2 L/min?
a. 100% c. 85%
b. 90% d. 40%

 

 

ANS:  B

The concentration of oxygen leaving the system depends on the flow rate set. For example, at flows less than 6 L/min, the gas contains approximately 92% to 97% oxygen.

 

PTS:   1                    REF:   Page 79

 

  1. Which is true about the process of fractional distillation of liquid air?
a. Compressed air is a by-product.
b. It produces pure liquid oxygen.
c. Liquid nitrous oxide is produced.
d. Concentrators use it to produce oxygen.

 

 

ANS:  B

The fractional distillation of liquid air creates pure liquid oxygen. There are no by-products from this method. Oxygen concentrators take in room air and separate oxygen from nitrogen.

 

PTS:   1                    REF:   Page 54, Box 3-1

 

  1. One liter of liquid oxygen is equivalent to _____ liters of gaseous oxygen.
a. 2.5 c. 348
b. 328 d. 860

 

 

ANS:  D

Oxygen expands to 860 times its liquid volume at 25° C and 1 atm; therefore, the total volume of gaseous oxygen available can be calculated by multiplying the number of liters of liquid oxygen by 860.

 

PTS:   1                    REF:   Page 67

 

  1. Which of the following statements are true given that, on one side of a medical gas cylinder, the only markings to appear are 3 (tw) 84 + *.
  2. The cylinder passed the hydrostatic test.
  3. The cylinder must be retested after 5 years.
  4. The cylinder must be retested after 10 years.
  5. The cylinder was manufactured in March 1984.
  6. Hydrostatic testing was performed in March 1984.
a. 2, 3, and 4 c. 1, 4, and 5
b. 2, 3, and 5 d. 1, 2, and 4

 

 

ANS:  D

See Figure 3-4.

 

PTS:   1                    REF:   Page 61

 

  1. Which of the following statements reflect(s) the recommendations of the NFPA and CGA for storing cylinders outdoors?
  2. Cylinders should not be stored in an area where the temperature exceeds 125° F.
  3. Cylinders must be protected from the weather.
  4. Full and empty cylinders should be kept separate.
  5. Cylinders should not be stored outside.
a. 4 c. 2 and 3
b. 1 and 2 d. 1, 2, and 3

 

 

ANS:  D

See Box 3-3.

 

PTS:   1                    REF:   Page 58, Box 3-3

 

  1. Which of the following large-cylinder safety recommendations is not appropriate?
a. Protective caps are not necessary during storage.
b. Cylinders should be transported with protective caps.
c. Cylinder carts used in the operating room must be grounded.
d. Transportation must occur on an appropriate cart, onto which the cylinder is secured by a chain.

 

 

ANS:  A

Large cylinders have a protective cap that fits over the valve stem. This cap should be kept on cylinders when moving or storing them.

 

PTS:   1                    REF:   Page 58, Box 3-3

 

  1. Which of the following types of oxygen storage device are appropriate for home care?
  2. Manifold
  3. Compressor
  4. Concentrator
  5. Bulk oxygen system
  6. Liquid oxygen cylinder
a. 2 and 5 c. 2, 3, and 5
b. 2 and 4 d. 1, 4, and 5

 

 

ANS:  A

Concentrators are used in the home care setting for patients who require low-flow oxygen. Liquid oxygen cylinders can allow the patient more time outside of the home during travel. Manifolds and bulk oxygen systems are not appropriate for home care. Compressors provide medical air, not oxygen.

 

PTS:   1                    REF:   Page 79

 

  1. Which of the following have the fastest diffusion rate through the semipermeable membrane of an oxygen concentrator?
  2. Carbon dioxide
  3. Water vapor
  4. Nitrogen
  5. Oxygen
a. 1 and 2 c. 3 and 4
b. 1 and 3 d. 2 and 4

 

 

ANS:  D

Oxygen concentrators are devices that produce enriched oxygen from atmospheric air. Thus, oxygen and water vapor diffuse through these membranes faster than nitrogen.

 

PTS:   1                    REF:   Page 77

 

  1. The concentration of oxygen leaving an oxygen concentrator depends on the:
a. number of sieves in the unit.
b. number of compressors used.
c. set flow rate of the gas exiting.
d. size of the sodium-aluminum silicate pellets.

 

 

ANS:  C

Atmospheric gases diffuse through the membrane at different rates. The rate at which a gas diffuses depends on its diffusion constant and solubility for the plastic membrane and the pressure gradient for the gas across the membrane.

 

PTS:   1                    REF:   Page 77

 

  1. Bulk oxygen is produced through which of the following?
a. Molecular sieves c. Semipermeable membranes
b. Fractional distillation d. Combustion of natural gas

 

 

ANS:  B

Fractional distillation generates bulk oxygen. Molecular sieves and semipermeable membranes are used in oxygen concentrators. The combustion of natural gas produces carbon dioxide.

 

PTS:   1                    REF:   Page 54

 

  1. Which of the following gases is used to treat singultus?
a. Air c. Nitrous oxide
b. Oxygen d. Carbon dioxide

 

 

ANS:  D

Carbon dioxide is used for the treatment of singultus (hiccups) and as a stimulant/depressant of the central nervous system.

 

PTS:   1                    REF:   Page 55

 

  1. At –183° C, which of the following gases exists as a pale, bluish liquid that is slightly heavier than water?
a. Air c. Nitrous oxide
b. Oxygen d. Carbon dioxide

 

 

ANS:  B

Oxygen is an elemental gas that is colorless, odorless, and tasteless at normal temperatures and pressures. It makes up 20.9% of the Earth’s atmosphere by volume and 23.2% by weight. It constitutes approximately 50% of the Earth’s crust by weight. Oxygen is slightly heavier than air, having a density of 1.326kg/m3 at 21.1° C and 760 mm Hg (specific gravity = 1.105). At temperatures less than –183° C (–300° F), oxygen exists as a pale, bluish liquid that is slightly heavier than water.

 

PTS:   1                    REF:   Page 54

 

  1. Which of the following gases may be used as a refrigerant?
a. Oxygen c. Carbon dioxide
b. Nitric oxide d. Carbon monoxide

 

 

ANS:  C

Solid carbon dioxide is used to refrigerate perishable materials during transport (e.g., food and laboratory specimens). Liquid carbon dioxide can be used as an expendable refrigerant and is used extensively as a fire-extinguishing agent in portable and stationary fire-extinguishing systems.

 

PTS:   1                    REF:   Page 55

 

  1. Which of the letters points to the manufacturer’s mark?

 

a. A c. C
b. B d. D

 

 

ANS:  B

See Figure 3-4.

 

PTS:   1                    REF:   Page 61

 

  1. Which size cylinder is currently used for the storage of nitric oxide?
a. 61.4 cubic feet c. 110 cubic feet
b. 82 cubic feet d. 152 cubic feet

 

 

ANS:  B

Before 1997, nitric oxide was supplied in cylinders with a volume capacity of 152 cubic feet. It is now supplied in smaller cylinders (82 cubic feet) with 626 CGA valve outlets.

 

PTS:   1                    REF:   Page 56

 

  1. The cylinder color for nitric oxide is:
a. red. c. teal and black.
b. light blue. d. brown and green.

 

 

ANS:  C

See Table 3-4.

 

PTS:   1                    REF:   Page 61

 

  1. Which gas law is applied in a fusible-plug pressure-relief valve?
a. Boyle’s c. Dalton’s
b. Charles’ d. Gay-Lussac’s

 

 

ANS:  D

The pressure-release valve allows some of the gas on top of the liquid to escape if the contents are warmed too much. This release of gas allows the gas within the container to expand, thus lowering the temperature. This maintains the gas under pressure between its boiling point and its critical temperature so that the majority of the reservoir’s contents will be maintained in the liquid state.

 

PTS:   1                    REF:   Page 67

 

  1. The American Standard System connections for all life support gases are _____-handed and _____.
a. Left; internal c. Right; internal
b. Left; external d. Right; external

 

 

ANS:  D

Note that the connections for oxygen and other life-support gases are right-handed and external.

 

PTS:   1                    REF:   Page 64

 

  1. Which of the following is the Pin Index Safety System pin position for oxygen?

 

a. A c. C
b. B d. D

 

 

ANS:  A

Recall that in this system, indexing is accomplished by the exact placement of two pins into holes in the post valve.

 

PTS:   1                    REF:   Page 66, Figure 3-9

 

  1. An “E” size oxygen cylinder with 2200 psig has a set flow rate of 2 L/min. It will take _____ hours and _____ minutes until the gauge pressure reaches 400 psig.
a. 5; 30 c. 4; 30
b. 5; 6 d. 4; 12

 

 

ANS:  D

Amount of time left in cylinder = (cylinder pressure ´ cylinder factor)/flow rate of gas (liters/minute). 2200 – 400 = 1800 psig (the amount of gas that will be used). (1800 ´ 0.28)/2 = 252 minutes/60 = 4 hours 12 minutes.

 

PTS:   1                    REF:   Page 67, Box 3-5

 

  1. Which of the following “E” size oxygen cylinders will last the longest?

Pressure            Flow

(psig)              (L/min)

a. 1600              3 c. 800                2
b. 1400              2.5 d. 400                1

 

 

ANS:  B

This answer was derived from the following formula:

 

 

1400 ´ 0.28 = 392/2.5 L/min = 156.8 minutes.

1400 psig at 2.5 L/min will last the longest compared with the other three.

 

PTS:   1                    REF:   Page 67, Box 3-5

 

  1. An “H” size oxygen cylinder with 1600 psig has a set flow rate of 3 L/min. It will take _____ hours and _____ minutes to reach 300 psig.
a. 17; 24 c. 22; 40
b. 21; 25 d. 27; 54

 

 

ANS:  C

The same formula as described in the previous question is used here; however, you first have to subtract 300 psig from 1600 psig to get the exact duration for 1300 psig. (1300 ´ 3.14)/3 = 1360.7 minutes/60 = approximately 22 hours 40 minutes.

 

PTS:   1                    REF:   Page 67, Box 3-5

 

  1. The following figure represents the components of which of the following?

 

a. Hydrostatic testing system c. Fractional distillation apparatus
b. Bulk liquid oxygen system d. Alternating oxygen supply system

 

 

ANS:  B

Recall also Figure 3-10.

 

PTS:   1                    REF:   Page 68, Box 3-6

 

  1. Which of the following “G” size oxygen cylinders will run out of oxygen first?

Pressure       Flow

(psig)        (L/min)

a. 700             1.5 c. 1100           2.5
b. 900             1.0 d. 1600           3.0

 

 

ANS:  C

This answer was derived from the following formula:

 

 

 

The cylinder factor is 3.14. 1100 psig has the shortest duration at 1382 minutes, or 23 hours.

 

PTS:   1                    REF:   Page 67, Box 3-5

 

  1. According to the NFPA, the minimum distance for a place of public assembly from a bulk oxygen storage system is how many feet?
a. 10 c. 25
b. 15 d. 50

 

 

ANS:  D

See Figure 3-11.

 

PTS:   1                    REF:   Page 70

 

  1. Storage of a portable liquid oxygen system adjacent to a heat source will _____ the _____ of the oxygen.
a. Increase; pressure c. Decrease; pressure
b. Increase; venting d. Decrease; venting

 

 

ANS:  B

Liquid oxygen units should not be located adjacent to heat sources, which can accelerate the venting of oxygen.

 

PTS:   1                    REF:   Page 72, Box 3-8

 

  1. A stationary liquid oxygen system contains 80 lb of oxygen when full. A home care patient is using it 8 hours each day, during sleep, at a rate of 3 L/min. At this usage, how many days will the liquid oxygen last?
a. 6 c. 19
b. 8 d. 27

 

 

ANS:  C

Use the liquid oxygen duration formula as given previously.

A liter of liquid oxygen weighs 2.5 lb, so: 80 lb/2.5 = 32 L.

Gaseous oxygen occupies a volume that is 860 times the volume of liquid oxygen, so: liters of liquid ´ 860 = liters of gas.

Duration of supply (minutes) = gas supply remaining (in liters) ÷ flow (liters/minute).

Once you get the answer in minutes, you divide by 60 to obtain the number of hours. Then divide the number of hours by the usage, which is 8 hr/day; that gives you 19 days.

 

PTS:   1                    REF:   Page 70, Box 3-7

 

Chapter 07: Lung Expansion Therapy Devices

 

MULTIPLE CHOICE

 

  1. The primary indication for lung expansion therapy is:
a. asthma. c. chronic bronchitis.
b. atelectasis. d. respiratory distress.

 

 

ANS:  B

Lung expansion therapy is used to either prevent or treat atelectasis.

 

PTS:   1                    REF:   Page 213

 

  1. Factors that increase the risk of atelectasis include:
a. productive cough.
b. lower extremity paralysis.
c. decreased intra-abdominal pressure.
d. chronic obstructive pulmonary disease.

 

 

ANS:  D

Factors that contribute to the development of atelectasis include retained secretions, altered breathing patterns, pain associated with surgery and trauma, chronic obstructive pulmonary disease, prolonged immobilization in a supine position, and increased intra-abdominal pressure.

 

PTS:   1                    REF:   Pages 213-214

 

  1. Untreated atelectasis can result in which of the following?
  2. Decreased shunting
  3. Increased shunting
  4. Hypercapnia
  5. Hypocapnia
a. 1 and 3 c. 1 and 4
b. 2 and 3 d. 2 and 4

 

 

ANS:  B

If atelectasis goes untreated, it can lead to pulmonary shunting, hypoxemia, hypercapnia, and ultimately respiratory failure.

 

PTS:   1                    REF:   Page 213

 

  1. Contraindications for incentive spirometry include:
a. post-thoracic surgery.
b. vital capacity less than 10 mL/kg.
c. restrictive pulmonary disease.
d. inspiratory capacity greater than predicted value.

 

 

ANS:  B

A vital capacity of less than 10 mL/kg demonstrates that the patient is unable to breathe deeply, effectively rendering the patient unable to perform the maneuver that is necessary to achieve positive results. Incentive spirometry is indicated for post-thoracic surgery and restrictive pulmonary disease. If a patient has an inspiratory capacity greater than predicted, that patient would be able to perform incentive spirometry.

 

PTS:   1                    REF:   Page 214

 

  1. Indications for incentive spirometry include:
a. post-abdominal surgery.
b. respiratory muscle weakness.
c. optimization of bronchodilator therapy.
d. inability to effectively deep breathe.

 

 

ANS:  A

Abdominal surgery predisposes a patient to the development of pulmonary atelectasis. Patients with respiratory muscle weakness or the inability to effectively deep breathe will not be able to perform incentive spirometry and therefore will not benefit from its use. Incentive spirometry is not used to optimize bronchodilator therapy.

 

PTS:   1                    REF:   Page 214

 

  1. Complications from incentive spirometry include:
a. barotrauma. c. pulmonary edema.
b. hypoventilation. d. subcutaneous emphysema.

 

 

ANS:  A

Pulmonary barotrauma is a complication of incentive spirometry that usually occurs in patients with emphysematous lungs. Hypoventilation, pulmonary edema, and subcutaneous emphysema are not complications of incentive spirometry.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. When instructing patients on the use of a volume-displacement incentive spirometer, the respiratory therapist should inform the patients to do which of the following?
a. Inhale deeply and hold for 3 to 5 seconds.
b. Exhale as fast as possible into the mouthpiece.
c. Inhale and exhale rapidly through the mouthpiece.
d. Perform 30 sustained maximum inspirations every 15 minutes.

 

 

ANS:  A

After patients have achieved the maximum volume, they should be instructed to hold this volume constant for 3 to 5 seconds. The other choices are not techniques for use with incentive spirometry.

 

PTS:   1                    REF:   Page 215

 

  1. A patient has undergone surgery and is receiving continuous supplemental oxygen via a 30% air-entrainment mask. He or she becomes pale and short of breath during incentive spirometry. Pulse oximetry reveals a significant drop in oxygen saturation during incentive spirometry. The respiratory therapist should do which of the following for subsequent incentive spirometry therapy?
a. Switch to a different type of incentive spirometer.
b. Request that incentive spirometry be discontinued.
c. Cut a hole in the mask for the incentive spirometer’s mouthpiece.
d. Use a 3 L/min nasal cannula during incentive spirometry.

 

 

ANS:  D

The drop in oxygen saturation during incentive spirometry is due to the interruption of oxygen therapy. For this patient it is necessary to maintain oxygen therapy during incentive spirometry. Because the use of a mask is difficult during incentive spirometry, a nasal cannula with a flow rate of 3 L/min will approximate the air-entrainment mask’s 30% supplemental oxygen.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. Which of the following is true concerning flow-dependent incentive spirometry devices?
a. The volume capacity for a child should be approximately 3 L.
b. The patient must perform a sustained maximum inspiration.
c. They are available as multiuse electrically powered devices.
d. Positive pressure within the device causes the flexible plastic bellows to rise.

 

 

ANS:  B

The performance of a sustained maximum inspiration is necessary to perform incentive spirometry with a flow-dependent incentive spirometer (or any incentive spirometry device).

 

PTS:   1                    REF:   Page 214

 

  1. During an incentive spirometry treatment, a patient holds the 600 mL/s ball up for 1.5 seconds; the patient inhaled a volume of _____ L.
a. 0.15 c. 0.60
b. 0.45 d. 0.90

 

 

ANS:  D

Flow = Tidal volume ÷ Inspiratory time.

Tidal volume = Flow ´ Inspiratory time.

Tidal volume = 600 mL/s ´ 1.5 s = 900 mL, or 0.90 L.

 

PTS:   1                    REF:   Page 215

 

  1. A patient reports that during incentive spirometry she becomes dizzy and must stop the maneuver when this happens. The most probable cause of this situation is:
a. hypoventilation. c. patient fatigue.
b. hyperventilation. d. bronchospasm.

 

 

ANS:  B

The patient’s light-headedness is caused by hyperventilation. This is a common complication of incentive spirometry.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. After abdominal surgery, a young, otherwise healthy patient is unable to meet the volume set for his volume-oriented incentive spirometer. This situation is most likely due to:
a. exacerbation of bronchospasm. c. major lung collapse.
b. inadequate pain control. d. hyperventilation.

 

 

ANS:  B

Patients who are recovering from abdominal or thoracic surgery might find it difficult to achieve incentive spirometry volume goals when their pain is not under control. An exacerbation of bronchospasm would most likely cause a patient to wheeze. Major lung collapse would cause respiratory failure, and hyperventilation would cause dizziness.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. A patient undergoing incentive spirometry should be monitored for outcome by assessing which of the following?
  2. Forced expiratory volume at 1 second (FEV1)
  3. Peak expiratory flow
  4. Partial pressure of arterial oxygen (PaO2)
  5. Blood pressure
a. 1 and 2 c. 1 and 4
b. 2 and 3 d. 3 and 4

 

 

ANS:  B

When assessing for outcome from incentive spirometry, the respiratory therapist is looking for the absence of or an improvement in signs of atelectasis. These signs are decreased respiratory rate, resolution of fever, normal pulse rate, improved breath sounds, a normal chest radiograph, improved arterial oxygenation, increased vital capacity and peak expiratory flows, return of functional residual capacity or vital capacity to preoperative values, and improved inspiratory muscle performance.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. A patient is able to sustain a flow of 900 cc/s to hold the ball of a flow-oriented incentive spirometer aloft for 2 seconds. Her inspired volume is ____ L.
a. 0.18 c. 1.45
b. 0.90 d. 1.80

 

 

ANS:  D

Flow = Tidal volume ÷ Inspiratory time.

Tidal volume = Flow ´ Inspiratory time.

Tidal volume = 900 mL/s ´ 2 s = 1800 mL, or 1.80 L.

 

PTS:   1                    REF:   Page 215

 

  1. To determine outcome for a patient undergoing intermittent positive-pressure breathing (IPPB) therapy, the respiratory therapist should assess which of the following?
  2. Peak expiratory flow
  3. Breath sounds
  4. Sputum color
  5. Maximum inspiratory pressure
a. 1 and 2 c. 1, 2, and 3
b. 3 and 4 d. 2, 3, and 4

 

 

ANS:  A

Assessment of outcomes for intermittent positive-pressure breathing include tidal volume measurement, FEV1, peak expiratory flows, cough assessment, chest radiograph review, and subjective patient response. The color of the patient’s sputum is not a determining factor in the outcome of intermittent positive-pressure breathing; it is an outcome assessment for the use of antibiotics. Maximum inspiratory pressure is not used in the determination of the effectiveness of intermittent positive-pressure breathing.

 

PTS:   1                    REF:   Page 217, Clinical Practice Guideline 7-2

 

  1. Myasthenia gravis is causing a patient to have respiratory muscle weakness. He has a vital capacity of 5 mL/kg and is unable to cough effectively. What therapy would you recommend to help prevent pulmonary complications?
a. Incentive spirometry
b. Deep-breathing exercises
c. Positive expiratory pressure
d. Intermittent positive-pressure breathing

 

 

ANS:  D

The patient’s vital capacity of 5 mL/kg is a contraindication for the use of incentive spirometry, and coupled with the fact that he is unable to cough effectively, this makes the use of deep-breathing exercises inappropriate. The patient’s respiratory weakness plus the fact that there is no mention of excessive sputum make positive expiratory pressure therapy inappropriate. Intermittent positive-pressure breathing is appropriate because of the patient’s low vital capacity and inability to cough effectively.

 

PTS:   1                    REF:   Page 217, Clinical Practice Guideline 7-2

 

  1. A 60-year-old female patient with a diagnosis of bilateral lower lobe pneumonia is brought to the emergency department. An assessment reveals a temperature of 38.5° C (101.3° F), a respiratory rate of 35 breaths/min, a pulse of 115 beats/min, and decreased breath sounds in both lower lobes; furthermore, she is not alert. What type of therapy should the respiratory therapist suggest?
a. Incentive spirometry
b. Deep-breathing exercises
c. Positive expiratory pressure
d. Intermittent positive-pressure breathing

 

 

ANS:  D

The patient’s ability to ventilate and cough effectively is compromised because she is not alert. Because of this, incentive spirometry, deep-breathing exercises, and positive expiratory pressure are not appropriate therapies. Intermittent positive-pressure breathing is appropriate because she is not alert.

 

PTS:   1                    REF:   Page 217, Clinical Practice Guideline 7-2

 

  1. A patient who is receiving intermittent positive-pressure breathing therapy for atelectasis now exhibits improved breath sounds and an increased ability to clear secretions. Chest radiography reveals improvement, but not total resolution, of atelectasis. The intermittent positive-pressure breathing therapy is discontinued. What is the most appropriate action at this time?
a. Flutter valve
b. Incentive spirometry
c. Continuous positive airway pressure
d. Intrapulmonary percussive ventilation (IPV)

 

 

ANS:  B

The patient’s increased ability to clear secretions, improved breath sounds, and improved chest radiograph demonstrate an improvement in his atelectasis and overall condition. At this time, “stepping-down” therapy would be appropriate. The most appropriate physiologic therapy that targets atelectasis is incentive spirometry. Flutter valve and intrapulmonary percussive ventilation are therapies for mobilizing retained secretions, and continuous positive airway pressure should be used when atelectasis fails to respond to incentive spirometry and intermittent positive-pressure breathing.

 

PTS:   1                    REF:   Page 217, Clinical Practice Guideline 7-2

 

  1. All intermittent positive-pressure breathing machines are required to have an operating gas pressure source of _____ lb force per square inch gauge (psig).
a. 25 to 35 c. 45 to 55
b. 35 to 45 d. 55 to 65

 

 

ANS:  C

Regardless of the manufacturer, all intermittent positive-pressure breathing machines require a 45-psig to 55-psig gas pressure source, such as a compressed gas cylinder, a bulk air or oxygen system, or an air compressor.

 

PTS:   1                    REF:   Page 227

 

  1. The variable that ends inspiration during intermittent positive-pressure breathing therapy with a Bird Mark 7 is:
a. time. c. volume.
b. flow. d. pressure.

 

 

ANS:  D

The Bird Mark 7 is a pneumatically powered ventilator that will pressure-cycle during intermittent positive-pressure breathing therapy. If used for short-term mechanical ventilation, it could be time-cycled.

 

PTS:   1                    REF:   Page 219

 

  1. Which of the following intermittent positive-pressure breathing machines is unable to provide short-term ventilatory support?
a. Bird Mark 7 c. Puritan Bennett AP-4
b. Bird Mark 14 d. Puritan Bennett PR-2

 

 

ANS:  C

The Puritan Bennett AP-4 is only patient-triggered, so it can be used for intermittent positive-pressure breathing therapy but not for providing short-term ventilatory support of patients with apnea. The other ventilators mentioned are able to support patients for short-term mechanical ventilation.

 

PTS:   1                    REF:   Page 218

 

  1. Which of the following intermittent positive-pressure breathing machines can deliver 100% oxygen?
a. Bird Mark 10 c. Puritan Bennett AP-5
b. Bird Mark 14 d. Puritan Bennett PR-2

 

 

ANS:  D

The Puritan Bennett PR-2 can deliver either 100% source gas or air-diluted source gas. The Bird Mark 10 and Mark 14 ventilators do not have an air-mix control, which means that they can operate only in the air-dilution mode. The gas in the Puritan Bennett AP-5 unit is provided by an air compressor and a Venturi jet that entrains additional air; there is no means to attach a gas source.

 

PTS:   1                    REF:   Page 218

 

  1. Minor leaks can be compensated for on a Puritan Bennett PR-1 or PR-2 with the use a __________ control.
a. Negative end-expiratory pressure c. Terminal flow
b. Diluter regulator d. Flow

 

 

ANS:  C

A terminal flow control is provided for minor leak compensation on the PR-1 or PR-2. Negative end-expiratory pressure is a negative pressure that can be applied to the end of expiration and does not have anything to do with leak compensation. The diluter regulator is an adjustable reducing valve that regulates the gas pressure delivered to the patient. The flow control adjusts the velocity of the gas flowing to the patient.

 

PTS:   1                    REF:   Page 218

 

  1. The diluter regulator on a Puritan Bennett PR-2 is used to do which of the following?
a. Adjust the flow rate.
b. Regulate gas pressure.
c. Eliminate leaks in the system.
d. Apply negative end-expiratory pressure.

 

 

ANS:  B

The diluter regulator is an adjustable reducing valve that regulates the gas pressure delivered to the patient. It can be set from 0 to 30 cm H2O by using a control knob on the front panel of the machine.

 

PTS:   1                    REF:   Page 218

 

  1. Pressure limits on the Puritan Bennett PR-2 can be set between _____ cm H2O.
a. 0 and 30 c. 0 and 60
b. 0 and 50 d. 10 and 30

 

 

ANS:  A

The gas pressure can be set from 0 to 30 cm H2O.

 

PTS:   1                    REF:   Page 218

 

  1. The Puritan Bennett PR-2’s sensitivity setting can be decreased (making it more difficult for the patient to trigger) by doing which of the following with the Sensitivity knob?
a. Pushing it in c. Rotating it clockwise
b. Pulling it out d. Rotating it counterclockwise

 

 

ANS:  D

The manufacturer presets the sensitivity of the machine at 0.5 cm H2O, but the sensitivity (or amount of patient effort) that must be exerted to trigger inspiration can be changed by rotating the Sensitivity knob counterclockwise.

 

PTS:   1                    REF:   Page 219

 

  1. The inspiratory phase on a Puritan Bennett PR-2 will end when which of the following occurs?
a. The clutch plate, diaphragm, and ceramic switch are forced left.
b. Gravity is sufficient to completely close the Bennett valve.
c. The Bennett valve rotates counterclockwise.
d. The set Sensitivity level is reached.

 

 

ANS:  B

When the gas flow through the Bennett valve decreases to between 1 and 3 L/min, the force of gravity is sufficient to swing the valve completely closed, thus terminating inspiration.

 

PTS:   1                    REF:   Page 219

 

  1. Which of the following intermittent positive-pressure breathing machines is electrically powered and patient-triggered only?
a. Bird Mark 7 c. Puritan Bennett AP-5
b. Bird Mark 14 d. Puritan Bennett PR-2

 

 

ANS:  C

The Puritan Bennett AP-5 machines are electrically powered and patient-triggered only. The other machines are pneumatically powered and can be time-triggered, as well as patient-triggered.

 

PTS:   1                    REF:   Page 218

 

  1. Which of the following intermittent positive-pressure breathing machines can produce pressure as high as 200 cm H2O?
a. Puritan Bennett PR-1 c. Bird Mark 10
b. Puritan Bennett PR-2 d. Bird Mark 14

 

 

ANS:  D

The Bird Mark 14 ventilators can produce pressure as high as 200 cm H2O.

 

PTS:   1                    REF:   Page 223

 

  1. During the inspiratory phase of a Bird Mark 7, the:
a. valve will close.
b. valve rotates counterclockwise.
c. diaphragm moves toward the left compartment.
d. diaphragm moves away from the left compartment.

 

 

ANS:  D

During inspiration, negative pressure generated by the patient (along with atmospheric pressure in the left compartment) causes the diaphragm to move toward the right, away from the left compartment. The valves are located on the Bennett PR series ventilators. At the beginning of exhalation on the Bird Mark 7, the diaphragm moves toward the left compartment.

 

PTS:   1                    REF:   Page 219

 

  1. Which of the following uses magnetism versus gas pressure as its basic principle of operation?
a. Bird Mark 14 ventilator
b. Puritan Bennett PR-2 ventilator
c. The Vest Airway Clearance System (also known as the ThAIRapy Vest)
d. Percussionaire Intrapulmonary Percussive Ventilator (IPV-1)

 

 

ANS:  A

The Bird Mark series ventilators use magnetism versus gas pressure as their basic principle of operation.

 

PTS:   1                    REF:   Page 218

 

  1. When the gas pressure in the right chamber of a Bird Mark 7 exceeds the magnetic attraction of the right magnet, which of the following occurs?
a. Exhalation ends. c. The diaphragm moves right.
b. Inspiration begins. d. The clutch plate is forced left.

 

 

ANS:  C

Toward the end of inspiration, the pressure in the pressure chamber exceeds the magnetic attraction of the right magnet. The diaphragm, clutch plate, and ceramic switch are then forced to the left, occluding gas flow into the ventilator and starting exhalation.

 

PTS:   1                    REF:   Page 219

 

  1. At the beginning of inspiration, gas flow to the patient from a Bird Mark 7 or 8 set on “air-mix” comes from which of the following?
a. Venturi device c. Diluter regulator
b. Flow controller d. Pneumatic cartridge

 

 

ANS:  A

When set on air-mix, a Bird Mark 7 or 8 will direct the incoming source gas to the jet of the air-mix Venturi. The gas going to the patient is from the Venturi jet, the air entrained by the Venturi system, and the nebulizer jet.

 

PTS:   1                    REF:   Page 219

 

  1. In the air-mix setting, the flow and pressure waveforms that can be produced by the Bird Mark 7 include:
a. constant-flow wave (square) and ascending-pressure wave.
b. ascending-flow wave and descending-pressure wave.
c. descending-flow wave and ascending-pressure wave.
d. sine-flow wave and ascending-pressure wave.

 

 

ANS:  C

In the air-mix position, the Venturi is activated, producing a descending-flow pattern and an irregular pressure waveform that ranges from ascending to rectangular, depending on the compliance and resistance of the patient’s respiratory system.

 

PTS:   1                    REF:   Page 220

 

  1. Which of the following is a compact, inexpensive, single-patient intermittent positive-pressure breathing device?
a. Bird Mark 7 c. Puritan Bennett PR-1
b. Puritan Bennett AP-4 d. VORTRAN-IPPB device

 

 

ANS:  D

The VORTRAN-IPPB device provides short-term, pressure-triggered, pressure-cycled, constant-flow ventilatory support in combination with aerosol therapy. The primary advantage of these devices is that they are relatively compact and inexpensive compared with conventional intermittent positive-pressure breathing devices. In addition, the VORTRAN-IPPB units are single-patient, multiple-use devices, a situation that reduces the incidence of nosocomial infections caused by cross-contamination.

 

PTS:   1                    REF:   Page 223

 

  1. The therapy that mobilizes retained secretions by using devices similar to, but less cumbersome than, continuous positive airway pressure is known as which of the following?
a. Expiratory positive airway pressure
b. Intermittent positive-pressure breathing
c. Intrapulmonary percussive ventilation
d. Positive expiratory pressure

 

 

ANS:  D

The rationale for the use of positive expiratory pressure therapy is similar to that for the use of continuous positive airway pressure, except that positive expiratory pressure seems to be less cumbersome and more manageable for patients. Expiratory positive airway pressure and intrapulmonary percussive ventilation are just as cumbersome as continuous positive airway pressure. Intermittent positive-pressure breathing is lung expansion therapy, not bronchial hygiene therapy.

 

PTS:   1                    REF:   Page 226

 

  1. Patients undergoing positive expiratory pressure therapy must have a high enough expiratory flow to generate pressure in the range of _____ cm H2O.
a. 5 to 10 c. 20 to 25
b. 10 to 20 d. 25 to 30

 

 

ANS:  B

A patient undergoing positive expiratory pressure therapy must be able to generate expiratory flows high enough to maintain expiratory pressure at 10 to 20 cm H2O.

 

PTS:   1                    REF:   Page 226, Box 7-1

 

  1. During a positive expiratory pressure therapy session, a patient should be told to:
a. stop after 20 to 30 breaths.
b. place lips into the mouthpiece.
c. take a deep breath, and then actively exhale.
d. breathe normally through the mouthpiece.

 

 

ANS:  C

Patients should be instructed to inspire through the one-way valve of the positive expiratory pressure device to a volume that is greater than the normal tidal volume—but not to the total lung capacity. At the end of inspiration, patients are encouraged to actively, but not forcefully, exhale to functional residual capacity.

 

PTS:   1                    REF:   Page 226, Box 7-1

 

  1. An assessment of a patient with newly diagnosed chronic bronchitis reveals an alert, cooperative, and oriented patient. Low-pitched wheezes are heard bilaterally on auscultation. The patient has a productive cough, producing copious amounts of sputum; no fever; a pulse of 85 beats/min; respirations of 18 breaths/min; and blood pressure of 145/90. The most appropriate lung expansion therapy for this patient is which of the following?
a. Incentive spirometry
b. Intermittent positive-pressure breathing
c. Positive expiratory pressure
d. Flutter valve

 

 

ANS:  C

Because he is alert, cooperative, and oriented, intermittent positive-pressure breathing is not appropriate for him. Incentive spirometry might be an alternative; however, it will not help this patient to mobilize the copious amounts of sputum being produced. Positive expiratory pressure not only acts as an enhancement to the movement of mucus, but it also reverses atelectasis and optimizes delivery of bronchodilators to patients with chronic bronchitis. The flutter valve will serve only as bronchial hygiene therapy.

 

PTS:   1                    REF:   Page 226

 

  1. Air trapping in patients with asthma or chronic obstructive pulmonary disease can be reduced by which of the following?
a. Intrapulmonary percussive ventilation
b. Intermittent positive-pressure breathing
c. Positive expiratory pressure
d. Incentive spirometry

 

 

ANS:  C

Positive airway pressure with positive expiratory pressure is indicated to reduce air trapping in patients with asthma or chronic obstructive pulmonary disease. Intrapulmonary percussive ventilation is a bronchial hygiene therapy only. Intermittent positive-pressure breathing is a lung expansion therapy that should be used only if another lung expansion therapy, such as incentive spirometry, is not appropriate.

 

PTS:   1                    REF:   Page 224, Clinical Practice Guideline 7-3

 

  1. A female patient’s chest radiograph shows bilateral lower lobe atelectasis. She is alert and oriented. Arterial blood gas analysis reveals mild hypoxemia and respiratory alkalemia; her vital signs are within normal limits. Which of the following is most appropriate at this time?
a. Chest physiotherapy every 4 hours
b. Continuous positive airway pressure +5 cm H2O
c. Intrapulmonary percussive ventilation every 2 hours
d. Intermittent positive-pressure breathing 35 cm H2O Q4

 

 

ANS:  B

This patient requires lung expansion therapy to reverse the atelectasis. Chest physiotherapy and intrapulmonary percussive ventilation are both bronchial hygiene therapy. Intermittent positive-pressure breathing is lung expansion therapy, but it is not appropriate for this patient because she is alert and oriented. Continuous positive airway pressure will help to reverse her mild hypoxemia and atelectasis.

 

PTS:   1                    REF:   Pages 216-224, Clinical Practice Guidelines 7-2 and 7-3

 

  1. An assessment of outcome for a patient receiving mask continuous positive airway pressure +8 cm H2O should include which of the following?
a. Cardiac output testing c. Intracranial pressure measurement
b. Pulse oximetry d. Pulmonary function testing

 

 

ANS:  B

Oxygen saturation should improve as atelectasis resolves. Pulse oximetry is an easy, quick, noninvasive, and cheap way of assessing patients undergoing positive airway pressure therapy.

 

PTS:   1                    REF:   Page 224, Clinical Practice Guideline 7-3

 

  1. Which of the following therapies can be used as an alternative to endotracheal intubation and continuous ventilation for patients requiring short-term ventilatory support?
a. Continuous positive airway pressure
b. Expiratory positive airway pressure
c. Intermittent positive-pressure breathing
d. Intrapulmonary percussive ventilation

 

 

ANS:  C

Since its introduction in 1947, intermittent positive-pressure breathing has been used for a variety of reasons, including short-term ventilatory support, lung expansion therapy, and as an aid in delivering aerosolized medications.

 

PTS:   1                    REF:   Page 216

 

  1. A patient with moderate kyphoscoliosis has bilateral lower lobe pneumonia. An assessment reveals impending respiratory failure. Which of the following machines should be used to deliver intermittent positive-pressure breathing to this patient?
a. Bird Mark 10 c. Puritan Bennett AP-5
b. Bird Mark 14 d. Puritan Bennett PR-2

 

 

ANS:  D

The PR-2 is the only ventilator on the list that can provide either air dilution or 100% oxygen that is also capable of time triggering.

 

PTS:   1                    REF:   Page 218

 

  1. Which of the following is a type of adjunctive therapy that aids in the mobilization of airway secretions through high-frequency percussive breaths applied inside the patient’s airways?
a. Intrapulmonary percussive ventilation
b. Continuous positive airway pressure
c. Expiratory positive airway pressure
d. Positive expiratory pressure

 

 

ANS:  A

Intrapulmonary percussive ventilation involves the delivery of high-frequency percussive breaths into the patient’s airways instead of applying percussions to the outside of the chest wall as in standard chest physiotherapy techniques.

 

PTS:   1                    REF:   Pages 228-229

 

  1. How much pressure is the Percussionaire IPV-1 able to deliver with each cycle?
a. 5 to 15 cm H2O c. 15 to 50 cm H2O
b. 10 to 35 cm H2O d. 25 to 40 cm H2O

 

 

ANS:  D

The Percussionaire IPV-1 can deliver percussive pressure of 25 to 40 cm H2O.

 

PTS:   1                    REF:   Page 228

 

  1. The maximum frequency of percussive breaths that a Percussionaire IPV-1 can deliver to a patient’s airways is ____ Hz.
a. 1.3 c. 3
b. 1.7 d. 5

 

 

ANS:  D

The rate for the Percussionaire is 100 to 300 cycles/min, or 1.7 to 5 Hz.

 

PTS:   1                    REF:   Page 228

 

  1. Intrapulmonary percussive ventilation mobilizes airway secretions by which of the following methods?
a. Generating a subatmospheric pressure on inspiration, then an expiratory resistance
b. Applying a positive pressure to a patient’s airways throughout the respiratory cycle
c. Delivering high-frequency percussive breaths into the patient’s airways
d. Applying an expiratory resistance to exhaled flow from the patient

 

 

ANS:  C

The Percussionaire Intrapulmonary percussive ventilation provides a form of oscillator therapy that delivers high-frequency percussive breaths into the patient’s airways. It is used as an adjunct for mobilizing airway secretions.

 

PTS:   1                    REF:   Page 228

 

  1. What is one major component of a pneumatically powered percussor?
a. Force control c. Amplitude control
b. Vibration control d. Convex applicator

 

 

ANS:  A

Each pneumatically powered percussor usually has a high-pressure hose, a body with controls for varying the frequency and the force of percussive strokes, and a remote head with a concave applicator.

 

PTS:   1                    REF:   Page 229

 

  1. One type of threshold resistor used to create continuous positive airway pressure is which of the following?
a. Bennett valve c. Underwater seal
b. Sliding Venturi d. Oscillator cartridge

 

 

ANS:  C

The underwater seal resistor has tubing attached to the expiratory port of the circuit and is submerged under a column of water. The level of continuous positive airway pressure is determined by the height of the column.

 

PTS:   1                    REF:   Page 224

 

  1. To apply positive airway pressure to a manual resuscitator bag during patient transport, which of the following are most appropriate?
  2. Spring-loaded valve
  3. Underwater seal
  4. Magnetic valve
  5. Weighted ball
a. 1 and 2 c. 2 and 4
b. 1 and 3 d. 3 and 4

 

 

ANS:  B

The spring-loaded valve and the magnetic valve are the only valves that are able to be used during patient transport. The water column would be subject to leaks and possible breakage of the cylinder. The weighted ball must always be held upright and is impractical for transport.

 

PTS:   1                    REF:   Page 224

 

  1. Bronchial hygiene therapy for patients with Duchenne muscular dystrophy or spinal muscular atrophy is most appropriate with which of the following?
a. Intermittent positive-pressure breathing
b. Incentive spirometry
c. Mechanical insufflation-exsufflation
d. Positive expiratory pressure

 

 

ANS:  C

The purpose of a mechanical insufflation-exsufflation device is to replace or augment cough clearance in individuals with respiratory muscle weakness or paralysis (e.g., neuromuscular disease).

 

PTS:   1                    REF:   Page 232

 

  1. Which of the following bronchial hygiene therapy devices can be used to ventilate a patient?
a. Hayek Oscillator c. Percussionaire IPV-1
b. The Vest d. Positive expiratory pressure

 

 

ANS:  A

The Hayek Oscillator is technically classified as an electrically powered noninvasive ventilator. This device consists of a flexible chest cuirass that is applied over the chest wall. The device delivers both negative and positive pressure to the chest wall during the respiratory cycle. The negative pressure creates inspiration, and the positive pressure produces a forced exhalation.

 

PTS:   1                    REF:   Pages 231-232

 

  1. A patient with chronic bronchitis is being discharged from the hospital. The simplest, most cost-efficient device to aid this patient with bronchial hygiene therapy is which of the following?
a. Percussionaire IPV-1 c. Bird Mark 8
b. Flutter therapy d. Pneumatic percussor

 

 

ANS:  B

Flutter therapy is relatively easy for patients to use and is less expensive than the other devices listed in the answer choices.

 

PTS:   1                    REF:   Page 231

 

  1. Contraindications to positive airway pressure adjuncts to bronchial hygiene therapy include which of the following?
a. Hiccups c. Esophageal surgery
b. Air swallowing d. Subcutaneous emphysema

 

 

ANS:  C

Esophageal surgery is listed in Clinical Practice Guideline 7-3 as a contraindication to the use of positive airway pressure adjuncts to bronchial hygiene therapy.

 

PTS:   1                    REF:   Page 224, Clinical Practice Guideline 7-3

 

  1. What is the function of the counterweight plug and magnet in the Acapella Flutter type of device?
a. Creates positive and negative pressure in the chest
b. Provides high-frequency external chest wall oscillations
c. Creates oscillations that are transmitted into the lungs
d. Creates positive pressure throughout the respiratory cycle

 

 

ANS:  C

Acapella is a flutter type of valve that creates a series of high-frequency oscillations that are transmitted into the lungs through the airway opening.

 

PTS:   1                    REF:   Page 230

 

  1. The device that will prevent early airway closure is:
a. incentive spirometry.
b. intermittent positive-pressure breathing.
c. flutter valve therapy.
d. high-frequency chest wall oscillation.

 

 

ANS:  C

The steel ball of the flutter valve or the counterweighted plug and magnet help to prevent early airway closure.

 

PTS:   1                    REF:   Page 230

Chapter 07: Lung Expansion Therapy Devices

 

MULTIPLE CHOICE

 

  1. The primary indication for lung expansion therapy is:
a. asthma. c. chronic bronchitis.
b. atelectasis. d. respiratory distress.

 

 

ANS:  B

Lung expansion therapy is used to either prevent or treat atelectasis.

 

PTS:   1                    REF:   Page 213

 

  1. Factors that increase the risk of atelectasis include:
a. productive cough.
b. lower extremity paralysis.
c. decreased intra-abdominal pressure.
d. chronic obstructive pulmonary disease.

 

 

ANS:  D

Factors that contribute to the development of atelectasis include retained secretions, altered breathing patterns, pain associated with surgery and trauma, chronic obstructive pulmonary disease, prolonged immobilization in a supine position, and increased intra-abdominal pressure.

 

PTS:   1                    REF:   Pages 213-214

 

  1. Untreated atelectasis can result in which of the following?
  2. Decreased shunting
  3. Increased shunting
  4. Hypercapnia
  5. Hypocapnia
a. 1 and 3 c. 1 and 4
b. 2 and 3 d. 2 and 4

 

 

ANS:  B

If atelectasis goes untreated, it can lead to pulmonary shunting, hypoxemia, hypercapnia, and ultimately respiratory failure.

 

PTS:   1                    REF:   Page 213

 

  1. Contraindications for incentive spirometry include:
a. post-thoracic surgery.
b. vital capacity less than 10 mL/kg.
c. restrictive pulmonary disease.
d. inspiratory capacity greater than predicted value.

 

 

ANS:  B

A vital capacity of less than 10 mL/kg demonstrates that the patient is unable to breathe deeply, effectively rendering the patient unable to perform the maneuver that is necessary to achieve positive results. Incentive spirometry is indicated for post-thoracic surgery and restrictive pulmonary disease. If a patient has an inspiratory capacity greater than predicted, that patient would be able to perform incentive spirometry.

 

PTS:   1                    REF:   Page 214

 

  1. Indications for incentive spirometry include:
a. post-abdominal surgery.
b. respiratory muscle weakness.
c. optimization of bronchodilator therapy.
d. inability to effectively deep breathe.

 

 

ANS:  A

Abdominal surgery predisposes a patient to the development of pulmonary atelectasis. Patients with respiratory muscle weakness or the inability to effectively deep breathe will not be able to perform incentive spirometry and therefore will not benefit from its use. Incentive spirometry is not used to optimize bronchodilator therapy.

 

PTS:   1                    REF:   Page 214

 

  1. Complications from incentive spirometry include:
a. barotrauma. c. pulmonary edema.
b. hypoventilation. d. subcutaneous emphysema.

 

 

ANS:  A

Pulmonary barotrauma is a complication of incentive spirometry that usually occurs in patients with emphysematous lungs. Hypoventilation, pulmonary edema, and subcutaneous emphysema are not complications of incentive spirometry.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. When instructing patients on the use of a volume-displacement incentive spirometer, the respiratory therapist should inform the patients to do which of the following?
a. Inhale deeply and hold for 3 to 5 seconds.
b. Exhale as fast as possible into the mouthpiece.
c. Inhale and exhale rapidly through the mouthpiece.
d. Perform 30 sustained maximum inspirations every 15 minutes.

 

 

ANS:  A

After patients have achieved the maximum volume, they should be instructed to hold this volume constant for 3 to 5 seconds. The other choices are not techniques for use with incentive spirometry.

 

PTS:   1                    REF:   Page 215

 

  1. A patient has undergone surgery and is receiving continuous supplemental oxygen via a 30% air-entrainment mask. He or she becomes pale and short of breath during incentive spirometry. Pulse oximetry reveals a significant drop in oxygen saturation during incentive spirometry. The respiratory therapist should do which of the following for subsequent incentive spirometry therapy?
a. Switch to a different type of incentive spirometer.
b. Request that incentive spirometry be discontinued.
c. Cut a hole in the mask for the incentive spirometer’s mouthpiece.
d. Use a 3 L/min nasal cannula during incentive spirometry.

 

 

ANS:  D

The drop in oxygen saturation during incentive spirometry is due to the interruption of oxygen therapy. For this patient it is necessary to maintain oxygen therapy during incentive spirometry. Because the use of a mask is difficult during incentive spirometry, a nasal cannula with a flow rate of 3 L/min will approximate the air-entrainment mask’s 30% supplemental oxygen.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. Which of the following is true concerning flow-dependent incentive spirometry devices?
a. The volume capacity for a child should be approximately 3 L.
b. The patient must perform a sustained maximum inspiration.
c. They are available as multiuse electrically powered devices.
d. Positive pressure within the device causes the flexible plastic bellows to rise.

 

 

ANS:  B

The performance of a sustained maximum inspiration is necessary to perform incentive spirometry with a flow-dependent incentive spirometer (or any incentive spirometry device).

 

PTS:   1                    REF:   Page 214

 

  1. During an incentive spirometry treatment, a patient holds the 600 mL/s ball up for 1.5 seconds; the patient inhaled a volume of _____ L.
a. 0.15 c. 0.60
b. 0.45 d. 0.90

 

 

ANS:  D

Flow = Tidal volume ÷ Inspiratory time.

Tidal volume = Flow ´ Inspiratory time.

Tidal volume = 600 mL/s ´ 1.5 s = 900 mL, or 0.90 L.

 

PTS:   1                    REF:   Page 215

 

  1. A patient reports that during incentive spirometry she becomes dizzy and must stop the maneuver when this happens. The most probable cause of this situation is:
a. hypoventilation. c. patient fatigue.
b. hyperventilation. d. bronchospasm.

 

 

ANS:  B

The patient’s light-headedness is caused by hyperventilation. This is a common complication of incentive spirometry.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. After abdominal surgery, a young, otherwise healthy patient is unable to meet the volume set for his volume-oriented incentive spirometer. This situation is most likely due to:
a. exacerbation of bronchospasm. c. major lung collapse.
b. inadequate pain control. d. hyperventilation.

 

 

ANS:  B

Patients who are recovering from abdominal or thoracic surgery might find it difficult to achieve incentive spirometry volume goals when their pain is not under control. An exacerbation of bronchospasm would most likely cause a patient to wheeze. Major lung collapse would cause respiratory failure, and hyperventilation would cause dizziness.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. A patient undergoing incentive spirometry should be monitored for outcome by assessing which of the following?
  2. Forced expiratory volume at 1 second (FEV1)
  3. Peak expiratory flow
  4. Partial pressure of arterial oxygen (PaO2)
  5. Blood pressure
a. 1 and 2 c. 1 and 4
b. 2 and 3 d. 3 and 4

 

 

ANS:  B

When assessing for outcome from incentive spirometry, the respiratory therapist is looking for the absence of or an improvement in signs of atelectasis. These signs are decreased respiratory rate, resolution of fever, normal pulse rate, improved breath sounds, a normal chest radiograph, improved arterial oxygenation, increased vital capacity and peak expiratory flows, return of functional residual capacity or vital capacity to preoperative values, and improved inspiratory muscle performance.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. A patient is able to sustain a flow of 900 cc/s to hold the ball of a flow-oriented incentive spirometer aloft for 2 seconds. Her inspired volume is ____ L.
a. 0.18 c. 1.45
b. 0.90 d. 1.80

 

 

ANS:  D

Flow = Tidal volume ÷ Inspiratory time.

Tidal volume = Flow ´ Inspiratory time.

Tidal volume = 900 mL/s ´ 2 s = 1800 mL, or 1.80 L.

 

PTS:   1                    REF:   Page 215

 

  1. To determine outcome for a patient undergoing intermittent positive-pressure breathing (IPPB) therapy, the respiratory therapist should assess which of the following?
  2. Peak expiratory flow
  3. Breath sounds
  4. Sputum color
  5. Maximum inspiratory pressure
a. 1 and 2 c. 1, 2, and 3
b. 3 and 4 d. 2, 3, and 4

 

 

ANS:  A

Assessment of outcomes for intermittent positive-pressure breathing include tidal volume measurement, FEV1, peak expiratory flows, cough assessment, chest radiograph review, and subjective patient response. The color of the patient’s sputum is not a determining factor in the outcome of intermittent positive-pressure breathing; it is an outcome assessment for the use of antibiotics. Maximum inspiratory pressure is not used in the determination of the effectiveness of intermittent positive-pressure breathing.

 

PTS:   1                    REF:   Page 217, Clinical Practice Guideline 7-2

 

  1. Myasthenia gravis is causing a patient to have respiratory muscle weakness. He has a vital capacity of 5 mL/kg and is unable to cough effectively. What therapy would you recommend to help prevent pulmonary complications?
a. Incentive spirometry
b. Deep-breathing exercises
c. Positive expiratory pressure
d. Intermittent positive-pressure breathing

 

 

ANS:  D

The patient’s vital capacity of 5 mL/kg is a contraindication for the use of incentive spirometry, and coupled with the fact that he is unable to cough effectively, this makes the use of deep-breathing exercises inappropriate. The patient’s respiratory weakness plus the fact that there is no mention of excessive sputum make positive expiratory pressure therapy inappropriate. Intermittent positive-pressure breathing is appropriate because of the patient’s low vital capacity and inability to cough effectively.

 

PTS:   1                    REF:   Page 217, Clinical Practice Guideline 7-2

 

  1. A 60-year-old female patient with a diagnosis of bilateral lower lobe pneumonia is brought to the emergency department. An assessment reveals a temperature of 38.5° C (101.3° F), a respiratory rate of 35 breaths/min, a pulse of 115 beats/min, and decreased breath sounds in both lower lobes; furthermore, she is not alert. What type of therapy should the respiratory therapist suggest?
a. Incentive spirometry
b. Deep-breathing exercises
c. Positive expiratory pressure
d. Intermittent positive-pressure breathing

 

 

ANS:  D

The patient’s ability to ventilate and cough effectively is compromised because she is not alert. Because of this, incentive spirometry, deep-breathing exercises, and positive expiratory pressure are not appropriate therapies. Intermittent positive-pressure breathing is appropriate because she is not alert.

 

PTS:   1                    REF:   Page 217, Clinical Practice Guideline 7-2

 

  1. A patient who is receiving intermittent positive-pressure breathing therapy for atelectasis now exhibits improved breath sounds and an increased ability to clear secretions. Chest radiography reveals improvement, but not total resolution, of atelectasis. The intermittent positive-pressure breathing therapy is discontinued. What is the most appropriate action at this time?
a. Flutter valve
b. Incentive spirometry
c. Continuous positive airway pressure
d. Intrapulmonary percussive ventilation (IPV)

 

 

ANS:  B

The patient’s increased ability to clear secretions, improved breath sounds, and improved chest radiograph demonstrate an improvement in his atelectasis and overall condition. At this time, “stepping-down” therapy would be appropriate. The most appropriate physiologic therapy that targets atelectasis is incentive spirometry. Flutter valve and intrapulmonary percussive ventilation are therapies for mobilizing retained secretions, and continuous positive airway pressure should be used when atelectasis fails to respond to incentive spirometry and intermittent positive-pressure breathing.

 

PTS:   1                    REF:   Page 217, Clinical Practice Guideline 7-2

 

  1. All intermittent positive-pressure breathing machines are required to have an operating gas pressure source of _____ lb force per square inch gauge (psig).
a. 25 to 35 c. 45 to 55
b. 35 to 45 d. 55 to 65

 

 

ANS:  C

Regardless of the manufacturer, all intermittent positive-pressure breathing machines require a 45-psig to 55-psig gas pressure source, such as a compressed gas cylinder, a bulk air or oxygen system, or an air compressor.

 

PTS:   1                    REF:   Page 227

 

  1. The variable that ends inspiration during intermittent positive-pressure breathing therapy with a Bird Mark 7 is:
a. time. c. volume.
b. flow. d. pressure.

 

 

ANS:  D

The Bird Mark 7 is a pneumatically powered ventilator that will pressure-cycle during intermittent positive-pressure breathing therapy. If used for short-term mechanical ventilation, it could be time-cycled.

 

PTS:   1                    REF:   Page 219

 

  1. Which of the following intermittent positive-pressure breathing machines is unable to provide short-term ventilatory support?
a. Bird Mark 7 c. Puritan Bennett AP-4
b. Bird Mark 14 d. Puritan Bennett PR-2

 

 

ANS:  C

The Puritan Bennett AP-4 is only patient-triggered, so it can be used for intermittent positive-pressure breathing therapy but not for providing short-term ventilatory support of patients with apnea. The other ventilators mentioned are able to support patients for short-term mechanical ventilation.

 

PTS:   1                    REF:   Page 218

 

  1. Which of the following intermittent positive-pressure breathing machines can deliver 100% oxygen?
a. Bird Mark 10 c. Puritan Bennett AP-5
b. Bird Mark 14 d. Puritan Bennett PR-2

 

 

ANS:  D

The Puritan Bennett PR-2 can deliver either 100% source gas or air-diluted source gas. The Bird Mark 10 and Mark 14 ventilators do not have an air-mix control, which means that they can operate only in the air-dilution mode. The gas in the Puritan Bennett AP-5 unit is provided by an air compressor and a Venturi jet that entrains additional air; there is no means to attach a gas source.

 

PTS:   1                    REF:   Page 218

 

  1. Minor leaks can be compensated for on a Puritan Bennett PR-1 or PR-2 with the use a __________ control.
a. Negative end-expiratory pressure c. Terminal flow
b. Diluter regulator d. Flow

 

 

ANS:  C

A terminal flow control is provided for minor leak compensation on the PR-1 or PR-2. Negative end-expiratory pressure is a negative pressure that can be applied to the end of expiration and does not have anything to do with leak compensation. The diluter regulator is an adjustable reducing valve that regulates the gas pressure delivered to the patient. The flow control adjusts the velocity of the gas flowing to the patient.

 

PTS:   1                    REF:   Page 218

 

  1. The diluter regulator on a Puritan Bennett PR-2 is used to do which of the following?
a. Adjust the flow rate.
b. Regulate gas pressure.
c. Eliminate leaks in the system.
d. Apply negative end-expiratory pressure.

 

 

ANS:  B

The diluter regulator is an adjustable reducing valve that regulates the gas pressure delivered to the patient. It can be set from 0 to 30 cm H2O by using a control knob on the front panel of the machine.

 

PTS:   1                    REF:   Page 218

 

  1. Pressure limits on the Puritan Bennett PR-2 can be set between _____ cm H2O.
a. 0 and 30 c. 0 and 60
b. 0 and 50 d. 10 and 30

 

 

ANS:  A

The gas pressure can be set from 0 to 30 cm H2O.

 

PTS:   1                    REF:   Page 218

 

  1. The Puritan Bennett PR-2’s sensitivity setting can be decreased (making it more difficult for the patient to trigger) by doing which of the following with the Sensitivity knob?
a. Pushing it in c. Rotating it clockwise
b. Pulling it out d. Rotating it counterclockwise

 

 

ANS:  D

The manufacturer presets the sensitivity of the machine at 0.5 cm H2O, but the sensitivity (or amount of patient effort) that must be exerted to trigger inspiration can be changed by rotating the Sensitivity knob counterclockwise.

 

PTS:   1                    REF:   Page 219

 

  1. The inspiratory phase on a Puritan Bennett PR-2 will end when which of the following occurs?
a. The clutch plate, diaphragm, and ceramic switch are forced left.
b. Gravity is sufficient to completely close the Bennett valve.
c. The Bennett valve rotates counterclockwise.
d. The set Sensitivity level is reached.

 

 

ANS:  B

When the gas flow through the Bennett valve decreases to between 1 and 3 L/min, the force of gravity is sufficient to swing the valve completely closed, thus terminating inspiration.

 

PTS:   1                    REF:   Page 219

 

  1. Which of the following intermittent positive-pressure breathing machines is electrically powered and patient-triggered only?
a. Bird Mark 7 c. Puritan Bennett AP-5
b. Bird Mark 14 d. Puritan Bennett PR-2

 

 

ANS:  C

The Puritan Bennett AP-5 machines are electrically powered and patient-triggered only. The other machines are pneumatically powered and can be time-triggered, as well as patient-triggered.

 

PTS:   1                    REF:   Page 218

 

  1. Which of the following intermittent positive-pressure breathing machines can produce pressure as high as 200 cm H2O?
a. Puritan Bennett PR-1 c. Bird Mark 10
b. Puritan Bennett PR-2 d. Bird Mark 14

 

 

ANS:  D

The Bird Mark 14 ventilators can produce pressure as high as 200 cm H2O.

 

PTS:   1                    REF:   Page 223

 

  1. During the inspiratory phase of a Bird Mark 7, the:
a. valve will close.
b. valve rotates counterclockwise.
c. diaphragm moves toward the left compartment.
d. diaphragm moves away from the left compartment.

 

 

ANS:  D

During inspiration, negative pressure generated by the patient (along with atmospheric pressure in the left compartment) causes the diaphragm to move toward the right, away from the left compartment. The valves are located on the Bennett PR series ventilators. At the beginning of exhalation on the Bird Mark 7, the diaphragm moves toward the left compartment.

 

PTS:   1                    REF:   Page 219

 

  1. Which of the following uses magnetism versus gas pressure as its basic principle of operation?
a. Bird Mark 14 ventilator
b. Puritan Bennett PR-2 ventilator
c. The Vest Airway Clearance System (also known as the ThAIRapy Vest)
d. Percussionaire Intrapulmonary Percussive Ventilator (IPV-1)

 

 

ANS:  A

The Bird Mark series ventilators use magnetism versus gas pressure as their basic principle of operation.

 

PTS:   1                    REF:   Page 218

 

  1. When the gas pressure in the right chamber of a Bird Mark 7 exceeds the magnetic attraction of the right magnet, which of the following occurs?
a. Exhalation ends. c. The diaphragm moves right.
b. Inspiration begins. d. The clutch plate is forced left.

 

 

ANS:  C

Toward the end of inspiration, the pressure in the pressure chamber exceeds the magnetic attraction of the right magnet. The diaphragm, clutch plate, and ceramic switch are then forced to the left, occluding gas flow into the ventilator and starting exhalation.

 

PTS:   1                    REF:   Page 219

 

  1. At the beginning of inspiration, gas flow to the patient from a Bird Mark 7 or 8 set on “air-mix” comes from which of the following?
a. Venturi device c. Diluter regulator
b. Flow controller d. Pneumatic cartridge

 

 

ANS:  A

When set on air-mix, a Bird Mark 7 or 8 will direct the incoming source gas to the jet of the air-mix Venturi. The gas going to the patient is from the Venturi jet, the air entrained by the Venturi system, and the nebulizer jet.

 

PTS:   1                    REF:   Page 219

 

  1. In the air-mix setting, the flow and pressure waveforms that can be produced by the Bird Mark 7 include:
a. constant-flow wave (square) and ascending-pressure wave.
b. ascending-flow wave and descending-pressure wave.
c. descending-flow wave and ascending-pressure wave.
d. sine-flow wave and ascending-pressure wave.

 

 

ANS:  C

In the air-mix position, the Venturi is activated, producing a descending-flow pattern and an irregular pressure waveform that ranges from ascending to rectangular, depending on the compliance and resistance of the patient’s respiratory system.

 

PTS:   1                    REF:   Page 220

 

  1. Which of the following is a compact, inexpensive, single-patient intermittent positive-pressure breathing device?
a. Bird Mark 7 c. Puritan Bennett PR-1
b. Puritan Bennett AP-4 d. VORTRAN-IPPB device

 

 

ANS:  D

The VORTRAN-IPPB device provides short-term, pressure-triggered, pressure-cycled, constant-flow ventilatory support in combination with aerosol therapy. The primary advantage of these devices is that they are relatively compact and inexpensive compared with conventional intermittent positive-pressure breathing devices. In addition, the VORTRAN-IPPB units are single-patient, multiple-use devices, a situation that reduces the incidence of nosocomial infections caused by cross-contamination.

 

PTS:   1                    REF:   Page 223

 

  1. The therapy that mobilizes retained secretions by using devices similar to, but less cumbersome than, continuous positive airway pressure is known as which of the following?
a. Expiratory positive airway pressure
b. Intermittent positive-pressure breathing
c. Intrapulmonary percussive ventilation
d. Positive expiratory pressure

 

 

ANS:  D

The rationale for the use of positive expiratory pressure therapy is similar to that for the use of continuous positive airway pressure, except that positive expiratory pressure seems to be less cumbersome and more manageable for patients. Expiratory positive airway pressure and intrapulmonary percussive ventilation are just as cumbersome as continuous positive airway pressure. Intermittent positive-pressure breathing is lung expansion therapy, not bronchial hygiene therapy.

 

PTS:   1                    REF:   Page 226

 

  1. Patients undergoing positive expiratory pressure therapy must have a high enough expiratory flow to generate pressure in the range of _____ cm H2O.
a. 5 to 10 c. 20 to 25
b. 10 to 20 d. 25 to 30

 

 

ANS:  B

A patient undergoing positive expiratory pressure therapy must be able to generate expiratory flows high enough to maintain expiratory pressure at 10 to 20 cm H2O.

 

PTS:   1                    REF:   Page 226, Box 7-1

 

  1. During a positive expiratory pressure therapy session, a patient should be told to:
a. stop after 20 to 30 breaths.
b. place lips into the mouthpiece.
c. take a deep breath, and then actively exhale.
d. breathe normally through the mouthpiece.

 

 

ANS:  C

Patients should be instructed to inspire through the one-way valve of the positive expiratory pressure device to a volume that is greater than the normal tidal volume—but not to the total lung capacity. At the end of inspiration, patients are encouraged to actively, but not forcefully, exhale to functional residual capacity.

 

PTS:   1                    REF:   Page 226, Box 7-1

 

  1. An assessment of a patient with newly diagnosed chronic bronchitis reveals an alert, cooperative, and oriented patient. Low-pitched wheezes are heard bilaterally on auscultation. The patient has a productive cough, producing copious amounts of sputum; no fever; a pulse of 85 beats/min; respirations of 18 breaths/min; and blood pressure of 145/90. The most appropriate lung expansion therapy for this patient is which of the following?
a. Incentive spirometry
b. Intermittent positive-pressure breathing
c. Positive expiratory pressure
d. Flutter valve

 

 

ANS:  C

Because he is alert, cooperative, and oriented, intermittent positive-pressure breathing is not appropriate for him. Incentive spirometry might be an alternative; however, it will not help this patient to mobilize the copious amounts of sputum being produced. Positive expiratory pressure not only acts as an enhancement to the movement of mucus, but it also reverses atelectasis and optimizes delivery of bronchodilators to patients with chronic bronchitis. The flutter valve will serve only as bronchial hygiene therapy.

 

PTS:   1                    REF:   Page 226

 

  1. Air trapping in patients with asthma or chronic obstructive pulmonary disease can be reduced by which of the following?
a. Intrapulmonary percussive ventilation
b. Intermittent positive-pressure breathing
c. Positive expiratory pressure
d. Incentive spirometry

 

 

ANS:  C

Positive airway pressure with positive expiratory pressure is indicated to reduce air trapping in patients with asthma or chronic obstructive pulmonary disease. Intrapulmonary percussive ventilation is a bronchial hygiene therapy only. Intermittent positive-pressure breathing is a lung expansion therapy that should be used only if another lung expansion therapy, such as incentive spirometry, is not appropriate.

 

PTS:   1                    REF:   Page 224, Clinical Practice Guideline 7-3

 

  1. A female patient’s chest radiograph shows bilateral lower lobe atelectasis. She is alert and oriented. Arterial blood gas analysis reveals mild hypoxemia and respiratory alkalemia; her vital signs are within normal limits. Which of the following is most appropriate at this time?
a. Chest physiotherapy every 4 hours
b. Continuous positive airway pressure +5 cm H2O
c. Intrapulmonary percussive ventilation every 2 hours
d. Intermittent positive-pressure breathing 35 cm H2O Q4

 

 

ANS:  B

This patient requires lung expansion therapy to reverse the atelectasis. Chest physiotherapy and intrapulmonary percussive ventilation are both bronchial hygiene therapy. Intermittent positive-pressure breathing is lung expansion therapy, but it is not appropriate for this patient because she is alert and oriented. Continuous positive airway pressure will help to reverse her mild hypoxemia and atelectasis.

 

PTS:   1                    REF:   Pages 216-224, Clinical Practice Guidelines 7-2 and 7-3

 

  1. An assessment of outcome for a patient receiving mask continuous positive airway pressure +8 cm H2O should include which of the following?
a. Cardiac output testing c. Intracranial pressure measurement
b. Pulse oximetry d. Pulmonary function testing

 

 

ANS:  B

Oxygen saturation should improve as atelectasis resolves. Pulse oximetry is an easy, quick, noninvasive, and cheap way of assessing patients undergoing positive airway pressure therapy.

 

PTS:   1                    REF:   Page 224, Clinical Practice Guideline 7-3

 

  1. Which of the following therapies can be used as an alternative to endotracheal intubation and continuous ventilation for patients requiring short-term ventilatory support?
a. Continuous positive airway pressure
b. Expiratory positive airway pressure
c. Intermittent positive-pressure breathing
d. Intrapulmonary percussive ventilation

 

 

ANS:  C

Since its introduction in 1947, intermittent positive-pressure breathing has been used for a variety of reasons, including short-term ventilatory support, lung expansion therapy, and as an aid in delivering aerosolized medications.

 

PTS:   1                    REF:   Page 216

 

  1. A patient with moderate kyphoscoliosis has bilateral lower lobe pneumonia. An assessment reveals impending respiratory failure. Which of the following machines should be used to deliver intermittent positive-pressure breathing to this patient?
a. Bird Mark 10 c. Puritan Bennett AP-5
b. Bird Mark 14 d. Puritan Bennett PR-2

 

 

ANS:  D

The PR-2 is the only ventilator on the list that can provide either air dilution or 100% oxygen that is also capable of time triggering.

 

PTS:   1                    REF:   Page 218

 

  1. Which of the following is a type of adjunctive therapy that aids in the mobilization of airway secretions through high-frequency percussive breaths applied inside the patient’s airways?
a. Intrapulmonary percussive ventilation
b. Continuous positive airway pressure
c. Expiratory positive airway pressure
d. Positive expiratory pressure

 

 

ANS:  A

Intrapulmonary percussive ventilation involves the delivery of high-frequency percussive breaths into the patient’s airways instead of applying percussions to the outside of the chest wall as in standard chest physiotherapy techniques.

 

PTS:   1                    REF:   Pages 228-229

 

  1. How much pressure is the Percussionaire IPV-1 able to deliver with each cycle?
a. 5 to 15 cm H2O c. 15 to 50 cm H2O
b. 10 to 35 cm H2O d. 25 to 40 cm H2O

 

 

ANS:  D

The Percussionaire IPV-1 can deliver percussive pressure of 25 to 40 cm H2O.

 

PTS:   1                    REF:   Page 228

 

  1. The maximum frequency of percussive breaths that a Percussionaire IPV-1 can deliver to a patient’s airways is ____ Hz.
a. 1.3 c. 3
b. 1.7 d. 5

 

 

ANS:  D

The rate for the Percussionaire is 100 to 300 cycles/min, or 1.7 to 5 Hz.

 

PTS:   1                    REF:   Page 228

 

  1. Intrapulmonary percussive ventilation mobilizes airway secretions by which of the following methods?
a. Generating a subatmospheric pressure on inspiration, then an expiratory resistance
b. Applying a positive pressure to a patient’s airways throughout the respiratory cycle
c. Delivering high-frequency percussive breaths into the patient’s airways
d. Applying an expiratory resistance to exhaled flow from the patient

 

 

ANS:  C

The Percussionaire Intrapulmonary percussive ventilation provides a form of oscillator therapy that delivers high-frequency percussive breaths into the patient’s airways. It is used as an adjunct for mobilizing airway secretions.

 

PTS:   1                    REF:   Page 228

 

  1. What is one major component of a pneumatically powered percussor?
a. Force control c. Amplitude control
b. Vibration control d. Convex applicator

 

 

ANS:  A

Each pneumatically powered percussor usually has a high-pressure hose, a body with controls for varying the frequency and the force of percussive strokes, and a remote head with a concave applicator.

 

PTS:   1                    REF:   Page 229

 

  1. One type of threshold resistor used to create continuous positive airway pressure is which of the following?
a. Bennett valve c. Underwater seal
b. Sliding Venturi d. Oscillator cartridge

 

 

ANS:  C

The underwater seal resistor has tubing attached to the expiratory port of the circuit and is submerged under a column of water. The level of continuous positive airway pressure is determined by the height of the column.

 

PTS:   1                    REF:   Page 224

 

  1. To apply positive airway pressure to a manual resuscitator bag during patient transport, which of the following are most appropriate?
  2. Spring-loaded valve
  3. Underwater seal
  4. Magnetic valve
  5. Weighted ball
a. 1 and 2 c. 2 and 4
b. 1 and 3 d. 3 and 4

 

 

ANS:  B

The spring-loaded valve and the magnetic valve are the only valves that are able to be used during patient transport. The water column would be subject to leaks and possible breakage of the cylinder. The weighted ball must always be held upright and is impractical for transport.

 

PTS:   1                    REF:   Page 224

 

  1. Bronchial hygiene therapy for patients with Duchenne muscular dystrophy or spinal muscular atrophy is most appropriate with which of the following?
a. Intermittent positive-pressure breathing
b. Incentive spirometry
c. Mechanical insufflation-exsufflation
d. Positive expiratory pressure

 

 

ANS:  C

The purpose of a mechanical insufflation-exsufflation device is to replace or augment cough clearance in individuals with respiratory muscle weakness or paralysis (e.g., neuromuscular disease).

 

PTS:   1                    REF:   Page 232

 

  1. Which of the following bronchial hygiene therapy devices can be used to ventilate a patient?
a. Hayek Oscillator c. Percussionaire IPV-1
b. The Vest d. Positive expiratory pressure

 

 

ANS:  A

The Hayek Oscillator is technically classified as an electrically powered noninvasive ventilator. This device consists of a flexible chest cuirass that is applied over the chest wall. The device delivers both negative and positive pressure to the chest wall during the respiratory cycle. The negative pressure creates inspiration, and the positive pressure produces a forced exhalation.

 

PTS:   1                    REF:   Pages 231-232

 

  1. A patient with chronic bronchitis is being discharged from the hospital. The simplest, most cost-efficient device to aid this patient with bronchial hygiene therapy is which of the following?
a. Percussionaire IPV-1 c. Bird Mark 8
b. Flutter therapy d. Pneumatic percussor

 

 

ANS:  B

Flutter therapy is relatively easy for patients to use and is less expensive than the other devices listed in the answer choices.

 

PTS:   1                    REF:   Page 231

 

  1. Contraindications to positive airway pressure adjuncts to bronchial hygiene therapy include which of the following?
a. Hiccups c. Esophageal surgery
b. Air swallowing d. Subcutaneous emphysema

 

 

ANS:  C

Esophageal surgery is listed in Clinical Practice Guideline 7-3 as a contraindication to the use of positive airway pressure adjuncts to bronchial hygiene therapy.

 

PTS:   1                    REF:   Page 224, Clinical Practice Guideline 7-3

 

  1. What is the function of the counterweight plug and magnet in the Acapella Flutter type of device?
a. Creates positive and negative pressure in the chest
b. Provides high-frequency external chest wall oscillations
c. Creates oscillations that are transmitted into the lungs
d. Creates positive pressure throughout the respiratory cycle

 

 

ANS:  C

Acapella is a flutter type of valve that creates a series of high-frequency oscillations that are transmitted into the lungs through the airway opening.

 

PTS:   1                    REF:   Page 230

 

  1. The device that will prevent early airway closure is:
a. incentive spirometry.
b. intermittent positive-pressure breathing.
c. flutter valve therapy.
d. high-frequency chest wall oscillation.

 

 

ANS:  C

The steel ball of the flutter valve or the counterweighted plug and magnet help to prevent early airway closure.

 

PTS:   1                    REF:   Page 230

Chapter 07: Lung Expansion Therapy Devices

 

MULTIPLE CHOICE

 

  1. The primary indication for lung expansion therapy is:
a. asthma. c. chronic bronchitis.
b. atelectasis. d. respiratory distress.

 

 

ANS:  B

Lung expansion therapy is used to either prevent or treat atelectasis.

 

PTS:   1                    REF:   Page 213

 

  1. Factors that increase the risk of atelectasis include:
a. productive cough.
b. lower extremity paralysis.
c. decreased intra-abdominal pressure.
d. chronic obstructive pulmonary disease.

 

 

ANS:  D

Factors that contribute to the development of atelectasis include retained secretions, altered breathing patterns, pain associated with surgery and trauma, chronic obstructive pulmonary disease, prolonged immobilization in a supine position, and increased intra-abdominal pressure.

 

PTS:   1                    REF:   Pages 213-214

 

  1. Untreated atelectasis can result in which of the following?
  2. Decreased shunting
  3. Increased shunting
  4. Hypercapnia
  5. Hypocapnia
a. 1 and 3 c. 1 and 4
b. 2 and 3 d. 2 and 4

 

 

ANS:  B

If atelectasis goes untreated, it can lead to pulmonary shunting, hypoxemia, hypercapnia, and ultimately respiratory failure.

 

PTS:   1                    REF:   Page 213

 

  1. Contraindications for incentive spirometry include:
a. post-thoracic surgery.
b. vital capacity less than 10 mL/kg.
c. restrictive pulmonary disease.
d. inspiratory capacity greater than predicted value.

 

 

ANS:  B

A vital capacity of less than 10 mL/kg demonstrates that the patient is unable to breathe deeply, effectively rendering the patient unable to perform the maneuver that is necessary to achieve positive results. Incentive spirometry is indicated for post-thoracic surgery and restrictive pulmonary disease. If a patient has an inspiratory capacity greater than predicted, that patient would be able to perform incentive spirometry.

 

PTS:   1                    REF:   Page 214

 

  1. Indications for incentive spirometry include:
a. post-abdominal surgery.
b. respiratory muscle weakness.
c. optimization of bronchodilator therapy.
d. inability to effectively deep breathe.

 

 

ANS:  A

Abdominal surgery predisposes a patient to the development of pulmonary atelectasis. Patients with respiratory muscle weakness or the inability to effectively deep breathe will not be able to perform incentive spirometry and therefore will not benefit from its use. Incentive spirometry is not used to optimize bronchodilator therapy.

 

PTS:   1                    REF:   Page 214

 

  1. Complications from incentive spirometry include:
a. barotrauma. c. pulmonary edema.
b. hypoventilation. d. subcutaneous emphysema.

 

 

ANS:  A

Pulmonary barotrauma is a complication of incentive spirometry that usually occurs in patients with emphysematous lungs. Hypoventilation, pulmonary edema, and subcutaneous emphysema are not complications of incentive spirometry.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. When instructing patients on the use of a volume-displacement incentive spirometer, the respiratory therapist should inform the patients to do which of the following?
a. Inhale deeply and hold for 3 to 5 seconds.
b. Exhale as fast as possible into the mouthpiece.
c. Inhale and exhale rapidly through the mouthpiece.
d. Perform 30 sustained maximum inspirations every 15 minutes.

 

 

ANS:  A

After patients have achieved the maximum volume, they should be instructed to hold this volume constant for 3 to 5 seconds. The other choices are not techniques for use with incentive spirometry.

 

PTS:   1                    REF:   Page 215

 

  1. A patient has undergone surgery and is receiving continuous supplemental oxygen via a 30% air-entrainment mask. He or she becomes pale and short of breath during incentive spirometry. Pulse oximetry reveals a significant drop in oxygen saturation during incentive spirometry. The respiratory therapist should do which of the following for subsequent incentive spirometry therapy?
a. Switch to a different type of incentive spirometer.
b. Request that incentive spirometry be discontinued.
c. Cut a hole in the mask for the incentive spirometer’s mouthpiece.
d. Use a 3 L/min nasal cannula during incentive spirometry.

 

 

ANS:  D

The drop in oxygen saturation during incentive spirometry is due to the interruption of oxygen therapy. For this patient it is necessary to maintain oxygen therapy during incentive spirometry. Because the use of a mask is difficult during incentive spirometry, a nasal cannula with a flow rate of 3 L/min will approximate the air-entrainment mask’s 30% supplemental oxygen.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. Which of the following is true concerning flow-dependent incentive spirometry devices?
a. The volume capacity for a child should be approximately 3 L.
b. The patient must perform a sustained maximum inspiration.
c. They are available as multiuse electrically powered devices.
d. Positive pressure within the device causes the flexible plastic bellows to rise.

 

 

ANS:  B

The performance of a sustained maximum inspiration is necessary to perform incentive spirometry with a flow-dependent incentive spirometer (or any incentive spirometry device).

 

PTS:   1                    REF:   Page 214

 

  1. During an incentive spirometry treatment, a patient holds the 600 mL/s ball up for 1.5 seconds; the patient inhaled a volume of _____ L.
a. 0.15 c. 0.60
b. 0.45 d. 0.90

 

 

ANS:  D

Flow = Tidal volume ÷ Inspiratory time.

Tidal volume = Flow ´ Inspiratory time.

Tidal volume = 600 mL/s ´ 1.5 s = 900 mL, or 0.90 L.

 

PTS:   1                    REF:   Page 215

 

  1. A patient reports that during incentive spirometry she becomes dizzy and must stop the maneuver when this happens. The most probable cause of this situation is:
a. hypoventilation. c. patient fatigue.
b. hyperventilation. d. bronchospasm.

 

 

ANS:  B

The patient’s light-headedness is caused by hyperventilation. This is a common complication of incentive spirometry.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. After abdominal surgery, a young, otherwise healthy patient is unable to meet the volume set for his volume-oriented incentive spirometer. This situation is most likely due to:
a. exacerbation of bronchospasm. c. major lung collapse.
b. inadequate pain control. d. hyperventilation.

 

 

ANS:  B

Patients who are recovering from abdominal or thoracic surgery might find it difficult to achieve incentive spirometry volume goals when their pain is not under control. An exacerbation of bronchospasm would most likely cause a patient to wheeze. Major lung collapse would cause respiratory failure, and hyperventilation would cause dizziness.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. A patient undergoing incentive spirometry should be monitored for outcome by assessing which of the following?
  2. Forced expiratory volume at 1 second (FEV1)
  3. Peak expiratory flow
  4. Partial pressure of arterial oxygen (PaO2)
  5. Blood pressure
a. 1 and 2 c. 1 and 4
b. 2 and 3 d. 3 and 4

 

 

ANS:  B

When assessing for outcome from incentive spirometry, the respiratory therapist is looking for the absence of or an improvement in signs of atelectasis. These signs are decreased respiratory rate, resolution of fever, normal pulse rate, improved breath sounds, a normal chest radiograph, improved arterial oxygenation, increased vital capacity and peak expiratory flows, return of functional residual capacity or vital capacity to preoperative values, and improved inspiratory muscle performance.

 

PTS:   1                    REF:   Page 215, Clinical Practice Guideline 7-1

 

  1. A patient is able to sustain a flow of 900 cc/s to hold the ball of a flow-oriented incentive spirometer aloft for 2 seconds. Her inspired volume is ____ L.
a. 0.18 c. 1.45
b. 0.90 d. 1.80

 

 

ANS:  D

Flow = Tidal volume ÷ Inspiratory time.

Tidal volume = Flow ´ Inspiratory time.

Tidal volume = 900 mL/s ´ 2 s = 1800 mL, or 1.80 L.

 

PTS:   1                    REF:   Page 215

 

  1. To determine outcome for a patient undergoing intermittent positive-pressure breathing (IPPB) therapy, the respiratory therapist should assess which of the following?
  2. Peak expiratory flow
  3. Breath sounds
  4. Sputum color
  5. Maximum inspiratory pressure
a. 1 and 2 c. 1, 2, and 3
b. 3 and 4 d. 2, 3, and 4

 

 

ANS:  A

Assessment of outcomes for intermittent positive-pressure breathing include tidal volume measurement, FEV1, peak expiratory flows, cough assessment, chest radiograph review, and subjective patient response. The color of the patient’s sputum is not a determining factor in the outcome of intermittent positive-pressure breathing; it is an outcome assessment for the use of antibiotics. Maximum inspiratory pressure is not used in the determination of the effectiveness of intermittent positive-pressure breathing.

 

PTS:   1                    REF:   Page 217, Clinical Practice Guideline 7-2

 

  1. Myasthenia gravis is causing a patient to have respiratory muscle weakness. He has a vital capacity of 5 mL/kg and is unable to cough effectively. What therapy would you recommend to help prevent pulmonary complications?
a. Incentive spirometry
b. Deep-breathing exercises
c. Positive expiratory pressure
d. Intermittent positive-pressure breathing

 

 

ANS:  D

The patient’s vital capacity of 5 mL/kg is a contraindication for the use of incentive spirometry, and coupled with the fact that he is unable to cough effectively, this makes the use of deep-breathing exercises inappropriate. The patient’s respiratory weakness plus the fact that there is no mention of excessive sputum make positive expiratory pressure therapy inappropriate. Intermittent positive-pressure breathing is appropriate because of the patient’s low vital capacity and inability to cough effectively.

 

PTS:   1                    REF:   Page 217, Clinical Practice Guideline 7-2

 

  1. A 60-year-old female patient with a diagnosis of bilateral lower lobe pneumonia is brought to the emergency department. An assessment reveals a temperature of 38.5° C (101.3° F), a respiratory rate of 35 breaths/min, a pulse of 115 beats/min, and decreased breath sounds in both lower lobes; furthermore, she is not alert. What type of therapy should the respiratory therapist suggest?
a. Incentive spirometry
b. Deep-breathing exercises
c. Positive expiratory pressure
d. Intermittent positive-pressure breathing

 

 

ANS:  D

The patient’s ability to ventilate and cough effectively is compromised because she is not alert. Because of this, incentive spirometry, deep-breathing exercises, and positive expiratory pressure are not appropriate therapies. Intermittent positive-pressure breathing is appropriate because she is not alert.

 

PTS:   1                    REF:   Page 217, Clinical Practice Guideline 7-2

 

  1. A patient who is receiving intermittent positive-pressure breathing therapy for atelectasis now exhibits improved breath sounds and an increased ability to clear secretions. Chest radiography reveals improvement, but not total resolution, of atelectasis. The intermittent positive-pressure breathing therapy is discontinued. What is the most appropriate action at this time?
a. Flutter valve
b. Incentive spirometry
c. Continuous positive airway pressure
d. Intrapulmonary percussive ventilation (IPV)

 

 

ANS:  B

The patient’s increased ability to clear secretions, improved breath sounds, and improved chest radiograph demonstrate an improvement in his atelectasis and overall condition. At this time, “stepping-down” therapy would be appropriate. The most appropriate physiologic therapy that targets atelectasis is incentive spirometry. Flutter valve and intrapulmonary percussive ventilation are therapies for mobilizing retained secretions, and continuous positive airway pressure should be used when atelectasis fails to respond to incentive spirometry and intermittent positive-pressure breathing.

 

PTS:   1                    REF:   Page 217, Clinical Practice Guideline 7-2

 

  1. All intermittent positive-pressure breathing machines are required to have an operating gas pressure source of _____ lb force per square inch gauge (psig).
a. 25 to 35 c. 45 to 55
b. 35 to 45 d. 55 to 65

 

 

ANS:  C

Regardless of the manufacturer, all intermittent positive-pressure breathing machines require a 45-psig to 55-psig gas pressure source, such as a compressed gas cylinder, a bulk air or oxygen system, or an air compressor.

 

PTS:   1                    REF:   Page 227

 

  1. The variable that ends inspiration during intermittent positive-pressure breathing therapy with a Bird Mark 7 is:
a. time. c. volume.
b. flow. d. pressure.

 

 

ANS:  D

The Bird Mark 7 is a pneumatically powered ventilator that will pressure-cycle during intermittent positive-pressure breathing therapy. If used for short-term mechanical ventilation, it could be time-cycled.

 

PTS:   1                    REF:   Page 219

 

  1. Which of the following intermittent positive-pressure breathing machines is unable to provide short-term ventilatory support?
a. Bird Mark 7 c. Puritan Bennett AP-4
b. Bird Mark 14 d. Puritan Bennett PR-2

 

 

ANS:  C

The Puritan Bennett AP-4 is only patient-triggered, so it can be used for intermittent positive-pressure breathing therapy but not for providing short-term ventilatory support of patients with apnea. The other ventilators mentioned are able to support patients for short-term mechanical ventilation.

 

PTS:   1                    REF:   Page 218

 

  1. Which of the following intermittent positive-pressure breathing machines can deliver 100% oxygen?
a. Bird Mark 10 c. Puritan Bennett AP-5
b. Bird Mark 14 d. Puritan Bennett PR-2

 

 

ANS:  D

The Puritan Bennett PR-2 can deliver either 100% source gas or air-diluted source gas. The Bird Mark 10 and Mark 14 ventilators do not have an air-mix control, which means that they can operate only in the air-dilution mode. The gas in the Puritan Bennett AP-5 unit is provided by an air compressor and a Venturi jet that entrains additional air; there is no means to attach a gas source.

 

PTS:   1                    REF:   Page 218

 

  1. Minor leaks can be compensated for on a Puritan Bennett PR-1 or PR-2 with the use a __________ control.
a. Negative end-expiratory pressure c. Terminal flow
b. Diluter regulator d. Flow

 

 

ANS:  C

A terminal flow control is provided for minor leak compensation on the PR-1 or PR-2. Negative end-expiratory pressure is a negative pressure that can be applied to the end of expiration and does not have anything to do with leak compensation. The diluter regulator is an adjustable reducing valve that regulates the gas pressure delivered to the patient. The flow control adjusts the velocity of the gas flowing to the patient.

 

PTS:   1                    REF:   Page 218

 

  1. The diluter regulator on a Puritan Bennett PR-2 is used to do which of the following?
a. Adjust the flow rate.
b. Regulate gas pressure.
c. Eliminate leaks in the system.
d. Apply negative end-expiratory pressure.

 

 

ANS:  B

The diluter regulator is an adjustable reducing valve that regulates the gas pressure delivered to the patient. It can be set from 0 to 30 cm H2O by using a control knob on the front panel of the machine.

 

PTS:   1                    REF:   Page 218

 

  1. Pressure limits on the Puritan Bennett PR-2 can be set between _____ cm H2O.
a. 0 and 30 c. 0 and 60
b. 0 and 50 d. 10 and 30

 

 

ANS:  A

The gas pressure can be set from 0 to 30 cm H2O.

 

PTS:   1                    REF:   Page 218

 

  1. The Puritan Bennett PR-2’s sensitivity setting can be decreased (making it more difficult for the patient to trigger) by doing which of the following with the Sensitivity knob?
a. Pushing it in c. Rotating it clockwise
b. Pulling it out d. Rotating it counterclockwise

 

 

ANS:  D

The manufacturer presets the sensitivity of the machine at 0.5 cm H2O, but the sensitivity (or amount of patient effort) that must be exerted to trigger inspiration can be changed by rotating the Sensitivity knob counterclockwise.

 

PTS:   1                    REF:   Page 219

 

  1. The inspiratory phase on a Puritan Bennett PR-2 will end when which of the following occurs?
a. The clutch plate, diaphragm, and ceramic switch are forced left.
b. Gravity is sufficient to completely close the Bennett valve.
c. The Bennett valve rotates counterclockwise.
d. The set Sensitivity level is reached.

 

 

ANS:  B

When the gas flow through the Bennett valve decreases to between 1 and 3 L/min, the force of gravity is sufficient to swing the valve completely closed, thus terminating inspiration.

 

PTS:   1                    REF:   Page 219

 

  1. Which of the following intermittent positive-pressure breathing machines is electrically powered and patient-triggered only?
a. Bird Mark 7 c. Puritan Bennett AP-5
b. Bird Mark 14 d. Puritan Bennett PR-2

 

 

ANS:  C

The Puritan Bennett AP-5 machines are electrically powered and patient-triggered only. The other machines are pneumatically powered and can be time-triggered, as well as patient-triggered.

 

PTS:   1                    REF:   Page 218

 

  1. Which of the following intermittent positive-pressure breathing machines can produce pressure as high as 200 cm H2O?
a. Puritan Bennett PR-1 c. Bird Mark 10
b. Puritan Bennett PR-2 d. Bird Mark 14

 

 

ANS:  D

The Bird Mark 14 ventilators can produce pressure as high as 200 cm H2O.

 

PTS:   1                    REF:   Page 223

 

  1. During the inspiratory phase of a Bird Mark 7, the:
a. valve will close.
b. valve rotates counterclockwise.
c. diaphragm moves toward the left compartment.
d. diaphragm moves away from the left compartment.

 

 

ANS:  D

During inspiration, negative pressure generated by the patient (along with atmospheric pressure in the left compartment) causes the diaphragm to move toward the right, away from the left compartment. The valves are located on the Bennett PR series ventilators. At the beginning of exhalation on the Bird Mark 7, the diaphragm moves toward the left compartment.

 

PTS:   1                    REF:   Page 219

 

  1. Which of the following uses magnetism versus gas pressure as its basic principle of operation?
a. Bird Mark 14 ventilator
b. Puritan Bennett PR-2 ventilator
c. The Vest Airway Clearance System (also known as the ThAIRapy Vest)
d. Percussionaire Intrapulmonary Percussive Ventilator (IPV-1)

 

 

ANS:  A

The Bird Mark series ventilators use magnetism versus gas pressure as their basic principle of operation.

 

PTS:   1                    REF:   Page 218

 

  1. When the gas pressure in the right chamber of a Bird Mark 7 exceeds the magnetic attraction of the right magnet, which of the following occurs?
a. Exhalation ends. c. The diaphragm moves right.
b. Inspiration begins. d. The clutch plate is forced left.

 

 

ANS:  C

Toward the end of inspiration, the pressure in the pressure chamber exceeds the magnetic attraction of the right magnet. The diaphragm, clutch plate, and ceramic switch are then forced to the left, occluding gas flow into the ventilator and starting exhalation.

 

PTS:   1                    REF:   Page 219

 

  1. At the beginning of inspiration, gas flow to the patient from a Bird Mark 7 or 8 set on “air-mix” comes from which of the following?
a. Venturi device c. Diluter regulator
b. Flow controller d. Pneumatic cartridge

 

 

ANS:  A

When set on air-mix, a Bird Mark 7 or 8 will direct the incoming source gas to the jet of the air-mix Venturi. The gas going to the patient is from the Venturi jet, the air entrained by the Venturi system, and the nebulizer jet.

 

PTS:   1                    REF:   Page 219

 

  1. In the air-mix setting, the flow and pressure waveforms that can be produced by the Bird Mark 7 include:
a. constant-flow wave (square) and ascending-pressure wave.
b. ascending-flow wave and descending-pressure wave.
c. descending-flow wave and ascending-pressure wave.
d. sine-flow wave and ascending-pressure wave.

 

 

ANS:  C

In the air-mix position, the Venturi is activated, producing a descending-flow pattern and an irregular pressure waveform that ranges from ascending to rectangular, depending on the compliance and resistance of the patient’s respiratory system.

 

PTS:   1                    REF:   Page 220

 

  1. Which of the following is a compact, inexpensive, single-patient intermittent positive-pressure breathing device?
a. Bird Mark 7 c. Puritan Bennett PR-1
b. Puritan Bennett AP-4 d. VORTRAN-IPPB device

 

 

ANS:  D

The VORTRAN-IPPB device provides short-term, pressure-triggered, pressure-cycled, constant-flow ventilatory support in combination with aerosol therapy. The primary advantage of these devices is that they are relatively compact and inexpensive compared with conventional intermittent positive-pressure breathing devices. In addition, the VORTRAN-IPPB units are single-patient, multiple-use devices, a situation that reduces the incidence of nosocomial infections caused by cross-contamination.

 

PTS:   1                    REF:   Page 223

 

  1. The therapy that mobilizes retained secretions by using devices similar to, but less cumbersome than, continuous positive airway pressure is known as which of the following?
a. Expiratory positive airway pressure
b. Intermittent positive-pressure breathing
c. Intrapulmonary percussive ventilation
d. Positive expiratory pressure

 

 

ANS:  D

The rationale for the use of positive expiratory pressure therapy is similar to that for the use of continuous positive airway pressure, except that positive expiratory pressure seems to be less cumbersome and more manageable for patients. Expiratory positive airway pressure and intrapulmonary percussive ventilation are just as cumbersome as continuous positive airway pressure. Intermittent positive-pressure breathing is lung expansion therapy, not bronchial hygiene therapy.

 

PTS:   1                    REF:   Page 226

 

  1. Patients undergoing positive expiratory pressure therapy must have a high enough expiratory flow to generate pressure in the range of _____ cm H2O.
a. 5 to 10 c. 20 to 25
b. 10 to 20 d. 25 to 30

 

 

ANS:  B

A patient undergoing positive expiratory pressure therapy must be able to generate expiratory flows high enough to maintain expiratory pressure at 10 to 20 cm H2O.

 

PTS:   1                    REF:   Page 226, Box 7-1

 

  1. During a positive expiratory pressure therapy session, a patient should be told to:
a. stop after 20 to 30 breaths.
b. place lips into the mouthpiece.
c. take a deep breath, and then actively exhale.
d. breathe normally through the mouthpiece.

 

 

ANS:  C

Patients should be instructed to inspire through the one-way valve of the positive expiratory pressure device to a volume that is greater than the normal tidal volume—but not to the total lung capacity. At the end of inspiration, patients are encouraged to actively, but not forcefully, exhale to functional residual capacity.

 

PTS:   1                    REF:   Page 226, Box 7-1

 

  1. An assessment of a patient with newly diagnosed chronic bronchitis reveals an alert, cooperative, and oriented patient. Low-pitched wheezes are heard bilaterally on auscultation. The patient has a productive cough, producing copious amounts of sputum; no fever; a pulse of 85 beats/min; respirations of 18 breaths/min; and blood pressure of 145/90. The most appropriate lung expansion therapy for this patient is which of the following?
a. Incentive spirometry
b. Intermittent positive-pressure breathing
c. Positive expiratory pressure
d. Flutter valve

 

 

ANS:  C

Because he is alert, cooperative, and oriented, intermittent positive-pressure breathing is not appropriate for him. Incentive spirometry might be an alternative; however, it will not help this patient to mobilize the copious amounts of sputum being produced. Positive expiratory pressure not only acts as an enhancement to the movement of mucus, but it also reverses atelectasis and optimizes delivery of bronchodilators to patients with chronic bronchitis. The flutter valve will serve only as bronchial hygiene therapy.

 

PTS:   1                    REF:   Page 226

 

  1. Air trapping in patients with asthma or chronic obstructive pulmonary disease can be reduced by which of the following?
a. Intrapulmonary percussive ventilation
b. Intermittent positive-pressure breathing
c. Positive expiratory pressure
d. Incentive spirometry

 

 

ANS:  C

Positive airway pressure with positive expiratory pressure is indicated to reduce air trapping in patients with asthma or chronic obstructive pulmonary disease. Intrapulmonary percussive ventilation is a bronchial hygiene therapy only. Intermittent positive-pressure breathing is a lung expansion therapy that should be used only if another lung expansion therapy, such as incentive spirometry, is not appropriate.

 

PTS:   1                    REF:   Page 224, Clinical Practice Guideline 7-3

 

  1. A female patient’s chest radiograph shows bilateral lower lobe atelectasis. She is alert and oriented. Arterial blood gas analysis reveals mild hypoxemia and respiratory alkalemia; her vital signs are within normal limits. Which of the following is most appropriate at this time?
a. Chest physiotherapy every 4 hours
b. Continuous positive airway pressure +5 cm H2O
c. Intrapulmonary percussive ventilation every 2 hours
d. Intermittent positive-pressure breathing 35 cm H2O Q4

 

 

ANS:  B

This patient requires lung expansion therapy to reverse the atelectasis. Chest physiotherapy and intrapulmonary percussive ventilation are both bronchial hygiene therapy. Intermittent positive-pressure breathing is lung expansion therapy, but it is not appropriate for this patient because she is alert and oriented. Continuous positive airway pressure will help to reverse her mild hypoxemia and atelectasis.

 

PTS:   1                    REF:   Pages 216-224, Clinical Practice Guidelines 7-2 and 7-3

 

  1. An assessment of outcome for a patient receiving mask continuous positive airway pressure +8 cm H2O should include which of the following?
a. Cardiac output testing c. Intracranial pressure measurement
b. Pulse oximetry d. Pulmonary function testing

 

 

ANS:  B

Oxygen saturation should improve as atelectasis resolves. Pulse oximetry is an easy, quick, noninvasive, and cheap way of assessing patients undergoing positive airway pressure therapy.

 

PTS:   1                    REF:   Page 224, Clinical Practice Guideline 7-3

 

  1. Which of the following therapies can be used as an alternative to endotracheal intubation and continuous ventilation for patients requiring short-term ventilatory support?
a. Continuous positive airway pressure
b. Expiratory positive airway pressure
c. Intermittent positive-pressure breathing
d. Intrapulmonary percussive ventilation

 

 

ANS:  C

Since its introduction in 1947, intermittent positive-pressure breathing has been used for a variety of reasons, including short-term ventilatory support, lung expansion therapy, and as an aid in delivering aerosolized medications.

 

PTS:   1                    REF:   Page 216

 

  1. A patient with moderate kyphoscoliosis has bilateral lower lobe pneumonia. An assessment reveals impending respiratory failure. Which of the following machines should be used to deliver intermittent positive-pressure breathing to this patient?
a. Bird Mark 10 c. Puritan Bennett AP-5
b. Bird Mark 14 d. Puritan Bennett PR-2

 

 

ANS:  D

The PR-2 is the only ventilator on the list that can provide either air dilution or 100% oxygen that is also capable of time triggering.

 

PTS:   1                    REF:   Page 218

 

  1. Which of the following is a type of adjunctive therapy that aids in the mobilization of airway secretions through high-frequency percussive breaths applied inside the patient’s airways?
a. Intrapulmonary percussive ventilation
b. Continuous positive airway pressure
c. Expiratory positive airway pressure
d. Positive expiratory pressure

 

 

ANS:  A

Intrapulmonary percussive ventilation involves the delivery of high-frequency percussive breaths into the patient’s airways instead of applying percussions to the outside of the chest wall as in standard chest physiotherapy techniques.

 

PTS:   1                    REF:   Pages 228-229

 

  1. How much pressure is the Percussionaire IPV-1 able to deliver with each cycle?
a. 5 to 15 cm H2O c. 15 to 50 cm H2O
b. 10 to 35 cm H2O d. 25 to 40 cm H2O

 

 

ANS:  D

The Percussionaire IPV-1 can deliver percussive pressure of 25 to 40 cm H2O.

 

PTS:   1                    REF:   Page 228

 

  1. The maximum frequency of percussive breaths that a Percussionaire IPV-1 can deliver to a patient’s airways is ____ Hz.
a. 1.3 c. 3
b. 1.7 d. 5

 

 

ANS:  D

The rate for the Percussionaire is 100 to 300 cycles/min, or 1.7 to 5 Hz.

 

PTS:   1                    REF:   Page 228

 

  1. Intrapulmonary percussive ventilation mobilizes airway secretions by which of the following methods?
a. Generating a subatmospheric pressure on inspiration, then an expiratory resistance
b. Applying a positive pressure to a patient’s airways throughout the respiratory cycle
c. Delivering high-frequency percussive breaths into the patient’s airways
d. Applying an expiratory resistance to exhaled flow from the patient

 

 

ANS:  C

The Percussionaire Intrapulmonary percussive ventilation provides a form of oscillator therapy that delivers high-frequency percussive breaths into the patient’s airways. It is used as an adjunct for mobilizing airway secretions.

 

PTS:   1                    REF:   Page 228

 

  1. What is one major component of a pneumatically powered percussor?
a. Force control c. Amplitude control
b. Vibration control d. Convex applicator

 

 

ANS:  A

Each pneumatically powered percussor usually has a high-pressure hose, a body with controls for varying the frequency and the force of percussive strokes, and a remote head with a concave applicator.

 

PTS:   1                    REF:   Page 229

 

  1. One type of threshold resistor used to create continuous positive airway pressure is which of the following?
a. Bennett valve c. Underwater seal
b. Sliding Venturi d. Oscillator cartridge

 

 

ANS:  C

The underwater seal resistor has tubing attached to the expiratory port of the circuit and is submerged under a column of water. The level of continuous positive airway pressure is determined by the height of the column.

 

PTS:   1                    REF:   Page 224

 

  1. To apply positive airway pressure to a manual resuscitator bag during patient transport, which of the following are most appropriate?
  2. Spring-loaded valve
  3. Underwater seal
  4. Magnetic valve
  5. Weighted ball
a. 1 and 2 c. 2 and 4
b. 1 and 3 d. 3 and 4

 

 

ANS:  B

The spring-loaded valve and the magnetic valve are the only valves that are able to be used during patient transport. The water column would be subject to leaks and possible breakage of the cylinder. The weighted ball must always be held upright and is impractical for transport.

 

PTS:   1                    REF:   Page 224

 

  1. Bronchial hygiene therapy for patients with Duchenne muscular dystrophy or spinal muscular atrophy is most appropriate with which of the following?
a. Intermittent positive-pressure breathing
b. Incentive spirometry
c. Mechanical insufflation-exsufflation
d. Positive expiratory pressure

 

 

ANS:  C

The purpose of a mechanical insufflation-exsufflation device is to replace or augment cough clearance in individuals with respiratory muscle weakness or paralysis (e.g., neuromuscular disease).

 

PTS:   1                    REF:   Page 232

 

  1. Which of the following bronchial hygiene therapy devices can be used to ventilate a patient?
a. Hayek Oscillator c. Percussionaire IPV-1
b. The Vest d. Positive expiratory pressure

 

 

ANS:  A

The Hayek Oscillator is technically classified as an electrically powered noninvasive ventilator. This device consists of a flexible chest cuirass that is applied over the chest wall. The device delivers both negative and positive pressure to the chest wall during the respiratory cycle. The negative pressure creates inspiration, and the positive pressure produces a forced exhalation.

 

PTS:   1                    REF:   Pages 231-232

 

  1. A patient with chronic bronchitis is being discharged from the hospital. The simplest, most cost-efficient device to aid this patient with bronchial hygiene therapy is which of the following?
a. Percussionaire IPV-1 c. Bird Mark 8
b. Flutter therapy d. Pneumatic percussor

 

 

ANS:  B

Flutter therapy is relatively easy for patients to use and is less expensive than the other devices listed in the answer choices.

 

PTS:   1                    REF:   Page 231

 

  1. Contraindications to positive airway pressure adjuncts to bronchial hygiene therapy include which of the following?
a. Hiccups c. Esophageal surgery
b. Air swallowing d. Subcutaneous emphysema

 

 

ANS:  C

Esophageal surgery is listed in Clinical Practice Guideline 7-3 as a contraindication to the use of positive airway pressure adjuncts to bronchial hygiene therapy.

 

PTS:   1                    REF:   Page 224, Clinical Practice Guideline 7-3

 

  1. What is the function of the counterweight plug and magnet in the Acapella Flutter type of device?
a. Creates positive and negative pressure in the chest
b. Provides high-frequency external chest wall oscillations
c. Creates oscillations that are transmitted into the lungs
d. Creates positive pressure throughout the respiratory cycle

 

 

ANS:  C

Acapella is a flutter type of valve that creates a series of high-frequency oscillations that are transmitted into the lungs through the airway opening.

 

PTS:   1                    REF:   Page 230

 

  1. The device that will prevent early airway closure is:
a. incentive spirometry.
b. intermittent positive-pressure breathing.
c. flutter valve therapy.
d. high-frequency chest wall oscillation.

 

 

ANS:  C

The steel ball of the flutter valve or the counterweighted plug and magnet help to prevent early airway closure.

 

PTS:   1                    REF:   Page 230