Question 1

To avoid the risk of aspiration after a fiberoptic bronchoscopy procedure, what would you recommend that the patient do?

Accepted Answer

A) be placed in the supine Trendelenburg position for 2 hours 
B) remain in a sitting position and NPO until sensation returns 
C) receive additional aerosolized lidocaine by nebulizer 
D) be continuously monitored for oxygenation through pulse oximetry 
A) be placed in the supine Trendelenburg position for 2 hours 
B) remain in a sitting position and NPO until sensation returns 
C) receive additional aerosolized lidocaine by nebulizer 
D) be continuously monitored for oxygenation through pulse oximetry B

Question 2

Lower airway anesthesia for fiberoptic bronchoscopy can be achieved via which of the following routes of administration?
I.bronchoscopic instillation
II.intravenous administration
III.nebulization (aerosol delivery)

Accepted Answer

A) I and II 
B) I and III 
C) II and III 
D) I, II, and III 
A) I and II 
B) I and III 
C) II and III 
D) I, II, and III B

Question 3

What is the most common complication of suctioning?

Accepted Answer

A) hypoxemia 
B) hypotension 
C) arrhythmias 
D) infection 
A) hypoxemia 
B) hypotension 
C) arrhythmias 
D) infection A

Question 4

During fiberoptic bronchoscopy, a patient's SpO2 drops from 91% to 87%. Which of the following actions would be appropriate?
I.	Apply suction through the scope’s open channel.
II.	Give oxygen through the scope’s open channel.
III.	Increase the cannula or mask oxygen flow.

Accepted Answer

A) I and II 
B) II and III 
C) I and III 
D) I, II, and III 
A) I and II 
B) II and III 
C) I and III 
D) I, II, and III

Question 5

What is the average distance from the tip of a properly positioned oral endotracheal tube to the incisors of an adult man?

Accepted Answer

A) 16 to 18 cm 
B) 19 to 21 cm 
C) 21 to 23 cm 
D) 24 to 26 cm 
A) 16 to 18 cm 
B) 19 to 21 cm 
C) 21 to 23 cm 
D) 24 to 26 cm

Question 6

A patient has been receiving positive-pressure ventilation through a tracheostomy tube for 4 days. In the past 2 days, there is evidence of both recurrent aspiration and abdominal distention but minimal air leakage around the tube cuff. What is most likely cause of the problem?

Accepted Answer

A) paralysis of the vocal cords 
B) underinflated tube cuff 
C) tracheoesophageal fistula 
D) tracheoinnominate fistula 
A) paralysis of the vocal cords 
B) underinflated tube cuff 
C) tracheoesophageal fistula 
D) tracheoinnominate fistula

Question 7

After coming on a patient with complete obstruction of an oral endotracheal tube, your efforts to relieve the obstruction by moving the patient's head and neck and deflating the cuff both fail. What should be your next step?

Accepted Answer

A) Immediately extubate the patient. 
B) Try to pass a suction catheter. 
C) Call for an emergency tracheotomy. 
D) Apply manual positive pressure. 
A) Immediately extubate the patient. 
B) Try to pass a suction catheter. 
C) Call for an emergency tracheotomy. 
D) Apply manual positive pressure.

Question 8

What size endotracheal tube would you select to intubate a 1500-g newborn infant?

Accepted Answer

A) 2.5 mm 
B) 3.0 mm 
C) 3.5 mm 
D) 4.0 mm 
A) 2.5 mm 
B) 3.0 mm 
C) 3.5 mm 
D) 4.0 mm

Question 9

How often should patients be suctioned?

Accepted Answer

A) at least once every 2 to 3 hours 
B) whenever they are moved or ambulated 
C) when physical findings support the need 
D) whenever the charge nurse requests it 
A) at least once every 2 to 3 hours 
B) whenever they are moved or ambulated 
C) when physical findings support the need 
D) whenever the charge nurse requests it

Question 10

An alert patient with a long-term need for a tracheostomy tube (because of recurrent aspiration) is having difficulty communicating with the intensive care unit staff. Which of the following would you recommend to help this patient communicate better?
I.	Use a letter, phrase, or picture board.
II.	Consider switching to a fenestrated tracheostomy tube.
III.	Consider a “talking” tracheostomy tube.

Accepted Answer

A) I and II 
B) I and III 
C) II and III 
D) I, II, and III 
A) I and II 
B) I and III 
C) II and III 
D) I, II, and III

Question 11

After an intubation attempt, an expired capnogram indicates a CO2 level near zero. What does this finding probably indicate?

Accepted Answer

A) abnormally high ventilation/perfusion ratio ( $\dot { V } / \dot { Q }$ ) 
B) placement of the endotracheal tube in the esophagus 
C) placement of the endotracheal tube in the trachea 
D) failure of the cuff to properly seal the airway 
A) abnormally high ventilation/perfusion ratio ( $\dot { V } / \dot { Q }$ ) 
B) placement of the endotracheal tube in the esophagus 
C) placement of the endotracheal tube in the trachea 
D) failure of the cuff to properly seal the airway

Question 12

Therapeutic indications for fiberoptic bronchoscopy include which of the following?
I.inspect the airways
II.retrieve foreign bodies
III.obtain specimens for analysis
IV.aid endotracheal intubation

Accepted Answer

A) II and IV 
B) III and IV 
C) I, II, and III 
D) I, II, III, and IV 
A) II and IV 
B) III and IV 
C) I, II, and III 
D) I, II, III, and IV

Question 13

Before beginning an intubation procedure, the practitioner should check and confirm the operation of which of the following?
I.laryngoscope light source
II.endotracheal tube cuff
III.suction equipment
IV.cardiac defibrillator

Accepted Answer

A) I, II, and III 
B) II and IV 
C) III and IV 
D) I, III, and IV 
A) I, II, and III 
B) II and IV 
C) III and IV 
D) I, III, and IV

Question 14

A surgical resident has asked that you assist in an elective tracheotomy procedure on an orally intubated patient. Which of the following would be an appropriate action?

Accepted Answer

A) Remove the oral tube just before tracheostomy tube insertion. 
B) Remove the oral tube before the tracheotomy is performed. 
C) Pull the oral tube only after the tracheostomy tube is placed. 
D) Withdraw the oral tube 2 to 3 inches while the incision is made. 
A) Remove the oral tube just before tracheostomy tube insertion. 
B) Remove the oral tube before the tracheotomy is performed. 
C) Pull the oral tube only after the tracheostomy tube is placed. 
D) Withdraw the oral tube 2 to 3 inches while the incision is made.

Question 15

Which of the following are appropriate orders before an elective fiberoptic bronchoscopy procedure scheduled for the next morning?
I.	Have patient take nothing by mouth (NPO) after midnight.
II.	Establish vascular access.
III.	Premedicate with a benzodiazepine.

Accepted Answer

A) I and II 
B) I and III 
C) II and III 
D) I, II, and III 
A) I and II 
B) I and III 
C) II and III 
D) I, II, and III

Question 16

Absolute contraindication for nasotracheal suctioning includes which of the following?
I.epiglottitis
II.croup
III.irritable airway

Accepted Answer

A) I and II 
B) I and III 
C) II and III 
D) I, II, and III 
A) I and II 
B) I and III 
C) II and III 
D) I, II, and III

Question 17

Before the suctioning of a patient, auscultation reveals coarse breath sounds during both inspiration and expiration. After suctioning, the coarseness disappears, but expiratory wheezing is heard over both lung fields. What is most likely the problem?

Accepted Answer

A) Secretions are still present and the patient should be suctioned again. 
B) The patient has hyperactive airways and has developed bronchospasm. 
C) A pneumothorax has developed and the patient needs a chest tube. 
D) The patient has developed a mucous plug and should undergo bronchoscopy. 
A) Secretions are still present and the patient should be suctioned again. 
B) The patient has hyperactive airways and has developed bronchospasm. 
C) A pneumothorax has developed and the patient needs a chest tube. 
D) The patient has developed a mucous plug and should undergo bronchoscopy.

Question 18

What size endotracheal tube would you select to intubate an adult female?

Accepted Answer

A) 6 mm 
B) 7 mm 
C) 8 mm 
D) 9 mm 
A) 6 mm 
B) 7 mm 
C) 8 mm 
D) 9 mm

Question 19

While checking a crash cart for intubation equipment, you find the following: suction equipment, oxygen apparatus, two laryngoscopes and assorted blades, five tubes, Magill forceps, tape, lubricating gel, and local anesthetic. What is missing?
I.obturator
II.syringe(s)III.resuscitator bag or mask
IV.tube stylet

Accepted Answer

A) I, II, and III 
B) II and IV 
C) II, III, and IV 
D) I, II, III and IV 
A) I, II, and III 
B) II and IV 
C) II, III, and IV 
D) I, II, III and IV

Question 20

Which of the following is likely to increase the likelihood of damage to the tracheal mucosa?

Accepted Answer

A) maintaining cuff pressures below 20 to 25 mm Hg 
B) using the minimal leak technique for inflation 
C) using a low-residual-volume, low-compliance cuff 
D) monitoring intracuff pressures every 1 to 2 hours 
A) maintaining cuff pressures below 20 to 25 mm Hg 
B) using the minimal leak technique for inflation 
C) using a low-residual-volume, low-compliance cuff 
D) monitoring intracuff pressures every 1 to 2 hours

Exam 33: Airway Management

To avoid the risk of aspiration after a fiberoptic bronchoscopy procedure, what would you recommend that the patient do?

Lower airway anesthesia for fiberoptic bronchoscopy can be achieved via which of the following routes of administration? I.bronchoscopic instillation II.intravenous administration III.nebulization (aerosol delivery)

What is the most common complication of suctioning?

During fiberoptic bronchoscopy, a patient's SpO2 drops from 91% to 87%. Which of the following actions would be appropriate? I. Apply suction through the scope’s open channel. II. Give oxygen through the scope’s open channel. III. Increase the cannula or mask oxygen flow.

What is the average distance from the tip of a properly positioned oral endotracheal tube to the incisors of an adult man?

A patient has been receiving positive-pressure ventilation through a tracheostomy tube for 4 days. In the past 2 days, there is evidence of both recurrent aspiration and abdominal distention but minimal air leakage around the tube cuff. What is most likely cause of the problem?

After coming on a patient with complete obstruction of an oral endotracheal tube, your efforts to relieve the obstruction by moving the patient's head and neck and deflating the cuff both fail. What should be your next step?

What size endotracheal tube would you select to intubate a 1500-g newborn infant?

How often should patients be suctioned?

After an intubation attempt, an expired capnogram indicates a CO2 level near zero. What does this finding probably indicate?

Therapeutic indications for fiberoptic bronchoscopy include which of the following? I.inspect the airways II.retrieve foreign bodies III.obtain specimens for analysis IV.aid endotracheal intubation

Before beginning an intubation procedure, the practitioner should check and confirm the operation of which of the following? I.laryngoscope light source II.endotracheal tube cuff III.suction equipment IV.cardiac defibrillator

A surgical resident has asked that you assist in an elective tracheotomy procedure on an orally intubated patient. Which of the following would be an appropriate action?

Which of the following are appropriate orders before an elective fiberoptic bronchoscopy procedure scheduled for the next morning? I. Have patient take nothing by mouth (NPO) after midnight. II. Establish vascular access. III. Premedicate with a benzodiazepine.

Absolute contraindication for nasotracheal suctioning includes which of the following? I.epiglottitis II.croup III.irritable airway

Before the suctioning of a patient, auscultation reveals coarse breath sounds during both inspiration and expiration. After suctioning, the coarseness disappears, but expiratory wheezing is heard over both lung fields. What is most likely the problem?

What size endotracheal tube would you select to intubate an adult female?

Which of the following is likely to increase the likelihood of damage to the tracheal mucosa?

History of Respiratory Care

Quality and Evidence-Based Respiratory Care

Patient Safety, Communication, and Record Keeping

Principles of Infection Control

Ethical and Legal Implications of Practice

Physical Principles of Respiratory Care

Computer Applications in Respiratory Care

The Respiratory System

The Cardiovascular System

Ventilation

Gas Exchange and Transport

Solutions, Body Fluids, and Electrolytes

Acid-Base Balance

Regulation of Breathing

Bedside Assessment of the Patient

Interpretation of Clinical Laboratory Data

Interpreting the Electrocardiogram

Analysis and Monitoring of Gas Exchange

Pulmonary Function Testing

A Review of Thoracic Imaging

Nutrition Assessment

Pulmonary Infections

Obstructive Lung Disease: Copd, Asthma, and Related Diseases

Interstitial Lung Disease

Pleural Diseases

Pulmonary Vascular Disease

Acute Lung Injury, Pulmonary Edema, and Multiple System Organ

Lung Cancer

Neuromuscular and Other Diseases of the Chest Wall

Disorders of Sleep

Neonatal and Pediatric Respiratory Disorders

Airway Pharmacology

Emergency Cardiovascular Life Support

Humidity and Bland Aerosol Therapy

Aerosol Drug Therapy

Storage and Delivery of Medical Gases

Medical Gas Therapy

Lung Expansion Therapy

Bronchial Hygiene Therapy

Respiratory Failure and the Need for Ventilatory Support

Mechanical Ventilators

Physiology of Ventilatory Support

Initiating and Adjusting Ventilatory Support

Noninvasive Positive Pressure Ventilation

Monitoring and Management of the Patient in the Intensive Care Unit

Discontinuing Ventilatory Support

Neonatal and Pediatric Respiratory Care

Patient Education and Health Promotion

Cardiopulmonary Rehabilitation

Respiratory Care in Alternative Settings

Filters

During fiberoptic bronchoscopy, a patient's SpO₂ drops from 91% to 87%. Which of the following actions would be appropriate? I. Apply suction through the scope’s open channel. II. Give oxygen through the scope’s open channel. III. Increase the cannula or mask oxygen flow.

After an intubation attempt, an expired capnogram indicates a CO₂ level near zero. What does this finding probably indicate?