Question 1

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 in 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 in while the incision is made.

Question 2

What is the purpose of the additional side port (Murphy eye) on most modern endotracheal tubes?

Accepted Answer

A)  Protect the airway against aspiration. 
B)  Help ascertain proper tube position. 
C)  Minimize mucosal trauma during insertion. 
D)  Ensure gas flow if the main port is blocked. 
A)  Protect the airway against aspiration. 
B)  Help ascertain proper tube position. 
C)  Minimize mucosal trauma during insertion. 
D)  Ensure gas flow if the main port is blocked.

Question 3

After repeated nasotracheal suctioning over 2 days, a patient with retained secretions develops minor bleeding through the nose. Which of the following actions would you recommend?

Accepted Answer

A)  Perform a tracheotomy for better access to the lower airway. 
B)  Discontinue nasotracheal suctioning for 48 hr and reassess. 
C)  Stop the bleeding and use a nasopharyngeal airway for access. 
D)  Orally intubate the patient for better access to the lower airway. 
A)  Perform a tracheotomy for better access to the lower airway. 
B)  Discontinue nasotracheal suctioning for 48 hr and reassess. 
C)  Stop the bleeding and use a nasopharyngeal airway for access. 
D)  Orally intubate the patient for better access to the lower airway.

Question 4

After intubation of a cardiac arrest victim, you observe a slow but steady rise in the expired CO2 levels as measured by a bedside capnometer. Which of the following best explains this observation?

Accepted Answer

A)  Return of spontaneous circulation 
B)  Abnormally high 
C)  Placement of the endotracheal tube in the esophagus 
D)  Failure of the cuff to properly seal the airway 
A)  Return of spontaneous circulation 
B)  Abnormally high 
C)  Placement of the endotracheal tube in the esophagus 
D)  Failure of the cuff to properly seal the airway

Question 5

While checking a Miller and a MacIntosh blade on an intubation tray during an emergency intubation, you find that the Miller blade "lights" but the MacIntosh blade does not. What should you do now?

Accepted Answer

A)  Swap the defective MacIntosh for the good Miller blade. 
B)  Check and replace the bulb in the MacIntosh blade. 
C)  Replace the batteries in the laryngoscope handle. 
D)  Check and clean the laryngoscope handle electrical contact. 
A)  Swap the defective MacIntosh for the good Miller blade. 
B)  Check and replace the bulb in the MacIntosh blade. 
C)  Replace the batteries in the laryngoscope handle. 
D)  Check and clean the laryngoscope handle electrical contact.

Question 6

To minimize laryngeal swelling, a physician orders "continuous aerosol therapy" after the extubation of a patient. Which of the following specific approaches would you recommend?

Accepted Answer

A)  Heated mist therapy through a jet nebulizer and aerosol mask 
B)  Cool mist therapy through a jet nebulizer and aerosol mask 
C)  Oxygen therapy through a "venti-mask" and bubble humidifier 
D)  Racemic epinephrine or saline through a small jet nebulizer 
A)  Heated mist therapy through a jet nebulizer and aerosol mask 
B)  Cool mist therapy through a jet nebulizer and aerosol mask 
C)  Oxygen therapy through a "venti-mask" and bubble humidifier 
D)  Racemic epinephrine or saline through a small jet nebulizer

Question 7

Which of the following statements are true about the potential for aspiration in patients with cuffed tracheal tubes?
1) Periodic oropharyngeal suctioning can help to minimize aspiration.
2) Aspiration is least likely in spontaneously breathing patients.
3) The methylene blue test can help detect leakage-type aspiration.
4) Aspiration is more likely with tracheostomy tubes than with endotracheal tubes.

Accepted Answer

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

Question 8

Ideally, the distal tip of a properly positioned endotracheal tube (in an adult man) should be positioned approximately how far above the carina?

Accepted Answer

A)  1 to 3 cm 
B)  3 to 6 cm 
C)  7 to 9 cm 
D)  4 to 6 in 
A)  1 to 3 cm 
B)  3 to 6 cm 
C)  7 to 9 cm 
D)  4 to 6 in

Question 9

Which of the following indicate an inability to adequately protect the airway?
1) Wheezing
2) Coma
3) Lack of gag reflex
4) Inability to cough

Accepted Answer

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

Question 10

Therapeutic indications for fiberoptic bronchoscopy include which of the following?
1) Inspect the airways.
2) Retrieve foreign bodies.
3) Obtain specimens for analysis.
4) Aid endotracheal intubation.

Accepted Answer

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

Question 11

What is the purpose of an endotracheal tube stylet?

Accepted Answer

A)  It helps ascertain proper tube position. 
B)  It adds rigidity and shape to ease insertion. 
C)  It minimizes mucosal trauma during insertion. 
D)  It protects the airway against aspiration. 
A)  It helps ascertain proper tube position. 
B)  It adds rigidity and shape to ease insertion. 
C)  It minimizes mucosal trauma during insertion. 
D)  It protects the airway against aspiration.

Question 12

A physician has requested your assistance in extubating an orally intubated patient. Which of the following should be done before the tube itself is removed?
1) Suction the orolaryngopharynx
2) Preoxygenate the patient
3) Suction the endotracheal tube
4) Confirm cuff inflation

Accepted Answer

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

Question 13

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?
1) Use a letter, phrase, or picture board.
2) Consider switching to a fenestrated tracheostomy tube.
3) Consider a "talking" tracheostomy tube.

Accepted Answer

A) 1 and 2 only 
B) 1 and 3 only 
C) 2 and 3 only 
D) 1, 2, and 3 
A) 1 and 2 only 
B) 1 and 3 only 
C) 2 and 3 only 
D) 1, 2, and 3

Question 14

A patient with a tracheal airway exhibits signs of tube obstruction. Which of the following are possible causes of this obstruction?
1) The tube cuff has herniated over the tip of the tube.
2) The tube is obstructed by a mucus plug or secretions.
3) The tube is kinked, or the patient is biting the tube.
4) The tube orifice is impinging on the tracheal wall.

Accepted Answer

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

Question 15

Although different techniques are used to actually remove the endotracheal tube during an extubation procedure, all aim to ensure which of the following?

Accepted Answer

A)  Maximal adduction of the vocal cords 
B)  Maximal abduction of the vocal cords 
C)  Maintenance of the appropriate cuff pressure 
D)  Elimination of the pharyngeal (gag) reflex 
A)  Maximal adduction of the vocal cords 
B)  Maximal abduction of the vocal cords 
C)  Maintenance of the appropriate cuff pressure 
D)  Elimination of the pharyngeal (gag) reflex

Question 16

What does a positive cuff leak test indicate?

Accepted Answer

A)  The patient has significant upper airway edema. 
B)  The patient's neuromuscular function is adequate to protect the lower airway. 
C)  The patient is at minimal risk for upper airway obstruction. 
D)  The patient's muscle strength will provide an effective cough. 
A)  The patient has significant upper airway edema. 
B)  The patient's neuromuscular function is adequate to protect the lower airway. 
C)  The patient is at minimal risk for upper airway obstruction. 
D)  The patient's muscle strength will provide an effective cough.

Question 17

A physician is concerned about the potential for tracheal damage due to tube movement in a patient who recently underwent tracheotomy and is now receiving 40% oxygen through a T tube (Briggs adapter). Which of the following would be the best way to limit tube movement in this patient?

Accepted Answer

A)  Give a neuromuscular blocker to prevent patient movement. 
B)  Secure the T tube delivery tubing to the bed rail. 
C)  Tape the T tube to the tracheostomy tube connector. 
D)  Switch from the T tube to a tracheostomy collar. 
A)  Give a neuromuscular blocker to prevent patient movement. 
B)  Secure the T tube delivery tubing to the bed rail. 
C)  Tape the T tube to the tracheostomy tube connector. 
D)  Switch from the T tube to a tracheostomy collar.

Question 18

What is the primary indication for tracheal suctioning?

Accepted Answer

A)  Presence of pneumonia 
B)  Presence of atelectasis 
C)  Ineffective coughing 
D)  Retention of secretions 
A)  Presence of pneumonia 
B)  Presence of atelectasis 
C)  Ineffective coughing 
D)  Retention of secretions

Question 19

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 () 
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 () 
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 20

What is the purpose of a cuff on an artificial tracheal airway?

Accepted Answer

A)  To seal off and protect the lower airway 
B)  To stabilize the tube and prevent its movement 
C)  To provide a means to determine tube position via radiograph 
D)  To help clinicians determine the depth of tube insertion 
A)  To seal off and protect the lower airway 
B)  To stabilize the tube and prevent its movement 
C)  To provide a means to determine tube position via radiograph 
D)  To help clinicians determine the depth of tube insertion

Exam 36: Airway Management

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?

What is the purpose of the additional side port (Murphy eye) on most modern endotracheal tubes?

After repeated nasotracheal suctioning over 2 days, a patient with retained secretions develops minor bleeding through the nose. Which of the following actions would you recommend?

After intubation of a cardiac arrest victim, you observe a slow but steady rise in the expired CO2 levels as measured by a bedside capnometer. Which of the following best explains this observation?

While checking a Miller and a MacIntosh blade on an intubation tray during an emergency intubation, you find that the Miller blade "lights" but the MacIntosh blade does not. What should you do now?

To minimize laryngeal swelling, a physician orders "continuous aerosol therapy" after the extubation of a patient. Which of the following specific approaches would you recommend?

Ideally, the distal tip of a properly positioned endotracheal tube (in an adult man) should be positioned approximately how far above the carina?

Which of the following indicate an inability to adequately protect the airway? 1) Wheezing 2) Coma 3) Lack of gag reflex 4) Inability to cough

Therapeutic indications for fiberoptic bronchoscopy include which of the following? 1) Inspect the airways. 2) Retrieve foreign bodies. 3) Obtain specimens for analysis. 4) Aid endotracheal intubation.

What is the purpose of an endotracheal tube stylet?

A physician has requested your assistance in extubating an orally intubated patient. Which of the following should be done before the tube itself is removed? 1) Suction the orolaryngopharynx 2) Preoxygenate the patient 3) Suction the endotracheal tube 4) Confirm cuff inflation

Although different techniques are used to actually remove the endotracheal tube during an extubation procedure, all aim to ensure which of the following?

What does a positive cuff leak test indicate?

A physician is concerned about the potential for tracheal damage due to tube movement in a patient who recently underwent tracheotomy and is now receiving 40% oxygen through a T tube (Briggs adapter). Which of the following would be the best way to limit tube movement in this patient?

What is the primary indication for tracheal suctioning?

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

What is the purpose of a cuff on an artificial tracheal airway?

History of Respiratory Care

Delivering Evidence-Based Respiratory Care

Quality, Patient Safety, and Communication, and Recordkeeping

Principles of Infection Prevention and Control

Ethical and Legal Implications of Practice

Physical Principles of Respiratory Care

E-Medicine in Respiratory Care

Fundamentals of Respiratory Care Research

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

Interpreting Clinical and Laboratory Data

Interpreting the Electrocardiogram

Analysis and Monitoring of Gas Exchange

Pulmonary Function Testing

Review of Thoracic Imaging

Flexible Bronchoscopy and the Respiratory Therapist

Nutrition Assessment

Pulmonary Infections

Obstructive Lung Disease: Chronic Obstructive Pulmonary Disease Copd, Asthma, and Related Diseases

Interstitial Lung Disease

Pleural Diseases

Pulmonary Vascular Disease

Acute Respiratory Distress Syndrome

Trauma, Burns and Near Drowning

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

Airway Clearance Therapy Act

Respiratory Failure and the Need for Ventilatory Support

Mechanical Ventilators

Physiology of Ventilatory Support

Patient Ventilator Interaction

Initiating and Adjusting Invasive Ventilatory Support

Noninvasive Ventilation

Extracorporeal Life Support Ecls

Monitoring 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

After intubation of a cardiac arrest victim, you observe a slow but steady rise in the expired CO₂ levels as measured by a bedside capnometer. Which of the following best explains this observation?

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