RC 140 MIDTERM QUESTIONS & ANSWERS
List the clinical indications for OPA insertion. - Answers - Unconscious patient, no gag,
inserting a bite block, oral suction or deep throat
List complications associated with OPA insertion - Answers - Gagging, vomiting,
spasms, suffocating
List indications for NPA insertion. - Answers - Nasal suctioning, conscious patient, oral
trauma, or for bagging purposes
Explain the correct way to perform a jaw thrust maneuver? - Answers - Gently lifting the
patient's jaw upward and forward while guiding the lower jaw forward to promote a chin-
up position. Airway should open up.
List signs and symptoms of a sever airway obstruction. - Answers - Choking or gagging,
diaphoretic, hypoxemia, increased WOB
What are some possible reasons for a flow inflating Ambu bag to fail to inflate? -
Answers - Not enough flow being provided, a leak, having an open flow valve, or
bagging too fast
List the indications for nasal or oral intubation. - Answers - Impending airway
compromise, intraoral and oropharyngeal surgery, protecting the airway
What anatomical structures are visible with a mallampati score of 3? - Answers - The
soft palate, hard palate and the base of the uvula.
List the bedside assessments that are utilized to establish the accurate placement of an
endotracheal tube. - Answers - CO2 detector, CXR, listen to breathe sounds (lungs and
stomach), having a ambu bag as well
Which airway is most commonly used in surgery to provide ventilation to the patient
during the procedure?
-Laryngeal mask airway (LMA)
-Oropharyngeal airway
-Double-lumen ET tube
-Esophageal-tracheal Combitube - Answers - Laryngeal mask airway (LMA)
A 6 ft 2 in tall male patient is intubated with a 7.5-mm ET tube that is taped at the lip at
the 22 cm mark. The respiratory therapist hears a gurgling sound during inspiration and
observes the patient's exhaled tidal volume is 250 mL less than the inhaled tidal
volume. The therapist increases the cuff pressure from 18 cm H2O to 27 cm H2O with
no sound or exhaled volume change. The therapist should:
,-Deflate the cuff and suction the ET tube
-Advance the tube to the 24 cm mark on the tube.
-Extubate the patient and change to a 8.0 mm ET tube.
-Increase the cuff pressure to 35 cm H2O. - Answers - Extubate the patient and change
to a 8.0 mm ET tube.
List the suction pressures for infants, children, and adults. - Answers - Infants (80-100),
children (100-120), adults (120-150)
A conscious patient with an intact gag reflex requires an artificial airway to prevent
obstruction of the upper airway by the tongue. Which type of airways is most
appropriate in this situation? - Answers - NPA
An unonscious patient with an intact gag reflex requires an artificial airway to prevent
obstruction of the upper airway by the tongue. Which type of airways is most
appropriate in this situation? - Answers - NPA
What structures are visible with a mallampati score of two? - Answers - The soft palate,
hard palate, and upper portion of the uvula
What size suction catheter would be appropriate for a 7.5 mm ID endotracheal tube?
-10
-12
-8
-14 - Answers - 10
How often should patients be suctioned?
-When physical findings support the need
-At least once every 2 to 3 hr
-Whenever they are moved or ambulated
-Whenever the charge nurse requests it - Answers - When physical findings support the
need
Total application time for endotracheal suction in adults should not exceed which of the
following? - Answers - 15 seconds
After repeated nasotracheal suctioning over two days, a patient with retained secretions
develops minor bleeding through the nose. Which of the following actions would you
recommend?
-Stop the bleeding and use a nasopharyngeal airway for access.
-Orally intubate the patient for better access to the lower airway.
-Discontinue nasotracheal suctioning for 48 hr and reassess.
, -Perform a tracheotomy for better access to the lower airway. - Answers - Stop the
bleeding and use a nasopharyngeal airway for access
What is the purpose of a tracheostomy tube obturator? - Answers - To ensure the trach
tube is correctly inserted and positioned in the airway (allows to stay open as well)
When checking for proper placement of an endotracheal tube in an adult patient on a
chest radiograph, it is noted that the distal tip of the tube is 1 cm above the carina. What
actions would you recommend? - Answers - Pull back the tube 1-2 cm
An adult man on ventilatory support has just been intubated with a 7-mm oral
endotracheal tube equipped with a high-residual-volume, low-pressure cuff. When
sealing the cuff to achieve a minimal occluding volume, you note a cuff pressure of 45
cm H2O. What is most likely the problem? - Answers - The ETT tube is too small.
A tracheostomy tube patient receives positive-pressure ventilation through a volume
ventilator. Over the past 5 min, the peak inspiratory pressure has risen, and the
pressure limit alarm is now sounding. On quick examination, you notice a generalized
decrease in breathing sounds. What is the most likely problem? - Answers - The patient
is probably having secretions
A patient with a tracheal airway exhibits severe respiratory distress. On quick
examination, you notice the absence of breath sounds and no gas flowing through the
airway. What is most likely the problem? - Answers - Either the patient is having
secretions or trach popped out and causing airway issues.
An adult patient receiving cool mist therapy after extubation begins to develop stridor.
Which of the following actions would you recommend?
-Re-intubate the patient immediately.
-Draw and analyze an arterial blood gas.
-Administer a racemic epinephrine treatment.
-Change from cool mist to heated aerosol. - Answers - Administer a racemic
epinephrine treatment
What percentage of amyotrophic lateral sclerosis patients die within 5 years of
diagnosis?
10
25
50
80 - Answers - 80
At what level do the nerves that innervate the diaphragm exit the spine?
C1-3
C3-5
C6-7
List the clinical indications for OPA insertion. - Answers - Unconscious patient, no gag,
inserting a bite block, oral suction or deep throat
List complications associated with OPA insertion - Answers - Gagging, vomiting,
spasms, suffocating
List indications for NPA insertion. - Answers - Nasal suctioning, conscious patient, oral
trauma, or for bagging purposes
Explain the correct way to perform a jaw thrust maneuver? - Answers - Gently lifting the
patient's jaw upward and forward while guiding the lower jaw forward to promote a chin-
up position. Airway should open up.
List signs and symptoms of a sever airway obstruction. - Answers - Choking or gagging,
diaphoretic, hypoxemia, increased WOB
What are some possible reasons for a flow inflating Ambu bag to fail to inflate? -
Answers - Not enough flow being provided, a leak, having an open flow valve, or
bagging too fast
List the indications for nasal or oral intubation. - Answers - Impending airway
compromise, intraoral and oropharyngeal surgery, protecting the airway
What anatomical structures are visible with a mallampati score of 3? - Answers - The
soft palate, hard palate and the base of the uvula.
List the bedside assessments that are utilized to establish the accurate placement of an
endotracheal tube. - Answers - CO2 detector, CXR, listen to breathe sounds (lungs and
stomach), having a ambu bag as well
Which airway is most commonly used in surgery to provide ventilation to the patient
during the procedure?
-Laryngeal mask airway (LMA)
-Oropharyngeal airway
-Double-lumen ET tube
-Esophageal-tracheal Combitube - Answers - Laryngeal mask airway (LMA)
A 6 ft 2 in tall male patient is intubated with a 7.5-mm ET tube that is taped at the lip at
the 22 cm mark. The respiratory therapist hears a gurgling sound during inspiration and
observes the patient's exhaled tidal volume is 250 mL less than the inhaled tidal
volume. The therapist increases the cuff pressure from 18 cm H2O to 27 cm H2O with
no sound or exhaled volume change. The therapist should:
,-Deflate the cuff and suction the ET tube
-Advance the tube to the 24 cm mark on the tube.
-Extubate the patient and change to a 8.0 mm ET tube.
-Increase the cuff pressure to 35 cm H2O. - Answers - Extubate the patient and change
to a 8.0 mm ET tube.
List the suction pressures for infants, children, and adults. - Answers - Infants (80-100),
children (100-120), adults (120-150)
A conscious patient with an intact gag reflex requires an artificial airway to prevent
obstruction of the upper airway by the tongue. Which type of airways is most
appropriate in this situation? - Answers - NPA
An unonscious patient with an intact gag reflex requires an artificial airway to prevent
obstruction of the upper airway by the tongue. Which type of airways is most
appropriate in this situation? - Answers - NPA
What structures are visible with a mallampati score of two? - Answers - The soft palate,
hard palate, and upper portion of the uvula
What size suction catheter would be appropriate for a 7.5 mm ID endotracheal tube?
-10
-12
-8
-14 - Answers - 10
How often should patients be suctioned?
-When physical findings support the need
-At least once every 2 to 3 hr
-Whenever they are moved or ambulated
-Whenever the charge nurse requests it - Answers - When physical findings support the
need
Total application time for endotracheal suction in adults should not exceed which of the
following? - Answers - 15 seconds
After repeated nasotracheal suctioning over two days, a patient with retained secretions
develops minor bleeding through the nose. Which of the following actions would you
recommend?
-Stop the bleeding and use a nasopharyngeal airway for access.
-Orally intubate the patient for better access to the lower airway.
-Discontinue nasotracheal suctioning for 48 hr and reassess.
, -Perform a tracheotomy for better access to the lower airway. - Answers - Stop the
bleeding and use a nasopharyngeal airway for access
What is the purpose of a tracheostomy tube obturator? - Answers - To ensure the trach
tube is correctly inserted and positioned in the airway (allows to stay open as well)
When checking for proper placement of an endotracheal tube in an adult patient on a
chest radiograph, it is noted that the distal tip of the tube is 1 cm above the carina. What
actions would you recommend? - Answers - Pull back the tube 1-2 cm
An adult man on ventilatory support has just been intubated with a 7-mm oral
endotracheal tube equipped with a high-residual-volume, low-pressure cuff. When
sealing the cuff to achieve a minimal occluding volume, you note a cuff pressure of 45
cm H2O. What is most likely the problem? - Answers - The ETT tube is too small.
A tracheostomy tube patient receives positive-pressure ventilation through a volume
ventilator. Over the past 5 min, the peak inspiratory pressure has risen, and the
pressure limit alarm is now sounding. On quick examination, you notice a generalized
decrease in breathing sounds. What is the most likely problem? - Answers - The patient
is probably having secretions
A patient with a tracheal airway exhibits severe respiratory distress. On quick
examination, you notice the absence of breath sounds and no gas flowing through the
airway. What is most likely the problem? - Answers - Either the patient is having
secretions or trach popped out and causing airway issues.
An adult patient receiving cool mist therapy after extubation begins to develop stridor.
Which of the following actions would you recommend?
-Re-intubate the patient immediately.
-Draw and analyze an arterial blood gas.
-Administer a racemic epinephrine treatment.
-Change from cool mist to heated aerosol. - Answers - Administer a racemic
epinephrine treatment
What percentage of amyotrophic lateral sclerosis patients die within 5 years of
diagnosis?
10
25
50
80 - Answers - 80
At what level do the nerves that innervate the diaphragm exit the spine?
C1-3
C3-5
C6-7
