EGAN'S FINAL EXAM QUESTIONS & ANSWERS

EGAN'S FINAL EXAM QUESTIONS & ANSWERS What is the primary indication for tracheal suctioning? Retention of secretions What is the most common complication of suctioning? hypoxemia. Complications of tracheal suctioning include all of the following except: hyperinflation How often should patients be suctioned? When physical findings support the need What is the normal range of negative pressure to use when suctioning an adult patient? -100 to -120 mm Hg but in egan's -120 to -150 mmHg What is the normal range of negative pressure to use when suctioning children? -100 to -120 mm Hg or -80 to -120 mmHg You are about to suction a 10-year-old patient who has a 6-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter that you would use in this case? 10Fr You are about to suction a female patient who has an 8-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter you would use in this case? 14 Fr To prevent hypoxemia when suctioning a patient, the respiratory care practitioner should initially do which of the following? preoxygenate To maintain positive end expiratory pressure (PEEP) and high FiO2 when suctioning a mechanically ventilated patient, what would you recommend? Use a closed-system multiuse suction catheter. Total application time for endotracheal suction in adults should not exceed which of the following? 10-15 sec While suctioning a patient, you observe an abrupt change in the electrocardiogram waveform being displayed on the cardiac monitor. Which of the following actions would be most appropriate? Stop suctioning and immediately administer oxygen what methods can help to reduce the likelihood of atelectasis due to tracheal suctioning? 1. Limit the amount of negative pressure used. 2. Hyperoxygenate the patient before and after the procedure. 3. Suction for as short a period of time as possible. Which of the following can help to minimize the likelihood of mucosal trauma during suctioning? 1. Use as large a catheter as possible. 2. Rotate the catheter while withdrawing. 3. Use as rigid a catheter as possible. 4. Limit the amount of negative pressure. 2 and 4 Absolute contraindication for nasotracheal suctioning includes which of the following? 1. Epiglottitis 2. Croup 3. Irritable airway 1 and 2 Which of the following equipment is NOT needed to perform nasotracheal suctioning? on kit (catheter, gloves, basin, etc.) goscope with MacIntosh and Miller blades n delivery system (mask and manual resuscitator) e of sterile water or saline solution goscope with MacIntosh and Miller blades 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? Stop the bleeding and use a nasopharyngeal airway for access. 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? The patient has hyperactive airways and has developed bronchospasm. What general condition requires airway management? 1. Airway compromise 2. Respiratory failure 3. Need to protect the airway 1, 2, and 3 Which of the following conditions require emergency tracheal intubation? 1. Upper airway or laryngeal edema 2. Loss of protective reflexes 3. Cardiopulmonary arrest 4. Traumatic upper airway obstruction 1,2,3,4 All of the following indicate an inability to adequately protect the airway except: ing of gag reflex lity to cough ing Compared with the nasal route, the advantages of oral intubation include all of the following except: ed risk of kinking retching and gagging r suctioning traumatic insertion retching and gagging Compared with the oral route, the advantages of nasal intubation include all of the following except: ed risk of kinking retching and gagging accidental extubation er long-term comfort ed risk of kinking Compared with translaryngeal intubation, the advantages of tracheostomy include all of the following except: er patient comfort ed risk of bronchial intubation upper airway complications ased frequency of aspiration ased frequency of aspiration What is the standard size for endotracheal or tracheostomy tube adapters? 15 mm external diameter What is the purpose of the additional side port (Murphy eye) on most modern endotracheal tubes? ensure gas flow if the main port is blocked What is the purpose of a cuff on an artificial tracheal airway? to seal off and protect the lower airway What is the purpose of the pilot balloon on an endotracheal or a tracheostomy tube? to monitor cuff status and pressure Which of the following features incorporated into most modern endotracheal tubes assist in verifying proper tube placement? 1. Length markings on the curved body of the tube 2. Imbedded radiopaque indicator near the tube tip 3. Additional side port (Murphy eye) near the tube tip 1 and 2 The removable inner cannula commonly incorporated into modern tracheostomy tubes serves which of the following purposes? 1. aid in routine tube cleaning and tracheostomy care 2. prevent the tube from slipping into the trachea 3. provide a patent airway should it become obstructed 1 and 3 What is the purpose of a tracheostomy tube obturator? assist in the insertion of a tracheostomy tube In the absence of neck or facial injuries, what is the procedure of choice to establish a patent tracheal airway in an emergency? Orotracheal intubation 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? Check and replace the bulb in the MacIntosh blade. What size endotracheal tube would you select to intubate a 3-year-old child? 4.5-5.0 mm What size endotracheal tube would you select to intubate a 1500-g newborn infant? 3.0mm What size endotracheal tube would you select to intubate an adult female? 8mm To make oral intubation easier, how should the patient's head and neck be positioned? neck flexed, with head supported by towel and tilted back What should be the maximum time devoted to any intubation attempt? 20sec During oral intubation of an adult, the endotracheal tube should be advanced into the trachea about how far? Until its cuff has passed the cords What is the average distance from the tip of a properly positioned oral endotracheal tube to the incisors of an adult man? 21-23cm After an intubation attempt, an expired capnogram indicates a CO2 level near zero. What does this finding probably indicate? Placement of the endotracheal tube in the esophagus When performing blind nasotracheal intubation, successful tube passage through the larynx is indicated by which of the following? 1. louder breath sounds 2. harsh cough 3. vocal silence 2 and 3 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? Withdraw the oral tube 2 to 3 inches while the incision is made What is the most common sign associated with the transient glottic edema or vocal cord inflammation that follows extubation? hoarseness Soon after endotracheal tube extubation, an adult patient exhibits a high-pitched inspiratory noise, heard without a stethoscope. Which of the following actions would you recommend? STAT racemic epinephrine aerosol treatment which of the following injuries are NOT seen with tracheostomy tubes? 1. tracheomalacia 2. tracheal stenosis 3. glottic edema 4. vocal cord granulomas 3. glottic edema 4. vocal cord granulomas 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? tracheoesophageal fistula 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? Switch from the T-tube to a tracheostomy collar. When checking for proper placement of an endotracheal tube or a tracheostomy tube on a chest radiograph, how far above the carina should the distal tip of the tube be positioned? 3 to 6 cm When checking for proper placement of an endotracheal tube in an adult patient on chest radiograph, it is noted that the distal tip of the tube is 2 cm above the carina. Which of the following actions would you recommend? Withdraw the tube by 1 to 2 cm What does a positive cuff leak test indicate? The patient is at minimal risk for upper airway obstruction All of the following indicate that a patient being considered for extubation can provide adequate clearance of pulmonary secretions except: The patient has a dead space to tidal volume ratio of 0.7 Which of the following equipment would you gather before assisting in extubation of a patient? 1. suctioning apparatus 2. oxygen or aerosol therapy equipment 3. manual resuscitator and mask 4. nebulizer with racemic epinephrine 5. intubation tray 1, 2, 3, 4, and 5 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 1, 2, 3, and 4 Although different techniques are used to actually remove the endotracheal tube during an extubation procedure, all aim to ensure which of the following? Maximal abduction of the vocal cords.