ch 42

96問 • 2年前

問題一覧

What are the specific clinical objectives of oxygen (O2) therapy? 1. Decrease the symptoms caused by chronic hypoxemia. 2. Decrease the workload hypoxemia imposes on the heart and lungs. 3. Correct documented arterial hypoxemia. 4. Correct documented respiratory acidosis.

1, 2, and 3 only

What can properly applied O2 therapy decrease? 1. Ventilatory demand 2. Work of breathing 3. Cardiac output

1, 2, and 3

What are the benefits of properly applied O2 therapy in patients with chronic hypoxemia? 1. Reversal of pulmonary vasoconstriction 2. Relief of pulmonary hypertension 3. Decreased right ventricular workload 4. Improved pulmonary vital capacity

1, 2, and 3 only

What are the indications for a need for O2 therapy for an adult or a child? 1. SaO2 less than 90% 2. PaCO2 greater than 45 mm Hg 3. PaO2 less than 60 mm Hg

1 and 3 only

You start a chronic obstructive pulmonary disease (COPD) patient on a nasal O2 cannula at 2 L/min. What is the maximum time that should pass before assessing this patient’s PaO2 or SaO2?

2 hr

According to AARC clinical practice guidelines, what is the minimum frequency for checking the functioning of an O2 delivery system?

Every 24 hr

You set up an Oxy-Hood with an FiO2 of 0.5 for a newborn infant. What is the maximum time that should pass before assessing this patient’s PaO2 or SaO2?

1 hr

When determining a need for O2 therapy, what should the respiratory therapist assess? 1. Neurologic status 2. Pulmonary status 3. Cardiac status

1, 2, and 3

What are the signs and symptoms associated with the presence of hypoxemia? 1. Tachypnea 2. Tachycardia 3. Cyanosis 4. Bradycardia

1, 2, and 3 only

What is/are the primary organ system(s) affected by O2 toxicity? 1. Central nervous system (CNS) 2. Lungs 3. Kidneys

1 and 2 only

What typically occurs first when monitoring the earliest physiologic response to breathing 100% O2?

Substernal chest pain

What would a patient breathing 100% O2 for 24 hr or longer would most likely exhibit? 1. Decreased DLCO 2. Decreased CL 3. Increased PAO2 – PaO2 4. Decreased VC

1, 2, 3, and 4

What type of condition is consistent with the radiographic appearance after prolonged exposure to O2?

Patchy infiltrates

A physician places a patient in respiratory failure on 100% O2. To avoid the hazards of O2 toxicity, you would recommend that every effort is made to reduce this FiO2 to less than 50% within what timeframe?

5 days

If a patient with chronic hypercapnia is placed on an FiO2 of 0.6, what may cause him to start hypoventilating.

O2-induced hypoventilation

Retinopathy of prematurity (ROP) is a potentially serious management problem mainly in the care of whom?

Premature or low-birth-weight infants

What are strategies for minimizing the risk of fire hazards with O2 therapy? 1. Using the lowest effective FiO2 2. Properly educating patients and caregivers 3. Avoiding aluminum regulators and other high-risk devices 4. Mixing the oxygen with carbon dioxide.

1, 2, and 3 only

To minimize the risk of retinopathy of prematurity (ROP), the American Academy of Pediatrics recommends keeping the PaO2 below what level?

80mmHg

What is absorption atelectasis and when does it occur? 1. It can occur only when breathing supplemental O2. 2. Its risk is increased in patients breathing at low tidal volumes (VT values). 3. Its risk is decreased through the natural “sigh” mechanism. 4. It results in an increase in the physiologic shunt fraction.

2, 3, and 4 only

What factors should be used in properly selecting an O2 delivery device? 1. Knowledge of general performance of the device 2. Physician’s preference 3. Individual capabilities of the equipment

1 and 3 only

To ensure a stable FiO2 under varying patient demands, what must an O2 delivery system do?

It must provide all the gas needed by the patient during inspiration.

What are the considerations about low-flow O2 delivery systems? 1. The greater the patient’s inspiratory flow, the greater is the FiO2. 2. All low-flow devices provide variable O2 concentrations. 3. The O2 provided by a low-flow device is diluted with air. 4. The patient’s flow usually exceeds that from a low-flow device.

2, 3, and 4 only

Delivery systems that provide only a portion of a patient’s inspired gas are referred to as what?

Variable-performance systems

Name the low-flow O2 delivery systems used in respiratory care. 1. Nasal O2 cannula 2. Nasal O2 catheter 3. Air-entrainment mask 4. Transtracheal catheter

1, 2, and 4 only

A cooperative and alert postoperative patient who is able to eat requires a continuous but low FiO2. Precise FiO2 concentrations are not needed. Whar devices would best achieve this end?

Nasal cannula

What are the advantages of the nasal cannula as a low-flow O2 delivery system? 1. Stability 2. Low cost 3. Easy application 4. Disposability

2, 3, and 4 only

What are the advantages of the transtracheal catheter?

It requires 40% to 60% less O2 flow than the nasal cannula.

What are the major disadvantages of the transtracheal catheter? 1. Infection 2. Mucus plugging 3. Excessive oxygen use 4. Lost tract or insertion opening

1, 2, and 4 only

What factors will decrease the FiO2 delivered by a low-flow O2 system? 1. Short inspiratory time 2. Fast rate of breathing 3. Lower O2 input 4. Large minute ventilation

1, 2, 3, and 4

A 27-year-old woman received from the emergency department is on a nasal cannula at 5 L/min. Approximately what FiO2 is this patient receiving?

40%

You enter the room of a patient who is receiving nasal O2 through a bubble humidifier at 5 L/min. You immediately notice that the humidifier pressure relief is popping off. What actions would be most appropriate in this situation?

Look for crimped or twisted delivery tubing.

Which of the following is true about reservoir cannulas?

Nasal anatomy and breathing pattern can affect performance of the device.

What are the disadvantages of standard O2 masks? 1. Being difficult to apply to patients. 2. Patient discomfort (straps and heat). 3. Increasing the risk of aspiration. 4. Must be removed for eating.

2, 3, and 4 only

Which of the following is false about the simple O2 mask?

It can easily deliver high FiO2 values (>0.6 to 0.7).

A physician orders 2 L/min O2 through a simple mask to a 33-year-old postoperative woman with moderate hypoxemia breathing room air (PaO2 = 52 mm Hg). What would be the correct action at this time?

Recommend a flow of at least 5 L/min to washout carbon dioxide (CO2).

What is the minimum flow setting for a simple mask applied to an adult?

5 L/min

A 52-year-old man is admitted to the hospital emergency department with a primary complaint of severe radiating chest pain and signs of central cyanosis. The attending asks for your advice on selecting a device that provides a moderate FiO2 for this patient. What would you recommend?

Simple O2 mask at 8 L/min

A physician orders supplemental O2 for a patient through a nasal cannula at a flow of 10 L/min. When you ask what the goal is, the physician states that the patient should receive approximately 65% O2. What should you recommend?

The O2 should be given through a simple mask set at 5 to 12 L/min.

A well-fitted nonrebreathing mask, adjusted so that the patient’s inhalation does not deflate the bag (flows approximately 10 L/min), should provide inspired O2 concentrations in what range?

55% to 70%

You must deliver the highest possible FiO2 to a 67-year-old man with pulmonary edema breathing at a rate of 35/min. What O2 delivery systems would be most appropriate?

Nonrebreathing mask at 12 to 15 L/min

A patient is receiving O2 through a nonrebreathing mask set at 6 L/min. You notice that the mask’s reservoir bag collapses completely before the end of each inspiration. What action is appropriate in this case?

Increase the liter flow.

A true high-flow O2 delivery system should provide at least what flow?

60 L/min

Which of the following are true about air-entrainment systems? 1. Their FiO2 values are directly proportional to their total flow. 2. They can provide variable FiO2 values under some clinical conditions. 3. They always deliver O2 concentrations less than 100%. 4. They yield a set FiO2 only if their flow exceeds the patient’s.

2, 3, and 4 only

What factors determine the actual O2 provided by an air-entrainment system? 1. O2 input flow to the jet 2. Air-to-O2 ratio of the device 3. Resistance downstream from the jet

2 and 3 only

A patient receiving 28% O2 through an air-entrainment mask set at 8 L/min input flow becomes tachypneic. Simultaneously, you notice that the SpO2 has fallen from 91% to 87%. What actions would be most appropriate in this situation?

Increase the device’s input flow to 10 L/min.

You design an air-entrainment system that mixes air with O2 at a fixed ratio of 1:10. Approximately what O2 concentration will this device provide?

90%

A 45-year-old patient with congestive heart failure is receiving O2 through a 35% air-entrainment mask. With an O2 input of 6 L/min, what is the total output gas flow?

36 L/min

You note that the air intake ports surrounding the jet of a 35% air-entrainment mask are partially obstructed by the patient’s bedding. What would you expect? 1. Decrease in the device’s total output flow 2. Increase in the percent O2 delivered by the device 3. Change in the FiO2 received by the patient

1 and 2 only

A physician orders 35% O2 through an air-entrainment nebulizer for a patient with a minute volume of 12 L/min. What is the minimum nebulizer input flow required to ensure the prescribed FiO2?

10 L/min

You connect an intubated patient to an air-entrainment nebulizer system through a T tube set at 60% with an input flow of 15 L/min. Toward the middle of inspiration, you observe that mist stops exiting from the open end of the T tube. What does this indicate?

Patient is not receiving 60% O2

What is the maximum FiO2 expected to be delivered by most air-entrainment masks?

50%

What alternatives may increase the FiO2 capabilities of air-entrainment nebulizers? 1. Add open reservoir to expiratory side of T tube. 2. Connect together two or more nebulizers. 3. Use a commercial dual-flow system. 4. Add open reservoir to inspiratory side of T tube.

1, 2, and 3 only

To ensure the prescribed FiO2 for a patient receiving 65% O2, you apply a closed reservoir delivery system with a one-way expiratory valve. What other component must be included in this system to ensure a fail-safe operation?

Emergency inlet valve

An O2 delivery device takes separate pressurized air and O2 sources as input, then mixes these gases through a precision valve. What does this describe?

O2 blending system

A physician requests that you provide a patient with exactly 40% O2 at a flow of 60 L/min. Lacking a blender, you must manually mix air and O2 to achieve the desired mixture at the prescribed flow. What air and O2 flows would you select?

What are the components of a typical O2 blender? 1. Precision metering device or mixture control 2. Audible dual low-pressure alarm system 3. Pressure regulating and equalizing valves 4. Variable-size air-entrainment port

1, 2, and 3 only

To confirm proper operation of an O2 blending system, what should you do? 1. Test low-pressure alarms and bypass systems. 2. Analyze FiO2 at 0.21, 1.00, and prescribed level. 3. Confirm air and O2 inlet pressures.

1, 2, and 3

What is the upper limit of O2 concentrations available through tents?

40% to 50%

A physician wants a stable FiO2 of 0.5 for a newborn infant with severe hypoxemia. What would you select?

O2 hood with blender and heated humidifier

What is the problem with input flows greater than 10 to 15 L/min in an infant Oxy-Hood?

Production of harmful noise levels

In giving O2 to an infant through a hood, what conditions should occur? 1. A neutral thermal environment should be maintained. 2. Gases should be directed away from the infant’s face. 3. High input flow (>10 to 15 L/min) should be avoided. 4. A minimum flow of 7 L/min must be maintained.

1, 2, 3, and 4

What can result when directing a cool O2 mixture to an infant in an Oxy-Hood? 1. Increased O2 consumption 2. Increased convective heat loss 3. Apnea (cessation of breathing)

1, 2, and 3

What temperature is required to maintain a neutral thermal environment (NTE) in an Oxy-Hood for infants weighing 2500 g or more?

35° C

An infant requires both a precise high FiO2 and maintenance of a neutral thermal environment. What system can best achieve these goals? 1. Oxy-Hood or warmed O2 blending system without incubator 2. Heated incubator with automatic O2 controlling system 3. Heated incubator with Oxy-Hood or O2 blending system

1 and 2 only

What is variant of a common low-flow, nasal O2 delivery device that is capable of providing both high humidity and a high FiO2?

High-flow nasal cannula

What are some key patient considerations in selecting O2 therapy equipment? 1. Type of airway (natural or artificial) 2. Severity and cause of the hypoxemia 3. Age group (infant, child, adult) 4. Stability of the minute ventilation

1, 2, 3, and 4

In what clinical situations would you recommend hyperbaric oxygen (HBO) therapy, if available? 1. Carbon monoxide poisoning 2. Respiratory or cardiac arrest 3. Severe trauma 4. Cyanide poisoning

1 and 4 only

A patient receiving 3 L/min O2 through a nasal cannula has a measured SpO2 of 93% and no clinical signs of hypoxemia. At this point, what should you recommend?

Decreasing the flow to 2 L/min and rechecking the SpO2

What would indicate adequate oxygenation for adult patients with chronic lung disease and an accompanying acute-on-chronic hypoxemia? 1. SaO2 of 90% or higher 2. PaO2 of 50 to 60 mm Hg 3. SaO2 of 85% to 90%

2 and 3 only

What is the level of SpO2 typically associated with discontinuation of O2 therapy?

92%

What does 1 atmospheric pressure absolute (ATA) equal?

1 and 3 only

Physiologic effects of hyperbaric oxygen (HBO) therapy include all of the following except:

systemic vasodilation.

During hyperbaric oxygen therapy at 3 ATA, plasma contains about how much dissolved O2?

7 ml/dl

Which of the following is false about multiplace hyperbaric oxygenation chambers?

The chamber normally is filled with 100% O2.

Which of the following conditions can be treated with hyperbaric oxygen (HBO) therapy? 1. Carbon monoxide poisoning 2. Septic shock 3. Air embolism 4. Clostridial gangrene

1, 3, and 4 only

In what procedures are air embolisms a potential complication? 1. Central line placement 2. Lung biopsy 3. Hemodialysis

1, 2, and 3

At an FiO2 of 1, what is the approximate half-life of blood carboxyhemoglobin?

80 min

During hyperbaric oxygen (HBO) therapy at 3 ATA, what is the approximate half-life of blood carboxyhemoglobin?

23 min

What are the criteria for initiating hyperbaric oxygen (HBO) therapy on an adult patient suspected of suffering from acute carbon monoxide poisoning? 1. History of unconsciousness 2. Carboxyhemoglobin saturation less than 20% 3. Presence of neurologic abnormality 4. Presence of cardiac instability

1, 3, and 4 only

At what level of carboxyhemoglobin saturation is hyperbaric oxygen (HBO) therapy indicated for an adult patient?

Greater than 25%

What are the Primary safety concerns in the application of hyperbaric oxygenation? 1. Sudden decompression 2.. Electrical fires 3. CO2 accumulation

1 and 2 only

What is the most common complication of hyperbaric oxygen therapy?

Ear or sinus barotrauma

What are the physiologic effects of inhaled nitric oxide (NO)? 1. Recruitment of collapsed alveoli 2. Improved blood flow to ventilated alveoli 3. Decreased pulmonary vascular resistance 4. Reduced intrapulmonary shunting

2, 3, and 4 only

What does a well-designed oxygen protocol ensure? 1. The patient undergoes initial assessment. 2. The patient is evaluated for protocol criteria. 3. The patient receives a treatment plan that is modified according to need. 4. The patient stops receiving therapy as soon as it is no longer needed.

1, 2, 3, and 4

What is the recommended maximum initial dose of inhaled NO in neonates with respiratory distress syndrome?

20 ppm

What are the toxic side effects of inhaled NO? 1. Acute pulmonary edema 2. Direct cellular damage 3. Impaired surfactant production 4. Sulfhemoglobinemia

1, 2, and 3 only

What are the considerations about using NO2? 1. NO2 levels greater than 10 ppm can cause hemorrhage, pulmonary edema, and death. 2. NO2 is produced spontaneously whenever NO is exposed to O2. 3. The Occupational Safety and Health Administration (OSHA) safety limit for NO2 exposure is 5 ppm. 4. NO2 exposure should be kept below 5 ppm during NO administration.

1, 2, and 3 only

What are the potential adverse effects associated with NO therapy? 1. Poor or paradoxical response 2. Increased blood clotting 3. Increased left ventricular filling pressures 4. Rebound hypoxemia or pulmonary hypertension

1, 3, and 4 only

What are the features of an ideal delivery system for NO for use with mechanical ventilation? 1. Provides precise and stable NO dose delivery. 2. Premixes NO and O2 in a holding reservoir. 3. Provides accurate NO and NO2 monitoring. 4. Maintains proper ventilator function.

1, 3, and 4 only

What should you do to prevent an adverse rebound effect when withdrawing NO therapy? 1. Reduce the NO to the lowest effective dose (ideally, less than 5 ppm). 2. Hyperoxygenate the patient just before discontinuing NO. 3. Ensure that the patient is hemodynamically stable.

1, 2, and 3

What is an indication for the use of helium-O2 mixtures?

Large-airway obstruction

What is the density of an 80% He and 20% O2 mixture, compared to air?

One-third as much

A physician orders a 70% He:30% O2 mixture to reduce the work of breathing in a patient having an acute asthmatic attack. What delivery system would be appropriate in this case?

Nonrebreathing mask at 10 L/min

You are giving a 80% He:20% O2 mixture to an asthmatic patient through a nonrebreathing mask with a compensated Thorpe tube O2 flowmeter set at 8 L/min. What is the actual flow being delivered to the patient?

14 L/min

Before administering a helium-O2 mixture to a patient with large airway obstruction, what should you do?

Analyze the O2 concentration of the mixture.

Mixtures of carbon dioxide and oxygen in blends of 5%:95% or 7%:93%, which are occasionally used to prevent complete washout of carbon dioxide during cardiopulmonary bypass or treat hiccoughs is known as which of the following?

Carbogen

ch. 2

Darya Rose · 83問 · 2年前

ch. 2