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Duplicate of Ch 37 airway management Flashcards | StudBud
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Duplicate of Ch 37 airway management
Duplicate of Ch 37 airway management
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1
Repeated connecting and disconnecting of a cuff pressure manometer to the pilot tube of a cuffed airway will do what
Decrease cuff pressure
Rupture the cuff
Not affect cuff pressure
Increase cuff pressure
2
What is the purpose of the additional side port on ET tube
Protect airway against aspiration
Help ascertain proper tube position
Ensure gas flow if the main port is blocked
Minimize mucosal trauma during insertion
3
After a intubation attempt an expired CO2 has level of zero what does this indicate
Placement of ET tube in esophagus
Placement of ET tube in trachea
Failure of the cuff to seal airway
Abnormally high VQV ratio
4
Before suctioning you hear wheezing bilaterally what is the problem?
A pneumo has developed and pt needs a chest tube
Pt has developed a mucus plug and should undergo bronchoscope
Secretions are still present and pt needs suctioned again
Pt has hyperactive airway and developed bronchospasm
5
Pt with trach is having difficulty comminicating with icu staff, what would you recommend
Consider switching to a fenestrated trach tube
Use a letter, phrase or picture board
Consider a “talking” trach tube
6
What is the primary indication for tracheal suctioning?
Presence of atelectasis
Ineffective coughing
Retention of secretions
Presence of pneumonia
7
Compared with the oral route the advantages of nasal intubation include which
Less retching and gagging
Reduced risk of kinking
Less accidental extubation
Greater long term comfort
8
Pt on PPV through tracheostomy, last 2 days evidence of recurrent aspiration and abdominal distinction, what’s the cause
Tracheoesophogeal fistula
Paralysis of vocal cords
Under inflated tube cuff
Tracheoinnominate fistula
9
During oral intubation of an adult the ET tube should be advanced into the trachea how far
Until the cuff has passed the cords
Just far enough so that tube cuff is no longer visible
Until its in 2-3 inches
10
Which of the following can help to minimize mucosal trauma during suctioning?
Rotate the catheter while withdrawing
Use as large a catheter as possible
Use a rigid catheter if possible
Limit the amount of negative pressure
11
What is the normal range of negative pressure to use when suctioning an adult patient?
-100 to -120
-80 to -100
-120 to -150
-60 to -80
12
Which of the following is a reason to collect a sputum sample from a patient?
Assess extubation readiness
Improve mechanical ventilation synchrony
Identify organisms infecting the airway
Reduce the risk of accidental extubation
13
Which of the following approaches may be used in weaning a patient from trach tube
Using fenestrated tube
Using progressively smaller tubes
Using a trach button
14
What should the maximum time devoted to intubation attempt be
2 min
30 sec
90 sec
60 sec
15
Which of the following is an absolute contraindication for percutaneous dilation tracheostomy?
Need for emergent surgical airway
Coagulopathy
Children under 12
Pulsating blood vessel over tracheotomy site
16
Suction female patient who has 8mm ET tube in place, what is max size catheter used?
14
12
8
10
17
Soon after ET extubation an adult has an audible, high pitched inspiratory noise, what would you recommend
Stat racemic epi aerosol treatment
STAT heated aerosol treatment with saline
Careful observation of the patient for six hours
Immediate reintubation via the nasal route
18
Which of the following methods can help reduce atelectasis due to tracheal suctioning?
Hyperinflate the patient before and after the procedure
Limit the amount of negative pressure used
Suction for as short a period as possible
19
What is the purpose of an endotracheal tube stylet?
It helps ascertain proper tube placement
It minimizes mucosal trauma during insertion
It protects the airway against aspiration
It adds rigidity and shape to case insertion
20
Surgical resident has asked you assist in elective tracheal procedure, an pt with ET, which would be appropriate
Remove oral tube just before trach insertion
Remove oral tube before trach insertion
Withdraw oral tube 2-3 inches while the incision is made
Pull oral tube only after et tube is placed
21
Which of the following is likely to increase the likelihood of damage in the tracheal mucosa?
Monitoring intracuff pressure every 1-2 hours
Maintaining cuff pressures below 20-25
Using a low residual volume low compliance cuff
Using minimal leak technique for inflation
22
In a properly performed surgical tracheotomy entrance to the trachea is made through an incision in what area
Ligament between the thyroid and cricoid cartilages
Between the second and third tracheal rings
Cricoid cartilage and first tracheal ring
First and second tracheal rings
23
Which of the following features incorporated into the most modern ET tubes to assist in verifying placement
Additional side port near tube tip
Imbedded radiopaque indicator near the tube tip
Length marking on the curved body of the tube
24
An adult receiving cool mist therapy after extubation begins to develop stride, what do you do
Administer racemic epi treatment
Re intubate pt immediately
Change from cool to heated
Draw and analyze ABG
25
To minimize swelling DR orders aerosol therapy, which do you recommend
Heated mist therapy thru jet new or aerosol mask
Racemic epi
Cool mist therapy through jet neb and aerosol mask
Oxygen therapy through a venti mask and bubble humidifier
26
What size ET tube would you select to intubate a 1500g newborn infant
4
2.5
3
3.5
27
When checking ET placement distal tip of tube is 1cm above carina, which action would you recommend
Advance tube by 7-8 cm
Withdraw tube by 2-4 cm
Withdraw the tube by 7-8 cm
Advance tube by 2-4 cm
28
After removal of an ET tube a pt exhibits hoarseness and strider that does not resolve with racemic epi what caused it
Glottic edema or cord inflammation
Vocal cord paralysis
Tracheoesophogeal fistula
Tracheomalacia
29
Tracheal stenosis occurs in 1:10 pt’s, at what sites does this stenosis occur
Cuff site
Tip of the tube
Stoma site
30
Which of the following types of artificial airways are inserted through the larynx?
Pharyngeal airways
Nasotracheal tubes
Tracheostomy tubes
Orotracheal tubes
31
Which of the following are potential complications of suctioning?
Hypotension
Arrhythmias
Hypoxemia
Gastrointestinal disease
32
The removable inner cannula commonly incorporated into modern tracheostomy tubes serves what purpose
Prevent the tube from slipping into the trachea
Aid in routine tube cleaning and tracheostomy care
Provide a patent airway should it become obstructed
33
What is the standard size for endotracheal or tracheostomy tube adapters?
15 external
22 external
15 internal
22 internal
34
What is the purpose of a cuff on an artificial tracheal airway?
To seal off and protect lower airway
To help clinicians determine the depth of tube insertion
To provide a means to determine tube position via radiograph
To stabilize the tube and prevent its movement
35
Adult male intubated with 7 ET , when sealing you note a cuff pressure of 45 cm H20 what is the problem
Tube is in the right main stem
Cuff pilot balloon and line are obstructed
Cuff has herniated over the tube tip
Tube is too small for the patient
36
What is the purpose of a tracheostomy tube obturator?
Help ascertain the proper tube position by radiograph
Provide a means to infiltrate and deflate the tube cuff
Minimize trauma to the tracheal mucosal during insertion
To provide patent airway should tube become obstructed
37
Successful tube passage through the larynx during blind naso intubation is indicated by what
Louder breath sounds
Vocal silence
Harsh cough
38
What is the most common problem with fenestrated trach tubes
Poor positioning of the tube fenestration
Inability to provide mechanical ventilation
Relative frequency of accidental extubation
Increased likelihood of Tracheomalacia
39
What is the average distance from the tip of a properly positioned oral endotracheal tube to the incisors of a male
24-26
16-18
21-23
19-21
40
After determining pt has complete obstruction of ET tube you deflate/ inflate but didn’t fix it what’s the next step
Immediately remove the airway
Apply manual positive pressure
Call for emergency tracheotomy
Suction
41
The major limitations of using a laryngeal mask airway are
Cannot provide high ventilation pressure if needed
Short term use
Aspiration is not avoided
42
To prevent Hypoxemia when suctioning the RT should initially do what?
Preoxygenate with 100% oxygen
Have the patient hyperventilate for 2 min
Manually ventilate the patient with a resuscitator
Give pt a bronchodilator treatment
43
Immediately after insertion of an oral ET tube on an adult what should you do
Stabilize it with your right hand
Provide ventilation or oxygenation
Inflate the tube cuff
44
Which of the following techniques may be used to diagnose injury associated with artificial airways
Air tomography
Pulmonary function studies
Laryngoscopy or bronchoscopy
Physical examination
45
In the absence of neck or facial injuries what is the procedure of choice to establish a patent airway in an emergency
Cricothyrotomy
Surgical tracheotomy
Orotracheal intubation
Nasotracheal intubation
46
While suctioning ECG has abrupt change, which action is most appropriate
Change to smaller catheter and repeat procedure
Stop suctioning and report findings to RN
Stop suctioning and immediately administer oxygen
Decrease the amount of negative pressure being used
47
After repeated nasotracheal suctioning over 2 days a pt with retained secretions develops bleeding in nose
Orally intubate the patient for better access to lower airway
Stop the bleeding and use an NPA for access
Perform a tracheotomy for better access to the lower airway
Discontinue NT suctioning for 48 hours and reassess
48
Which of the following procedures should be used to help minimize infection of a tracheotomy stoma
Regular change of tracheotomy dressings
Adherence to sterile techniques
Regular aseptic stoma cleaning
49
Which of the following is an advantage of oral intubation?
Improved ability to swallow oral secretions
Insertion is fast
Esthetically displeasing
AIDS feeding, oral care, suctioning and speech
50
To maintain PEEP and high Fi02 when suctioning a mechanically ventilated pt
Limit suctioning to once an hour
Use the smallest possible catheter
Use a closed system multi use suction catheter
Limit suction time to no more than 5 seconds
51
What is the purpose of the pilot balloon on an endotracheal or tracheostomy tube?
To help ascertain proper tube position
Monitor cuff status and pressure
Protect the airway against aspiration
Minimize mucosal trauma during insertion
52
For which of the following purposes is a tracheal button appropriate?
Aid in positive pressure ventilation
Protect airways from aspiration
Facilitate secretion removal
Relieve airway obstruction
53
A pt with tracheal airway exhibits signs of tube obstruction which are possible causes
Tube orifice is impinging on tracheal wall
Tube is kinked or patient is biting it
Tube is obstructed by a mucus plug or secretion
Tube cuff has herniated over the tip of the tube
54
Pt on vent accidentally displaces ET tube out of trachea, what is most appropriate action
Apply manual ventilation
Push the tube back into the trachea by moving the patients neck
Remove the tube and provide manual ventilation/oxygenation
Suction with yankaer
55
What gives a false negative finding for capnometry
Right main stem intubation
Gastric CO2 diffusion
Cardiac arrest
Delivery of a high Fi02
56
Suction 10 yr old with 6mm et tube in place, what is max size catheter you would use?
14
8
6
10
57
What is the maximum recommended range for cuff pressures
30-40 cm H20
20-30 cmH20
30-40 mmHg
20-30 mmHg
58
What is the primary indication for tracheostomy
Pt has upper airway obstruction due to secretions
Pt has been orally intubated for more than 24 hours
Pt loses pharyngeal or laryngeal reflexes
Pt has a long term need for artificial airway
59
You have been asked to monitor a pt who was just extubation, which do you monitor
Color
Inspiratory force
Vital signs
Breath sounds
60
To make oral intubation easier how should the patients head and neck be positioned
Neck extended over the edge of bed legs hanging down
Neck flexed with head supported by towel and tilted back
Neck extended with head supported by towel flexed forward
Both head and neck fully extended with neck supported by towel
61
Serious complications of oral intubation include which of the following
Tongue laceration
Acute Hypoxemia
Bradycardia
Cardiac arrest
62
Before beginning an intubation the RT should confirm and check what
Laryngoscope light
Suction equipment
Cardiac defibrillator
ET tube cuff
63
Which of the following injuries are seen with tracheostomy tubes?
Glottic edema
Tracheomalacia
Vocal cord granulomas
Tracheal stenosis
64
Which factors should be considered when deciding to chance from an ET tube to tracheotomy tube
Length of time pt will need artificial airway
Relative risks of continued intubation vs tracheostomy
Patients severity of illness and overall condition
Pat’s ability to tolerate a surgical procedure
Pt’s tolerance of ET tube
65
How often should patients be suctioned?
Whenever charge RN requests it
When physical findings support the need
Every 2-3 hours
Whenever they are moved or ambulated
66
Which is true about percutaneous dilational tracheostomies?
Lower incidence of complications
Can be performed at bedside
Faster than traditional tracheotomy
Does not require anterior neck dissection
67
Which of the following bedside methods can confirm proper ET tube placement in the trachea
Fiber optic laryngoscopy
Tube length
Auscultation
Observation of chest movement
68
Which of the following is an indication for nasotracheal suctioning?
Patient preference
Hyperinflation
Retained secretions without artificial airway
Bronchospasm
69
What size ET tube would you use for a 3 year old child
5.5-6
4.5-5
3-4
6-7
70
To provide local anesthetia and vasoconstriction during nasal intubation what would you recommend
Mixture of .25% phenylephrine and 3% lidocaine
Nasal spray of .25% phenylephrine
SVN aerosol delivery of 2% lidocaine for 10 minutes
SVN of .25% phenylephrine for 10 minutes
71
To minimize problems associated with pharyngeal aspiration in tubed patients which would you recommend
Use of medications for stress ulcer prophylaxis, such as sucralfate
Position patient prone
Provide continuous aspiration of subglottic secretions
Position patient with head of the bed elevated 30 degrees
72
Pt w maxillofacial injury requires short term ventilators support, which airway approach would you recommend
Insert an OPA
Perform an emergency tracheotomy
Intubate via the oral route
Intubate via the nasal route
73
What is the most common sign associated with the transient glottic edema or vocal cord inflammation following extubation
Wheezing
Hoarseness
Difficulty in swallowing
Orthopnea
74
What size ET tube would you select to intubate an adult female
7
9
6
8
75
When checking for proper placement of an ET tube or Trach tube on a chest radiograph how far above the carina ?
2-4 cm
6-8 cm
3-6 cm
1-2 cm
76
Pt with trach tube PIP has risen pressure alarm is sounding you notice decreased breath sounds, what is the problem
Complete obstruction of trach tube
Obstruction of the left bronchus by a mucus plug
Development of a left sided pneumo
Partial obstruction of the trach tube
77
What is a rare but serious complication associated with ET tube extubation
Laryngospasm
Infection
Aspiration
Bradycardia
78
suction equip, oxygen apparatus, 2 laryngoscopes and blades, five tubes, McGill forceps, lube, meds what’s missing
Syringes
Tube stylet
BVM
Obturator
79
Which of the following equipment is needed to perform nasotracheal suctioning?
Suction kit (gloves basin etc)
Laryngoscope with Mac or miller blades
Oxygen delivery system (mask and manual resuscitator)
Bottle of sterile water or saline solution
80
Total application time for ET suction in adults should not exceed which of the following
10 sec
15 sec
20 sec
3 sec
81
While checking Mac and miller blade, miller lights Mac does not, what should you do
Swap the defective Mac for a good miller
Check and replace the bulb in the Mac blade
Replace the batteries in the handle
Check and clean laryngoscope handle
82
Compared with translaryngeal intubation the advantages of tracheostomy include which
Greater patient comfort
No upper airway complications
Reduced risk of bronchial intubation
Decreased frequency of aspiration
83
What is the normal range of negative pressure to use when suctioning children?
-120 to -150
-80 to -100
-60 to -80
-100 to -120
84
Ideally the distal tip of an ET tube should be positioned how far above carina
3-6 cm
4-6 cm
1-3 cm
7-9 cm
85
What best explains a steady rise in capnometry of an intubated cardiac arrest patient?
Abnormally high
Return of spontaneous circulation
Placement of the ET tube in the esophagus
Failure of the cuff to properly seal the airway
86
Which of the following statements are true about methods used to displace the epiglottis during oral intubation
Miller lifts the epiglottis directly
Levering the laryngoscope against the teeth can aid displacement
Regardless of blade used laryngoscope is lifted up and forward
Curved blade lifts the epiglottis indirectly
87
What is the normal range of negative pressure to use when suctioning an infant
-120 to -150
-100 to -120
-60 to -80
-80 to -100
88
Different techniques are used to remove ET tube, all aim to ensure what?
Maintenance of the appropriate cuff pressure
Maximal abduction of vocal cords
Elimination of the gag reflex
Maximal addiction of vocal cords
89
Tracheal airways increase the incidence of pulmonary infections for which of the following reasons
Contaminated equipment or solutions
Ineffective cough clearance through cough
Increased aspiration of pharyngeal material
Lower levels of humidification
90
Compared to the nasal route the advantages of oral intubation include which
Easier suctioning
Less traumatic insertion
Reduced risk of kinking
Less retching and gagging
91
Pt intubated for longer than 3 months, flow volume demonstrates fixed obstructive pattern what is the cause
Tracheal stenosis
Laryngeal web
Cord paralysis
Tracheomalacia
92
Pt with trach tube is in severe respiratory distress you notice absence of breath sounds, what is likely the problem
Partial tube obstruction
Complete tube obstruction
Right sided pneumo
Vocal cord paralysis