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Flashcards in ch35 Deck (64):
1

The equipment needed for bland aerosol therapy includes:
A. Baffle
B. USN
C. LVN
D. SVN

B & C
Devices used to generate bland aerosols include LVN & USN

2

A large volume jet nebulizer is powered?
A. mechanically
B. Pneumatically
C. Electrically

Pneumatically

3

Bland Aerosols are used for:
A. Presence of upper airway edema-cool, bland aerosol
B. Laryngotracheobronchitis
C. Subglottic edema
D. Atelectasis

A, B, & C

4

To manage the upper airways of post op patients we often use SVN? T or F

False

5

Name two contraindications of when you would not use bland aerosols?

Bronchoconstriction
History of airway hyperresponsiveness

6

Name 4 hazards or complications of bland aerosol administration?

Edema of the upper airway
Wheezing or bronchospasm
Bronchoconstriction when artificial airway used
Infection
Overhydration
Patient discomfort
Caregiver exposure
Sputum indication causing bronchoconstriction
Edema from decreased compliance and gas exchange

7

Name factors that can allow you to assess the need of aerosol therapy.

Stridor
Brassy, crouplike cough
Hoarseness of extubation
Diagnosis of laryngotracheobronchitis or croup
History of upper airway irritation and increased work of breathing (ex. smoke inhalation)
Patient discomfort associated with airway instrumentation or insult
Bypassed upper airway
Need for sputum induction

8

Name some desired outcomes of aerosol therapy.

Decreased work of breathing
Improved vital signs
Decreased stridor
Decreased dyspnea
Improved arterial blood gas values
Improved O2 saturation on pulse oximetry

9

The frequency of monitoring should be as follows:
A. Once every hour
B. Every 30 minutes
C. Based on the stability and severity of patients condition
D. Twice daily

C. Based on the stability and severity of patients condition

10

Which of the following statements is true.
a.
Water that exists in the form of individual molecules in a gaseous state is humidity.
b.
Water that exists in the form of individual molecules is an aerosol.
c.
Water that exists in the form of particulate matter is relative humidity (RH).
d.
Water that exerts no pressure is as a vapor.

ANS: A
Humidity is water that exists in the form of individual molecules in the vaporous or gaseous state. An aerosol is a suspension of solid or liquid particles in a gas. Water vapor does exert pressure, although the pressure may vary

11

Humidity is:
A. Heated water molecules
B. Water that exists in the form of individual molecules in gaseous state
C. Water that exists in the form of individual molecules in the vaporous state
D. Water that exists in the form of individual in the vaporous or gaseous state

D. Water that exists in the form of individual in the vaporous or gaseous state

12

A patient has a heated air-entrainment large-volume jet nebulizer. The aerosol disappears completely during each inspiration. The most-appropriate action to take is to:
a.
Decrease the oxygen flow to the LVN
b.
Increase the oxygen flow to the LVN
c.
Decrease the heat level
d.
Remove the corrugated reservoir tubing

ANS: B
The aerosol should not completely disappear during inspiration. This means that the device is not meeting the needs of the patient. The oxygen flow can be increased without worry that the fractional inspired oxygen will increase, because the device uses air entrainment to set the oxygen concentration. This is the only answer that will increase the output of the device to meet the patient’s inspiratory needs.

13

T or F; Fogs and mist are considered Aerosols

T

14

T or F; Fogs and mist are considered water vapor

F

15

Medical aersols range in size from :
A. 0.2 μm to 50 μm.
B. 1 um to 10 um
C. 5 to 10 um
D. .1 to 10 um

A. 0.2 μm to 50 μm.

16

Which are larger, medical aerosols or water vapor?

Medical aersols, otherwise they would be too stable to deposit at their target site

17

3. A patient is receiving albuterol through a small-volume nebulizer (SVN). Where in the body will the greatest effect take place?
a.
Localized effect in the lungs
b.
Systemic effect
c.
Local and systemic effect
d.
Depends on the size, temperature, and volume of the aerosol

D Aerosols have the potential to cause both local and systemic effects. However, these effects largely depend on the drug concentration delivered, particle size, temperature, and volume of the aerosol.

18

T or F: Water vapor is a true gas used for the administration of aerosol therapy

F; It is not a true gas and doesn’t have a constant pressure. As the temperature of a gas increases, water vapor pressure increases and water molecules leave the liquid state through evaporation.

19

Which of the following is true concerning water vapor?
a.
It is a true gas.
b.
It has a constant pressure.
c.
It exerts a partial pressure.
d.
It exists above its critical temperature.

C Water vapor exerts a pressure (PH2O) that results from the continuous, random movement of water molecules. It is not a true gas and doesn’t have a constant pressure. As the temperature of a gas increases, water vapor pressure increases and water molecules leave the liquid state through evaporation.

20

A water molecule at the surface contains enough kinetic activity to enter the vapor state. This is the definition of which of the following?
a.
Evaporation
b.
Vaporization
c.
The boiling point
d.
The critical point

ANS: A
Evaporation occurs when liquid molecules near the surface contain enough kinetic energy to break free and enter a vapor state without the addition of heat. Vaporization is the energy required to vaporize a liquid. The boiling point is when the water is heated to a point at which molecules leave the liquid state and produce water vapor

21

At 37° C, water vapor exerts a partial pressure of ____ mm Hg and contains _____ mg H2O/L.
a.
43.9; 47
b.
47; 43.9
c.
44; 44
d. 100; 100

ANS: B
At sea level, a gas at body temperature (37° C), at a pressure of 47 mm Hg, and at a saturation of 100% will contain 43.9 mg of water per liter of gas.

22

Condensation will form in large-bore corrugated tubing during the delivery of bland aerosol because the:
a.
Gas is warmed by ambient air
b.
Corrugated tubing is too short
c.
Gas is cooled by ambient air
d.
Particles are susceptible to gravity

ANS: D
The liquid particles suspended in gas grow larger and heavier, condense, and then fall out, because large particles are more susceptible to gravity than small particles

23

A pulse oximeter on a patient with a tracheostomy shows 89% saturation. The patient has a heated humidifier with a 40% air-entrainment tracheostomy collar. A rapid assessment shows no secretion production and equal breath sounds. Which of the following is the most appropriate first step?
a.
Increase the oxygen delivered through the flowmeter.
b.
Increase the air-entrainment device to 60%.
c.
Apply positive pressure with bag-valve ventilation.
d.
Check to see whether water is collected in the gas-delivery tube.

ANS: D
The condensation collected in the gas-delivery tube must be removed because it becomes an obstruction that disrupts gas and humidity delivery to the patient. The other choices disregard the simplest step, which should be taken first.

24

The isothermic saturation boundary is located just below the:
a.
Carina
b.
Nasopharynx
c.
Lobar bronchi
d.
Mainstem bronchi

ANS: A
The isothermic saturation boundary (ISB) is the point, typically 5 cm below the carina, at which body temperature and pressure, saturated (BTPS) is reached. The nasopharynx is above the carina.

25

Which of the following are true about the function of the upper airways?
I. They cool inspired air.
II. They filter out secretions.
III. They humidify inspired air.
IV. They keep the nasal mucosa moist.

III & IV
The upper airway is responsible for humidifying inspired air. The upper airways add heat and humidity to inspired gases during inhalation. The nasal mucosa is kept moist by secretions from the mucous glands. Humidity and warmth are captured by the nasal mucosa, and exhaled air is cooled.

26

A large humidity deficit will cause:
a.
A nonproductive cough
b.
Increased cilia function
c.
Increased movement of mucus
d.
Decreased airway resistance

ANS: A
When the airways are exposed to dry, cold air, ciliary motility is reduced; the airways become more irritable; and because mucous production is increased, pulmonary secretions become thick and inspissated, with increased airway resistance and a nonproductive cough.

27

The structure that has a large surface area and therefore increases contact between inspired air and mucosa is the:
a.
Nose
b.
Carina
c.
Larynx
d.
Epiglottis

ANS: A
In the nose the tortuous path of the turbinates increases contact between the inspired air and the mucosa.

28

Inspired air is humidified and warmed through what two physical processes?
I. Condensation
II. Evaporation
III. Convection
IV. Conduction
a.
I and II
b.
I and IV
c.
II and III
d.
III and IV

ANS: C
As the inspired air enters the nose, it is warmed by convection, not by conduction, and picks up water vapor from the moist mucosal lining by evaporation, not by condensation.

29

the point, typically 5 cm below the carina, at which body temperature and pressure, saturated (BTPS) is reached
A. Mediation point
B. The isothermic saturation boundary (ISB)
C. Carina
D. Trachea

B. ISB

30

16.Which of the following statements about the ISB is true?
a.
Exercise causes the ISB to shift higher in the trachea.
b.
At 2 cm above the carina, inhaled gas reaches BTPS.
c.
Inhalation through the mouth shifts the ISB downward.
d.
Below the ISB, temperature and RH are variables.

ANS: C
At the ISB, inhaled gas reaches BTPS, which is below the carina. The temperature and RH are constant after that point. Because exercise causes an increase in the volume, rate, and type of breathing (i.e., breathing through the mouth), the ISB would shift downward.

31

The RH of an inspired gas is greater than 60% of BTPS. Which of the following statements is true?
a.
Production of mucus in the airways will increase.
b.
The work of breathing will increase.
c.
The airways will function normally.
d.
Secretions will become thick and dehydrated.

C
When the RH of inspired gas is greater than 60% of BTPS conditions, no injury is believed to occur in normal lungs. The production of mucus will increase, work of breathing will increase, and secretions will become thick and dehydrated when the RH is less than 60% of BTPS.

32

Indications for the use of warm, humidified gas are which of the following?
I. Patients with hypothermia
II. Patients with croup
III. Those with bronchospasm
IV. Those with postextubation edema

I & III

33

Indications for the use of cool, humidified gas in conjuction with aerosol therapy are which of the following?
I. Patients with epiglottitis
II. Patients with croup
III. Those with bronchospasm
IV. Those with postextubation edema

I, II, IV

34

Which of the following statements about humidifiers is appropriate?
a.
The warmer the gas, the less water vapor it can hold.
b.
Evaporation occurs more rapidly with a large water-to-gas surface area.
c.
High peak flows improve the efficacy of a humidifier.
d.
The mass of the water is inversely proportional to its capacity to transfer heat.

ANS: B
Larger surface areas will increase the amount of evaporation that will occur. The warmer the gas, the more water it can hold. High flows through a humidifier decrease its efficiency, because there is less time for contact between the gas and water. According to the principles of thermodynamics, the mass of the water is directly proportional to its capacity to transfer heat

35

26.Which of the following humidifiers is classified as passive?
a.
Bubble humidifier
b.
Large-volume nebulizer (LVN)
c.
Passover humidifier
d.
Heat and moisture exchanger (HME)

ANS: D
An HME is a passive humidifier. All the others are active humidifiers.

36

The efficiency of a humidifier depends on which of the following?
I. Presence of a diffuser
II. Water level in the humidifier
III. Surface area between the gas and water
IV. Length of the oxygen tubing being used
a.
I only
b.
II and IV only
c.
III and IV only
d.
I, II, and III only

ANS: D
The effectiveness of bubble humidifiers depends of the presence of a diffuser, the water level in the humidifier, and the surface area between the gas and water. The length of the oxygen tubing being used will not affect the efficiency of the bubble humidifier.

37

A patient with pneumonia has been intubated. Which of the following consequences of intubation will most likely occur?
a.
The humidity deficit will be zero.
b.
No turbulent convection will occur.
c.
Secretions will become more mobile.
d.
There will be an increase in ciliary action.

ANS: B
When the upper airway is bypassed by endotracheal tube (ETT), no turbulent convection occurs in the nose. The humidity deficit will be high, the secretions thick, and there will be a decrease in ciliary action

38

Appropriate use of a USN will aid which of the following?
a.
Ribavirin delivery
b.
Sputum induction
c.
Croup tent use
d.
Pentamidine aerosolization

ANS: B
USNs generate bland aerosols and aid the delivery of sterile water and hypotonic, isotonic, or hypertonic saline aerosols. They are very effective when used to induce sputum production for laboratory testing. Ribavirin is aerosolized in the small-particle aerosol generator model 2 (SPAG-2). Pentamidine is aerosolized in the Circulaire or Respirgard-type nebulizers that have filters to remove the aerosol before it is emitted into the environment

39

A respiratory therapist needs to deliver hypotonic solution to a patient through a large-volume jet nebulizer. The gas flow setting should be ___ L/min to ___ L/min.
a.
2; 4
b.
4; 6
c.
6; 8
d.
6; 15

ANS: D
Jet nebulizers typically operate at a flow of 6 L/min to 15 L/min.

40

The respiratory therapist needs to deliver a bland aerosol to a 24-month-old child through a spinning disk device. The appropriate flow setting is ___ L/min to ___ L/min.
a.
3; 5
b.
6; 8
c.
10; 15
d.
20; 22

ANS: D

41

The device that presents the least risk of cross-contamination as a room humidifier is which of the following?
a.
Bubble humidifier
b.
LVN
c.
Wick humidifier
d.
USN

ANS: C
Passover and wick-type humidifiers present less risk of cross-contamination than does the USN as a room humidifier, which can easily become contaminated, resulting in airborne transmission of pathogens.

42

Which of the following is not a complication from bland aerosol therapy?
a. Infection
b. Overhydration
c. Bronchospasm
d. Upper airway edema

ANS: D
The most-common problems with bland aerosol delivery systems involve infection control, environmental safety, inadequate mist production, overhydration, bronchospasm, and noise

43

Which of the following presents the greatest risk for an infant being treated with a heated jet nebulizer?
a. Infection
b. bronchospasm
c. Overhydration
d. Tachycardia

ANS: C
Overhydration

44

Which of the following humidifiers should be used for a patient with chronic obstructive pulmonary disease (COPD) who is receiving noninvasive nasal continuous positive airway pressure (CPAP)?
I. Cool passover humidifier
II. Heated passover humidifier
III. HME
IV. Large-volume nebulizer
a.
II
b.
III and IV
c.
I and II
d.
I, II, and III

ANS: C
Passover humidifiers for noninvasive nasal CPAP or bilevel positive airway pressure (BiPAP) use cool or heated fluid. Either CPAP or BIPAP is used in patients with COPD.

45

The types of humidifiers that can be used during invasive mechanical ventilation include:
I. HMEs
II. Simple reservoir passover humidifiers
III. Heated passover humidifiers
IV. Diffuser humidifiers
a.
I and III
b.
I and IV
c.
II and III
d.
II and IV

ANS: A
HMEs have been used successfully to meet the short-term humidification needs of mechanically ventilated patients with ET or tracheostomy tubes. Heated passover humidifiers, such as a wick humidifier, can accommodate the high flow rates of a mechanical ventilator. The simple reservoir passover humidifiers and diffuser humidifiers cannot adequately humidify the gas that flows more than 10 L/min.

46

Which of the following devices would be the least-effective in reducing a patient’s humidity deficit while intubated?
a. An HME
b. An unheated bubble humidifier
c. A wick humidifier set at 35° C
d. Heated air–entrainment nebulizer

ANS: B
The unheated bubble humidifier has a water vapor output of 10 to 20 mg H2O/L compared with the HME, with approximately 30 mg H2O/L; the wick humidifier, with 44 mg H2O/L; and the heated air entrainment nebulizer, with 33 to 55 mg H2O/L.

47

Type of humidifier that captures exhaled heat and moisture and uses it to head and humidify the next inspiration
A. Vaporizer Humidifer
B. Heat & Moisture Exchange-HME
C. Bubble humidifier
D. Hydrophobic humidifer

B. HME

48

To meet ISO standards HME should operate at:
A. 70% efficiency or better providing at least 30 mg/L of water vapor
B. 90% efficiency or better providing at least 30 mg/L of water vapor
C. 70% efficiency or better providing at least 55 mg/L of water vapor
D. 70% efficiency or better providing at least 30 ml of RH

A. 70% efficiency or better providing at least 30 mg/L of water vapor

49

According to the American Association for Respiratory Care’s Clinical Practice Guideline, HMEs should not be used for long-term humidification of patients who are receiving invasive mechanical ventilation. T or F

True

50

Bland aerosol therapy for a patient with upper airway edema is best achieved by using which of the following?
a. Heated, hypotonic saline aerosol
b. Cool, hypertonic saline aerosol
c. Heated, bland aerosol
d. Cool, bland aerosol

ANS: D
Cool, bland aerosol will produce a vasoconstriction and reduce the edema. Anything heated might increase edema. Cool, hypertonic saline aerosol is used to induce sputum

51

A recently extubated patient has developed stridor. The most-appropriate recommendation at this time is _____ aerosol.
a. Cool, bland
b. Heated, bland
c. Antiallergic
d. Hypertonic saline

A Cool, bland aerosol

52

Creation of aerosol particles within a small volume nebulizer is based on:
a. Stokes’ law
b. Brownian motion
c. Bernoulli principle
d. Reynolds’ number

ANS: C

53

Driving an SVN with heliox, instead of air or oxygen, has what effect on the aerosol produced?
a. Increases upper airway impaction
b. Creates larger particles
c. Decreases the aerosol output
d. Increases the turbulence of the aerosol

ANS: A
The density of the driving gas affects both aerosol generation and the delivery of aerosols to the lungs. Lowering the density of the carrier gas reduces the amount of turbulent flow, which results in less aerosol impaction in the upper airways. When heliox is used to drive a jet nebulizer at standard flow rates, aerosol output is substantially less than with air or oxygen and aerosol particles are considerably smaller

54

Medication aerosol pulmonary deposition during mechanical ventilation with a standard SVN is:
a. 2%
b. 5%
c. 10%
d. 25%

ANS: A

55

Which of the following devices can be used to administer a continuous bland aerosol?
I. Face tent
II. Simple mask
III. Nonrebreathing mask
IV. Tracheostomy collar
a. I
b. I and IV
c. II and III
d. II, III, and IV

ANS: B
The face tent and tracheostomy collar are patient interface appliances used to deliver bland aerosol therapy. The others are not.

56

A patient with subglottic edema might benefit from what type of humidity or aerosol therapy?
a. Continuous heated bland aerosol
b. Humidity from a bubble humidifier
c. Continuous cold-nebulized bland aerosol
d. DPI with a bronchodilator

ANS: C
A continuous cold-nebulized bland aerosol will produce vasoconstriction and reduce edema.

57

Continuous bland aerosol administration can be hazardous when administered to patients with:
I. Asthma
II. Pneumonia
III. Cystic fibrosis
IV. Ineffective cough mechanisms
a. I and III
b. I and IV
c. II and IV
d. II, III, and IV

ANS: B

58

Which of the following are complications from the use of large-volume air-entrainment jet nebulizers for neonates within oxygen hoods?
I. Bronchospasm
II. Overhydration
III. Hearing loss
IV. Infection
a. I, II, and III
b. I and IV
c. II and III
d. III and IV

ANS: C
Bronchospasm, overhydration, hearing loss, and infection are complications of large-volume air-entrainment jet nebulizers in general. However, because of neonates’ light weight, hearing loss and overhydration are more serious complications than the others.

59

Which of the following will correct the problem of tubing condensation within the ventilator circuit?
a. Water traps
b. Increase the room temperature
c. Hot-wire circuit
d. Both a and c

ANS: D
Hot-wire circuits are quite common in the intensive care unit. The placement of wire-heating elements into the ventilator circuit allows the gas delivered to the patient to remain at a constant temperature.

60

Which of the following are contraindications for HME use?
I. Hypothermia
II. Uncuffed ETT
III. With heated humidification
IV. Decrease volume of secretions
a. I, II, and III
b. I and III
c. II and III
d. II and IV

ANS: A
Contraindications of HME use are hypothermia, the presence of an uncuffed ETT, use with heated humidification, and an increase in the volume of secretions.

61

An HME is best placed where in the ventilator circuit?
a. Directly at the patient Y-connector
b. 20 cm away from the ETT
c. At the ventilator outlet
d. At the ventilator inlet

ANS: A
HMEs should be placed directly at the airway or patient Y-connector. Other HME locations that might also prove effective are 10 cm away from the ETT.

62

Use of an HME is beneficial to a patient with a(n):
a. Tracheostomy who is receiving low-flow oxygen
b. Tracheostomy who is receiving room air
c. Open stoma
d. All of the above

D

63

Which of the following offers the most accurate and reliable method for measuring the temperature and humidity level within a ventilator circuit?
a. Humidity control of hot-wire humidification system
b. Oxygen analyzer
c. Hygrometer-thermometer
d. Not able to measure humidity level

ANS: C
The most accurate and reliable way to ensure that patients are receiving gas at the expected temperature and humidity level is to measure these parameters with the portable battery-operated digital hygrometer-thermometer system. Humidity control on a hot-wire humidification system will not provide a measurement of AH or RH; instead, it will enable the measurement of only the temperature differential between the humidifier and the airway sensor.

64

Reactive bronchospasm and increased airway resistance can be caused by:
a.
Warm humidity
b.
Warm aerosol
c.
Aerosolized normal saline
d.
Cold high-density aerosol

ANS: D