Special Procedures - A (Module) Flashcards
Which of the following are considered contraindications for bronchoscopy?
- Status asthmaticus
- Marked hypercapnia
- Hemoptysis
- Bleeding disorders
A. 2 and 4 only
B. 1 and 3 only
C. 2, 3, and 4 only
D. 1, 2, and 4 only
d. 1, 2, and 4 only
page D-4
The following are contraindications for bronchoscopy:
Bleeding disorders
Cardiovascular instability
Status asthmaticus
Marked hypercapnia
Status asthmaticus is an extreme emergency.
“Marked” anything is an emergency.
Bleeding disorders also need to be stabilized before a bronchoscopy.
Hemoptysis is actually an indication for bronchoscopy.
Which of the following blood vessels is appropriate for obtaining a venipuncture sample?
A. radial artery
B. heel of the patient’s foot
C. antecubital vein
D. brachial artery
C. antecubital vein
Arteries will not provide venous samples.
A heel sample is a capillary sample, not venous.
The following blood gas values were measured from a patient with a body temperature of 39C (102F):
pH: 7.5
PaCO2: 30
PaO2: 71
Which of the following results should the technologist record?
A. ph 7.51, paco2 30, pao2 70
B. ph 7.16, paco2 78, pao2 50
C. ph 7.55, paco2 25, pao2 65
D. ph 7.44, paco2 36, pao2 83
D. ph 7.44, paco2 36, pao2 83
*page D-12 (bottom written note)
Remember, analyzer temp is 37C. Whatever direction the temperature on the gas goes, the PaO2 and PaCO2 will go. The pH will move in the opposite direction.
Temp goes up?
PaO2 and PaCO2 goes up
Temp goes down?
PaO2 and PaCO2 goes down.
The pulmonary function technologist estimates that a patient’s anatomic deadspace is 200ml. The patient’s Vd/Vt ratio is 0.33. The patient’s calculated tidal volume is
A. 200 ml
B. 400 ml
C. 600 ml
D. 800 ml
C. 600 ml
Vd/Vt is 33% of tidal volume as stated in the question.
Vd (200) divided by Vt (600) is about 0.33, or 33%
200 is also 1/3 of 600, (33%).
The following data is available for a patient breathing room air:
pH 7.38 PaCO2 34 torr PaO2 84 torr HCO3- 19 mEq/L Hb 12 g/100 mL SaO2 94% SvO2 74% CvO2 12 vol%
Which of the following is the correct value for the C(a-v)O2?
A. 2.0 vol %
B. 3.0 vol %
C. 5.0 vol %
D. 6.0 vol %
B. 3.0 vol %
listen to audio.
(Hb x 1.3 x SaO2) - Cv02
=
3
A 76-year-old male patient diagnosed with COPD has been referred to a smoking cessation program. The patient has made numerous attempts over the last several decades to quit smoking without success. His attempts include cold turkey, nicotine replacement and group counseling and support. Which of the following should the technologist recommend as additional therapy for the patient’s comprehensive smoking cessation program?
A. Addition of bupropion hydrochloride
B. Monitor cotinine levels in the urine
C. Continuous oxygen at 2 L/min
D. Daily monitoring of CO2 levels
A. Addition of bupropion hydrochloride
*page D-37
Bupropion hydrochloride is an anti-depressant that works well in conjunction with group counseling, and has been shown to dramatically reduce nicotine withdrawal symptoms.
The other choices do nothing to curb smoking.
The pulmonary function technologist is assisting the physician with a fiberoptic bronchoscopy on a 45-year-old patient. During the procedure the physician experiences difficulty passing the bronchoscope through the patient’s larynx. The technologist should
A. instruct the patient to hold his breath.
B. apply cricoid pressure to the larynx.
C. administer a sedative to the patient.
D. have the patient inhale deeply and slowly.
D. have the patient inhale deeply and slowly.
Inhaling deep and slow will relax and open the larynx.
*page D-8
Breath hold would close the glottis
Cricoid pressure is used during an intubation to visualize the airway and won’t open the larynx.
Sedatives should have already been administered.
A radial artery blood gas sample was obtained prior to a pulmonary function test on a 54-year-old patient with no history of smoking. The patient is resting comfortably and breathing room air. The patient’s PaO2 value is reported at 72 torr and PaCO2 value is reported at 56 torr. Which of the following is the best explanation for these results?
A. The sample was not properly cooled before analysis.
B. There was an air bubble in the sample.
C. Excess heparin in the sample.
D. The patient was hypoventilating during the procedure.
A. the sample was not properly cooled before analysis
Results are inconsistent with the patient.
PaO2 is low, PaCO2 is high.
What can cause this? The gas is still burning up oxygen and metabolism is increasing CO2.
All of the other choices would decrease PaCO2 and increase PaO2.
A patient has a measured temperature of 35.0°C and the following blood gas results on room air:
pH 7.49
PaCO2 28 torr
PaO2 71 torr
What effect would this situation have on the oxygen-hemoglobin dissociation curve position?
A. Shift the curve to the right
B. It would remain unchanged
C. Shift the curve to the left
D. Curve would flatten at the top
C. Shift the curve to the left
Temp down
PaCO2 down
PaO2 down
Shift left
Temp up
PaCO2 up
PaO2 up
Shift right
Calculate the VD/VT ratio for a patient with the following blood gas results:
pH 7.43 PaCO2 40 torr PaO2 75 torr HCO3- 25 mEq/L FIO2 0.21 SaO2 93% PeCO2 20 VT 200 F 32/min.
A. 20%
B. 40%
C. 50%
D. 75%
C. 50%
PaCO2 - PeCO2
_____________
PaCO2
40-20 / 40 = 0.5
A 74-year-old male patient recently diagnosed with pulmonary fibrosis and in the final week of his 6-week pulmonary rehabilitation program informs the pulmonary function technologist that he has planned a special trip for him and his wife to travel abroad on a 7-day cruise. The patient has made excellent progress during his program that includes improved ability to perform his ADL and reduced severity of dyspnea. The patient is on continuous oxygen therapy at 2 L/min. The physician and the pulmonary rehabilitation department have given the patient clearance to travel as long as he can secure proper oxygen delivery for his entire trip. Which of the following should the technologist recommend to assist the patient with his oxygen therapy?
A. Make arrangements with the patient’s home care company to provide the oxygen for the trip.
B. Have the patient bring his portable oxygen from home with him on the trip.
C. Contact the airline and cruise ship line for proper oxygen delivery for each phase of the trip.
D. Contact the medical services division at the final destination.
C. contact the airline and cruise ship line for proper oxygen delivery for each phasse of the trip.
*page D-41
Which of the following is/are considered potentially responsible for transmission of a nosocomial infection in the pulmonary function laboratory?
- Use of standard precautions
- Proper disinfection techniques
- Droplet nuclei
- Laboratory personnel
A. 3 and 4 only
B. 1 and 3 only
C. 2 and 4 only
D. 1, 2, and 4 only
A. 3 and 4 only
1 and 2 reduce transmission of nosocomial infection.
3 and 4 are potential transmission risks.
A patient has the following laboratory results:
pH 7.45 PaCO2 39 torr PaO2 94 torr HCO3- 27 mEq/L BE +3 SaO2 96% Hb 15.8 g QT 5.2 L/min. CaO2 19.3 vol% CvO2 14.3 vol%
The pulmonary function technologist should estimate the patient’s hematocrit level as
A. 5.2 %
B. 7.9 %
C. 44.5 %
D. 47.4 %
D. 47.4 %
Hemoglobin x 3 = Hematocrit
Hb x 3 = Hct
Hyperventilation is best described as a
A. level of ventilation that produces a respiratory alkalosis.
B. minute ventilation of 25 L/min.
C. spontaneous tidal volume greater than 500 mL.
D. respiratory rate of 30 breaths per minute.
A. level of ventilation that produces a respiratory alkalosis.
Hyperventilation is “excessive” ventilation.
A RR, Ve, or Vt alone cannot tell you if a patient is hyperventilating, but a respiratory alkalosis can.
The pulmonary function technologist reviews a patient’s record and notes that the patient’s exhaled CO2 measured by capnography is 30 torr. The technologist also notes that one hour later, the reading was 20 torr. The patient’s blood gas results remain normal. Which of the following best explains the change in the capnograph reading?
A. The patient’s alveolar deadspace has increased.
B. The capnograph should be re-calibrated.
C. The patient is hyperventilating.
D. The patient’s condition is improving.
A. the patient’s alveolar deadspace has increased.
EtCO2 of 30 is normal.
EtCO2 of 20 is low an hour later. If the PaCO2 in the blood gas is still normal, the only explanation is an increase in deadspace.
You can do the Vd/Vt formula. the deadspace increased from 25% to 50%
Normal deaspace is 20%-40%
Associate an increase in deadspace with pulmonary embolism.
