Deck 21: Artificial Airway Care

Question 1

What is defined as the removal of a tracheostomy tube?

A)Decannulation
B)Leak technique
C)Invagination
D)Wash-out volume

Answer 1

Decannulation

Question 2

What should be done to prevent a high-risk patient from aspiration of gastric contents?

A)Proper maintenance of cuff pressures
B)Use of humidification of secretions with a heated humidifier
C)Elevation of the patient's head 30-45 degrees
D)The use of subglottic secretion drainage

Answer 2

Elevation of the patient's head 30-45 degrees

Question 3

Personnel should perform a baseline assessment for indications of respiratory distress and
The need for nasotracheal suctioning as recognized by presenting indications.Which of the following would be an assessment that needs to be made by the respiratory care practitioner?
I.Oxygen saturation
II.Auscultation of chest
III.Respiratory rate

A)I,II,III
B)I and II
C)I and III
D)II only

Answer 3

I,II,III

Question 4

Tissue trauma is a hazard of suctioning.All of the following will prevent tissue trauma EXCEPT ____________________

A)hyperinflation of the patient's lungs before and after the procedure.
B)limiting the suction attempt to no more than 15-seconds.
C)vacuum pressures between -80 and -120 mmHg.
D)pressures should be set as low as possible while still permitting effective removal of secretions.

Question 5

A physician orders nasotracheal suctioning to be done as needed on a 72 year-old patient with pneumonia.Which of the following would indicate that the patient may have problems clearing secretions from the large/central airways?
I.Decreased tactile fremitus
II.Increased tactile fremitus
III.Clear chest radiograph
IV.Diminished breath sounds

A)I and III
B)II and IV
C)I only
D)II,III,and IV

Question 6

A patient's chest radiograph indicates pneumonia and atelectasis of the left upper lobe.Which type of suction catheter should be used to ensure the catheter enters the left lung?

A)Whistle tip catheter
B)Coudé catheter
C)Closed system suction catheter
D)Fenestrated suction catheter

Question 7

A patient has just been nasotracheally suctioned by the respiratory care practitioner.What improvements in the patient should occur after the procedure to indicate that the nasotracheal suctioning procedure was effective?
I.Improved breath sounds
II.Removal of secretions
III.Improved blood gas data or pulse oximetry
IV.Decreased work of breathing

A)I and II
B)III and IV
C)I only
D)I,II,III,IV

Question 8

If the volume ventilator is used for preoxygenation and preventilation prior to suctioning a patient,you must wait up to 2 minutes,depending on the rate and the tidal volume,before the patient receives 100% oxygen.What is the reason for this?

A)Vagus nerve stimulation
B)Suction catheter size
C)The invagination of the airway mucosal tissue
D)The effects of the wash-out volume

Question 9

A patient on mechanical ventilation has been suctioned and a large amount of thick secretions are obtained.Which of the following clinical signs would you expect after suctioning?

A)More pressure limiting delivering the tidal volume
B)Deterioration of the patient's arterial blood gases
C)Increased PIP/plateau pressure difference
D)Decreased PIP/plateau pressure difference

Question 10

When using a fenestrated tracheostomy tube to facilitate weaning the patient from the tracheostomy tube,what procedure(s)should be performed?

A)The cuff should be deflated
B)The inner cannula should be removed
C)The minimum occluding volume should be done
D)a and b

Question 11

When evaluating sputum suctioned from a patient that is being mechanically ventilated,which of the following characteristics should be evaluated?
I.Color
II.Consistency
III.Odor
IV.Amount

A)I and III
B)II and IV
C)I,II,III,IV
D)I,II,IV

Question 12

A patient has been placed on mechanical ventilation.The respiratory care practitioner needs to know the absolute contraindication to suctioning a patient through an endotracheal tube that is on mechanical ventilation is:

A)a bronchospasm.
B)coagulopathy.
C)an irritable airway.
D)none of these.

Question 13

What is the maximum amount of time that a suction procedure should last?

A)5 seconds
B)10 seconds
C)15 seconds
D)20 seconds

Question 14

A patient on mechanical ventilation is suctioned.The patient's heart rate decreases from 120/minute before the procedure to 66/minute after the procedure.What is the cause of this decrease in the heart rate?

A)Tissue trauma
B)Vagus nerve stimulation
C)Hyperventilation of the patient
D)Stimulation of the sympathetic nervous system

Question 15

What is the proper size of a suction catheter to be used through an endotracheal tube or tracheostomy tube?

A)The inside diameter of the catheter should not exceed one-half of the inside diameter of the artificial airway
B)The outside diameter of the catheter should not exceed one-third of the inside diameter of the artificial airway
C)The outside diameter of the catheter should not exceed one-half of the inside diameter of the artificial airway
D)A size 14-Fr suction catheter should be used for a 5-mm inside diameter of the artificial airway,otherwise a size 12-Fr catheter should be used.

Question 16

Which of the following are absolute contraindications for nasotracheal suctioning?

A)Croup
B)Laryngospasm
C)Epiglottitis
D)a and c

Question 17

PEEP therapy through a mechanical ventilator may increase the patient's susceptibility to significant hypoxemia.Which suction catheter will maintain the PEEP level in a ventilated patient?

A)Whistle tip suction catheter
B)Coude suction catheter
C)Closed suction system catheter
D)Fenestrated suction catheter

Question 18

The patient has been decannulated.The chest radiograph indicates atelectasis in the right lower lobe caused by retained secretions.The patient's cough is weak and non-productive.Since the patient needs to be suctioned periodically,which of the following would be best to facilitate suctioning without reinserting the tracheostomy tube?

A)Use of a Bivona tube
B)Use of IPPB
C)Use a tracheostomy button
D)Use of a Silver Holinger tube

Question 19

Because suctioning is an invasive procedure,strict aseptic technique should be used at all times to prevent the inadvertent introduction of bacteria into the tracheobronchial tree.Sterile gloves should be used to maintain with all suction catheters EXCEPT _______________

A)a whistle tip suction catheter.
B)a Coude tip suction catheter.
C)a closed system suction catheter.
D)sterile gloves should be worn with all suctioning catheters.

Question 20

If a patient is expected to be on a ventilator for more than _________,a heated humidifier should be used if the patient has an artificial airway in place.

A)24 hours
B)48 hours
C)72 hours
D)96 hours

Question 21

Why should the patient's chest be auscultated before tracheostomy care is performed?

A)To determine if the patient's lungs are clear of secretions.
B)To confirm if tracheostomy care needs to be done
C)To determine whether suctioning is required prior to performing tracheostomy care.
D)a and c

Question 22

Before suctioning a patient,you notice that no suction pressure is being generated at the end of the suction catheter when you attempt to suction sterile water through the catheter.What could be causing the problem?

Question 23

What should be done to the patient's tracheostomy tube when a Passy-Muir is placed on the tube?

A)The cuff must be inflated to a pressure between 20-25 cmH20
B)The tracheostomy must be suctioned until it is clear
C)The tracheostomy cuff must be deflated
D)The tracheostomy tube should be replaced by a button

Question 24

A patient requires nasotracheal suctioning as evidenced by coarse breath sounds.How should the patient be positioned for the procedure?

A)Semi-Fowler's position
B)Sniffing position
C)Prone position
D)Either a or b

Question 25

You are suctioning a patient with a metal (silver)tracheostomy with an inner cannula that has a one-way valve.You insert the catheter through the one-way valve to suction the patient but are unable to remove the catheter because the valve closes on the catheter.What should you do now?

Question 26

Which of the following would help the patient with a tracheostomy talk?

A)Single cuff tracheostomy tube
B)Passy-Muir valve
C)Minimal occluding volume
D)Minimal leak technique

Question 27

Why is the nasopharyngeal airway placed for frequent nasotracheal suctioning?

A)To minimize trauma to the patient's nose and nasopharynx
B)To allow the patient to be able to speak during the procedure
C)To prevent aspiration of abdominal contents
D)To prevent hypoxemia during the procedure

Question 28

You cannot pass the suction catheter down the endotracheal tube on an intubated patient.What should you do and how would you correct the problems?