Deck 51: Respiratory Care in Alternative Settings

Question 1

For which of the following categories of disorders is respiratory home care NOT considered appropriate?

A)cystic fibrosis
B)chronic neuromuscular disorders
C)acute restrictive disorders
D)pulmonary obstructive lung disease

Answer 1

C

Question 2

What statutory regulations ensure that skilled nursing facilities and home health agencies meet minimum health and safety requirements?
I)The Joint Commission (formerly Joint Commission on Accreditation of Hospitals Organization [JCAHO]) accreditation standards
II)Medicare provider certification program
III)state health agency regulations

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

Answer 2

A

Question 3

What are some desired outcomes of the discharge plan?
I)prevent hospital readmission due to poor planning
II)satisfactory performance of all treatments by caregivers
III)caregivers' ability to assess the patient and solve problems
IV)patient's and family's satisfaction

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

Answer 3

A

Question 4

Providing necessary home care equipment and supplies and handling any emergency situations involving delivery or equipment operation is the responsibility of which member of the respiratory home care team?

A)social services representative
B)respiratory care practitioner
C)nurse
D)durable medical equipment (DME) company representative

Question 5

From where do standards for the delivery of subacute and home health care derive?
I)state licensing laws
II)private sector standards
III)federal regulations

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

Question 6

Which of the following is NOT normally included as part of a good discharge plan?

A)evaluating both the patient and the discharge site
B)providing caregiver travel to and from the discharge site
C)confirming or securing financial resources
D)providing patient and caregiver education and training

Question 7

Where is most postacute respiratory care provided?

A)skilled nursing facilities
B)the home
C)rehabilitation facilities
D)subacute care facilities

Question 8

Which of the following key features distinguish delivery of respiratory care services in alternative settings (subacute, long-term, and home care) from traditional acute care delivery?
I)reliance on outside vendors for most lab and diagnostic testing
II)reliance mainly on portable equipment (oxygen [O₂], suction, aerosol)III.most work independently performed with minimal supervision
IV)heavy reliance on assessment and documentation in care planning
V)intensive interaction with professional team and patient's family

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

Question 9

Studies have shown that carefully selected home treatment regimens can play an important role in achieving which of the following?
I)maintaining patients' lives
II)improving patients' quality of life
III)increasing patients' functional performance
IV)reducing hospitalization costs

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

Question 10

Which of the following is NOT normally part of the respiratory home care team?

A)respiratory care
B)durable medical equipment supplier
C)pulmonary function
D)nursing

Question 11

Making necessary contacts with outside agencies that can assist with home care is the responsibility of which member of the respiratory home care team?

A)attending physician
B)social services representative
C)respiratory care practitioner
D)nurse

Question 12

What agency is primarily responsible for voluntary accreditation of postacute care providers?

A)The Joint Commission (TJC) (formerly Joint Commission on Accreditation of Hospitals Organization [JCAHO])
B)AARC
C)CAAHEP
D)ASTM

Question 13

Under which conditions is the home NOT the best setting for providing subacute care?
I)when the patient is unable to do self-care
II)when adequate caregiver support is unavailable
III)when the patient's physician cannot make home visits

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

Question 14

Establishing therapeutic objectives for home care is normally the responsibility of which member of the respiratory home care team?

A)physical therapist
B)respiratory care practitioner
C)nurse
D)attending physician

Question 15

Providing regular in-home follow-up visits and assessing the patient's overall progress is the responsibility of which member of the respiratory home care team?

A)social services representative
B)nurse
C)attending physician
D)respiratory care practitioner

Question 16

Respiratory home care contributes to achieving which of the following goals?
I)improving patients' physical and social well-being
II)ensuring cost-effective delivery of care
III)supporting and maintaining patients' lives
IV)promoting patient and family self-sufficiency

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

Question 17

Which patients are better suited for subacute rather than for acute care?
I)those who no longer need diagnostics or invasive procedures
II)those who have a determined course of treatment
III)those who are recovering from an acute illness

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

Question 18

All of the following are components of the patient evaluation aspect of a good discharge plan except the patient's:

A)socioeconomic status and neighborhood characteristics
B)(and family's) expectations and psychosocial readiness
C)functional ability and activities of daily living (ADLs)
D)respiratory and ventilatory support needs

Question 19

Postacute care settings include all of the following except:

A)rehabilitation facilities
B)the home
C)trauma centers
D)skilled nursing facilities (SNFs)

Question 20

Patient- and resident-focused functions addressed in The Joint Commission (formerly Joint Commission on Accreditation of Hospitals Organization [JCAHO]) standards for long-term, subacute care, and home care include all of the following except:

A)patient education
B)treatment
C)rights and ethics
D)infection control

Question 21

Which of the following are acceptable methods of documenting the presence of hypoxemia in patients being considered for home O₂ therapy?
I)blood gas analysis
II)pulse oximetry
III)physical exam

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

Question 22

Which of the following is FALSE about home O₂ therapy?

A)A PRN (as needed) prescription for O₂ is acceptable.
B)Hypoxemia can be confirmed by arterial blood gas (ABG) or oximetry.
C)A PaO₂ at or below 55 mm Hg documents need.
D)An SaO₂ below 88% is clinical evidence of need.

Question 23

In addition to specifying the liter flow or concentration, which of the following must a physician include in a home O₂ prescription?
I)evidence of central cyanosis
II)appropriate medical diagnosis
III)laboratory evidence of hypoxemia
IV)frequency of use of O₂
V)duration of need for O₂

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

Question 24

A home care patient will be receiving nasal O₂ at 0.5 L/min using a large compressed gas cylinder. Which of the following additional equipment would you specify for this patient?
I)bubble humidifier
II)pressure-reducing valve
III)calibrated low-flow flowmeter

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

Question 25

Which of the following are acceptable indicators of hypoxemia for purposes of justifying home O₂ therapy?
I.resting PaO₂ of 65 mm Hg (room air)
II.drop in Sao₂ below 89% during ambulation
III.resting arterial SaO₂ below 88% (room air)

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

Question 26

Once the need for long-term home O₂ therapy has been documented, why should repeated laboratory assessment (ABG or oximetry) be conducted?
I)to follow the course of the disease
II)to assess changes in clinical status
III)to facilitate changes in the prescription

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

Question 27

Home O₂ can be supplied by which of the following systems?
I)REDOX chemical reactors
II)liquid O₂ systems
III)O₂ concentrators

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

Question 28

Durable medical equipment (DME) companies usually provide which of the following respiratory home care services?
I)third-party insurance processing
II)most respiratory care modalities
III)24-hours/7-days-a-week service
IV)home instruction and follow-up

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

Question 29

What is the primary use of compressed O₂ cylinders in alternative settings?
I.ambulation (small cylinders)
II.backup supply (large cylinders)
III.primary supply (large cylinders)

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

Question 30

What is the most common respiratory home care modality?

A)aerosol therapy
B)mechanical ventilation
C)O₂ therapy
D)nasal continuous positive airway pressure (CPAP)

Question 31

Key environmental factors that should be assessed in considering discharge of a patient to the home care setting include all of the following except:

A)heating and ventilation
B)humidity
C)lighting
D)airborne pollutants

Question 32

HCFA regulations require that prescriptions for home O₂ therapy be based on:

A)documented hypoxemia
B)documented symptoms
C)written diagnosis
D)presence of cyanosis

Question 33

Factors to consider when advising a patient on selection of durable medical equipment (DME) include all of the following except:

A)accreditation
B)finder's fees
C)cost
D)availability

Question 34

Advantages of using compressed O₂ cylinders in the home include which of the following?
I)minimal waste or loss
II)unlimited storage time
III)widespread availability
IV)minimal user hazards

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

Question 35

Home O₂ therapy can be justified in patients with PaO₂ values greater than 55 mm Hg in all of the following conditions except:

A)cor pulmonale
B)erythrocythemia (hematocrit greater than 56%)
C)congestive heart failure
D)peripheral vascular disease

Question 36

Disadvantages of using compressed O₂ cylinders in the home include all of the following except:

A)high-pressure hazards
B)limited volume of O₂
C)gas waste when not used
D)need for frequent deliveries

Question 37

To determine if a home setting can support the equipment needs of a mechanically ventilated patient being considered for discharge, which of the following would you assess?
I)available space for equipment
II)amperage of power supply
III)number and location of grounded outlets
IV)presence of hazardous appliances

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

Question 38

Which of the following would you recommend as the solution used to fill a bubble humidifier used for home O₂ therapy?

A)sterile water
B)distilled water
C)0.9% saline
D)tap water

Question 39

To determine the need for long-term home O₂ therapy after initial justification, when should blood gas analysis be repeated?

A)1 to 3 weeks after initiation
B)1 to 3 days after initiation
C)1 to 3 months after initiation
D)1 to 3 years after initiation

Question 40

Physical hazards associated with home O₂ therapy equipment include all of the following except:

A)unsecured cylinders
B)gaseous explosions
C)ungrounded equipment
D)liquid O₂ burns

Question 41

Advantages of O₂ concentrators for home O₂ therapy include all of the following except they:

A)operate at safe low pressures
B)are cost-effective for continuous use
C)do not waste or lose any O₂
D)can power most pneumatic equipment

Question 42

At normal liquid cylinder operating pressures, 1 lb of stored liquid O₂ equals about how many liters of gaseous O₂?

A)860.00
B)344.00
C)22.80
D)7.48

Question 43

Advantages of home liquid O₂ systems include all of the following except they:

A)usually include a small refillable portable subsystem
B)do not require an O₂ service delivery company
C)provide large-volume O₂ storage in a small space
D)are useful for rehabilitation activities (e.g., walking)

Question 44

When the flow-metering device of a home liquid O₂ system is turned on, O₂ leaves the container through a vaporizing coil, where it is heated by exposure to which of the following?

A)hot water
B)ambient air
C)electrical energy
D)ultrasound

Question 45

What is the purpose of the small refillable liquid O₂ tank that comes with many stationary home liquid O₂ reservoirs?

A)provide O₂ to ambulatory patients outside the home
B)serve as a backup should the primary reservoir fail
C)collect and save gas vented by the primary reservoir
D)provide higher flows for patients requiring high FIO₂ values

Question 46

Most portable home liquid O₂ systems can provide low-flow O₂ (2 L/min) for about how long?

A)1 to 3 hours
B)3 to 5 hours
C)8 to 12 hours
D)5 to 8 hours

Question 47

To help prevent problems with home O₂ therapy, you should have the patient or caregiver check all delivery equipment at least how often?

A)once a day
B)once a week
C)every other day
D)once a month

Question 48

A home care patient receiving long-term O₂ therapy at 5 L/min complains that her nondisposable humidifier is not bubbling properly. Upon inspection of the humidifier, you notice hard white deposits in and around the diffusing element. Which of the following would you recommend to this patient?

A)Stop using the humidifier because there is no need for it at this flow.
B)Replace the device and fill with distilled water, not tap water.
C)Increase the flow at night to help clean out the humidifier.
D)Replace the device and fill with sterile water, not tap water.

Question 49

Other than providing a backup H cylinder for a home care O₂ therapy patient who uses a concentrator, what other safety measure would you take to ensure an uninterrupted supply?

A)Provide an emergency backup battery-powered concentrator.
B)Arrange for emergency transport of the patient to a hospital.
C)Notify the power company that life support equipment is in use.
D)Provide an emergency backup liquid O₂ system.

Question 50

One cubic foot (1 cu/ft) of liquid O₂ equals how many cu/ft of gaseous O₂?

A)22.80
B)7.48
C)860.00
D)3.14

Question 51

The O₂ in the inner reservoir of a home liquid O₂ system is maintained at what temperature?

A)-300° F
B)212° F
C)0° F
D)-150° F

Question 52

The gauge reading of a 50-lb home liquid O₂ system indicates that the cylinder is a third full. What is the approximate duration of flow of this system at 2 L/min?

A)24 hours
B)48 hours
C)72 hours
D)95 hours

Question 53

At flows between 1 and 2 L/min, a typical molecular sieve O₂ concentrator provides an O₂ concentration of about what level?

A)65%
B)75%
C)85%
D)95%

Question 54

In setting up a home care chronic obstructive pulmonary disease patient for continuous low-flow O₂ therapy through an O₂ concentrator, which of the following additional equipment must you provide?

A)pressure-reducing valve
B)backup gas cylinder
C)emergency generator
D)backup concentrator

Question 55

Disadvantages of home liquid O₂ systems include which of the following?
I.Oxygen is lost when not used (because of venting).
II.The low temperature of liquid O₂ can be a hazard.
III.Liquid O₂ must be delivered when needed.
IV.These systems cannot drive pneumatic equipment.

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

Question 56

An ambulatory home O₂ therapy patient complains that the portable liquid (at 3 L/min) does not last long enough for a visit with the grandchildren. What might you recommend to overcome this limitation?

A)Decrease the flow to 2 L/min.
B)Put a couple of E cylinders in her car.
C)Use an O₂-conserving device.
D)Put the large liquid unit in the car.

Question 57

What are some disadvantages of O₂ concentrators for home O₂ therapy?
I.FIO₂ values decrease with increased flow.
II.Backup O₂ is required in case of electrical failure.
III.They cannot operate high-pressure devices.
IV.Loss of electricity disrupts delivery.

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

Question 58

When not in use, vaporization in a home liquid O₂ system maintains the pressure in the container at what range?

A)10 to 15 psi
B)45 to 55 psi
C)80 to 90 psi
D)20 to 25 psi

Question 59

At 3 to 5 L/min output, a typical molecular sieve O₂ concentrator provides O₂ concentrations at what level?

A)65% to 78%
B)78% to 85%
C)85% to 93%
D)>93%

Question 60

What electrically powered device can separate the O₂ in room air from N₂, thereby providing an enriched flow of O₂ for therapeutic use?

A)O₂ concentrator
B)O₂-conserving device
C)Joule-Thompson enricher
D)molecular impactor

Question 61

What are some major problems with demand O₂ delivery systems?
I.They are cumbersome and unattractive.
II.Equipment and maintenance costs are high.
III.The device valve may have slow response times.
IV.Catheter and sensor malfunction is common.

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

Question 62

Which O₂ delivery system would you recommend for an active home care patient with low FIO₂ needs who desires increased mobility?

A)traditional low-flow nasal cannula supplied by O₂ concentrator
B)compressor-driven humidifier with supplemental O₂ through a concentrator
C)conserving device used in conjunction with a portable liquid O₂ system
D)air entrainment mask driven by a large (H/K) compressed gas cylinder

Question 63

A home care patient using a reservoir cannula for long-term low-flow O₂ therapy objects to the cosmetic appearance of the device. Which of the following alternatives would you recommend to this patient's physician as capable of addressing the patient's concerns?
I)transtracheal catheter
II)entrainment mask
III)pendant reservoir

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

Question 64

Conditions in which patient need for home mechanical ventilation is generally limited to daytime or nocturnal support include all of the following except:

A)kyphoscoliosis
B)high spinal cord injuries
C)amyotrophic lateral sclerosis
D)myasthenia gravis

Question 65

When visiting a home care patient receiving nasal O₂ at 2 L/min through an O₂ concentrator, you measure the FIO₂ of the outlet gas as 0.63. Which of the following best explains this finding?

A)This FIO₂ is normal at this flow.
B)The sieve pellets are exhausted.
C)The gas inlet filter must be clogged.
D)Electrical power is inadequate.

Question 66

A home care patient on transtracheal O₂ therapy at 0.5 L/min frantically calls you, unable to reinsert the catheter after cleaning. What would you recommend?

A)Use a clean, pointed instrument to guide catheter reinsertion.
B)Put on a nasal cannula at 1 L/min and call the physician.
C)Insert the catheter into the nasal cavity about 3 to 4 inches.
D)Insert the catheter into the oral cavity.

Question 67

Which of the following are good candidates for home mechanical ventilation?
I)a patient who cannot maintain adequate ventilation at night
II)a patient who requires continuous ventilation to survive
III)a terminally ill patient who requires ventilatory support

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

Question 68

Home care patients requiring continuous ventilatory support for long-term survival include which of the following?
I)those with high spinal cord injuries
II)those with late-stage muscular dystrophy
III)those with bronchogenic carcinoma

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

Question 69

All of the following indicate that a patient is stable enough to be considered for home ventilatory support except:

A)pH = 7.34; PCO₂ = 48; HCO₃^- = 27
B)FIO₂ = 35%
C)15 cm H₂O positive end-expiratory pressure (PEEP)
D)absence of cardiac arrhythmias

Question 70

Routine removing and cleaning of a transtracheal O₂ catheter should be performed by whom?

A)visiting nurse
B)respiratory care practitioner
C)physician
D)patient

Question 71

Routine in-home monthly maintenance of an O₂ concentrator should include which of the following?
I)flushing the system for 20 minutes with an inert gas
II)confirming the FIO₂ with a calibrated O₂ analyzer
III)cleaning and replacing the internal and external filters

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

Question 72

Oxygen-conserving delivery systems include which of the following?
I)transtracheal catheter
II)reservoir cannula or pendant
III)pulse-dose

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

Question 73

Complications associated with insertion of a transtracheal O₂ catheter include all of the following except:

A)bleeding
B)pneumothorax
C)bronchospasm
D)abscess

Question 74

A home care patient with kyphoscoliosis requires intermittent positive-pressure breathing (IPPB) treatments twice per day with O₂. A local charitable organization has given the family a pneumatically powered IPPB device for this purpose. Which of the following gas sources would you recommend to drive this device?
I)liquid O₂ reservoir
II)O₂ concentrator
III)compressed gas cylinder

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

Question 75

While visiting a patient who has been receiving transtracheal O₂ therapy for 6 months, you note marked erythema and swelling at the stoma site. Which of the following actions would be appropriate at this time?

A)Question the patient and family about their cleaning methods.
B)Promptly report your observations to the prescribing physician.
C)Liberally apply tincture of benzoin to the stoma site.
D)Flush the catheter and the tubing with H₂O₂.

Question 76

To avoid product failure, transtracheal catheters and their tubing should be replaced every how often?

A)every week
B)every 3 months
C)every month
D)every 6 months

Question 77

Transtracheal O₂ therapy (TTOT) should be considered as an option for what patients requiring long-term O₂ therapy?
I)those who remain hypoxemic with standard approaches
II)those who do not comply well when using other devices
III)those who exhibit complications with nasal delivery
IV)those who prefer TTOT for cosmetic reasons
V)those who require increased mobility

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

Question 78

Examples of terminally ill patients with short life expectancies who can receive ventilatory support in the home setting include which of the following?
I)patients with end-stage chronic obstructive pulmonary disease
II)patients with kyphoscoliosis
III)patients with lung cancer

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

Question 79

What is the most common O₂ delivery system for long-term care?

A)simple mask
B)entrainment mask
C)transtracheal catheter
D)nasal cannula

Question 80

You are caring for a patient who has just received a transtracheal catheter for long-term continuous home O₂ therapy. Which of the following problems should you be on guard for with this patient?
I)airway obstruction
II)catheter clogging
III)stoma infection

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