Deck 56: Respiratory Care in Alternative Settings

Question 1

From where do standards for the delivery of subacute and home health care derive?
1) State licensing laws
2) Private-sector standards
3) Federal regulations

A)2 and 3 only
B)1 and 2 only
C)3 only
D)1, 2, and 3

Answer 1

D

Question 2

Which of the following is an additional goal of home care of the terminally ill patient near the end of life?

A) Prolong life.
B) Maximize comfort and well-being.
C) Maximize equipment use.
D) Minimize medication use.

Answer 2

B
Explanation: Although the primary goal of home care involves minimizing a patient's dependence on institutional care, an additional goal is to maximize the comfort and well-being of the terminally ill patient near the end of life.

Question 3

While visiting a home care patient who uses a multidose vial of an expensive bronchodilator, you notice that the expiration date for this medication has passed. Which of the following actions would you recommend at this time?

A) Mix the remaining medication with a fresh batch.
B) Dispose of the medication as recommended by the manufacturer.
C) Dilute the remaining medication with saline.
D) Use the remaining medication until it is gone.

Answer 3

B
Explanation: It is further recommended that manufacturers' guidelines for the proper handling of specific medications be strictly followed.

Question 4

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

A) The Joint Commission
B) AARC
C) CAAHEP
D) ASTM

Question 5

Which patients are better suited for subacute rather than for acute care?
1) Those who no longer need diagnostics or invasive procedures
2) Those who have a determined course of treatment
3) Those who are recovering from an acute illness

A)2 and 3 only
B)1 and 2 only
C)3 only
D)1, 2, and 3

Question 6

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 7

Respiratory home care contributes to achieving which of the following goals?
1) Improving patients' physical and social well-being
2) Ensuring cost-effective delivery of care
3) Supporting and maintaining patients' lives
4) Promoting patient and family self-sufficiency

A)2 and 4 only
B)1, 2, and 3 only
C)2 and 3 only
D)1, 2, 3, and 4

Question 8

What statutory regulations ensure that skilled nursing facilities and home health agencies meet minimum health and safety requirements?
1) The Joint Commission accreditation standards
2) Medicare provider certification program
3) State health agency regulations

A)2 and 3 only
B)1 and 2 only
C)3 only
D)1, 2, and 3

Question 9

Which of the following are normally parts of the respiratory home care team?
1) Respiratory care
2) Durable medical equipment supplier
3) Pulmonary function
4) Nursing

A)1 and 3 only
B)1, 2, and 4 only
C)3 and 4 only
D)2, 3, and 4 only

Question 10

Where is most postacute respiratory care provided?

A) Skilled nursing facilities
B) The home
C) Rehabilitation facilities
D) Subacute care facilities

Question 11

Postacute care settings include which of the following?
1) Rehabilitation facilities
2) The home
3) Trauma centers
4) Skilled nursing facilities (SNFs)

A)1 and 3 only
B)1, 2, and 4 only
C)3 and 4 only
D)2, 3, and 4 only

Question 12

What are some desired outcomes of the discharge plan?
1) Prevent hospital readmission due to poor planning
2) Satisfactory performance of all treatments by caregivers
3) Caregivers' ability to assess the patient and solve problems
4) Patient's and family's satisfaction

A)1, 2, 3, and 4
B)2 and 4 only
C)1, 2, and 3 only
D)3 and 4 only

Question 13

Under which conditions is the home the best setting for providing subacute care?
1) When the patient is unable to do self-care
2) When adequate caregiver support is unavailable
3) When the patient's physician cannot make home visits

A)2 and 3 only
B)1 and 2 only
C)3 only
D)1, 2, and 3

Question 14

Making necessary contacts with outside agencies that can help 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 15

For which of the following categories of disorders is respiratory home care considered appropriate?
1) Cystic fibrosis
2) Chronic neuromuscular disorders
3) Acute restrictive disorders
4) Pulmonary obstructive lung disease

A)1 and 3 only
B)1, 2, and 4 only
C)3 and 4 only
D)2, 3, and 4 only

Question 16

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 17

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 which of the following?
1) Patient education
2) Treatment
3) Rights and ethics
4) Infection control

A)1 and 3 only
B)1, 2, and 4 only
C)2 and 4 only
D)2, 3, and 4 only

Question 18

Which of the following is typically not 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 19

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 20

Studies have shown that carefully selected home treatment regimens can play an important role in achieving which of the following?
1) Maintaining patients' lives
2) Improving patients' quality-of-life
3) Increasing patients' functional performance
4) Reducing hospitalization costs

A)2 and 4 only
B)1, 2, 3, and 4
C)3 and 4 only
D)1, 2, and 3 only

Question 21

Which of the following agents is recommended by the American Respiratory Care Foundation for disinfection of respiratory home care equipment?

A) Activated glutaraldehyde
B) 70% ethyl alcohol solution
C) Sodium hypochlorite solution
D) Quaternary ammonium compound

Question 22

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 23

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 24

Factors to consider when advising a patient on selection of durable medical equipment (DME) include which of the following?
1) Accreditation
2) Finder's fees
3) Cost
4) Availability

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 3, and 4 only

Question 25

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?
1) Available space for equipment
2) Amperage of power supply
3) Number and location of grounded outlets
4) Presence of hazardous appliances

A)2 and 4 only
B)1, 2, 3, and 4
C)3 and 4 only
D)1, 2, and 3 only

Question 26

Which of the following are acceptable methods of documenting the presence of hypoxemia in patients being considered for home O₂ therapy?
1) Blood gas analysis
2) Pulse oximetry
3) Physical examination

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)1, 2, and 3

Question 27

Which of the following are acceptable indicators of hypoxemia for purposes of justifying home O₂ therapy?
1) Resting PaO₂ of 55 mm Hg (room air)
2) Drop in SaO₂ below 89% during ambulation
3) Resting arterial SaO₂ below 88% (room air)

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)1, 2, and 3

Question 28

CMS 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 29

Durable medical equipment (DME) companies usually provide which of the following respiratory home care services?
1) Third-party insurance processing
2) Most respiratory care modalities
3) 24-hr/7-days-a-week service
4) Home instruction and follow-up

A)2 and 4 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 2, 3, and 4

Question 30

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 31

Physical hazards associated with home O₂ therapy equipment include which of the following?
1) Unsecured cylinders
2) Gaseous explosions
3) Ungrounded equipment
4) Liquid O₂ burns

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 3, and 4 only

Question 32

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

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)1, 2, and 3

Question 33

Disadvantages of using compressed O₂ cylinders in the home include which of the following?
1) High-pressure hazards
2) Limited volume of O₂
3) Gas waste when not used
4) Need for frequent deliveries

A)1 and 3 only
B)1, 2, and 4 only
C)2 and 4 only
D)2, 3, and 4 only

Question 34

Home O₂ therapy can be justified in patients with PaO₂ values greater than 55 mm Hg in which of the following conditions?
1) Cor pulmonale
2) Erythrocythemia (hematocrit >56%)
3) Congestive heart failure
4) Peripheral vascular disease

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 35

What is the primary use of compressed O₂ cylinders in alternative settings?
1) Ambulation (small cylinders)
2) Backup supply (large cylinders)
3) Primary supply (large cylinders)

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)1, 2, and 3

Question 36

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?
1) Bubble humidifier
2) Pressure-reducing valve
3) Calibrated low-flow flowmeter

A)1 and 2 only
B)1, 2, and 3
C)2 and 3 only
D)1 and 3 only

Question 37

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 38

Key environmental factors that should be assessed in considering discharge of a patient to the home care setting include which of the following?
1) Heating and ventilation
2) Humidity
3) Lighting
4) Airborne pollutants

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 39

Home O₂ can be supplied by which of the following systems?
1) REDOX chemical reactors
2) Liquid O₂ systems
3) O₂ concentrators

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)1, 2, and 3

Question 40

Advantages of using compressed O₂ cylinders in the home include which of the following?
1) Minimal waste or loss
2) Unlimited storage time
3) Widespread availability
4) Minimal user hazards

A)1, 2, and 3 only
B)2 and 4 only
C)1, 2, 3, and 4
D)1, 2, and 4 only

Question 41

Advantages of O₂ concentrators for home O₂ therapy include which of the following?
1) Operate at safe low pressures.
2) Are cost-effective for continuous use.
3) Do not waste or lose any O₂.
4) Can power most pneumatic equipment.

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 42

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 43

Advantages of home liquid O₂ systems include which of the following?
1) Usually include a small refillable portable subsystem.
2) Do not require an O₂ service delivery company.
3) Provide large-volume O₂ storage in a small space.
4) Are useful for rehabilitation activities (e.g., walking).

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 3, and 4 only

Question 44

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 45

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 46

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

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

Question 47

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 48

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 49

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

A) To provide O₂ to ambulatory patients outside the home
B) To serve as a backup should the primary reservoir fail
C) To collect and save gas vented by the primary reservoir
D) To provide higher flows for patients requiring high FiO₂ values

Question 50

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 51

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 52

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 53

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 54

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

A)1, 2, and 3 only
B)2 and 4 only
C)1, 2, 3, and 4
D)3 and 4 only

Question 55

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 56

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

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

Question 57

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) Greater than 93%

Question 58

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

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

Question 59

What are some disadvantages of O₂ concentrators for home O₂ therapy?
1) FiO₂ values decrease with increased flow.
2) Backup O₂ is required in case of electrical failure.
3) They cannot operate high-pressure devices.
4) Loss of electricity disrupts delivery.

A)2 and 4 only
B)1, 2, and 3 only
C)2 and 3 only
D)1, 2, 3, and 4

Question 60

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 hr
B) 48 hr
C) 72 hr
D) 95 hr

Question 61

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 62

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?
1) Airway obstruction
2) Catheter clogging
3) Stoma infection

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)1, 2, and 3

Question 63

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?
1) Liquid O₂ reservoir
2) O₂ concentrator
3) Compressed gas cylinder

A)1 and 2 only
B)2 and 3 only
C)3 only
D)1, 2, and 3

Question 64

Conditions in which patient need for home mechanical ventilation is generally limited to daytime or nocturnal support include which of the following?
1) Kyphoscoliosis
2) High spinal cord injuries
3) Amyotrophic lateral sclerosis
4) Myasthenia gravis

A)1 and 3 only
B)1, 3, and 4 only
C)2 and 4 only
D)2, 3, and 4 only

Question 65

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

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)1, 2, and 3

Question 66

Routine in-home monthly maintenance of an O₂ concentrator should include which of the following?
1) Flushing the system for 20 min with an inert gas
2) Confirming the FiO₂ with a calibrated O₂ analyzer
3) Cleaning and replacing the internal and external filters

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)1, 2, and 3

Question 67

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 68

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 69

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 70

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

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

Question 71

Basic principles of infection control in the home care setting include which of the following?
1) Avoid visits by friends with respiratory infections.
2) Have caregivers follow proper handwashing techniques.
3) Incinerate all disposable equipment and supplies.

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)1, 2, and 3

Question 72

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?
1) Transtracheal catheter
2) Entrainment mask
3) Pendant reservoir

A)1 only
B)2 and 3 only
C)1 and 2 only
D)1, 2, and 3

Question 73

Which of the following are good candidates for home mechanical ventilation?
1) A patient who cannot maintain adequate ventilation at night
2) A patient who requires continuous ventilation to survive
3) A terminally ill patient who requires ventilatory support

A)2 and 3 only
B)1 and 2 only
C)1, 2, and 3
D)1 and 3 only

Question 74

Who should perform routine removing and cleaning of a transtracheal O₂ catheter?

A) Visiting nurse
B) Respiratory care practitioner
C) Physician
D) Patient

Question 75

Oxygen-conserving delivery systems include which of the following?
1) Transtracheal catheter
2) Reservoir cannula or pendant
3) Pulse dose

A)2 and 3 only
B)1 and 2 only
C)1, 2, and 3
D)1 and 3 only

Question 76

Home care patients requiring continuous ventilatory support for long-term survival include which of the following?
1) Those with high spinal cord injuries
2) Those with late-stage muscular dystrophy
3) Those with bronchogenic carcinoma

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)1, 2, and 3

Question 77

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 approximately 3 to 4 in.
D) Insert the catheter into the oral cavity.

Question 78

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 79

What are some major problems with demand-flow O₂ delivery systems?
1) They are cumbersome and unattractive.
2) Equipment and maintenance costs are high.
3) The device valve may have slow response times.
4) Catheter and sensor malfunction is common.

A)2 and 4 only
B)1, 2, and 3 only
C)2 and 3 only
D)1, 2, 3, and 4

Question 80

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