| A | B |
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| 1) A respiratory assessment includes which of the following? | (*A) all of the following (B) sputum colour and amount (C) respiratory rate & rhythm (D) breath sounds |
| 2) Tidal Volume is | (C) the amount of air either inspired or expired in one breath |
| What is a breath? | (1) the air taken into or expelled from the lungs |
| 3) Complete trach care consists of: | (A) changing/cleaning the inner cannula (B) changing the dressing site (C) cleaning the stoma site with cotton tip applicator (*d) all of the above |
| 4) Increased airway pressure can indicate: | (A) secretions in the airway |
| 5) Which of the following could be a sign(s) of a cuff leak? | (A) deflated pilot balloon (B) patient talking (C) air heard escaping through the nose & mouth (*D) all of the above |
| 6) What should you do when you determine that there is a cuff leak? | (1) check trach tube placement and slowly add air to cuff, if necessary |
| 7) Signs & symptoms of a tracheal stoma infection can include: | (A) Green drainage, stoma redness/swelling |
| 8) You hear a wheeze during auscultation in the left lung. What is the best way to document this finding? | (1) expiratory wheeze heard during exhalation in the left lung |
| 9) Potential complication(s) to having a tracheostomy tube in place include? | (A) mucous plugs (B) cuff leak (C) aspiration, TE fistula (*D) all of the above |
| 10) What emergency equipment should be at the bedside of EVERY ventilator-dependent patient? | (*A) all of the below (B) resuscitation bag, with mask (C) properly functioning suction equipment (D) spare trach tube |
| 11) The MOST common cause of a ventilator high pressure alarm is? | (1) Coughing and /or secretion accumulation |
| 12) Which of the following can be an IMMEDIATE side effect of suctioning? | (1) shortness of breath |
| 13) The MOST common cause of a low pressure alarm is? | (1) disconnection between patient and ventilator |
| 14) If the cause of the ventilator alarm canNOT be found; to ensure patient safety the next step: | (1) remove the patient from the ventilator and manually ventilate with the resuscitation bag |
| 15) To keep the ventilator internal battery charged you should? | (1) ventilator should always be plugged into A/C power when not transporing |
| 16) When doing a routine trach change, the FIRST thing you should do after inserting the new trach is | (1) remove the obturator |
| 17) Before using a speaking valve you should: | suction the trach tube then deflate the cuff |
| 18) Having oxygen near gas stoves, cigarettes or sparks from electrical equipment is considered a hazard | True |
| 19) Jack has been your ventilator-dependent pt for 6 mos. He is completely V-D. Today, the high pressure alarm(HPA) sounds while turning Jack. You return Jack to the supine position, however, the HPA continues | (1) secretion accumulation (2) coughing (C) mucus plugging (*D) all of the above |
| 20) In response to the high pressure alarm(HPA), you should FIRST: | (*A) attempt to suction (B) remove the trach tube (C) assess for cuff leak (D) call the home care vendor |
| 21) You are unable to pass the suction catheter. Jack is now in respiratory distress, what do you perform next | (A) call 911 (*B) begin to manually ventilate with the resuscitation bag (C) remove trach tube and call vendor (D) replace existing trach tube with new trach tube, using a clean procedure |
| 22) You begin to manually ventilate, however, you are having a difficult time moving air into the lungs with the resuscitation bag. Which do you next perform? | (a) attempt to suction again (B) replace trach ties (*C) replace existing trach tube with new trach tube, using a clean procedure (D) call 911 |
| 23) You are attempting to insert the new trach tube, however, it does NOT seem to fit. Jack becomes cyanotic. A family member call 911. Which of the following actions would NOT be safe? | (1) stand by and do nothing, help is on the way |
| 24) Which of the following is NOT considered safe suctioning technique? | (1) suction continuously on catheter insertion |
| 25) In the event of a complete ventilator failure, you should: | (1)manually ventilate patient with resuscitation bag and call 911 |
| 26) During a scheduled trach tube change, you are unable to insert the new tube. Your next action is: | (1) try to reinsert the old tube or a smaller sized trach tube |
| 27) Tom is a completely paralyzed patient d/t his C3&C4 fractures. He receives mechanical ventilation because he is unable to breathe on his own. Earlier today the PEEP was changed from +5 to 0 per MD order. During your assessment you count his respirations and realize it is higher than his set respiratory rate. What is causing his change in rate? | (1) the breathing effort/sensitivity is set inappropriately causing the ventilator to auto-cycle |
| 28) Ventilator information should be documented (ex. flow sheet, nursing notes, electronic or paper documentation) for the reason(s) | (a) patient parameters can be recorded and compared with previous findings (B) ventilator settings are being recorded (C) changes in ventilator settings are being recorded (D*) all of the above |
| 29) Passy-Muir Valve is the only brand of speaking valve | (1) false |
| 30) You can hear air leaking around the trach cuff. You add air to the cuff but 30 minutes later you hear the leak again. How do you fix this problem? | prepare to replace the entire trach tube |
| 31) A decrease in lung compliance (a.k.a. stiff lungs) caused by pneumonia will increase airway pressure | (1) true |
| 32) You notice the trach tube partially displaced (out of the stoma several inches). The proper reinsertion technique is: | (1) deflate the cuff, advance the tube, reinflate the cuff then auscultate |
| 33) Which is NOT a cause of low pressure alarm | (1) ventilator circuit kinked between patient and exhalation valve |
| 34) In response to a ventilator low pressure alarm, you assess the patient and find an uncorrectable cuff leak. You should | (1)change the trach tube |
| 35) After a trach tube change, the patient should be assessed for the following: | (A) correct amount of air in cuff (minimum leak technique) (B) bilateral breath sounds (C) properly secured tube (*D) all of the above |
| 36) In assist control (A/C) mode, the ventilator will deliver a preset tidal volume with each breath | (1) true |
| 37) Which mode of ventilation allows the patient to breathe at their own respiratory rate and tidal volume in-between preset breaths? | (1) synchronized intermittent mandatory ventilation (SIMV) |
| 38) The amount of pressure needed to deliver a ventilator brath is the: | (1) peak inspiration pressure (PIP) |
| 39) Which of the following are indications for PEEP (Positive End Expiratory Pressure)? | (1) improve oxygenation & prevent atelectasis |
| 40) Mr Jones is a C2 quad who is completely vent-dependent at home. His current vent settings are: Mode: (1) Assist Control (A/C) (2) Respiratory Rate: 16 bpm (3) Tidal Volume: 550ml (4) PEEP: =5cmH20 (5) Inspiratory Time: 1 sec (6) Sensitivity Setting: 3 (7) Low Pressure Alarm Setting: 20cmH20 (8) High pressure Alarm Setting: 50cmH20. Mr Jones peak inspiratory pressures normally ranges from 25-35cmH20. You enter the room because you hear an alarmsounding. The vent shows low peak preasure. What could cause this alarm? | (A) circuit disconnection (B) trach tube cuff leak (C) a hole in the ventilator circuit (*D) all of the above |
| 41) Mr Jones is a C2 quad who is completely vent-dependent at home. His current vent settings are: Mode: (1) Assist Control (A/C) (2) Respiratory Rate: 16 bpm (3) Tidal Volume: 550ml (4) PEEP: =5cmH20 (5) Inspiratory Time: 1 sec (6) Sensitivity Setting: 3 (7) Low Pressure Alarm Setting: 20cmH20 (8) High pressure Alarm Setting: 50cmH20. Mr Jones peak inspiratory pressures normally ranges from 25-35cmH20. The peak inspiratory pressure is reading 12cmH20. This is an emergence because | (B) Mr Jones is not being properly ventilated |
| 42) Mr Jones is a C2 quad who is completely vent-dependent at home. His current vent settings are: Mode: (1) Assist Control (A/C) (2) Respiratory Rate: 16 bpm (3) Tidal Volume: 550ml (4) PEEP: =5cmH20 (5) Inspiratory Time: 1 sec (6) Sensitivity Setting: 3 (7) Low Pressure Alarm Setting: 20cmH20 (8) High pressure Alarm Setting: 50cmH20. Mr Jones peak inspiratory pressures normally ranges from 25-35cmH20. Your response would be to | (A) quickly assess Mr. Jones and check for leaks in the circuit |
| 43)Mr Jones is a C2 quad who is completely vent-dependent at home. His current vent settings are: Mode: (1) Assist Control (A/C) (2) Respiratory Rate: 16 bpm (3) Tidal Volume: 550ml (4) PEEP: =5cmH20 (5) Inspiratory Time: 1 sec (6) Sensitivity Setting: 3 (7) Low Pressure Alarm Setting: 20cmH20 (8) High pressure Alarm Setting: 50cmH20. Mr Jones peak inspiratory pressures normally ranges from 25-35cmH20. Assessment show circuit is w/o leaks, however, Jones does NOT have adequate chest rise & fall. The LP alarm continues. Your immediate response is | (B) Begin manual ventilation |
| 44) If there is a power outage, the following will occur | (b) ventilator will automatically switch to internal battery and alarm to notify |
| 45) An indication for chest physiotherapy | (B) difficulty clearing secretions |
| 46) Oxygen concentrators | (B) need air circulation to function properly and to keep cool |
| 47) JCAHO reviewed 23 reports of death or injury related to long term ventilator use and found that: | (D) the most frequent finding was a malfunction, misuse or inadequate alarm settings |
| 48) In the home setting, it is NOT always possible to use sterile technique when suctioning, therefore, it is very important to use as clean a technique as possible | (1) true |
| 49) Humidification can aid with secretion mobilization | (1) true |
| 50) Minimum Leak Technique(MLT) or Minimum Occluding Volume (MOV) is a procedure used to prevent unnecessary cuff pressure against the tracheal wall | (1) true |
| The MOST Common causes of ventilator low pressure allarm | (*1) disconnection between patient & ventilator (2) significant cuff leak (3) hole in the ventilator circuit (4) all of the above |
