Answer Key

1. C
2. D
3. B
4. A
5. C
6. B
7. B
8. C
9. A
10. D
11. B

RAE tube
12. B
13. D

standard ET vs. Armored ET

14. A
Lanz tube
15. A
16. C
17. D
18. A
19. D
20. B
21. C
22. B
23. B
24. A
25. B
26. D
27. E
28. B
29. B
30. C
31. D
32. D
33. B
34. A
35. B
36. C
37. B
38. C
39. A
40. D
41. D
42. C
43. C
44. D
45. D
46. B
47. C
48. C
49. D
50. D
51. B
52. B
53. A
54. B
55. C
56. D
57. A
58. B
59. C
60. B
61. A
62. B
63. C
64. C
65. C
66. C
67. A
68. B
69. D
70. A
71. C
72. C
73. ANS: D Transtracheal invasive airway insertion is a procedure that involves the
surgical placement of a catheter through the airway and does not require
extension of the neck. For nasopharyngeal airway insertion, the head and neck
do not need to be adjusted. The jaw thrust or chin lift is used if the neck is not
able to be extended because of cervical spine injuries.
74. ANS: A The jaw thrust is the maneuver used to intubate a patient with an
unstable cervical spine injury. The presence of temporomandibular joint disease
can be an indication of a difficult intubation, but it is not a contraindication for
the sniffing position. When a patient is vomiting, his head should be turned to
one side to prevent aspiration.
75. ANS: A The neck extension and sniffing position are both contraindicated for an
unstable cervical spine injury. The head is elevated too high in the Fowler
position to facilitate intubation.
76. ANS: D The chin lift and jaw thrust are contraindicated in the case of a fractured
mandible. Use of any of the oropharyngeal airways might cause gagging or
vomiting in patients who are awake.
77. ANS: A It can be assumed that the tongue is the most common cause of airway
obstruction, because many devices have been developed to displace the tongue
and create a passage for air. Bleeding from the nose and mucus production can
cause airway obstruction but are not the most common causes. Cardiac arrest is
 not the cause of an obstructed airway; rather, it is the tongue that will obstruct
the airway during a cardiac arrest.
78. ANS: B The oropharyngeal airways are not placed deep enough in the airway to
create esophageal or pharyngeal wall damage.
79. ANS: A A Mallampati airway class III and a thyromental distance of less than 6 cm
are predictors of a difficult airway. Because this airway examination
demonstrates an airway that is not difficult, the initial attempts to establish an
airway should be by means of oral intubation.
80. ANS: B The Guedel airway has a central channel, is measured in millimeters, and
differs from the Berman airway in its cross-sectional profile.
81. ANS: D A Berman airway has a shape similar to that of the Guedel airway, but it
has a different crosssectional profile without a protected central channel. It can
be inserted in several ways.
82. ANS: A An important sign that the distal airway tip may not have passed the back
of the tongue is if the flange protrudes excessively from the patient’s mouth. If
attempts to push the airway farther in just bounce it back out, it is probably
catching on the back of the tongue and should be removed and replaced
immediately by using one of the previously described methods of insertion. REF:
Page 177
83. ANS: A The placement of an LMA does not necessitate airway manipulation or a
special device. It does not protect the lungs from aspiration because it does not
reliably seal the esophageal inlet. It is, however, superior to a nasopharyngeal
airway.
84. ANS: C If the patient struggles to expel an oropharyngeal airway, attempts at
insertion should be abandoned and an improved head position or a
nasopharyngeal airway should be used to open the upper airway. The
nasopharyngeal airway will also facilitate nasotracheal suction to evacuate
excess mucus in the airways. A tracheostomy is not appropriate in this situation
because it is too invasive. A Berman airway is another type of oropharyngeal
airway that this kind of patient will not be able to tolerate. Sedation of the
patient is not appropriate at this time.
85. ANS: B Insertion of an oropharyngeal airway is done upside-down and then
turned. Inserting the nasopharyngeal airway parallel to the long axis of the nose
is inserting it “up the nose” and is likely to cause bleeding. It is impossible to
insert the nasopharyngeal airway perpendicular to the nasal pharynx floor.
86. ANS: D A tongue blade can be used during the insertion of an oropharyngeal
airway to move the tongue to one side. Intermittent pressure might cause
damage and bleeding to the inside of the nasal cavity. An Endotrol tube is an
endotracheal (ET) tube that allows for the manipulation of the tip of the tube. It
does not facilitate insertion of a nasal airway.
87. ANS: C Insertion of a nasal airway when there is a basilar skull fracture does
increase the risk of penetrating the brain with the nasal airway, but it is not a
long-term complication. Nasal bleeding is a complication of the insertion of the
airway. Hypoxia is a risk factor when an airway is not able to be established or is
 compromised. A nasal airway can introduce organisms into the nasal cavity and
the sinuses; therefore, when long-term nasal tube use is required, the risk to the
patient increases.
88. ANS: A The LMA is the only airway that has a cuff that rests in the posterior
pharynx, with its tip on the upper esophageal sphincter.
89. ANS: D The size of the LMA is based on the patient’s weight and may not be easy
to choose. The placement of an LMA must be checked by using measurements of
end-tidal carbon dioxide (CO2) and breath sounds. LMAs do not protect the
lungs from aspiration because they are noninvasive. LMAs are useful in
emergencies because they do not require airway manipulation or extreme head
positioning, which minimizes flexion and extension of the cervical spine for
proper placement.
90. ANS: D The LMA is designed to form a low-pressure seal in the laryngeal inlet by
means of an inflated cuff. The cuff pressures should not exceed 60 cm H2O.
91. ANS: C The cuff of the LMA is seated laterally in the pyriform fossa, not in the
esophagus, interarytenoid notch, or antecubital fossa (bend in the elbow).
92. ANS: C According to “Difficult Airway Algorithm” set forth by the American
Society of Anesthesiologists, because the patient is unable to be invasively
intubated and remains awake, the noninvasive airway approach with an LMA is
necessary.
93. ANS: A Pregnant patients predictably have improved ventilation with an LMA
when compared with other mask techniques. The tracheostomy is too invasive
for this situation. The nasal and oropharyngeal airways do not facilitate manual
ventilation better than the LMA
94. ANS: C The LMA is of particular benefit in patients with a known or anticipated
difficult airway.
95. ANS: C Because the endotracheal tube is inserted into the trachea and sealed
with a cuff, it is considered to be a secure airway. The esophageal cuff affords
some protection from regurgitation, but, as with the LMA, the Combitube is not
considered a secure airway device; neither is the Berman airway.
96. ANS: C LMAs can be resterilized 100 to 200 times, but marked discoloration and
failure of the pilot tube and cuff to hold pressure are indications that the tube
should be discarded. The cuff should not be filled with water, and LMAs do not
have foam cuffs.
97. ANS: B A finger is used to guide the deflated cuff past the tongue and pharynx.
The tube is held in place with the other hand while the guiding finger is
withdrawn. A stylet and Miller laryngoscope are used in the placement of an
endotracheal tube. A lighted stylet is used in the blind placement of an
endotracheal tube.
98. ANS: D According to the difficult airway algorithm, when face mask ventilation is
inadequate and intubation attempts are unsuccessful, an attempt to place an
LMA should be made.
99. ANS: A The Combitube has two cuffs; one is proximal and the other distal. They
are designed to seal the esophagus and the pharynx.
100. ANS: C The small distal lumen of the Combitube usually advances into the
esophagus, but in the case of a tracheal entry of the distal lumen, the Combitube
can be used as a conventional endotracheal tube. This will secure the airway.
101. ANS: D ET tubes allow ventilation with high levels of positive pressure;
provide direct access to the lower airway for secretion removal and drug
delivery; prevent aspiration of foreign material into the lung; and permit
bronchoscopic examination of the peripheral airways. None of the other airways
mentioned are able to maintain ventilation with high pressures without leaking
or allowing gastric distention.
102. ANS: A In children, the epiglottis is less rigid and longer than in adults,
and often a straight-blade technique (i.e., lifting the epiglottis) is necessary. No
standardized size equivalency is represented in blade numbers, but a #0 or #1
blade is generally correct for infants and a #3 blade is usually appropriate for
average adults.
103. ANS: B The ET tube tip can be controlled with an Endotrol tube. With this
device, an implanted string with a pull-ring turns the tip anterior when pulled
(Figure 6-35). This device is particularly well-suited for blind nasotracheal
intubation.

104. ANS: C The curved blade gives better tongue control than the straight
blade. Both types of blades must be inserted along the right side of the tongue.
The Macintosh blade lifts the epiglottis indirectly by being placed in the vallecula,
not directly on the epiglottis.
105. ANS: B The sniffing position is ideal for opening up the upper airway and
aligning the trachea for intubation. The chin lift or jaw thrust should be used to
open the airway of a patient with cervical spine injuries. The neutral head
position is most appropriate for blind nasal intubation.
106. ANS: D Manipulation of the ET tube into the trachea can be facilitated by
the proper position of the intubator with respect to the patient. The intubator’s
head should be far enough away from the patient’s mouth to allow binocular
vision, as seen in Figure 6-34A. When the intubator is too close, the clinician’s
depth perception is compromised.
107. ANS: C Instead of the sniffing position, a neutral or slightly flexed head
position is optimal for blind nasal intubation. Jaw thrust and chin lift are used for
 patients with cervical spine injuries. An extreme head position would not
facilitate either a nasal intubation or an oral intubation.
108. ANS: D Because of tracheal mucosal blood pressure-flow characteristics,
cuff pressure should be below 25 mm Hg to prevent tracheal ischemic damage.
High cuff pressure is not an indication for extubation. Adding more volume
would increase the cuff pressure even more, creating more of a blockage to
blood and lymph circulation in the area surrounding the cuff.
109. ANS: C Because of the flow characteristics of tracheal mucosal blood
pressure, cuff pressure should be below 25 mm Hg to prevent tracheal ischemic
damage. The acceptable range for cuff pressures is 20 to 25 mm Hg or 25 to 35
cm H2O.
110. ANS: D A curved blade enables identification of the epiglottis; the blade
tip should be inserted above the epiglottis into the vallecula, which is the space
between the tongue base and the epiglottis. With a forward and upward lift, the
larynx is illuminated and the ET tube can be passed into the trachea. The blade is
inserted along the right side of the tongue. The tip of the blade needs to be in
the vallecula. The epiglottis should not be hooked with the tip of the blade.
111. ANS: A The most sensitive and rapid way to confirm correct placement is
to detect expired carbon dioxide by means of a capnograph or a color-change
capnometric device. A chest radiograph is used to determine proper position
with respect to the carina. Chest auscultation is subjective, and referred sounds
from the stomach might be confused with breath sounds. Fiberoptic
bronchoscopy is another way to confirm placement, but this procedure may take
time for preparation.
112. ANS: C This problem is caused by intubation of the right mainstem
airway. The patient’s ET tube must be repositioned by suctioning the pharynx,
deflating the cuff, pulling the ET tube back slightly, reinflating the cuff, then
auscultating for bilateral breath sounds.
113. ANS: D A common problem with ET tubes is that they are either inserted
too far or migrate too far into the trachea, so the cuff might obstruct a bronchus
or only one lung might be ventilated. Right mainstem intubation is most
common, especially in children, because not only is the angle of take-off of the
right main bronchus less than that of the left, but the distance between the
glottis and carina is quite small.
114. ANS: C According to the difficult airway algorithm, in this type of
situation, emergency invasive airway access should be initiated. This includes
either surgical or percutaneous tracheostomy or cricothyrotomy.
115. ANS: B The simplest invasive airway device is a large-bore intravenous
catheter inserted percutaneously through the cricothyroid membrane, a
procedure called needle cricothyroidotomy. This easily identified space is located
between the thyroid cartilage and the cricoid ring.
116. ANS: B Subglottic or laryngeal stenosis can be a long-term problem after
cricothyroidotomy.
117. ANS: C Complications of needle-jet ventilation include formation of a
false passage into subcutaneous tissue, development of subcutaneous
emphysema, creation of a pneumothorax, bleeding, failure to ventilate, and
damage to neck structures.
118. ANS: D Most authorities suggest elective conversion of an emergency
cricothyroidotomy to a formal tracheostomy within 24 hours to reduce the
likelihood of severe problems.
119. ANS: D If ventilation is difficult after urgent replacement of a dislodged
TT, it might not lie in the trachea and manual ventilation through the upper
airway should be initiated without delay.
120. ANS: A A Passy-Muir valve is a one-way valve that attaches to the TT to
allow inspiration from the TT and exhalation upward through the larynx. This
restores the patient’s ability to speak.
121. ANS: A A tracheal button can be used to maintain a small stoma and may
be removed for suctioning.
122. ANS: D The tracheal button must be changed to a cuffed TT in order to
maintain positive-pressure ventilation.
123. ANS: B A double-lumen endotracheal tube is used outside the operating
room to protect the “good,” or healthy, lung from blood contamination in
patients with massive hemoptysis or infection from an empyema.
124. ANS: D The general recommendation is that the catheter diameter should
be no more than half the internal diameter of the artificial airway.
125. ANS: D (9 × 3) / 2 = 13.5 French. Therefore, out of the choices given the
maximum size is a 13 French.
126. ANS: B(5 × 3) / 2 = 7.5 French.
127. ANS: D A functional vacuum system that can generate pressures from 100
to 150 mm Hg should be available for suctioning.
128. ANS: C Preoxygenation of the patient with 100% oxygen for a minimum
of 30 to 60 seconds before suctioning is required to avoid the hazards of
hypoxemia
129. ANS: C Suctioning should be limited to between 10 and 15 seconds or less
to decrease the risk of hypoxemia.
130. ANS: C During the suctioning process the air that is present in the lungs is
removed. This can lead to serious cardiac arrhythmias.
131. ANS: D If the pilot balloon or pilot balloon valve fails to hold air, the
entire assembly may be temporarily replaced by inserting a cut-off 19-gauge
needle with a stopcock into the pilot tubing. The cuff can then be reinflated with
a 10-cc syringe.
132. ANS: B A malfunction of the pilot valve will cause a leak. This will not
allow for the ET cuff to maintain appropriate pressure to seal the airway.
133. ANS: C The ASTM and the ISO recommend that manual resuscitators be
capable of delivering a fractional inspired oxygen of 0.85 with an oxygen flow of
15 L/min.
134. ANS: A According to the ASTM and the ISO patient connectors of the
resuscitator valve must have a 15:22- mm ID:OD.
135. ANS: B Oxygen-powered resuscitators are pressure-limited devices that
work similarly to reducing valves. A typical oxygen-powered resuscitator consists
of a demand valve that can be manually operated or patient triggered.
136. ANS: D According to the ASTM and ISO devices used for infants may
incorporate a pressure-release valve that limits peak inspiratory pressure to 40 ±
5 cm H2O.
137. ANS: C Failure to maintain an adequate seal between the mask and the
patient’s face can lead to the delivery of low tidal volumes.
138. ANS: C The American Heart Association recommends 6 to 8 mL/kg at a
rate of 40 breaths/minute for infants.
139. ANS: B One feature of an ideal manual resuscitator is to be able to deliver
oxygen concentrations of 0.4 when oxygen is available.
140. ANS: B The presence of reservoirs allows for oxygen accumulation and
the potential delivery of 100% oxygen.
141. ANS: B Rapid rates with a manual resuscitator will decrease the amount
of time the bag has to refill with the appropriate amount of volume and will also
decrease the amount of oxygen accumulating in the reservoir thereby decreasing
the delivered oxygen concentration and decreasing the tidal volume delivered.
142. ANS: D A manual resuscitator bag should have low inspiratory and
expiratory airflow resistance to ensure ease of use.
143. ANS: B Resuscitation bags used for children should have a volume of at
least 500 mL to ventilate children appropriately.
144. ANS: C If the mask seal is inadequate the volume necessary to ventilate
the patient will be inadequate which will result in lack of chest movement. If the
resuscitator bag is too small there is not enough volume to adequately ventilate
the patient and the chest will not rise appropriately. If the leaf valve is missing
the gas from the bag will not be directed to the patient and therefore result in
inadequate chest movement.
145. ANS: B Stridor is often treated with epinephrine (2.25% racemic solution
or levoepinephrine 1:1000) via aerosol.
146. ANS: A Vocal cord paralysis is likely in extubated patients with hoarseness
and stridor that does not resolve with treatment or time.
147. ANS: C Whereas laryngeal lesions occur only with oral or nasal
endotracheal tubes, tracheal lesions can occur with any tracheal airway. These
tracheal lesions are granulomas, tracheomalacia, and tracheal stenosis.
148. ANS: D In patients with tracheostomy tubes, stenosis may occur at the
cuff, tube tip, or stoma sites, with the stoma site being the most common.
149. ANS: D Tracheal stenosis will appear as a fixed obstructive pattern, with
flattening of both the inspiratory and expiratory limbs of the flow-volume loop
150. ANS: C Diagnosis can be made by a history of recurrent aspiration and
abdominal distention as air is forced into the esophagus during positive-pressure
ventilation.
151. ANS: D If the tracheostomy patient requires oxygen therapy,
tracheostomy collars are preferred to Ttubes or Briggs adapters.
152. ANS: D Good tracheostomy care, including aseptic cleaning of the stoma
with sterile normal saline or half strength hydrogen peroxide, should be carried
out routinely.
153. ANS: C The tube tip should be about 3 to 6 cm above the carina in adults,
or between the second and fourth tracheal rings.
154. ANS: A If the tube is malpositioned, you should remove the old tape and
reposition the tube, using the centimeter markings as a guide.
155. ANS: B A better solution is a letter, phrase, or picture board. These
devices allow patients to communicate by simple pointing. Large and simple
drawings are particularly important for patients who cannot clearly see print. For
conscious patients with a long-term tracheostomy and ventilator dependent,
communication can be enhanced with a “talking” tracheostomy tube (Figure 33-
27).
156. ANS: A These devices can provide saturated gas to the airway at
temperatures between 32° and 35° C.
157. ANS: A As indicated in Box 33-7, there are several reasons why tracheal
tubes increase the incidence of pulmonary infection
158. ANS: C In the past, high-pressure tracheal tube cuffs were a major cause
of airway damage. Since the 1970s, high-residual-volume, low-pressure cuffs
have become the norm
159. ANS: B The goal is to keep cuff pressures below the tracheal mucosal
capillary perfusion pressure, estimated to range between 20 and 25 mm Hg to
help minimize aspiration
160. ANS: C Attaching the measurement system to the pilot tube evacuates
some volume from the cuff (and lowers its pressure). For this reason, you should
always adjust the pressure to the desired level, never just measure it.
161. ANS: A High pressures may be caused by the need to overinflate the cuff
to seal the airway. This problem is common if the tube chosen is too small for
the patient’s trachea, positioned too high in the trachea or if the patient has
developed tracheomalacia which is softening of the tracheal tissue.
162. ANS: A Cuff pressure measurements should be done regularly to maintain
the cuff pressure in the safe range to avoid tracheal wall injury and minimize risk
of aspiration of oral secretions.
163. ANS: B The Lanz tube incorporates an external pressure regulating valve
and control reservoir designed to limit the cuff pressure between 16 and 18 mm
Hg. The foam cuff is another alternative, which is designed to seal the trachea
with atmospheric pressure in the cuff (Figure 33-32).
164. ANS: B Aspiration is reported to be more common in spontaneously
breathing patients than in those patients receiving positive-pressure ventilation.
This may be due to the movement of pharyngeal secretions around the cuff
during the negative-pressure phase of a spontaneous inspiration.
165. ANS: C Ideally, the patient should be switched to a tube that continually
aspirates subglottic secretions. If this is not possible, oropharyngeal suctioning
(above the tube cuff) should be performed as needed. To decrease the possibility
of aspiration with feedings, the head of the bed should be elevated 30 degrees
when possible. Also, the feeding tube can be inserted into the duodenum, with
its position confirmed by radiograph. The use of slightly higher cuff pressure
during and after feedings may also minimize aspiration.
166. ANS: D Obstruction of the tube is one of the most common causes of
airway emergencies. Tube obstruction can be caused by (1) the kinking of the
tube or the patient biting on the tube, (2) herniation of the cuff over the tube tip,
(3) obstruction of the tube orifice against the tracheal wall, and (4) mucus
plugging
167. ANS: A A spontaneously breathing patient with partial airway obstruction
will exhibit decreased breath sounds and decreased airflow through the tube. If
the patient is receiving volumecontrolled ventilation, peak inspiratory pressures
will rise, often causing the high-pressure alarm to sound; during pressure-
controlled ventilation, delivered tidal volumes will fall
168. ANS: C With complete tube obstruction, the patient will exhibit severe
distress, no breath sounds will be heard, and there will be no gas flow through
the tube.
169. ANS: A If you cannot clear the obstruction by using the above techniques,
you must remove the airway and replace it.
170. ANS: A In these cases, completely remove the tube and provide
ventilatory support as needed until the patient can be reintubated or the
tracheostomy tube reinserted.
171. ANS: C The presence of a peritubular leak during spontaneous breathing
indicates no encroachment of airway (a positive test).
172. ANS: C Excerpts from the AARC guideline (CPG 33-4), includes indications,
contraindications, hazards and complications, assessment of need, assessment
of outcome, and monitoring.
173. ANS: D Needed equipment includes suctioning apparatus, two age-
appropriate suction kits with sterile suction catheters and gloves, tonsillar
suction tip (Yankauer), 10 or 12 mL syringe, oxygen and aerosol therapy
equipment, manual resuscitator and mask, aerosol nebulizer with racemic
epinephrine and normal saline (if ordered), and an intubation tray.
174. ANS: D Step 2: Suction the Endotracheal Tube and Pharynx to Above the
Cuff. Suctioning before extubation helps prevent aspiration of secretions after
cuff deflation. After use, dispose of the first suction kit and prepare another for
use, or prepare a rigid tonsillar (Yankauer) suction tip. Because patients will often
cough after the tube is pulled, you may need to help them clear secretions. Step
3: Oxygenate the Patient Well After Suctioning. Extubation is a stressful
procedure that can cause hypoxemia and unwanted cardiovascular side effects.
Administer 100% oxygen for 1 to 2 minutes to help avoid these problems. Step 4:
Deflate the Cuff. Attach the 10 or 12 mL syringe to the pilot tubing. Withdraw at
 the air from the cuff while applying positive pressure to direct any pooled
secretions above the cuff up into the oropharynx where they can immediately be
suctioned with the tonsillar suction tip. Listen for an audible leak around the
tube. If no audible leak is present re-inflate the cuff and discuss with the
physician how to proceed.
175. ANS: B The technique used to remove the tube should help avoid
aspiration of pharyngeal secretions and maximally abduct the vocal cords.
176. ANS: B If humidity/aerosol therapy is indicated, most clinicians suggest a
cool mist immediately after extubation.
177. ANS: A After extubation, check for good air movement by auscultation.
Stridor or decreased air movement after extubation indicates upper airway
problems. Next, assess the patient’s respiratory rate, breathing pattern, heart
rate, blood pressure, and oxygen saturation.
178. ANS: C Because laryngeal edema may worsen with time and stridor may
develop, be sure that racemic epinephrine for nebulization is available.
179. ANS: D A rare, but serious, complication associated with extubation is
laryngospasm.
180. ANS: D Weaning is accomplished by using fenestrated tubes,
progressively smaller tubes, or tracheostomy buttons.
181. ANS: B Removal of the inner cannula opens the fenestration allowing air
to pass into the upper airway. Capping or placing a peaking valve on the proximal
opening of the tube’s outer cannula, accompanied by deflation of the cuff, allows
for assessment of upper airway function.
182. ANS: C One problem associated with this type of tracheostomy tube is
malposition of the fenestration, such as between the skin and stoma, or against
the posterior wall of the larynx.
183. ANS: A Because the tracheal button has no cuff, its use is limited to
relieving airway obstruction and aiding the removal of secretions.
184. ANS: D The purposes of bronchoscopy are to inspect the airway, remove
objects from the airway, collect samples from the airway, and place devices into
the airway.
185. ANS: C Excerpts from the AARC guideline, including indications,
contraindications, precautions and/or possible complications, assessment of
need, assessment of outcome, and monitoring,
186. ANS: A Excerpts from the AARC guideline (CPG 33-5), includes indications,
contraindications, precautions and/or possible complications, assessment of
need, assessment of outcome, and monitoring.
187. ANS: D Key points to consider in planning and conducting fiberoptic
bronchoscopy include premedication, equipment preparation, airway
preparation, and monitoring.
188. ANS: D To reduce the risk of aspiration due to gagging and loss of airway
reflexes, the patient should refrain from food or drink for at least 8 hours prior to
the start of the procedure. In addition, if the intravenous route is not already
available, vascular access should be obtained prior to the start of the procedure.
 Bronchoscopy is an uncomfortable procedure. To decrease anxiety, the patient
should be premedicated 30-45 minutes before the procedure.
189. ANS: A This promotes anesthetic deposition, aids visibility, and can
reduce procedure time. An anticholinergic agent, such as atropine given prior to
the procedure, is used for this purpose. Atropine may also help decrease vagal
responses (such as bradycardia and hypotension) that can occur during
bronchoscopy.
190. ANS: B Of course, caution must be taken to avoid respiratory depression.
Should it occur, naloxone (Narcan) must be available.
191. ANS: D
192. ANS: D The goals of airway preparation are to prevent bleeding, decrease
cough and gagging, and decrease pain.
193. ANS: C Topical vasoconstrictors such as pseudoephedrine or dilute
epinephrine (usually 1:10,000) may be used to prevent or treat bleeding.
194. ANS: B Lidocaine is commonly delivered by an atomizer to the nose, by
mouthwash to the oropharynx, and by nebulizer and/or instillation through the
bronchoscope to the lower airways.
195. ANS: B If desaturation occurs, the FIO2 should be increased with an
oxygen therapy device. Alternatively, the procedure can be temporarily halted,
and oxygen can be given through the scope’s open channel. The latter technique
has the advantage of defogging the scope and diffusing any secretions.
Suctioning for brief periods will help reduce the incidence or severity of
hypoxemia.
196. ANS: A Hypoxemia that occurs during the procedure may persist after
completion. Oxygen therapy should be maintained for up to 4 hours.
197. ANS: B The risk of aspiration persists as long as the airway is
anesthetized. Therefore, patients should remain in a sitting position and refrain
from eating or drinking until sensation returns.
198. ANS: C Patients should also be assessed for the development of stridor or
wheezes. The physician should be notified and appropriate aerosol therapy with
nebulized racemic epinephrine or bronchodilators should be instituted.
199. ANS: A There are two methods to obtain sputum samples. One method is
to have the patient expectorate into a sterile specimen cup. The second is to
suction the patient nasotracheally or with a catheter which is in-line with the
ventilator circuit.
200. ANS: D There are two major limitations to its use. First, it cannot be used
in the conscious or semicomatose patient due to stimulation of the gag reflex.
Second, if ventilating pressures greater than 20 cm H2O are needed, gastric
distention may occur. In addition, it may not provide absolute protection against
aspiration.