RT 220 B C Airwaystudyguide

Wilkins: Egan's Fundamentals of Respiratory Care, 9th Edition

Chapter 33:Airway Management/Artificial Airway

MULTIPLE CHOICE1. What is the primary indication for tracheal suctioning?

A. presence of pneumoniaB. presence of atelectasisC. ineffective coughingD. retention of secretions

REF: 6952. What is the most common complication of suctioning?

A. hypoxemiaB. hypotensionC. arrhythmiasD. infection

REF: 6953. Complications of tracheal suctioning include all of the following except:

A. bronchospasmB. hyperinflationC. mucosal traumaD. elevated intracranial pressure

REF: 695

4. How often should patients be suctioned?A. at least once every 2 to 3 hoursB. whenever they are moved or ambulatedC. when physical findings support the needD. whenever the charge nurse requests it

REF: 6955. What is the normal range of negative pressure to use when suctioning an adult patient?

A. –100 to –120 mm HgB. –80 to –100 mm HgC. –60 to –80 mm HgD. –20 to –30 mm Hg

REF: 6956. What is the normal range of negative pressure to use when suctioning children?

A. –60 to –80 mm HgB. –80 to –100 mm HgC. –100 to –120 mm HgD. –150 to –200 mm HgREF: 695

7. You are about to suction a 10-year-old patient who has a 6-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter that you would use in this case?A. 6 FrB. 8 FrC. 10 FrD. 14 FrREF: 695

8. You are about to suction a female patient who has an 8-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter you would use in this case?A. 8 FrB. 10 FrC. 12 FrD. 14 FrREF: 695

9. To prevent hypoxemia when suctioning a patient, the respiratory care practitioner should initially do which of the following?A. Manually ventilate the patient with a resuscitator.B. Preoxygenate the patient with 100% oxygen.C. Give the patient a bronchodilator treatment.D. Have the patient hyperventilate for 2 minutes.

REF: 69510. To maintain positive end-expiratory pressure (PEEP) and high FIO2 when suctioning a

mechanically ventilated patient, what would you recommend?A. Limit suction time to no more than 5 seconds.B. Use a closed-system multiuse suction catheter.C. Limit suctioning to once an hour.D. Use the smallest possible catheter.REF: 695

11. Total application time for endotracheal suction in adults should not exceed which of the following?A. 20 to 25 secondsB. 15 to 20 secondsC. 10 to 15 secondsD. 3 to 5 secondsREF: 697

12. While suctioning a patient, you observe an abrupt change in the electrocardiogram wave form being displayed on the cardiac monitor. Which of the following actions would be most appropriate?A. Change to a smaller catheter and repeat the procedure.B. Stop suctioning and immediately administer oxygen.C. Stop suctioning and report your findings to the nurse.D. Decrease the amount of negative pressure being used.REF: 698

13. Which of the following methods can help to reduce the likelihood of atelectasis due to tracheal suctioning?

I. Limit the amount of negative pressure used.II. Hyperinflate the patient before and after the procedure.III.Suction for as short a period of time as possible.

A. I and IIB. I and IIIC. II and IIID. I, II, and III

REF: 69814. Which of the following can help to minimize the likelihood of mucosal trauma during

suctioning?I. Use as large a catheter as possible.II. Rotate the catheter while withdrawing.III. Use as rigid a catheter as possible.IV. Limit the amount of negative pressure.

A. I and IIB. II and IVC. III and IVD. I, II, and IV

REF: 698

15. Absolute contraindication for nasotracheal suctioning includes which of the following?I. epiglottitisII. croupIII. irritable airway


REF: 69816. Which of the following equipment is NOT needed to perform nasotracheal suctioning?

A. suction kit (catheter, gloves, basin, etc.)B. laryngoscope with MacIntosh and Miller bladesC. oxygen delivery system (mask and manual resuscitator)D. bottle of sterile water or saline solution

See Box 33-1.REF: 698

17. After repeated nasotracheal suctioning over 2 days, a patient with retained secretions develops minor bleeding through the nose. Which of the following actions would you recommend?A. Perform a tracheotomy for better access to the lower airway.B. Discontinue nasotracheal suctioning for 48 hours and reassess.C. Stop the bleeding and use a nasopharyngeal airway for access.D. Orally intubate the patient for better access to the lower airway.

REF: 70018. Before the suctioning of a patient, auscultation reveals coarse breath sounds during both

inspiration and expiration. After suctioning, the coarseness disappears, but expiratory wheezing is heard over both lung fields. What is most likely the problem?A. Secretions are still present and the patient should be suctioned again.B. The patient has hyperactive airways and has developed bronchospasm.

C. A pneumothorax has developed and the patient needs a chest tube.D. The patient has developed a mucous plug and should undergo bronchoscopy.

REF: 70019. What general condition requires airway management?

I. airway compromiseII. respiratory failureIII. need to protect the airway


REF: 70020. Which of the following conditions require emergency tracheal intubation?

I. upper airway or laryngeal edemaII. loss of protective reflexesIII. cardiopulmonary arrestIV. traumatic upper airway obstruction

A. I and IVB. III and IVC. I, II, and IIID. I, II, III, and IV

REF: 700

21. Which of the following autonomic or protective neural responses represent potential hazards of emergency airway management?

I. hypotensionII. bradycardiaIII. cardiac arrhythmiasIV. laryngospasm

A. I, II, and IIIB. I and IVC. III and IVD. I, II, III, and IV.REF: 700

22. All of the following indicate an inability to adequately protect the airway except:A. wheezingB. comaC. lack of gag reflexD. inability to coughREF: 700

23. Which of the following types of artificial airways are inserted through the larynx?I. pharyngeal airwaysII. tracheostomy tubesIII. nasotracheal tubesIV. orotracheal tubes

A. I and IVB. I, II, and IIIC. III and IVD. I, II, III, and IV

REF: 70324. Compared with the nasal route, the advantages of oral intubation include all of the following

except:A. reduced risk of kinkingB. less retching and gaggingC. easier suctioningD. less traumatic insertionREF: 703

25. Compared with the oral route, the advantages of nasal intubation include all of the following except:A. reduced risk of kinkingB. less retching and gaggingC. less accidental extubationD. greater long-term comfortREF: 703

26. Compared with translaryngeal intubation, the advantages of tracheostomy include all of the following except:A. greater patient comfortB. reduced risk of bronchial intubationC. no upper airway complicationsD. decreased frequency of aspiration

REF: 703

27. What is the standard size for endotracheal or tracheostomy tube adapters?A. 22 mm external diameterB. 15 mm external diameterC. 15 mm internal diameterD. 22 mm internal diameter

REF: 70328. What is the purpose of the additional side port (Murphy eye) on most modern endotracheal

tubes?A. protect the airway against aspirationB. help ascertain proper tube positionC. minimize mucosal trauma during insertionD. ensure gas flow if the main port is blocked

REF: 70329. What is the purpose of a cuff on an artificial tracheal airway?

A. seal off and protect the lower airwayB. stabilize the tube and prevent its movementC. provide a means to determine tube position via radiographD. help clinicians determine the depth of tube insertion.REF: 703

30. What is the purpose of the pilot balloon on an endotracheal or a tracheostomy tube?A. help ascertain proper tube positionB. minimize mucosal trauma during insertionC. monitor cuff status and pressureD. protect the airway against aspirationREF: 703

31. Which of the following features incorporated into most modern endotracheal tubes assist in verifying proper tube placement?

I. length markings on the curved body of the tubeII. imbedded radiopaque indicator near the tube tipIII. additional side port (Murphy eye) near the tube tip

A. I and IIB. I and IIIC. II and IIID. I, II, and III REF: 703

32. The removable inner cannula commonly incorporated into modern tracheostomy tubes serves which of the following purposes?

I. aid in routine tube cleaning and tracheostomy careII. prevent the tube from slipping into the tracheaIII. provide a patent airway should it become obstructed

A. I and IIIB. II and IIIC. III onlyD. I, II, and IIIREF: 705

33. What is the purpose of a tracheostomy tube obturator?A. minimize trauma to the tracheal mucosal during insertionB. provide a patent airway should the tube become obstructedC. help ascertain the proper tube position by radiographD. provide a means to inflate and deflate the tube cuff

REF: 70634. In the absence of neck or facial injuries, what is the procedure of choice to establish a patent

tracheal airway in an emergency?A. surgical tracheotomyB. orotracheal intubationC. nasotracheal intubationD. cricothyrotomyREF: 706

35. While checking a crash cart for intubation equipment, you find the following: suction equipment, oxygen apparatus, two laryngoscopes and assorted blades, five tubes, Magill forceps, tape, lubricating gel, and local anesthetic. What is missing?

I. obturatorII. syringe(s)III. resuscitator bag or maskIV. tube stylet

A. I, II, and IIIB. II and IVC. II, III, and IVD. I, II, III and IV

REF: 70636. Before beginning an intubation procedure, the practitioner should check and confirm the

operation of which of the following?I. laryngoscope light sourceII. endotracheal tube cuffIII. suction equipmentIV. cardiac defibrillator

A. I, II, and IIIB. II and IVC. III and IVD. I, III, and IVREF: 706

37. While checking a Miller and a MacIntosh blade on an intubation tray during an emergency intubation, you find that the Miller blade “lights” but the MacIntosh blade does not. What should you do now?A. Swap the defective MacIntosh for the good Miller blade.B. Check and replace the bulb in the MacIntosh blade.C. Replace the batteries in the laryngoscope handle.D. Check and clean the laryngoscope handle electrical contact.

REF: 70638. What size endotracheal tube would you select to intubate a 3-year-old child?

A. 3.0 to 4.0 mmB. 4.5 to 5.0 mmC. 5.5 to 6.0 mmD. 6.0 to 7.0 mmREF: 706

39. What size endotracheal tube would you select to intubate a 1500-g newborn infant?A. 2.5 mmB. 3.0 mmC. 3.5 mmD. 4.0 mm

REF: 706

40. What size endotracheal tube would you select to intubate an adult female?A. 6 mmB. 7 mmC. 8 mmD. 9 mm

REF: 70641. What is the purpose of an endotracheal tube stylet?

A. helps ascertain proper tube positionB. adds rigidity and shape to ease insertionC. minimizes mucosal trauma during insertionD. protects the airway against aspiration

REF: 70742. To make oral intubation easier, how should the patient’s head and neck be positioned?

A. neck extended over the edge of the bed, with head dangling downB. neck extended, with head supported by towel and flexed forwardC. both the neck and head fully extended, with neck supported by towelD. neck flexed, with head supported by towel and tilted back

REF: 70743. What should be the maximum time devoted to any intubation attempt?

A. 30 secondsB. 60 secondsC. 90 secondsD. 2 minutesREF: 707

44. Which of the following statements are FALSE about methods used to displace the epiglottis during oral intubation?A. Regardless of the blade used, the laryngoscope is lifted up and forward.B. The curved (MacIntosh) blade lifts the epiglottis indirectly.C. The straight (Miller) blade lifts the epiglottis directly.D. Levering the laryngoscope against the teeth can aid displacement.

REF: 70845. During oral intubation of an adult, the endotracheal tube should be advanced into the trachea

about how far?A. until its cuff has passed the cordsB. just far enough so that the tube cuff is no longer visibleC. until its cuff has passed the cords by 2 to 3 inchesD. until its tip has passed the cords by 2 to 3 cmR

REF: 70846. Immediately after insertion of an oral endotracheal tube on an adult, what should you do?

I. Stabilize it with your right hand.II. Inflate the tube cuff.III. Provide ventilation or oxygenation.


REF: 708

47. Ideally, the distal tip of a properly positioned endotracheal tube (in an adult man) should be positioned about how far above the carina?A. 1 to 3 cmB. 4 to 6 cmC. 7 to 9 cmD. 4 to 6 inches

REF: 70948. Which of the following bedside methods can absolutely confirm proper endotracheal tube

position in the trachea?A. auscultationB. observation of chest movementC. tube length (cm to teeth)D. fiberoptic laryngoscopyREF: 709

49. What is the average distance from the tip of a properly positioned oral endotracheal tube to the incisors of an adult man?A. 16 to 18 cmB. 19 to 21 cmC. 21 to 23 cmD. 24 to 26 cmREF: 710

50. When using a bulb-type esophageal detection device (EDD) during an intubation attempt, how do you know that the endotracheal tube is in the esophagus?A. The bulb fails to reexpand upon release.B. The bulb quickly reexpands upon release.C. The bulb cannot be completely squeezed closed.D. The bulb cannot be attached to the endotracheal tube.

REF: 71051. After an intubation attempt, an expired capnogram indicates a CO2 level near zero. What does

this finding probably indicate?A. abnormally high ventilation/perfusion ratio ( )B. placement of the endotracheal tube in the esophagusC. placement of the endotracheal tube in the tracheaD. failure of the cuff to properly seal the airway

REF: 71052. When using capnometry or colorimetry to differentiate esophageal from tracheal placement of an

endotracheal tube, which of the following conditions can result in a false-negative finding (i.e., no CO2 present even when the tube is in the trachea)?A. cardiac arrestB. gastric CO2 diffusionC. right mainstem intubationD. delivery of a high FIO2

REF: 710

53. After intubation of a cardiac arrest victim, you observe a slow but steady rise in the expired CO2 levels as measured by a bedside capnometer. Which of the following best explains this observation?A. return of spontaneous circulationB. abnormally high C. placement of the endotracheal tube in the esophagusD. failure of the cuff to properly seal the airway

REF: 710

54. Serious complications of oral intubation include which of the following?I. cardiac arrestII. acute hypoxemiaIII. bradycardiaIV. tongue lacerations

A. II and IVB. I, II, and IIIC. II, III, and IVD. I, II, III, and IV

REF: 71255. You are assisting a physician in the emergency care of a patient with a maxillofacial injury who

will require short-term ventilatory support. Which of the following airway approaches would you recommend?A. Intubate via the oral route.B. Insert an oropharyngeal airway.C. Perform an emergency tracheotomy.D. Intubate via the nasal route.REF: 712

56. To provide local anesthesia and vasoconstriction during nasal intubation, what would you recommend?A. nasal spray of 0.25% racemic epinephrineB. SVN aerosol delivery of 2% lidocaine for 10 minutesC. nasal spray of 0.25% racemic epinephrine/2% lidocaineD. SVN aerosol delivery of 0.25% racemic epinephrine for 10 minutesREF: 712

57. What is the average depth of proper nasal endotracheal tube insertion in adult men?A. 23 cm from the patient’s teethB. 28 cm from the external narisC. 28 inches from the tube connectorD. 32 cm from the patient’s teeth

REF: 71258. When performing blind nasotracheal intubation, successful tube passage through the larynx is

indicated by which of the following?I. louder breath soundsII. harsh coughIII. vocal silence


REF: 71359. What is the primary indication for tracheostomy?

A. when a patient loses pharyngeal or laryngeal reflexesB. when a patient has a long-term need for an artificial airwayC. when a patient has been orally intubated for more than 24 hoursD. when a patient has upper airway obstruction due to secretions

REF: 71360. Which of the following factors should be considered when deciding to change from an

endotracheal tube to a tracheostomy tube?I. patient’s tolerance of the endotracheal tubeII. relative risks of continued intubation versus tracheostomyIII. patient’s severity of illness and overall conditionIV. length of time that the patient will need an artificial airwayV. patient’s ability to tolerate a surgical procedure

A. I, III, and IVB. III, IV, and VC. II, III, IV, and VD. I, II, III, IV, and V

REF: 713

61. In a properly performed traditional surgical tracheotomy, entrance to the trachea is made through an incision in what area?A. through or between the first and second tracheal ringsB. through the ligament between the thyroid and cricoid cartilagesC. through or between the second and third tracheal ringsD. between the cricoid cartilage and the first tracheal ring

REF: 71362. A surgical resident has asked that you assist in an elective tracheotomy procedure on an orally

intubated patient. Which of the following would be an appropriate action?A. Remove the oral tube just before tracheostomy tube insertion.B. Remove the oral tube before the tracheotomy is performed.C. Pull the oral tube only after the tracheostomy tube is placed.D. Withdraw the oral tube 2 to 3 inches while the incision is made.

REF: 71463. Compared with traditional surgical tracheostomy, all of the following are TRUE about

percutaneous dilatational tracheostomy except:A. Percutaneous dilatational tracheostomy has a lower incidence of complications.B. Percutaneous dilatational tracheostomy is faster that traditional tracheostomy.C. Percutaneous dilatational tracheostomy can be performed at the bedside.D. Percutaneous dilatational tracheostomy does not require anterior neck dissection.

REF: 714

64. Which of the following techniques may be used to diagnose injury associated with artificial airways?

I. laryngoscopy or bronchoscopyII. physical examinationIII. air tomographyIV. pulmonary function studies

A. I and IIB. I and IIIC. II, III, and IVD. I, II, III, and IV

REF: 71565. What is the most common sign associated with the transient glottic edema or vocal cord

inflammation that follows extubation?A. difficulty in swallowingB. wheezingC. orthopneaD. hoarseness

REF: 71566. Soon after endotracheal tube extubation, an adult patient exhibits a high-pitched inspiratory

noise, heard without a stethoscope. Which of the following actions would you recommend?A. STAT heated aerosol treatment with salineB. STAT racemic epinephrine aerosol treatmentC. careful observation of the patient for 6 hoursD. immediate reintubation via the nasal route

REF: 715

67. After removal of an oral endotracheal tube, a patient exhibits hoarseness and stridor that do not resolve with racemic epinephrine treatments. What is most likely the problem?A. vocal cord paralysisB. tracheoesophageal fistulaC. glottic edema or cord inflammationD. tracheomalacia

REF: 71668. Which of the following injuries are NOT seen with tracheostomy tubes?

I. tracheomalaciaII. tracheal stenosisIII. glottic edemaIV. vocal cord granulomas

A. I and IVB. II and IVC. III and IVD. I, II, and III

REF: 71669. Tracheal stenosis occurs in as many as 1 in 10 patients after prolonged tracheostomy. At what

sites does this stenosis usually occur?I. cuff siteII. tip of the tubeIII. stoma site


REF: 71670. A patient is being evaluated for tracheal damage sustained while having undergone prolonged

tracheostomy intubation approximately 3 months earlier. The flow-volume loop demonstrates a fixed obstructive pattern. What is the most likely cause of the problem?A. tracheomalaciaB. laryngeal webC. cord paralysisD. tracheal stenosis

REF: 71671. A patient has been receiving positive-pressure ventilation through a tracheostomy tube for 4

days. In the past 2 days, there is evidence of both recurrent aspiration and abdominal distention but minimal air leakage around the tube cuff. What is most likely cause of the problem?A. paralysis of the vocal cordsB. underinflated tube cuff

C. tracheoesophageal fistulaD. tracheoinnominate fistula

REF: 71772. A physician is concerned about the potential for tracheal damage due to tube movement in a

patient who recently underwent tracheotomy and is now receiving 40% oxygen through a T-tube (Briggs adapter). Which of the following would be the best way to limit tube movement in this patient?A. Give a neuromuscular blocker to prevent patient movement.B. Secure the T-tube delivery tubing to the bed rail.C. Tape the T-tube to the tracheostomy tube connector.D. Switch from the T-tube to a tracheostomy collar.

REF: 71773. Which of the following techniques or procedures should be used to help minimize infection of a

tracheotomy stoma?I. regular aseptic stoma cleaningII. adherence to sterile techniquesIII. regular change of tracheostomy dressings


REF: 71774. When checking for proper placement of an endotracheal tube or a tracheostomy tube on a chest

radiograph, how far above the carina should the distal tip of the tube be positioned?A. 1 to 2 cmB. 2 to 4 cmC. 4 to 6 cmD. 6 to 8 cm

REF: 71775. When checking for proper placement of an endotracheal tube in an adult patient on chest

radiograph, it is noted that the distal tip of the tube is 2 cm above the carina. Which of the following actions would you recommend?A. Withdraw the tube by 2 to 3 cm (using tube markings as a guide).B. Withdraw the tube by 7 to 8 cm (using tube markings as a guide).C. Advance the tube by 2 to 3 cm (using tube markings as a guide).D. Advance the tube by 7 to 8 cm (using tube markings as a guide).

REF: 717-71876. An alert patient with a long-term need for a tracheostomy tube (because of recurrent aspiration)

is having difficulty communicating with the intensive care unit staff. Which of the following would you recommend to help this patient communicate better?

I. Use a letter, phrase, or picture board.II. Consider switching to a fenestrated tracheostomy tube.

III. Consider a “talking” tracheostomy tube.


REF: 71877. To ensure adequate humidification for a patient with an artificial airway, inspired gas at the

proximal airway should be 100% saturated with water vapor and at which of the following temperatures?A. 32° to 35° CB. 37° to 40° CC. 30° to 32° CD. 40° to 42° C

REF: 72078. Tracheal airways increase the incidence of pulmonary infections for all of the following reasons

except:A. lower levels of humidificationB. increased aspiration of pharyngeal materialC. contaminated equipment or solutionsD. ineffective clearance through cough

REF: 72079. Which of the following is likely to increase the likelihood of damage to the tracheal mucosa?

A. maintaining cuff pressures below 20 to 25 mm HgB. using the minimal leak technique for inflationC. using a low-residual-volume, low-compliance cuffD. monitoring intracuff pressures every 1 to 2 hours

REF: 72080. What is the maximum recommended range for tracheal tube cuff pressures?

A. 15 to 20 mm HgB. 20 to 25 mm HgC. 25 to 30 mm HgD. 30 to 35 mm Hg

REF: 72081. Repeated connecting and disconnecting of a cuff pressure manometer to the pilot tube of a cuffed

tracheal airway will do which of the following?A. increase cuff pressureB. not affect cuff pressureC. decrease cuff pressureD. rupture the cuff

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.REF: 720

82. An adult man on ventilatory support has just been intubated with a 7-mm oral endotracheal tube equipped with a high-residual-volume, low-pressure cuff. When sealing the cuff to achieve a minimal occluding volume, you note a cuff pressure of 45 cm H2O. What is most likely the problem?A. The tube chosen is too small for the patient.B. The cuff pilot balloon and line are obstructed.C. The tube is in the right mainstem bronchus.D. The cuff has herniated over the tube tip.

REF: 720-72183. Which of the following is false about cuff inflation techniques (MOV = minimal occluding

volume; MLT = minimal leak technique)?A. The MLT approach negates the need for pressure monitoring.B. The MLT allows a small leak at peak or end of inspiration.C. At MOV, air leakage around the tube cuff should cease.D. With MLT, secretions tend to be blown upward during inflation.

REF: 72284. Which of the following tracheal tube cuff designs are used as alternatives to cuff pressure

measurement?I. Kamen-Wilkinson foam cuffII. low-residual-volume cuffIII. Lanz pressure-regulated cuff


REF: 72285. Which of the following statements is false about the potential for aspiration in patient with

cuffed tracheal tubes?A. Periodic oropharyngeal suctioning can help to minimize aspiration.B. Aspiration is least likely in spontaneously breathing patients.C. The methylene blue test can help detect leakage-type aspiration.D. Aspiration is more likely with tracheostomy tubes than with endotracheal tubes.

REF: 723

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