Deck 5: Airway Management Devices and Advanced Cardiac Life Support

Question 1

Laryngeal mask airways are useful in emergency situations because:

A) an appropriate size is easy to choose.
B) placement does not have to be checked.
C) they protect the lungs from aspiration.
D) minimum head and neck movement is required.

Answer 1

D
The size of the laryngeal mask airway is based on the patient's weight and may not be easy to choose.The placement of a laryngeal mask airway must be checked by using measurements of end-tidal carbon dioxide (CO₂)and breath sounds.Laryngeal mask airways do not protect the lungs from aspiration because they are noninvasive.Laryngeal mask airways 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.

Question 2

Which of the following is the method for the insertion of a nasopharyngeal airway?

A) Upside-down and then turned
B) Parallel to the nasal pharynx floor
C) Parallel to the long axis of the nose
D) Perpendicular to the floor of the nasal pharynx

Answer 2

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.

Question 3

Which of the following are complications associated with the placement of an oropharyngeal airway?
1)Gagging
2)Vomiting
3)Esophageal injury
4)Dissection of the posterior pharyngeal wall

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

Answer 3

B
The oropharyngeal airways are not placed deep enough in the airway to create esophageal or pharyngeal wall damage.

Question 4

The most appropriate method for opening the airway of an awake patient with a fractured mandible is which of the following?

A) Chin lift
B) Jaw thrust
C) Guedel airway
D) Sniffing position

Question 5

The maximum laryngeal mask airway cuff pressure is ____ cm H₂O.

A) 15
B) 30
C) 45
D) 60

Question 6

Insertion of a laryngeal mask airway:

A) is superior to the insertion of a nasopharyngeal device.
B) requires airway manipulation.
C) usually requires a special device.
D) protects the lungs from aspiration.

Question 7

Which of the following is true of a Guedel airway?

A) There is no protected central channel.
B) It consists of a hollow central channel.
C) Its length is measured in centimeters.
D) It is identical to a Berman airway.

Question 8

The most effective type of emergency airway to manually ventilate a patient in her 36th week of pregnancy is a(n):

A) laryngeal mask airway.
B) nasopharyngeal airway.
C) oropharyngeal airway.
D) tracheostomy tube.

Question 9

A long-term risk of nasopharyngeal tube placement is represented by which of the following?

A) Penetration of the brain by the airway
B) Nasal bleeding
C) Sinus infection
D) Hypoxia

Question 10

The airway examination of a patient reveals Mallampati airway class II and a thyromental distance of 7 cm.The statement that is most appropriate about the intubation of this patient is which of the following?

A) An oral intubation should be attempted first.
B) Routine intubation of this patient may be impossible.
C) This patient will have an airway management problem.
D) This patient may require invasive airway management in the future.

Question 11

An accident victim with an unstable cervical spine injury needs to be intubated. This type of intubation will be facilitated by which of the following?

A) Chin lift
B) Fowler position
C) Neck extension
D) Sniffing position

Question 12

Insertion of a nasopharyngeal airway is accomplished by using which of the following?

A) A tongue blade
B) Intermittent pressure
C) An Endotrol tube
D) Gentle, continuous pressure

Question 13

Which of the following statements is true concerning the sniffing position?

A) It is the best position for oral intubation.
B) It is indicated when a patient is vomiting.
C) It is used for an unstable cervical spine injury.
D) It is contraindicated for temporomandibular joint disease.

Question 14

A respiratory therapist notices that a semiconscious patient is not moving enough air and has a problem coughing up mucus.An attempt to insert an oropharyngeal airway is unsuccessful because the patient is struggling.Which of the following is the most appropriate action?

A) Perform a tracheostomy.
B) Insert a Berman airway.
C) Use a nasopharyngeal airway.
D) Sedate the patient, and insert the oropharyngeal airway.

Question 15

Which of the following is the most appropriate type of airway for use with a semiconscious patient for whom intubation with an endotracheal tube is unsuccessful?

A) Berman airway
B) Tracheostomy tube
C) Laryngeal mask airway
D) Nasopharyngeal airway

Question 16

The airway device that has a cuff that rests against the upper esophageal sphincter when in place is a(n):

A) laryngeal mask airway.
B) tracheostomy tube.
C) endotracheal tube.
D) Guedel airway.

Question 17

Which of the following is the most common cause of an obstructed airway?

A) Tongue falling backward
B) Bleeding from the nose
C) Mucus production
D) Cardiac arrest

Question 18

After inserting an oropharyngeal airway,the respiratory therapist notices that the flange is protruding excessively from the patient's mouth.Attem

A) Remove and replace the airway immediately.
B) Turn the airway to the side, and try to catch the tongue in the curve.
C) Take no action; the airway should protrude excessively from the mouth.
D) Turn the airway upside down, and attempt to advance it farther into the mouth.

Question 19

Which of the following is true about a Berman airway?

A) It has a central channel.
B) It is smaller than a Guedel airway.
C) It must be inserted upside down.
D) Its shape is similar to that of a Guedel airway.

Question 20

"Elevating the head and extending the neck" describes which of the following?

A) The position for transtracheal invasive airway insertion
B) The position for a nasopharyngeal airway insertion
C) A maneuver called the jaw thrust or chin lift
D) A maneuver called the sniffing position

Question 21

If the esophageal lumen of the Combitube enters the trachea,the Combitube:

A) will not secure the airway.
B) must be removed immediately.
C) can be used as an endotracheal tube.
D) must be pulled back to rest in the pharynx.

Question 22

Two cuffs are incorporated into which of the following artificial airways?

A) Combitube
B) Berman airway
C) Endotracheal tube
D) Laryngeal mask airway

Question 23

If breath sounds are not heard over the left lung after intubation,the most likely cause is which of the following?

A) An endotracheal tube that is not inserted far enough
B) Cuff not inflated enough
C) Left mainstem intubation
D) Right mainstem intubation

Question 24

Both the respiratory therapist and the physician have made several attem

A) Administer a paralyzing agent.
B) Make another attempt at oral intubation.
C) Establish an airway with a tracheostomy.
D) Attempt to establish a nasopharyngeal airway.

Question 25

After several unsuccessful attem

A) Guedel airway
B) Berman airway
C) Nasopharyngeal airway
D) Laryngeal mask airway

Question 26

During intubation,the intubator should stand in which of the following positions?

A) As close as possible to the patient
B) Approximately 2 feet away from the patient's mouth
C) As far away from the patient's mouth as possible
D) Far enough away from the mouth to allow binocular vision

Question 27

Which of the following is considered a secure airway device?

A) Combitube
B) Berman airway
C) Endotracheal tube
D) Laryngeal mask airway

Question 28

When a Macintosh type of laryngoscope blade is used,which of the following actions is most appropriate?

A) Insert the blade along the left side of the tongue.
B) Insert the tip of the blade below the level of the vallecula.
C) Identify the epiglottis, and hook it with the tip of the blade.
D) Lift the laryngoscope forward and upward to visualize the larynx.

Question 29

A blind nasotracheal intubation may be aided by a(n):

A) Combitube.
B) Endotrol tube.
C) foil-wrapped tube.
D) Cole endotracheal tube.

Question 30

High positive airway pressure can be maintained with which of the following airways?

A) Guedel airway
B) Laryngeal mask airway
C) Nasopharyngeal airway
D) Endotracheal tube airway

Question 31

A non-disposable laryngeal mask airway should be checked for:

A) ability of the cuff to hold water.
B) number of times it was sterilized.
C) discoloration and integrity of the cuff.
D) resilience of the self-inflating foam cuff.

Question 32

Which of the following statements concerning endotracheal tubes and their insertion is true?

A) The straight blade gives better tongue control than the curved blade.
B) The Macintosh blade must be inserted along the left side of the tongue.
C) The Miller blade is inserted along the right side of the tongue.
D) The epiglottis must be hooked with the tip of the Macintosh blade.

Question 33

A patient's endotracheal tube cuff pressure is measured at 35 mm Hg.The most appropriate immediate action to take is:

A) extubate the patient immediately.
B) do nothing; this pressure is acceptable.
C) add more volume to the cuff, and recheck pressure.
D) remove some volume from the cuff, and recheck pressure.

Question 34

Blood flow to the tracheal mucosa will become compromised if endotracheal tube cuff pressures are greater than ____ mm Hg.

A) 15
B) 20
C) 25
D) 30

Question 35

A blind nasal intubation is facilitated by which of the following patient positions?

A) Chin lift
B) Jaw thrust
C) Neutral head
D) Extreme head

Question 36

The position that best facilitates the insertion of an oral endotracheal tube is the _____ position.

A) Chin lift
B) Sniffing
C) Neutral head
D) Jaw thrust

Question 37

Laryngeal mask airway placement includes the use of which of the following?

A) Stylet
B) Finger
C) Lighted stylet
D) Miller laryngoscope

Question 38

A newly intubated patient is assessed with a color-changing CO₂ detection device.The presence of CO₂ is confirmed,as is moisture on exhalation.However,auscultation reveals decreased breath sounds on the right side.This problem can be corrected by doing which of the following?

A) Extubate and use a laryngeal mask airway.
B) Order a chest radiograph to determine what is happening.
C) Reposition the endotracheal tube, and auscultate again.
D) Push the tube in farther, and listen for bilateral breath sounds.

Question 39

Rapid feedback to confirm the correct placement of an endotracheal tube immediately after intubation is achieved by which of the following?

A) Capnography
B) Chest radiography
C) CAT Scan
D) Fiberoptic bronchoscopy

Question 40

The airway of choice for an obese patient with a known difficult airway is a:

A) Guedel airway.
B) Berman airway.
C) laryngeal mask airway.
D) nasopharyngeal airway.

Question 41

Complications from an emergency cricothyroidotomy can be prevented by doing which of the following?

A) Using a small scalpel
B) Using a large-gauge needle
C) Orally intubating the patient
D) Converting to a tracheostomy

Question 42

The maximum size catheter that can be used for a size 9.0 (ID)TT is ___ French.

A) 6
B) 11
C) 12
D) 13

Question 43

Oxygen-powered resuscitators are classified as which of the following?
1)Volume-limited
2)Pressure-limited
3)Patient-triggered
4)Operator-triggered

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

Question 44

The ventilation patterns specified by the American Heart Association require that:

A) infant resuscitator bags deliver 20 mL at a rate of 60 breaths/min.
B) adult resuscitation bags deliver 600 mL at a rate of 20 breaths/min.
C) infant resuscitator bags deliver 6 to 8 mL/kg at a rate of 40 breaths/min.
D) child resuscitator bags deliver at least 300 mL at a rate of 20 breaths/min.

Question 45

An ideal manual resuscitator should be able to deliver a minimum of _____ FɪO₂ when oxygen is available.

A) 0.35
B) 0.40
C) 0.45
D) 0.50

Question 46

The appropriate size of suction catheter for a size 5.0 TT is ___ French.

A) 3.5
B) 7.5
C) 12
D) 15

Question 47

Complications of a cricothyroidotomy include which of the following?

A) Tracheal stenosis
B) Laryngeal stenosis
C) Ruptured epiglottis
D) Vocal cord paralysis

Question 48

The appropriate device for maintaining a small stoma to facilitate tracheal suctioning is which of the following?

A) Tracheal button
B) Luer-Lok system
C) Transtracheal needle
D) Silastic TT

Question 49

The American Society for Testing and Materials (ASTM)and the International Standards Organization (ISO)recommend that manual resuscitators be capable of delivering a minimum fractional inspired oxygen (FɪO₂)of _____ with an oxygen flow of ______ L/min.

A) 1.00; 12
B) 0.95; 20
C) 0.85; 15
D) 0.50; 10

Question 50

A patient with an Olympic button arrives in the emergency department via ambulance and has a respiratory arrest in the hospital.To establish a secure airway that could be attached to a mechanical ventilator,the respiratory therapist should:

A) insert an laryngeal mask airway.
B) place a nasopharyngeal airway in the nose.
C) intubate the patient with an uncuffed endotracheal tube.
D) replace the Olympic button with a cuffed TT.

Question 51

The function of a double-lumen endotracheal tube is to:

A) facilitate speaking.
B) protect one lung from the other.
C) maintain a tracheostomy stoma.
D) assist in weaning a patient from a TT.

Question 52

The size of a suction catheter should be:

A) a 12-French catheter.
B) the same as the internal diameter (ID) of the endotracheal tube.
C) two thirds the size of the outer diameter of the endotracheal tube.
D) less than half of the ID of the artificial airway.

Question 53

When resuscitating a newborn,which of the following devices is most appropriate?

A) Manual resuscitator bag with a minimum volume of 600 mL
B) Oxygen-powered resuscitator with a 60-cm H₂O pressure-release valve
C) Oxygen-powered resuscitator with a 50-cm H₂O pressure-release valve
D) Manual resuscitator bag with a 35- to 45-cm H₂O pressure-release valve

Question 54

Inability to maintain an adequate mask seal during manual ventilation will cause:

A) gastric distention.
B) pressures to exceed 40 cm H₂O.
C) lower tidal volumes to be delivered.
D) tidal volumes to exceed 800 mL.

Question 55

After reinsertion of a tracheostomy tube (TT),manual ventilation is difficult.What immediate action should be taken?

A) Reattempt insertion.
B) Perform a cricothyroidotomy.
C) Remove the tube, and insert another tracheostomy tube.
D) Manually ventilate the patient through the upper airway.

Question 56

Failure to secure an appropriately placed endotracheal tube with the addition of air into the cuff might be due to which of the following?

A) Herniation of the cuff
B) Malfunction of the pilot valve
C) Pilot tubing that is too long
D) An endotracheal tube that is too small

Question 57

The patient connectors of a resuscitator valve must have which of the following inside diameter to outside diameter?

A) 15:22 mm (inside diameter [ID]:outside diameter [OD])
B) 20:25 mm (ID:OD)
C) 12:20 mm (ID:OD)
D) 18:24 mm (ID:OD)

Question 58

Endotracheal tube suctioning should be preceded by:

A) pulse oximetry.
B) instillation of 15 mL of sterile saline solution.
C) preoxygenation for 30 seconds.
D) hyperinflation for 60 seconds.

Question 59

Complications from needle-jet ventilation include:

A) hyperventilation.
B) subglottic stenosis.
C) subcutaneous emphysema.
D) right bronchus intubation.

Question 60

The proper location for transtracheal needle insertion is:

A) into the cricoid cartilage.
B) through the cricothyroid membrane.
C) between the first and second tracheal cartilage rings.
D) under the hyoid bone, through the thyrohyoid ligament.

Question 61

With a manual resuscitator bag,the use of rapid rates causes which of the following?
1)An increase in fractional delivered oxygen concentration (FDO₂)
2)A decrease in FDO₂
3)An increase in tidal volume delivered
4)A decrease in tidal volume delivered

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

Question 62

The following diagram represents which artificial airways?

A) Combitube
B) Endotrol tube
C) Guedel airway
D) Laryngeal mask airway

Question 63

In this diagram,where does the part labeled A-1 fit into this tracheostomy tube?

A) A
B) B
C) C
D) D

Question 64

The minimum volume of a child manual resuscitator bag should be _____ mL.

A) 800
B) 500
C) 300
D) 200

Question 65

A reservoir on a manual resuscitator does which of the following?
A) Accumulate exhaled tidal volume with high oxygen concentrations.
B) Allow for higher oxygen concentrations to be delivered.
C) Increase the amount of volume being delivered.
D) Collect exhaled volume for measurement.

A) Accumulate exhaled tidal volume with high oxygen concentrations.
B) Allow for higher oxygen concentrations to be delivered.
C) Increase the amount of volume being delivered.
D) Collect exhaled volume for measurement.

Question 66

A 30-year-old male is admitted to the emergency room after a severe motor vehicle accident.Assessment reveals he had a full stomach with significant reflux.His effective static compliance is measured at 20 mL/cm H₂O.Which of the following types of airways would be appropriate to provide ventilatory support for this patient?

A) Nasopharyngeal airway
B) Laryngeal mask airway
C) Endotracheal tube
D) Endobronchial tube

Question 67

Compression of a 2.0-L manual resuscitator bag is not moving the patient's chest.Possible causes include which of the following?
1)The diaphragm valve is missing.
2)The mask seal is inadequate.
3)The oxygen level is too low.
4)The bag volume is too small.
5)The leaf valve is missing.

A) 2 and 3
B) 3 and 4
C) 1,2,and 5
D) 1,3,and 4

Question 68

Properties of an ideal adult manual resuscitator bag include which of the following?

A) Dead space volume greater than 30 mL
B) Bag volume of at least 800 mL
C) Bag construction allowing for slow refill
D) Low inspiratory and expiratory airflow resistance

Question 69

The safety air inlet is represented in this diagram by which of the following letters?

A) A
B) B
C) C
D) D

Question 70

When performing endotracheal intubation the respiratory care practitioner is unable to successfully intubate the patient.He or she is unable to visualize the uvula or the soft palate; only the hard palate is visible.Which of the following statements best describe this situation?

A) The patient has increased neck circumference.
B) The epiglottis shows evidence of inflammation.
C) The data indicates a Mallampati classification of IV.
D) The data indicates that a smaller endotracheal tube is necessary.