Question 1

Although different techniques are used to actually remove the endotracheal tube during an extubation procedure, all aim to ensure which of the following?

Accepted Answer

The technique used to remove the tube should help avoid aspiration of pharyngeal secretions and maximally abduct the vocal cords.

Question 2

A patient with a tracheal airway exhibits severe respiratory distress. On quick examination, you notice the complete absence of breath sounds and no gas flowing through the airway. What is most likely the problem?

Accepted Answer

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.

Question 3

A patient with a tracheostomy tube is receiving positive-pressure ventilation through a volume ventilator. Over the past 5 min, the peak inspiratory pressure has risen, and the pressure limit alarm is now sounding. On quick examination, you notice a generalized decreased in breath sounds. Which of the following problems is most likely?

Accepted Answer

A spontaneously breathing patient with partial airway obstruction will exhibit decreased breath sounds and decreased airflow through the tube. If the patient is receiving volume-controlled ventilation, peak inspiratory pressures will rise, often causing the high-pressure alarm to sound; during pressure-controlled ventilation, delivered tidal volumes will fall.

Question 4

After determining a patient has a complete obstruction of an oral endotracheal tube, your efforts to relieve the obstruction by moving the patient's head and neck and deflating the cuff both fail. What should be your next step?

Accepted Answer

If you cannot clear the obstruction by using the above techniques, you must remove the airway and replace it.

Question 5

A physician has requested your assistance in extubating an orally intubated patient. Which of the following should be done before the tube itself is removed?
1) Suction the orolaryngopharynx
2) Preoxygenate the patient
3) Suction the endotracheal tube
4) Confirm cuff inflation

Accepted Answer

The answer of A physician has requested your assistance in...

Question 6

Which of the following equipment would you gather before assisting in extubation of a patient?
1) Suctioning apparatus
2) Oxygen or aerosol therapy equipment
3) Manual resuscitator and mask
4) Nebulizer with racemic epinephrine
5) Intubation tray

Accepted Answer

The answer of Which of the following equipment would you...

Question 7

What is a rare but serious complication associated with endotracheal tube extubation?

Accepted Answer

A rare, but serious, complication associated with extubation is laryngospasm.

Question 8

What is the most common problem with fenestrated tracheostomy tubes?

Accepted Answer

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.

Question 9

A patient receiving mechanical ventilatory support accidentally displaces the endotracheal tube out of the trachea. What would be the most appropriate action at this time?

Accepted Answer

In these cases, completely remove the tube and provide ventilatory support as needed until the patient can be reintubated or the tracheostomy tube reinserted.

Question 10

You have been asked to monitor a patient who has just been extubated. Which of the following parameters would you monitor?
1) Color
2) Breath sounds
3) Vital signs
4) Inspiratory force

Accepted Answer

When a patient is extubated, it is important to monitor for any signs of respiratory distress or compromise. Monitoring color (to assess for adequate oxygenation), breath sounds (to assess for any changes in air movement in the lungs), and vital signs (to monitor for any changes in heart rate, blood pressure, and respiratory rate) are all important parameters to assess immediately after extubation. Inspiratory force may also be monitored but is not as essential as the other three parameters listed.

Question 11

To minimize laryngeal swelling, a physician orders "continuous aerosol therapy" after the extubation of a patient. Which of the following specific approaches would you recommend?

Accepted Answer

If humidity/aerosol therapy is indicated, most clinicians suggest a cool mist immediately after extubation.

Question 12

Which of the following is false about cuff inflation techniques (MOV = minimal occluding volume; MLT = minimal leak technique)?

Accepted Answer

The suction pressure should be set at the lowest effective level. Negative pressures of 80 to 100 mm Hg in neonates and less than 150 mm Hg in adults are generally recommended.

Question 13

What does a positive cuff leak test indicate?

Accepted Answer

The presence of a peritubular leak during spontaneous breathing indicates no encroachment of airway (a positive test).

Question 14

Which of the following indicate that a patient being considered for extubation can provide adequate clearance of pulmonary secretions? 1) The patient has a maximum inspiratory pressure of 73 cm H₂O. 2) The patient is alert and cooperative. 3) The patient has a dead space-to-tidal volume ratio of 0.7. 4) The patient coughs rigorously on suctioning.

Accepted Answer

The ability to clear pulmonary secretions effectively is indicated by a patient's alertness and cooperation (2), which suggests they can follow commands and participate in their care, and a vigorous cough on suctioning (4), demonstrating effective cough strength. Maximum inspiratory pressure (1) is related to the strength of respiratory muscles but does not directly indicate the ability to clear secretions.

Question 15

Which of the following statements are true about the potential for aspiration in patients with cuffed tracheal tubes?
1) Periodic oropharyngeal suctioning can help to minimize aspiration.
2) Aspiration is least likely in spontaneously breathing patients.
3) The methylene blue test can help detect leakage-type aspiration.
4) Aspiration is more likely with tracheostomy tubes than with endotracheal tubes.

Accepted Answer

1) Periodic oropharyngeal suctioning can help prevent the accumulation of secretions in the oropharynx, reducing the risk of aspiration.
2) Spontaneously breathing patients are less likely to aspirate compared to mechanically ventilated patients because the cough reflex is intact and the airway clearance mechanisms are more functional. 
3) Methylene blue test involves injecting methylene blue dye through the tracheal tube cuff to detect any leaks into the subglottic space, which can increase the risk of aspiration. 
4) Tracheostomy tubes have a higher risk of aspiration compared to endotracheal tubes because of the longer length, increased dead space, and deviation from the natural tracheal anatomy, which can impair airway clearance mechanisms.

Question 16

A patient with a tracheal airway exhibits signs of tube obstruction. Which of the following are possible causes of this obstruction?
1) The tube cuff has herniated over the tip of the tube.
2) The tube is obstructed by a mucus plug or secretions.
3) The tube is kinked, or the patient is biting the tube.
4) The tube orifice is impinging on the tracheal wall.

Accepted Answer

All listed options (1, 2, 3, and 4) are possible causes of tracheal airway obstruction.

Question 17

An adult patient receiving cool mist therapy after extubation begins to develop stridor. Which of the following actions would you recommend?

Accepted Answer

Because laryngeal edema may worsen with time and stridor may develop, be sure that racemic epinephrine for nebulization is available.

Question 18

Which of the following approaches may be used in "weaning" a patient from a tracheostomy tube?
1) Using progressively smaller tubes
2) Using a fenestrated tube
3) Using a tracheostomy button

Accepted Answer

All three approaches mentioned can be used in the process of weaning a patient from a tracheostomy tube. Using progressively smaller tubes and a fenestrated tube can help the patient adapt to breathing without the full support of the original tracheostomy tube, while a tracheostomy button can maintain the stoma opening without providing full ventilatory support, allowing for further adaptation and eventual removal of the tracheostomy.

Question 19

To minimize the problems associated with pharyngeal aspiration in intubated patients, which of the following could you recommend?
1) Position patients in semi-recumbent position.
2) Insert the feeding tube into the duodenum.
3) Suction above the tracheal tube cuff.
4) Provide continuous aspiration of subglottic secretions.

Accepted Answer

Positioning patients in a semi-recumbent position, inserting the feeding tube into the duodenum, suctioning above the tracheal tube cuff, and providing continuous aspiration of subglottic secretions are all strategies that can help minimize the risk of pharyngeal aspiration in intubated patients.

Question 20

A physician asks you to assess the upper airway function of a patient with a fenestrated tracheostomy tube. How should this be accomplished?

Accepted Answer

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.

Quiz 36: Airway Management

Although different techniques are used to actually remove the endotracheal tube during an extubation procedure, all aim to ensure which of the following?

A patient with a tracheal airway exhibits severe respiratory distress. On quick examination, you notice the complete absence of breath sounds and no gas flowing through the airway. What is most likely the problem?

After determining a patient has a complete obstruction of an oral endotracheal tube, your efforts to relieve the obstruction by moving the patient's head and neck and deflating the cuff both fail. What should be your next step?

A physician has requested your assistance in extubating an orally intubated patient. Which of the following should be done before the tube itself is removed? 1) Suction the orolaryngopharynx 2) Preoxygenate the patient 3) Suction the endotracheal tube 4) Confirm cuff inflation

Which of the following equipment would you gather before assisting in extubation of a patient? 1) Suctioning apparatus 2) Oxygen or aerosol therapy equipment 3) Manual resuscitator and mask 4) Nebulizer with racemic epinephrine 5) Intubation tray