Question 1

Compared with the nasal route, the advantages of oral intubation include which of the following?
1) Reduced risk of kinking
2) Less retching and gagging
3) Easier suctioning
4) Less traumatic insertion
A)1 and 3 only
B)1, 2, and 3 only
C)1, 2, 3, and 4
D)1, 3, and 4 only

Accepted Answer

Compared with the nasal route, oral intubation has reduced risk of kinking (1) and less traumatic insertion (4). It also allows easier suctioning (3). However, oral intubation may cause more retching and gagging (2) due to stimulation of the pharyngeal reflexes. Therefore, the correct answer is D, 1, 3, and 4 only.

Question 2

What is the purpose of a tracheostomy tube obturator?
A) To minimize trauma to the tracheal mucosal during insertion
B) To provide a patent airway should the tube become obstructed
C) To help ascertain the proper tube position by radiograph
D) To provide a means to inflate and deflate the tube cuff

Accepted Answer

An obturator with a rounded tip is used for tube insertion. Prior to insertion, the obturator is placed within the outer cannula, with its tip extending just beyond the far end of the tube. This minimizes mucosal trauma during insertion.

Question 3

Before beginning an intubation procedure, the practitioner should check and confirm the operation of which of the following?
1) Laryngoscope light source
2) Endotracheal tube cuff
3) Suction equipment
4) Cardiac defibrillator
A)1, 2, and 3 only
B)2 and 4 only
C)3 and 4 only
D)1, 3, and 4 only

Accepted Answer

Before beginning an intubation procedure, the practitioner should check and confirm the operation of the laryngoscope light source, endotracheal tube cuff, and suction equipment as they are essential for the procedure. The cardiac defibrillator is not directly related to intubation and thus does not need to be checked before the procedure.

Question 4

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?
1) Obturator
2) Syringe(s)
3) Resuscitator bag and mask
4) Tube stylet
A)1, 2, and 3 only
B)2 and 4 only
C)2, 3, and 4 only
D)1, 2, 3, and 4

Accepted Answer

A syringe is needed to inflate the cuff of the endotracheal tube, a resuscitator bag and mask are essential for ventilation, and a tube stylet helps guide the tube during intubation. An obturator is not typically part of intubation equipment.

Question 5

Which of the following types of artificial airways are inserted through the larynx?
1) Pharyngeal airways
2) Tracheostomy tubes
3) Nasotracheal tubes
4) Orotracheal tubes
A)1 and 4 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 2, 3, and 4

Accepted Answer

Nasotracheal and orotracheal tubes are inserted through the larynx to maintain an open airway, directly into the trachea. Pharyngeal airways (like nasopharyngeal and oropharyngeal airways) do not pass through the larynx; they help keep the upper airway open. Tracheostomy tubes are inserted through a surgical opening in the neck into the trachea, bypassing the larynx.

Question 6

Compared with translaryngeal intubation, the advantages of tracheostomy include which of the following?
1) Greater patient comfort
2) Reduced risk of bronchial intubation
3) No upper airway complications
4) Decreased frequency of aspiration
A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Accepted Answer

Tracheostomy offers greater patient comfort, reduces the risk of bronchial intubation, and avoids upper airway complications, making options 1, 2, and 3 correct.

Question 7

What size endotracheal tube would you select to intubate an adult female?
A) 6 mm
B) 7 mm
C) 8 mm
D) 9 mm

Accepted Answer

Table 36-4 lists recommended orotracheal tube sizes according to patient weight or age.

Question 8

What size endotracheal tube would you select to intubate a 1500-g newborn infant?
A) 2.5 mm
B) 3.0 mm
C) 3.5 mm
D) 4.0 mm

Accepted Answer

Table 36-4 lists recommended orotracheal tube sizes according to patient weight or age.

Question 9

What is the purpose of the pilot balloon on an endotracheal or a tracheostomy tube?
A) To help ascertain proper tube position
B) To minimize mucosal trauma during insertion
C) To monitor cuff status and pressure
D) To protect the airway against aspiration

Accepted Answer

A small filling tube leads from the cuff to a pilot balloon, used to monitor cuff status and pressure once the tube is in place.

Question 10

The removable inner cannula commonly incorporated into modern tracheostomy tubes serves which of the following purposes?
1) Aid in routine tube cleaning and tracheostomy care
2) Prevent the tube from slipping into the trachea
3) Provide a patent airway should it become obstructed
A)1 and 3 only
B)2 and 3 only
C)3 only
D)1, 2, and 3

Accepted Answer

The removable inner cannula serves two main purposes - it aids in routine cleaning and care of the tracheostomy tube, and it allows for an obstructed airway to be quickly cleared by removing the inner cannula and replacing it with a new one. It does not prevent the tube from slipping into the trachea - this is typically prevented by the flange at the base of the tracheostomy tube.

Question 11

Which of the following autonomic or protective neural responses represent potential hazards of emergency airway management?
1) Hypotension
2) Bradycardia
3) Cardiac arrhythmias
4) Laryngospasm
A)1, 2, and 3 only
B)1 and 4 only
C)3 and 4 only
D)1, 2, 3, and 4

Accepted Answer

Emergency airway management can trigger various autonomic or protective neural responses due to the stimulation of the airway. These responses include hypotension (due to vasodilation or decreased cardiac output), bradycardia (via the vagus nerve), cardiac arrhythmias (from hypoxia or sympathetic stimulation), and laryngospasm (a protective reflex to prevent aspiration). All these responses (1, 2, 3, and 4) represent potential hazards during the procedure.

Question 12

What size endotracheal tube would you select to intubate a 3-year-old child?
A) 3.0 to 4.0 mm
B) 4.5 to 5.0 mm
C) 5.5 to 6.0 mm
D) 6.0 to 7.0 mm

Accepted Answer

Table 36-4 lists recommended orotracheal tube sizes according to patient weight or age.

Question 13

What is the standard size for endotracheal or tracheostomy tube adapters?
A) 22-mm external diameter
B) 15-mm external diameter
C) 15-mm internal diameter
D) 22-mm internal diameter

Accepted Answer

The proximal end of the tube is attached to a standard adapter with a 15-mm external diameter.

Question 14

What is the purpose of the additional side port (Murphy eye) on most modern endotracheal tubes?
A) Protect the airway against aspiration.
B) Help ascertain proper tube position.
C) Minimize mucosal trauma during insertion.
D) Ensure gas flow if the main port is blocked.

Accepted Answer

In addition to the beveled opening at the tip, there should be an additional side port or "Murphy eye," which ensures gas flow if the main port should become obstructed. The tube cuff is permanently bonded to the tube body. Inflation of the cuff seals off the lower airway, either for protection from aspiration or to provide positive pressure ventilation.

Question 15

Which of the following features incorporated into most modern endotracheal tubes assist in verifying proper tube placement?
1) Length markings on the curved body of the tube
2) Imbedded radiopaque indicator near the tube tip
3) Additional side port (Murphy eye) near the tube tip
A)1 and 2 only
B)1 and 3 only
C)2 and 3 only
D)1, 2, and 3

Accepted Answer

Length markings and an imbedded radiopaque indicator help verify proper tube placement. The Murphy eye is for ventilation, not placement verification.

Question 16

Which of the following indicate an inability to adequately protect the airway?
1) Wheezing
2) Coma
3) Lack of gag reflex
4) Inability to cough
A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Accepted Answer

Coma, lack of gag reflex, and inability to cough are all indicators of an inability to adequately protect the airway. Wheezing, while a sign of airway obstruction, does not directly indicate an inability to protect the airway.

Question 17

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 tracheotomy
B) Orotracheal intubation
C) Nasotracheal intubation
D) Cricothyrotomy

Accepted Answer

Orotracheal intubation is the preferred route for establishing an emergency tracheal airway.

Question 18

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.

Accepted Answer

If the light does not function, first check that the bulb is tight. If the scope still does not light, check the batteries or replace the bulb.

Question 19

What is the purpose of a cuff on an artificial tracheal airway?
A) To seal off and protect the lower airway
B) To stabilize the tube and prevent its movement
C) To provide a means to determine tube position via radiograph
D) To help clinicians determine the depth of tube insertion

Accepted Answer

The purpose of a cuff on an artificial tracheal airway is to seal off and protect the lower airway by preventing leakage of air or fluid around the tube. This is particularly important in mechanically ventilated patients to prevent aspiration of secretions or gastric contents into the lungs.

Answer: B
 While stabilizing the tube and preventing movement is important in preventing accidental dislodgement, this is not the primary purpose of the cuff on an artificial tracheal airway.

Answer: C
 While some types of artificial tracheal airways may have radiopaque markers to help determine tube position, the cuff is not typically used for this purpose.

Answer: D
 While the cuff may provide some information about the depth of tube insertion, this is not its primary purpose. The depth of insertion is typically determined by measuring the distance from the patient's teeth or lips.

Question 20

Compared with the oral route, the advantages of nasal intubation include which of the following?
1) Reduced risk of kinking
2) Less retching and gagging
3) Less accidental extubation
4) Greater long-term comfort
A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Accepted Answer

Nasal intubation tends to cause less retching and gagging compared to oral intubation, is associated with less accidental extubation due to the more secure placement through the nasal passages, and is generally more comfortable for long-term use, making it preferable for patients requiring extended intubation.

Quiz 36: Airway Management

Compared with the nasal route, the advantages of oral intubation include which of the following? 1) Reduced risk of kinking 2) Less retching and gagging 3) Easier suctioning 4) Less traumatic insertion

What is the purpose of a tracheostomy tube obturator?

Before beginning an intubation procedure, the practitioner should check and confirm the operation of which of the following? 1) Laryngoscope light source 2) Endotracheal tube cuff 3) Suction equipment 4) Cardiac defibrillator

Which of the following types of artificial airways are inserted through the larynx? 1) Pharyngeal airways 2) Tracheostomy tubes 3) Nasotracheal tubes 4) Orotracheal tubes

Compared with translaryngeal intubation, the advantages of tracheostomy include which of the following? 1) Greater patient comfort 2) Reduced risk of bronchial intubation 3) No upper airway complications 4) Decreased frequency of aspiration

What size endotracheal tube would you select to intubate an adult female?

What size endotracheal tube would you select to intubate a 1500-g newborn infant?

What is the purpose of the pilot balloon on an endotracheal or a tracheostomy tube?

The removable inner cannula commonly incorporated into modern tracheostomy tubes serves which of the following purposes? 1) Aid in routine tube cleaning and tracheostomy care 2) Prevent the tube from slipping into the trachea 3) Provide a patent airway should it become obstructed

Which of the following autonomic or protective neural responses represent potential hazards of emergency airway management? 1) Hypotension 2) Bradycardia 3) Cardiac arrhythmias 4) Laryngospasm

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

What is the standard size for endotracheal or tracheostomy tube adapters?

What is the purpose of the additional side port (Murphy eye) on most modern endotracheal tubes?

Which of the following features incorporated into most modern endotracheal tubes assist in verifying proper tube placement? 1) Length markings on the curved body of the tube 2) Imbedded radiopaque indicator near the tube tip 3) Additional side port (Murphy eye) near the tube tip

Which of the following indicate an inability to adequately protect the airway? 1) Wheezing 2) Coma 3) Lack of gag reflex 4) Inability to cough

In the absence of neck or facial injuries, what is the procedure of choice to establish a patent tracheal airway in an emergency?

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?

What is the purpose of a cuff on an artificial tracheal airway?

Compared with the oral route, the advantages of nasal intubation include which of the following? 1) Reduced risk of kinking 2) Less retching and gagging 3) Less accidental extubation 4) Greater long-term comfort