Kacmarek: Egan's Fundamentals of Respiratory Care, 10th Edition

Chapter 38: Medical Gas Therapy

Test Bank

MULTIPLE CHOICE

1. Specific clinical objectives of oxygen (O2) therapy include which of the following?
1. decrease the symptoms caused by chronic hypoxemia
2. decrease the workload hypoxemia imposes on the heart and lungs
3. correct documented arterial hypoxemia
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: D
Specific clinical objectives of O2 therapy are to (1) correct documented or suspected acute
hypoxemia, (2) decrease the symptoms associated with chronic hypoxemia, and (3) decrease
the workload hypoxemia imposes on the cardiopulmonary system.

DIF: Recall REF: p. 910 OBJ: 1

2. Properly applied O2 therapy can decrease which of the following?

1. ventilatory demand
2. work of breathing
3. cardiac output
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

ANS: C
In cases of acute hypoxemia, supplemental O2 can decrease demands on both the heart and the
lungs.

DIF: Recall REF: p. 910 OBJ: 1

3. Benefits of properly applied O2 therapy in patients with chronic hypoxemia include all of the
following except:
a. reversal of pulmonary vasoconstriction
b. relief of pulmonary hypertension
c. decreased right ventricular workload
d. improved pulmonary using capacity

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 Test bank 38-2

ANS: D
Oxygen therapy can reverse pulmonary vasoconstriction and decrease right ventricular
workload.

DIF: Recall REF: p. 910 OBJ: 1

4. Which of the following would indicate a need for O2 therapy for an adult or child?
1. SaO2 less than 90%
2. PaCO2 greater than 45 mm Hg
3. PaO2 less than 60 mm Hg
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

ANS: D
Excerpts from the AARC guideline on O2 therapy in acute care hospitals appear in CPG 38-1.

DIF: Application REF: p. 911 OBJ: 1

5. You start a chronic obstructive pulmonary disease (COPD) patient on a nasal O2 cannula at 2
L/min. What is the maximum time that should pass before assessing this patient’s PaO2 or
SaO2?
a. 2 hours
b. 8 hours
c. 12 hours
d. 72 hours

ANS: A
Excerpts from the AARC guideline on O2 therapy in acute care hospitals appear in CPG 38-1.

DIF: Application REF: p. 911 OBJ: 1

6. According to ARC clinical practice guidelines, what is the minimum frequency for checking
the functioning of an O2 delivery system?
a. every 4 hours
b. every 8 hours
c. every 24 hours
d. every 48 hours

ANS: C
Excerpts from the AARC guideline on O2 therapy in acute care hospitals appear in CPG 38-1.

DIF: Recall REF: p. 911 OBJ: 1

7. You set up an Oxy-Hood with an FIO2 of 0.5 for a newborn infant. What is the maximum time
that should pass before assessing this patient’s PaO2 or SaO2?

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 Test bank 38-3

a. 1 hour
b. 2 hours
c. 8 hours
d. 12 hours

ANS: A
Excerpts from the AARC guideline on O2 therapy in acute care hospitals appear in CPG 38-1.

DIF: Application REF: p. 911 OBJ: 1

8. When determining a need for O2 therapy, the respiratory therapist should assess which of the
following?
1. neurologic status
2. pulmonary status
3. cardiac status
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: D
Excerpts from the AARC guideline on O2 therapy in acute care hospitals appear I CPG 38-1.

DIF: Recall REF: p. 911 OBJ: 2

9. Which of the following signs and symptoms are associated with the presence of hypoxemia?
1. tachypnea
2. tachycardia
3. cyanosis
4. bradycardia
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 4

ANS: C
Last, hypoxemia has many manifestations, such as tachypnea, tachycardia, cyanosis, and
distressed overall appearance.

DIF: Recall REF: p. 912 OBJ: 2

10. What is/are the primary organ system(s) affected by O2 toxicity?

1. central nervous system (CNS)
2. lungs
3. kidneys
a. 1
b. 1 and 3

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 Test bank 38-4

c. 1 and 2
d. 1, 2, and 3

ANS: B
Oxygen toxicity primarily affects the lungs and the CNS.

DIF: Recall REF: p. 910 OBJ: 3

11. Which of the following typically occurs first when monitoring the earliest physiologic
response to breathing 100% O2?
a. substernal chest pain
b. decreased using capacity (DLCO)
c. decreased lung compliance (CL)
d. decreased vital capacity (VC)

ANS: A
Table 38-2 summarizes the physiologic response to breathing 100% O2 at sea level.

DIF: Recall REF: p. 911 OBJ: 3

12. A patient breathing 100% O2 for 24 hours or longer would most likely exhibit which of the
following?
1. decreased DLCO
2. decreased CL
3. increased PAO2 – PaO2
4. decreased VC
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

ANS: D
Table 38-2 summarizes the physiological response to breathing 100% O2 at sea level.

DIF: Recall REF: p. 911 OBJ: 3

13. Which of the following is consistent with the radiographic appearance after prolonged
exposure to O2?
a. air bronchograms
b. pulmonary abscess
c. patchy infiltrates
d. pneumothorax

ANS: C
Patchy infiltrates appear on chest radiographs and usually are most prominent in the lower
lung fields.

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 Test bank 38-5

DIF: Recall REF: p. 911 OBJ: 3

14. A physician places a patient in respiratory failure on 100% O2. To avoid the hazards of O2
toxicity, you would recommend that every effort be made to reduce this FIO2 to less than 50%
within what time frame?
a. 8 hours
b. 24 hours
c. 48 hours
d. 5 days

ANS: D
Avoiding O2 toxicity: Limit patient exposure to 100% O2 to less than 24 hours whenever
possible. High FIO2 is acceptable if the concentration can be decreased to 70% within 2 days
and 50% or less in 5 days.

DIF: Application REF: p. 913 OBJ: 3

15. A patient with chronic hypercapnia placed on an FIO2 of 0.6 starts hypoventilating. What is a
possible cause of this phenomenon?
a. decreased cardiac output
b. O2 toxicity
c. O2-induced hypoventilation
d. absorption atelectasis

ANS: C
When breathing moderate to high O2 concentrations, COPD patients with chronic hypercapnia
may tend to ventilate less.

DIF: Application REF: p. 913 OBJ: 3

16. Retinopathy of prematurity (ROP) is a potentially serious management problem mainly in the
care of whom?
a. premature or low-birth-weight infants
b. cystic fibrosis patients
c. children with asthma
d. patients with acute respiratory distress syndrome (ARDS)

ANS: A
ROP, also called retrolental fibroplasia, is an abnormal eye condition that occurs in some
premature or low-birth-weight infants who receive supplemental O2.

DIF: Application REF: p. 914 OBJ: 3

17. Some strategies for minimizing the risk of fire hazard with O2 therapy include all of the
following, except:
a. using the lowest effective FIO2
b. properly educating patients and caregivers

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 Test bank 38-6

c. avoiding aluminum regulators and other high risk devices

d. mixing the oxygen with carbon dioxide.

ANS: D
Common ways to minimize the fire risk with supplemental oxygen include using the lowest
effective FIO2, properly educating users and avoiding high-risk equipment.

DIF: Application REF: p. 915 OBJ: 3

18. To minimize the risk of retinopathy of prematurity (ROP), the American Academy of
Pediatrics recommends keeping the PaO2 below what level?
a. 60 mm Hg
b. 70 mm Hg
c. 80 mm Hg
d. 90 mm Hg

ANS: C
The American Academy of Pediatrics recommends keeping an infant’s arterial PO2 below 80
mm Hg as the best way of minimizing the risk of ROP.
With no source for repletion, the total gas pressure in the alveolus progressively decreases
until the alveolus collapses. Because collapsed alveoli are perfused but not ventilated,
absorption atelectasis increases the physiologic shunt and worsens blood oxygenation.

DIF: Recall REF: p. 916 OBJ: 3

19. Which of the following is false about absorption atelectasis?

a. It can occur only when breathing supplemental O2.
b. Its risk is increased in patients breathing at low tidal volumes (VT values).
c. Its risk is decreased through the natural “sigh” mechanism.
d. It results in an increase in the physiologic shunt fraction.

ANS: A
The risk of absorption atelectasis is greatest in patients breathing at low tidal volumes as a
result of sedation, surgical pain, or CNS dysfunction. In these cases, poorly ventilated alveoli
may become unstable when they lose O2 faster than it can be replaced. The result is a more
gradual shrinking of the alveoli that may lead to complete collapse, even when the patient is
not breathing supplemental O2. For an alert patient this is not a great risk, because the natural
sigh mechanism periodically hyperinflates the lung.

DIF: Analysis REF: p. 916 OBJ: 3

20. Which of the following factors should be used in properly selecting an O2 delivery device?
1. knowledge of general performance of the device
2. physician’s preference
3. individual capabilities of the equipment
a. 2 and 3
b. 1 and 2

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 Test bank 38-7

c. 1, 2, and 3
d. 1 and 3

ANS: D
Proper device selection requires in-depth knowledge of both the general performance
characteristics of these systems and the individual capabilities.

DIF: Application REF: p. 915 OBJ: 4

21. To ensure a stable FIO2 under varying patient demands, what must an O2 delivery system do?
a. It must have a reservoir system at least equal to the VT.
b. It must provide all the gas needed by the patient during inspiration.
c. It must maintain flows that are at least equal to the patient’s peak flows.
d. It must be able to deliver any O2 concentration from 21% to 100%.

ANS: B
If the system provides all of the patient’s inspired gas, the FIO2 remains stable, even under
changing demands.

DIF: Application REF: p. 915 OBJ: 4

22. Which of the following statements is false about low-flow O2 delivery systems?
a. The greater the patient’s inspiratory flow, the greater is the FIO2.
b. All low-flow devices provide variable O2 concentrations.
c. The O2 provided by a low-flow device is diluted with air.
d. The patient’s flow usually exceeds that from a low-flow device.

ANS: A
In this case, the more the patient breathes, the more air dilutes the delivered O2, and the lower
is the FIO2. Hence, there is an inverse or opposite relationship between FIO2 and inspiratory
flow with such O2 devices.

DIF: Application REF: p. 915 OBJ: 4

23. Delivery systems that provide only a portion of a patient’s inspired gas are referred to as
what?
a. fixed-performance systems
b. variable-performance systems
c. high-flow O2 systems
d. air-entrainment systems

ANS: B
A system that supplies only a portion of the inspired gas always provides a variable FIO2. An
example of a variable-performance system is a nasal cannula.

DIF: Application REF: p. 915 OBJ: 3

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 Test bank 38-8

24. Low-flow O2 delivery systems used in respiratory care include all of the following except:
a. nasal O2 cannula
b. nasal O2 catheter
c. air-entrainment mask
d. transtracheal catheter

ANS: C
Low-flow O2 delivery systems include the nasal cannula, the nasal catheter, and the
transtracheal catheter.

DIF: Application REF: p. 916 OBJ: 4

25. A cooperative and alert post-op patient who is able to eat requires a continuous but low FIO2.
Precise FIO2 concentrations are not needed. Which of the following devices would best
achieve this end?
a. simple O2 mask
b. air-entrainment mask
c. nasal cannula
d. nonrebreathing mask

ANS: C
Table 38-3 outlines the FIO2 range, FIO2 stability, advantages, disadvantages, and best use of
oxygen delivery devices. Based on these guidelines, the nasal cannula appears most suitable
for this patient.

DIF: Application REF: p. 917 OBJ: 4

26. Which of the following are advantages of the nasal cannula as a low-flow O2 delivery system?
1. stability
2. low cost
3. easy application
4. disposability
a. 2 and 4
b. 1, 2, and 4
c. 2, 3, and 4
d. 1, 2, 3, and 4

ANS: C
Table 38-3 lists the FIO2 range, FIO2 stability, advantages, disadvantages, and best use of the
nasal cannula.

DIF: Application REF: p. 917 OBJ: 4

27. Which of the following is considered an advantage of the transtracheal catheter?

a. It does not provide any economic benefit compared with the nasal cannula.
b. It decreases the anatomic reservoir.
c. It requires 40% to 60% less O2 flow than the nasal cannula.

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 Test bank 38-9

d. It requires higher flows than the nasal cannula.

ANS: C
Compared with a nasal cannula, a transtracheal catheter needs 40% to 60% less O2 flow to
achieve a given arterial partial pressure of O2 (PaO2).

DIF: Application REF: p. 919 OBJ: 4

28. Some of the major disadvantages of the transtracheal catheter are all of the following, except:
a. infection
b. mucus plugging
c. excessive oxygen use
d. lost tract or insertion opening

ANS: C
Though there are several advantages to the transtracheal catheter, some of the major
disadvantages include infection, mucus plugging and a lost insertion opening or tract.

DIF: Application REF: p. 917 OBJ: 4

29. Which of the following factors will decrease the FIO2 delivered by a low-flow O2 system?
1. short inspiratory time
2. fast rate of breathing
3. lower O2 input
4. large minute ventilation
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

ANS: D
The amount of air dilution depends on several patient and equipment variables. Table 38-4
summarizes these key variables and how they affect the FIO2 provided by low-flow systems

DIF: Application REF: p. 919 OBJ: 4

30. A 27-year-old woman received from the emergency department is on a nasal cannula at 5
L/min. Approximately what FIO2 is this patient receiving?
a. 28%
b. 32%
c. 35%
d. 40%

ANS: D

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 Test bank 38-10

Estimating the FIO2 provided by low-flow systems: For patients with a normal rate and depth
of breathing, each liter per minute of nasal O2 increases the FIO2 approximately 4%. For
example, a patient using a nasal cannula at 4 L/min has an estimated FIO2 of approximately
37% (21 + 16).

DIF: Application REF: p. 919 OBJ: 4

31. You enter the room of a patient who is receiving nasal O2 through a bubble humidifier at 5
L/min. You immediately notice that the humidifier pressure relief is popping off. Which of the
following actions would be most appropriate in this situation?
a. Check and tighten all connections.
b. Replace the humidifier with a new one.
c. Look for crimped or twisted delivery tubing.
d. Decrease the flow rate to 2 L/min.

ANS: C
Table 38-5 provides guidance on troubleshooting the most common clinical problems with
nasal cannulas. In this instance, the problem is probably with the tubing which is twisted or
crimped down-stream from the humidifier.
OBJ 4, 6
DIFF: Analysis

DIF: Analysis REF: p. 920 OBJ: 4, 6

32. Which of the following is TRUE about reservoir cannulas?

a. They reduce O2 use as much as 200%.
b. During exercise, they do not reduce O2 use.
c. Humidification is absolutely necessary.
d. Nasal anatomy and breathing pattern can affect performance of the device.

ANS: D
Although flow savings is fairly predictable, factors such as nasal anatomy and breathing
pattern can affect the performance of the device.

DIF: Application REF: p. 920 OBJ: 4

33. Disadvantages of standard O2 masks include all of the following except:

a. being difficult to apply to patients
b. patient discomfort (straps and heat)
c. increasing the risk of aspiration
d. must be removed for eating

ANS: A
Table 38-3 lists the FIO2 range, FIO2 stability, advantages, disadvantages, and best use of each
of these devices.

DIF: Application REF: p. 917 OBJ: 4

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 Test bank 38-11

34. Which of the following is FALSE about the simple O2 mask?

a. It has no valving system or reservoir bag.
b. It can easily deliver high FIO2 values (greater than 0.6 to 0.7)
c. It requires a minimal input flow of 5 L/min.
d. It generally functions as a variable-performance system.

ANS: B
Table 38-3 lists the FIO2 range, FIO2 stability, advantages, disadvantages, and best use of each
of these devices.

DIF: Application REF: p. 917 OBJ: 4

35. A physician orders 2 L/min O2 through a simple mask to a 33-year-old postoperative woman
with moderate hypoxemia breathing room air (PaO2 = 52 mm Hg). What would be the correct
action at this time?
a. Carry out the physician’s prescription exactly as written.
b. Recommend that the mask be changed to a cannula at 2 L/min.
c. Recommend a flow of at least 5 L/min to wash out carbon dioxide (CO2).
d. Do not apply the O2 until the medical director has been contacted.

ANS: C
At a flow less than 5 L/min, the mask volume acts as dead space and causes CO2 rebreathing.

DIF: Analysis REF: p. 921 OBJ: 4, 5, 6

36. What is the minimum flow setting for a simple mask applied to an adult?
a. 3 L/min
b. 5 L/min
c. 8 L/min
d. 10 L/min

ANS: B
At a flow less than 5 L/min, the mask volume acts as dead space and causes CO2 rebreathing.

DIF: Application REF: p. 921 OBJ: 4 , 5

37. A 52-year-old man is admitted to the hospital emergency department with a primary
complaint of severe radiating chest pain and signs of central cyanosis. The attending asks for
your advice on selecting a device that provides a moderate FIO2 for this patient. Which of the
following would you recommend?
a. simple O2 mask at 8 L/min
b. air-entrainment mask at 40% O2
c. nasal cannula at 5 L/min
d. nonrebreathing mask at 10 L/min

ANS: A

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 Test bank 38-12

Table 38-3 lists the FIO2 range, FIO2 stability, advantages, disadvantages, and best use of each
of these devices.

DIF: Analysis REF: p. 917 OBJ: 4 , 5

38. A physician orders supplemental O2 for a patient through a nasal cannula at a flow of 12
L/min. When you ask what the goal is, the physician states that the patient should receive
about 60% O2. Which of the following should you recommend?
a. The O2 should be given through a reservoir mask at 10 L/min.
b. The cannula flow should be set to 15 instead of 12 L/min.
c. The O2 should be given through a simple mask set at 5 to 12 L/min.
d. The O2 should be given through a simple mask set at 12 to 15 L/min.

ANS: C
Table 38-3 lists the FIO2 range, FIO2 stability, advantages, disadvantages, and best use of each
of these devices.

DIF: Analysis REF: p. 917 OBJ: 4 , 5

39. A well-fitted nonrebreathing mask, adjusted so that the patient’s inhalation does not deflate
the bag (flows approximately 10 L/min), should provide inspired O2 concentrations in what
range?
a. 55% to 70%
b. 45% to 60%
c. 75% to 90%
d. 70% to 85%

ANS: A
As indicated in Table 38-3, however, modern disposable nonrebreathing masks normally do
not provide much more than approximately 70% O2.
OBJ 4 , 5
DIFF: Application

DIF: Application REF: p. 917 OBJ: 4 , 5

40. You must deliver the highest possible FIO2 to a 67-year-old man with pulmonary edema
breathing at a rate of 35/min. Which of the following O2 delivery systems would be most
appropriate?
a. nonrebreathing mask at 12 to 15 L/min
b. simple mask at 12 to 15 L/min
c. partial rebreathing mask at 12 to 15 L/min
d. aerosol mask with nebulizer set to 100%

ANS: A
Table 38-3 lists the FIO2 range, FIO2 stability, advantages, disadvantages, and best use of each
of these devices.

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 Test bank 38-13

DIF: Analysis REF: p. 917-918 OBJ: 4, 5

41. A patient is receiving O2 through a nonrebreathing mask set at 8 L/min. You notice that the
mask’s reservoir bag collapses completely before the end of each inspiration. Which of the
following actions is appropriate in this case?
a. Change to a partial rebreather.
b. Decrease the liter flow.
c. Increase the liter flow.
d. Change to a simple mask.

ANS: C
Table 38-6 provides guidance on troubleshooting the most common clinical problems with
reservoir masks.

DIF: Application REF: p. 923 OBJ: 4, 5, 6

42. A true high-flow O2 delivery system should provide at least what flow?
a. 60 L/min
b. 50 L/min
c. 40 L/min
d. 30 L/min

ANS: A
To qualify as a high-flow device, a system should provide at least 60 L/min total flow.

DIF: Application REF: p. 923 OBJ: 4, 5

43. Which of the following is FALSE about air-entrainment systems?

a. Their FIO2 values are directly proportional to their total flow.
b. They can provide variable FIO2 values under some clinical conditions.
c. They always deliver O2 concentrations less than 100%.
d. They yield a set FIO2 only if their flow exceeds the patient’s.

ANS: A
The more air they entrain, the higher is the total output flow, but the lower is the delivered
FIO2.

DIF: Application REF: p. 923 OBJ: 4

44. Which of the following factors determine the actual O2 provided by an air-entrainment
system?
1. O2 input flow to the jet
2. air-to-O2 ratio of the device
3. resistance downstream from the jet
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3

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 Test bank 38-14

d. 1 and 3

ANS: A
The FIO2 provided by air-entrainment devices depends on two key variables: the air-to-O2
ratio and the amount of flow resistance downstream from the mixing site.

DIF: Application REF: p. 924 OBJ: 4

45. A patient receiving 35% O2 through an air-entrainment mask set at 6 L/min input flow
becomes tachypneic. Simultaneously, you notice that the SpO2 has fallen from 91% to 87%.
Which of the following actions would be most appropriate in this situation?
a. Switch the patient to a 40% air-entrainment mask.
b. Increase the device’s input flow to 10 L/min.
c. Switch the patient to a 28% air-entrainment mask.
d. Decrease the device’s input flow to 4 L/min.

ANS: B
Computing the total flow output of an air-entrainment device

PROBLEM

A patient is receiving O2 through an air-entrainment device set to deliver 50% O2. The input
O2 flow is set to 15 L/min. What is the total output flow of this system?
SOLUTION
Step 1: Compute the air-to-O2 ratio by substituting 50 for the % O2 in Equation 38-2:
=
=
=
=
Step 2: Add the air-to-O2 ratio parts:
1.7 + 1 = 2.7
Step 3: Multiply the sum of the ratio parts times the O2 input flow:
2.7 × 15 L/min = 41 L/min
An air-entrainment device set to deliver 50% O2 that has an input flow of 15 L/min provides a
total output flow of approximately 41 L/min.

DIF: Analysis REF: p. 924 OBJ: 4, 6

46. You design an air-entrainment system that mixes air with O2 at a fixed ratio of 1:7 (1 L air to 7
L O2). About what O2 will this device provide?
a. 33%
b. 40%
c. 80%
d. 90%

ANS: D

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 Test bank 38-15

Table 38-7 lists the approximate air-to-O2 ratios for several common O2 percentages.

DIF: Application REF: p. 925 OBJ: 4

47. A 45-year-old patient with congestive heart failure is receiving O2 through a 35%
air-entrainment mask. With an O2 input of 6 L/min, what is the total output gas flow?
a. 16 L/min
b. 24 L/min
c. 28 L/min
d. 36 L/min

ANS: D
Table 38-7 lists the approximate air-to-O2 ratios for several common O2 percentages.

DIF: Application REF: p. 925 OBJ: 4

48. You note that the air intake ports surrounding the jet of a 35% air-entrainment mask are
partially obstructed by the patient’s bedding. Which of the following would you expect?
1. decrease in the device’s total output flow
2. increase in the percent O2 delivered by the device
3. change in the FIO2 received by the patient
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: A
In the presence of flow resistance distal to the jet, the volume of air entrained always
decreases. With less air being entrained, total flow output decreases, and the delivered O2
concentration increases.

DIF: Analysis: REF: p. 925 OBJ: 4, 5, 6

49. A physician orders 40% O2 through an air-entrainment nebulizer for a patient with a minute
volume of 12 L/min. What is the minimum nebulizer input flow required to ensure the
prescribed FIO2?
a. 8 L/min
b. 10 L/min
c. 12 L/min
d. 14 L/min

ANS: B
For example, the total output flow of an air-entrainment nebulizer set to deliver 40% O2
ranges from 48 to 60 L/min.

DIF: Application REF: p. 927 OBJ: 4, 5

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 Test bank 38-16

50. You connect an intubated patient to an air-entrainment nebulizer system through a T-tube set
at 60% with an input flow of 15 L/min. Toward the middle of inspiration, you observe that
mist stops exiting from the open end of the T-tube. What does this indicate?
a. Flow is adequate to meet patient needs.
b. Patient has a low inspiratory flow rate.
c. Flowmeter must be calibrated.
d. Patient is not receiving 60% O2.

ANS: D
As long as mist can be seen escaping throughout inspiration, flow is adequate to meet the
patient’s needs, and the delivered FIO2 is ensured.

DIF: Application REF: p. 927 OBJ: 4, 5, 6

51. What is the maximum FIO2 expected to be delivered by most air-entrainment masks?
a. 30%
b. 40%
c. 50%
d. 60%

ANS: C
Most air-entrainment masks can be set to deliver no more than 50% O2.

DIF: Application REF: p. 926 OBJ: 4

52. Which of the following alternatives may increase the FIO2 capabilities of air-entrainment
nebulizers?
1. Add open reservoir to expiratory side of T-tube.
2. Connect together two or more nebulizers.
3. Use a commercial dual-flow system.
4. Add open reservoir to inspiratory side of T-tube.
a. 1 and 2
b. 1, 2, and 3
c. 1 and 4
d. 1, 2, 3, and 4

ANS: B
The five alternatives for boosting the FIO2 capabilities in these situations are presented in Box
38-2.

DIF: Analysis REF: p. 928 OBJ: 4, 5, 8

53. To ensure the prescribed FIO2 for a patient receiving 65% O2, you apply a closed reservoir
delivery system with a one-way expiratory valve. What other component must be included in
this system to ensure a fail-safe operation?
a. water trap
b. high-pressure alarm

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 Test bank 38-17

c. emergency inlet valve

d. low-pressure alarm

ANS: C
These systems must be equipped with an emergency inlet valve that allows room air breathing
in the event of source gas failure.

DIF: Application REF: p. 928 OBJ: 4, 5

54. An O2 delivery device takes separate pressurized air and O2 sources as input, then mixes these
gases through a precision valve. What does this describe?
a. O2 blending system
b. reservoir system
c. air-entrainment system
d. low-flow system

ANS: A
With a blending system, separate pressurized air and O2 sources are input, and the gases are
mixed either manually or with a precision valve (blender).

DIF: Application REF: p. 929 OBJ: 4

55. A physician requests that you provide a patient with exactly 45% O2 at a flow of 60 L/min.
Lacking a blender, you must manually mix air and O2 to achieve the desired mixture at the
prescribed flow. Which of the following air and O2 flows would you select?
Air (L/min) O2 (L/min)
a.
b.
c.
d.

ANS: A
Manually mixing air and oxygen to achieve specified concentration at a given flow
PROBLEM
To manually mix air and O2 to provide a patient with 50% O2 at a total flow of 60 L/min, what
O2 and air flow would you set?
SOLUTION
1. Use Equation 38-3 to compute the O2 flow:

O2 flow = 22 L/min
2. Compute the air flow:
Air flow = Total flow – O2 flow
Air flow = 60 – 22
Air flow = 38 L/min

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 Test bank 38-18

To provide a patient with 50% O2 at a total flow of 60 L/min, blend 22 L of O2 with 38 L of

air.

DIF: Analysis REF: p. 930 OBJ: 4, 5

56. Which of the following are components of a typical O2 blender?

1. precision metering device or mixture control
2. audible dual low-pressure alarm system
3. pressure regulating and equalizing valves
4. variable-size air-entrainment port
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 3, and 4

ANS: B
Figure 38-20 shows the major components of a typical O2 blender.

DIF: Application REF: p. 930 OBJ: 4, 5

57. To confirm proper operation of an O2 blending system, what should you do?
1. Test low-pressure alarms and bypass systems.
2. Analyze FIO2 at 0.21, 1.00, and prescribed level.
3. Confirm air and O2 inlet pressures.
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: D
To confirm proper operation, the respiratory therapist always should conduct an operational
check of any blender before using it on a patient (Box 38-3).

DIF: Application REF: p. 930 OBJ: 4

58. What is the upper limit of O2 concentrations available through tents?

a. 60% to 70%
b. 50% to 60%
c. 40% to 50%
d. 30% to 40%

ANS: C
For example, in large tents O2 input flow of 12 to 15 L/min can provide only 40% to 50% O2
levels.

DIF: Application REF: p. 930 OBJ: 4, 5

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 Test bank 38-19

59. A physician wants a stable FIO2 of 0.5 for a newborn infant with severe hypoxemia. Which of
the following systems would you select?
a. O2 hood with blender and heated humidifier
b. pediatric (“croup”) tent with O2 input of 8 L/min
c. O2 hood with blender and unheated humidifier
d. infant incubator with O2 input of 10 L/min

ANS: A
Oxygen is delivered to the hood through either a heated air-entrainment nebulizer or a
blending system with a heated humidifier.

DIF: Application REF: p. 931 OBJ: 4, 5

60. What is the problem with input flows greater than 10 to 15 L/min in an infant Oxy-Hood?
a. production of harmful noise levels
b. difficulty in maintaining adequate humidification
c. difficulty in maintaining stable high FIO2 values
d. increased likelihood of cold stress

ANS: A
Higher flow generally is not needed and may produce a harmful noise level and additional
stress on neonatal patients.

DIF: Application REF: p. 931 OBJ: 4, 5

61. In giving O2 to an infant through a hood, which of the following is/are correct?
1. A neutral thermal environment should be maintained.
2. Gases should be directed away from the infant’s face.
3. High input flow (greater than 10 to 15 L/min) should be avoided.
4. A minimum flow of 7 L/min must be maintained.
a. 1, 2, and 3
b. 2 and 4
c. 2, 3, and 4
d. 1, 2, 3, and 4

ANS: D
In the care of premature infants, it is especially important to ensure that the gas mixture is
properly warmed and humidified and not directed toward the patient’s face or head.

DIF: Application REF: p. 931 OBJ: 4, 5

62. Directing a cool O2 mixture to an infant in an Oxy-Hood can result in which of the following?
1. increased O2 consumption
2. increased convective heat loss
3. apnea (cessation of breathing)
a. 1 and 2
b. 2 and 3

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 Test bank 38-20

c. 1 and 3
d. 1, 2, and 3

ANS: D
In premature infants, cold stress can increase O2 consumption and even cause apnea.
OBJ 4, 5, 6
DIFF: Application

DIF: Application REF: p. 931 OBJ: 4, 5, 6

63. What temperature is required to maintain a neutral thermal environment (NTE) in an

Oxy-Hood for infants weighing 2500 g or more?
a. 25° C
b. 30° C
c. 35° C
d. 40° C

ANS: C
For example, the NTE temperature for newborns weighing less than 1200 g is 35° C.

DIF: Application REF: p. 931 OBJ: 4, 5

64. An infant requires both a precise high FIO2 and maintenance of a neutral thermal environment.
Which of the following systems can best achieve these goals?
1. Oxy-Hood or warmed O2 blending system without incubator
2. heated incubator with automatic O2 controlling system
3. heated incubator with Oxy-Hood or O2 blending system
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: A
Given the highly variable O2 concentration provided by these devices, the best way to control
O2 delivery to infants in an incubator is with an Oxy-Hood. The Oxy-Hood is placed over the
infant’s head inside the incubator. The O2 concentration and gas temperature within the
Oxy-Hood, not in the incubator, must be assessed. It is ideal to monitor incubator or
Oxy-Hood O2 concentration continuously.

DIF: Analysis REF: p. 932 OBJ: 4, 5

65. A variant of a common low-flow, nasal O2 delivery device which is capable of providing both
high humidity and a high FIO2 is known as which of the following?
a. high-flow nasal cannula
b. transtracheal catheter
c. nasal catheter
d. demand flow oxygen

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 Test bank 38-21

ANS: A
A variation of the standard nasal cannula which can provide both a high FIO2 and high
humidity is known as a high-flow nasal cannula.

DIF: Application REF: p. 932 OBJ: 4, 5

66. What are some key patient considerations in selecting O2 therapy equipment?
1. type of airway (natural or artificial)
2. severity and cause of the hypoxemia
3. age group (infant, child, adult)
4. stability of the minute ventilation
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

ANS: D
Table 38-8 lists guidelines for selecting an O2 delivery system on the basis of the level and
stability of the FIO2 needed.

DIF: Application REF: p. 933 OBJ: 4, 5

67. In which of the following clinical situations would you recommend hyperbaric oxygen (HBO)
therapy, if available?
1. carbon monoxide poisoning
2. respiratory or cardiac arrest
3. severe trauma
4. cyanide poisoning
a. 1 and 4
b. 2 and 3
c. 1, 2, 3, and 4
d. 1, 2, and 4

ANS: A
Carbon monoxide and cyanide poisoning may necessitate HBO therapy.

DIF: Application REF: p. 933 OBJ: 4, 5, 10

68. A patient receiving 3 L/min O2 through a nasal cannula has a measured SpO2 of 93% and no
clinical signs of hypoxemia. At this point, what should you recommend?
a. decreasing the flow to 2 L/min and rechecking the SpO2
b. maintaining the therapy as is and rechecking the SpO2 on the next shift
c. increasing the flow to 4 L/min and rechecking the SpO2
d. discontinuing the O2 therapy

ANS: A

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 Test bank 38-22

The goal is a PaO2 greater than 60 mm Hg or a hemoglobin saturation greater than 90%.

DIF: Application REF: p. 934 OBJ: 4, 5, 7, 8

69. Which of the following would indicate adequate oxygenation for adult patients with chronic
lung disease and an accompanying acute-on-chronic hypoxemia?
1. SaO2 of 90% or higher
2. PaO2 of 50 mm Hg to 60 mm Hg
3. SaO2 of 85% to 90%
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: B
Adequate oxygenation of these patients generally means an SaO2 of 85% to 90% with a PaO2
of 50 to 60 mm Hg.

DIF: Application REF: p. 934 OBJ: 4, 5

70. What is the level of SpO2 typically associated with discontinuation of O2 therapy?
a. 88%
b. 90%
c. 92%
d. 94%

ANS: C
Once the SpO2 is 92% or higher on room air, therapy is often discontinued.

DIF: Application REF: p. 933 OBJ: 4, 5, 7, 8, 9

71. What does 1 atmospheric pressure absolute (ATA) equal?

1. 101 kPa
2. 50 psi
3. 760 mm Hg
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: C
One ATA equals 760 mm Hg (101.32 kPa).

DIF: Recall REF: p. 934 OBJ: 10

72. Physiologic effects of hyperbaric oxygen (HBO) therapy include all of the following except:
a. neovascularization

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 Test bank 38-23

b. bubble reduction
c. enhanced immune function
d. systemic vasodilation

ANS: D
The known physiologic effects of HBO therapy are summarized in Box 38-5.

DIF: Application REF: p. 934 OBJ: 10

73. During hyperbaric oxygen therapy at 3 ATA, plasma contains about how much dissolved O2?
a. 1 ml/dl
b. 3 ml/dl
c. 5 ml/dl
d. 7 ml/dl

ANS: D
At 3 ATA, plasma contains nearly 7 ml/dl dissolved O2, a level exceeding average resting
tissue uptake.

DIF: Recall REF: p. 935 OBJ: 10

74. Which of the following is false about multiplace hyperbaric oxygenation chambers?
a. The chamber normally is filled with 100% O2.
b. Air locks allow entry and egress of caregivers.
c. Pressures of 6 ATA or more can be applied.
d. Care is provided directly within the chamber.

ANS: A
The multiplace chamber is filled with air.
OBJ 10
DIFF: Application

DIF: Application REF: p. 935 OBJ: 10

75. All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy except:
a. carbon monoxide poisoning
b. septic shock
c. air embolism
d. clostridial gangrene

ANS: B
Other indications for HBO therapy are listed in Box 38-6.

DIF: Application REF: p. 935 OBJ: 9, 10

76. In which of the following procedures is air embolism a potential complication?

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 Test bank 38-24

1. central line placement

2. lung biopsy
3. hemodialysis
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: D
Air embolism is a complication that can occur with certain cardiovascular procedures, lung
biopsy, hemodialysis, and central line placement.

DIF: Application REF: p. 935 OBJ: 10

77. At an FIO2 of 1, what is the approximate half-life of blood carboxyhemoglobin?

a. 20 minutes
b. 80 minutes
c. 3 hours
d. 5 hours

ANS: B
Breathing 100% O2 reduces this “half-life” to 80 minutes.

DIF: Application REF: p. 936 OBJ: 10

78. During hyperbaric oxygen (HBO) therapy at 3 ATA, what is the approximate half-life of blood
carboxyhemoglobin?
a. 23 minutes
b. 80 minutes
c. 5 hours
d. 24 hours

ANS: A
The half-life of carboxyhemoglobin under HBO at 3 ATA is only 23 minutes.

DIF: Application REF: p. 894 OBJ: 10

79. Criteria for initiating hyperbaric oxygen (HBO) therapy on an adult patient suspected of
suffering from acute carbon monoxide poisoning include all of the following except:
a. history of unconsciousness
b. carboxyhemoglobin saturation less than 20%
c. presence of neurologic abnormality
d. presence of cardiac instability

ANS: B
Box 38-7 lists current criteria for selecting patients with acute carbon monoxide poisoning for
treatment with HBO.

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 Test bank 38-25

DIF: Application REF: p. 936 OBJ: 9, 10

80. At what level of carboxyhemoglobin saturation is hyperbaric oxygen (HBO) therapy indicated
for an adult patient?
a. greater than 10%
b. greater than 15%
c. greater than 20%
d. greater than 25%

ANS: D
Box 38-7 lists current criteria for selecting patients with acute carbon monoxide poisoning for
treatment with HBO.

DIF: Application REF: p. 936 OBJ: 9, 10

81. Primary safety concerns in the application of hyperbaric oxygenation include which of the
following?
1. sudden decompression
2. electrical fires
3. CO2 accumulation
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: A
The common complications of hyperbaric oxygenation are listed in Box 38-8.

DIF: Application REF: p. 937 OBJ: 10

82. What is the most common complication of hyperbaric oxygen therapy?

a. air embolism
b. pneumothorax
c. ear or sinus barotrauma
d. seizures or convulsions

ANS: C
The most frequent problems involve barotrauma to closed body cavities, such as the middle
ear or sinuses.

DIF: Application REF: p. 936 OBJ: 10

83. Physiologic effects of inhaled nitric oxide (NO) include all of the following except:
a. recruitment of collapsed alveoli
b. improved blood flow to ventilated alveoli
c. decreased pulmonary vascular resistance

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 Test bank 38-26

d. reduced intrapulmonary shunting

ANS: A
The result is a reduction in intrapulmonary shunting, an improvement in arterial oxygenation,
and a decrease in pulmonary vascular resistance and pulmonary arterial pressure.

DIF: Application REF: p. 938 OBJ: 11

84. Potential uses for inhaled NO include all of the following except:
a. acute respiratory distress syndrome (ARDS)
b. persistent pulmonary hypertension of the newborn
c. primary pulmonary hypertension
d. status asthmaticus

ANS: D
Several potential indications for inhaled NO are listed in Box 38-9.

DIF: Application REF: p. 938 OBJ: 11

85. What is the recommended maximum initial dose of inhaled NO in neonates with respiratory
distress syndrome?
a. 5 ppm
b. 10 ppm
c. 20 ppm
d. 30 ppm

ANS: C
The recommended maximum initial dose of NO is 20 ppm.

DIF: Application REF: p. 938 OBJ: 11

86. Toxic side effects of inhaled NO include all of the following except:
a. acute pulmonary edema
b. direct cellular damage
c. impaired surfactant production
d. sulfhemoglobinemia

ANS: D
Levels greater than 10 ppm can cause cell damage, hemorrhage, pulmonary edema, and death.

DIF: Application REF: p. 938 OBJ: 11

87. Which of the following is FALSE about NO2?

a. NO2 levels greater than 10 ppm can cause hemorrhage, pulmonary edema, and
death.
b. NO2 is produced spontaneously whenever NO is exposed to O2.

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 Test bank 38-27

c. The Occupational Safety and Health Administration (OSHA) safety limit for NO2
exposure is 5 ppm.
d. NO2 exposure should be kept below 5 ppm during NO administration.

ANS: D
OSHA has set the safety limit for nitrogen dioxide exposure at 5 ppm.

DIF: Application REF: p. 938 OBJ: 11

88. Potential adverse effects associated with NO therapy include all of the following except:
a. poor or paradoxical response
b. increased blood clotting
c. increased left ventricular filling pressures
d. rebound hypoxemia or pulmonary hypertension

ANS: B
Potential adverse effects associated with NO therapy are listed in Box 38-10.

DIF: Application REF: p. 938 OBJ: 11

89. Features of an ideal delivery system for NO for use with mechanical ventilation include all of
the following except:
a. provides precise and stable NO dose delivery
b. premixes NO and O2 in a holding reservoir
c. provides accurate NO and NO2 monitoring
d. maintains proper ventilator function

ANS: B
Features of an ideal NO delivery system are listed in Box 38-11.

DIF: Application REF: p. 939 OBJ: 11

90. To prevent an adverse rebound effect when withdrawing NO therapy, what should you do?
1. Reduce the NO to the lowest effective dose (ideally, less than 5 ppm).
2. Hyperoxygenate the patient just before discontinuing NO.
3. Ensure that the patient is hemodynamically stable.
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: D
First, the NO level should be reduced to the lowest effective dose (ideally =5 ppm). Second,
the patient’s condition should be hemodynamically stable, and the patient should be able to
maintain adequate oxygenation while breathing a moderate FIO2 (0.4 or less) on low levels of
positive end-expiratory pressure Third, the patient should be hyperoxygenated (FIO2, 0.60 to
0.70) just before discontinuation of NO inhalation.

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 Test bank 38-28

DIF: Analysis REF: p. 940 OBJ: 11

91. Which of the following is an indication for the use of helium-O2 mixtures?
a. large-airway obstruction
b. small-airway obstruction
c. restrictive diseases
d. physiologic shunting

ANS: A
Helium-oxygen has been used for more than 70 years as an adjunct tool in the management of
large airway obstruction.

DIF: Application REF: p. 940 OBJ: 1

92. Compared to air, the density of an 80% He and 20% O2 mixture is about which of the
following?
a. two-thirds as much
b. one-half as much
c. one-third as much
d. one-fifth as much

ANS: C
Although air has a density of 1.293 g/L, the density of an 80% helium mixture is 0.429 g/L.

DIF: Recall REF: p. 940 OBJ: 12

93. A physician orders a 70% He:30% O2 mixture to reduce the work of breathing in a patient
having an acute asthmatic attack. Which of the following delivery systems would be
appropriate in this case?
a. adult O2 tent at 15 L/min
b. aerosol mask at 12 L/min
c. nasal cannula at 6 L/min
d. nonrebreathing mask at 10 L/min

ANS: D
In general, heliox should be delivered to most spontaneously breathing patients via a
tight-fitting (nondisposable) nonrebreathing mask with a fully functional valved exhalation
port.

DIF: Application REF: p. 940 OBJ: 12

94. You are giving a 80% He:20% O2 mixture to an asthmatic patient through a nonrebreathing
mask with a compensated Thorpe tube O2 flowmeter set at 8 L/min. What is the actual flow
being delivered to the patient?
a. 10 L/min
b. 12 L/min

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 Test bank 38-29

c. 14 L/min
d. 18 L/min

ANS: C
For example, the correction for an 80:20 helium-O2 mixture is 1.8.

DIF: Application REF: p. 941 OBJ: 12

95. Before administering a helium-O2 mixture to a patient with large airway obstruction, what
should you do?
a. Analyze the helium concentration of the mixture.
b. Heat the cylinder to ensure complete mixing of contents.
c. Analyze the O2 concentration of the mixture.
d. Roll the cylinder to ensure complete mixing of contents.

ANS: C
In addition to special flow considerations, the respiratory therapist should use an O2 analyzer
to continuously monitor heliox (actually O2) concentrations between the source of the mixture
and the patient.

DIF: Application REF: p. 941 OBJ: 12

96. Mixtures of carbon dioxide and oxygen in blends of 5% : 95% or 7% : 93%, which are
occasionally used to prevent complete washout of carbon dioxide during cardiopulmonary
bypass or treat hiccoughs is known as which of the following?
a. heliox
b. carbogen
c. nitrogen dioxide
d. flolan

ANS: B
A therapeutic mixture of carbon dioxide and oxygen is known as Carbogen.

DIF: Recall REF: p. 941 OBJ: 12

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