Management of Devices and Patient Safety Procedures practice questions

Answer: B) Green

• AIncorrect. That's nitrous oxide.
• BCorrect. Internationally white.
• CIncorrect. That's medical air.
• DIncorrect. That's helium.

Answer: A) Low pressure or volume from a disconnection

• ACorrect. Check the patient connection first.
• BIncorrect. That's a rate alarm.
• CIncorrect. That's an FiO2 alarm.
• DIncorrect. It signals a disconnect.

Answer: B) American Standard Safety System (ASSS)

Large cylinders with threaded valve outlets use the American Standard Safety System (ASSS) to prevent gas misconnections. PISS covers small yoke-type cylinders, and DISS covers low-pressure connections of 200 psi or less.

• AIncorrect. PISS uses a yoke with gas-specific pin and hole positions on the cylinder post valve. It applies to small cylinders (sizes A through E), not to H cylinders with threaded outlets.
• BCorrect. ASSS sets gas-specific threaded high-pressure outlet connections for large cylinders. Thread size and type, right- or left-hand threading, and nipple-seat design differ by gas, so the wrong regulator will not fit.
• CIncorrect. DISS covers low-pressure connections (200 psi or less), such as the outlet side of regulators, flowmeters and equipment hoses. It does not cover the high-pressure cylinder valve outlet.
• DIncorrect. Quick-connect adapters are gas-specific fittings on wall or piped-gas station outlets. They are not used on cylinder valve outlets.

Answer: A) Run the pre-use operational check with the new circuit, including the leak test and alarm verification

A pre-use operational check (circuit integrity and leak test, components, humidifier, alarms) is required before a ventilator is used on a patient, and again whenever the circuit is changed.

• ACorrect. Manufacturers recommend a pre-operational check before a ventilator is used on a patient. The check confirms the circuit is intact and that the components, humidifier and tubing work. It must be repeated any time the circuit is changed.
• BIncorrect. Yesterday's check did not test the new circuit and humidifier. A precheck is required any time the circuit is changed or modified.
• CIncorrect. Watching volumes after connection can catch some problems, but it puts the patient on an unverified system. Leaks or faulty parts should be found before the patient depends on the ventilator.
• DIncorrect. Alarms are a key safety feature and should be checked and set to fit the patient, not widened to avoid sounding. Alarms should not be ignored or silenced without first checking the problem.

Answer: A) 40 L/min

• ACorrect. Add the ratio parts (3 + 1) and multiply by the oxygen flow.
• BIncorrect. That adds only 3.
• CIncorrect. That leaves out the oxygen.
• DIncorrect. That's just the oxygen flow.

Answer: B) Small gas cylinder valves

• AIncorrect. Those use DISS or quick-connects.
• BCorrect. Such as E cylinders.
• CIncorrect. Those use threaded connections.
• DIncorrect. PISS is for small cylinders.

Answer: A) Measure with a cuff manometer and keep cuff pressure at 20–30 cm H2O

Measure ETT cuff pressure directly with a cuff manometer and keep it at about 20–30 cm H2O. Too low a pressure risks aspiration and VAP; too high a pressure risks tracheal necrosis and stricture.

• ACorrect. A manometer gives an actual pressure reading. The recommended range of 20–30 cm H2O limits aspiration of secretions above the cuff without compromising tracheal perfusion.
• BIncorrect. A fixed volume and a firm feel do not show the actual pressure. Cuff pressure can easily end up too high or too low.
• CIncorrect. Pressure above the recommended range can compromise tracheal perfusion and lead to necrosis and stricture.
• DIncorrect. Underinflation increases the risk of secretions above the cuff being aspirated (and VAP) and of losing the delivered tidal volume.

Answer: D) Maintaining a thermoneutral environment

• AIncorrect. It maintains temperature.
• BIncorrect. It maintains temperature.
• CIncorrect. It maintains temperature.
• DCorrect. Reducing oxygen consumption.

Answer: B) High-level disinfection

Under the Spaulding classification, items that touch mucous membranes are semicritical and need at least high-level disinfection. Sterilization is also acceptable. Low- and intermediate-level disinfection are for noncritical items.

• AIncorrect. Cleaning is a necessary first step before disinfection, but by itself it does not meet the requirement for semicritical items.
• BCorrect. The CDC says semicritical items, which contact mucous membranes or nonintact skin and include respiratory therapy equipment and laryngoscope blades, minimally require high-level disinfection.
• CIncorrect. Low-level disinfection is suitable for noncritical items and surfaces that touch only intact skin, such as blood pressure cuffs and bed rails.
• DIncorrect. Intermediate-level disinfection is used for some noncritical items. It falls short of the high-level disinfection that semicritical items need.

Answer: A) About 860 L

• ACorrect. That's why liquid systems store a lot of oxygen.
• BIncorrect. That's far too few.
• CIncorrect. It expands greatly.
• DIncorrect. That's far too many.