Initiation and Modification of Interventions practice questions

Answer: B) Short-acting beta-2 agonist

• AIncorrect. That's tiotropium.
• BCorrect. A rescue bronchodilator.
• CIncorrect. That's budesonide or fluticasone.
• DIncorrect. That's acetylcysteine or dornase.

Answer: C) 88% to 92%

Patients with COPD who chronically retain CO2 are titrated to an SpO2 of 88% to 92%. This avoids hypoxemia and also avoids the rise in PaCO2 that excess oxygen can cause.

• AIncorrect. This range allows clinically significant hypoxemia and inadequate tissue oxygen delivery.
• BIncorrect. Hyperoxia in CO2 retainers worsens V/Q mismatch and dead space, which raises PaCO2.
• CCorrect. This target corrects hypoxemia while limiting the risk of oxygen-induced hypercapnia in patients with chronic CO2 retention.
• DIncorrect. This is the usual target for patients without a risk of hypercapnia. It is too high for a chronic CO2 retainer.

Answer: C) Controlled tidal breathing at low, then mid, then high lung volumes to move mucus up

Autogenic drainage is a self-directed breathing technique. The patient breathes at progressively larger lung volumes (unstick, collect, evacuate) to mobilize secretions without devices or an assistant.

• AIncorrect. This describes the active cycle of breathing technique (ACBT), a different device-free airway clearance method built around the forced expiration technique.
• BIncorrect. This describes positive expiratory pressure (PEP) therapy, which needs a mask or mouthpiece device with a resistor.
• CCorrect. Autogenic drainage moves through unstick (low volume), collect (mid volume) and evacuate (high volume) phases. The airflow shears mucus from the airway walls and moves it toward the mouth, with no equipment needed.
• DIncorrect. This is conventional chest physiotherapy (postural drainage with percussion and vibration). It needs a caregiver and is not a self-directed breathing technique.

Answer: A) Amplitude (delta P)

• ACorrect. Mean airway pressure mainly affects oxygenation.
• BIncorrect. It affects oxygen.
• CIncorrect. That mainly affects oxygenation.
• DIncorrect. It doesn't control CO2.

Answer: B) Lower pulmonary artery pressure and improve oxygenation

• AIncorrect. It's a pulmonary vasodilator.
• BCorrect. It dilates pulmonary vessels.
• CIncorrect. It isn't an antibiotic.
• DIncorrect. It's a vasodilator.

Answer: A) A vibrating mesh nebulizer placed between the leak port and a non-vented mask

Aerosol can be given in-line during NIV. Delivery is best with a vibrating mesh nebulizer between the leak port and a non-vented mask and minimal mask leak, since high leak and vented masks greatly reduce the delivered dose.

• ACorrect. In this position the inspiratory pressure pushes the aerosol toward the patient, and mesh nebulizers deliver more drug than jet nebulizers because they have less dead volume.
• BIncorrect. Vented masks and high mask leak sharply reduce delivered dose. Aerosol is lost through the leak instead of reaching the lungs.
• CIncorrect. This interrupts ventilatory support in a patient with respiratory failure. In-line delivery lets therapy continue during NIV.
• DIncorrect. In-line MDI delivery uses a spacer/chamber adapter in the circuit, timed with inspiration. Firing without a spacer between breaths leaves most of the dose on the mask and circuit.

Answer: A) 92% to 96%

For a ventilated adult without chronic hypercapnia, titrate FiO2 to an SpO2 of about 92–96%. Use 88–92% only for chronic hypercapnic patients, and avoid running SpO2 near 100% on a high FiO2.

• ACorrect. For a hypoxemic adult without chronic hypercapnia, 92–96% gives enough oxygen and stays within the 92–98% upper bound for otherwise healthy patients. It also lets the FiO2 come down from a level that risks oxygen toxicity.
• BIncorrect. This lower range is for patients with chronic hypercapnic conditions such as COPD. This patient has no chronic lung disease and a normal PaCO2.
• CIncorrect. Keeping SpO2 near 100% means more oxygen than needed and keeps the FiO2 high. A prolonged FiO2 above 0.60 can cause pulmonary oxygen toxicity.
• DIncorrect. This is below accepted targets even for chronic hypercapnic patients and would leave this patient hypoxemic for no reason.

Answer: D) Poor-quality compressions or low cardiac output

• AIncorrect. It's too low.
• BIncorrect. That shows a sudden rise.
• CIncorrect. ETCO2 reflects perfusion here.
• DCorrect. Improve compressions.

Answer: B) Positive-pressure breaths to help lung expansion

• AIncorrect. It's positive pressure.
• BCorrect. It's used when other methods fail.
• CIncorrect. It delivers pressure breaths.
• DIncorrect. That's a different device.

Answer: A) PaO2 of 54 mm Hg or SaO2 of 87%

Medicare Group I criteria for home oxygen are PaO2 ≤55 mm Hg or SaO2 ≤88% at rest on room air. Values of 56–59 mm Hg or 89% qualify only with Group II supporting conditions.

• ACorrect. Group I criteria are an arterial PO2 at or below 55 mm Hg or an arterial oxygen saturation at or below 88%, measured at rest on room air. These values meet that threshold, so no other findings are needed.
• BIncorrect. A PO2 of 56–59 mm Hg or SaO2 of 89% falls into Group II. Group II also requires dependent edema suggesting heart failure, pulmonary hypertension or cor pulmonale, or a hematocrit above 56%.
• CIncorrect. These values are above both the Group I and Group II resting thresholds, so they don't qualify for home oxygen at rest.
• DIncorrect. Shortness of breath alone isn't a qualifying criterion. Exercise-based qualification requires documented desaturation to PO2 ≤55 mm Hg or SaO2 ≤88% during exercise, plus proof that oxygen improves it.