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

Chapter 37: Storage and Delivery of Medical Gases

Test Bank

MULTIPLE CHOICE

1. Which of the following is/are considered therapeutic gases?

1. O2
2. O2–NO mixture
3. O2–He mixture
4. N2O
a. 1 and 2
b. 2 and 4
c. 3 and 4
d. 1, 2, and 3

ANS: D
Although there are many commercially produced gases, only a few are used medically (Table
37-1).

DIF: Recall REF: p. 888 OBJ: 1

2. What is the fire-risk classification of N and CO2?

a. flammable
b. supports combustion
c. inflammable
d. nonflammable

ANS: D
See Table 37-1.

DIF: Recall REF: p. 888 OBJ: 1

3. Which of the following medical gases support combustion?

1. O2
2. N2O
3. compressed air
4. CO2

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-2

a. 1 and 4
b. 2 and 3
c. 1, 2, and 3
d. 1, 3, and 4

ANS: D
See Table 37-1.

DIF: Recall REF: p. 888 OBJ: 1

4. Which of the following statements regarding O2 is false?

a. It is only slightly soluble in water.
b. It is odorless and transparent.
c. It is flammable.
d. It is heavier than air.

ANS: C
Oxygen is a colorless, odorless, transparent, and tasteless gas. It exists naturally as free
molecular oxygen and as a component of a host of chemical compounds. Oxygen constitutes
almost 50% by weight of the earth’s crust and occurs in all living matter in combination with
hydrogen as water. At standard temperature, pressure, and dry (STPD), oxygen has a density
of 1.429 g/L, being slightly heavier than air (1.29 g/L). Oxygen is not very soluble in water.

DIF: Recall REF: p. 888 OBJ: 1

5. What factors affect the combustion-supporting properties of O2?

1. concentration
2. partial pressure
3. humidity
a. 1
b. 2
c. 1 and 2
d. 1, 2, and 3

ANS: C
Oxygen is nonflammable, but it greatly accelerates combustion. Burning speed increases with
either (1) an increase in oxygen percentage at a fixed total pressure or (2) an increase in total
pressure of oxygen at a constant gas concentration. Thus, both oxygen concentration and
partial pressure influence the rate of burning.

DIF: Recall REF: p. 888 OBJ: 1

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-3

6. By what means is air for medical use in a hospital most commonly produced?
a. chemical decomposition
b. electrolysis
c. fractional distillation
d. physical separation

ANS: C
Most large quantities of medical oxygen are produced by fractional distillation of atmospheric
air.

DIF: Recall REF: p. 888 OBJ: 2

7. What is the most common and least expensive method for commercial production of O2?
a. electrolysis of water
b. fractional distillation of air
c. physical separation by molecular sieves
d. chemical decomposition of sodium chlorate

ANS: B
Fractional distillation is the most common and least expensive method for producing oxygen.

DIF: Recall REF: p. 888 OBJ: 1

8. What is the U.S. Food and Drug Administration (FDA) purity standard for O2?
a. 21%
b. 90%
c. 95%
d. 99%

ANS: D
FDA standards require an oxygen purity of at least 99.0%.

DIF: Recall REF: p. 888 OBJ: 1

9. Which of the following methods of producing O2 is commonly used in the home care setting?
a. chemical decomposition
b. electrolysis
c. fractional distillation
d. physical separation

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-4

ANS: D
These devices, called oxygen concentrators, are used primarily for supplying low-flow oxygen
in the home care setting.

DIF: Recall REF: p. 888 OBJ: 2

10. Components of a large medical air compressor include which of the following?
1. drying system
2. diaphragm or turbine
3. reservoir tank
4. pressure-reducing valve
a. 2 and 3
b. 2 and 4
c. 1, 2, and 3
d. 1, 3, and 4

ANS: D
Figure 37-1 shows a typical large medical air compressor system.

DIF: Recall REF: p. 889 OBJ: 2

11. Air for medical use in a hospital should be which of the following?
1. particle-free
2. oil-free
3. dry
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

ANS: D
For medical gas use, air must be dry and free of oil or particulate contamination.

DIF: Recall REF: p. 889 OBJ: 2

12. Large hospital air compressor systems must be capable of maintaining 50 pounds per square
inch gauge (psig) at what flows?
a. 10 L/min
b. 15 L/min
c. 50 L/min
d. 100 L/min

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-5

ANS: D
Large medical air compressors must provide high flow (at least 100 L/min) at the standard
working pressure of 50 psig for all equipment in use.

DIF: Recall REF: p. 889 OBJ: 2

13. Which of the following equipment could be powered by a small diaphragm or turbine air
compressor?
1. small-volume medication nebulizer
2. all-purpose large-volume jet nebulizer
3. intermittent positive-pressure breathing device
a. 1
b. 1 and 2
c. 2 and 3
d. 1, 2, and 3

ANS: A
Small diaphragm or turbine compressors are ideal for powering devices such as small-volume
medication nebulizers.

DIF: Recall REF: p. 889 OBJ: 2

14. Which of the following statements about CO2 is FALSE?

a. It does not support animal life.
b. It is a flammable gas.
c. It is odorless and colorless.
d. It is heavier than air.

ANS: B
At STPD, CO2 is a colorless and odorless gas with a specific gravity of 1.52 (approximately
1.5 times heavier than air). Carbon dioxide does not support combustion or maintain animal
life.

DIF: Recall REF: p. 889 OBJ: 1

15. Which of the following statements about He is false?

a. It is an inert gas.
b. It is odorless.
c. It is nonflammable.
d. It is heavier than air.

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-6

ANS: D
Helium is second only to hydrogen as the lightest of all gases; it has a density at STPD of
0.1785 g/L. Helium is odorless, tasteless, nonflammable, and chemically and physiologically
inert.

DIF: Recall REF: p. 889 OBJ: 1

16. What key property of He makes it useful as a therapeutic gas?

a. low solubility
b. chemical inertness
c. low cost
d. low density

ANS: D
The low density of the results in a more laminar flow of gas thus decreasing the work of
breathing.

DIF: Recall REF: p. 890 OBJ: 2

17. Which of the following gases is used to treat conditions causing hypoxic respiratory failure?
a. N2O
b. He
c. NO
d. cyclopropane

ANS: C
NO is FDA approved for use in the treatment of term and near-term infants for hypoxic
respiratory failure.

DIF: Recall REF: p. 890 OBJ: 2

18. Compressed gas cylinders are manufactured from which of the following?
a. copper or brass
b. seamless steel
c. seamless aluminum
d. fiberglass

ANS: B
Gas cylinders are made of seamless steel and are classified by the federal Department of
Transportation (DOT) according to their fabrication method.

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-7

DIF: Recall REF: p. 890 OBJ: 3

19. Department of Transportation (DOT) regulations require compressed gas cylinders to be

hydrostatically tested for leaks and expansion every how often?
a. 1 to 2 years
b. 3 to 5 years
c. 6 to 8 years
d. 5 to 10 years

ANS: D
Safety tests are conducted on each cylinder every 5 or 10 years, as specified in DOT
regulations.

DIF: Recall REF: p. 891 OBJ: 3

20. During inspection of the shoulder of a compressed gas cylinder, you note a plus sign (+) next
to the test date. This indicates what about the cylinder?
a. It is made of spun aluminum, not steel.
b. It only requires a 10-year DOT inspection.
c. It can be filled to 10% above its service pressure.
d. It has a high coefficient of elastic expansion.

ANS: C
A plus sign (+) means the cylinder is approved for filling to 10% above its service pressure.

DIF: Recall REF: p. 891 OBJ: 3

21. According to the U.S. Department of Commerce, a gas cylinder that is color coded blue
should contain which of the following?
a. air
b. He
c. N2O
d. O2

ANS: C
Table 37-2 lists the color codes for medical gases as adopted by the Bureau of Standards of
the U.S. Department of Commerce.

DIF: Recall REF: p. 891 OBJ: 3

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-8

22. According to the National Institute of Standards and Technology of the U.S. Department of
Commerce, a gas cylinder that is color-coded brown and green should contain which of the
following?
a. O2–N2 mixture
b. O2–CO2 mixture
c. CO2
d. O2–He mixture

ANS: D
Table 37-2 lists the color codes for medical gases as adopted by the Bureau of Standards of
the U.S. Department of Commerce.

DIF: Recall REF: p. 891 OBJ: 3

23. In clinical practice, how is a positive identification made of the contents of a medical gas
cylinder?
a. noting the color of the cylinder
b. inspecting the cylinder threads
c. reading the cylinder label
d. collecting and analyzing a gas sample

ANS: C
As with any drug agent, the cylinder contents always must be identified through careful
inspection of the label.

DIF: Recall REF: p. 891 OBJ: 3

24. What is the key difference between small compressed gas cylinders (sizes AA to E) and their
larger counterparts (sizes F to K)?
a. Small gas cylinders do not undergo regular DOT testing.
b. Small gas cylinders are always filled to lower pressures.
c. Small gas cylinders cannot be used for anesthetic gases.
d. Small gas cylinders use a yoke (not threaded) connector.

ANS: D
Small cylinders have a post valve and yoke connector.

DIF: Recall REF: p. 892 OBJ: 3

25. Which of the following mechanisms do all compressed gas cylinders use to avoid excessively
high buildup of cylinder pressure?

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-9

a. internal convection cooling mechanism

b. pressure-relief mechanism on the valve stem
c. automatic cylinder breech mechanism
d. pressure-relief mechanism on the cylinder body

ANS: B
To prevent this type of accident, all cylinders have high-pressure relief valves.

DIF: Recall REF: p. 892 OBJ: 3

26. Which of the following medical gases can be stored in cylinders as liquids at room
temperature?
1. CO2
2. O2
3. N2O
a. 1
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3

ANS: C
Gases with critical temperatures above room temperature can be stored as liquids at room
temperature. These gases include carbon dioxide and nitrous oxide.

DIF: Recall REF: p. 892 OBJ: 3

27. Cylinders of liquid gases are filled according to what specification?

a. filling density
b. critical weight
c. elastic expansion
d. filling pressure

ANS: A
Rather than being filled to filling pressure, cylinders of these gases are filled according to a
specified filling density.

DIF: Recall REF: p. 892 OBJ: 3

28. The measured pressure in a liquid-filled cylinder is equivalent to which of the following?
a. the force necessary to compress its volume within the cylinder
b. its filling density divided by the cylinder gas factor

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-10

c. the pressure of the surface vapor at any given temperature

d. the weight of the liquid divided by the density of water

ANS: C
The pressure in a liquid-filled cylinder thus equals the pressure of the vapor at any given
temperature.

DIF: Recall REF: p. 893 OBJ: 3

29. The measured pressure in a gas-filled cylinder is equivalent to which of the following?
a. its filling density divided by the cylinder gas factor
b. gas temperature times its coefficient of expansion
c. gas density divided by the density of air at standard temperature, standard pressure,
dry (STPD)
d. the force required to compress its volume within the cylinder

ANS: D
In a gas-filled cylinder, the pressure represents the force required to compress the gas into its
smaller volume.

DIF: Recall REF: p. 893 OBJ: 3

30. When full, a gas cylinder registers a pressure of 2200 psig. After a few hours of use, the
pressure gauge reads 550 psig. The cylinder is now how full?
a. one half
b. one third
c. one fourth
d. two thirds

ANS: C
For gas-filled cylinders, the volume of gas in the cylinder is directly proportional to its
pressure at a constant temperature. If a cylinder is full at 2200 psig, it will be half full when
the pressure decreases to 1100 psig.

DIF: Recall REF: p. 894 OBJ: 3

31. What is the usual method of monitoring the remaining contents in a gas-filled cylinder?
a. Weigh the cylinder.
b. Read the pressure gauge.
c. Compute the gas density.
d. Read the cylinder label.

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-11

ANS: B
To know how much gas is contained in a compressed gas cylinder, one needs only measure its
pressure.

DIF: Recall REF: p. 894 OBJ: 3

32. To accurately determine the remaining contents of a liquid-filled CO2 cylinder, what would
you do?
a. Multiply the pressure by the cylinder factor.
b. Divide the pressure by the cylinder factor.
c. Weigh the contents of the cylinder.
d. Empty the cylinder while timing its flow.

ANS: C
Weighing a liquid-filled cylinder is the only accurate method for determining the contents.

DIF: Recall REF: p. 893 OBJ: 4

33. A cylinder of N2O has a gauge pressure of 750 psig when full. What will be the pressure in
this cylinder when it is half full?
a. 375 psig
b. 750 psig
c. 1500 psig
d. 2200 psig

ANS: B
Figure 37-6 compares the behavior of compressed gas and liquid gas cylinders during use.
The vapor pressure of liquid gas cylinders varies with the temperature of the contents. For
example, the pressure in a nitrous oxide cylinder at 70° F is 745 psig; at 60° F, the pressure
decreases to 660 psig. As the temperature increases toward the critical point, more liquid
vaporizes, and the cylinder pressure increases.

DIF: Analysis REF: p. 893 OBJ: 4

34. Under what conditions will the gauge pressure of a cylinder of N2O accurately represent its
contents?
1. when the liquid in the cylinder has completely vaporized
2. when the ambient temperature exceeds the critical temperature
3. when the filling density is less than 1.0 (water-filled)
a. 1 and 2

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-12

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

ANS: C
Should a cylinder of nitrous oxide warm to 97.5° F (its critical temperature), all the contents
would convert to gas. Only at this temperature and above does the cylinder gauge pressure
accurately reflect cylinder contents.

DIF: Recall REF: p. 893 OBJ: 5

35. One cubic foot of any gas is equivalent to how many liters of gas?
a. 1.00
b. 3.79
c. 7.48
d. 28.30

ANS: B
Table 37-4 provides the factors needed to convert these units.

DIF: Recall REF: p. 894 OBJ: 1

36. What cylinder factor is used to compute the duration of flow for a 244 cu/ft (H/K) O2 or air
cylinder?
a. 0.16
b. 0.28
c. 3.14
d. 2.41

ANS: C
Table 37-4 provides cylinder factors for the therapeutic medical gases and common cylinder
sizes.

DIF: Recall REF: p. 894 OBJ: 4

37. What cylinder factor is used to compute the duration of flow for a 22 cu/ft O2 or air E
cylinder?
a. 0.28
b. 1.34
c. 2.41
d. 3.14

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-13

ANS: A
Table 37-4 provides cylinder factors for the therapeutic medical gases and common cylinder
sizes.

DIF: Recall REF: p. 894 OBJ: 4

38. The gauge on an H cylinder of O2 reads 2000 psig. About how long would the contents of this
cylinder last, until completely empty, at a flow of 6 L/min?
a. 1 hour 30 minutes
b. 17 hours 30 minutes
c. 18 hours 10 minutes
d. 21 hours 50 minutes

ANS: B
Once the factor for a given gas and cylinder is known, calculating the duration of flow is a
simple matter of applying the following equation:
Duration of flow (min) = Pressure (psig)  Cylinder factor / Flow (L/min)

DIF: Application REF: p. 894 OBJ: 4

39. The gauge on a G cylinder of O2 reads 400 psig. About how long would the contents of this
cylinder last, until completely empty, at a flow of 5 L/min?
a. 2 hours 40 minutes
b. 3 hours 10 minutes
c. 4 hours 30 minutes
d. 9 hours 15 minutes

ANS: B
Once the factor for a given gas and cylinder is known, calculating the duration of flow is a
simple matter of applying the following equation:
Duration of flow (min) = Pressure (psig)  Cylinder factor / Flow (L/min)

DIF: Application REF: p. 894 OBJ: 4

40. The gauge on an E cylinder of O2 reads 800 psig. About how long would the contents of this
cylinder last, until completely empty, at a flow of 3 L/min?
a. 1 hour 15 minutes
b. 1 hour 45 minutes
c. 2 hours 10 minutes
d. 2 hours 40 minutes

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-14

ANS: A
Once the factor for a given gas and cylinder is known, calculating the duration of flow is a
simple matter of applying the following equation:
Duration of flow (min) = Pressure (psig)  Cylinder factor / Flow (L/min)

DIF: Application REF: p. 894 OBJ: 4

41. You are planning a patient transport that will take about 1 hours. The patient requires manual
ventilation with 10 L/min of O2. What is the minimum number of full E cylinders you would
take with you?
a. 2
b. 3
c. 4
d. 5

ANS: A
See Rule of Thumb p. 894.

DIF: Analysis REF: p. 894 OBJ: 4

42. One cu/ft of liquid O2 is the equivalent of about how many cu/ft of gaseous O2?
a. 28
b. 244
c. 360
d. 860

ANS: D
Because 1 L of liquid oxygen weighs 2.5 lb and produces 860 L of oxygen in its gaseous state,
the amount of gas in a liquid oxygen cylinder can be calculated with the following formula:
Amount of gas in cylinder = Liquid O2 weight (lb)  860 / 2.5 lb/L

DIF: Recall REF: p. 894 OBJ: 5

43. Compared to portable cylinders, a centrally located, piped-in bulk O2 system has which of the
following advantages?
1. no need for a backup or reserve system
2. more convenient and less hazardous than cylinders
3. oxygen already reduced to its working pressure
4. less risk of the O2 supply being depleted
a. 1, 2, and 3

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-15

b. 2 and 4
c. 3 and 4
d. 2, 3, and 4

ANS: D
A bulk oxygen system has several advantages over portable cylinders. Although initially
expensive to construct, bulk oxygen systems are far less expensive over the long term. Bulk
oxygen systems are less prone to interruption. These systems eliminate the inconvenience and
hazard of transporting and storing large numbers of cylinders. Bulk oxygen systems regulate
delivery pressures centrally, thereby eliminating the need for separate pressure-reducing
valves at each outlet. Last, bulk systems operate at low pressures, making them much safer
than high-pressure cylinders.

DIF: Recall REF: p. 896 OBJ: 7

44. Which of the following components are common to a standard compressed gas cylinder
manifold system?
1. automatic switch-over control
2. pressure-reducing valves
3. primary and reserve bank
4. alarm system
a. 1, 2, and 3
b. 2 and 4
c. 3 and 4
d. 1, 2, 3, and 4

ANS: D
The alternating supply or cylinder manifold system consists of large (normally H or K size)
cylinders of compressed oxygen banked together in series (Figure 37-7). This alternating
supply system has two sides: a primary bank and a reserve bank. When the pressure in the
primary bank decreases to a set level, a control valve automatically switches over to the
reserve bank. When this occurs, the primary bank is taken off-line, and the empty cylinders
are replaced with full ones. The replenished primary bank becomes the reserve bank. Some
large alternating supply systems are permanently fixed and are refilled on site by a supply
truck. These cylinder manifold systems have pressure-reducing valves for regulation of
delivered pressure and normally have low-pressure alarms. These alarms sound when reserve
switch-over occurs, and they warn of impending depletion or malfunction.

DIF: Recall REF: p. 896 OBJ: 7

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-16

45. Unlike CO2 or N2O, O2 cannot be stored as a liquid at room temperature but must be kept in
special cryogenic containers. Why is this so?
a. O2 is 20 times less diffusible than CO2, N2O, or cyclopropane.
b. O2 has a critical temperature well below room temperature.
c. O2 has an extremely high gas solubility coefficient.
d. O2 has a boiling point below well below room temperature.

ANS: B
Oxygen has a critical temperature well below room temperature (–181.4° F [–118.6° C]).
Liquid oxygen must continually be stored below this temperature, or it reverts to its gaseous
state.

DIF: Recall REF: p. 896 OBJ: 6

46. What do the components of a liquid O2 bulk storage tank include?

1. inner and outer steel shells, separated by a vacuum
2. safety system that vents O2 if warming occurs
3. vaporizer system that converts liquid O2 to gas
4. pressure-reducing valves to lower pressure to 50 psig
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

ANS: C
These stand tanks are like giant thermos bottles, consisting of inner and outer steel shells
separated by an insulated vacuum chamber (Figure 37-10). Because it eliminates heat
conduction, the vacuum keeps the liquid oxygen below its critical temperature without
refrigeration. When it flows through vaporizer coils exposed to ambient temperature, the
liquid oxygen quickly converts back to a gas. With the oxygen in its gaseous form, the
pressure is decreased to the standard working pressure of 50 psi by a pressure-reducing valve.
A safety vent allows vaporized liquid oxygen to escape if warming causes cylinder pressure to
increase above a set limit.

DIF: Recall REF: p. 896 OBJ: 7

47. The NFPA standard for bulk liquid O2 systems requires that the reserve supply be which of the
following?
a. fixed cylinder bank of 75 H cylinders
b. at least one large liquid O2 cylinder
c. equal to the average gas use of 1 day

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-17

d. at least 3000 cu/ft of gaseous O2

ANS: C
Among the key provisions in these standards is the requirement for a reserve or backup gas
supply to equal the average daily gas use of the hospital.

DIF: Recall REF: p. 897 OBJ: 7

48. Structural requirements for the central piping systems that are used in hospitals to distribute
gases are established by whom?
a. American National Standards Institute (ANSI)
b. Department of Transportation
c. National Fire Protection Association (NFPA)
d. Compressed Gas Association (CGA)

ANS: C
Structural standards for piping systems are established by the NFPA and are described in more
detail elsewhere.

DIF: Recall REF: p. 898 OBJ: 7

49. The pressure of O2 or air in a bulk supply system is reduced to what standard working
pressure?
a. 10 psig
b. 14 psig
c. 25 psig
d. 50 psig

ANS: D
The gas pressure in a central piping system normally is reduced to the standard working
pressure of 50 psi at the bulk storage location.

DIF: Recall REF: p. 898 OBJ: 7

50. Why are zone valves incorporated into a hospital's central gas piping systems?
1. to terminate O2 delivery to an area in case of fire
2. to allow selective maintenance without shutting the system down
3. to allow variable pressure reduction throughout the system
a. 1 and 2
b. 1 and 3
c. 2 and 3

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-18

d. 1, 2, and 3

ANS: A
Zone valves (Figure 37-12) throughout the system can be closed for system maintenance or in
case of fire.

DIF: Recall REF: p. 898 OBJ: 7

51. What is the primary purpose of indexed connector systems?

a. to prevent inadvertent misconnections between equipment
b. to speed making connections between equipment
c. to allow U.S. equipment to “mate” with foreign equipment
d. to provide universal connections among all equipment

ANS: A
These safety systems make misconnection between pieces of equipment nearly impossible.

DIF: Recall REF: p. 898 OBJ: 9

52. What is the indexed safety system for threaded high-pressure connections between large
compressed gas cylinders and their attachments?
a. Pin-Indexed Safety System (PISS)
b. Diameter-Index Safety System (DISS)
c. American Standard Safety System (ASSS)
d. CGA System

ANS: C
Adopted in the United States and Canada, the ASSS provides standards for threaded high-
pressure connections between large compressed gas cylinders (sizes F through H/K) and their
attachments.

DIF: Recall REF: p. 899 OBJ: 9

53. Which of the following is false about ASSS standards?

a. They provide specifications for more than 60 gases and mixtures.
b. They apply only to cylinders sizes F through H/K.
c. They apply to high-pressure connections.
d. They provide a separate connector for all gases.

ANS: D

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-19

Because there are only 26 connections for the 62 listed gases and mixtures, each gas may not
have a unique connection. This means that some gases have identical connections.

DIF: Recall REF: p. 899 OBJ: 9

54. Which of the following statements is FALSE about PISS standards?

a. The exact positions of pins and pinholes do not vary for each gas.
b. In order to work, the yoke nipple has to seat in the recessed valve outlet.
c. They apply only to cylinders using a yoke connection .
d. They have 6 pin positions and 10 possible pin/hole combinations.

ANS: A
The exact positions of pins and pinholes vary for each gas. Unless the pins and holes align
perfectly, the yoke nipple cannot seat in the recessed valve outlet. Six holes and pin positions
constitute the total system. Because overlapping holes cannot be used, there are 10 possible
pin combinations.

DIF: Recall REF: p. 899 OBJ: 9

55. What is the PISS index hole position for O2?

a. 1 and 5
b. 2 and 5
c. 1 and 6
d. 4 and 6

ANS: B
See Table 37-5.

DIF: Recall REF: p. 900 OBJ: 9

56. What safety system is designed to prevent accidental interchanging among low-pressure (less
than 200 psig) connectors such as those found on flowmeters and ventilators?
a. PISS
b. ASSS
c. DISS
d. CGA

ANS: C
Whereas the ASSS and the PISS provide standards for high-pressure connections between
cylinders and equipment, the DISS was established to prevent accidental interchange of low-
pressure (less than 200 psig) medical gas connectors.

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-20

DIF: Recall REF: p. 900 OBJ: 9

57. Where do respiratory therapists typically find DISS connections?

1. at the outlets of pressure-reducing valves attached to cylinders
2. at the nurse station
3. at the station outlets of central piping systems
4. at the inlets of blenders, flowmeters, ventilators, and other pneumatic equipment
a. 1, 2
b. 1, 2, 3
c. 1, 2, 4
d. 3, 4

ANS: C
Respiratory therapists typically find DISS connections (1) at the outlets of pressure-reducing
valves attached to cylinders, (2) at the station outlets of central piping systems, and (3) at the
inlets of blenders, flowmeters, ventilators, and other pneumatic equipment.

DIF: Recall REF: p. 900 OBJ: 9

58. You must connect a large-volume nebulizer to a bedside compressed-air outlet through a
flowmeter. You have only standard O2 flowmeters available. Which of the following actions is
appropriate?
a. Connect the O2 flowmeter to the air outlet with piping tape.
b. Use an O2-to-air DISS adapter to join the flowmeter and outlet.
c. Connect the O2 flowmeter to the air outlet with a petroleum jelly seal.
d. Try to cross-thread an O2 flowmeter directly on the air outlet.

ANS: B
To avoid stocking a large variety of pressure regulators, flowmeters, and connectors for
special gas use, adapters can be used to convert various DISS connections so that they can be
used for a different purpose.

DIF: Analysis REF: p. 900 OBJ: 11

59. What is the greatest potential problem with quick-connect DISS systems (such as Ohio, NCG,
or Puritan)?
a. increased cost of flowmeter equipment
b. decreased accuracy in flowmeter equipment
c. difficulty in training new personnel
d. incompatibility among different manufacturers

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-21

ANS: D
Various manufacturers have designed specially shaped connectors for each gas (Figure 37-17).
Because each connector has a distinct shape, it does not fit into an outlet for another gas, and
each manufacturer has its own unique design.

DIF: Recall REF: p. 901 OBJ: 12

60. What device is used to reduce the pressure and control the flow of a compressed medical gas?
a. Bourdon gauge
b. regulator
c. flowmeter
d. reducing valve

ANS: B
If control of both pressure and flow is needed, a regulator is used.

DIF: Recall REF: p. 900 OBJ: 10

61. If you had to power a ventilator from a large cylinder of compressed gas, which of the
following devices would be required?
a. flowmeter
b. regulator
c. reducing valve
d. oxygen blender

ANS: C
For bulk delivery systems with individual station outlets, built-in reducing valves decrease the
delivered pressure to 50 psig.

DIF: Recall REF: p. 901 OBJ: 7

62. If you have to deliver medical gas to a patient from a compressed gas cylinder, which of the
following devices would you select to control gas flow?
a. regulator
b. oxygen blender
c. reducing valve
d. flowmeter

ANS: D

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-22

If the goal is to control gas delivery to a patient for oxygen therapy or nebulized medication
(see Chapters 36 and 38), a flowmeter must also be used.

DIF: Recall REF: p. 901 OBJ: 10

63. A very common application of the adjustable pressure-reducing valve is in combination with
which of the following?
a. flow restrictor
b. Thorpe tube flowmeter
c. Bourdon gauge
d. uncompensated flowmeter

ANS: C
The adjustable reducing valve commonly is used in combination with a Bourdon-type flow
gauge.

DIF: Recall REF: p. 902 OBJ: 10

64. How can one determine whether a pressure-reducing valve uses multiple stages for pressure
reduction?
a. by noting the number of gauges attached to the valve
b. by noting the DISS code
c. by noting the ASSS code
d. by noting the number of pressure relief vents

ANS: D
Because each pressure chamber has one safety relief vent, the user usually can determine the
number of stages in a reducing valve by noting the number of relief vents present.

DIF: Recall REF: p. 903 OBJ: 10

65. When minimal fluctuations in pressure and flow are critical factors, which of the following
pressure-reducing valves would be the best choice?
a. single-stage preset pressure-reducing valve
b. multiple-stage pressure-reducing valve
c. uncompensated Thorpe tube flowmeter
d. Bourdon adjustable pressure regulator

ANS: B

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-23

For this reason, a multiple-stage reducing valve should be considered only if minimal
fluctuations in pressure or flow are critical factors, as in research activities. For routine
hospital work, single-stage reducing valves are satisfactory.

DIF: Recall REF: p. 903 OBJ: 10

66. To clean a cylinder valve outlet of foreign material, what should you do?
a. Wipe the valve outlet with a light oil.
b. Quickly open, then close, the valve.
c. Blow into the valve outlet a few times.
d. Wipe the valve outlet with an alcohol swab.

ANS: B
See Box 37-1.

DIF: Recall REF: p. 903 OBJ: 12

67. When used to control the flow of medical gases to a patient, how is a flow restrictor
classified?
a. variable-orifice, constant-pressure flowmeter device
b. fixed-orifice, variable-pressure flowmeter device
c. variable-orifice, variable-pressure flowmeter device
d. fixed-orifice, constant-pressure flowmeter device

ANS: D
A flow restrictor is a fixed-orifice, constant-pressure flowmeter device.

DIF: Recall REF: p. 904 OBJ: 8

68. Which of the following are advantages of a using a flow restrictor to control the delivery of
medical gases to a patient?
1. preset metered flow
2. low cost and simplicity
3. gravity independence
4. wide range of utility
a. 1, 2, and 3
b. 1, 2, and 4
c. 2 and 4
d. 3 and 4

ANS: A

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-24

See Table 37-6.

DIF: Recall REF: p. 904 OBJ: 8

69. When used to control the flow of medical gases to a patient, how is a Bourdon gauge
classified?
a. fixed-orifice, variable-pressure flowmeter device
b. fixed-orifice, constant-pressure flowmeter device
c. variable-orifice, variable-pressure flowmeter device
d. variable-orifice, constant-pressure flowmeter device

ANS: A
The Bourdon gauge is a fixed-orifice, variable-pressure flowmeter device.

DIF: Recall REF: p. 904 OBJ: 10

70. You are preparing to conduct a complex transport of a patient receiving O2, and you expect to
have to alter O2 flows during the transport. Which of the following devices would best meet
your needs?
a. uncompensated Thorpe tube
b. flow restrictor
c. compensated Thorpe tube
d. Bourdon gauge

ANS: D
The Bourdon gauge is the best choice when a flowmeter cannot be maintained in an upright
position.

DIF: Recall REF: p. 905 OBJ: 10

71. Which of the following is FALSE about a Bourdon gauge?

a. It is always used with an adjustable high pressure-reducing valve.
b. It actually senses pressure but is calibrated to display flow.
c. It reads a flow higher than actual if downstream pressure increases.
d. It will register zero flow when the outlet is completely blocked.

ANS: D
Because it measures upstream pressure, the gauge registers flow even when the outlet is
completely blocked (Figure 37-24).

DIF: Recall REF: p. 905 OBJ: 10

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-25

72. If you have to deliver O2 to a patient directly from a bedside outlet station, which of the
following devices would you select?
a. Thorpe tube flowmeter
b. Bourdon-type gauge
c. pressure-reducing valve
d. medical gas regulator

ANS: A
The Thorpe tube flowmeter (Figure 37-26) is always attached to a 50-psig source, either a
preset pressure-reducing valve or a bedside station outlet.

DIF: Application REF: p. 906 OBJ: 10

73. When used to control the flow of medical gases to a patient, how is a Thorpe tube classified?
a. variable-orifice, constant-pressure flowmeter device
b. fixed-orifice, constant-pressure flowmeter device
c. variable-orifice, variable-pressure flowmeter device
d. fixed-orifice, variable-pressure flowmeter device

ANS: A
Compared with the flow restrictor and the Bourdon gauge, the Thorpe tube functions as a
variable-orifice, constant-pressure flowmeter device, so increasing the size of the orifice
increases the gas flow.

DIF: Recall REF: p. 906 OBJ: 10

74. Which of the following is TRUE about an uncompensated Thorpe tube?

a. flow lower than actual if downstream pressure increases
b. fixed-orifice, variable-pressure flowmeter device
c. flow-control needle valve placed distal to the flow tube
d. accuracy unaffected by changes in downstream resistance

ANS: A
Under these conditions, an uncompensated Thorpe tube falsely shows a flow lower than that
actually delivered to the patient.

DIF: Recall REF: p. 907 OBJ: 10

75. Which of the following is FALSE about a compensated Thorpe tube?

a. variable-orifice, constant-pressure flowmeter device

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-26

b. calibrated in L/min at atmospheric pressure

c. flow-control needle valve placed distal to the flow tube
d. accuracy unaffected by changes in downstream resistance

ANS: B
The scale of the compensated Thorpe tube flowmeter is calibrated at 50 psig instead of at
atmospheric pressure.

DIF: Recall REF: p. 907 OBJ: 10

76. Which of the following devices would you select if the goal was to accurately meter the flow
through a jet nebulizer?
a. Bourdon gauge
b. flow restrictor
c. uncompensated Thorpe tube
d. compensated Thorpe tube

ANS: D
See Mini Clini p. 908.

DIF: Recall REF: p. 908 OBJ: 10

77. What is the only major factor limiting the use of pressure-compensated Thorpe tube
flowmeters?
a. downstream resistance
b. effect of position (gravity)
c. DISS connector availability
d. use with gases other than O2

ANS: B
The only factor limiting the use of a pressure-compensated Thorpe tube is gravity. Because it
is accurate only in an upright position, a Thorpe tube is not the ideal choice for patient
transport. In these cases, the gravity-independent Bourdon gauge is a satisfactory alternative.

DIF: Recall REF: p. 907 OBJ: 10

78. You are called by a nursing home to help set up O2 for a patient, delivered through a jet
nebulizer. Unfortunately, all that is available is an old uncompensated Thorpe tube flowmeter.
When set to 8 L/min, the nebulizer creates an additional 30 psig of downstream pressure.
About what flow of O2 will the patient now receive?
a. 4 L/min

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
 Test bank 37-27

b. 6 L/min
c. 8 L/min
d. 12 L/min

ANS: D
See Figure 37-28.

DIF: Analysis REF: p. 907 OBJ: 10

79. The needle valve of a flowmeter with a ball and float tube is completely closed. When you
plug the flowmeter into a gas source, the float does not move. Which of the following can be
concluded?
a. The device is not calibrated at 50 psi.
b. The device is a Bourdon-gauge flowmeter.
c. The device is pressure compensated.
d. The device is affected by gravity.

ANS: C
See Figure 37-29.

DIF: Application REF: p. 907 OBJ: 11

80. When using a Bourdon gauge against high outflow resistance, what will the flowmeter
reading show?
a. exceed actual flow
b. be less than actual flow
c. equal actual flow
d. equal 50 psi

ANS: A
See Figure 37-29.

DIF: Recall REF: p. 907 OBJ: 10

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.