CHS Patient Assessment & Evaluation 2 — Questions and Answers
Question 1: A patient with a history of spontaneous pneumothorax presents for HBO therapy. What is the most appropriate action?
- Proceed with treatment at reduced pressure
- Obtain physician clearance and consider prophylactic chest tube (Correct answer)
- Delay treatment until the patient is asymptomatic for 6 months
- Administer supplemental oxygen at 2 L/min before treatment
Correct answer: Obtain physician clearance and consider prophylactic chest tube
Prior spontaneous pneumothorax is a relative contraindication requiring physician evaluation; prophylactic chest tube placement may be needed before HBO.
Question 2: Which ear exam finding would most likely lead to postponement of HBO therapy?
- Mild cerumen impaction
- Acute otitis media with effusion (Correct answer)
- Tympanosclerosis without perforation
- History of pressure equalization tubes that have extruded
Correct answer: Acute otitis media with effusion
Acute otitis media with effusion impairs Eustachian tube function and increases risk of tympanic membrane barotrauma during pressurization.
Question 3: During the pre-treatment assessment, a patient reports taking bleomycin for cancer. This is significant because HBO may cause:
- Increased hepatotoxicity
- Pulmonary oxygen toxicity potentiation (Correct answer)
- Hypoglycemia during treatment
- Peripheral neuropathy worsening
Correct answer: Pulmonary oxygen toxicity potentiation
Bleomycin sensitizes lung tissue to oxygen toxicity, making HBO a relative contraindication requiring oncologist consultation.
Question 4: A diabetic patient's blood glucose before HBO therapy is 60 mg/dL. What is the correct response?
- Proceed with treatment and monitor closely
- Administer insulin to normalize glucose first
- Delay treatment and provide a carbohydrate snack, then recheck (Correct answer)
- Cancel treatment for the day and notify the ordering physician
Correct answer: Delay treatment and provide a carbohydrate snack, then recheck
Hypoglycemia must be corrected before HBO because the metabolic demands of treatment can worsen low blood sugar.
Question 5: Which cranial nerve is primarily evaluated when assessing a patient's ability to auto-insufflate during descent?
- CN V (Trigeminal)
- CN VII (Facial)
- CN IX (Glossopharyngeal) (Correct answer)
- CN X (Vagus)
Correct answer: CN IX (Glossopharyngeal)
CN IX innervates the Eustachian tube musculature involved in auto-insufflation (Valsalva and Toynbee maneuvers).
Question 6: What baseline vital sign parameter is MOST important to document before each HBO treatment session for a patient with a recent stroke?
- Respiratory rate
- Blood pressure (Correct answer)
- Oxygen saturation on room air
- Body temperature
Correct answer: Blood pressure
Blood pressure must be documented because hypertension or hypotension can increase the risk of neurological complications during HBO in stroke patients.
Question 7: A patient reports taking disulfiram (Antabuse). This is relevant to HBO assessment because it:
- Increases CNS oxygen toxicity risk (Correct answer)
- Blocks Eustachian tube function
- Causes photosensitivity under pressure
- Lowers the seizure threshold independently
Correct answer: Increases CNS oxygen toxicity risk
Disulfiram inhibits superoxide dismutase, reducing the body's antioxidant defense and potentially increasing CNS oxygen toxicity risk during HBO.
CHS Patient Assessment & Evaluation 2
A patient with a history of spontaneous pneumothorax presents for HBO therapy.
What is the most appropriate action?