Airway Clearance Techniques Flashcards
(95 cards)
1
Q
A normal cough reflex includes which of the following phases?
- irritation
- inspiration
- compression
- expulsion
A
1, 2, 3, and 4
- irritation
- inspiration
- compression
- expulsion
2
Q
Which of the following is/are necessary for normal airway clearance?
- patent airway
- functional mucociliary escalator
- effective cough
A. 2 and 3
B. 1 and 2
C. 1, 2, 3
D. 2
A
C.1, 2, 3
- patent airway
- functional mucociliary escalator
- effective cough
3
Q
Which of the following can provoke a cough?
- anesthesia
- foreign bodies
- infection
- irritating gases
A. 2, 3, and 4
B. 3 and 4
C. 2 and 4
D. 1, 2, and 3
A
A. 2, 3, and 4
- foreign bodies
- infectioN
- irritating gases
4
Q
Which of the following occur(s) during the compression phase of a cough?
- expiratory muscle
- contraction opening of the glottis
- rapid drop in alveolar pressure
A. 2 and 3
B. 1 and 2
C. 1
D. 1 and 3
A
1.expiratory muscle
5
Q
Retention of secretions can result in full or partial airway obstruction. Mucus plugging can result in which of the following?
- hypoxemia
- atelectasis
- Shunting
A. 1, 2, and 3
B. 1 and 3
C. 2 and 3
D. 1 and 2
A
A. 1, 2, and 3
- hypoxemia
- atelectasis
- Shunting
6
Q
Partial airway obstruction can result in all of the following except:
A. ventilation/perfusion ratio imbalances
B. air-trapping or overdistention
C. increased work of breathing
D. increased expiratory flows
A
D. increased expiratory flows
7
Q
A patient with abdominal muscle weakness is having difficulty developing an effective cough. Which of the following phases of the cough reflex are primarily affected in this patient?
- irritation
- inspiration
- compression
- expulsion
A. 3 and 4
B. 2 and 4
C. 2, 3, and 4
D. 1, 2, and 3
A
A. 3 and 4
- compression
- expulsion
8
Q
A patient recovering from anesthesia after abdominal surgery is having difficulty developing an effective cough. Which of the following phases of the cough reflex are primarily affected in this patient?
A. compression
B. expulsion
C. inspiration
D. irritation
A
D. irritation
9
Q
A patient with a tracheostomy tube is having difficulty developing an effective cough. Which of the following phases of the cough reflex are primarily affected in this patient
A. irritation
B. compression
C. inspiration
D. expulsion
A
B. compression
10
Q
A patient with a neuromuscular disorder causing generalized muscle weakness is having difficulty developing an effective cough. Which of the following cough phases are primarily affected in this patient
A. expulsion
B. compression
C. inspiration
D. irritation
A
C. inspiration
11
Q
All of the following can impair mucociliary clearance in intubated patients except:
A. use of respiratory stimulants
B. inadequate humidification
C. high inspired oxygen concentrations
D. tracheobronchial suctioning
A
A. use of respiratory stimulants
12
Q
ll of the following drug categories can impair mucociliary clearance in intubated patients except:
A. general anesthetics
B. narcotics
C. opiates
D. bronchodilators
A
D. bronchodilators
13
Q
Conditions that can affect airway patency and cause abnormal clearance of secretions include which of the following?
- foreign bodies
- tumors
- inflammation
- bronchospasm
A. 2 and 4
B. 1, 2, 3, and 4
C. 2, 3, and 4
D. 1, 2, and 3
A
B. 1, 2, 3, and 4
- foreign bodies
- tumors
- inflammation
- bronchospasm
14
Q
Which of the following conditions alter normal mucociliary clearance?
- bronchospasm
- cystic fibrosis (CF)
- ciliary dyskinesia
A. 1, 2, and 3
B. 1 and 2
C. 1 and 3
D. 2 and 3
A
D. 2 and 3
- cystic fibrosis (CF)
- ciliary dyskinesia
15
Q
Conditions that can lead to bronchiectasis include all of the following except:
a. chronic airway infection
b. muscular dystrophy
c. foreign body aspiration
d. obliterative bronchiolitis
A
b.muscular dystrophy
16
Q
All of the following conditions impair secretion clearance by affecting the cough reflex except:
A. chronic bronchitis
B. muscular dystrophy
C. amyotrophic lateral sclerosis
D. cerebral palsy
A
A. chronic bronchitis
17
Q
All of the following are goals of airway clearance therapy except:
A. Reverse the underlying disease process.
B. Help mobilize retained secretion.
C. Reduce the work of breathing.
D. Improve pulmonary gas exchange.
A
A. Reverse the underlying disease process.
18
Q
Which of the following acutely ill patients is LEAST likely to benefit from application of chest physical therapy?
A. patient with copious amounts of secretions
B. patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD)
C. patient with acute lobar atelectasis
D. patient with low due to unilateral infiltrates
A
B. patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD)
19
Q
Which of the following conditions are associated with chronic production of large volumes of sputum?
- bronchiectasis
- pulmonary fibrosis
- cystic fibrosis
- chronic bronchitis
A. 2 and 4
B. 1, 2, 3, and 4
C. 1, 3, and 4
D. 3 and 4
A
C. 1, 3, and 4
- bronchiectasis
- cystic fibrosis
- chronic bronchitis
20
Q
In general, chest physical therapy can be expected to improve airway clearance when a patient’s sputum production exceeds what volume?
A. 15 ml/day
B. 10 ml/day
C. 20 ml/day
D. 30 ml/day
A
D. 30 ml/day
21
Q
Which of the following measures would you use to ask patients for the presence of copious mucus production?
A. 1 gallon
B. 1 tablespoon
C. 1 ounce
D. 1 pint
A
C. 1 ounce
22
Q
What are the best documented preventive uses of airway clearance therapy?
- Prevent retained secretions in the acutely ill.
- Maintain lung function in cystic fibrosis.
- Prevent postoperative pulmonary complications.
A. 2 and 3
B. 1 and 2
C. 1 and 3
D. 1, 2, and 3
A
B. 1 and 2
- Prevent retained secretions in the acutely ill.
- Maintain lung function in cystic fibrosis.
23
Q
When assessing the potential need for postoperative airway clearance for a patient, all of the following factors are relevant except:
A. patient’s age and respiratory history
B. number of prior surgical procedures
C. type of anesthesia (e.g., local versus general)
D. nature and duration of current surgery
A
B. number of prior surgical procedures
24
Q
All of the following laboratory data are essential in assessing a patient’s need for airway clearance therapy except:
A. pulmonary function tests (PFTs)
B. ABGs/oxygen saturation
C. hematology results
D. chest radiograph
A
C. hematology results
25
Key considerations in initial and ongoing patient assessment for chest physical therapy include which of the following
1. posture and muscle tone
2. breathing pattern and ability to cough
3. sputum production
4. cardiovascular stability
A. 1, 2, 3, and 4
B. 1, 2, and 3
C. 2 and 4
D. 3 and 4
A. 1, 2, 3, and 4
1. posture and muscle tone
2. breathing pattern and ability to cough
3. sputum production
4. cardiovascular stability
26
Which of the following clinical signs indicate that a patient is having a problem with retained secretions?
1. lack of sputum production
2. labored breathing
3. development of a fever
4. increased inspiratory and expiratory crackles
A. 1, 2, and 3
B. 1, 2, 3, and 4
C. 2 and 4
D. 3 and 4
B. 1, 2, 3, and 4
1. lack of sputum production
2. labored breathing
3. development of a fever
4. increased inspiratory and expiratory crackles
27
All of the following are considered airway clearance therapies except:
A. incentive spirometry
B. postural drainage and percussion
C. percussion, vibration, and oscillation
D. positive airway pressure
A. incentive spirometry
28
The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following?
A. directed coughing
B. breathing exercises
C. hyperinflation therapy
D. postural drainage therapy
D. postural drainage therapy
29
Postural drainage should be considered in all of the following situations except:
a. in patients with chronic obstructive lung disease
b. in patients who expectorate more than 25 to 30 ml sputum per day
c. in the presence of atelectasis caused by mucus plugging
d. in patients with cystic fibrosis or bronchiectasis
a.in patients with chronic obstructive lung disease
30
Absolute contraindications for postural drainage include which of the following?
1. head and neck injury (until stabilized)
2. active hemorrhage with hemodynamic instability
3. uncontrolled airway at risk for aspiration
A. 1 and 2
B. 2 and 3
C. 1 and 3
D. 1, 2, and 3
A. 1 and 2
1. head and neck injury (until stabilized)
2. active hemorrhage with hemodynamic instability
31
Which of the following is NOT a hazard or complication of postural drainage therapy?
A. acute hypotension
B. cardiac arrhythmias
C. pulmonary barotraumas
D. increased intracranial pressure
C. pulmonary barotraumas
32
Primary objectives for turning include all of the following except to:
A. prevent postural hypotension
B. prevent retention of secretions
C. improve oxygenation
D. promote lung expansion
A. prevent postural hypotension
33
Which if the following is the only absolute contraindication to turning?
A. when the patient cannot or will not change body position
B. when poor oxygenation is associated with unilateral lung disease
C. when the patient has or is at high risk for atelectasis
D. when the patient has unstable spinal cord injuries
D. when the patient has unstable spinal cord injuries
34
Which of the following is/are TRUE of postural drainage?
1.It is most effective in disorders causing excessive sputum.
2.It is most effective in head-down positions greater than 25 degrees.
3.It requires adequate systemic hydration to be effective.
4.It improves mucociliary clearance in normal subjects.
5.It improves pulmonary function in stable chronic obstructive pulmonary disease patients.
A. 3 and 5
B. 1, 2, and 4
C. 1, 2, and 3
D. 2 and 4
C. 1, 2, and 3
1. It is most effective in disorders causing excessive sputum.
2. It is most effective in head-down positions greater than 25 degrees.
3. It requires adequate systemic hydration to be effective.
35
In which of the following patients would you consider modifying any head-down positions used for postural drainage?
1. a patient with unstable blood pressure
2. a patient with a cerebrovascular disorder
3. a patient with systemic hypertension
4. a patient with orthopnea
A. 1, 2, 3, and 4
B. 2, 3, and 4
C. 2 and 4
D. 2 and 4
A. 1, 2, 3, and 4
1. a patient with unstable blood pressure
2. a patient with a cerebrovascular disorder
3. a patient with systemic hypertension
4. a patient with orthopnea
36
In setting up a postural drainage treatment schedule for a postoperative patient, which of the following information would you try to obtain from the patient’s nurse? patient’s medication schedule patient’s meal schedule location of surgical incisiona.1 and 2b.2 and 3c.1 and 3d.1, 2, and 3 In setting up a postural drainage treatment schedule for a postoperative patient, which of the following information would you try to obtain from the patient’s nurse?
1. patient’s medication schedule
2. patient’s meal schedule
3. location of surgical incision
A. 2 and 3
B. 1, 2, and 3
C. 1 and 3
D. 1 and 2
B. 1, 2, and 3
37
A patient about to receive postural drainage and percussion is attached to an electrocardiographic (ECG) monitor and is receiving both intravenous (IV) solutions and O2 (through a nasal cannula). Which of the following actions would be appropriate for this patient?
A. Inspect and adjust the equipment to ensure function during therapy.
B. Turn off the IV line, but keep the monitor on and the O2 going.
C. Cancel the therapy because the patient cannot be repositioned.
D. Turn off the ECG monitor, but keep the IV line and O2 going.
A. Inspect and adjust the equipment to ensure function during therapy.
38
Which of the following are mandatory components of the preassessment for postural drainage?
1. vital signs
2. bedside pulmonary function tests
3. auscultation
A. 1, 2, and 3
B. 1 and 2
C. 2 and 4
D. 1 and 3
D. 1 and 3
1. vital signs
3. auscultation
39
If a patient’s chest radiograph shows infiltrates in the posterior basal segments of the lower lobes, what postural drainage position would you recommend?
A. head down, patient prone with a pillow under abdomen
B. patient prone with a pillow under head, bed flat
C. patient supine with a pillow under knees, bed flat
D. head down, patient supine with a pillow under knees
A. head down, patient prone with a pillow under abdomen
40
A physician orders postural drainage for a patient with an abscess in the right middle lobe. Which of the following positions would you recommend for this patient?
A. head down, patient prone with a pillow under abdomen
B. patient supine with a pillow under knees, bed flat
C. head down, patient supine with a pillow under knees
D. head down, patient half-rotated to left, right lung up
D. head down, patient half-rotated to left, right lung up
41
A physician orders postural drainage for a patient with aspiration pneumonia in the superior segments of the left lower lobe. Which of the following positions would you recommend for this patient?
A. patient prone with a pillow under abdomen, bed flat
B. head down, patient supine with a pillow under knees
C. head down, patient prone with a pillow under abdomen
D. patient supine with a pillow under knees, bed flat
A. patient prone with a pillow under abdomen, bed flat
42
A physician orders postural drainage for a patient with aspiration pneumonia in the anterior segments of the upper lobes. Which of the following positions would you recommend for this patient?
A. patient prone with a pillow under abdomen, bed flat
B. patient supine with a pillow under knees, bed flat
C. head down, patient supine with a pillow under knees
D. head down, patient prone with a pillow under abdomen
B. patient supine with a pillow under knees, bed flat
43
If tolerated, a specified postural drainage position should be maintained for at least how long?
A. 3 to 15 minutes
B. 1 to 2 minutes
C. 20 to 30 minutes
D. 3 to 5 minutes
A. 3 to 15 minutes
44
While reviewing the chart of a patient receiving postural drainage therapy, you notice that the patient tends to undergo mild desaturation during therapy (a drop in SpO2 from 93% to 89% to 90%). Which of the following would you recommend to manage this problem?
A. Decrease the frequency of treatments.
B. Increase the patient’s FIO2 during therapy.
C. Discontinue the postural drainage therapy entirely.
D. Discontinue the percussion and vibration only.
B. Increase the patient’s FIO2 during therapy.
45
Why is strenuous patient coughing during postural drainage in a head-down position contraindicated?
A. It can cause air trapping and pulmonary distension.
B. It can impair the mucociliary clearance mechanism.
C. It can markedly increase intracranial pressure (ICP).
D. It can increase expiratory airway resistance (Raw).
C. It can markedly increase intracranial pressure (ICP).
46
Soon after you initiate postural drainage in a Trendelenburg position, the patient develops a vigorous and productive cough. Which of the following actions would be appropriate at this time?
A. Drop the head of the bed farther and encourage more coughing.
B. Move the patient to the sitting position until the cough subsides.
C. Maintain the drainage position while carefully watching the patient.
D. Stop the treatment at once and report the incident to the nurse.
B. Move the patient to the sitting position until the cough subsides.
47
All of the following would indicate a successful outcome for postural drainage therapy except:
A. normalization in ABGs
B. decreased sputum production
C. improvement in chest radiograph
D. improved breath sounds
B. decreased sputum production
48
All of the following responses indicate that postural drainage should be terminated except:
A. complaint of discomfort
B. severe bradycardia
C. irregular blood pressure
D. severe tachycardia
A. complaint of discomfort
49
Which of the following should be charted after completing a postural drainage treatment?
1. amount and consistency of sputum produced
2. patient tolerance of procedure
3. position(s) used (including time)
4. any untoward effects observed
A. 3 and 4
B. 1, 2, 3, and 4
C. 1, 2, and 3
D. 2 and 4
B. 1, 2, 3, and 4
1. amount and consistency of sputum produced
2. patient tolerance of procedure
3. position(s) used (including time)
4. any untoward effects observed
50
Percussion should NOT be performed over which of the following areas?
1. surgery sites
2. bony prominences
3. fractured ribs
A. 3
B. 1 and 2
C. 1, 2, and 3
D. 2 and 3
C. 1, 2, and 3
1. surgery sites
2. bony prominences
3. fractured ribs
51
Properly performed chest vibration is applied at what point?
A. throughout expiration
B. at the start of inspiration
C. at the end of expiration
D. throughout inspiration
A. throughout expiration
52
Directed coughing is useful in helping to maintain airway clearance in all of the following cases except:
A. spinal cord injury
B. cystic fibrosis
C. acute asthma
D. bronchiectasis
C. acute asthma
53
Indications for directed coughing include all of the following except to:
A. help prevent postoperative pulmonary complications
B. obtain sputum specimens for diagnostic analysis
C. enhance other airway clearance therapies
D. help patients with tuberculosis clear secretions
D. help patients with tuberculosis clear secretions
54
All of the following are contraindications for directed coughing except the presence of:
A. necrotizing pulmonary infection
B. infection spread by droplet nuclei
C. reduced coronary artery perfusion
D. elevated intracranial pressure or intracranial aneurysm
A. necrotizing pulmonary infection
55
For which of the following patients directed coughing might be contraindicated?
1. patient with poor coronary artery perfusion
2. postoperative upper-abdominal surgery patient
3. long-term care patient with retained secretions
4. patient with an acute unstable spinal injury
A. 1 and 4
B. 2 and 3
C. 2, 3, and 4
D. 1, 2, and 3
A. 1 and 4
1. patient with poor coronary artery perfusion
4. patient with an acute unstable spinal injury
56
What factors can hinder effective coughing
1. artificial airways
2. neuromuscular disease
3. systemic dehydration
4. pain or fear of pain
5. use of expectorants
A. 2, 4, and 5
B. 1, 2, 3, and 4
C. 1, 2, 3, 4, and 5
D. 1, 2, and 4
B. 1, 2, 3, and 4
1. artificial airways
2. neuromuscular disease
3. systemic dehydration
4. pain or fear of pain
57
Key consideration in teaching a patient to develop an effective cough regimen includes which of the following?
1. strengthening of the expiratory muscles
2. instruction in breathing control
3. instruction in proper positioning
A. 1, 2, and 3
B. 1 and 3
C. 2 and 3
D. 1 and 2
A. 1, 2, and 3
1. strengthening of the expiratory muscles
2. instruction in breathing control
3. instruction in proper positioning
58
What is the ideal patient position for directed coughing?
A. supine, with forearms relaxed and feet supported
B. sitting with one shoulder rotated inward, the head and spine slightly flexed
C. supine, with knees slightly flexed and feet braced
D. prone, with the head and spine slightly flexed
B. sitting with one shoulder rotated inward, the head and spine slightly flexed
59
A patient recovering from abdominal surgery is having difficulty developing an effective cough. Which of the following actions would you recommend to aid this patient in generating a more effective cough?
1. coordinating coughing with pain medication
2. using the forced expiration technique (FET)
3. supplying manual epigastric compression
4. “splinting” the operative site
A. 2, 3, and 4
B. 3 and 4
C. 1, 2, and 3
D. 1, 2, and 4
D. 1, 2, and 4
1. coordinating coughing with pain medication
2. using the forced expiration technique (FET)
4. “splinting” the operative site
60
Strenuous expiratory efforts in some chronic obstructive pulmonary disease (COPD) patients limit the effectiveness of coughing. Why is this so?
A. Strenuous expiration causes the upper airway to collapse.
B. High expiratory pleural pressures compress the small airways.
C. All COPD patients have severe abdominal muscle weakness.
D. The accessory muscles of inspiration oppose the exhalation.
B. High expiratory pleural pressures compress the small airways.
61
A chronic obstructive pulmonary disease patient cannot develop an effective cough. Which of the following would you recommend to help this patient generate a more effective cough?
1. enhancing expiratory flow by bending forward at the waist
2. using short, expiratory bursts or the “huffing” method
3. using only moderate (as opposed to full) inspiration
4. having the patient “tense” the neck muscles while coughing
A. 1, 2, and 4
B. 1, 2, and 3
C. 2 and 4
D. 3 and 4
B. 1, 2, and 3
1. enhancing expiratory flow by bending forward at the waist
2. using short, expiratory bursts or the “huffing” method
3. using only moderate (as opposed to full) inspiration
62
A nurse explains to you that a certain neuromuscular patient cannot develop a good cough. Which of the following would you consider to manage this patient’s clearance problem?
1. combining manual chest compression with suctioning
2. coordinating the coughing regimen with pain medication
3. using the autogenic drainage method
4. using mechanical insufflation-exsufflation
A. 1, 2, and 3
B. 1, 2, and 4
C. 1 and 4
D. 2 and 3
C. 1 and 4
1. combining manual chest compression with suctioning
4. using mechanical insufflation-exsufflation
63
Which of the following is false about the FET?
A. It occurs from mid to low lung volume without glottis closure.
B. It occurs from mid to high lung volume without glottis closure.
C. It has a period of diaphragmatic breathing and relaxation.
D. It causes less bronchiolar collapse than traditional coughing.
B. It occurs from mid to high lung volume without glottis closure.
64
Maintaining an open glottis during coughing (as with the FET) can help to minimize increases in pleural pressure and lessen the likelihood of bronchiolar collapse. Which of the following techniques can aid the practitioner in teaching the patient this maneuver?
A. having the patient phonate or “huff” during expiration
B. having the patient “tense” the neck muscles while coughing
C. having the patient inhale slowly through the nose
D. telling the patient to exert effort, as in straining at stool
A. having the patient phonate or “huff” during expiration
65
Whether using traditional methods or the FET, a period of diaphragmatic breathing and relaxation should always follow attempts at coughing. What is the purpose of this approach?
A. to decrease the likelihood of acute air-trapping
B. to allow the patient time to ask questions
C. to restore lung volume and minimize fatigue
D. to restore the patient’s SO2
C. to restore lung volume and minimize fatigue
66
What is the correct sequence of actions during the active cycle of breathing (ACB) method?
1. relaxation and breathing control
2. three or four thoracic expansion exercises
3. one or two FETs (huffs)
A. 1, 2, 1, and 3
B. 1, 3, 2, and 1
C. 3, 1, 2, and 1
D. 1, 3, 1, and 2
A.1, 2, 1, and 3
1. relaxation and breathing control
2. three or four thoracic expansion exercises
3. one or two FETs (huffs)
67
During autogenic drainage, when should patients be encouraged to cough?
A. throughout the procedure
B. after phase 2 only
C. after phase 3 only
D. after phase 1 only
C. after phase 3 only
68
What does phase 1 of autogenic drainage involve?
A. breathing at low to mid-lung volumes
B. an inspiratory capacity maneuver, followed by breathing at low lung volumes
C. vigorous coughing using the FET
D. progressive breaths at higher and higher lung volumes
B. an inspiratory capacity maneuver, followed by breathing at low lung volumes
69
What happens during the exsufflation phase of mechanical insufflation-exsufflation
1. Airway pressure is abruptly decreased to –30 to –50 cm H2O.
2. Negative airway pressure is maintained for 2 to 3 seconds.
3. Peak expiratory “cough” flows reach near normal values.
A. 2 and 3
B. 1 and 2
C. 1, 2, and 3
D. 1 and 3
C. 1, 2, and 3
1. Airway pressure is abruptly decreased to –30 to –50 cm H2O.
2. Negative airway pressure is maintained for 2 to 3 seconds.
3. Peak expiratory “cough” flows reach near normal values.
70
A typical mechanical insufflation-exsufflation treatment session should continue until what point?
1. Secretions are cleared.
2. The vital capacity (VC) returns to baseline.
3. The SpO2 returns to baseline.
A. 1 and 2
B. 2 and 3
C. 1 and 3
D. 1, 2, and 3
D. 1, 2, and 3
1. Secretions are cleared.
2. The vital capacity (VC) returns to baseline.
3. The SpO2 returns to baseline.
71
Under which of the following conditions would mechanical insufflation-exsufflation with an oronasal mask probably NOT be effective?
1. if the glottis collapses during exsufflation
2. presence of fixed airway obstruction
3. presence of a chronic neuromuscular disorder
A. 2 and 3
B. 1 and 2
C. 1, 2, and 3
D. 1 and
B. 1 and 2
1. if the glottis collapses during exsufflation
2. presence of fixed airway obstruction
72
Which of the following are potential indications for positive airway pressure therapies?
1. reduce air-trapping in asthma or chronic obstructive pulmonary disease
2. help mobilize retained secretions
3. prevent or reverse atelectasis
4. optimize bronchodilator delivery
A. 3 and 4
B. 1, 2, and 3
C. 1, 2, 3, and 4
D. 2 and 4
C. 1, 2, 3, and 4
1. reduce air-trapping in asthma or chronic obstructive pulmonary disease
2. help mobilize retained secretions
3. prevent or reverse atelectasis
4. optimize bronchodilator delivery
73
Contraindications for positive airway pressure therapies include all of the following except:
A. preexisting pulmonary barotrauma (e.g., pneumothorax)
B. air-trapping/pulmonary overdistention in chronic obstructive pulmonary disease
C. intracranial pressure exceeding 20 mm Hg
D. recent facial, oral, or skull surgery or trauma
B. air-trapping/pulmonary overdistention in chronic obstructive pulmonary disease
74
All of the following are hazards of positive airway pressure therapies (EPAP, PEP, CPAP) except:
A. decreased venous return
B. increased intracranial pressure
C. pulmonary barotrauma
D. epistaxis
D. epistaxis
75
Hazards of positive airway pressure therapies associated with the apparatus used include which of the following?
1. increased work of breathing
2. claustrophobia
3. epistaxis
4. vomiting and aspiration
5. skin breakdown and discomfort
A. 1, 3, and 4
B. 2, 3, 4, and 5
C. 3, 4, and
D. 1, 2, 3, 4, and 5
D. 1, 2, 3, 4, and 5
1. increased work of breathing
2. claustrophobia
3. epistaxis
4. vomiting and aspiration
5. skin breakdown and discomfort
76
A physician orders positive expiratory pressure therapy for a 14-year-old child with cystic fibrosis. All of the following responses should be monitored on this patient except:
A. peak flow or forced expiratory volume in 1 second (FEV1) per forced vital capacity percentage
B. patient’s minute volume
C. breath sounds
D. quantity and character of sputum
B. patient’s minute volume
77
Which of the following best describes positive expiratory pressure (PEP) therapy?
A. expiration against a fixed threshold resistance
B. expiration against a variable flow resistance
C. inspiration against a fixed threshold resistance
D. inspiration against a variable flow resistance
B. expiration against a variable flow resistance
78
In theory, how does positive expiratory pressure (PEP) help to move secretions into the larger airways?
1. filling underaerated segments through collateral ventilation
2. preventing airway collapse during expiration
3. causing bronchodilation during inspiration
A. 1, 2, and 3
B. 2 and 3
C. 1 and 3
D. 1 and 2
D. 1 and 2
1. filling underaerated segments through collateral ventilation
2. preventing airway collapse during expiration
79
Proper instructions for positive expiratory pressure include all of the following except:
A. Exhale forcefully and maintain an expiratory pressure of 10 to 20 cm H2O.
B. Take in a breath that is larger than normal, but do not fill lungs completely.
C. Repeat the cycle 4 to 8 times, not to exceed 20 minutes.
D. After 10 to 20 breaths, take two or three “huff”’ coughs, and rest as needed.
A. Exhale forcefully and maintain an expiratory pressure of 10 to 20 cm H2O.
80
A physician orders bronchodilator drug therapy in combination with positive expiratory pressure (PEP). Which of the following methods could you use to provide this combined therapy?
1. Attach a dry powder inhaler in-line with the PEP apparatus.
2. Attach a metered-dose inhaler to the system’s one-way valve inlet.
3. Place a small-volume nebulizer in-line with the PEP apparatus.
A. 1 and 2
B. 2 and 3
C. 1, 2, and 3
D. 1 and 3
B. 2 and 3
2. Attach a metered-dose inhaler to the system’s one-way valve inlet.
3. Place a small-volume nebulizer in-line with the PEP apparatus.
81
What is the movement of small volumes of air back and forth in the respiratory tract at high frequencies (12 to 25 Hz) called?
A. huffing
B. oscillation
C. active cycle breathing
D. tidal breathing
B. oscillation
82
Which of the following parts are required to conduct high-frequency external chest wall compression?
1. variable air-pulse generator
2. expiratory flow resistor with one-way valve
3. nonstretch inflatable thoracic vest
A. 1, 2, and 3
B. 1 and 2
C. 1 and 3
D. 2 and 3
C. 1 and 3
1. variable air-pulse generator
3. nonstretch inflatable thoracic vest
83
All of the following are typical of high-frequency external chest wall compression therapy except:
A. one to six sessions per day
B. 30-minute therapy sessions
C. long inspiratory oscillations
D. oscillations at 5 to 25 Hz
C. long inspiratory oscillations
84
Which of the following determines effectiveness of high-frequency external chest wall compression therapy?
1. compression frequency
2. largest volumes
3. flow bias
A. 1
B. 2 and 3
C. 2
D. 1 and 3
D. 1 and 3
1. compression frequency
3. flow bias
85
The airway clearance technique that uses a pneumatic device to deliver compressed gas minibursts to the airway at rates above 100/min best describes which of the following?
A. intermittent positive-pressure breathing
B. high-frequency external chest wall compression
C. active cycle of breathing
D. intrapulmonary percussive ventilation
A. intermittent positive-pressure breathing
86
Which of the following is true about exercise and airway clearance?
1. Exercise can enhance mucus clearance.
2. Exercise can improve pulmonary function.
3. Exercise can improve matching.
4. Exercise can cause desaturation in some patients.
A. 1, 2, 3, and 4
B. 1, 2, and 3
C. 2, 3, and 4
D. 1, 3, and 4
A. 1, 2, 3, and 4
1. Exercise can enhance mucus clearance.
2. Exercise can improve pulmonary function.
3. Exercise can improve matching.
4. Exercise can cause desaturation in some patients.
87
Patients can control a flutter valve’s pressure by changing what?
A. the expired volume
B. the angle of the device
C. their inspiratory flow
D. their expiratory flow
D. their expiratory flow
88
Advantages of the flutter valve over other airway clearance methods include all of the following except:
A. good patient acceptance
B. independent use
C. full portability
D. greater effectiveness
D. greater effectiveness
89
Which of the following is not an advantage of the Acapella over the flutter?
A. It can be used in any posture.
B. It can customize frequency.
C. It can customize flow resistance.
D. It is more portable.
D. It is more portable.
90
Which of the following should be considered when selecting a airway clearance strategy
1. patient’s goals, motivation, and preferences
2. effectiveness and limitations of technique or method
3. patient’s age, ability to learn, and tendency to fatigue
4. need for assistants, equipment, and cost
A. 1, 3, and 4
B. 1, 2, and 3
C. 1, 2, 3, and 4
D. 2 and 3
C. 1, 2, 3, and 4
1. patient’s goals, motivation, and preferences
2. effectiveness and limitations of technique or method
3. patient’s age, ability to learn, and tendency to fatigue
4. need for assistants, equipment, and cost
91
Which of the following airway clearance techniques would you recommend for a 15-month-old infant with cystic fibrosis?
A. intrapulmonary percussive ventilation
B. positive expiratory pressure therapy
C. postural drainage, percussion, and vibration
D. mechanical insufflation-exsufflation
C.postural drainage, percussion, and vibration
92
Which of the following airway clearance techniques would you recommend for a patient with a neurologic abnormality (bulbar palsy) and intact upper airway?
1. postural drainage, percussion, and vibration
2. positive expiratory pressure therapy
3. mechanical insufflation-exsufflation
A. 1 and 3
B. 1, 2, and 3
C. 1 and 2
D. 2 and 3
A. 1 and 3
1. postural drainage, percussion, and vibration
3. mechanical insufflation-exsufflation
93
In assessing an adult outpatient for airway clearance therapy, you notice the following: (1) no history of cystic fibrosis or bronchiectasis, (2) sputum production of 30 to 50 ml/day, (3) an effective cough, and (4) good hydration. Which of the following would you recommend?
A. mechanical insufflation-exsufflation
B. intrapulmonary percussive ventilation
C. positive expiratory pressure therapy
D. postural drainage, percussion, and vibration
C. positive expiratory pressure therapy
94
Which of the following is the most appropriate airway clearance method for an infant with cystic fibrosis?
A. PDPV
B. exercise
C. PEP
D. MIE
A. PDPV - postural drainage, percussion, and vibration
95
What duration of time and pressure is recommended when using MIE devices to clear airways secretions in adults?
A. 10 to 30 cm H2O at 1 to 3 seconds
B. 10 to 30 cm H2O at 5 to 10 seconds
C. 30 to 50 cm H2O at 5 to 10 seconds
D. 30 to 50 cm H2O at 1 to 3 seconds
D. 30 to 50 cm H2O at 1 to 3 seconds
