Chapter 39 Stem

Question 1

Persistent breathing at small tidal volumes

Answer 1

compression atelectasis/passive atelectasis

Question 2

Which patient categories are at high risk for developing atelectasis?

Answer 2

Thoracic surgery
Abdominal surgery
Neuromuscular disorder
Sedation

Question 3

What is the major contributing factor in the development of postoperative atelectasis?

Answer 3

Repeatitive shallow breathing

Question 4

Which of the following groups of patients is not at risk for developing postoperative atelectasis?

Answer 4

pneumonia

Question 5

Which of the following clinical findings indicate the development of atelectasis?

Answer 5

opacified areas on a chest xray
diminshed or bronchial breath sounds
tachypnea

Question 6

How do all modes of lung expansion therapy aid lung expansion?

Answer 6

Increasing the transpulmonary pressure gradient

Question 7

How can the transpulmonary pressure gradient be increased?

Answer 7

Increasing aveolar pressure

Decreasing plueral pressure

Question 8

Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure include which of the following?

Answer 8

Postive end-expiratory pressure therapy
Intermittent positive-pressure breathing (IPPB)
Expiratory positive airway pressure (EPAP)

Question 9

Which of the following modes of lung expansion therapy is physiologically most normal?

Answer 9

Incentive spirometry

Question 10

An alert and cooperative 28-year-old woman with no prior history of lung disease underwent cesarean section 16 hours earlier. Her x-ray film currently is clear. Which of the following approaches to preventing atelectasis would you recommend for this patient?

Answer 10

Incentive spirometry

Question 11

Which of the following are potential indications for incentive spirometry?

Answer 11

Restrictive disorder (quadrapeligic)
Abdominal surgery of COPD patient
Presence of pulmonary atelectasis

Question 12

Which of the following situations is a contraindication for incentive spirometry?

Answer 12

Vital capacity less than 10 ml/kg
Cannot cooperate or follow instructions
Unconscious

Question 13

Which of the following is not a potential hazard or complication of incentive spirometry?

Answer 13

decreased cadiac output

Question 14

A postoperative patient using incentive spirometry complains of dizziness and numbness around the mouth after therapy sessions. What is the most likely cause of these symptoms?

Answer 14

Hyperventilation

Question 15

Incentive spirometry devices can generally be categorized as which of the following?

Answer 15

Flow-oriented

Volume-oriented

Question 16

Which of the following is FALSE about flow-oriented incentive spirometry devices?

Answer 16

Proved less effective than volumetric systems

Question 17

Which of the outcomes would indicate improvement in a patient previously diagnosed with atelectasis who has been receiving incentive spirometry?

Answer 17

Improved PaO2
Decreased respiratory rate
Improved chest radiolograph

Question 18

Ideally, when should high-risk surgical patients be oriented to incentive spirometry?

Answer 18

Preoperatively - before surgical procedure

Question 19

Successful application of incentive spirometry depends on:

Answer 19

Effectiveness of teaching the patient

Question 20

Correct instruction in the technique of incentive spirometry should include which of the following?

Answer 20

Diaphramic breathing at slow or moderate flows

Question 21

In performing the sustained maximal inspiration maneuver during incentive spirometry, the patient should be instructed to sustain the breath for at least how long?

Answer 21

5 to 10 seconds

Question 22

In observing a postoperative woman conduct incentive spirometry, you note repetitive performance of the sustained maximal inspiration maneuver at a rate of about 10 to 12/min. Which of the following would you recommend to her?

Answer 22

Take a 30 second rest period between breaths

Question 23

For patients receiving incentive spirometry, what is the minimum number of sustained maximal inspirations (SMIs) per hour that you would recommend?

Answer 23

minimum of 5 to 10 SMI

Question 24

What should the monitoring of patients using incentive spirometry include?

Answer 24

number of breaths per session
volume and flow goals achieved
maintenance of breath-hold
Patient effort and motivation

Question 25

The short-term application of inspiratory positive pressure to a spontaneously breathing patient best defines which of the following?

Answer 25

Intermittent positive-pressure breathing

Question 26

Which of the following is false about intermittent positive-pressure breathing?

Answer 26

The aveoli pressure decrease during inspiration.

Question 27

Intermittent positive-pressure breathing is associated with

Answer 27

a passive exhalation.