CHAPTER 5 - Therapeutic Procedure

Question 1

1. How should a CRT instruct a patient who has severe pulmonary emphysema to cough?
   A. The patient should be instructed to take as deep a
   breath as possible, and then cough as forcefully as
   possible.
   B. The patient should be instructed to place his
   hands across his abdomen and compress them inward
   as he coughs, following a full inspiration.
   C. The patient should be instructed to inhale slightly
   more than a tidal breath and exhale with short,
   rapid bursts of air.
   D. The patient should be instructed to place a pillow
   against his chest as he exhales moderately through
   pursed lips

Question 2

2. Which of the following factors should be included in documentation of a respiratory-therapy procedure?
   I. type of therapy
   II. date and time of administration
   III. effects of therapy
   IV. adverse effects noted
   A. I, II only
   B. I, III only
   C. I, II, III only
   D. I, II, III, IV

Question 3

3. How should a patient who is receiving helium-oxygen therapy be instructed to cough during this procedure?

A. The patient should be instructed to cough from total lung capacity.
B. The patient should be instructed to cough from a volume slightly larger than a tidal volume.
C. The patient should exhale rapidly through pursed lips from total lung capacity.
D. The patient should breathe a few breaths of room air before attempting to cough.

Question 4

4. What are some actions that family members who smoke can take to assist a COPD patient to quit smoking?

I. Avoid smoking-related activities.
II. Smoke low-nicotine cigarettes when the patient is present.
III. Create a calm, low-stress environment at home.
IV. Help remind the patient to avoid using nicotine gum in stressful situations.

A. I, III only
B. II, IV only
C. I, III, IV only
D. I, II, III, IV

Question 5

5. An asthmatic patient is about to be discharged from the hospital. What information must the CRT give the
   patient before the patient leaves the hospital?

I. how to avoid asthma triggers
II. how to use metered-dose inhalers (MDIs)
III. how to determine which spirometric test is best
IV. how to taper oral corticosteroids

A. I, II only
B. III, IV only
C. I, II, IV only
D. I, II, III, IV

Question 6

6. Which of the following information should be discussed with patients in a smoking-cessation program?
   I. how to help others quit smoking
   II. what type of withdrawal symptoms to expect
   III. how the body’s metabolism is affected
   IV. how to modify their own behavior

A. I, IV only
B. II, III only
C. II, III, IV only
D. I, II, III, IV

Question 7

7. Which of the following responses or levels of consciousness reflect a patient’s ability to follow instructions?

A. orientation to person
B. performance of tasks when asked
C. orientation to place
D. orientation to time

Question 8

8. A 60-year-old COPD patient is experiencing dyspnea at rest. The physician orders a bronchodilator delivered from an MDI for the patient. As the CRT enters the patient’s room to discuss and administer the initial treatment, the patient belligerently demands the CRT to leave the room and leave behind the MDI. What should the CRT do at this time?

A. Talk calmly and try to be convincing to the patient.
B. Be assertive and demand that the patient listen and comply with the orders.
C. Do as the patient requests.
D. Request the nurse to perform the treatment.

Question 9

9. A COPD patient is receiving a beta-two agonist via a small-volume nebulizer. The CRT notes that the patient’s heart rate has increased from 75 beats/minute before the treatment to 105 beats/minute during the treatment. What should the CRT do at this time?
   A. Switch to a different beta-two agonist.
   B. Continue the treatment and monitor the patient.
   C. Terminate the treatment and notify the physician.
   D. Have the patient use an MDI instead of the small volume nebulizer

Question 10

10. While recording the results of an aerosolized B-2 agonist treatment, the CRT erroneously wrote the trade name of the wrong B-2 agonist. What should she do in this situation?
    A. Leave the trade name written, because it is also classified as a B-2 agonist.
    B. Erase the wrong trade name and write in the name of the correct drug.
    C. Use correction fluid on the wrong trade name and write in the name of the correct medication.
    D. Draw a horizontal line through the incorrect tradename, print the word “error” above it, and continue charting

Question 11

11. After recently changing a dyspneic COPD patient’s oxygen-delivery device from a nasal cannula at 5 liters/min to an air entrainment mask delivering an
    FIO2 of 0.40, the CRT is unable to determine the patient’s response to the change in therapy. What action should the CRT take when documenting his actions in the patient’s chart pertaining to this situation?

A. He should exercise his judgment and make some interpretation.
B. He should address in the chart his inability to evaluate the situation and seek input from a supervisor
C. He should chart his actions and defer an interpretation.
D. He should leave a blank area in the patient’s chart to be filled in later after consulting a supervisor.

Question 12

12. The CRT has just completed performing postural drainage on a patient who has retained secretions.
    Which of the following aspects of the therapeutic procedure need to be included in the patient’s chart?

I. the position(s) used
II. how long the patient was maintained in each position
III. the patient’s fluid-volume intake
IV. discomfort expressed by the patient

A. I, II only
B. III, IV only
C. I, II, IV only
D. I, II, III, IV

Question 13

13. A CRT has been asked to assess the effectiveness of chest physiotherapy being performed TID for the past two days on a 67-year-old asthmatic patient who is being treated for pneumonia. Auscultation of the lower lobes reveals diminished breath sounds and rhonchi
    over the posterior thorax. What recommendation should the CRT make based on these findings?

A. The therapy has been effective and should now be discontinued.
B. An aerosolized beta-2 agonist should be added to the therapy.
C. The patient has had an adverse reaction to the therapeutic regimen.
D. The therapy is ineffective and should be discontinued

Question 14

14. An asthmatic patient is receiving an aerosolized, beta adrenergic bronchodilator. While monitoring the patient during the treatment, the CRT obtains the following data:
    * heart rate: 125 beats/minute
    * blood pressure: 185/115 torr
    * ventilatory rate: 30 breaths/minute
    The patient complains of dizziness and displays tremors. Which of the following action(s) is (are) appropriate at this time?
    I. performing an arterial puncture
    II. terminating the treatment
    III. initiating suctioning
    IV. instructing the patient to take slow, deep breaths

A. II only
B. I, II only
C. I, IV only
D. I, II, III only

Question 15

15. During the administration of an anticholinergic bronchodilator treatment, the patient’s blood pressure becomes 80/50 torr. His radial pulse is rapid and thready, and he exhibits respiratory distress. What type of adverse reaction to the medication does this situation exemplify?

A. tachyphylaxis
B. anaphylaxis
C. idiosyncrasy
D. toxicity

Question 16

16. A patient complains of dizziness, sweating, and tingling of the fingers and toes after every IPPB. Which of the following causes might be responsible for this patient’s symptoms?
    A. The patient was inhaling too deeply or too rapidly.
    B. The patient was rebreathing a portion of her exhaled volume.
    C. The sensitivity was set too high.
    D. The patient is receiving too high of an FIO2.

Question 17

17. The CRT measured a normal patient’s lung volumes and capacity with a spirometer under normal barometric conditions at a temperature of 24ºC. The patient’s vital capacity was measured to be 5.00 liters and was
    recorded as 5.00 liters. A coworker questioned the value of the vital capacity. What was the basis for
    questioning the recorded value?

A. The coworker is incorrect for questioning the recorded value of the vital capacity.
B. The CRT did not report the vital capacity in terms of the body temperature, pressure, and saturation.
C. The CRT should have subtracted the PH2O at 37ºC from the barometric pressure.
D. The CRT should have subtracted the PH2O at 37ºC from the measured volume.

Question 18

18. While reviewing the chart of a mechanically ventilated patient, the CRT notices that a PEEP trial was conducted
    when the patient was receiving an FIO2 of 0.60 (refer to Table 5-4). The current ventilator settings include the following:
    * mode: control
    * tidal volume: 900 ml
    * ventilatory rate: 12 breaths/minute
    * FIO2: 0.70
    The following arterial blood-gas data were obtained at
    these settings.
    PO2 55 torr
    PCO2 46 torr
    pH 7.34
    The PEEP study being reviewed by the CRT is as follows:
    Table 5-4: PEEP trial performed at FIO2 0.60
    PEEP CL C.O. pressure (beats/ PaO2
    (cm H2O) (ml/cm H2O) (L/min.) (torr) minute) (torr)
    0 25 4.20 130/60 115 55
    5 29 4.90 135/70 111 59
    8 35 5.30 135/75 106 69
    10 28 4.80 120/65 112 60

Based on these findings, what should the CRT recommend?

A. Reduce the FIO2 to 0.60.
B. Institute PEEP.
C. Institute pressure-support ventilation.
D. Institute inverse-ratio ventilation

Question 19

19. The CRT is attempting to obtain a sputum sample from a patient. After coughing vigorously, the patient expectorates white, clear, frothy sputum into the specimen cup. What should the CRT do at this time?

A. Discard the sample and try again later.
B. Cap the specimen cup and send it to the lab.
C. Keep the specimen cup uncovered until the frothy material evaporates.
D. Add sterile water to the specimen cup to help eliminate the froth.

Question 20

20. The CRT observes immediately after surgery the following clinical signs over the right lower lobe of a post-op thoracotomy patient.
21. decreased tactile fremitus
22. right-sided, reduced chest wall expansion
23. dull percussion notes
24. decreased breath sounds
25. radiopacity
    After a day and a half of hyperinflation therapy, the patient now exhibits the following signs over the same lung area:
26. feeling of vibrations on the chest wall as the patient speaks
27. bilateral movement of the thumbs from the patient’s midline by 4 cm
28. moderately low-pitched percussion note
29. no adventitious breath sounds
30. radiolucency
    What interpretation should the CRT make based on these findings?

A. The patient has developed pulmonary edema.
B. The patient’s pneumothorax has been absorbed.
C. The patient’s atelectasis has reversed.
D. The patient’s pneumonia has resolved.

Question 20

21. A patient who is receiving mechanical ventilatory support
    is being weaned via Briggs adaptor trials. The physician’s order calls for the initial trials to be 15
    minutes each hour. The following data were obtained before the first trial:

• heart rate: 80 beats/minute
• ventilatory rate: 18 breaths/minute
• FIO2: 0.40
• maximum inspiratory pressure: –25 cm H2O
• vital capacity: 10 ml/kg
• SpO2: 94%

After breathing 10 minutes via the Briggs adaptor, the measurements shown below were obtained.
* heart rate: 100 beats/minute
* ventilatory rate: 28 breaths/minute
* FIO2: 0.40
* maximum inspiratory pressure: –13 cm H2O
* vital capacity: 7 ml/kg
* SpO2: 86%
What should the CRT do at this time?

A. Continue with the weaning procedure and monitor the patient.
B. Reconnect the patient to the mechanical ventilator.
C. Nebulize a bronchodilator in-line with the Briggs adaptor.
D. Add 50 cc more of reservoir tubing to the distal end of the Briggs adaptor.

Question 21

22. A patient is receiving metaproterenol via a small volume
    nebulizer. The CRT notes that the patient’s pulse increases from 80 beats/minute to 95 beats/ minute. What should the CRT do at this time?

A. Dilute the medication with normal saline.
B. Continue the treatment and monitor the patient.
C. Stop the treatment and notify the physician.
D. Stop the treatment and perform chest physiotherapy.

Question 22

23. A patient who has severe COPD and is in respiratory distress was given oxygen via a nasal cannula at 2
    liters/min. Over time, the patient’s ventilatory rate progressively decreased while the patient’s SpO2 gradually
    declined from 90% to 75%. The patient was switched to an air entrainment mask at 24%. Shortly, the patient’s
    ventilatory rate normalized, and the SpO2 rose to 92%. How should the CRT interpret this situation?

A. The patient experienced oxygen-induced hypoventilation.
B. The patient had reversal of microatelectasis.
C. The nasal cannula was defective.
D. The nasal cannula was not providing the patient with enough oxygen.

Question 23

24. A COPD patient has been receiving oxygen at home via an oxygen concentrator. The patient’s oxygen-delivery system was switched to a liquid-oxygen system. The patient
    was using a nasal cannula at 2 liters/min., with the concentrator and remains on the same flow rate with a
    pendant reservoir cannula attached to the liquid-oxygen system. The patient’s SpO2 on the nasal cannula was 92%. The SpO2 is now 99% with the pendant nasal cannula. What action should the CRT take at this time?

A. Switch back to the nasal cannula for the liquid oxygen system.
B. Reduce the flow rate to the pendant nasal cannula to 1 liter/min.
C. Switch from the pendant nasal cannula to a reservoir cannula.
D. This effect is transitory and will self-correct when the temperature of the liquid oxygen reaches room temperature.

Question 24

25. The CRT is asked to evaluate a patient for possible therapeutic intervention. Upon performing inspection, the CRT observes a thin patient whose transverse chest-wall diameter appears equal to his anteroposterior diameter. The CRT also notices paradoxical abdominal movement, intercostal space retractions, and accessory ventilatory-muscle usage as the patient breathes. Chest auscultation reveals bilaterally diminished and distant breath sounds. The patient appears to have labored breathing but is not complaining of dyspnea. Which of the following recommendations would be appropriate to include in the patient’s chart?

A. The patient appears to have asthma and should be evaluated via pre- and post-bronchodilator spirometry.
B. A sputum sample should be obtained for culture and sensitivity.
C. The patient apparently has pulmonary emphysema
and should be instructed on diaphragmatic and pursed-lip breathing.
D. The patient might have a pneumothorax and should be evaluated via chest radiography

Question 25

26. During an IPPB treatment, the patient experiences an episode of vomiting. What member of the health-care team should be informed of the event?
    A. the nurse
    B. the physician
    C. the dietician
    D. the respiratory care supervisor

Question 26

27. Which of the following considerations are important to take into account when scheduling patient therapy?

I. patient visiting hours
II. meal times
III. other therapeutic procedures schedules
IV. patient attitude

A. II, III only
B. I, II, III only
C. I, IV only
D. I, II, III, IV

Question 27

28. Which of the following types of clinical information are available from waveform analysis during mechanical
    ventilation?

I. auto-PEEP
II. compliance changes
III. airway resistance changes
IV. WOB

A. II, III only
B. I, IV only
C. II, III, IV only
D. I, II, III, IV

Question 28

29. The CRT enters the ICU and approaches the ventilator of a patient receiving pressure-limited IMV at a mechanical rate of 10 breaths/minute. Based on assessing the flow, volume, and pressure waveforms in Figure
    5-1, what problem can the CRT detect?

A. The patient is experiencing auto-PEEP.
B. A gas leak is occurring during inspiration.
C. The patient’s lung compliance has decreased.
D. Secretions have accumulated in the patient’s lungs.