Chest Physiotherapy Flashcards
A nurse is caring for a patient with cystic fibrosis who requires chest physiotherapy. Which of the following is the primary purpose of chest physiotherapy?
A. Reduce lung inflammation
B. Improve diaphragmatic excursion
C. Mobilize and remove pulmonary secretions
D. Prevent alveolar collapse
C. Mobilize and remove pulmonary secretions
Rationale: The primary goal of chest physiotherapy is to mobilize and remove excessive pulmonary secretions, improving ventilation and gas exchange.
A nurse is preparing to perform chest physiotherapy on a patient. Which of the following conditions are indications for chest physiotherapy? (SATA)
A. Atelectasis
B. Pulmonary edema
C. Cystic fibrosis
D. Pneumonia with copious secretions
E. Chronic bronchitis
A. Atelectasis
C. Cystic fibrosis
D. Pneumonia with copious secretions
E. Chronic bronchitis
Rationale: Chest physiotherapy is indicated for patients with conditions that cause excessive mucus production or impaired clearance, such as atelectasis, cystic fibrosis, pneumonia with secretions, and chronic bronchitis. It is not indicated for pulmonary edema, as the problem is fluid overload rather than secretion retention.
Which patient would be contraindicated for chest physiotherapy?
A. A 75-year-old with pneumonia and thick secretions
B. A 40-year-old postoperative patient with a history of deep vein thrombosis (DVT)
C. A 60-year-old patient with COPD experiencing increased sputum production
D. A 50-year-old with bronchiectasis and retained secretions
B. A 40-year-old postoperative patient with a history of deep vein thrombosis (DVT)
Rationale: Patients with a history of DVT are at risk for embolization if percussion or vibration techniques are used. Other contraindications include unstable head or neck injuries, rib fractures, and recent hemoptysis.
The nurse is educating a patient on proper postural drainage techniques at home. Which of the following instructions should the nurse include? (SATA)
A. Perform the therapy before meals or 1-2 hours after eating.
B. Maintain each position for 10-15 minutes.
C. Inhale deeply and hold the breath before exhaling forcefully.
D. Increase fluid intake to help thin secretions.
E. Perform chest physiotherapy while lying flat on the back.
A. Perform the therapy before meals or 1-2 hours after eating.
B. Maintain each position for 10-15 minutes.
C. Inhale deeply and hold the breath before exhaling forcefully.
D. Increase fluid intake to help thin secretions.
Rationale: Postural drainage should be done before meals or 1-2 hours after to prevent aspiration. Each position should be maintained for 10-15 minutes. Deep breathing and controlled coughing techniques aid secretion mobilization. Increased hydration helps thin secretions. Lying flat is not always appropriate as certain positions depend on which lung segments require drainage.
A patient with chronic bronchitis is receiving chest physiotherapy. The nurse evaluates the effectiveness by:
A. Noting increased oxygen saturation levels
B. Assessing for a decrease in productive cough
C. Measuring a reduction in lung crackles on auscultation
D. Observing the expectoration of sputum following therapy
D. Observing the expectoration of sputum following therapy
Which of the following techniques is used during chest physiotherapy to help loosen thick pulmonary secretions?
A. Incentive spirometry
B. Chest percussion and vibration
C. Nasotracheal suctioning
D. Continuous positive airway pressure (CPAP)
B. Chest percussion and vibration
Rationale: Chest percussion and vibration help loosen thick mucus in the lungs, making it easier for the patient to expectorate or clear the airway.
The nurse is positioning a patient with left lower lobe pneumonia for postural drainage. Which positions are appropriate for draining secretions from this lobe? (SATA)
A. Right side-lying position with the bed in Trendelenburg
B. Left side-lying position with the head of the bed elevated
C. Prone position with the foot of the bed elevated
D. Supine position with a pillow under the knees
E. Sitting upright with arms resting on a table
A. Right side-lying position with the bed in Trendelenburg
C. Prone position with the foot of the bed elevated
Rationale: To drain the left lower lobe, the patient should be in a right side-lying or prone position with the foot of the bed elevated to facilitate gravity drainage of secretions.
Which statement by a patient receiving chest physiotherapy requires further teaching?
A. “I should perform chest physiotherapy before meals to avoid nausea.”
B. “I should inhale deeply through my nose and exhale through pursed lips.”
C. “If I feel lightheaded, I should continue deep breathing until it passes.”
D. “I should drink plenty of fluids to help loosen secretions.”
C. “If I feel lightheaded, I should continue deep breathing until it passes.”
Rationale: Lightheadedness may indicate hyperventilation, and the patient should pause or slow their breathing instead of continuing deep breathing.
A nurse is performing postural drainage for a patient with cystic fibrosis. Which of the following actions are appropriate? (SATA)
A. Perform the therapy before meals or 1-2 hours after eating.
B. Encourage the patient to cough forcefully after the procedure.
C. Apply percussion over the ribs and spine to enhance secretion movement.
D. Use a cupped hand for percussion.
E. Stop the therapy if the patient experiences mild discomfort.
A. Perform the therapy before meals or 1-2 hours after eating.
B. Encourage the patient to cough forcefully after the procedure.
D. Use a cupped hand for percussion.
Rationale: Chest physiotherapy should be performed before meals to prevent aspiration. The patient should be encouraged to cough to clear loosened secretions. A cupped hand is used for percussion. Percussion should never be applied over the ribs or spine, and mild discomfort is expected, but severe pain should be addressed.
Which assessment finding would indicate that chest physiotherapy was effective for a patient with pneumonia?
A. Decreased oxygen saturation
B. Increased adventitious breath sounds
C. Decreased work of breathing and improved breath sounds
D. Decreased sputum production
C. Decreased work of breathing and improved breath sounds
Rationale: Effective chest physiotherapy should result in better airway clearance, improved breath sounds, and decreased respiratory effort.
Which of the following patients would benefit most from chest physiotherapy?
A. A patient with a pulmonary embolism and pleuritic chest pain
B. A patient with a fractured rib following a motor vehicle accident
C. A patient with chronic bronchitis and retained mucus secretions
D. A patient with pulmonary hypertension receiving oxygen therapy
C. A patient with chronic bronchitis and retained mucus secretions
Rationale: Chest physiotherapy is beneficial for conditions involving excessive mucus production, such as chronic bronchitis.
A nurse is educating a patient with bronchiectasis about home chest physiotherapy. What should be included in the teaching? (SATA)
A. Perform the therapy at least twice a day.
B. Use a positive expiratory pressure (PEP) device if available.
C. Avoid coughing during therapy to prevent discomfort.
D. Maintain each postural drainage position for 10-15 minutes.
E. Expect to have increased sputum production after therapy.
A. Perform the therapy at least twice a day.
B. Use a positive expiratory pressure (PEP) device if available.
D. Maintain each postural drainage position for 10-15 minutes.
E. Expect to have increased sputum production after therapy.
Rationale: Chest physiotherapy should be performed at least twice daily, PEP devices can aid secretion clearance, postural drainage positions should be maintained for 10-15 minutes, and increased sputum production is an expected outcome. Coughing should be encouraged to clear secretions.
A nurse is evaluating a patient’s response to chest physiotherapy. Which finding suggests the therapy was ineffective?
A. Increased ability to expectorate sputum
B. Decreased breath sounds and increased respiratory effort
C. Improved arterial blood gas (ABG) results
D. Decreased respiratory rate with improved oxygenation
B. Decreased breath sounds and increased respiratory effort
Rationale: Decreased breath sounds and increased respiratory effort suggest mucus retention and worsening respiratory status, indicating ineffective therapy.
Which of the following conditions are contraindications for chest physiotherapy? (SATA)
A. Rib fractures
B. Uncontrolled hypertension
C. Recent hemoptysis
D. Spinal cord injury
E. Pleural effusion
A. Rib fractures
C. Recent hemoptysis
D. Spinal cord injury
Rationale: Chest physiotherapy is contraindicated in patients with rib fractures (risk of further injury), recent hemoptysis (risk of worsening bleeding), and spinal cord injury (risk of exacerbating damage).
A nurse is teaching a patient about using a high-frequency chest wall oscillation (HFCWO) vest. Which statement indicates understanding?
A. “I should use this vest before meals and at bedtime.”
B. “I should use the vest for 5 minutes at a time to prevent discomfort.”
C. “I don’t need to cough after using the vest, as it clears secretions automatically.”
D. “I can use the vest while lying completely flat on my back.”
A. “I should use this vest before meals and at bedtime.”
Rationale: HFCWO therapy should be performed before meals to prevent nausea and aspiration. It should be used for longer durations (typically 15-30 minutes), and patients should be encouraged to cough after therapy to clear secretions.
A nurse is performing chest physiotherapy on a patient with chronic obstructive pulmonary disease (COPD). Which nursing action is most appropriate?
A. Perform percussion over bony prominences to loosen secretions
B. Administer a bronchodilator before starting the therapy
C. Encourage the patient to hyperventilate before postural drainage
D. Place the patient in a supine position for all techniques
B. Administer a bronchodilator before starting the therapy
Rationale: Bronchodilators should be given before chest physiotherapy to open the airways and enhance secretion clearance.
Which of the following patient conditions require caution when performing chest physiotherapy? (SATA)
A. Osteoporosis
B. Increased intracranial pressure
C. Chronic bronchitis
D. Recent abdominal surgery
E. Congestive heart failure with pulmonary edema
A. Osteoporosis
B. Increased intracranial pressure
D. Recent abdominal surgery
E. Congestive heart failure with pulmonary edema
Rationale: Patients with osteoporosis (risk of fractures), increased intracranial pressure (risk of worsening pressure), recent abdominal surgery (risk of dehiscence), and congestive heart failure with pulmonary edema (risk of worsening fluid overload) require caution when performing chest physiotherapy.
Which intervention enhances the effectiveness of chest physiotherapy?
A. Restricting fluids to prevent overhydration
B. Administering an antitussive before therapy
C. Performing therapy at least 1 hour after eating
D. Keeping the patient in a supine position throughout therapy
C. Performing therapy at least 1 hour after eating
Rationale: Chest physiotherapy should be done at least 1 hour after eating to prevent nausea and aspiration.
The nurse is providing discharge teaching for a patient performing chest physiotherapy at home. Which statements should the nurse include? (SATA)
A. “Increase your fluid intake to help loosen secretions.”
B. “Perform therapy in the morning and at bedtime.”
C. “Cough after each session to remove loosened mucus.”
D. “Use a firm, flat hand for percussion over the lungs.”
E. “If dizziness occurs, take a break and resume when it passes.”
A. “Increase your fluid intake to help loosen secretions.”
B. “Perform therapy in the morning and at bedtime.”
C. “Cough after each session to remove loosened mucus.”
E. “If dizziness occurs, take a break and resume when it passes.”
Rationale: Hydration, scheduled therapy sessions, controlled coughing, and pausing for dizziness are all essential for effective therapy. Percussion should be performed with a cupped hand, not a flat one.
A patient with bronchiectasis is receiving postural drainage. The nurse determines the therapy is effective if:
A. The patient has an increased respiratory rate
B. The patient reports less coughing than before therapy
C. The patient is able to expectorate secretions more easily
D. Breath sounds are diminished after therapy
C. The patient is able to expectorate secretions more easily
Rationale: The goal of chest physiotherapy is to improve airway clearance and facilitate expectoration.
The nurse is teaching a patient about using an incentive spirometer in conjunction with chest physiotherapy. Which instructions should the nurse include? (SATA)
A. “Take a slow, deep breath in through the device.”
B. “Hold your breath for about 3-5 seconds before exhaling.”
C. “Use the device 5 times per session.”
D. “Sit upright while using the device.”
E. “Perform the exercise at least 10 times every hour while awake.”
A. “Take a slow, deep breath in through the device.”
B. “Hold your breath for about 3-5 seconds before exhaling.”
D. “Sit upright while using the device.”
E. “Perform the exercise at least 10 times every hour while awake.”
Rationale: The patient should inhale deeply, hold the breath briefly, use the device in an upright position, and repeat it frequently (at least 10 times per hour).
A patient with a history of recent head trauma requires chest physiotherapy. What modification should the nurse make to prevent complications?
A. Avoid positioning that increases intracranial pressure
B. Perform therapy immediately after meals
C. Perform therapy while the patient is lying flat
D. Limit therapy to 5 minutes per session
A. Avoid positioning that increases intracranial pressure
Rationale: Patients with head trauma are at risk for increased intracranial pressure, so positioning should be adjusted accordingly.
The nurse is reviewing a patient’s response to chest physiotherapy. Which findings indicate that the therapy was successful? (SATA)
A. The patient has a stronger cough
B. The patient has an increased ability to clear secretions
C. The patient’s breath sounds have improved
D. The patient reports less shortness of breath
E. The patient reports decreased mucus production
A. The patient has a stronger cough
B. The patient has an increased ability to clear secretions
C. The patient’s breath sounds have improved
D. The patient reports less shortness of breath
Rationale: Effective chest physiotherapy results in better cough strength, increased secretion clearance, improved breath sounds, and reduced dyspnea. Decreased mucus production is not an expected finding, as therapy mobilizes secretions rather than reducing their production.
A patient with pneumonia and thick secretions refuses chest physiotherapy, stating, “It makes me too tired.” What is the best nursing response?
A. “You must continue therapy, or your pneumonia will worsen.”
B. “Let’s try shorter, more frequent therapy sessions to reduce fatigue.”
C. “If you’re too tired, we can stop therapy until you feel better.”
D. “You can take a break from therapy for a couple of days.”
B. “Let’s try shorter, more frequent therapy sessions to reduce fatigue.”
Rationale: Adjusting the therapy to shorter, more frequent sessions helps the patient tolerate it while maintaining effectiveness.
A nurse is assessing a patient with cystic fibrosis after performing chest physiotherapy. Which finding requires immediate intervention?
A. The patient expectorates thick yellow sputum
B. The patient reports mild chest discomfort
C. The patient has a sudden drop in oxygen saturation
D. The patient reports feeling tired after therapy
C. The patient has a sudden drop in oxygen saturation
Rationale: A sudden decrease in oxygen saturation may indicate mucus plugging or respiratory distress, requiring immediate intervention.
