Unit 7 Exam Flashcards
A normal cough reflex includes which the following phases?
I. Irritation
II. Inspiration
III. Compression
IV. Expulsion
Irritation, inspiration, compression, and expulsion
Which of the following is/are necessary for normal airway clearance?
I. Patent airway
II. Functional mucociliary escalator
III. Effective cough
Patent airway, functional mucociliary escalator, effective cough
Which of the following can provoke a cough?
I. Anesthesia
II. Foreign bodies
III. Infection
IV. Irritating gases
Foreign bodies, infection, irritating gases
Retention of secretions can result in full or partial airway obstruction. Mucus plugging can result in which of the following?
I. Hypoxemia
II. Atelectasis
III. Shunting
Hypoxemia, atelectasis, and shunting
Which of the following conditions after normal mucociliary clearance?
I. Bronchospasm
II. Cystic fibrosis
III. Ciliary dyskinesia
Cystic fibrosis and ciliary dyskinesia
A condition that can lead to bronchiectasis include all of the following:
I. Chronic airway infection
II. Muscular dystrophy
III. Foreign body aspiration
IV. Obliterative bronchiolitis
Chronic airway infection, foreign body aspiration, and obliterative bronchiolitis
All of the following are goals of bronchial hygiene therapy:
I. Reverse the underlying disease process
II. Help mobilize retained secretion
III. Improve pulmonary gas exchange
IV. Reduce the work of breathing
Help mobilize retained secretion, Improve pulmonary gas exchange, Reduce the work of breathing
Which of the following conditions are associated with chronic production of large volumes of sputum?
I. Bronchiectasis
II. Pulmonary fibrosis
III.Cystic fibrosis
IV. Chronic bronchitis
Bronchiectasis, cystic fibrosis, and chronic bronchitis
All of the following laboratory data are essential in assessing a patient’s need for bronchial hygiene therapy except:
I. Chest radiograph
II. Pulmonary function test
III. Hematology results
IV. ABGs/oxygen saturation
Hematology results
Which of the following clinical signs indicate that a patient is having a problem with retained secretions?
I. Lack of sputum production
II. Labored breathing
III. Development of a fever
IV. Increased inspiratory and expiratory crackles
Lack of sputum production, Labored breathing, Development of a fever, Increased inspiratory and expiratory crackles
All of the following are considered bronchial hygiene therapies except:
I. Postural drainage and percussion
II. Incentive spirometry
III. Positive airway pressure
IV. Percussion, vibration, and oscillation
Incentive Spirometry
The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following?
Postural drainage therapy
Primary objectives for postural drainage include all of the following expect:
I. Prevent pneumonia
II. Normalize functional residual capacity
III. Help mobilize secretions
IV. Improve V/Q
Normalize functional residual capacity
Absolute contraindications for postural drainage include which of the following?
I. Head and neck injury (until stabilized)
II. Active hemorrhage with hemodynamic instability
III. Uncontrolled airway at risk for aspiration
Head and neck injury (until stabilized), active hemorrhage with hemodynamic instability, uncontrolled airway at risk for aspiration
Which of the following is NOT a hazard or complication of postural drainage therapy?
I. Cardiac arrhythmias
II. Increased intracranial pressure
III. Acute hypotension
IV. Pulmonary barotraumas
Pulmonary barotraumas
In which of the following patients would you consider modifying any head-down positions used for postural drainage?
A patient with unstable blood pressure
A patient with a cerebrovascular disorder
A patient with systemic hypertension
A patient with orthopnea
A patient with unstable blood pressure, a patient with a cerebrovascular disorder, a patient with systemic hypertension, a patient with orthopnea
In setting up postural drainage treatment schedule for a postoperative patient, which of the following information would you try to obtain from the patient’s nurse?
I. Patient’s medication schedule
II. Patient’s meal schedule
III. Location of surgical incision
Patient’s medication schedule, patient’s meal schedule, location of surgical incision
Which of the following are mandatory components of the pre-assessment for postural drainage?
I. Vital signs
II. Bedside pulmonary function tests
III. Auscultation
Vital signs, and auscultation
If a patient’s chest radiograph shows infiltrates in the posterior basal segments of the lower lobes, what postural drainage position would you recommend?
Head down, patient prone with a pillow under abdomen
A physician orders postural drainage for a pattens with an abscess in the right middle lobe, what postural drainage position would you recommend?
Head down, patient half-rotated to left, right lung up
A physician orders postural drainage for a patient with aspiration pneumonia in the superior segment of the left lower lobes, what postural drainage position would you recommend?
Patient prone with a pillow under abdomen, bed flat
A physician orders postural drainage for a patient with aspiration pneumonia in the anterior segments of the upper lobes, what postural drainage position would you recommend?
Patient supine with a pillow under knees, HOB slightly elevated
If tolerated, a specified postural drainage position should be maintained for at least how long?
3 to 15 minutes
During chest physical therapy, a patient has an epidote of hemoptysis. Which of the following would be appropriate at this time?
Stop therapy, sit the patient up, give O2, and contact the physician
While reviewing the chart of a patient receiving postural drainage therapy, you notice that the patient tends to undergo mild desaturation during therapy. Which of the following would you recommend to manage this problem?
Increase the patient’s FIO2 during therapy
Soon after you initiate postural drainage in a trendelenburg position, the patient develops vigorous and productive cough. Which of the following actions would be appropriate at this time?
Move the patient to the sitting position until the cough subsides
All of the following responses indicate that postural drainage should be terminated except:
I. Sever tachycardia
II. Complaint of discomfort
III. Irregular blood pressure
IV. Sever bradycardia
Complaint of discomfort
Which of the following should be charted after completing a postural drainage treatment?
I. Amount of consistency of sputum produced
II. Patient tolerance of procedure
III. Position(s) used (including time)
IV. Any untoward effects observed
Amount of consistency of sputum produced, patient tolerance of procedure, position(s) used (including time), any untoward effects observed
Percussion should NOT be performed over which of the following areas?
I. Surgery sites
II. Bony prominences
III. Fractured ribs
Surgery sites, body prominences, and fractured ribs
Properly performed chest vibration is applied at what point?
Throughout expiration
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?
I. Combining manual chest compression with suctioning
II. Coordinating the coughing regimen with pain medication
III. Using the autogenic drainage method
IV. Using mechanical insufflation-exsufflation
Combining manual chest compression with suctioning, and using mechanical insufflation-exsufflation
What happens during the exsufflation phase of mechanical insufflation-exsufflation?
I. Airway pressure is abruptly decreased to -30 to -50 cmH2O
II. Negative airway pressure is maintained for 2 to 3 seconds
III. Peak expiratory “cough” flows reach near normal values
Airway pressure is abruptly decreased to -30 to -50 cmH2O, negative airway pressure is maintained for 2 to 3 seconds, peak expiratory “cough” flows reach near normal values
All of the following are hazards of positive airway pressure therapies (EPAP, PEP, CPAP) except:
I. Decreased venous return
II. Epistaxis
III. Pulmonary barotrauma
IV. Increased intracranial pressure
Epistaxis
Which of the following best describes positive expiratory pressure (PEP) therapy?
Expiration against a variable flow resistance
In theory, how does positive expiratory pressure (PEP) help to move secretions into the larger airways?
I. Filling underrated segments through collateral ventilation
II. Preventing airway collapse during expiration
III. Causing bronchodilator during inspiration
Filling underrated segments through collateral ventilation, preventing airway collapse during expiration
What is the movement of small volumes of air back and forth in the respiratory tract at high frequencies (12 to 25 Hz) called?
Oscillation
The airway clearance technique that uses a pneumatic device to deliver compressed gas mini bursts to the airway are rates above 100/min best describes which of the following?
Intermittent positive-pressure breathing
Patients can control a flutter valve’s pressure by changing what?
Their expiratory flow
Advantages of the flutter valve over other bronchial hygiene methods include all of the following except:
I. Good patient acceptance
II. Greater effectiveness
III. Full portability
IV. Independent use
Greater effectiveness
Which of the following airway clearance techniques would you recommend for a 15-month old infant with cystic fibrosis?
Postural drainage, percussion, and vibration
All of the following are included in a sequence of a cough except:
I. Shallow inspiration
II. Closure of the glottis
III. Contraction of abdominal muscles
IV. Opening of the glottis and rapid and forceful exhalation
Shallow inspiration
The right and left lung combined have ___ pulmonary segments
18
Indication for CPT include
Retained secretions, atelectasis due to mucus plugging, and prophylactic care of the post-operative patient
Which modality uses positioning and gravity to accomplish its primary goal?
Postural drainage
What modality or modalities require tense shoulders and arms kept straight?
Vibrations and shaking
What do you need to determine proper positioning for PD?
CXR, doctor order, and breath sounds
Contraindications for trendelenburg positioning include:
I. Unstable cardiac status
II. Head trauma
III. Recent tube feeding or meals
IV. Obesity
V. All of the above
All of the above
Percussion (clapping) is performed on
Both inspiration and expiration
Which of the following would be considered the appropriate hand positioning for performing chest percussion?
Relaxed wrist, cupped hands
Contraindications for percussion include all of the following expect :
I. Metastatic cancer
II. Pulmonary embolus
III. Stable cardiac status
IV. Osteoporotic changes
V. Rib fractures
Stable cardiac status
This modality is performed by keeping arms straight and applying a vibrating action from shoulder to hands
Chest vibrations (shaking)
What methods can be used to perform percussion:
I. Electric percussor
II. Pneumatic percussor
III. Hands
IV. Palm cups
V. All of the above
All of the above
Chest vibrations (shaking) is performed on
Expiration only
In which of the following techniques is the satinet instructed to “sniff”?
Diaphragmatic breathing
Hazards of CPT include all of the following
Hypoxemia, hemorrhage, fractured ribs, and increased ICP
You have received an order to perform CPT on a recent trauma patient who underwent a frontal craniotomy. The CXR reveals a LLL pneumonia and the therapy is ordered QID. What is the most appropriate response in this case?
Inform the MD of possible hazards and ask for clarification
Which technique is the patient instructed to follow normal cough sequence but to keep the tongue forwards to prevent swallowing any secretions?
Panting
In which technique is the patient instructed to rapidly expel air through an open glottis?
Huffing
Components of a PEP device include
Pressure manometer, expiratory resistor, one-way valve, an d interface device (mask, mp, nose clips)
For effective treatment of the PEP valve pressures of ___ to ___ cm H2O are used
10-20
Percussion should be performed over each affected area or segment for ___ to ___ minutes
2-5
The I:E ratio should be achieved when using the PEP valve should be:
1:3 and 1:4
You have a patient performing PEP therapy on a patient and the setting is set at 15 cmH2O. On each expiratory phase the manometer only reaches 10 cmH2O. What is the best course of action at this time?
Increase the resistance setting
Which device combines PAP, high frequency oscillations, and rapid vibratory movement of air back and fourth in the respiratory tract?
Flutter valve
The flutter valve is a piped shaped device through which the patient exhales to produce positive expiratory pressure. The weight of the ball serves as EPAP pressures of ____ to ____ cm H2O and produces ____ Hz.
10-25, 15
Which device utilizes volume expansion as part of prevention and mobilization of secretions?
MetaNeb
HFCWO (high frequency chest0wall oscillation) is most commonly used for?
Cystic fibrosis
Forms of bronchial hygiene include:
PEP therapy, percussion, and postural drainage
Mechanisms of a cough
Irritation
Inspiration
Compression
Expulsion
Contraindications
Had just eaten
Surgery
Untreated pneumothorax
Injured
10-20 cmH2O
PEP
PEP and high frequency oscillations indicated using a
Fluter valve
What does a metaneb help with
Expansion
Vest
Why: Mobilization of secretions, for mucous clearance, and deep breathing
How to: turn it on, set it to like 14 Hz, do it for 20-30 minutes (between 5 and 25 HZ)
Who: Cystic fibrosis
PEP
Why: Mobilize secretions, prevent atelectasis, reduce air trapping
How to: Slow breath in and out, taught cheeks (like blowing bubbles), 10-20 breaths, and huff cough, do it 4 times a day
Who: Change in vital signs, abnormal CXR, pulmonary problems, sputum retention
Monitor: HR, cardiac rhythm, BP, breath sounds, skin color, sputum production, pain, mental function, discomfort
MetaNeb
Why: Volume expansion, and prevention/mobilization of secretions, for mucous clearance, and deep breathing, give medications
How to: Turn it on set it on the flow and turn the other two to a certain, things, and then half way through turn the two nobs, a total of 10 minutes
Who: Asthma, emphysema, COPD
