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saelee
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2012-11-13 21:38:46
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chapter 39
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lung expansion therapy
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  1. 1. Persistent breathing at small tidal volumes can result in which of the following?
    a. reabsorption atelectasis
    b. spontaneous pneumothorax
    c. compression atelectasis
    d. respiratory alkalosis
    compression atelectasis
  2. Which of the following patient categories are at high risk for developing atelectasis?
    1. those who are heavily sedated
    2. those with abdominal or thoracic pain
    3. those with neuromuscular disorders
    a. 1 and 2
    b. 2 and 3
    c. 1 and 3
    d. 1, 2, and 3
    D
  3. What is the major contributing factor in the development of postoperative atelectasis?
    a. uncontrolled hyperpyrexia
    b. central nervous system overstimulation
    c. decreased cardiac output
    d. repetitive, shallow breathing
    • ans: D
    • Most postoperative patients also have problems coughing effectively because of their reducedability to take deep breaths.
  4. Which of the following groups of patients is not at risk for developing postoperativeatelectasis?
    a. those with chronic obstructive pulmonary disease
    b. those with a significant history of cigarette smoking
    c. those with impaired mucociliary clearance
    d. those with pneumonia
    D
  5. Which of the following clinical findings indicate the development of atelectasis?
    1. opacified areas on the chest x-ray film
    2. inspiratory and expiratory wheezing
    3. tachypnea
    4. diminished or bronchial breath sounds
    a.1, 3, and 4
    b. 1, 2, 3, and 4
    c. 1 and 4
    d. 2, 3, and 4
    A
  6. How do all modes of lung expansion therapy aid lung expansion?
    a. increasing the transpulmonary pressure gradient
    b. decreasing the transthoracic pressure gradient
    c. increasing the pressure in the pleural space
    d. decreasing the pressure in the alveoli
    A
  7. How can the transpulmonary pressure gradient be increased?
    1. increasing alveolar pressure
    2. decreasing pleural pressure
    3. decreasing transthoracic pressure
    a. 1 and 2
    b. 2 and 3
    c. 1 and 3
    d. 1, 2, and 3
    A
  8. Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure include which of the following?
    1. incentive spirometry (IS)
    2. positive end-expiration pressure therapy
    3. intermittent positive-pressure breathing (IPPB)
    4. expiratory positive airway pressure (EPAP)
    a. 1 and 2
    b. 2, 3, and 4
    c. 1 and 3
    d. 1, 2, 3, and 4
    B
  9. Which of the following modes of lung expansion therapy is physiologically most normal?
    a. continuous positive airway pressure
    b. incentive spirometry
    c. positive end-expiratory pressure
    d. intermittent positive-pressure breathing therapy
    B
  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?
    a. incentive spirometry
    b. PEEP therapy
    c. deep breathing exercises
    d. intermittent positive-pressure breathing therapy
    A
  11. All of the following can impair mucociliary clearance in intubated patients except:
    a. use of respiratory stimulants
    b. tracheobronchial suctioning
    c. inadequate humidification
    d. high inspired oxygen concentrations
    A
  12. All of the following drug categories can impair mucociliary clearance in intubated patients except:
    a. general anesthetics
    b. bronchodilators
    c. opiates
    d. narcotics
    B
  13. Conditions that can affect airway patency and cause abnormal clearance of secretions include which of the following?
    1. foreign bodies
    2. tumors
    3. inflammation
    4. bronchospasm
    a. 1, 2, and 3
    b. 2 and 4
    c. 2, 3, and 4
    d. 1, 2, 3, and 4
    D
  14. Which of the following conditions alter normal mucociliary clearance?
    1. bronchospasm
    2. cystic fibrosis (CF)
    3. ciliary dyskinesia
    a. 1, 2, and 3
    b. 1 and 2
    c. 1 and 3
    d. 2 and 3
    D
  15. 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
    B
  16. All of the following conditions impair secretion clearance by affecting the cough reflex except:
    a. muscular dystrophy
    b. amyotrophic lateral sclerosis
    c. chronic bronchitis
    d. cerebral palsy
    • C
    • most common conditions affecting cough reflex are musculoskeletal and neurological disorders
  17. All of the following are goals of airway clearance therapy except:
    a. Reverse the underlying disease process.
    b. Help mobilize retained secretion.
    c. Improve pulmonary gas exchange.
    d. Reduce the work of breathing.
    A
  18. Which of the following acutely ill patients is LEAST likely to benefit from application of chest physical therapy?
    a. patient with acute lobar atelectasis
    b. patient with copious amounts of secretions
    c. patient with an acute exacerbation of chronic obstructive pulmonary disease(COPD)
    d. patient with low V/Q due to unilateral infiltrates
    C
  19. Which of the following conditions are associated with chronic production of large volumes ofsputum?
    1. bronchiectasis
    2. pulmonary fibrosis
    3. cystic fibrosis
    4. chronic bronchitis
    a. 1, 3, and 4
    b. 2 and 4
    c. 1, 2, 3, and 4
    d. 3 and 4
    A
  20. In general, chest physical therapy can be expected to improve airway clearance when a patient’s sputum production exceeds what volume?
    a. 30 ml/day
    b. 20 ml/day
    c. 15 ml/day
    d. 10 ml/day
    • A
    • production must exceed 25-30 ml/day for clearance therapy to be effective
  21. Which of the following measures would you use to ask patients for the presence of copiousmucus production?
    a. 1 pint
    b. 1 ounce
    c. 1 gallon
    d. 1 tablespoon
    B
  22. What are the best documented preventive uses of airway clearance therapy?
    1. Prevent retained secretions in the acutely ill.
    2. Maintain lung function in cystic fibrosis.
    3. Prevent postoperative pulmonary complications.
    a. 1, 2, and 3
    b. 1 and 2
    c. 1 and 3
    d. 2 and 3
    B
  23. When assessing the potential need for postoperative airway clearance for a patient, all of thefollowing factors are relevant except:
    a. patient’s age and respiratory history
    b. nature and duration of current surgery
    c. number of prior surgical procedures
    d. type of anesthesia (e.g., local versus general)
    C
  24. All of the following laboratory data are essential in assessing a patient’s need for airwayclearance therapy except:
    a. chest radiograph
    b. pulmonary function tests (PFTs)
    c. hematology results
    d. ABGs/oxygen saturation
    C
  25. Key considerations in initial and ongoing patient assessment for chest physical therapyinclude 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, and 3
    b. 2 and 4
    c. 1, 2, 3, and 4
    d. 3 and 4
    C
  26. Which of the following clinical signs indicate that a patient is having a problem with retainedsecretions?
    1. lack of sputum production
    2. labored breathing
    3. development of a fever
    4. increased inspiratory and expiratory crackles
    a. 2 and 4
    b. 1, 2, and 3
    c. 3 and 4
    d. 1, 2, 3, and 4
    D
  27. All of the following are considered airway clearance therapies except:
    a. postural drainage and percussion
    b. incentive spirometry
    c. positive airway pressure
    d. percussion, vibration, and oscillation
    B
  28. The application of gravity to achieve specific clinical objectives in respiratory care bestdescribes which of the following?
    a. breathing exercises
    b. postural drainage therapy
    c. hyperinflation therapy
    d. directed coughing
    B
  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
  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
  31. Which of the following is NOT a hazard or complication of postural drainage therapy?
    a. cardiac arrhythmias
    b. increased intracranial pressure
    c. acute hypotension
    d. pulmonary barotraumas
    D
  32. Primary objectives for turning include all of the following except to:
    a. prevent postural hypotension
    b. promote lung expansion
    c. prevent retention of secretions
    d. improve oxygenation
    A
  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
  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. 2 and 4
    b. 1, 2, and 3
    c. 3 and 5
    d. 1, 2, and 4
    B
  35. In which of the following patients would you consider modifying any head-down positionsused 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 and 4
    c. 2, 3, and 4
    d. 2 and 4
    A
  36. In setting up a postural drainage treatment schedule for a postoperative patient, which of thefollowing 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. 1 and 2
    b. 2 and 3
    c. 1 and 3
    d. 1, 2, and 3
    D
  37. A patient about to receive postural drainage and percussion is attached to anelectrocardiographic (ECG) monitor and is receiving both intravenous (IV) solutions and O2(through a nasal cannula). Which of the following actions would be appropriate for thispatient?
    a. Cancel the therapy because the patient cannot be repositioned.
    b. Inspect and adjust the equipment to ensure function during therapy.
    c. Turn off the ECG monitor, but keep the IV line and O2 going.
    d. Turn off the IV line, but keep the monitor on and the O2 going.
    B
  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 and 2
    b. 2 and 4
    c. 1 and 3
    d. 1, 2, and 3
    C
  39. If a patient’s chest radiograph shows infiltrates in the posterior basal segments of the lowerlobes, what postural drainage position would you recommend?
    a. head down, patient supine with a pillow under knees
    b. patient prone with a pillow under head, bed flat
    c. patient supine with a pillow under knees, bed flat
    d. head down, patient prone with a pillow under abdomen
    D
  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. head down, patient supine with a pillow under knees
    c. patient supine with a pillow under knees, bed flat
    d. head down, patient half-rotated to left, right lung up
    D
  41. A physician orders postural drainage for a patient with aspiration pneumonia in the superiorsegments of the left lower lobe. Which of the following positions would you recommend forthis patient?
    a. patient prone with a pillow under abdomen, bed flat
    b. head down, patient prone with a pillow under abdomen
    c. head down, patient supine with a pillow under knees
    d. patient supine with a pillow under knees, bed flat
    A
  42. A physician orders postural drainage for a patient with aspiration pneumonia in the anteriorsegments of the upper lobes. Which of the following positions would you recommend for thispatient?
    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. patient prone with a pillow under abdomen, bed flat
    B
  43. If tolerated, a specified postural drainage position should be maintained for at least how long?
    a. 1 to 2 minutes
    b. 3 to 5 minutes
    c. 20 to 30 minutes
    d. 3 to 15 minutes
    D
  44. While reviewing the chart of a patient receiving postural drainage therapy, you notice that thepatient 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. Increase the patient’s FIO2 during therapy.
    b. Discontinue the postural drainage therapy entirely.
    c. Discontinue the percussion and vibration only.
    d. Decrease the frequency of treatments.
    A
  45. Why is strenuous patient coughing during postural drainage in a head-down positioncontraindicated?
    a. It can impair the mucociliary clearance mechanism.
    b. It can increase expiratory airway resistance (Raw).
    c. It can cause air trapping and pulmonary distension.
    d. It can markedly increase intracranial pressure (ICP).
    D
  46. Soon after you initiate postural drainage in a Trendelenburg position, the patient develops avigorous and productive cough. Which of the following actions would be appropriate at thistime?
    a. Maintain the drainage position while carefully watching the patient.
    b. Move the patient to the sitting position until the cough subsides.
    c. Stop the treatment at once and report the incident to the nurse.
    d. Drop the head of the bed farther and encourage more coughing.
    B
  47. All of the following would indicate a successful outcome for postural drainage therapy except:
    a. decreased sputum production
    b. normalization in ABGs
    c. improved breath sounds
    d. improvement in chest radiograph
    A
  48. All of the following responses indicate that postural drainage should be terminated except:
    a. severe tachycardia
    b. complaint of discomfort
    c. irregular blood pressure
    d. severe bradycardia
    B
  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. 1, 2, and 3
    b. 2 and 4
    c. 1, 2, 3, and 4
    d. 3 and 4
    C

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