question

Strenuous expiratory efforts in some chronic obstructive pulmonary disease (COPD) patients limit the effectiveness of coughing. Why is this so?

answer

High expiratory pleural pressures compress the small airways.

question

Under which of the following conditions would mechanical insufflation-exsufflation with an oronasal mask probably NOT be effective?

answer

I and II - I. If the glottis collapses during exsufflation. II. Presence of fixed airway obstruction.

question

Whether using traditional methods or the FET, a period of diaphragmatic breathing and relaxation should always follow attempts at coughing. What is the purpose of this approach?

answer

Restore lung volume and minimize fatigue

question

All of the following are goals of bronchial hygiene therapy except:

answer

reverse the underlying disease process

question

Soon after you initiate postural drainage in a Trendelenburg position, the patient develops a vigorous and productive cough. Which of the following actions would be appropriate at this time?

answer

Move the patient to the sitting position until the cough subsides

question

All of the following conditions impair secretion clearance by affecting the cough reflex except:

answer

Chronic Bronchitis

question

A typical mechanical insufflation-exsufflation treatment session should continue until what point?

answer

C) I, II, and III - I. Secretions are cleared. II. The vital capacity (VC) returns to baseline. III. The SpO2 returns to baseline.

question

What are the best documented preventive uses of bronchial hygiene therapy?

answer

I and II - I. Prevent retained secretions in the acutely ill. II. Maintain lung function in cystic fibrosis.

question

Primary objectives for turning include all of the following except to:

answer

to prevent postural hypotension

question

Which of the following acutely ill patients is LEAST likely to benefit from application of chest physical therapy?

answer

C) Patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD)

question

A physician orders postural drainage for a patient with aspiration pneumonia in the anterior segments of the upper lobes. Which of the following positions would you recommend for this patient?

answer

Patient supine with a pillow under knees, bed flat

question

During chest physical therapy, a patient has an episode of hemoptysis. Which of the following actions would be appropriate at this time?

answer

Stop therapy, sit the patient up, give O2, and contact the physician.

question

A chronic obstructive pulmonary disease patient cannot develop an effective cough. Which of the following would you recommend to help this patient generate a more effective cough?

answer

I, II, and III - I. Enhancing expiratory flow by bending forward at the waist. II. Using short, expiratory bursts or the "huffing" method. III. Using only moderate (as opposed to full) inspiration

question

Which of the following is NOT a hazard or complication of postural drainage therapy?

answer

Pulmonary barotraumas

question

Which if the following is the only absolute contraindication to turning?

answer

When the patient has unstable spinal cord injuries

question

A physician orders postural drainage for a patient with aspiration pneumonia in the superior segments of the left lower lobe. Which of the following positions would you recommend for this patient?

answer

Patient prone with a pillow under abdomen, bed flat

question

In which of the following patients would you consider modifying any head-down positions used for postural drainage?

answer

I, II, III, and IV - I. A patient with unstable blood pressure. II. A patient with a cerebrovascular disorder. III. A patient with systemic hypertension. IV. A patient with orthopne

question

Which of the following is false about the FET?

answer

It occurs from mid to high lung volume without glottis closure.

question

When assessing the potential need for postoperative bronchial hygiene for a patient, all of the following factors are relevant except:

answer

number of prior surgical procedures

question

Which of the following measures would you use to ask patients for the presence of copious mucus production?

answer

1 ounce

question

Which of the following occur(s) during the compression phase of a cough?

answer

Expiratory muscle contraction

question

A patient recovering from abdominal surgery is having difficulty developing an effective cough. Which of the following actions would you recommend to aid this patient in generating a more effective cough?

answer

I, II, and IV - I. Coordinating coughing with pain medication II. Using the forced expiration technique (FET) IV. "Splinting" the operative site

question

Primary objectives for postural drainage include all of the following except:

answer

prevent pneumonia

question

All of the following laboratory data are essential in assessing a patient's need for bronchial hygiene therapy except:

answer

hematology results

question

Percussion should NOT be performed over which of the following areas?

answer

I, II, and III - I. Surgery sites II. Bony prominences III. Fractured ribs

question

Conditions that can lead to bronchiectasis include all of the following except:

answer

muscular dystrophy

question

A patient about to receive postural drainage and percussion is attached to an (ECG) monitor and is receiving both intravenous (IV) solutions and O2 (through a nasal cannula). Which of the following actions would be appropriate for this patient?

answer

Inspect and adjust the equipment to ensure function during therapy

question

Properly performed chest vibration is applied at what point?

answer

Throughout expiration

question

In general, chest physical therapy can be expected to improve airway clearance when a patient's sputum production exceeds what volume?

answer

25-30 ml/day

question

Which of the following conditions are associated with chronic production of large volumes of sputum?

answer

I, III, and IV - I. Bronchiectasis III. Cystic fibrosis IV. Chronic bronchitis

question

Which of the following are mandatory components of the preassessment for postural drainage?

answer

I and III - I. Vital signs III. Auscultation

question

Which of the following should be charted after completing a postural drainage treatment?

answer

I, II, III, and IV - I. Amount and consistency of sputum produced II. Patient tolerance of procedure III. Position(s) used (including time) IV. Any untoward effects observed

question

Maintaining an open glottis during coughing (as with the FET) can help to minimize increases in pleural pressure and lessen the likelihood of bronchiolar collapse. Which of the following techniques can aid the teaching the patient this maneuver?

answer

Having the patient phonate or "huff" during expiration

question

Key considerations in initial and ongoing patient assessment for chest physical therapy include which of the following?

answer

I, II, III, and IV - I. Posture and muscle tone II. Breathing pattern and ability to cough III. Sputum production IV. Cardiovascular stability

question

While reviewing the chart of a patient receiving postural drainage therapy, you notice that the patient tends to undergo mild desaturation during therapy (a drop in SpO2 from 93% to 89% to 90%). Which would you recommend to manage this problem?

answer

Increase the patient's FIO2 during therapy.

question

Conditions that can affect airway patency and cause abnormal clearance of secretions include which of the following?

answer

I, II, III, and IV - I. Foreign bodies II. Tumors III. Inflammation IV. Bronchospasm

question

Which of the following is/are necessary for normal airway clearance?

answer

I, II, III - I. Patent airway II. Functional mucociliary escalator III. Effective cough

question

The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following?

answer

Postural drainage therapy

question

For which of the following patients directed coughing might be contraindicated?

answer

I and IV - I. Patient with poor coronary artery perfusion IV. Patient with an acute unstable spinal injury

question

All of the following are contraindications for directed coughing except the presence of:

answer

necrotizing pulmonary infection

question

Which of the following is/are TRUE of postural drainage?

answer

I, II, and III I. It is most effective in disorders causing excessive sputum. II. It is most effective in head-down positions greater than 25 degrees. III. It requires adequate systemic hydration to be effective

question

Key consideration in teaching a patient to develop an effective cough regimen includes which of the following?

answer

I, II, and III - I. Strengthening of the expiratory muscles II. Instruction in breathing control III. Instruction in proper positioning

question

All of the following are considered bronchial hygiene therapies except:

answer

incentive spirometry

question

Directed coughing is useful in helping to maintain bronchial hygiene in all of the following cases except:

answer

acute asthma

question

All of the following can impair mucociliary clearance in intubated patients except:

answer

Use of respiratory stimulants

question

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?

answer

Head down, patient half-rotated to left, right lung up

question

Absolute contraindications for postural drainage include which of the following?

answer

I and II - I. Head and neck injury (until stabilized) II. Active hemorrhage with hemodynamic instability

question

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?

answer

I and IV - I. Combining manual chest compression with suctioning. IV. Using mechanical insufflation-exsufflation

question

During autogenic drainage, when should patients be encouraged to cough?

answer

After phase 3 only

question

Partial airway obstruction can result in all of the following except:

answer

increased expiratory flows

question

When instructing a patient to cough the respiratory therapist must be aware that the adverse effects of coughing include all of the following except ____.

answer

decreases in airway resistance

question

Ciliary dyskinesis can occur as a result of all of the following except ____.

answer

humidification of inspired air

question

Important physical properties of mucus that may alter mucus transport include ____. I. thickening (inspissation) II. mucostasis (normal clearance) III. viscosity

answer

I. thickening (inspissation) III. viscosity

question

Patients most likely to develop alveolar collapse due to retention of secretions include those who ____. I. take intermittent sigh breaths and have a strong non productive cough II. those who have shallow monotonous breathing patterns III. those that are in pain when taking deep breaths and coughing

answer

II. those who have shallow monotonous breathing patterns III. those that are in pain when taking deep breaths and coughing

question

The effectiveness of a cough can be limited by ____. I. post-surgical pain II. artificial airways III. neuromuscular disorders

answer

I. post-surgical pain II. artificial airways III. neuromuscular disorders

question

Which of the following is/are necessary for normal airway clearance? I. patent airway II.functional mucociliary escalator III. effective cough

answer

I. patent airway II.functional mucociliary escalator III. effective cough

question

A normal cough reflex includes which of the following phases? I. irritation II. inspiration III. compression IV. expulsion

answer

I. irritation II. inspiration III. compression IV. expulsion

question

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

answer

I. hypoxemia II. atelectasis III. shunting

question

Which of the following can provoke a cough? I. anesthesia II. foreign bodies III. infection IV. irritating gases

answer

II. foreign bodies III. infection IV. irritating gases

question

A patient recovering from anesthesia after abdominal surgery is having difficulty developing an effective cough. Which of the following phases of the cough reflex are primarily affected in this patient? a. irritation b. inspiration c. compression d. expulsion

answer

a. irritation

question

All of the following can impair mucociliary clearance in intubated patients except: a. inadequate humidification b. tracheobronchial suctioning c. use of respiratory stimulants d. high inspired oxygen concentrations

answer

c. use of respiratory stimulants

question

Which of the following conditions alter normal mucociliary clearance? I. bronchospasm II. cystic fibrosis (CF) III. ciliary dyskinesia

answer

II. cystic fibrosis (CF) III. ciliary dyskinesia

question

All of the following conditions impair secretion clearance by affecting the cough reflex except: a. muscular dystrophy b. cerebral palsy c. chronic bronchitis d. amyotrophic lateral sclerosis

answer

c. chronic bronchitis

question

What are the best documented preventive uses of bronchial hygiene therapy? I. prevent retained secretions in the acutely ill II. maintain lung function in cystic fibrosis III. prevent postoperative pulmonary complications

answer

I. prevent retained secretions in the acutely ill II. maintain lung function in cystic fibrosis

question

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

answer

I. bronchiectasis III.cystic fibrosis IV.chronic bronchitis

question

Key considerations in initial and ongoing patient assessment for chest physical therapy include which of the following? I. posture and muscle tone II. breathing pattern and ability to cough III. sputum production IV. cardiovascular stability

answer

I. posture and muscle tone II. breathing pattern and ability to cough III. sputum production IV. cardiovascular stability

question

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

answer

I. lack of sputum production II. labored breathing III. development of a fever IV. increased inspiratory and expiratory crackles

question

All of the following are considered bronchial hygiene therapies except: a. postural drainage and percussion b. incentive spirometry c. positive airway pressure d. percussion, vibration, and oscillation

answer

b. incentive spirometry

question

Primary objectives for postural drainage include all of the following except: a. prevent pneumonia b. normalize functional residual capacity c. help mobilize secretions d. improve V/Q

answer

a. prevent pneumonia

question

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 unstable spinal cord injuries d. when the patient has or is at high risk for atelectasis

answer

c. when the patient has unstable spinal cord injuries

question

When turning a critically ill patient, one should be on guard for which of the following "plumbing" problems? I. aspiration of circuit condensate II. disconnection of vascular lines III. ventilator disconnection IV. accidental extubation

answer

I. aspiration of circuit condensate II. disconnection of vascular lines III. ventilator disconnection IV. accidental extubation

question

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

answer

I. head and neck injury (until stabilized) II. active hemorrhage with hemodynamic instability

question

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

answer

d. pulmonary barotraumas

question

Which of the following is/are TRUE of postural drainage? I. It is most effective in disorders causing excessive sputum. II. It is most effective in head-down positions greater than 25 degrees. III. It requires adequate systemic hydration to be effective. IV. It improves mucociliary clearance in normal subjects. V. It improves pulmonary function in stable chronic obstructive pulmonary disease patients.

answer

I. It is most effective in disorders causing excessive sputum. II. It is most effective in head-down positions greater than 25 degrees. III. It requires adequate systemic hydration to be effective.

question

If a patient's chest radiograph shows infiltrates in the posterior basal segments of the lower lobes, 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

answer

d. head down, patient prone with a pillow under abdomen

question

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

answer

d. head down, patient half-rotated to left, right lung up

question

If tolerated, a specified postural drainage position should be maintained for at least how long? a. 20 to 30 minutes b. 3 to 15 minutes c. 1 to 2 minutes d. 3 to 5 minutes

answer

b. 3 to 15 minutes

question

During chest physical therapy, a patient has an episode of hemoptysis. Which of the following actions would be appropriate at this time? a. Put the patient in a sitting position and have him or her cough strenuously. b. Place the patient in a head-down position and call the nurse. c. Immediately perform nasotracheal suctioning of the patient. d. Stop therapy, sit the patient up, give O2, and contact the physician.

answer

d. Stop therapy, sit the patient up, give O2, and contact the physician.

question

Soon after you initiate postural drainage in a Trendelenburg position, the patient develops a vigorous and productive cough. Which of the following actions would be appropriate at this time? 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.

answer

b. Move the patient to the sitting position until the cough subsides.

question

Why is strenuous patient coughing during postural drainage in a head-down position contraindicated? a. It can impair the mucociliary clearance mechanism. b. It can markedly increase intracranial pressure (ICP). c. It can cause air trapping and pulmonary distension. d. It can increase expiratory airway resistance (Raw).

answer

b. It can markedly increase intracranial pressure (ICP).

question

Percussion should NOT be performed over which of the following areas? I. surgery sites II. bony prominences III. fractured ribs

answer

I. surgery sites II. bony prominences III. fractured ribs

question

What factors can hinder effective coughing? I. artificial airways II. neuromuscular disease III. systemic dehydration IV. pain or fear of pain V. use of expectorants

answer

I. artificial airways II. neuromuscular disease III. systemic dehydration IV. pain or fear of pain

question

Key consideration in teaching a patient to develop an effective cough regimen includes which of the following? I. strengthening of the expiratory muscles II. instruction in breathing control III. instruction in proper positioning

answer

I. strengthening of the expiratory muscles II. instruction in breathing control III. instruction in proper positioning

question

Directed coughing is useful in helping to maintain bronchial hygiene in all of the following cases except: a. bronchiectasis b. acute asthma c. cystic fibrosis d. spinal cord injury

answer

b. acute asthma

question

A patient recovering from abdominal surgery is having difficulty developing an effective cough. Which of the following actions would you recommend to aid this patient in generating a more effective cough? I. coordinating coughing with pain medication II. using the forced expiration technique (FET) III. supplying manual epigastric compression IV. "splinting" the operative site

answer

I. coordinating coughing with pain medication II. using the forced expiration technique (FET) IV. "splinting" the operative site

question

Strenuous expiratory efforts in some chronic obstructive pulmonary disease (COPD) patients limit the effectiveness of coughing. Why is this so? a. The accessory muscles of inspiration oppose the exhalation. b. All COPD patients have severe abdominal muscle weakness. c. High expiratory pleural pressures compress the small airways. d. Strenuous expiration causes the upper airway to collapse.

answer

c. High expiratory pleural pressures compress the small airways.

question

Which of the following is false about the FET? a. It causes less bronchiolar collapse than traditional coughing b. It occurs from mid to low lung volume without glottis closure. c. It has a period of diaphragmatic breathing and relaxation. d. It occurs from mid to high lung volume without glottis closure.

answer

d. It occurs from mid to high lung volume without glottis closure.

question

Maintaining an open glottis during coughing (as with the FET) can help to minimize increases in pleural pressure and lessen the likelihood of bronchiolar collapse. Which of the following techniques can aid the practitioner in teaching the patient this maneuver? a. having the patient inhale slowly through the nose b. having the patient phonate or "huff" during expiration c. having the patient "tense" the neck muscles while coughing d. telling the patient to exert effort, as in straining at stool

answer

b. having the patient phonate or "huff" during expiration

question

What is the correct sequence of actions during the active cycle of breathing (ACB) method? I. relaxation and breathing control II. three or four thoracic expansion exercises III. one or two FETs (huffs)

answer

a. I, II, I, and III

question

What happens during the exsufflation phase of mechanical insufflation-exsufflation? I. Airway pressure is abruptly decreased to -30 to -50 cm H2O. II. Negative airway pressure is maintained for 2 to 3 seconds. III. Peak expiratory "cough" flows reach near normal values.

answer

I. Airway pressure is abruptly decreased to -30 to -50 cm H2O. II. Negative airway pressure is maintained for 2 to 3 seconds. III. Peak expiratory "cough" flows reach near normal values.

question

A typical mechanical insufflation-exsufflation treatment session should continue until what point? I. Secretions are cleared. II. The vital capacity (VC) returns to baseline. III. The SpO2 returns to baseline.

answer

I. Secretions are cleared. II. The vital capacity (VC) returns to baseline. III. The SpO2 returns to baseline.

question

Which of the following best describes positive expiratory pressure (PEP) therapy? a. expiration against a variable flow resistance b. expiration against a fixed threshold resistance c. inspiration against a variable flow resistance d. inspiration against a fixed threshold resistance

answer

a. expiration against a variable flow resistance

question

In theory, how does positive expiratory pressure (PEP) help to move secretions into the larger airways? I. filling underaerated segments through collateral ventilation II. preventing airway collapse during expiration III. causing bronchodilation during inspiration

answer

I. filling underaerated segments through collateral ventilation II. preventing airway collapse during expiration

question

Contraindications for positive airway pressure therapies include all of the following except: a. intracranial pressure exceeding 20 mm Hg b. recent facial, oral, or skull surgery or trauma c. preexisting pulmonary barotrauma (e.g., pneumothorax) d. air-trapping/pulmonary overdistention in chronic obstructive pulmonary disease

answer

d. air-trapping/pulmonary overdistention in chronic obstructive pulmonary disease

question

All of the following are hazards of positive airway pressure therapies (EPAP, PEP, CPAP) except: a. pulmonary barotrauma b. epistaxis c. increased intracranial pressure d. decreased venous return

answer

b. epistaxis

question

What is the movement of small volumes of air back and forth in the respiratory tract at high frequencies (12 to 25 Hz) called? a. tidal breathing b. active cycle breathing c. oscillation d. huffing

answer

c. oscillation

question

All of the following are typical of high-frequency external chest wall compression therapy except: a. 30-minute therapy sessions b. oscillations at 5 to 25 Hz c. one to six sessions per day d. long inspiratory oscillations

answer

d. long inspiratory oscillations

question

The airway clearance technique that uses a pneumatic device to deliver compressed gas minibursts to the airway at rates above 100/min best describes which of the following? a. high-frequency external chest wall compression b. active cycle of breathing c. intrapulmonary percussive ventilation d. intermittent positive-pressure breathing

answer

c. intrapulmonary percussive ventilation

question

Which of the following is true about exercise and airway clearance? I. Exercise can enhance mucus clearance. II. Exercise can improve pulmonary function. III. Exercise can improve V/Q matching. IV. Exercise can cause desaturation in some patients.

answer

I. Exercise can enhance mucus clearance. II. Exercise can improve pulmonary function. III. Exercise can improve V/Q matching. IV. Exercise can cause desaturation in some patients.

question

Patients can control a flutter valve's pressure by changing what? a. their inspiratory flow b. the angle of the device c. their expiratory flow d. the expired volume

answer

c. their expiratory flow

question

Which of the following is not an advantage of the Acapella over the flutter? a. It can customize frequency. b. It can be used in any posture. c. It is more portable. d. It can customize flow resistance.

answer

c. It is more portable.

question

Which of the following should be considered when selecting a bronchial hygiene strategy? I. patient's goals, motivation, and preferences II. effectiveness and limitations of technique or method III. patient's age, ability to learn, and tendency to fatigue IV. need for assistants, equipment, and cost

answer

I. patient's goals, motivation, and preferences II. effectiveness and limitations of technique or method III. patient's age, ability to learn, and tendency to fatigue IV. need for assistants, equipment, and cost

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