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Ch 40 pgs 921-937
RES 130 Lung Expansion Therapy/Bronchial Hygiene Exam 3
| Question | Answer |
|---|---|
| Strenuous expiratory efforts in some chronic obstructive pulmonary disease (COPD) patients limit the effectiveness of coughing. Why is this so? | C) High expiratory pleural pressures compress the small airways. |
| Under which of the following conditions would mechanical insufflation-exsufflation with an oronasal mask probably NOT be effective? | B) I and II I. If the glottis collapses during exsufflation. II. Presence of fixed airway obstruction. |
| 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? | B) Restore lung volume and minimize fatigue. |
| All of the following are goals of bronchial hygiene therapy except: | A) reverse the underlying disease process. |
| 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? | B) Move the patient to the sitting position until the cough subsides. |
| All of the following conditions impair secretion clearance by affecting the cough reflex except: | C) chronic bronchitis. |
| A typical mechanical insufflation-exsufflation treatment session should continue until what point? | C) I, II, and III I. Secretions are cleared. II. The vital capacity (VC) returns to baseline. III. The SpO2 returns to baseline. |
| What are the best documented preventive uses of bronchial hygiene therapy? | B) I and II I. Prevent retained secretions in the acutely ill. II. Maintain lung function in cystic fibrosis. |
| Primary objectives for turning include all of the following except to: | A) prevent postural hypotension. |
| Which of the following acutely ill patients is LEAST likely to benefit from application of chest physical therapy? | C) Patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD). |
| 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? | B) Patient supine with a pillow under knees, bed flat |
| During chest physical therapy, a patient has an episode of hemoptysis. Which of the following actions would be appropriate at this time? | D) Stop therapy, sit the patient up, give O2, and contact the physician. |
| 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? | B) 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. |
| Which of the following is NOT a hazard or complication of postural drainage therapy? | D) Pulmonary barotraumas |
| Which if the following is the only absolute contraindication to turning? | D) When the patient has unstable spinal cord injuries. |
| 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? | A) Patient prone with a pillow under abdomen, bed flat |
| In which of the following patients would you consider modifying any head-down positions used for postural drainage? | A) 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 |
| Which of the following is false about the FET? | D) It occurs from mid to high lung volume without glottis closure. |
| When assessing the potential need for postoperative bronchial hygiene for a patient, all of the following factors are relevant except: | C) number of prior surgical procedures. |
| Which of the following measures would you use to ask patients for the presence of copious mucus production? | B) 1 ounce |
| Which of the following occur(s) during the compression phase of a cough? | D) I I. Expiratory muscle contraction |
| 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? | A) I, II, and IV I. Coordinating coughing with pain medication II. Using the forced expiration technique (FET) IV. “Splinting” the operative site |
| Primary objectives for postural drainage include all of the following except: | A) prevent pneumonia. |
| All of the following laboratory data are essential in assessing a patient’s need for bronchial hygiene therapy except: | C) hematology results. |
| Percussion should NOT be performed over which of the following areas? | D) I, II, and III I. Surgery sites II. Bony prominences III. Fractured ribs |
| Conditions that can lead to bronchiectasis include all of the following except: | B) muscular dystrophy. |
| 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? | B) Inspect and adjust the equipment to ensure function during therapy. |
| Properly performed chest vibration is applied at what point? | D) Throughout expiration |
| 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 |
| Which of the following conditions are associated with chronic production of large volumes of sputum? | A)I, III, and IV I. Bronchiectasis III. Cystic fibrosis IV. Chronic bronchitis |
| Which of the following are mandatory components of the preassessment for postural drainage? | C) I and III I. Vital signs III. Auscultation |
| Which of the following should be charted after completing a postural drainage treatment? | C) 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 |
| 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? | B) Having the patient phonate or “huff” during expiration. |
| Key considerations in initial and ongoing patient assessment for chest physical therapy include which of the following? | C) I, II, III, and IV I. Posture and muscle tone II. Breathing pattern and ability to cough III. Sputum production IV. Cardiovascular stability |
| 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? | A) Increase the patient’s FIO2 during therapy. |
| Conditions that can affect airway patency and cause abnormal clearance of secretions include which of the following? | D) I, II, III, and IV I. Foreign bodies II. Tumors III. Inflammation IV. Bronchospasm |
| Which of the following is/are necessary for normal airway clearance? | B) I, II, III I. Patent airway II. Functional mucociliary escalator III. Effective cough |
| The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following? | B) Postural drainage therapy |
| For which of the following patients directed coughing might be contraindicated? | C) I and IV I. Patient with poor coronary artery perfusion IV. Patient with an acute unstable spinal injury |
| All of the following are contraindications for directed coughing except the presence of: | D) necrotizing pulmonary infection. |
| Which of the following is/are TRUE of postural drainage? | B) 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. |
| Key consideration in teaching a patient to develop an effective cough regimen includes which of the following? | C) I, II, and III I. Strengthening of the expiratory muscles II. Instruction in breathing control III. Instruction in proper positioning |
| All of the following are considered bronchial hygiene therapies except: | B) incentive spirometry. |
| Directed coughing is useful in helping to maintain bronchial hygiene in all of the following cases except: | B) acute asthma. |
| All of the following can impair mucociliary clearance in intubated patients except: | A) use of respiratory stimulants. |
| 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? | D) Head down, patient half-rotated to left, right lung up |
| Absolute contraindications for postural drainage include which of the following? | A) I and II I. Head and neck injury (until stabilized) II. Active hemorrhage with hemodynamic instability |
| 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? | A) I and IV I. Combining manual chest compression with suctioning. IV. Using mechanical insufflation-exsufflation. |
| During autogenic drainage, when should patients be encouraged to cough? | D) After phase 3 only |
| Partial airway obstruction can result in all of the following except: | C) increased expiratory flows |
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