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RES130 FINAL EXAM
RES130 FINAL EXAM REVIEW
| Question | Answer |
|---|---|
| What are the causes associated with resorption and passive atelectasis? | Passive atelectasis = Persistent breathing at small tidal volumes Resorption atelectasis = Mucus plugging present in the airways that block ventilation REF: 904 |
| True or False: Patients at high risk for developing atelectasis can be those who are heavily sedated, those with neuromuscular disorders, or those with abdominal or thoracic pain. | True REF: 904 |
| True or False: Clinical findings that indicate the development of atelectasis normally include inspiratory and expiratory wheezing. | False REF: 905 |
| True or False: Increasing the transpulmonary pressure gradient is responsible for increasing lung volume during lung expansion therapy. | True REF: 905 |
| ____________________ is the most physiologic form of lung expansion therapy. | Incentive spirometry REF: 905 |
| An alert and cooperative 30-year-old man with no prior history of lung disease underwent knee repair surgery. His x-ray film currently is clear. Which of the following approaches to preventing atelectasis would you recommend for this patient? | A. incentive spirometry A, REF: 905 |
| True or False: The most likely cause of a postoperative patient using incentive spirometry and complaining of dizziness and numbness around the mouth after therapy sessions is gastric insufflation | False REF: 906 |
| How are incentive spirometry devices generally categorized? | As flow-oriented or volume-oriented devices REF: 908 |
| True or False: Flow-oriented devices have proved less effective than volumetric systems. | False REF: 908 |
| In teaching a patient to perform the sustained maximal inspiration maneuver during incentive spirometry, what would you say? | A. “Exhale normally, then inhale as deeply as you can, then hold your breath for 5 to 10 seconds.” A, REF: 909 |
| True or False: Diaphragmatic breathing at slow to moderate flows is the correct instruction technique used for teaching incentive spirometry | True REF: 909 |
| How long should a patient be told to sustain a breath during the performance of a sustained maximal inspiration during incentive spirometry? | 5 to 10 seconds REF: 909 |
| Which of the following conditions is most likely to predispose a patient to atelectasis? | C. Gall bladder surgery. C, Page: 904 |
| Physical signs of atelectasis include: I. Decreased or bronchial/tubular breath sounds II. Tachypnea III. Normal breath sounds IV. Tachycardia when hypoxemia is present | D. I, II and IV only I. Decreased or bronchial/tubular breath sounds II. Tachypnea IV. Tachycardia when hypoxemia is present D, Page: 905 |
| An increase in the __________________pressure gradient is responsible for the way lung expansion therapy works. | transpulmonary Page: 905 |
| True or False: Intermittent positive-pressure breathing is associated with a passive exhalation. | A. true A, REF: 909 |
| Which of the following patient groups should be considered for lung expansion therapy using intermittent positive-pressure breathing (IPPB)? | A. I and II I. patients with clinically diagnosed atelectasis who are not responsive to other therapies II. patients at high risk for atelectasis who cannot cooperate with other methods A, REF: 911 |
| True or False: IPPB should be the single treatment modality used for resorption atelectasis. | False,REF: 911 |
| Which of the following is NOT a potential contraindication for intermittent positive-pressure breathing? | A. neuromuscular disorders A,REF: 912 |
| True or False: Respiratory alkalosis is probably the most common complication associated with intermittent positive-pressure breathing (IPPB)? | True, REF: 912 |
| Intermittent positive-pressure breathing (IPPB) can be associated with which of the following hazards? | D,REF: 912 D. I, II, III, and IV I. hyperventilation II. air-trapping, auto-PEEP III. increased airway resistance IV. nosocomial infection |
| Potential outcomes of IPB Therapy should include: I. Improved VC II. Improved oxygenation III. Improved breath sounds IV. Decreased secretion clearance and reduced cough mechanism | C,REF: 913 C. I, II, and III I. Improved VC II. Improved oxygenation III. Improved breath sounds |
| Which of the following are potential desirable outcomes of (IPPB) therapy? I. improved oxygenation II. increased cough and secretion clearance III. improved breath sounds IV. reduced dyspnea (subjective response) | D,REF: 913 D. I, II, III, and IV I. improved oxygenation II. increased cough and secretion clearance III. improved breath sounds IV. reduced dyspnea (subjective response) |
| What should the practitioner explain before starting an (IPPB) on a new patient? I. what the IPPB treatment will do II. why the physician ordered the treatment III. what the expected results are IV. how the IPPB treatment will feel | D,REF: 913 D. I, II, III, and IV I. what the IPPB treatment will do II. why the physician ordered the treatment III. what the expected results are IV. how the IPPB treatment will feel |
| True or False: The semi-fowler’s position is ideal for the patient receiving an intermittent positive-pressure breathing treatment. | True REF: 914 |
| Which of the following adjuncts would you attempt first in order to eliminate leaks in an alert patient receiving an intermittent positive-pressure breathing treatment? | D. nose clip |
| Which of the following parameters are you changing when you adjust the sensitivity control on an intermittent positive-pressure breathing device, | B,REF: 914 B. effort required to cycle the device “on” (begin inspiration) |
| True or False: The following are appropriate initial settings for an IPPB treatment given to a new patient: Sensitivity –1 to –2 cm H2O Pressure 10 to 15 cm H2O Moderate flow | True,REF: 914 |
| Which of the following are appropriate volume goals for intermittent positive-pressure breathing (IPPB) therapy? I. 10 to 15 ml/kg ideal body weight II. at least 30% of the inspiratory capacity (IC) | B,REF: 914 B. I and II I. 10 to 15 ml/kg ideal body weight II. at least 30% of the inspiratory capacity (IC) |
| True or False: All of the following factors are responsible for making an IPPB device cycle off prematurely? I. airflow obstructed II. kinked tubing III. occluded mouthpiece IV. active resistance to inhalation | True, REF: 915 |
| Select the mechanisms below that probably contribute to the beneficial effects of continuous positive airway pressure (CPAP) in treating atelectasis? | D,REF: 916 D. I, II, III, and IV I. recruitment of collapsed alveoli II. decreased work of breathing III. improved distribution of ventilation IV. increased efficiency of secretion removal |
| Which of the following are contraindications for continuous positive airway pressure (CPAP) therapy? I. hemodynamic instability II. hypoventilation III. facial trauma IV. low intracranial pressures | C,REF: 916 C. I, II, and III I. hemodynamic instability II. hypoventilation III. facial trauma |
| True or False: Potential complications associated with CPAP therapy usually include all of the following: barotrauma, hypoventilation, gastric distention, and hypercapnia | True,REF: 916 |
| List the essential components of a CPAP flow system? | I. blended source of pressurized gas II. nonrebreathing circuit with reservoir bag III. low-pressure or disconnect alarm IV. expiratory threshold resistor |
| True or False: During administration of a continuous positive airway pressure flow mask to a patient the most common problem is system leaks or leaks around the mask. | True REF: 917 |
| What initial flow setting would you use when setting up a CPAP mask system for a patient with atelectasis? | 2 to 3 times the patient’s minute ventilation REF: 917 |
| Which of the following hyperinflation techniques relies on the patient’s ventilatorymuscles to achieve hyperinflation goals? | D. II and IV II. incentive spirometry IV. positive expiratory pressure (PEP) therapy |
| True or False: Irritation, inspiration, compression, and expulsion are all part of the normal cough reflex. | True,REF: 922 |
| True or False: A patent airway, functional mucociliary escalator, and effective cough are all necessary for normal airway clearance. | True, REF: 922 |
| True or False: Anesthesia can provoke a cough? | False REF: 922-923 |
| Partial airway obstruction can result in all of the following except: | C,REF: 923 C. increased oxygenation |
| Match the phase of a cough on the “right” with the mechanism responsible for impairing the cough on the “left”. Answers may be used once, more than once or not at all. ____1. Abdominal muscle weakness | 1. C & D C. Compression D. Expulsion |
| Match the phase of a cough on the “right” with the mechanism responsible for impairing the cough on the “left”. Answers may be used once, more than once or not at all. ____2. Anesthesia | A. Irritation |
| Match the phase of a cough on the “right” with the mechanism responsible for impairing the cough on the “left”. Answers may be used once, more than once or not at all. 3. Tracheostomy tube | 3. C C. Compression |
| Match the phase of a cough on the “right” with the mechanism responsible for impairing the cough on the “left”. Answers may be used once, more than once or not at all. ____4. Pain | 4. B B. Inspiration |
| Match the phase of a cough on the “right” with the mechanism responsible for impairing the cough on the “left”. Answers may be used once, more than once or not at all. ____5. Emphysema | 5. D D. Expulsion |
| All of the following drug categories can impair mucociliary clearance in intubated patients except: A. general anesthetics B. bronchodilators C. opiates D. narcotics | B,REF: 923 B. bronchodilators |
| Conditions that can affect airway patency and cause abnormal clearance of secretions include which of the following? I. foreign bodies II. tumors III. inflammation IV. bronchospasm | D,REF: 924 D. I, II, III, and IV I. foreign bodies II. tumors III. inflammation IV. bronchospasm |
| Which of the following conditions alter normal mucociliary clearance? I. bronchodilation II. cystic fibrosis (CF) III. ciliary dyskinesia | D,REF: 924 D. II and III II. cystic fibrosis (CF) III. ciliary dyskinesia |
| True or False: The primary goal of bronchial hygiene therapy is to help mobilize and remove retained secretions. | True,REF: 924 |
| 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 | A,REF: 925 A. I, III, and IV I. bronchiectasis III. cystic fibrosis IV. chronic bronchitis |
| Chest physical therapy can be expected to improve airway clearance when a patient’s sputum production exceeds _____________ml/day | D, REF: 925 D. 25 to 30 |
| True or False: When assessing the potential need for postoperative bronchial hygiene for a patient, considering the number of prior surgeries is very relevant. | False,REF: 925 |
| 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 | C. I, II, III, and IV REF: 925 I. posture and muscle tone II. breathing pattern and ability to cough III. sputum production IV. cardiovascular stability |
| True or False: Lack of sputum production, development of a fever, labored breathing, and increased inspiratory and expiratory crackles are all clinical signs that indicate a patient is having a problem with retained secretions? | True,REF: 925 |
| True or False: Incentive spirometry is considered bronchial hygiene therapy: | False,REF: 925 |
| Postural drainage therapy uses the application of __________ to achieve specific clinical objectives in respiratory care | B,REF: 925 B. gravity |
| Which of the following is NOT a hazard or complication of postural drainage therapy? | D,REF: 926 D. pulmonary barotraumas |
| Primary objectives for turning include all of the following except to: | A,REF: 928 A. prevent postural hypotension |
| Which if the following is the only absolute contraindication to turning? | D. when the patient has unstable spinal cord injuries REF: 928 |
| In which of the following patients would you consider modifying any head-down positions used for postural drainage? | I, II, III, and IV REF: 929 I. a patient with unstable blood pressure II. a patient with a cerebrovascular disorder III. a patient with systemic hypertension IV. a patient with orthopnea |
| True or False: Vital signs, bedside PFTs, and auscultation are all mandatory components of the pre-assessment for postural drainage? | False, REF: 929 |
| What postural drainage position would you recommend if a patient’s chest radiograph shows infiltrates in the posterior basal segments of the lower lobes? | Head down (foot of bed elevated 18 inches), patient prone with a pillow under abdomen REF: 930 Figure 40-3. |
| What postural drainage position would you recommend for a patient with an infiltrate in the right middle lobe. | Head down (foot of bed elevated 12 inches), patient half-rotated to left, right lung up REF: 930 See Figure 40-3 |
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