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EXAM II
| Question | Answer |
|---|---|
| A goal of incentive spirometry is: | To provide means of using a patient's muscles to hyperinflate the lungs |
| A sign that your patient may be hyperventilating during incentive spirometry is: | light headedness, dizziness, tingling sensation |
| Of the following, which is the most important aspect of the incentive spirometry? | thorough patient instruction |
| A short-term application of inspiratory positive pressure to a spontaneously breathing patient best defines which of the following? | intermittent positive-pressure breathing (IPPB) |
| How do modes of lung expansion therapy aid lung expansion? | Increasing the transpulmonary gradient |
| While testing the IPPB machine before patient use, you notice that it turns on at a rate of 30 times per minute. Which of the following is most likely the cause? | the machines SENSITIVITY is inappropriately set |
| Which of the following modes of lung expansion therapy is physiologically most normal? | Incentive Spirometry |
| Which of the following are contraindications for continuous positive airway pressure (CPAP) I. esophageal resection II. hypoventilation III. facial trauma IV. low intracranial pressures | I, II, and III |
| Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure include which of the following: I. IS II. PEP III. IPPB IV. CPAP | II, III, and IV |
| All of the following are hazards of positive airway pressure therapies (CPAP, PEP, CPAP) EXCEPT: | epistaxis |
| Persistent breathing at small tidal volumes can result in which of the following? | compression atelectasis |
| 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 | 1, 2, and 3 |
| How can the transpulmonary gradient be increased? 1. increasing alveolar pressure 2. decreasing pleural pressure 3. decreasing transthoracic pressure | 1 and 2 |
| Which of the following mechanisms contribute to the beneficial effects of continuous positive airway pressure (CPAP) in treating atelectasis? recruitment of collapsed alveoli ↓ WOB improved distribution of ventilation ↑ efficiency of secretion removal | ALL OF THE ABOVE |
| In teaching a patient to perform the sustained maximal inspiration maneuver during incentive spirometry, what would you say? | exhale normally, then inhale as deeply as you can, then hold your breath for 5-10 sec |
| What are the normal cough reflex phases? | irritation, inspiration, compression, and expulsion |
| The RT receives an order to perform PD on the ANTERIOR SEGMENT of the pt’s upper lobes. How should the patient be positioned? | bed flat, patient supine, pillow supporting knees |
| The RT receives an order to perform PD on the RIGHT MIDDLE LOBE of the patient. How should the patient be positioned? | foot of bed elevated 12", patient lying on left side (right side up), pillows supporting back. |
| The RT receives an order to perform PD on the SUPERIOR SEGMENT of the pt’s lower lobes. How should the patient be positioned? | bed flat, patient prone, pillow under abdomen |
| The RT receives an order to perform PD on the POSTERIOR BASAL SEGMENT of the pt’s lower lobes. How should the patient be positioned? | foot of bed elevated 18", patient prone, pillow under abdomen |
| Which of the following can provoke a cough? 1. anesthesia 2. foreign bodies 3. infection 4. irritating gases | 2, 3, and 4 |
| A patient with abdominal muscle weakness is having difficulty developing an effective cough. Which of the following phases of the cough reflex are primarily affected in this patient? | Inspiration, Compression, and Expulsion |
| All of the following are considered airway clearance therapies except: | Incentive Spirometer |
| What factors can hinder effective coughing? 1. artificial airways 2. neuromuscular disease 3. systemic dehydration 4. pain or fear of pain 5. use of expectorants | 1, 2, 3, and 4 |
| 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? | coordinating coughing with pain medication, forced expiratory technique (FET), splinting the operative site |
| While reviewing the chart of a patient receiving CPT/PD QID, the patient tends to undergo mild desaturation during therapy (a drop in SpO2 from 94% to 89% to 92% while on 2 lpm NC). Which of the following would you recommend to manage this problem? | increase the patients FIO2 during therapy |
| In theory, how does (PEP) help to move secretions into the larger airways? 1. filling underrated segments through collateral ventilation 2. preventing airway collapse during expiration 3. causing bronchodilation during inspiration | 1 and 2 |
| Patients can control a flutter valve’s pressure by changing what? | their expiratory flow |
| During chest physical therapy, a patient has an episode of hemoptysis. Which of the following actions would be appropriate at this time? | stop therapy, sit patient up, give O2, contact physician |
| Contraindications for positive airway pressure therapies include all of the following EXCEPT: | air-trapping/pulmonary overdistention in chronic obstructive pulmonary disease |
| FET stands for: | forced expiratory technique |
| All of the following are goals of bronchial hygiene therapy EXCEPT: | reverse the underlying disease process |
| What are the goals of bronchial hygiene therapy? | help mobilize secretions, improve pulmonary gas exchange, reduce work of breathing |
| When using a metered-dose inhaler without a holding chamber or a spacer, the patient should be instructed to fire the device at what point? | immediately after beginning a slow inspiration |
| patient suffering from acute exacerbation of asthma is not responding to the standard dose & frequency of an aerosolized BD and is now receiving SVN therapy every 15-30 min. Which of the following would you recommend to the patient's doctor at this time? | consider continuous nebulization of the drug |
| whichof the following can be used to ↓ the effects of environmental exposure to ribavirin or pentamidine? isolation booth/tent with HEPA-filtered exhaust. healthcare personnel wear a HEPA-filtered mask. Use (-) pressure room with adequate air exchange. | all of the above |
| Where do most aerosol particles that are less than 3 um deposit? | parenchyma |
| What is the primary mechanism for deposition of large, high-mass particles (greater than 5 microns) in the respiratory tract? | inertial impaction |
| Advantages of small-volume ultrasonic nebulizers for drug delivery include all of the following EXCEPT: | decreased cost |
| When done appropriately, what percentage of the drug dose delivered by a simple metered-dose inhaler (MDI) deposits in the lungs? | about 20% |
| For which of the following patient groups is use of a DPI for bronchodilator administration recommended? I. Children > 5-6 years of age II. Patients suffering an acute bronchospastic episode III. Patients requiring maintenance therapy | I and III |
| All of the following drugs or drug categories have been associated with increased airway resistance and bronchospasm during aerosol administration EXCEPT which one? | albuterol |
| Which of the following describes the output produced by a nebulizer? | emitted dose |
| Where do most aerosol particles in the 5-10 um range deposit? | upper airways |
| of the following are beneficial of using a holding chamber with MDI? I.Usage of MDI can be adapted to children&elderly II.↓ in need for handbreath coordination III.Elimination of the need to do a 10 sec. breath hold IV.↑ deposition in the oropharynx | I and II |
| Which of the following statements about atomizers is FALSE? | atomizers are useful for bronchospasms |
| What is the major problem with using large-volume nebulizers for continuous aerosol drug therapy? | drug reconcentration and toxicity |
| aerosol drug delivery(SVN) set at 8 LPM, patient asks to be lowered to a semi-Fowler’s position. After, you observe a significant ↓ in SVN aerosol output, despite at least 3 ml of solution left in the reservoir. What would you do to correct this problem? | reposition the patient so that the SVN is more upright |
| Which of the following is/are necessary for normal airway clearance? I. Patent airway II. Functional mucociliary escalator III. Effective cough | I, II, III |
| Which of the following occurs during the compression phase of a cough? I. Expiratory muscle contraction II. Opening of the glottis III. Rapid drop in alveolar pressure | I. expiratory muscle contraction |
| A patient recovering from anesthesia rafter abdominal surgery is having difficulty developing an effective cough. Which of the following phase of the cough reflex are primarily affected in this patient? | irritation |
| All of the following drug categories can impair mucociliary clearance in intubated patients except A) General anesthetics B) Bronchodilators C) Opiates D) narcotics | bronchodilators |
| The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following? | postural drainage |
| What is the major contributing factor in the development of postoperative atelectasis? | repetitive shallow breathing |
| Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure include which of the following? | PEEP, IPPB, PAP |
| Which of the following is an absolute contraindication for using intermittent positive-pressure breathing? | tension pneumothorax |
| The position that facilitates the greatest chest expansion is: | dangling |
| The contraindications to PEP therapy may include: | acute sinusitis |
| You should never percuss: | bony areas, breast tissue, surgical areas, ribs |
| Which of the following is/are (an) indication(s) for Flutter valve therapy? | retained secretions, atelectasis, cystic fibrosis |
| A patient in position for draining the posterior basal segments of both lungs complains of a headache when coughing. The most likely cause is: | increased intercranial pressure |
| The CoughassistTM Mechanical In-Exsufflator: I. provides positive pressure during inhalation. II. provides negative pressure during exhalation. III. is intended for intermittent use. IV. facilitates secretion removal. | provides positive pressure during inhalation and exhalation, intermittent use, secretion removal |
| Which of the following should be included in a complete physician’s order for IPPB? | medication and dilution, frequency, and duration of therapy |
| an airway clearance manuever that combines breathing control, thoracic expansion control and forced expiration technique | active cycle of breathing |
| a technique that aims to achieve the highest possible airflow in different generations of bronchi to move secretions | autogenic drainage |
| technique used to help remove mucus and fluid from the lungs. Conventional forms include postural drainage, percussion, and vibration | Chest physiotherapy (CPT) |
| A breathing manuever that consists of one or two forced expirations or huff combined with a period of controlled breathing | forced expiratory technique |
| An airway clearance that uses a vest to compress the chest externally with short, rapid expiratory flow pulses; relies on chest wall elastic recoil to return lungs to FRC | high-frequency chest wall compression |
| forced expiratory technique that is preformed by sharply exhaling from high to mid-lung volumes through an open glottis; used for patients unable to generate effective cough | huff coughing |
| used to mimic natural sighing or yawning maneuvers; sustained maximal inspiration | IS |
| A person climbs up Mt. Everest. What type of hypoxia is she most likely to develop? | Histotoxic hypoxia |
| A rapid breathing pattern is called (RR greater than 20) | Tachypnea |
| Why do oxygen masks require minimum flow rate for operation? | to provide a way to wash out carbon dioxide |
| Which of the following is NOT a common cause of tachypnea? | Narcotic overdose |
| Two large-volume all purpose nebular are set in tandem at an FIO2 of 50% and a flow rate of 10LPM to deliver humidified oxygen to a patient with a tracheostomy. The nebulizer are producing very little mist. What could be done to improve aerosol output? | Check water level in the nebulizers, drain condensate from the supply tubing, and increase the flow rate to each LVN |
| A humidifier produces 21 mg of water per liter gas delivered. In terms of the lung, what humidity deficit is produced? | 44-21 = 23 mg |
| factors affecting a humidifiers performance include all of the following EXCEPT: | outlet size |
| Inhalation of dry gases can do which of the following? | Increase viscosity of secretions, impair mucocilliary motility, increase irritability |
| The AARC CPG states that HME's may be used in which of the following situations? | Minute volumes greater or equal to 10 LPM, Body temperature > 37 Celsius |
| Which of the following characteristics is least typical for pleuritic chest pain? | Radiates to the arm |
| What is the entrainment ratio for an FIO2 of 28%? | 10:1 |
| Which of the following changes is consistent with a fever? | increase pulse rate, increase oxygen consumption, increase CO2 production |
| A patient is receiving oxygen via 3 L nasal cannula The order for oxygen is >92%. Her SpO2 is 93% and has no clinical signs of hypoxemia. At this point, what should you recommend? | maintaining the therapy as is and rechecking the SpO2 on the next shift. |
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monkeeyy246
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