Lung Expansion Test III

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

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

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

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?

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

Which of the following determines effectiveness of high-frequency external chest wall compression therapy?

I. Compression frequency III. Flow bias

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 the patient up, give O2, and contact the physician.

Patients can control a flutter valve's pressure by changing what?

Their expiratory flow

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

After phase 3 only

What does phase 1 of autogenic drainage involve?

An inspiratory capacity maneuver, followed by breathing at low lung volumes

If a patient's chest radiograph shows infiltrates in the posterior basal segments of the lower lobes, what postural drainage position would you recommend?

Head down, patient prone with a pillow under abdomen

Proper instructions for positive expiratory pressure include all of the following except.

Exhale forcefully and maintain an expiratory pressure of 10 to 20 cm H2O.

Which of the following best describes positive expiratory pressure (PEP) therapy?

Expiration against a variable flow resistance

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

Expiratory muscle contraction

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?

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 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.

Absolute contraindications for postural drainage include which of the following?

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

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

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

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

Hazards of positive airway pressure therapies associated with the apparatus used include which of the following?

I. Increased work of breathing II. Claustrophobia III. Increased ICP IV. Vomiting and aspiration V. Skin breakdown and discomfort

A normal cough reflex includes which of the following phases?

I. Irritation II. Inspiration III. Compression IV. Expulsion

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

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

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.

Which of the following airway clearance techniques would you recommend for a patient with a neurologic abnormality (bulbar palsy) and intact upper airway?

I. Postural drainage, percussion, and vibration III. Mechanical insufflation-exsufflation

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

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.

A physician orders positive expiratory pressure therapy for a 14-year-old child with cystic fibrosis. Which of the following should be monitored?

I. Sputum production II. Breath sounds III. Pulse rate IV. Breathing pattern

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

I. Surgery sites II. Bony prominences III. Fractured ribs

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

I. Vital signs III. Auscultation

A physician orders bronchodilator drug therapy in combination with positive expiratory pressure (PEP). Which of the following methods could you use to provide this combined therapy

II. Attach a metered-dose inhaler to the system's one-way valve inlet. III. Place a small-volume nebulizer in-line with the PEP apparatus.

Which of the following can provoke a cough?

II. Foreign bodies III. Infection IV. Irritating gases

A patient about to receive postural drainage and percussion is attached to an electrocardiographic (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?

Inspect and adjust the equipment to ensure function during therapy

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?

Intrapulmonary percussive ventilation

Why is strenuous patient coughing during postural drainage in a head-down position contraindicated?

It can markedly increase intracranial pressure (ICP).

Which of the following is false about the FET?

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

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?

Patient supine with a pillow under knees, bed flat

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

Pulmonary barotraumas

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

When the patient has unstable spinal cord injuries.

Contraindications for positive airway pressure therapies include all of the following except:

air-trapping/pulmonary overdistention in chronic obstructive pulmonary disease

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

bronchodilators.

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

chronic bronchitis.

Advantages of the flutter valve over other bronchial hygiene methods include all of the following except

greater effectiveness

Indications for directed coughing include all of the following except to:

help patients with tuberculosis clear secretions.

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

hematology results.

All of the following are hazards of positive airway pressure therapies (EPAP, PEP, CPAP) except

improvement in ABG values

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

increased expiratory flows

All of the following are typical of high-frequency external chest wall compression therapy except:

long inspiratory oscillations.

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

muscular dystrophy.

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

necrotizing pulmonary infection.

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

number of prior surgical procedures.

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

prevent postural hypotension

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

reverse the underlying disease process.