1. 1. Persistent breathing at small tidal volumes can result in which of the following?
    a. reabsorption atelectasis
    b. spontaneous pneumothorax
    c. compression atelectasis
    d. respiratory alkalosis
    compression atelectasis
  2. 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

  3. What is the major contributing factor in the development of postoperative atelectasis?
    a. uncontrolled hyperpyrexia
    b. central nervous system overstimulation
    c. decreased cardiac output
    d. repetitive, shallow breathing
    • ans: D
    • Most postoperative patients also have problems coughing effectively because of their reducedability to take deep breaths.
  4. Which of the following groups of patients is not at risk for developing postoperativeatelectasis?

  5. Which of the following clinical findings indicate the development of atelectasis?
    1. opacified areas on the chest x-ray film
    2. inspiratory and expiratory wheezing
    3. tachypnea
    4. diminished or bronchial breath sounds

  6. How do all modes of lung expansion therapy aid lung expansion?

  7. How can the transpulmonary pressure gradient be increased?
    1. increasing alveolar pressure
    2. decreasing pleural pressure
    3. decreasing transthoracic pressure

  8. Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure include which of the following?
    1. incentive spirometry (IS)
    2. positive end-expiration pressure therapy
    3. intermittent positive-pressure breathing (IPPB)
    4. expiratory positive airway pressure (EPAP)

  9. Which of the following modes of lung expansion therapy is physiologically most normal?

  10.  An alert and cooperative 28-year-old woman with no prior history of lung disease underwent cesarean section 16 hours earlier. Her x-ray film currently
    is clear. Which of the following approaches to preventing atelectasis would you recommend for
    this patient?

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

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

  13. Conditions that can affect airway patency and cause abnormal clearance of secretions include which of the following?
    1. foreign bodies
    2. tumors
    3. inflammation
    4. bronchospasm

  14. Which of the following conditions alter normal mucociliary clearance?
    1. bronchospasm
    2. cystic fibrosis (CF)
    3. ciliary dyskinesia

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

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

    • A.
    • most common conditions affecting cough reflex are musculoskeletal and neurological disorders
  17. All of the following are goals of airway clearance therapy except:

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

  19. Which of the following conditions are associated with chronic production of large volumes ofsputum?
    1. bronchiectasis
    2. pulmonary fibrosis
    3. cystic fibrosis
    4. chronic bronchitis

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

    • D.
    • production must exceed 25-30 ml/day for clearance therapy to be effective
  21. Which of the following measures would you use to ask patients for the presence of copiousmucus production?

  22. What are the best documented preventive uses of airway clearance therapy?
    1. Prevent retained secretions in the acutely ill.
    2. Maintain lung function in cystic fibrosis.
    3. Prevent postoperative pulmonary complications.

  23. When assessing the potential need for postoperative airway clearance for a patient, all of thefollowing factors are relevant except:

  24. All of the following laboratory data are essential in assessing a patient’s need for airwayclearance therapy except:

  25. Key considerations in initial and ongoing patient assessment for chest physical therapyinclude which of the following?
    1. posture and muscle tone
    2. breathing pattern and ability to cough
    3. sputum production
    4. cardiovascular stability

  26. Which of the following clinical signs indicate that a patient is having a problem with retainedsecretions?
    1. lack of sputum production
    2. labored breathing
    3. development of a fever
    4. increased inspiratory and expiratory crackles

  27. All of the following are considered airway clearance therapies except:

  28. The application of gravity to achieve specific clinical objectives in respiratory care bestdescribes which of the following?

  29. Postural drainage should be considered in all of the following situations except:

  30. Absolute contraindications for postural drainage include which of the following?
    1. head and neck injury (until stabilized)
    2. active hemorrhage with hemodynamic instability
    3. uncontrolled airway at risk for aspiration

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

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

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

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

  35. In which of the following patients would you consider modifying any head-down positionsused for postural drainage?
    1. a patient with unstable blood pressure
    2. a patient with a cerebrovascular disorder
    3. a patient with systemic hypertension
    4. a patient with orthopnea

  36. In setting up a postural drainage treatment schedule for a postoperative patient, which of thefollowing information would you try to obtain from the patient’s nurse?
    1. patient’s medication schedule
    2. patient’s meal schedule
    3. location of surgical incision

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

  38. Which of the following are mandatory components of the preassessment for postural
    1. vital signs
    2. bedside pulmonary function tests
    3. auscultation

  39. If a patient’s chest radiograph shows infiltrates in the posterior basal segments of the lowerlobes, what postural drainage position would you recommend?

  40. 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?

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

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

  43. If tolerated, a specified postural drainage position should be maintained for at least how long?

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

  45. Why is strenuous patient coughing during postural drainage in a head-down positioncontraindicated?

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

  47. All of the following would indicate a successful outcome for postural drainage therapy except:

  48. All of the following responses indicate that postural drainage should be terminated except:

  49. Which of the following should be charted after completing a postural drainage treatment?
    1. amount and consistency of sputum produced
    2. patient tolerance of procedure
    3. position(s) used (including time)
    4. any untoward effects observed

Card Set
lung expansion therapy