Persistent breathing at small tidal volumes can result in which of the following?
B. 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
A. 1, 2, and 3
What is the major contributing factor in the development of postoperative atelectasis?
B. repetitive, shallow breathing
Which of the following groups of patients is not at risk for developing postoperative atelectasis?
C. those with pneumonia
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
C. 1, 3, and 4
How do all modes of lung expansion therapy aid lung expansion?
A. increasing the transpulmonary pressure gradient
How can the transpulmonary pressure gradient be increased?
1.increasing alveolar pressure
2.decreasing pleural pressure
3.decreasing transthoracic pressure
C. 1 and 2
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)
C. 2, 3, and 4
Which of the following modes of lung expansion therapy is physiologically most normal?
D. incentive spirometry
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?
B. incentive spirometry
Which of the following are potential indications for incentive spirometry?
1.a restrictive disorder such as quadriplegia
2.abdominal surgery in a COPD patient 3.presence of pulmonary atelectasis
C. 1, 2, and 3
Which of the following situations is a contraindication for incentive spirometry?
1.a patient whose vital capacity is less than 10 ml/kg
2.a patient who cannot cooperate or follow instructions
3.an unconscious patient
C. 1, 2, and 3
Which of the following is not a potential hazard or complication of incentive spirometry?
A. decreased cardiac output
A postoperative patient using incentive spirometry complains of dizziness and numbness around the mouth after therapy sessions. What is the most likely cause of these symptoms?
C. hyperventilation
Incentive spirometry devices can generally be categorized as which of the following
1.pressure-oriented
2.flow-oriented
3.volume-oriented
B. 2 and 3
Which of the following is FALSE about flow-oriented incentive spirometry devices?
C. They have proved less effective than volumetric systems.
Which of the outcomes would indicate improvement in a patient previously diagnosed with atelectasis who has been receiving incentive spirometry?
1.improved PaO2
2.decreased respiratory rate
3.improved chest radiograph
4.decreased forced vital capacity (FVC) 5.tachycardia
B. 1, 2, and 3
Ideally, when should high-risk surgical patients be oriented to incentive spirometry?
D. preoperatively, before undergoing the surgical procedure
Successful application of incentive spirometry depends on:
B. the effectiveness of patient teaching
In teaching a patient to perform the sustained maximal inspiration maneuver during incentive spirometry, what would you say?
C. “Exhale normally, then inhale as deeply as you can, then hold your breath for 5 to 10 seconds.”
Correct instruction in the technique of incentive spirometry should include which of the following?
A. diaphragmatic breathing at slow to moderate flows
In performing the sustained maximal inspiration maneuver during incentive spirometry, the patient should be instructed to sustain the breath for at least how long?
B. 5 to 10 seconds
In observing a postoperative woman conduct incentive spirometry, you note repetitive performance of the sustained maximal inspiration maneuver at a rate of about 10 to 12/min. Which of the following would you recommend to her?
D. Take a 30-second rest period between breaths.
For patients receiving incentive spirometry, what is the minimum number of sustained maximal inspirations (SMIs) per hour that you would recommend?
B. 5 to 10
What should the monitoring of patients using incentive spirometry include?
1.number of breaths per session
2.volume and flow goals achieved
3.maintenance of breath-hold
4.patient effort and motivation
a.1, 3, and 4
b.2, 3, and 4
d.3 and 4
c.1, 2, 3, and 4
The short-term application of inspiratory positive pressure to a spontaneously breathing patient best defines which of the following?
A. intermittent positive-pressure breathing
Which of the following is false about intermittent positive-pressure breathing?
D. During inspiration, pressure in the alveoli decreases.
Intermittent positive-pressure breathing is associated with a passive exhalation.
a.True
b.False
a.True
Which of the following patient groups should be considered for lung expansion therapy using intermittent positive-pressure breathing (IPPB)?
1.patients with clinically diagnosed atelectasis who are not responsive to other therapies
2.patients at high risk for atelectasis who cannot cooperate with other methods
3.all obese patients who have undergone abdominal surgery
A. 1 and 2
Which of the following statements is not true about intermittent positive-pressure breathing (IPPB)?
D. IPPB should be the single treatment modality for gas absorbtion atelectasis.
What is the optimal breathing pattern for intermittent positive-pressure breathing (IPPB) treatment of atelectasis?
C. slow, deep breaths held at end-inspiration
Which of the following is NOT a potential contraindication for intermittent positive-pressure breathing?
C. neuromuscular disorders
Which of the following is an absolute contraindication for using intermittent positive-pressure breathing?
B. tension pneumothorax
What is the most common complication associated with intermittent positive-pressure breathing (IPPB)?
B. respiratory alkalosis
What is the minimum airway pressure at which the esophagus opens, allowing gas to pass directly into the stomach?
A. 20 cm H2O
Which of the following is false about gastric distention with intermittent positive-pressure breathing (IPPB)?
A. Gastric distention is a relatively harmless effect of IPPB.
Which of the following is not a potential hazard of intermittent positive-pressure breathing?
D. increased cardiac output
Which of the following are potential hazards of intermittent positive-pressure breathing (IPPB)?
1.air-trapping, auto-PEEP
2.hyperventilation
3.nosocomial infection
4.increased airway resistance
A. 1, 2, 3, and 4
Preliminary planning for intermittent positive-pressure breathing (IPPB) should include which of the following?
1.evaluating alternative approaches to the patient's problem
2.setting specific, individual clinical goals or objectives
3.conducting a baseline assessment of the patient
A. 1, 2, and 3
Which of the following are potential desirable outcomes of intermittent positive-pressure breathing (IPPB) therapy?
1.improved oxygenation
2.increased cough and secretion clearance 3.improved breath sounds
4.reduced dyspnea
A. 1, 2, 3, and 4
The general assessment, common to all patients for whom intermittent positive-pressure breathing (IPPB) is ordered, should include which of the following?
1.measurement of vital signs
2.appearance and sensorium
3.chest auscultation
4.arterial blood gas analysis
5.peak expiratory flow rates
C. 1, 2, and 3
When checking a patient’s intermittent positive-pressure breathing (IPPB) breathing circuit before use, you notice that the device will not cycle off, even when you occlude the mouthpiece. What would be the most appropriate action in this case?
a.Secure a new IPPB ventilator.
b.Check the circuit for leaks.
c.Decrease the flow setting.
d.Increase the pressure setting.
Check the circuit for leaks!
Prior to starting intermittent positive-pressure breathing (IPPB) on a new patient, what should the practitioner explain?
1.why the physician ordered the treatment
2.what the IPPB treatment will do
3.how the IPPB treatment will feel
4.what the expected results are
B. 1, 2, 3, and 4
Which of the following positions is ideal for intermittent positive-pressure breathing therapy?
D. semi-Fowler's
In order to eliminate leaks in an alert patient receiving intermittent positive-pressure breathing therapy, which of the following adjuncts would you first try?
D. nose clips
When adjusting the sensitivity control on an intermittent positive-pressure breathing device, which of the following parameters are you changing?
B. effort required to cycle the device “on” (begin inspiration)
Which of the following are appropriate initial settings for intermittent positive-pressure breathing given to a new patient?
D. sensitivity –1 to –2 cm H2O; pressure 10 to 15 cm H2O; moderate flow
In administering intermittent positive-pressure breathing therapy, which of the following breathing patterns would be most desirable?
C. 6 to 8 breaths/min, inspiration/expiration ratio (I:E) of 1:3
Which of the following are appropriate volume goals for intermittent positive-pressure breathing (IPPB) therapy?
1.10 to 15 ml/kg ideal body weight
2.at least 30% of the inspiratory capacity (IC)
3.pressure level as high as 30 to 35 cm H2O
B. 1 and 2
All of the following parameters should be evaluated after intermittent positive-pressure breathing therapy except:
A. temperature
Which of the following should be charted in the patient’s medical record after completion of an intermittent positive-pressure breathing treatment?
1.results of pre and posttreatment assessment
2.any side effects
3.duration of therapeutic session
C. 1, 2, and 3
All of the following machine performance characteristics should be monitored during intermittent positive-pressure breathing therapy except:
A. humidity output
In terms of machine performance, what large negative pressure swings early in inspiration indicate?
C. incorrect sensitivity
Which of the following will make an intermittent positive-pressure breathing (IPPB) device cycle off prematurely?
1. airflow obstructed
2. kinked tubing
3. occluded mouthpiece
4. active resistance to inhalation
A. 1, 2, 3, and 4
Which of the following mechanisms probably contribute to the beneficial effects of continuous positive airway pressure (CPAP) in treating atelectasis?
1. recruitment of collapsed alveoli
2. decreased work of breathing
3. improved distribution of ventilation
4. increased efficiency of secretion removal
A. 1, 2, 3, and 4
Which of the following are contraindications for continuous positive airway pressure (CPAP) therapy?
Which of the following are essential components of a continuous positive airway pressure (CPAP) flow system?
1. blended source of pressurized gas
2. nonrebreathing circuit with reservoir bag 3. low-pressure or disconnect alarm
4. expiratory threshold resistor
D. 1, 2, 3, and 4
During administration of a continuous positive airway pressure flow mask to a patient with atelectasis, you find it difficult to maintain the prescribed airway pressure. Which of the following is the most common explanation?
B. system or mask leaks
While monitoring a patient receiving +12 cm H2O flow-mask continuous positive airway pressure, you note that the pressure drops to +6 cm H2O during inspiration, but returns to +12 cm H2O during exhalation. Which of the following would likely correct this problem?
A. Increase the system flow.
A surgeon writes an order for lung expansion therapy for a 28-year-old 110-lb woman who has undergone lower abdominal surgery. In evaluating this patient at the bedside, you obtain a VC of 800 ml and an IC of 44% predicted. Although a chest radiograph indicates basal atelectasis, she has no problem with retained secretions. What lung expansion treatment would you recommend?
D. incentive spirometry 10 times an hour at an initial volume of 500 to 600 ml
A surgeon orders lung expansion therapy for an obtunded 68-year-old, 170-lb man who has developed atelectasis after thoracic surgery. On baseline assessment, the patient cannot perform an IC or VC maneuver, but has no evidence of retained secretions. Which of the following would you recommend?
C. intermittent positive-pressure breathing (IPPB) at 6 to 8 breaths/min at 10 to 15 ml/kg
Which of the following has a direct relationship between the degree to which atelectasis can present itself with a post-operative patient?
B. spontaneous respiratory rate
Which of the following are the hazards and complications of incentive spirometry?
1. hyperventilation
2. fatigue
3. discomfort secondary to inadequate pain control
4. barotrauma
C. 1, 2, 3, and 4
A 59 year old COPD patient comes to the hospital with upper abdominal surgery. The physician diagnoses the patient with pulmonary atelectasis. The patient has a vital capacity of 25 ml/ kg. Which of the following lung expansion therapy will you recommend to assist this patient’s atelectasis?
B. incentive spirometry
Which of the following possesses the most significant risk for hypoventilation?