Lung expansion therapy

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

C

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
a. 1 and 2
b. 2 and 3
C.
1 and 3
d.
1, 2, and 3

D

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

D

4.
Which of the following groups of patients is not at risk for developing postoperative
atelectasis?
a.
those with chronic obstructive pulmonary disease
b. those with a significant history of cigarette smoking
C.
those with impaired mucociliary clearance
d.
those with pneumonia

D

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
a.1, 3, and 4
b.1, 2, 3, and 4
C.1 and 4
d2, 3, and 4

A

6.
How do all modes of lung expansion therapy aid lung expansion?
a.increasing the transpulmonary pressure gradient
b.decreasing the transthoracic pressure gradient
C.increasing the pressure in the pleural space
d.decreasing the pressure in the alveoli

A

7. How can the transpulmonary pressure gradient be increased?
1. increasing alveolar pressure
2. decreasing pleural pressure
3. decreasing transthoracic pressure
a.1 and 2
b.2 and 3
C.1 and 3
d.1, 2, and 3

A

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)
a. 1 and 2
b. 2, 3, and 4
C.
1 and 3
d.
1, 2, 3, and 4

B

9. Which of the following modes of lung expansion therapy is physiologically most normal?
a.
continuous positive airway pressure
b.
incentive spirometry
c. positive end-expiratory pressure
d.
intermittent positive-pressure breathing therapy

B

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?
a.
incentive spirometry
b.
PEEP therapy
C.
deep breathing exercises
d.
intermittent positive-pressure breathing therapy

A

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
a.
1 and 2
b.
2 and 3
C.
1 and 3
d.
1, 2, and 3

D

12. 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
a.
1 and 2
b.
2 and 3
C.
1 and 3
d. 1,2, and 3

D

Which of the following is not a potential hazard or complication of incentive spirometry?
a. pulmonary barotrauma
b.decreased cardiac output
c. respiratory alkalosis
d. fatigue

B

14. 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?
a.
gastric insufflation
b. hyperventilation
C
pulmonary barotrauma
d.
respiratory acidosis

B

15. Incentive spirometry devices can generally be categorized as which of the following?
1. pressure-oriented
2. flow-oriented
3. volume-oriented
a.3
b.1 and 2
C.1, 2, and 3
d.2 and 3

D

16. Which of the following is FALSE about flow-oriented incentive spirometry devices?
a. Inspired volume is estimated as the product of flow and time.
b.
Motivation is based on keeping the indicator balls elevated.
C.
They have proved less effective than volumetric systems.
d.
They provide only an indirect measure of inspired volume.

C

17. Which of the outcomes would indicate improvement in a patient previously diagnosed with
atelectasis who has been receiving incentive spirometry?
1. improved PaOz
2. decreased respiratory rate
3. improved chest radiograph
4. decreased forced vital capacity (FVC)
5. tachycardia
a.
1, 2, and 3
b.
1, 3, and 4
C.
1, 2, 3, 4, and 5
d.
3, 4, and 5

A

18. Ideally, when should high-risk surgical patients be oriented to incentive spirometry?
a.
postoperatively, after full recovery from the anesthesia
b.
preoperatively, before undergoing the surgical procedure
C.
postoperatively, while they are still in the recovery room
d
postoperatively, but no sooner than 24 hours after surgery

B

19. Successful application of incentive spirometry depends on:
a.
the use of a true volume-oriented incentive spirometry system
b.
the type of surgery previously performed
C.
the effectiveness of patient teaching
d.
setting an easily achieved initial goal

C

20. 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.
b."Inhale as deeply as you can, then blow out as much air as you can as fast as
possible.
C."Exhale normally, then inhale as deeply as you can, then hold your breath for 10 to
20 seconds.
D. "Exhale as much as you can, then inhale as deeply as you can, then relax and let it
out.

A

21.
Correct instruction in the technique of incentive spirometry should include which of the
following?
a. use of accessory muscles at high inspiratory flows
b. diaphragmatic breathing at slow to moderate flows
C.
"panting" at volumes approaching total lung capacity
d.
use of accessory muscles at low inspiratory flows

B

22. In performing the sustained maximal inspiration maneuver during incentive spirometry, the
patient should be instructed to sustain the breath for at least how long?
a. 10 to 15 seconds
b. 5 to 10 seconds
C.
3 to 5 seconds
d. 1 to 2 seconds

B

23. 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?
a. Decrease the treatment frequency to 4 times/day.
b.
Increase her breathing rate to 12 to 15/min.
C.
Take a 30-second rest period between breaths.
d. Repeat the treatment every 30 minutes.

C

24. For patients receiving incentive spirometry, what is the minimum number of sustained
maximal inspirations (SMIs) per hour that you would recommend?
a. 25 to 30
b.
15 to 20
C.
5 to 10
d.
1 to 2

C

25. 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
C.1, 2, 3, and 4
D. 3 and 4

C

26. The short-term application of inspiratory positive pressure to a spontaneously breathing
patient best defines which of the following?
a.
sustained maximal inspiration
b. intermittent positive-pressure breathing
c. continuous positive airway pressure
d. positive end-expiration pressure

B

27. Which of the following is false about intermittent positive-pressure breathing?
a.
During inspiration, pressure in the alveoli decreases.
b. The pressure gradients of normal breathing are reversed
C.
During inspiration, alveolar pressure may exceed pleural pressure.
d. Energy stored during inspiration causes a passive exhalation.

A

28. Intermittent positive-pressure breathing is associated with a passive exhalation.
A.
True
b.
False

A

29. 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
b.
2 and 3
C.
1 and 3
d.
1, 2, and 3

A

30. Which of the following statements is not true about intermittent positive-pressure breathing
(IPPB)?
a. IPPB could cause lung overinflation.
b. IPPB could cause no expansion of regions affected by secretions.
c. Bronchial hygiene must be used in conjunction with IPPB to adequately manage
secretions.
d. IPPB should be the single treatment modality for gas absorbtion atelectasis.

D

31. What is the optimal breathing pattern for intermittent positive-pressure breathing (IPPB)
treatment of atelectasis?
a. slow, deep breaths held at end-inspiration
b. rapid, deep breaths held at end-inspiration
c. slow, shallow breaths held at end-inspiration
d. rapid, shallow breaths held at end-inspiration

A

32. Which of the following is NOT a potential contraindication for intermittent positive-pressure
breathing?
a.hemodynamic instability
b. recent esophageal surgery
C.
tension pneumothorax
d.
neuromuscular disorders

D

33. Which of the following is an absolute contraindication for using intermittent positive-pressure
breathing?
a.hemodynamic instability
b. recent esophageal surgery
C.
tension pneumothorax
d.
neuromuscular disorders

C

34. What is the most common complication associated with intermittent positive-pressure
breathing (IPPB)?
a. air-trapping
b. oral bleeding
c. respiratory alkalosis
d.
• gastric distention

C

35. What is the minimum airway pressure at which the esophagus opens, allowing gas to pass
directly into the stomach?
a. 25 cm H›0
b.
20 cm HO
C.
15 cm HO
d
10 cm H20

B

36. Which of the following is false about gastric distention with intermittent positive-pressure
breathing (IPPB)?
a.
Gastric distention is uncommon in alert and cooperative patients.
b.
Gastric distention is most likely at high airway pressures.
C.
Gastric distention is a significant risk in obtunded patients.
d. Gastric distention is a relatively harmless effect of IPPB.

D

37.
Which of the following is not a potential hazard of intermittent positive-pressure breathing?
a. increased cardiac output
b. respiratory alkalosis
c. pulmonary barotrauma
d.
gastric distention

A

38. 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
2.
1, 2, 3, and 4
b.
2 and 4
C.
2. 3, and 4
d.
3 and 4

A

39. 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 and
3
b.
1 and 2
C.
1, 2, and 3
d
2 and 3

C

40. 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. 2 and 4
b.
1, 2, and 3
C.
3 and 4
d. 1,2, 3, and 4

D

41. 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
a.
1 and 4
b.
2 and 5
C.
3 and 4
d. 1,2, and 3

D

42. 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

B

43. 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
a.1, 2, 3, and 4
b.2 and 4
C.2, 3, and 4
d. 1, 3, and 4

A

44. Which of the following positions is ideal for intermittent positive-pressure breathing therapy?
a.
semi-Fowler's
b.
standing
C.
supine
d
prone

A

45. In order to eliminate leaks in an alert patient receiving intermittent positive-pressure breathing
therapy, which of the following adjuncts would you first try?
a.
flanged mouthpiece
b.
form-fitting mask
C.
nasopharyngeal airway
d
nose clips

D

46. When adjusting the sensitivity control on an intermittent positive-pressure breathing device,
which of the following parameters are you changing?
a. volume of gas delivered to the patient during inhalation
b. effort required to cycle the device "off" (end inspiration)
C.
effort required to cycle the device "on" (begin inspiration)
d. maximum pressure delivered to the patient during inhalation

C

47. Which of the following are appropriate initial settings for intermittent positive-pressure
breathing given to a new patient?
Test bank
39-15
a.
sensitivity -2 cm H›O; pressure 20 to 25 cm H20; high flow
b. sensitivity -3 to -
4 cm H2O; pressure 5 to 10 cm H›O; moderate flow
C.
sensitivity -1 to -2 cm H2O; pressure 10 to 15 cm H›0; moderate flow
d.
sensitivity -8 cm H2O; pressure 15 cm H›O; moderate flow

C

48. In administering intermittent positive-pressure breathing therapy, which of the following
breathing patterns would be most desirable?
a.
6 to 8 breaths/min, inspiration/expiration ratio (I:E) of 1:3
b. 8 to 10 breaths/min, I:E of 1:1
C.
12 to 15 breaths/min, I:E of 1:2
d.
6 to 8 breaths/min, I:E of 1:1

A

49.
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 H20
a.
1 and 3
b. 1 and 2
C.
2 and 3
d.
1

B

50. All of the following parameters should be evaluated after intermittent positive-pressure
breathing therapy except:
a.
vital signs
b. sensorium
C.
breath sounds
d.
temperature

D

51. 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
a.
2 and 3
b. 1 and 3
C.
1 and 2
d.
1, 2, and 3

D

52.
All of the following machine performance characteristics should be monitored during
intermittent positive-pressure breathing therapy except:
a.
flow setting
b. sensitivity
C
humidity output
d.
peak pressure

C

53. In terms of machine performance, what large negative pressure swings early in inspiration
indicate?
a.
inadequate flow setting
b. incorrect sensitivity
C.
inadequate pressure setting
d. inadequate humidity

B

54. 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 and 2
b.
1 and 3
C.
1, 3, and 4
d. 1,2,3, and 4

D

55. Which of the following mechanisms probably contribute to the beneficial effects of
continuous positive airway pressure (PAP) 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, and 4
b.
2 and 3
C.
1 and 4
d.
1, 2, 3, and 4

D

56. Which of the following are contraindications for continuous positive airway pressure (CPAP)
therapy?
1. hemodynamic instability
2. hypoventilation
3. facial trauma
4. low intracranial pressures
a.
1 and 3
b.
2 and 3
C.
1, 2, and 3
d.
- 2, 3, and 4

C

57
Which of the following are potential complications of continuous positive airway pressure
(CPAP) therapy?
1. barotrauma
2. hyperventilation
3. gastric distention
4. hypercapnia
a.
1 and 3
b.
2 and 3
C.
1, 3, and 4
d. 2, 3, and 4

A

58. 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
a.
3 and.
4
b.
1, 2, and 4
C.
1 and 4
d.
1, 2, 3, and 4

D

59. 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?
a. system or mask leaks
b. outflow obstruction
C.
inadequate system flow
d.
inadequate trigger

A

60. While monitoring a patient receiving +12 cm H›O flow-mask continuous positive airway
pressure, you note that the pressure drops to +6 cm H2O during inspiration, but returns to +12
cm H›O during exhalation. Which of the following would likely correct this problem?
a.
Check and correct any mask leaks.
b.
Check and correct any outflow obstruction.
c. Increase the system flow.
d.
Increase the system pressure.

C

61.
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?
intermittent positive-pressure breathing at 6 to 8 breaths/min at 10 to 15 ml/kg
b. continuous positive airway pressure therapy at 10 cm H›O for 24 hours
C.
positive end-expiratory pressure therapy with bronchodilator and bronchial
hygiene
d. incentive spirometry 10 times an hour at an initial volume of 500 to 600 ml

D

62.
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?
a. intermittent positive-pressure breathing (IPPB) at 6 to 8 breaths/min at 10 to 15
ml/kg
b.
continuous positive airway pressure therapy at 12 cm H2O for 24 hours
C.
positive end-expiratory pressure therapy with bronchodilator and bronchial
hygiene
d. incentive spirometry 10 times an hour at an initial volume of 600 to 800 ml

A

63. Which of the following has a direct relationship between the degree to which atelectasis can
present itself with a post-operative patient?
a.
spontaneous respiratory rate
b. bradycardia
C.
hypocapnia
d. hypothermia

A

64.
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
a.1 and 2
b.2 and 3
C.1, 2, and 3
D.1, 2, 3, and 4

D

65. 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?
a. incentive spirometry
b. IPPB
C.
CPAP
d. EPAP

A

66. Which of the following possesses the most significant risk for hypoventilation?
a.
IPPB
b. IS
C.
IPAP/EPAP
d.
. CPAP

D