CH 44 Airway Clearance (Egan)

A normal cough reflex includes which of the following phases?

1. Irritation

2. Inspiration

3. Compression

4. Expulsion

a. 1, 2, and 3 only

b. 1 and 4 only

c. 1, 2, 3, and 4

d. 2 and 3 only

ANS: C

1. Irritation

2. Inspiration

3. Compression

4. Expulsion

Which of the following are necessary for normal airway clearance?

1. Patent airway

2. Functional mucociliary escalator

3. Effective cough

4. Normal pulmonary compliance

a. 1 and 4 only

b. 1, 2, and 3 only

c. 2 and 3 only

d. 2 and 4 only

ANS: B

1. Patent airway

2. Functional mucociliary escalator

3. Effective cough

Which of the following can provoke a cough?

1. Anesthesia

2. Foreign bodies

3. Infection

4. Irritating gases

a. 2 and 4 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: D

2. Foreign bodies

3. Infection

4. Irritating gases

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

1. Expiratory muscle contraction

2. Opening of the glottis

3. Rapid drop in alveolar pressure

a. 1 and 2 only

b. 2 and 3 only

c. 1 and 3 only

d. 1 only

ANS D

1. Expiratory muscle contraction

Retention of secretions can result in full or partial airway obstruction. Mucus plugging can result in which of the following?

1. Hypoxemia

2. Atelectasis

3. Shunting

a. 1, 2, and 3

b. 1 and 2 only

c. 1 and 3 only

d. 2 and 3 only

ANS: A

1. Hypoxemia

2. Atelectasis

3. Shunting

6. Partial airway obstruction can result in which of the following?

1. Increased work of breathing

2. Air trapping or overdistention

3. Increased expiratory flows

4. Ventilation/perfusion ratio ( ) imbalances

a. 1 and 2 only

b. 1, 2, and 4 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: B

1. Increased work of breathing

2. Air trapping or overdistention

4.Ventilation/perfusion ratio ( ) imbalances

7. 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?

1. Irritation

2. Inspiration

3. Compression

4. Expulsion

a. 1, 2, and 3 only

b. 2 and 4 only

c. 2, 3, and 4 only

d. 3 and 4 only

ANS: D

3. Compression

4. Expulsion

8. A patient recovering from anesthesia after abdominal surgery is having difficulty developing an effective cough. Which of the following phases of the cough reflex are primarily affected

in this patient?

a. Irritation

b. Inspiration

c. Compression

d. Expulsion

ANS: A

Irritation

9. A patient with a tracheostomy tube is having difficulty developing an effective cough. Which of the following phases of the cough reflex is primarily affected in this patient?

a. Irritation

b. Inspiration

c. Compression

d. Expulsion

ANS: C

Compression

10 A patient with a neuromuscular disorder causing generalized muscle weakness is having difficulty developing an effective cough. Which of the following cough phases are primarily affected in this patient?

a. Irritation

b. Inspiration

c. Compression

d. Expulsion

ANS: B

Inspiration

11. Which of the following can impair mucociliary clearance in intubated patients?

1. Use of respiratory stimulants

2. Tracheobronchial suctioning

3. Inadequate humidification

4. High inspired oxygen concentrations

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: D

2. Tracheobronchial suctioning

3. Inadequate humidification

4. High inspired oxygen concentrations

12. Which of the following drug categories can impair mucociliary clearance in intubated patients?

1. General anesthetics

2. Bronchodilators

3. Opiates

4. Narcotics

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 1, 3, and 4 only

ANS: D

1. General anesthetics

3. Opiates

4. Narcotics

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

a. 1, 2, and 3 only

b. 2 and 4 only

c. 2, 3, and 4 only

d. 1, 2, 3, and 4

ANS: D

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

4. Asthma

a. 1, 2, and 4 only

b. 1 and 2 only

c. 1 and 4 only

d. 2 and 3 only

ANS: D

2. Cystic fibrosis (CF)

3. Ciliary dyskinesia

15. Conditions that can lead to bronchiectasis include which of the following?

1. Chronic airway infection

2. Muscular dystrophy

3. Foreign body aspiration

4. Obliterative bronchiolitis

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 1, 3, and 4 only

ANS: D

1. Chronic airway infection

3. Foreign body aspiration

4. Obliterative bronchiolitis

16. Which of the following conditions impair secretion clearance by affecting the cough reflex?

1. Muscular dystrophy

2. Amyotrophic lateral sclerosis

3. Chronic bronchitis

4. Cerebral palsy

a. 1 and 3 only

b. 1, 2, and 4 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: B

1. Muscular dystrophy

2. Amyotrophic lateral sclerosis

4. Cerebral palsy

17. Which of the following are goals of airway clearance therapy?

1. Help reverse the underlying disease process.

2. Help mobilize retained secretion.

3. Improve pulmonary gas exchange.

4. Reduce the work of breathing.

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: D

2. Help mobilize retained secretion.

3. Improve pulmonary gas exchange.

4. Reduce the work of breathing.

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

a. Patient with acute lobar atelectasis

b. Patient with copious amounts of secretions

c. Patient with an acute exacerbation of COPD

d. Patient with low due to unilateral infiltrates

ANS: C

Patient with an acute exacerbation of COPD

19. Which of the following conditions are associated with chronic production of large volumes of sputum?

1. Bronchiectasis

2. Pulmonary fibrosis

3. Cystic fibrosis

4. Chronic bronchitis

a. 1, 3, and 4 only

b. 2 and 4 only

c. 2, 3, and 4 only

d. 3 and 4 only

ANS: A

1. Bronchiectasis

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?

a. 30 ml/day

b. 20 ml/day

c. 15 ml/day

d. 10 ml/day

ANS: A

30 ml/day

21. Which of the following measures would you use to ask patients for the presence of copious mucus production?

a. 1 pint

b. 1 ounce

c. 1 gallon

d. 1 tablespoon

ANS: B

1 ounce

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.

a. 1, 2, and 3

b. 1 and 2 only

c. 1 and 3 only

d. 2 and 3 only

ANS: B

1. Prevent retained secretions in the acutely ill.

2. Maintain lung function in cystic fibrosis.

23. When assessing the potential need for postoperative airway clearance for a patient, which of the following factors are relevant?

1. Patient's age and respiratory history

2. Nature and duration of current surgery

3. Number of prior surgical procedures

4. Type of anesthesia (e.g., local vs. general)

a. 1 and 3 only

b. 1, 2, and 4 only

c. 3 and 4 only

d. 1, 2, 3, and 4

ANS: B

1. Patient's age and respiratory history

2. Nature and duration of current surgery

4. Type of anesthesia (e.g., local vs. general)

24. Which of the following laboratory data are essential in assessing a patient's need for airway clearance therapy?

1. Chest radiograph

2. Pulmonary function tests

3. Hematology results

4. ABGs/oxygen saturation

a. 1 and 3 only

b. 1, 2, and 4 only

c. 3 and 4 only

d. 1, 2, 3, and 4

ANS: B

1. Chest radiograph

2. Pulmonary function tests

4. ABGs/oxygen saturation

25. Key considerations in initial and ongoing patient assessment for chest physical therapy include which of the following?

1. Posture and muscle tone

2. Breathing pattern and ability to cough

3. Sputum production

4. Cardiovascular stability

a. 1, 2, and 3 only

b. 2 and 4 only

c. 1, 2, 3, and 4

d. 3 and 4 only

ANS: C

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 retained secretions?

1. Copious amounts of sputum production

2. Labored breathing

3. Development of a fever

4. Increased inspiratory and expiratory crackles

a. 1 and 4 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: D

2. Labored breathing

3. Development of a fever

4. Increased inspiratory and expiratory crackles

27. Which of the following are considered airway clearance therapies?

1. Postural drainage and percussion

2. Incentive spirometry

3. Positive airway pressure

4. Percussion, vibration, and oscillation

a. 1 and 3 only

b. 1, 3, and 4 only

c. 2, 3, and 4 only

d. 2 and 4 only

ANS: B

1. Postural drainage and percussion

3. Positive airway pressure

4. Percussion, vibration, and oscillation

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

a. Breathing exercises

b. Postural drainage therapy

c. Hyperinflation therapy

d. Directed coughing

ANS: B

Postural drainage therapy

29. Postural drainage should be considered in which of the following situations?

1. In patients with chronic obstructive lung disease

2. In patients who expectorate more than 25 to 30 ml sputum per day

3. In the presence of atelectasis caused by mucus plugging

4. In patients with cystic fibrosis or bronchiectasis

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: D

2. In patients who expectorate more than 25 to 30 ml sputum per day

3. In the presence of atelectasis caused by mucus plugging

4. In patients with cystic fibrosis or bronchiectasis

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

a. 1 and 2 only

b. 2 and 3 only

c. 1 and 3 only

d. 1, 2, and 3

ANS: D

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 are hazards or complication of postural drainage therapy?

1. Cardiac arrhythmias

2. Increased intracranial pressure

3. Acute hypotension

4. Pulmonary barotraumas

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: B

1. Cardiac arrhythmias

2. Increased intracranial pressure

3. Acute hypotension

32. Primary objectives for turning include which of the following?

1. Prevent postural hypotension.

2. Promote lung expansion.

3. Prevent retention of secretions.

4. Improve oxygenation.

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: D

2. Promote lung expansion.

3. Prevent retention of secretions.

4. Improve oxygenation.

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

a. When the patient cannot or will not change body position

b. When poor oxygenation is associated with unilateral lung disease

c. When the patient has or is at high risk for atelectasis

d. When the patient has unstable spinal cord injuries

ANS: D

When the patient has unstable spinal cord injuries

34. Which of the following 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.

a. 2 and 4 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 1, 2, and 4 only

ANS: B

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.

35. In which of the following patients would you consider modifying any head-down positions used 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

a. 1, 2, 3, and 4

b. 2 and 4 only

c. 2, 3, and 4 only

d. 2 and 4 only

ANS: A

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 the following 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

a. 1 and 2 only

b. 2 and 3 only

c. 1 and 3 only

d. 1, 2, and 3

ANS: D

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 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?

a. Cancel the therapy because the patient cannot be repositioned.

b. Inspect and adjust the equipment to ensure function during therapy.

c. Turn off the ECG monitor, but keep the IV line and O2 going.

d. Turn off the IV line, but keep the monitor on and the O2 going.

ANS: B

Inspect and adjust the equipment to ensure function during therapy

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

1. Vital signs

2. Bedside pulmonary function tests

3. Auscultation

a. 1 and 2 only

b. 2 and 4 only

c. 1 and 3 only

d. 1, 2, and 3

ANS: C

1. Vital signs

3. Auscultation

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

a. Head down, patient supine with a pillow under knees

b. Patient prone with a pillow under head, bed flat

c. Patient supine with a pillow under knees, bed flat

d. Head down, patient prone with a pillow under abdomen

ANS: D

Head down, patient prone with a pillow under abdomen

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?

a. Head down, patient prone with a pillow under abdomen

b. Head down, patient supine with a pillow under knees

c. Patient supine with a pillow under knees, bed flat

d. Head down, patient half-rotated to left, right lung up

ANS: D

Head down, patient half-rotated to left, right lung up

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

a. Patient prone with a pillow under abdomen, bed flat

b. Head down, patient prone with a pillow under abdomen

c. Head down, patient supine with a pillow under knees

d. Patient supine with a pillow under knees, bed flat

ANS: A

Patient prone with a pillow under abdomen, bed flat

42. 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?

a. Head down, patient prone with a pillow under abdomen

b. Patient supine with a pillow under knees, bed flat

c. Head down, patient supine with a pillow under knees

d. Patient prone with a pillow under abdomen, bed flat

ANS: A

Head down, patient prone with a pillow under abdomen

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

a. 1 to 2 min

b. 10 to 20 min

c. 20 to 30 min

d. 3 to 15 min

ANS: D

3 to 15 min

44. While reviewing the chart of a patient receiving postural drainage therapy, you notice that the patient 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?

a. Increase the patient's FiO2 during therapy.

b. Discontinue the postural drainage therapy entirely.

c. Discontinue the percussion and vibration only.

d. Decrease the frequency of treatments.

ANS: A

Increase the patient's FiO2 during therapy.

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

a. It can impair the mucociliary clearance mechanism.

b. It can increase expiratory airway resistance (Raw).

c. It can cause air trapping and pulmonary distension.

d. It can markedly increase intracranial pressure (ICP).

ANS: D

It can markedly increase intracranial pressure (ICP).

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

time?

a. Maintain the drainage position while carefully watching the patient.

b. Move the patient to the sitting position until the cough subsides.

c. Stop the treatment at once and report the incident to the nurse.

d. Drop the head of the bed farther and encourage more coughing.

ANS: B

Move the patient to the sitting position until the cough subsides

47. Which of the following would indicate a successful outcome for postural drainage therapy?

1. Decreased sputum production

2. Normalization in ABGs

3. Improved breath sounds

4. Improvement in chest radiograph

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: D

2. Normalization in ABGs

3. Improved breath sounds

4. Improvement in chest radiograph

48. Which of the following responses indicate that postural drainage should be terminated?

1. Severe tachycardia

2. Complaint of discomfort

3. Irregular blood pressure

4. Severe bradycardia

a. 1 and 3 only

b. 1, 2, and 3 only

c. 2 and 4 only

d. 1, 3, and 4 only

ANS: D

1. Severe tachycardia

3. Irregular blood pressure

4. Severe bradycardia

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

a. 1, 2, and 3 only

b. 2 and 4 only

c. 1, 2, 3, and 4

d. 3 and 4 only

ANS: C

1. Amount and consistency of sputum produced

2. Patient tolerance of procedure

3. Position(s) used (including time)

4. Any untoward effects observed

50. Percussion should not be performed over which of the following areas?

1. Surgery sites

2. Bony prominences

3. Fractured ribs

a. 3 only

b. 1 and 2 only

c. 2 and 3 only

d. 1, 2, and 3

ANS: D

1. Surgery sites

2. Bony prominences

3. Fractured ribs

51. Properly performed chest vibration is applied at what point?

a. Throughout inspiration

b. At the end of expiration

c. At the start of inspiration

d. Throughout expiration

ANS: D

Throughout expiration

52. Directed coughing is useful in helping to maintain airway clearance in which of the following cases?

1. Bronchiectasis

2. Acute asthma

3. Cystic fibrosis

4. Spinal cord injury

a. 1 and 3 only

b. 1, 2, and 3 only

c. 1, 2, 3, and 4

d. 1, 3, and 4 only

ANS: D

1. Bronchiectasis

3. Cystic fibrosis

4. Spinal cord injury

53. Indications for directed coughing include which of the following?

1. Enhance other airway clearance therapies.

2. Help patients with tuberculosis clear secretions.

3. Help prevent postoperative pulmonary complications.

4. Obtain sputum specimens for diagnostic analysis.

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 1, 3, and 4 only

ANS: D

1. Enhance other airway clearance therapies.

3. Help prevent postoperative pulmonary complications.

4. Obtain sputum specimens for diagnostic analysis.

54. Which of the following are contraindications for directed coughing?

1. The presence of infection spread by droplet nuclei

2. Elevated intracranial pressure or intracranial aneurysm

3. Reduced coronary artery perfusion

4. Necrotizing pulmonary infection

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: B

1. The presence of infection spread by droplet nuclei

2. Elevated intracranial pressure or intracranial aneurysm

3. Reduced coronary artery perfusion

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

1. Patient with poor coronary artery perfusion

2. Postoperative upper-abdominal surgery patient

3. Long-term care patient with retained secretions

4. Patient with an acute unstable spinal injury

a. 2 and 3 only

b. 1, 2, and 3 only

c. 1 and 4 only

d. 2, 3, and 4 only

ANS: C

1. Patient with poor coronary artery perfusion

4. Patient with an acute unstable spinal injury

56. What factors can hinder effective coughing?

1. Artificial airways

2. Neuromuscular disease

3. Systemic overhydration

4. Pain or fear of pain

a. 1, 2, and 4 only

b. 2 and 4 only

c. 1 and 3 only

d. 3 and 4 only

ANS: A

1. Artificial airways

2. Neuromuscular disease

4. Pain or fear of pain

57. Key consideration in teaching a patient to develop an effective cough regimen includes which of the following?

1. Strengthening of the expiratory muscles

2. Instruction in breathing control

3. Instruction in proper positioning

a. 2 and 3 only

b. 1 and 2 only

c. 1, 2, and 3

d. 1 and 3 only

c

1. Strengthening of the expiratory muscles

2. Instruction in breathing control

3. Instruction in proper positioning

58. What is the ideal patient position for directed coughing?

a. Sitting with one shoulder rotated inward, the head and spine slightly flexed

b. Supine, with knees slightly flexed and feet braced

c. Prone, with the head and spine slightly flexed

d. Supine, with forearms relaxed and feet supported

ANS: A

Sitting with one shoulder rotated inward, the head and spine slightly flexed

59. 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?

1. Coordinating coughing with pain medication

2. Using the forced expiration technique (FET)

3. Supplying manual epigastric compression

4. "Splinting" the operative site

a. 1, 2, and 4 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: A

1. Coordinating coughing with pain medication

2. Using the forced expiration technique (FET)

4. "Splinting" the operative site

60. Strenuous expiratory efforts in some chronic obstructive pulmonary disease (COPD) patients limit the effectiveness of coughing. Why is this so?

a. The accessory muscles of inspiration oppose the exhalation.

b. All COPD patients have severe abdominal muscle weakness.

c. High expiratory pleural pressures compress the small airways.

d. Strenuous expiration causes the upper airway to collapse.

ANS: C

High expiratory pleural pressures compress the small airways

61. 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?

1. Enhancing expiratory flow by bending forward at the waist

2. Using short, expiratory bursts or the "huffing" method

3. Using only moderate (as opposed to full) inspiration

4. Having the patient "tense" the neck muscles while coughing

a. 2 and 4 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 1, 2, and 4 only

ANS: B

1. Enhancing expiratory flow by bending forward at the waist

2. Using short, expiratory bursts or the "huffing" method

3. Using only moderate (as opposed to full) inspiration

62. 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?

1. Combining manual chest compression with suctioning

2. Coordinating the coughing regimen with pain medication

3. Using the autogenic drainage method

4. Using mechanical insufflation-exsufflation

a. 1 and 4 only

b. 1, 2, and 3 only

c. 2 and 3 only

d. 1, 2, and 4 only

ANS: A

1. Combining manual chest compression with suctioning

4. Using mechanical insufflation-exsufflation

63. Which of the following are true about the FET?

1. It causes less bronchiolar collapse than traditional coughing.

2. It occurs from mid to low lung volume without glottis closure.

3. It has a period of diaphragmatic breathing and relaxation.

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

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

B

1. It causes less bronchiolar collapse than traditional coughing.

2. It occurs from mid to low lung volume without glottis closure.

3. It has a period of diaphragmatic breathing and relaxation.

64. Maintaining an open glottis during coughing (as with the FET) can help to minimize increases in pleural pressure and lessen the likelihood of bronchiolar collapse. Which of the following

techniques can aid the practitioner in teaching the patient this maneuver?

a. Having the patient inhale slowly through the nose

b. Having the patient phonate or "huff" during expiration

c. Having the patient "tense" the neck muscles while coughing

d. Telling the patient to exert effort, as in straining at stool

ANS: B

Having the patient phonate or "huff" during expiration

65. Whether using traditional methods or the FET, a period of diaphragmatic breathing and relaxation should always follow attempts at coughing. What is the purpose of this approach?

a. To restore the patient's SO2

b. To restore lung volume and minimize fatigue

c. To allow the patient time to ask questions

d. To decrease the likelihood of acute air trapping

ANS: B

To restore lung volume and minimize fatigue

66. What is the correct sequence of actions during the active cycle of breathing (ACB) method?

1. Relaxation and breathing control

2. Three or four thoracic expansion exercises

3. One or two FETs (huffs)

a. 1, 2, 1, and 3

b. 1, 3, 1, and 2

c. 3, 1, 2, and 1

d. 1, 3, 2, and 1

ANS: A

ANS: A 1, 2, 1, and 3

1. Relaxation and breathing control

2. Three or four thoracic expansion exercises

1. Relaxation and breathing control

3. One or two FETs (huffs)

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

a. Throughout the procedure

b. After phase 1 only

c. After phase 2 only

d. After phase 3 only

no doing ts

68. What does phase 1 of autogenic drainage involve?

a. Breathing at low to mid lung volumes

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

c. Vigorous coughing using the FET

d. Progressive breaths at higher and higher lung volumes

FART’

69. What happens during the exsufflation phase of mechanical insufflation-exsufflation?

1. Airway pressure is abruptly decreased to -30 to -50 cm H2O.

2. Negative airway pressure is maintained for 2 to 3 sec.

3. Peak expiratory "cough" flows reach near normal values.

a. 1 and 2 only

b. 2 and 3 only

c. 1 and 3 only

d. 1, 2, and 3

ANS: D

1. Airway pressure is abruptly decreased to -30 to -50 cm H2O.

2. Negative airway pressure is maintained for 2 to 3 sec.

3. Peak expiratory "cough" flows reach near normal values.

70. A typical mechanical insufflation-exsufflation treatment session should continue until what point?

1. Secretions are cleared.

2. The vital capacity (VC) returns to baseline.

3. The SpO2 returns to baseline.

a. 2 and 3 only

b. 1 and 2 only

c. 1, 2, and 3

d. 1 and 3 only

ANS: C

1. Secretions are cleared.

2. The vital capacity (VC) returns to baseline.

3. The SpO2 returns to baseline.

71. Under which of the following conditions would mechanical insufflation-exsufflation with an oronasal mask probably be effective?

1. If the glottis collapses during exsufflation

2. Presence of fixed airway obstruction

3. Presence of a chronic neuromuscular disorder

a. 3 only

b. 1 and 2 only

c. 1, 2, and 3

d. 1 and 3 only

ANS: A

3. Presence of a chronic neuromuscular disorder

72. Which of the following are potential indications for positive airway pressure therapies?

1. Reduce air trapping in asthma or chronic obstructive pulmonary disease.

2. Help mobilize retained secretions.

3. Prevent or reverse atelectasis.

4. Optimize bronchodilator delivery.

a. 2 and 4 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 1, 2, 3, and 4

ANS: D

1. Reduce air trapping in asthma or chronic obstructive pulmonary disease.

2. Help mobilize retained secretions.

3. Prevent or reverse atelectasis.

4. Optimize bronchodilator delivery.

73. Contraindications for positive airway pressure therapies include which of the following?

a. Intracranial pressure exceeding 20 mm Hg

b. Recent facial, oral, or skull surgery or trauma

c. Preexisting pulmonary barotrauma (e.g., pneumothorax)

d. Air trapping/pulmonary overdistention in chronic obstructive pulmonary disease

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: B

a. Intracranial pressure exceeding 20 mm Hg

b. Recent facial, oral, or skull surgery or trauma

c. Preexisting pulmonary barotrauma (e.g., pneumothorax)

74. Which of the following are hazards of positive airway pressure therapies (EPAP, PEP,

CPAP)?

1. Decreased venous return

2. Epistaxis

3. Pulmonary barotrauma

4. Increased intracranial pressure

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 1, 3, and 4 only

ANS: D

1. Decreased venous return

3. Pulmonary barotrauma

4. Increased intracranial pressure

75. What duration of time and pressure is recommended when using MIE devices to clear airways

secretions in adults?

a. 30 to 50 cm H2O at 1 to 3 sec

b. 10 to 30 cm H2O at 1 to 3 sec

c. 30 to 50 cm H2O at 5 to 10 sec

d. 10 to 30 cm H2O at 5 to 10 sec

ANS: A

30 to 50 cm H2O at 1 to 3 sec

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

1. Peak flow or forced expiratory volume in 1 sec (FEV1) per forced vital capacity percentage

2. Patient's minute volume

3. Quantity and character of sputum

4. Breath sounds

a. 1 and 3 only

b. 1, 2, and 3 only

c. 2 and 4 only

d. 1, 3, and 4 only

ANS: D

1. Peak flow or forced expiratory volume in 1 sec (FEV1) per forced vital capacity percentage

3. Quantity and character of sputum

4. Breath sounds

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

a. Expiration against a variable flow resistance

b. Expiration against a fixed threshold resistance

c. Inspiration against a variable flow resistance

d. Inspiration against a fixed threshold resistance

ANS: A

Expiration against a variable flow resistance

78. In theory, how does positive expiratory pressure (PEP) help to move secretions into the larger airways?

1. Filling underaerated segments through collateral ventilation

2. Preventing airway collapse during expiration

3. Causing bronchodilation during inspiration

a. 2 and 3 only

b. 1 and 2 only

c. 1, 2, and 3

d. 1 and 3 only

ANS: B

1. Filling underaerated segments through collateral ventilation

2. Preventing airway collapse during expiration

79. Proper instructions for positive expiratory pressure include which of the following?

1. Take in a breath that is larger than normal, but do not fill lungs completely.

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

3. After 10 to 20 breaths, take two or three "huff"' coughs, and rest as needed.

4. Repeat the cycle 8 to 10 times, not to exceed 30 min.

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: A

1. Take in a breath that is larger than normal, but do not fill lungs completely.

3. After 10 to 20 breaths, take two or three "huff"' coughs, and rest as needed.

80. 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?

1. Attach a dry powder inhaler in-line with the PEP apparatus.

2. Attach a metered dose inhaler to the system's one-way valve inlet.

3. Place a small volume nebulizer in-line with the PEP apparatus.

a. 2 and 3 only

b. 1 and 2 only

c. 1, 2, and 3

d. 1 and 3 only

ANS: A

2. Attach a metered dose inhaler to the system's one-way valve inlet.

3. Place a small volume nebulizer in-line with the PEP apparatus.

81. What is the movement of small volumes of air back and forth in the respiratory tract at high

frequencies (12 to 25 Hz) called?

a. Tidal breathing

b. Active cycle breathing

c. Oscillation

d. Huffing

C

Oscillation

82. Which of the following parts are required to conduct high-frequency external chest wall compression?

1. Variable air-pulse generator

2. Expiratory flow resistor with one-way valve

3. Nonstretch inflatable thoracic vest

a. 1 and 2 only

b. 2 and 3 only

c. 1 and 3 only

d. 1, 2, and 3

ANS: C

1. Variable air-pulse generator

3. Nonstretch inflatable thoracic vest

83. Which of the following are typical of high-frequency external chest wall compression therapy?

1. 30-min therapy sessions

2. Long inspiratory oscillations

3. One to six sessions per day

4. Oscillations at 20 to 25 Hz

a. 1 and 3 only

b. 1, 2, and 3 only

c. 3 and 4 only

d. 2, 3, and 4 only

ANS: C

3. One to six sessions per day

4. Oscillations at 20 to 25 Hz

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

1. Compression frequency

2. Largest volumes

3. Flow bias

a. 1 only

b. 2 only

c. 1 and 3 only

d. 2 and 3 only

ANS: C

1. Compression frequency

3. Flow bias

85. 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?

a. Intrapulmonary percussive ventilation

b. Active cycle of breathing

c. High-frequency external chest wall compression

d. Intermittent positive-pressure breathing

ANS: A

IPV

86. Which of the following is true about exercise and airway clearance?

1. Exercise can enhance mucus clearance.

2. Exercise can improve pulmonary function.

3. Exercise can improve matching.

4. Exercise can cause desaturation in some patients.

a. 1, 3, and 4 only

b. 1, 2, and 3 only

c. 1, 2, 3, and 4

d. 2, 3, and 4 only

ANS: C

1. Exercise can enhance mucus clearance.

2. Exercise can improve pulmonary function.

3. Exercise can improve matching.

4. Exercise can cause desaturation in some patients.

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

a. Their inspiratory flow

b. The angle of the device

c. Their expiratory flow

d. The expired volume

ANS: C

Their expiratory flow

88. Advantages of the flutter valve over other airway clearance methods include which of the following?

1. Good patient acceptance

2. Greater effectiveness

3. Full portability

4. Independent use

a. 1 and 3 only

b. 1, 2, and 3 only

c. 2 and 4 only

d. 1, 3, and 4 only

ANS: D

1. Good patient acceptance

3. Full portability

4. Independent use

89. Which of the following are advantages of the Acapella over the flutter?

1. It can customize frequency.

2. It can be used in any posture.

3. It is more portable.

4. It can customize flow resistance.

a. 1 and 3 only

b. 1, 2, and 4 only

c. 3 and 4 only

d. 1, 2, 3, and 4

ANS: B

1. It can customize frequency.

2. It can be used in any posture.

4. It can customize flow resistance.

90. Which of the following should be considered when selecting an airway clearance strategy?

1. Patient's goals, motivation, and preferences

2. Effectiveness and limitations of technique or method

3. Patient's age, ability to learn, and tendency to fatigue

4. Need for assistants, equipment, and cost

a. 1, 2, and 3 only

b. 1, 3, and 4 only

c. 2 and 3 only

d. 1, 2, 3, and 4

ANS: D

1. Patient's goals, motivation, and preferences

2. Effectiveness and limitations of technique or method

3. Patient's age, ability to learn, and tendency to fatigue

4. Need for assistants, equipment, and cost

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

1. Postural drainage, percussion, and vibration

2. Positive expiratory pressure therapy

3. Mechanical insufflation-exsufflation

a. 2 and 3 only

b. 1 and 2 only

c. 1, 2, and 3

d. 1 and 3 only

ANS: D

1. Postural drainage, percussion, and vibration

3. Mechanical insufflation-exsufflation

93. In assessing an adult outpatient for airway clearance therapy, you notice the following: (1) no history of cystic fibrosis or bronchiectasis, (2) sputum production of 30 to 50 ml/day, (3) an effective cough, and (4) good hydration. Which of the following would you recommend?

a. Postural drainage, percussion, and vibration

b. Positive expiratory pressure therapy

c. Mechanical insufflation-exsufflation

d. Intrapulmonary percussive ventilation

ANS: B

Positive expiratory pressure therapy