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1. Persistent breathing at small tidal volumes can result in which of the following?
a. reabsorption atelectasis
b. spontaneous pneumothorax
c. passive atelectasis
d. respiratory alkalosis |
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2. Which of the following patient categories are at high risk for developing atelectasis?
I. those who are heavily sedated
II. those with abdominal or thoracic pain
III. those with neuromuscular disorders
a. I and II
b. II and III
c. I and III
d. I, II, and III |
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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 |
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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 pneumoniad |
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5. Which of the following clinical findings indicate the development of atelectasis?
I. opacified areas on the chest x-ray film
II. inspiratory and expiratory wheezing
III. tachypnea
IV. diminished or bronchial breath sounds
a. I, III, and IV
b. I, II, III, and V
c. I and IV
d. II, III, and IV b |
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6. Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure include
which of the following?
I. incentive spirometry (IS)
II. positive end-expiration pressure therapy
III. intermittent positive-pressure breathing (IPPB)
IV. expiratory positive airway pressure (EPAP)
a. I and II
b. II, III, and IV
c. I and III
d. I, II, III, and IV |
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7. 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 |
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8. 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 |
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9. Which of the following are potential indications for incentive spirometry?
I. a restrictive disorder such as quadriplegia
II. abdominal surgery in a COPD patient
III. presence of pulmonary atelectasis
a. I and II
b. II and III
c. I and III
d. I, II, and III |
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10. Which of the following situations is a contraindication for incentive spirometry?
I. a patient whose vital capacity is less than 10 ml/kg
II. a patient who cannot cooperate or follow instructions
III. an unconscious patient
a. I and II
b. II and III
c. I and III
d. I, II, and III |
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11. 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 |
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12. 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 |
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13. Incentive spirometry devices can generally be categorized as which of the following?
I. pressure-oriented
II. flow-oriented
III. volume-oriented
a. III
b. I and II
c. I, II, and III
d. II and III |
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14. Which of the outcomes would indicate improvement in a patient previously diagnosed with atelectasis who has been
receiving incentive spirometry?
I. improved PaO2
II. decreased respiratory rate
III. improved chest radiograph
IV. decreased forced vital capacity (FVC)
V. tachycardia
a. I, II, and III
b. I, III, and IV
c. I, II, III, IV, and V
d. III, IV, and V |
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15. 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 |
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16. 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 |
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17. 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.” |
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18. 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 |
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19. 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 |
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20. What should the monitoring of patients using incentive spirometry include?
I. number of breaths per session
II. volume and flow goals achieved
III. maintenance of breath-hold
IV. patient effort and motivation
a. I, III, and IV
b. II, III, and IV
c. I, II, III, and IV
d. III, IV |
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21. 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 iarway pressure
d. positive end-expiration pressure |
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22. 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. |
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23. Intermittent positive-pressure breathing is associated with a passive exhalation.
a. true
b. false |
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24. Which of the following patient groups should be considered for lung expansion therapy using intermittent
positive-pressure breathing (IPPB)?
I. patients with clinically diagnosed atelectasis who are not responsive to other therapies
II. patients at high risk for atelectasis who cannot cooperate with other methods
III. all obese patients who have undergone abdominal surgery
a. I and II
b. II and III
c. I and III
d. I, II, and III |
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25. 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 |
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26. Which of the following is an absolute contraindication for using intermittent positive-pressure breathing?
a. hemodynamic instability
b. active untreated tuberculosis
c. tension pneumothorax
d. recent esophageal surgery |
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27. 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 |
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28. Which of the following are potential hazards of intermittent positive-pressure breathing (IPPB)?
I. air-trapping, auto-PEEP
II. hyperventilation
III. nosocomial infection
IV. increased airway resistance
a. I, II, III, and IV
b. II and IV
c. II, III, and IV
d. III and IV |
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29. Preliminary planning for intermittent positive-pressure breathing (IPPB) should include which of the following?
I. evaluating alternative approaches to the patient's problem
II. setting specific, individual clinical goals or objectives
III. conducting a baseline assessment of the patient
a. I and III
b. I and II
c. I, II, and III
d. II and III |
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30. Which of the following are potential desirable outcomes of intermittent positive-pressure breathing (IPPB) therapy?
I. improved oxygenation
II. increased cough and secretion clearance
III. improved breath sounds
IV. reduced dyspnea
a. II and IV
b. I, II, and III
c. III and IV
d. I, II, III, and IV |
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31. 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. |
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32. Prior to starting intermittent positive-pressure breathing (IPPB) on a new patient, what should the practitioner explain?
I. why the physician ordered the treatment
II. what the IPPB treatment will do
III. how the IPPB treatment will feel
IV. what the expected results are
a. I, II, III, and IV
b. II and IV
c. II, III, and IV
d. I, III, and IV |
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33. Which of the following positions is ideal for intermittent positive-pressure breathing therapy?
a. semi-Fowler's
b. standing
c. supine
d. prone |
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34. 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 |
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35. Which of the following are appropriate initial settings for intermittent positive-pressure breathing given to a new patient?
a. sensitivity –2 cm H2O; pressure 20 to 25 cm H2O; high flow
b. sensitivity –3 to –4 cm H2O; pressure 5 to 10 cm H2O; moderate flow
c. sensitivity –1 to –2 cm H2O; pressure 10 to 15 cm H2O; moderate flow
d. sensitivity –8 cm H2O; pressure 15 cm H2O; moderate flow |
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36. Which of the following are appropriate volume goals for intermittent positive-pressure breathing (IPPB) therapy?
I. 10 to 15 ml/kg ideal body weight
II. at least 30% of the inspiratory capacity (IC)
III. pressure level as high as 30 to 35 cm H2O
a. I and III
b. I and II
c. II and III
d. I only |
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37. 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 |
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38. Which of the following should be charted in the patient’s medical record after completion of an intermittent
positive-pressure breathing treatment?
I. results of pre- and posttreatment assessment
II. any side effects
III. duration of therapeutic session
a. II and III
b. I and III
c. I and II
d. I, II, and III |
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39. 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 |
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40. 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 |
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41. Which of the following will make an intermittent positive-pressure breathing (IPPB) device cycle off prematurely?
I. airflow obstructed
II. kinked tubing
III. occluded mouthpiece
IV. active resistance to inhalation
a. I and II
b. I and III
c. I, III, and IV
d. I, II, III, and IV |
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42. Which of the following mechanisms probably contribute to the beneficial effects of continuous positive airway pressure
(CPAP) in treating atelectasis?
I. recruitment of collapsed alveoli
II. decreased work of breathing
III. improved distribution of ventilation
IV. increased efficiency of secretion removal
a. I, II, and IV
b. II and III
c. I and IV
d. I, II, III, and IV |
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43. Which of the following are contraindications for continuous positive airway pressure (CPAP) therapy?
I. hemodynamic instability
II. hypoventilation
III. facial trauma
IV. low intracranial pressures
a. I and III
b. II and III
c. I, II, and III
d. II, III, and IV |
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44. Which of the following are potential complications of continuous positive airway pressure (CPAP) therapy?
I. barotrauma
II. hyperventilation
III. gastric distention
IV. hypercapnia
a. I and III
b. II and III
c. I, III, and IV
d. II, III, and IV |
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45. 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 |
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46. 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?
a. 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 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 500 to 600 ml |
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47. 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 |
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48. A normal cough reflex includes which of the following phases?
I. irritation
II. inspiration
III. compression
IV. expulsion
a. I, II, III
b. I and IV
c. I, II, III, and IV
d. II and III |
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49. Which of the following is/are necessary for normal airway clearance?
I. patent airway
II. functional mucociliary escalator
III. effective cough
a. I and II
b. I, II, III
c. II and III
d. II |
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50. Which of the following can provoke a cough?
I. anesthesia
II. foreign bodies
III. infection
IV. irritating gases
a. II and IV
b. I, II, and III
c. III and IV
d. II, III, and IV |
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51. 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
a. I, II, and III
b. I and II
c. I and III
d. II and III |
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Definition
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52. Partial airway obstruction can result in all of the following except:
a. increased work of breathing
b. air-trapping or overdistention
c. increased expiratory flows
d. ventilation/perfusion ratio (V/Q) imbalances |
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53. 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?
I. irritation
II. inspiration
III. compression
IV. expulsion
a. I, II, and III
b. II and IV
c. II, III, and IV
d. III and IV |
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Definition
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54. 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 |
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55. 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 |
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56. All of the following drug categories can impair mucociliary clearance in intubated patients except:
a. general anesthetics
b. bronchodilators
c. opiates
d. narcotics |
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57. Conditions that can affect airway patency and cause abnormal clearance of secretions include which of the following?
I. foreign bodies
II. tumors
III. inflammation
IV. bronchospasm
a. I, II, and III
b. II and IV
c. II, III, and IV
d. I, II, III, and IV |
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58. All of the following conditions impair secretion clearance by affecting the cough reflex except:
a. muscular dystrophy
b. amyotrophic lateral sclerosis
c. chronic bronchitis
d. cerebral palsy |
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Definition
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59. All of the following are goals of bronchial hygiene therapy except:
a. Reverse the underlying disease process.
b. Help mobilize retained secretion.
c. Improve pulmonary gas exchange.
d. Reduce the work of breathing. |
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Definition
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60. Which of the following clinical signs indicate that a patient is having a problem with retained secretions?
I. lack of sputum production
II. labored breathing
III. development of a fever
IV. increased inspiratory and expiratory crackles
a. II and IV
b. I, II, and III
c. III and IV
d. I, II, III, and IV |
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61. All of the following are considered bronchial hygiene therapies except:
a. postural drainage and percussion
b. incentive spirometry
c. positive airway pressure
d. percussion, vibration, and oscillation |
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Definition
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62. 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 |
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63. Which if 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 |
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64. 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. II and IV
b. I, II, III, and IV
c. I and III
d. II and III |
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65. 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?
I. patient’s medication schedule
II. patient’s meal schedule
III. location of surgical incision
a. I and II
b. II and III
c. I and III
d. I, II, and III |
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Definition
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66. Which of the following are mandatory components of the preassessment for postural drainage?
I. vital signs
II. bedside pulmonary function tests
III. auscultation
a. I and II
b. II and III
c. I and III
d. I, II, and III |
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Definition
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67. During chest physical therapy, a patient has an episode of hemoptysis. Which of the following actions would be
appropriate at this time?
a. Put the patient in a sitting position and have him or her cough strenuously.
b. Place the patient in a head-down position and call the nurse.
c. Immediately perform nasotracheal suctioning of the patient.
d. Stop therapy, sit the patient up, give O2, and contact the physician. |
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68. 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. |
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69. 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. |
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Definition
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70. All of the following would indicate a successful outcome for postural drainage therapy except:
a. decreased sputum production
b. normalization in ABGs
c. improved breath sounds
d. improvement in chest radiograph |
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Definition
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71. 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
a. I, II, and III
b. II and IV
c. I, II, III, and IV
d. III and IV |
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Definition
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72. Percussion should NOT be performed over which of the following areas?
I. surgery sites
II. bony prominences
III. fractured ribs
a. III
b. I and II
c. II and III
d. I, II, and III |
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Definition
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73. 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 |
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Definition
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Term
74. All of the following are contraindications for directed coughing except the presence of:
a. infection spread by droplet nuclei
b. elevated intracranial pressure or intracranial aneurysm
c. reduced coronary artery perfusion
d. necrotizing pulmonary infection |
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Definition
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75. For which of the following patients directed coughing might be contraindicated?
I. patient with poor coronary artery perfusion
II. postoperative upper-abdominal surgery patient
III. long-term care patient with retained secretions
IV. patient with an acute unstable spinal injury
a. II and III
b. I, II, and III
c. I and IV
d. II, III, and IV |
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Definition
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76. Key consideration in teaching a patient to develop an effective cough regimen includes which of the following?
I. strengthening of the expiratory muscles
II. instruction in breathing control
III. instruction in proper positioning
a. II and III
b. I and II
c. I, II, and III
d. I and III |
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Definition
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Term
77. 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?
I. coordinating coughing with pain medication
II. using the forced expiration technique (FET)
III. supplying manual epigastric compression
IV. “splinting” the operative site
a. I, II, and IV
b. I, II, and III
c. III and IV
d. II, III, and IV |
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Definition
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78. Which of the following are potential indications for positive airway pressure therapies?
I. reduce air-trapping in asthma or chronic obstructive pulmonary disease
II. help mobilize retained secretions
III. prevent or reverse atelectasis
IV. optimize bronchodilator delivery
a. II and IV
b. I, II, and III
c. III and IV
d. I, II, III, and IV |
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Definition
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Term
79. Contraindications for positive airway pressure therapies include all of the following except:
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 |
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Definition
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Term
80. 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 |
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Definition
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