Deck 17: Hyperinflation Therapy

Question 1

After a maximum inspiratory effort when a patient is utilizing an incentive spirometer,what should the patient do?

A) Cough
B) Exhale forcefully
C) Perform a 3 to 5 second breath hold
D) Perform pursed lip breathing

Answer 1

Perform a 3 to 5 second breath hold

Question 2

Which of the following volumes would indicate that a 55-kg,post-operative male patient needs IPPB?

A) Vital capacity of 0.75 L
B) Inspiratory capacity of 1/2 of predicted
C) Vital capacity of 450 ml
D) Inspiratory capacity 1.2 L, predicted inspiratory capacity of 2.9 L

Answer 2

Vital capacity of 450 ml

Question 3

All hyperinflation modalities provide methods for increasing _____________

A) expiratory flow rates.
B) inspiratory volumes.
C) peak expiratory flow rate.
D) residual volume.

Answer 3

inspiratory volumes.

Question 4

While administering IPPB with a inspiratory pressure of 25 cmH₂O,a patient develops sudden shortness of breath.When assessing the patient it is noted that breaths are absent on the right side.Percussion of the right side yields a hyperresonant percussion note.No chest tube has been placed yet.Which way would the patient's trachea shift?

A) Toward the right
B) Cephalid
C) Toward the left
D) It will remain midline

Question 5

While delivering IPPB,which I:E ratio would cause the least decrease of a patient's cardiac output or increase in a patient's intracranial pressure?

A) 1:1
B) 1:2
C) 1:3
D) 2:1

Question 6

An increase in ________ will enable the patient to generate greater flows and volumes during a cough.

A) peak pressure
B) tidal volume
C) residual volume
D) intrathoracic pressure

Question 7

What is defined as a combination of high-frequency phased pulse gas delivery and the administration of a dense aerosol?

A) Incentive spirometry (IS)
B) Intermittent positive pressure breathing (IPPB) therapy
C) Intrapulmonary percussive ventilation (IPV) therapy
D) High frequency chest wall oscillation (HFCWO) therapy

Question 8

How does expiration take place after a positive-pressure breath during an IPPB treatment?

A) The elastic recoil of the lungs and thorax allows the patient to exhale
B) The sensitivity is set to allow the ventilator to be 'sensitive' to the patient when exhalation is started
C) The expiratory timer is set to limit the amount of time inspiration takes place
D) The flow rate through the Venturi is cut off cycling the ventilator into expiration

Question 9

Which modality utilizes the patient's own muscular effort to accomplish hyperinflation of the lungs?

A) Incentive spirometry
B) Intermittent positive pressure breathing
C) Intermittent percussive ventilation
D) Positive airway pressure therapy

Question 10

Which of the following is an absolute contraindication of IPPB therapy?

A) Tension pneumothorax
B) Radiographic evidence of blebs
C) Pneumothorax with a functioning chest tube
D) a and c

Question 11

Which control would increase the tidal volume delivered to the patient on a pressure ventilator (e.g.Bird Mark 7)?

A) Tidal volume
B) Flow rate
C) Pressure
D) Sensitivity

Question 12

The effectiveness of any hyperinflation therapy is dependent on _____________

A) patient effort.
B) patient cooperation.
C) the patient's diagnosis.
D) a and b

Question 13

Which of the following are hazards of IS?
I.Exacerbation of bronchospasm
II.Hyperventilation
III.Barotrauma
IV.Oxygen induced hypoventilation

A) I and III
B) II and IV
C) I, II, III, and IV
D) I, II, and III

Question 14

When using flow measuring incentive spirometer,two balls are suspended for 4 seconds.One ball indicates 800 ml/second,two balls indicates 1000 ml/second,and three balls indicates 1200 ml/second.What is the volume the patient achieved?

A) 3200 ml
B) 4000 ml
C) 4800 ml
D) 1000 ml

Question 15

Which control on a pressure ventilator should be used if the patient is having trouble triggering the ventilator into inspiration?

A) Flow rate
B) Sensitivity
C) Expiratory timer
D) Air mix

Question 16

Which of the following volumes would indicate that a 70-kg,post-operative open heart male patient needs IS as hyperinflation therapy? (Predicted vital capacity [VC] 4.1L,predicted inspiratory capacity [IC] 2.5L)

A) IC of 1.0L
B) VC of 0.07L
C) IC of 0.75L
D) VC of 0.60L

Question 17

What is the purpose of the delivery of small volumes of gas at a high frequency (100 to 250/min)to the airways via a mouthpiece that serve to increase mean airway pressure?

A) To break up secretions
B) To distribute ventilation more evenly
C) To decrease mean airway pressure
D) a and b

Question 18

Which of the following is NOT an indication for incentive spirometry?

A) Presence of pulmonary atelectasis
B) Inability to clear secretions adequately because of pathology that severely limits the ability to cough effectively
C) Presence of a restrictive lung defect associated with quadriplegic and/or dysfunctional diaphragm
D) Presence of conditions predisposing to the development of pulmonary atelectasis

Question 19

During IPV (intrapulmonary percussive ventilation)therapy,how is the frequency of percussion to the airway controlled?

A) Operational pressure
B) Flow rate
C) Expiratory timer
D) By the Phasitron

Question 20

After inhalation during IPPB therapy,exhalation should _________________

A) take place quickly to maintain an I:E ratio of 1:1.
B) be performed against resistance to prolong exhalation.
C) take place forcefully.
D) take place passively.

Question 21

The patient position for IPPB therapy is with the patient ________________ I.sitting on the edge of the bed.
II.sitting upright in a chair.
III.in Fowler's position.
IV.in semi-Fowler's position.

A) IV only
B) I, II, III, and IV
C) I and II
D) II and III

Question 22

The following breathing pattern is ideal for which type of hyperinflation therapy? The patient should be instructed to hold the lips tightly around the mouthpiece and to depress the thumb button.Once the button has been depressed,percussive ventilation will begin.The patient should be instructed to inhale and allow the device to fill the lungs and to percuss them for approximately 5 seconds.After the lungs are full,the patient releases the thumb button and exhales completely through the mouthpiece.This process should be repeated until all of the medication in the nebulizer has been delivered.

A) PEP therapy
B) IPPB therapy
C) IPV therapy
D) Incentive spirometry

Question 23

The respiratory care department puts you in charge of the hyperinflation monitoring committee.What should be monitored to determine the type and the effectiveness of the hyperinflation therapy?

Question 24

During IPV how is the peak inspiratory pressure determined?

A) Measuring the heart rate
B) Measuring the respiratory rate
C) Observing the pressure manometer
D) Auscultate the breath sounds

Question 25

A patient with atelectasis is ordered to have IPPB therapy.The patient is recovering from a motor vehicle accident in which he suffered a concussion.During the therapy,the patient exhibits bulging around the eye orbits and his sensorium decreases.Which of the following could be happening to the patient?

A) Increased intracranial pressure
B) Tension pneumothorax
C) Subcutaneous emphysema
D) Decreased cardiac output

Question 26

A patient has been ordered to receive IPPB in the intensive care unit.He has an arterial line in place which indicates a decreased blood pressure during the therapy.How can this be corrected?

A) Discontinue therapy immediately. Stay with the patient and closely monitor the respiratory rate and depth, pulse, and blood pressure. Observe the patient for signs of cyanosis. If respiratory arrest occurs, initiate cardiopulmonary resuscitation (CPR) and get help.
B) Discontinue the therapy. Try to administer therapy with the patient in semi-Fowler's or full Fowler's position, if possible, to help reduce the effects of IPPB on intracranial pressure
C) Terminate the IPPB therapy. Quickly auscultate the chest. Monitor the respiratory rate and depth and pulse frequently.
D) Discontinue the therapy and monitor the patient closely. Continue monitoring the patient. If the blood pressure remains low and the cardiovascular system fails to recover after discontinuance of therapy, contact the physician immediately.

Question 27

What is the ideal breathing pattern for IPPB therapy?

A) Instruct the patient to inhale, which will trigger the respirator. Tell the patient to inhale with the ventilator. At the end of the inspiratory phase, instruct the patient to pause briefly before exhaling, to allow for a more even deposition of the aerosol. Have the patient exhale passively.
B) Instruct the patient to inhale and exhale passively. This will eliminate any air trapping.
C) Instruct the patient to inhale, which will trigger the respirator. Tell the patient to inhale with the ventilator. Have the patient exhale actively to eliminate any air that may have been trapped during inhalation..
D) Instruct the patient to exhale completely, inhale actively with the ventilator. At the end of the inspiratory phase, instruct the patient have the patient exhale passively.

Question 28

During IPV,what happens to the peak pressures during percussion when the source pressure is increased?

A) The peak pressures decrease
B) The peak pressures increase
C) Nothing, but the frequency of the percussion increases
D) The peak pressures remain the same as preset at the factory

Question 29

During hyperinflation therapy,the patient complains of dizziness,light-headedness,and tingling in the fingers.How should you treat this patient feeling and concern?

A) Continue the therapy and have the patient breath more shallow.
B) Continue the therapy, reassure the patient that this is a normal feeling, and chart the adverse effect in the chart.
C) Stop the therapy, and allow the patient to rest, breathing spontaneously for a few minutes, then continue.
D) Stop the therapy, explain to the patient that this is normal with this type of therapy, and continue.

Question 30

A 35 year-old patient is admitted for gall bladder surgery.The patient has a 40 pack/year smoking history,and has a past history of minor health problems.Breath sounds reveal expiratory wheezing and coarse crackles bilaterally.The patient is 5'6" and weighs 250 lbs.What risk factors does this patient have for post-operative atelectasis and what should be done?

Question 31

A patient with COPD is being administered IPPB therapy for atelectasis.Oxygen is being used as the source gas.During the therapy the patient becomes lethargic and drowsy,and the patient's respiratory rate decreases from 20 to 6/minute.What is the most likely reason for this occurrence?

A) The patient is sleep deprived and the relief of the work of breathing has relaxed the patient
B) The patient is experiencing interruption of the hypoxic drive
C) The patient is hyperventilating and is experiencing the signs of increased alveolar ventilation
D) The patient is experiencing decreased cardiac output and is having ventilation/perfusion mismatching

Question 32

A surgeon orders lung expansion therapy for an obtunded 68-year-old,170-lb (77.3 kg,IBW)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 type of hyperinflation therapy would you recommend?