Deck 40: Bronchial Hygiene Therapy

Question 1

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

Answer 1

A

Question 2

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

Answer 2

B

Question 3

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

Answer 3

A

Question 4

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

Question 5

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

Question 6

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 ( $\dot { V } / \dot { Q }$ ) imbalances

Question 7

Which of the following conditions are associated with chronic production of large volumes of sputum?
I)bronchiectasis
II)pulmonary fibrosis
III)cystic fibrosis
IV)chronic bronchitis

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

Question 8

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

Question 9

All of the following can impair mucociliary clearance in intubated patients except:

A)use of respiratory stimulants
B)tracheobronchial suctioning
C)inadequate humidification
D)high inspired oxygen concentrations

Question 10

Conditions that can lead to bronchiectasis include all of the following except:

A)chronic airway infection
B)muscular dystrophy
C)foreign body aspiration
D)obliterative bronchiolitis

Question 11

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.

Question 12

Which of the following conditions alter normal mucociliary clearance?
I)bronchospasm
II)cystic fibrosis (CF)III.ciliary dyskinesia

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

Question 13

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

Question 14

Which of the following occur(s) during the compression phase of a cough?
I)expiratory muscle contraction
II)opening of the glottis
III)rapid drop in alveolar pressure

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

Question 15

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

Question 16

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

Question 17

A patient with a tracheostomy tube 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

Question 18

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

Question 19

All of the following drug categories can impair mucociliary clearance in intubated patients except:

A)general anesthetics
B)bronchodilators
C)opiates
D)narcotics

Question 20

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 chronic obstructive pulmonary disease (COPD)
D)patient with low $\dot { V } / \dot { Q }$ due to unilateral infiltrates

Question 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

Question 22

In acute respiratory distress syndrome (ARDS) or ALI, use of the prone position can result on which of the following?
I.improvement of redistribution of blood flow
II.improvement of the lung's overall $\dot { V } / \dot { Q }$ balance
III.protection of the lung from pressure injury

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

Question 23

Which of the following is NOT a hazard or complication of postural drainage therapy?

A)cardiac arrhythmias
B)increased intracranial pressure
C)acute hypotension
D)pulmonary barotraumas

Question 24

All of the following laboratory data are essential in assessing a patient's need for bronchial hygiene therapy except:

A)chest radiograph
B)pulmonary function tests (PFTs)
C)hematology results
D)ABGs/oxygen saturation

Question 25

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

Question 26

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

Question 27

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

Question 28

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

Question 29

When assessing the potential need for postoperative bronchial hygiene for a patient, all of the following factors are relevant except:

A)patient's age and respiratory history
B)nature and duration of current surgery
C)number of prior surgical procedures
D)type of anesthesia (e.g., local versus general)

Question 30

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

Question 31

Postural drainage should be considered in all of the following situations except:

A)in patients with chronic obstructive lung disease
B)in patients who expectorate more than 25 to 30 ml sputum per day
C)in the presence of atelectasis caused by mucus plugging
D)in patients with cystic fibrosis or bronchiectasis

Question 32

Primary objectives for postural drainage include all of the following except:

A)prevent pneumonia
B)normalize functional residual capacity
C)help mobilize secretions
D)improve $\dot { V } / \dot { Q }$

Question 33

What are the best documented preventive uses of bronchial hygiene therapy?
I)prevent retained secretions in the acutely ill
II)maintain lung function in cystic fibrosis
III)prevent postoperative pulmonary complications

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

Question 34

Primary objectives for turning include all of the following except to:

A)prevent postural hypotension
B)promote lung expansion
C)prevent retention of secretions
D)improve oxygenation

Question 35

Which of the following is/are TRUE of postural drainage?
I)It is most effective in disorders causing excessive sputum.II.It is most effective in head-down positions greater than 25 degrees.III.It requires adequate systemic hydration to be effective.IV.It improves mucociliary clearance in normal subjects.V.It improves pulmonary function in stable chronic obstructive pulmonary disease patients.

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

Question 36

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

Question 37

In which of the following patients would you consider modifying any head-down positions used for postural drainage?
I)a patient with unstable blood pressure
II)a patient with a cerebrovascular disorder
III)a patient with systemic hypertension
IV)a patient with orthopnea

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

Question 38

Key considerations in initial and ongoing patient assessment for chest physical therapy include which of the following?
I)posture and muscle tone
II)breathing pattern and ability to cough
III)sputum production
IV)cardiovascular stability

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

Question 39

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.

Question 40

Absolute contraindications for postural drainage include which of the following?
I)head and neck injury (until stabilized)II.active hemorrhage with hemodynamic instability
III)uncontrolled airway at risk for aspiration

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

Question 41

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

Question 42

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.

Question 43

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).

Question 44

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

Question 45

What factors can hinder effective coughing?
I)artificial airways
II)neuromuscular disease
III)systemic dehydration
IV)pain or fear of pain
V)use of expectorants

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

Question 46

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

Question 47

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

Question 48

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

Question 49

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.

Question 50

All of the following responses indicate that postural drainage should be terminated except:

A)severe tachycardia
B)complaint of discomfort
C)irregular blood pressure
D)severe bradycardia

Question 51

Indications for directed coughing include all of the following except to:

A)enhance other bronchial hygiene therapies
B)help patients with tuberculosis clear secretions
C)help prevent postoperative pulmonary complications
D)obtain sputum specimens for diagnostic analysis

Question 52

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

Question 53

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

Question 54

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

Question 55

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

Question 56

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

Question 57

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.

Question 58

Directed coughing is useful in helping to maintain bronchial hygiene in all of the following cases except:

A)bronchiectasis
B)acute asthma
C)cystic fibrosis
D)spinal cord injury

Question 59

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

A)1 to 2 minutes
B)3 to 5 minutes
C)20 to 30 minutes
D)3 to 15 minutes

Question 60

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

Question 61

A typical mechanical insufflation-exsufflation treatment session should continue until what point?
I. Secretions are cleared.
II. The vital capacity (VC) returns to baseline.
III. The SpO₂ returns to baseline.

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

Question 62

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

Question 63

Under which of the following conditions would mechanical insufflation-exsufflation with an oronasal mask probably NOT be effective?
I)if the glottis collapses during exsufflation
II)presence of fixed airway obstruction
III)presence of a chronic neuromuscular disorder

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

Question 64

All of the following are hazards of positive airway pressure therapies (EPAP, PEP, CPAP) except:

A)decreased venous return
B)epistaxis
C)pulmonary barotrauma
D)increased intracranial pressure

Question 65

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?
I)enhancing expiratory flow by bending forward at the waist
II)using short, expiratory bursts or the "huffing" method
III)using only moderate (as opposed to full) inspiration
IV)having the patient "tense" the neck muscles while coughing

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

Question 66

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

Question 67

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)restore the patient's SO₂
B)restore lung volume and minimize fatigue
C)allow the patient time to ask questions
D)decrease the likelihood of acute air-trapping

Question 68

Which of the following is false about the FET?

A)It causes less bronchiolar collapse than traditional coughing.
B)It occurs from mid to low lung volume without glottis closure.
C)It has a period of diaphragmatic breathing and relaxation.
D)It occurs from mid to high lung volume without glottis closure.

Question 69

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

Question 70

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

A)peak flow or forced expiratory volume in 1 second (FEV₁) per forced vital capacity percentage
B)patient's minute volume
C)quantity and character of sputum
D)breath sounds

Question 71

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

Question 72

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

Question 73

Hazards of positive airway pressure therapies associated with the apparatus used include which of the following?
I)increased work of breathing
II)claustrophobia
III)epistaxis
IV)vomiting and aspiration
V)skin breakdown and discomfort

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

Question 74

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

Question 75

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.

Question 76

What happens during the exsufflation phase of mechanical insufflation-exsufflation?
I. Airway pressure is abruptly decreased to –30 to –50 cm H2O.
II. Negative airway pressure is maintained for 2 to 3 seconds.
III. Peak expiratory “cough” flows reach near normal values.

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

Question 77

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?
I)combining manual chest compression with suctioning
II)coordinating the coughing regimen with pain medication
III)using the autogenic drainage method
IV)using mechanical insufflation-exsufflation

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

Question 78

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

Question 79

What is the correct sequence of actions during the active cycle of breathing (ACB) method?
I)relaxation and breathing control
II)three or four thoracic expansion exercises
III)one or two FETs (huffs)

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

Question 80

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