Deck 42: Lung Expansion Therapy

Question 1

Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure include which of the following?
1) Incentive spirometry (IS)
2) Positive end-expiration pressure therapy
3) Intermittent positive-pressure breathing (IPPB)
4) Expiratory positive airway pressure (EPAP)

A)1 and 2 only
B)2, 3, and 4 only
C)1 and 3 only
D)1, 2, 3, and 4

Answer 1

B

Question 2

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

Answer 2

B
Explanation: Dizziness and numbness around the mouth are the most frequently reported symptoms associated with respiratory alkalosis.

Question 3

Which of the following clinical findings indicate the development of atelectasis?
1) Opacified areas on the chest x-ray film
2) Inspiratory and expiratory wheezing
3) Tachypnea
4) Diminished or bronchial breath sounds

A)1, 3, and 4 only
B)1, 2, 3, and 4
C)1 and 4 only
D)2, 3, and 4 only

Answer 3

A

Question 4

Which of the following are potential indications for incentive spirometry?
1) A restrictive disorder such as quadriplegia
2) Abdominal surgery in a COPD patient
3) Presence of pulmonary atelectasis

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)1, 2, and 3

Question 5

Which of the following groups of patients is not at risk for developing postoperative atelectasis?

A) Those with chronic obstructive pulmonary disease
B) Those with a significant history of cigarette smoking
C) Those with impaired mucociliary clearance
D) Those with pneumonia

Question 6

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.

Question 7

Persistent breathing at small tidal volumes typically results in which of the following?

A) Reabsorption atelectasis
B) Spontaneous pneumothorax
C) Compression atelectasis
D) Respiratory alkalosis

Question 8

Which of the following is FALSE about flow-oriented incentive spirometry devices?

A) Inspired volume is estimated as the product of flow and time.
B) Motivation is based on keeping the indicator balls elevated.
C) They have proved less effective than volumetric systems.
D) They provide only an indirect measure of inspired volume.

Question 9

Those with abdominal or thoracic pain

Question 10

Which of the outcomes would indicate improvement in a patient previously diagnosed with atelectasis who has been receiving incentive spirometry?
1) Improved PaO₂
2) Decreased respiratory rate
3) Improved chest radiograph
4) Decreased forced vital capacity (FVC)

A)1, 2, and 3 only
B)1, 3, and 4 only
C)1 and 2 only
D)4 only

Question 11

An alert and cooperative 28-year-old woman with no prior history of lung disease underwent cesarean section 16 hr 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

Question 12

Those with neuromuscular disorders

A) 1 and 2 only
B) 2 and 3 only
C) 1 and 3 only
D) 1, 2, and 3

Question 13

Which of the following patient categories are at high risk for developing atelectasis?

Question 14

How do all modes of lung expansion therapy aid lung expansion?

A) Increasing the transpulmonary pressure gradient
B) Decreasing the transthoracic pressure gradient
C) Increasing the pressure in the pleural space
D) Decreasing the pressure in the alveoli

Question 15

How can the transpulmonary pressure gradient be increased?
1) Increasing alveolar pressure
2) Decreasing pleural pressure
3) Decreasing transthoracic pressure

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)3 only

Question 16

Incentive spirometry devices can generally be categorized as which of the following?
1) Pressure-oriented
2) Flow-oriented
3) Volume-oriented

A)3 only
B)1 and 2 only
C)1, 2, and 3
D)2 and 3 only

Question 17

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

Question 18

Those who are heavily sedated

Question 19

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

Question 20

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 hr after surgery

Question 21

Preliminary planning for intermittent positive-pressure breathing (IPPB) should include which of the following?
1) Evaluating alternative approaches to the patient's problem
2) Setting specific, individual clinical goals or objectives
3) Conducting a baseline assessment of the patient
4) Taking a chest x-ray

A)1 and 3 only
B)1 and 4 only
C)1, 2, and 3 only
D)2 and 4 only

Question 22

Which of the following are potential hazards of intermittent positive-pressure breathing (IPPB)?
1) Air trapping, auto-PEEP
2) Hyperventilation
3) Nosocomial infection
4) Increased airway resistance

A)1, 2, 3, and 4
B)2 and 4 only
C)2, 3, and 4 only
D)3 and 4 only

Question 23

Which of the following are true about intermittent positive-pressure breathing?
1) During inspiration, pressure in the alveoli decreases.
2) The pressure gradients of normal breathing are reversed.
3) During inspiration, alveolar pressure may exceed pleural pressure.
4) Energy stored during inspiration causes a passive exhalation.

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 24

Which of the following possesses the most significant risk for hypoventilation?

A) IPPB
B) IS
C) IPAP/EPAP
D) CPAP

Question 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.

Question 26

Correct instruction in the technique of incentive spirometry should include which of the following?

A) Use of accessory muscles at high inspiratory flows
B) Diaphragmatic breathing at slow to moderate flows
C) "Panting" at volumes approaching total lung capacity
D) Use of accessory muscles at low inspiratory flows

Question 27

The short-term application of inspiratory positive pressure to a spontaneously breathing patient best defines which of the following?

A) Sustained maximal inspiration
B) Intermittent positive-pressure breathing
C) Continuous positive airway pressure
D) Positive end-expiration pressure

Question 28

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

Question 29

What should the monitoring of patients using incentive spirometry include?
1) Number of breaths per session
2) Volume and flow goals achieved
3) Maintenance of breath-hold
4) Patient effort and motivation

A)1, 3, and 4 only
B)2, 3, and 4 only
C)1, 2, 3, and 4
D)3 and 4 only

Question 30

In observing a postoperative woman conduct incentive spirometry, you note repetitive performance of the sustained maximal inspiration maneuver at a rate of approximately 10 to 12/min. Which of the following would you recommend to her?

A) Decrease the treatment frequency to 4 times/day.
B) Increase her breathing rate to 12 to 15/min.
C) Take a 30-sec rest period between breaths.
D) Repeat the treatment every 30 min.

Question 31

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."

Question 32

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

Question 33

Which of the following are potential contraindications for intermittent positive-pressure breathing?
1) Hemodynamic instability
2) Recent esophageal surgery
3) Tension pneumothorax
4) Neuromuscular disorders

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 34

What is the minimum airway pressure at which the esophagus opens, allowing gas to pass directly into the stomach?

A) 25 cm H₂O
B) 20 cm H₂O
C) 15 cm H₂O
D) 10 cm H₂O

Question 35

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

Question 36

What is the most common complication associated with intermittent positive-pressure breathing (IPPB)?

A) Air trapping
B) Oral bleeding
C) Respiratory alkalosis
D) Gastric distention

Question 37

Which of the following statements are true about intermittent positive-pressure breathing (IPPB)?
1) IPPB could cause lung overinflation.
2) IPPB could cause no expansion of regions affected by secretions.
3) Bronchial hygiene must be used in conjunction with IPPB to adequately manage secretions.
4) IPPB should be the single treatment modality for gas absorption atelectasis.

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 38

Which of the following patient groups should be considered for lung expansion therapy using intermittent positive-pressure breathing (IPPB)?
1) Patients with clinically diagnosed atelectasis who are not responsive to other therapies
2) Patients at high risk for atelectasis who cannot cooperate with other methods
3) All obese patients who have undergone abdominal surgery

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)1, 2, and 3

Question 39

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 sec
B) 5 to 10 sec
C) 3 to 5 sec
D) 1 to 2 sec

Question 40

Which of the following are true about gastric distention with intermittent positive-pressure breathing (IPPB)?
1) Gastric distention is uncommon in alert and cooperative patients.
2) Gastric distention is most likely at high airway pressures.
3) Gastric distention is a significant risk in obtunded patients.
4) Gastric distention is a relatively harmless effect of IPPB.

A)1 and 3 only
B)1, 2, and 3 only
C)2 and 4 only
D)1, 2, 3, and 4

Question 41

Which of the following are potential desirable outcomes of intermittent positive-pressure breathing (IPPB) therapy?
1) Improved oxygenation
2) Increased cough and secretion clearance
3) Improved breath sounds
4) Reduced pulmonary compliance

A)3 and 4 only
B)1, 2, and 4 only
C)3 and 4 only
D)1, 2, and 3 only

Question 42

In order to eliminate leaks in an alert patient receiving intermittent positive-pressure breathing therapy, which of the following adjuncts would you first try?

A) Flanged mouthpiece
B) Form-fitting mask
C) Nasopharyngeal airway
D) Nose clips

Question 43

In administering intermittent positive-pressure breathing therapy, which of the following breathing patterns would be most desirable?

A) 6 to 8 breaths/min, inspiration/expiration ratio (I:E) of 1:3
B) 8 to 10 breaths/min, I:E of 1:1
C) 12 to 15 breaths/min, I:E of 1:2
D) 6 to 8 breaths/min, I:E of 1:1

Question 44

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

Question 45

Which of the following positions is ideal for intermittent positive-pressure breathing therapy?

A) Semi-Fowler's
B) Standing
C) Supine
D) Prone

Question 46

Which of the following are contraindications for continuous positive airway pressure (CPAP) therapy?
1) Hemodynamic instability
2) Hypoventilation
3) Facial trauma
4) Low intracranial pressures

A)1 and 3 only
B)2 and 3 only
C)1, 2, and 3 only
D)2, 3, and 4 only

Question 47

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

Question 48

The general assessment, common to all patients for whom intermittent positive-pressure breathing (IPPB) is ordered, should include which of the following?
1) Measurement of vital signs
2) Appearance and sensorium
3) Chest auscultation
4) Arterial blood gas analysis

A)1 and 4 only
B)2 and 3 only
C)3 and 4 only
D)1, 2, and 3 only

Question 49

When checking a patient's intermittent positive-pressure breathing (IPPB) 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.

Question 50

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

Question 51

Which of the following should be charted in the patient's medical record after completion of an intermittent positive-pressure breathing treatment?
1) Results of pretreatment and posttreatment assessment
2) Any side effects
3) Duration of therapeutic session

A)2 and 3 only
B)1 and 3 only
C)1 and 2 only
D)1, 2, and 3

Question 52

Which of the following are essential components of a continuous positive airway pressure (CPAP) flow system?
1) Blended source of pressurized gas
2) Nonrebreathing circuit with reservoir bag
3) Low-pressure or disconnect alarm
4) Expiratory threshold resistor

A)3 and 4 only
B)1, 2, and 4 only
C)1 and 4 only
D)1, 2, 3, and 4

Question 53

Which of the following will make an intermittent positive-pressure breathing (IPPB) device cycle off prematurely?
1) Airflow obstructed
2) Kinked tubing
3) Occluded mouthpiece
4) Active resistance to inhalation

A)1 and 2 only
B)1 and 3 only
C)1, 3, and 4 only
D)1, 2, 3, and 4

Question 54

Which of the following machine performance characteristics should be monitored during intermittent positive-pressure breathing therapy?
1) Flow setting
2) Sensitivity
3) Humidity output
4) Peak pressure

A)1 and 3 only
B)1, 2, and 4 only
C)3 and 4 only
D)1, 2, 3, and 4

Question 55

In terms of machine performance, what do large negative pressure swings early in inspiration typically indicate?

A) Inadequate flow setting
B) Incorrect sensitivity
C) Inadequate pressure setting
D) Inadequate humidity

Question 56

Which of the following are potential complications of continuous positive airway pressure (CPAP) therapy?
1) Barotrauma
2) Hyperventilation
3) Gastric distention
4) Hypercapnia

A)1 and 3 only
B)2 and 3 only
C)1, 3, and 4 only
D)2, 3, and 4 only

Question 57

Which of the following are appropriate volume goals for intermittent positive-pressure breathing (IPPB) therapy?
1) 10 to 15 ml/kg ideal body weight
2) At least 30% of the inspiratory capacity (IC)
3) Pressure level as high as 30 to 35 cm H₂O

A)1 and 3 only
B)1 and 2 only
C)2 and 3 only
D)1 only

Question 58

Which of the following parameters should be evaluated after intermittent positive-pressure breathing therapy?
1) Vital signs
2) Sensorium
3) Breath sounds
4) Temperature

A)1 and 3 only
B)1, 2, and 3 only
C)2 and 4 only
D)1, 2, 3, and 4

Question 59

Which of the following mechanisms probably contribute to the beneficial effects of continuous positive airway pressure (CPAP) in treating atelectasis?
1) Recruitment of collapsed alveoli
2) Decreased work of breathing
3) Improved distribution of ventilation
4) Increased efficiency of secretion removal

A)1, 2, and 4 only
B)2 and 3 only
C)1 and 4 only
D)1, 2, 3, and 4

Question 60

Prior to starting intermittent positive-pressure breathing (IPPB) on a new patient, what should the practitioner explain?
1) Why the physician ordered the treatment.
2) What the IPPB treatment will do.
3) How the IPPB treatment will feel.
4) What the expected results are.

A)1, 2, 3, and 4
B)2 and 4
C)2, 3, and 4
D)1, 3, and 4

Question 61

A surgeon writes an order for lung expansion therapy for a 28-year-old 110-lb woman who has undergone lower abdominal surgery. In evaluating this patient at the bedside, you obtain a VC of 800 ml and an IC of 44% predicted. Although a chest radiograph indicates basal atelectasis, she has no problem with retained secretions. What lung expansion treatment would you recommend?

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 hr
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

Question 62

While monitoring a patient receiving +12 cm H₂O flow-mask continuous positive airway pressure, you note that the pressure drops to +6 cm H₂O during inspiration, but returns to +12 cm H₂O during exhalation. Which of the following would likely correct this problem?

A) Check and correct any mask leaks.
B) Check and correct any outflow obstruction.
C) Increase the system flow.
D) Increase the system pressure.

Question 63

Which of the following has a direct relationship with the degree to which atelectasis can present itself with a postoperative patient?

A) Spontaneous respiratory rate
B) Bradycardia
C) Hypocapnia
D) Hypothermia

Question 64

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 hr
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

Question 65

Which of the following are the hazards and complications of incentive spirometry?
1) Hyperventilation
2) Fatigue
3) Discomfort secondary to inadequate pain control
4) Barotrauma

A)1 and 2 only
B)2 and 3 only
C)1, 2, and 3 only
D)1, 2, 3, and 4

Question 66

A 59-year-old COPD patient comes to the hospital with upper abdominal surgery. The physician diagnoses the patient with pulmonary atelectasis. The patient has a vital capacity of 25 ml/kg. Which of the following lung expansion therapy will you recommend to assist this patient's atelectasis?

A) Incentive spirometry
B) IPPB
C) CPAP
D) EPAP