Question 1

On the basis of the following diagram, which of the following lung segments is being drained?

Accepted Answer

What is shown here (and in Figure 12-4H in the textbook) is the postural drainage position for draining the right middle lobe.

Question 2

During autogenic drainage, at which of the following levels does the patient begin breathing?

Accepted Answer

AD is a series of breathing exercises designed to mobilize secretions in patients with bronchiectasis or CF. To loosen secretions from the smallest airways, the patient begins breathing in a slow, controlled manner, first at the expiratory reserve volume level. The volume of ventilation is then increased, with the patient breathing in the normal tidal volume range but exhaling approximately halfway into the expiratory reserve volume.

Question 3

By which of the following mechanisms are high-frequency chest compressions purported to mobilize tracheobronchial secretions?

Accepted Answer

Commercially available devices have been developed that compress the entire chest wall at high frequencies by means of a snug-fitting inflatable vest connected to a high-performance air compressor (see Figure 12-6 in the textbook). Intermittent chest wall compression produces brief periods of high expiratory airflow, which loosens and mobilizes mucus from bronchial walls. This type of device is widely used in patients with CF.

Question 4

A respiratory therapist has been assigned to administer ACT to a number of patients on the ward. In which of the following conditions may ACT be beneficial?

Accepted Answer

The majority of patients with acute atelectasis secondary to mucous plugs respond with one ACT treatment.

Question 5

A respiratory therapist has been assigned to administer CPT to a patient with cystic fibrosis. What areas of the body should the RT avoid when percussing the patient?

Accepted Answer

Chest percussion should not be performed directly over fractured ribs, areas of subcutaneous emphysema, or recently burned or grafted skin.

Question 6

What is the most important variable used to assess the efficacy of CPT?

Accepted Answer

Because the goal of CPT is to promote the removal of excessive bronchial secretions, the most important variable for evaluating the effectiveness of CPT is the amount of secretions expectorated with therapy.

Question 7

What are the main components of the traditional airway clearance techniques?
I. Palpation of the chest wall
II. Postural drainage
III. Percussion
IV. Coughing

Accepted Answer

Traditional airway clearance techniques (ACTs) are designed to remove secretions from the lungs and include postural drainage, percussion, chest wall vibration, and coughing.

Question 8

The following postural drainage positions are shown for an infant patient.  Which of the diagrams demonstrates the postural drainage position for draining the lingular segments of the left upper lobe in an infant?

Accepted Answer

What is shown here (and in Figure 12-3I in the textbook) are the lingular segments of the left upper lobe; choice A (see Figure 12-3F in the textbook) shows the lateral basal segment of the right lower lobe; choice B (see Figure 12-3G in the textbook) shows the anterior basal segment of the right lower lobe; and choice D (see Figure 12-3D in the textbook) shows the superior segments of both lower lobes.

Question 9

On the basis of the following diagram, which of the following lung segments is being drained?

Accepted Answer

What is shown here (and in Figure 12-3E in the textbook) is the postural drainage position for draining the posterior basal segments of the right and left lower lobes.

Question 10

Which of the following maneuvers is characterized by having a patient forcibly exhale, from a middle to low lung volume, through an open glottis?

Accepted Answer

FET is also known as "huff" coughing. This maneuver requires the patient to forcibly exhale, from middle to low lung volumes, with an open glottis, but requires extreme cooperation and cannot be performed on infants or young children.

Question 11

A respiratory therapist has been assigned to administer FET to a 5-year-old patient. Since small children are typically unable to perform such a maneuver, what should the RT do at this time?

Accepted Answer

Infants and small children are unable to perform maneuvers such as FET or AD. Some clinicians have attempted to mimic these techniques with gentle chest wall compression during the expiratory phase, allowing the child to exhale to less than functional residual capacity. Like AD or FET performed in cooperative older patients, this technique results in increased expiratory air velocity at low lung volumes, improving mucous mobilization.

Question 12

What do postural drainage, positive expiratory pressure therapy, autogenic drainage, forced expiration techniques, and high-frequency chest compressions have in common?

Accepted Answer

Postural drainage, positive expiratory pressure (PEP), AD, FET, and HFCC attempt to prevent or compensate for dynamic airway collapse.

Question 13

Which of the following clinical parameters are important to determine a positive response to ACT?
I. Changes in sputum color
II. Breath sounds
III. Vital signs
IV. Lung mechanics

Accepted Answer

Changes in sputum production, breath sounds, vital signs, chest radiographic findings, blood gas values, and lung mechanics may indicate a positive response to the therapy.

Question 14

The following postural drainage positions are shown for a pediatric patient.  Which of the diagrams demonstrates the postural drainage position for draining the posterior subsegment of the apical-posterior segment of the left upper lobe?

Accepted Answer

What is shown here (and in Figure 12-4A in the textbook) is the apical segment of the right upper lobe and the apical subsegment of the apical-posterior segment of the left upper lobe; choice B (see Figure 12-4B in the textbook) shows the posterior segment of the right upper lobe and the posterior subsegment of the apical-posterior segments of the left upper lobe; choice C (see Figure 12-4C in the textbook) shows the anterior segments of the right and left upper lobes; and choice D (see Figure 12-4D in the textbook) shows the superior segments of both lower lobes.

Question 15

A respiratory therapist has been assigned to administer ACT to a patient with acute lobar atelectasis. What should the RT consider to determine the length and frequency of the treatment?
I. Most pediatric patients require ACTs for at least 60 minutes.
II. ACT is rarely needed more than every 4 hours.
III. ACT orders should be evaluated at least every 48 hours for patients in the ICU.
IV. ACT for patients with atelectasis due to CF requires at least 30 to 45 minutes.

Accepted Answer

Treatments for patients with CF or bronchiectasis should be performed for at least 30 minutes, with many patients benefiting from therapy lasting 45 minutes or longer. Patients with severe dyspnea may require rest periods, which will further prolong therapy. Most pediatric respiratory care departments limit routine ACT treatments to 15 to 20 minutes. ACT is rarely needed more than every 4 hours, although selected patients may benefit from more frequent suctioning or coughing. ACT orders should be evaluated at least every 48 hours for patients in intensive care units, at least every 72 hours for acute care patients, or whenever there is a change in a patient's status.

Question 16

Which of the following is the best explanation of why the therapist should routinely avoid advancing the catheter tip beyond the distal end of the endotracheal tube when performing endotracheal suctioning on a neonate?

Accepted Answer

The trachea and bronchi of the newborn appear especially vulnerable to damaging effects from endotracheal tubes and suction catheters. Consequences of deep endotracheal suctioning include the development of bronchial stenosis and granulomas. Avoiding deep endotracheal suctioning minimizes these risks. Therefore when suctioning intubated infants after chest physical therapy (CPT), the therapist should not routinely advance the suction catheter beyond the distal end of the endotracheal tube. If evidence of persistent secretion retention exists despite adequate suctioning of the endotracheal tube, the suction catheter can be carefully and slowly advanced 1 or 2 cm beyond the tip of the endotracheal tube.

Question 17

A respiratory therapist has been assigned to administer ACT to a number of patients on the ward. In which of the following conditions may ACT be contraindicated?
I. Bronchial secretions
II. Frank hemoptysis
III. Empyema
IV. Untreated pneumothorax

Accepted Answer

Frank hemoptysis, empyema, foreign body aspiration, and untreated pneumothorax are often considered contraindications to all components of ACT.

Question 18

A patient with an excessive amount of secretions and atelectasis has been receiving ACT. The most commonly cited complication is _____________________________.

Accepted Answer

The most commonly cited adverse effect of ACT is hypoxemia.

Quiz 12: Airway Clearance Techniques and Hyperinflation Therapy

On the basis of the following diagram, which of the following lung segments is being drained?

During autogenic drainage, at which of the following levels does the patient begin breathing?

By which of the following mechanisms are high-frequency chest compressions purported to mobilize tracheobronchial secretions?

A respiratory therapist has been assigned to administer ACT to a number of patients on the ward. In which of the following conditions may ACT be beneficial?

A respiratory therapist has been assigned to administer CPT to a patient with cystic fibrosis. What areas of the body should the RT avoid when percussing the patient?

What is the most important variable used to assess the efficacy of CPT?

What are the main components of the traditional airway clearance techniques? I. Palpation of the chest wall II. Postural drainage III. Percussion IV. Coughing

The following postural drainage positions are shown for an infant patient. Which of the diagrams demonstrates the postural drainage position for draining the lingular segments of the left upper lobe in an infant?

On the basis of the following diagram, which of the following lung segments is being drained?

Which of the following maneuvers is characterized by having a patient forcibly exhale, from a middle to low lung volume, through an open glottis?

A respiratory therapist has been assigned to administer FET to a 5-year-old patient. Since small children are typically unable to perform such a maneuver, what should the RT do at this time?

What do postural drainage, positive expiratory pressure therapy, autogenic drainage, forced expiration techniques, and high-frequency chest compressions have in common?

Which of the following clinical parameters are important to determine a positive response to ACT? I. Changes in sputum color II. Breath sounds III. Vital signs IV. Lung mechanics

The following postural drainage positions are shown for a pediatric patient. Which of the diagrams demonstrates the postural drainage position for draining the posterior subsegment of the apical-posterior segment of the left upper lobe?

Which of the following is the best explanation of why the therapist should routinely avoid advancing the catheter tip beyond the distal end of the endotracheal tube when performing endotracheal suctioning on a neonate?

A respiratory therapist has been assigned to administer ACT to a number of patients on the ward. In which of the following conditions may ACT be contraindicated? I. Bronchial secretions II. Frank hemoptysis III. Empyema IV. Untreated pneumothorax

A patient with an excessive amount of secretions and atelectasis has been receiving ACT. The most commonly cited complication is _____________________________.