Question 1

In treating a trauma patient,both active and passive relaxation techniques should be used.Which of the following is not a method of passive relaxation?

Accepted Answer

Passive relaxation refers to relaxing the patient using passive procedures including,but not limited to,body positioning,physical supports,talking calmly and slowly,and taking adequate time for conducting treatments.Active relaxation refers to relaxing the patient through participation of the patient in relaxation procedures.

Question 2

Where would you place a chest tube in the treatment of a pneumothorax?

Accepted Answer

For a pneumothorax,the chest tube should be placed in the second or third intercostal space in the midclavicular line.

Question 3

While treating an obese patient,which of the following would not be an appropriate intervention?

Accepted Answer

The weight of the abdominal viscera limits diaphragmatic descent and elevates its resting position.Placing an obese patient in a prone position can simulate benefits of the upright lean-forward position.

Question 4

What is a major pathophysiological mechanism of significantly impaired cardiovascular and pulmonary function in a very heavy (obese)individual?

Accepted Answer

In very heavy individuals,cardiovascular and pulmonary function can be significantly impaired,resulting in hypoxemia and cardiovascular and pulmonary failure.The major pathophysiological mechanisms behind this include significant alveolar hypoventilation,reactive hypoxic pulmonary vasoconstriction,increased pulmonary vascular resistance,myocardial hypertrophy,increased right ventricular work,altered position of the thoracic structures,abnormal compression of the heart,lungs,and mediastinal structures,abnormal position of the heart,cardiomegaly,increased intraabdominal pressure,elevated hemidiaphragms with resulting pressure on the underside of the diaphragm,impaired cough effectiveness,impaired mucociliary transport,mucous obstruction of airways,airway narrowing,bronchospasm,impaired mechanical efficiency of diaphragmatic excursion,and impaired respiratory mechanics and breathing efficiency.

Question 5

While treating a patient with head injuries,what is a generally accepted increase in intracranial pressure during treatment provided it returns to normal immediately after the removal of the pressure potentiating stimulus?

Accepted Answer

During treatment,particularly with turning or suctioning,the ICP may increase up to 30 mm Hg provided it returns to pretreatment levels immediately.

Question 6

You have just finished positioning your obese patient upright in a chair at bedside when you notice the patient slumping.What action should you take?

Accepted Answer

Obese people often slump after being positioned upright.This slumped position can be counterproductive in that the benefits of the upright position are significantly reduced and can lead to further deterioration.

Question 7

What would be an appropriate intervention technique for a patient with multiple fractures and spinal involvement?

Accepted Answer

Body positioning for a patient with multiple fractures and spinal involvement should be kept to log-rolling maneuvers to protect the cervical spine.ROM exercises of the head,neck,and shoulders are not prescribed.

Question 8

Which of the following findings would you not expect with a patient with a flail chest segment?

Accepted Answer

Flail chest results from two or more rib fractures.This usually results in chest wall instability and depression of the chest wall during inspiration.

Question 9

How should you position the bed to reduce intracranial pressure in a patient with a head injury?

Accepted Answer

The head of the bed elevated to 30 to 40 degrees promotes venous return and thereby reduces intracranial pressure.

Question 10

For which body position should mobilizations be performed for patients with restrictive pulmonary disease secondary to neuromuscular conditions?

Accepted Answer

Treatment goals for these patients are to maximize oxygen delivery,enhance the efficiency of oxygen uptake and utilization,and reduce the work of breathing.Therefore,any position that meets these goals should be used.

Question 11

What side effect of muscle relaxants and corticosteroids might affect how a patient performs during therapy?

Accepted Answer

Muscle relaxants and corticosteroids can lead to muscle weakness because of deterioration of inspiratory and expiratory muscle strength and endurance,which in turn can affect alveolar ventilation and lung volumes and impair glottis closure and weakness of pharyngeal and laryngeal structures.

Question 12

While working with a patient,the patient begins to experience deterioration in level of consciousness,pupillary reflexes,ocular reflexes,pattern of respiration,and exaggerated muscle tone and posture.What do you suspect is occurring with this patient?

Accepted Answer

These are all symptoms of advancing cerebral edema.These signs correspond to increasing ICP from the cortex toward the medullopontine region.

Question 13

Which of the following does not contribute to impaired mucociliary transport and secretion accumulation?

Accepted Answer

Bronchospasm,impaired mobility,and inability to cough effectively along with a decreased airway diameter impair mucociliary transport.Along with impaired glottis closure and increased risk of reflux,additionally exposes the airway to risk of aspiration.

Question 14

What signs and symptoms would you expect to see with a patient with advancing cerebral edema?

Accepted Answer

Advancing cerebral edema is evidenced by deterioration in level of consciousness,pupillary reflexes,ocular reflexes,pattern of respiration,and exaggerated muscle tone and posture.

Question 15

What technique is best described as a modified cough with the glottis open and with abdominal support to help mobilize secretions?

Accepted Answer

This is the definition of huffing.This technique may be used with patients with generalized weakness and may help mobilize secretions.

Question 16

Which of the following is the optimal resting position for a morbidly obese patient?

Accepted Answer

Morbidly obese patients have a high incidence of upper airway obstruction and sleep apnea.In a bed with the head of the bed elevated reduces the stress and may allow for improved rest and sleep.

Question 17

What should not be included during treatment and management of a patient with central nervous system trauma?

Accepted Answer

Patients with central nervous system trauma should be managed with a stringent turning regimen.

Question 18

Which of the following is not a goal of treatment for a patient with burns?

Accepted Answer

Improving arterial saturation,maintaining fluid balance,and preventing infection are all goals of how treatment of burn patients should be directed.

Question 19

Where would you place a chest tube in the treatment of a hemothorax?

Accepted Answer

For a hemothorax,the chest tube should be placed in the second or third intercostal space in the posterior axillary line.

Question 20

Which of the following body positions will reduce respiratory distress to the greatest extent in a patient with neuromuscular dysfunction?

Accepted Answer

With the patient upright and leaning forward,the respiratory distress in these patients can be reduced to its greatest extent.Additionally,the body position and length of time in any one position should be monitored closely.

Quiz 35: Intensive Care Management of Individuals With Secondary Cardiovascular and Pulmonary Dysfunction