Question 1

After postural drainage therapy,the patient's pulse increases from 80/min to 90/min and the respiratory rate increases from 18/min to 22/min after 15 minutes of therapy.The patient expectorates an average of 20 ml of therapy after each therapy which is given BID.What should be recommended at this time?

Accepted Answer

In this case,the therapy should be continued.Moderate changes in respiratory rate and/or pulse rate are expected.Bradycardia,tachycardia,or an increase in irregularity of pulse,or fall or dramatic increase in blood pressure are indications for stopping therapy.

Question 2

Trendelenburg position is contraindicated for ___________________.
I.Intracranial pressure (ICP)of 30-mm Hg
II.Uncontrolled airway at risk for aspiration
III.Distended abdomen
IV.Recent gross hemoptysis associated with radiation therapy

Accepted Answer

Trendelenburg position is contraindicated for I)Intracranial pressure (ICP)> 20-mm Hg,II)uncontrolled airway at risk for aspiration (tube feeding or recent meal),III)distended abdomen,IV)increased intracranial pressure (e.g. ,neurosurgery,aneurysms,eye surgery),as well as uncontrolled hypertension and esophageal surgery.

Question 3

Abnormal chest x-ray consistent with atelectasis and mucus plugging,rhonchi suggesting secretions in the airways,and excessive sputum production would establish the need for:

Accepted Answer

The following should be assessed together to establish a need for postural drainage therapy: 1)Excessive sputum production,2)effectiveness of cough,3)history of pulmonary problems treated successfully with PDT (e.g. ,bronchiectasis,cystic fibrosis,lung abscess),4)decreased breath sounds or crackles or rhonchi suggesting secretions in the airway,5)change in vital signs,6)abnormal chest x-ray consistent with atelectasis,mucous plugging,or infiltrates,and 7)deterioration in arterial blood gas values or oxygen saturation.

Question 4

Which of the following is NOT a hazard or complication of a directed cough?

Accepted Answer

Increased cerebral perfusion is not a hazard or complication of a directed cough.

Question 5

The respiratory therapy practitioner asks the patient how she feels during postural drainage therapy.The patient complains of feelings of pain,shortness of breath,and nausea.What should be done at this time?

Accepted Answer

Feelings of pain,discomfort,shortness of breath,dizziness,and nausea should be considered in decisions to modify or stop therapy.Easier clearance of secretions and increased volume of secretions during and after treatments support continuation.The caregiver should ask patient how he or she feels before,during,and after therapy.

Question 6

A patient positioned on their back is placed in which position?

Accepted Answer

A patient positioned on their back is placed in the supine position.

Question 7

Vibration is an isometric maneuver performed with the arm and hand.It is only performed on:

Accepted Answer

Vibration is employed only on exhalation.

Question 8

Which one of the following therapies would be best used to reduce air trapping in asthma and COPD?

Accepted Answer

One of the indications for PAP therapy is to reduce air trapping in asthma and COPD.

Question 9

What bronchial hygiene technique is indicated for a patient who has poor oxygenation associated with a unilateral lung disease?

Accepted Answer

Turning is indicated for patients who have poor oxygenation associated with position (e.g. ,unilateral lung disease).

Question 10

Postural drainage therapy is indicated for adult patients with secretion production of at least _______________

Accepted Answer

Postural drainage is indicated for adult patients who have difficulty clearing secretions with expectorated sputum production greater than 25-30-ml/day.

Question 11

You are called to assess a patient and recommend the appropriate therapy.Upon assessment the patient exhibits an abnormal chest radiograph consistent with infiltrates,sputum retention not responsive to directed coughing,and a deterioration in the patient's arterial blood gas values.What therapy should be recommended for this patient?

Accepted Answer

The following should be assessed together to establish a need for positive expiratory pressure (PEP)therapy: Sputum retention not responsive to spontaneous or directed coughing;history of pulmonary problems treated successfully with postural drainage therapy;decreased breath sounds or adventitious sounds suggesting secretions in the airway;change in vital signs-increase in breathing frequency,& tachycardia;an abnormal chest radiograph consistent with atelectasis,mucous plugging,or infiltrates;and deterioration in arterial blood gas values or oxygen saturation.

Question 12

During bronchial hygiene therapy in the Trendelenburg position,the patient's heart rhythm exhibits bigeminy PVCs.What intervention would be the most correct for the Respiratory Care Practitioner to take at this time?

Accepted Answer

If dysrhythmias occur while the patient is in the Trendelenburg position,the practitioner should be stop therapy,return the patient to previous resting position,and administer or increase oxygen delivery while contacting the physician.

Question 13

During bronchial hygiene therapy in the Trendelenburg position,the patient's SpO₂ decreases from 92% on a 35% Venturi mask to 80% during the first 5 minutes of the therapy.What intervention would be the most correct for the Respiratory Care Practitioner to take at this time?

Accepted Answer

If a patient becomes hypoxemic during treatment,administer 100% oxygen,stop therapy immediately,return the patient to original resting position,and consult the physician.Ensure adequate ventilation.Hypoxemia during postural drainage may be avoided in unilateral lung disease by placing the involved lung uppermost with patient on his or her side.

Question 14

How would you drain the medial and lateral segments of the right middle lobe?

Accepted Answer

The right middle lobe,medial and lateral segments,are drained with the patient's foot of the bed elevated 12 inches with the patient rotated one-quarter turn from supine,right side up.

Question 15

The patient vomits and aspirates in the flat,supine position.A therapeutic bronchoscopy is performed and confirms that the patient has aspirated into the superior segments of both lower lobes.The physician orders postural drainage for these segments.How should this be performed?

Accepted Answer

The superior segments of both lower lobes are drained with the patient prone with the head of the bed flat.

Question 16

If sputum production in an optimally hydrated patient is 10 ml/day with postural drainage therapy (PDT),_______________

Accepted Answer

If postural drainage does not increase sputum in a patient who produces >30-ml/day of sputum without postural drainage,the procedure is not justified.

Question 17

The left lung has ____ lobes and the right lung has ______ lobes.There are ____ bronchopulmonary segments total in both lungs.

Accepted Answer

Owing to the position of the heart,the left lung has two lobes while the right lung has three.There are 18 bronchopulmonary segments total in both lungs.

Question 18

What is the only absolute contraindication to a directed cough?

Accepted Answer

There are only relative contraindications to a directed cough.Directed cough is rarely contraindicated.The contraindications listed must be weighed against potential benefit in deciding to eliminate cough from the care of the patient.

Question 19

During bronchial hygiene therapy in the Trendelenburg position,the patient vomits and aspirates.What intervention would be the most correct for the Respiratory Care Practitioner to take at this time?

Accepted Answer

The practitioner should stop therapy,clear airway and suction as needed,administer oxygen,maintain airway,return the patient to previous resting position,and contact the physician immediately.

Question 20

Lifting should be performed with the ________________

Accepted Answer

Lifting should be performed with the legs,not the back.Keep the object close to the body,minimizing muscle strain.

Quiz 16: Bronchial Hygiene Therapy

Trendelenburg position is contraindicated for ___________________. I.Intracranial pressure (ICP) of 30-mm Hg II.Uncontrolled airway at risk for aspiration III.Distended abdomen IV.Recent gross hemoptysis associated with radiation therapy