Deck 7: Lung Expansion Therapy Devices

Question 1

A patient who is receiving intermittent positive-pressure breathing therapy for atelectasis now exhibits improved breath sounds and an increased ability to clear secretions.Chest radiography reveals improvement,but not total resolution,of atelectasis.The intermittent positive-pressure breathing therapy is discontinued. What is the most appropriate action at this time?

A) Flutter valve
B) Incentive spirometry
C) Continuous positive airway pressure
D) Intrapulmonary percussive ventilation (IPV)

Answer 1

B
The patient's increased ability to clear secretions,improved breath sounds,and improved chest radiograph demonstrate an improvement in his atelectasis and overall condition.At this time,"stepping-down" therapy would be appropriate.The most appropriate physiologic therapy that targets atelectasis is incentive spirometry.Flutter valve and intrapulmonary percussive ventilation are therapies for mobilizing retained secretions,and continuous positive airway pressure should be used when atelectasis fails to respond to incentive spirometry and intermittent positive-pressure breathing.

Question 2

The variable that ends inspiration during intermittent positive-pressure breathing therapy with a Bird Mark 7 is:

A) time.
B) flow.
C) volume.
D) pressure.

Answer 2

D
The Bird Mark 7 is a pneumatically powered ventilator that will pressure-cycle during intermittent positive-pressure breathing therapy.If used for short-term mechanical ventilation,it could be time-cycled.

Question 3

During an incentive spirometry treatment,a patient holds the 600 mL/s ball up for 1.5 seconds; the patient inhaled a volume of _____ L.

A) 0.15
B) 0.45
C) 0.60
D) 0.90

Answer 3

D
Flow = Tidal volume ÷ Inspiratory time.
Tidal volume = Flow * Inspiratory time.
Tidal volume = 600 mL/s * 1.5 s = 900 mL,or 0.90 L.

Question 4

A 60-year-old female patient with a diagnosis of bilateral lower lobe pneumonia is brought to the emergency department.An assessment reveals a temperature of 38.5° C (101.3° F),a respiratory rate of 35 breaths/min,a pulse of 115 beats/min,and decreased breath sounds in both lower lobes; furthermore,she is not alert.What type of therapy should the respiratory therapist suggest?

A) Incentive spirometry
B) Deep-breathing exercises
C) Positive expiratory pressure
D) Intermittent positive-pressure breathing

Question 5

Complications from incentive spirometry include:

A) barotrauma.
B) hypoventilation.
C) pulmonary edema.
D) subcutaneous emphysema.

Question 6

Contraindications for incentive spirometry include:

A) post-thoracic surgery.
B) vital capacity less than 10 mL/kg.
C) restrictive pulmonary disease.
D) inspiratory capacity greater than predicted value.

Question 7

After abdominal surgery,a young,otherwise healthy patient is unable to meet the volume set for his volume-oriented incentive spirometer.This situation is most likely due to:

A) exacerbation of bronchospasm.
B) inadequate pain control.
C) major lung collapse.
D) hyperventilation.

Question 8

Indications for incentive spirometry include:

A) post-abdominal surgery.
B) respiratory muscle weakness.
C) optimization of bronchodilator therapy.
D) inability to effectively deep breathe.

Question 9

Factors that increase the risk of atelectasis include:

A) productive cough.
B) lower extremity paralysis.
C) decreased intra-abdominal pressure.
D) chronic obstructive pulmonary disease.

Question 10

To determine outcome for a patient undergoing intermittent positive-pressure breathing (IPPB)therapy,the respiratory therapist should assess which of the following?
1)Peak expiratory flow
2)Breath sounds
3)Sputum color
4)Maximum inspiratory pressure

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

Question 11

A patient reports that during incentive spirometry she becomes dizzy and must stop the maneuver when this happens.The most probable cause of this situation is:

A) hypoventilation.
B) hyperventilation.
C) patient fatigue.
D) bronchospasm.

Question 12

A patient has undergone surgery and is receiving continuous supplemental oxygen via a 30% air-entrainment mask.He or she becomes pale and short of breath during incentive spirometry.Pulse oximetry reveals a significant drop in oxygen saturation during incentive spirometry.The respiratory therapist should do which of the following for subsequent incentive spirometry therapy?

A) Switch to a different type of incentive spirometer.
B) Request that incentive spirometry be discontinued.
C) Cut a hole in the mask for the incentive spirometer's mouthpiece.
D) Use a 3 L/min nasal cannula during incentive spirometry.

Question 13

Which of the following is true concerning flow-dependent incentive spirometry devices?

A) The volume capacity for a child should be approximately 3 L.
B) The patient must perform a sustained maximum inspiration.
C) They are available as multiuse electrically powered devices.
D) Positive pressure within the device causes the flexible plastic bellows to rise.

Question 14

Myasthenia gravis is causing a patient to have respiratory muscle weakness.He has a vital capacity of 5 mL/kg and is unable to cough effectively.What therapy would you recommend to help prevent pulmonary complications?

A) Incentive spirometry
B) Deep-breathing exercises
C) Positive expiratory pressure
D) Intermittent positive-pressure breathing

Question 15

A patient is able to sustain a flow of 900 cc/s to hold the ball of a flow-oriented incentive spirometer aloft for 2 seconds.Her inspired volume is ____ L.

A) 0.18
B) 0.90
C) 1.45
D) 1.80

Question 16

The primary indication for lung expansion therapy is:

A) asthma.
B) atelectasis.
C) chronic bronchitis.
D) respiratory distress.

Question 17

All intermittent positive-pressure breathing machines are required to have an operating gas pressure source of _____ lb force per square inch gauge (psig).

A) 25 to 35
B) 35 to 45
C) 45 to 55
D) 55 to 65

Question 18

When instructing patients on the use of a volume-displacement incentive spirometer,the respiratory therapist should inform the patients to do which of the following?

A) Inhale deeply and hold for 3 to 5 seconds.
B) Exhale as fast as possible into the mouthpiece.
C) Inhale and exhale rapidly through the mouthpiece.
D) Perform 30 sustained maximum inspirations every 15 minutes.

Question 19

A patient undergoing incentive spirometry should be monitored for outcome by assessing which of the following?
1)Forced expiratory volume at 1 second (FEV₁)
2)Peak expiratory flow
3)Partial pressure of arterial oxygen (PaO₂)
4)Blood pressure

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

Question 20

Untreated atelectasis can result in which of the following?
1)Decreased shunting
2)Increased shunting
3)Hypercapnia
4)Hypocapnia

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

Question 21

The diluter regulator on a Puritan Bennett PR-2 is used to do which of the following?

A) Adjust the flow rate.
B) Regulate gas pressure.
C) Eliminate leaks in the system.
D) Apply negative end-expiratory pressure.

Question 22

Pressure limits on the Puritan Bennett PR-2 can be set between _____ cm H₂O.

A) 0 and 30
B) 0 and 50
C) 0 and 60
D) 10 and 30

Question 23

When the gas pressure in the right chamber of a Bird Mark 7 exceeds the magnetic attraction of the right magnet,which of the following occurs?

A) Exhalation ends.
B) Inspiration begins.
C) The diaphragm moves right.
D) The clutch plate is forced left.

Question 24

Patients undergoing positive expiratory pressure therapy must have a high enough expiratory flow to generate pressure in the range of _____ cm H₂O.

A) 5 to 10
B) 10 to 20
C) 20 to 25
D) 25 to 30

Question 25

Which of the following intermittent positive-pressure breathing machines is electrically powered and patient-triggered only?

A) Bird Mark 7
B) Bird Mark 14
C) Puritan Bennett AP-5
D) Puritan Bennett PR-2

Question 26

Which of the following uses magnetism versus gas pressure as its basic principle of operation?

A) Bird Mark 14 ventilator
B) Puritan Bennett PR-2 ventilator
C) The Vest Airway Clearance System (also known as the ThAIRapy Vest)
D) Percussionaire Intrapulmonary Percussive Ventilator (IPV-1)

Question 27

Which of the following intermittent positive-pressure breathing machines can deliver 100% oxygen?

A) Bird Mark 10
B) Bird Mark 14
C) Puritan Bennett AP-5
D) Puritan Bennett PR-2

Question 28

Which of the following intermittent positive-pressure breathing machines is unable to provide short-term ventilatory support?

A) Bird Mark 7
B) Bird Mark 14
C) Puritan Bennett AP-4
D) Puritan Bennett PR-2

Question 29

Air trapping in patients with asthma or chronic obstructive pulmonary disease can be reduced by which of the following?

A) Intrapulmonary percussive ventilation
B) Intermittent positive-pressure breathing
C) Positive expiratory pressure
D) Incentive spirometry

Question 30

The therapy that mobilizes retained secretions by using devices similar to,but less cumbersome than,continuous positive airway pressure is known as which of the following?

A) Expiratory positive airway pressure
B) Intermittent positive-pressure breathing
C) Intrapulmonary percussive ventilation
D) Positive expiratory pressure

Question 31

Minor leaks can be compensated for on a Puritan Bennett PR-1 or PR-2 with the use a __________ control.

A) Negative end-expiratory pressure
B) Diluter regulator
C) Terminal flow
D) Flow

Question 32

An assessment of a patient with newly diagnosed chronic bronchitis reveals an alert,cooperative,and oriented patient.Low-pitched wheezes are heard bilaterally on auscultation.The patient has a productive cough,producing copious amounts of sputum; no fever; a pulse of 85 beats/min; respirations of 18 breaths/min; and blood pressure of 145/90.The most appropriate lung expansion therapy for this patient is which of the following?

A) Incentive spirometry
B) Intermittent positive-pressure breathing
C) Positive expiratory pressure
D) Flutter valve

Question 33

Which of the following intermittent positive-pressure breathing machines can produce pressure as high as 200 cm H₂O?

A) Puritan Bennett PR-1
B) Puritan Bennett PR-2
C) Bird Mark 10
D) Bird Mark 14

Question 34

The Puritan Bennett PR-2's sensitivity setting can be decreased (making it more difficult for the patient to trigger)by doing which of the following with the Sensitivity knob?

A) Pushing it in
B) Pulling it out
C) Rotating it clockwise
D) Rotating it counterclockwise

Question 35

Which of the following is a compact,inexpensive,single-patient intermittent positive-pressure breathing device?

A) Bird Mark 7
B) Puritan Bennett AP-4
C) Puritan Bennett PR-1
D) VORTRAN-IPPB device

Question 36

During a positive expiratory pressure therapy session,a patient should be told to:

A) stop after 20 to 30 breaths.
B) place lips into the mouthpiece.
C) take a deep breath, and then actively exhale.
D) breathe normally through the mouthpiece.

Question 37

In the air-mix setting,the flow and pressure waveforms that can be produced by the Bird Mark 7 include:

A) constant-flow wave (square) and ascending-pressure wave.
B) ascending-flow wave and descending-pressure wave.
C) descending-flow wave and ascending-pressure wave.
D) sine-flow wave and ascending-pressure wave.

Question 38

During the inspiratory phase of a Bird Mark 7,the:

A) valve will close.
B) valve rotates counterclockwise.
C) diaphragm moves toward the left compartment.
D) diaphragm moves away from the left compartment.

Question 39

At the beginning of inspiration,gas flow to the patient from a Bird Mark 7 or 8 set on "air-mix" comes from which of the following?

A) Venturi device
B) Flow controller
C) Diluter regulator
D) Pneumatic cartridge

Question 40

The inspiratory phase on a Puritan Bennett PR-2 will end when which of the following occurs?

A) The clutch plate, diaphragm, and ceramic switch are forced left.
B) Gravity is sufficient to completely close the Bennett valve.
C) The Bennett valve rotates counterclockwise.
D) The set Sensitivity level is reached.

Question 41

Which of the following bronchial hygiene therapy devices can be used to ventilate a patient?

A) Hayek Oscillator
B) The Vest
C) Percussionaire IPV-1
D) Positive expiratory pressure

Question 42

Contraindications to positive airway pressure adjuncts to bronchial hygiene therapy include which of the following?

A) Hiccups
B) Air swallowing
C) Esophageal surgery
D) Subcutaneous emphysema

Question 43

The maximum frequency of percussive breaths that a Percussionaire IPV-1 can deliver to a patient's airways is ____ Hz.

A) 1.3
B) 1.7
C) 3
D) 5

Question 44

A female patient's chest radiograph shows bilateral lower lobe atelectasis.She is alert and oriented. Arterial blood gas analysis reveals mild hypoxemia and respiratory alkalemia; her vital signs are within normal limits.Which of the following is most appropriate at this time?

A) Chest physiotherapy every 4 hours
B) Continuous positive airway pressure +5 cm H₂O
C) Intrapulmonary percussive ventilation every 2 hours
D) Intermittent positive-pressure breathing 35 cm H₂O Q4

Question 45

A patient with chronic bronchitis is being discharged from the hospital.The simplest,most cost-efficient device to aid this patient with bronchial hygiene therapy is which of the following?

A) Percussionaire IPV-1
B) Flutter therapy
C) Bird Mark 8
D) Pneumatic percussor

Question 46

One type of threshold resistor used to create continuous positive airway pressure is which of the following?

A) Bennett valve
B) Sliding Venturi
C) Underwater seal
D) Oscillator cartridge

Question 47

What is one major component of a pneumatically powered percussor?

A) Force control
B) Vibration control
C) Amplitude control
D) Convex applicator

Question 48

The device that will prevent early airway closure is:

A) incentive spirometry.
B) intermittent positive-pressure breathing.
C) flutter valve therapy.
D) high-frequency chest wall oscillation.

Question 49

Intrapulmonary percussive ventilation mobilizes airway secretions by which of the following methods?

A) Generating a subatmospheric pressure on inspiration, then an expiratory resistance
B) Applying a positive pressure to a patient's airways throughout the respiratory cycle
C) Delivering high-frequency percussive breaths into the patient's airways
D) Applying an expiratory resistance to exhaled flow from the patient

Question 50

How much pressure is the Percussionaire IPV-1 able to deliver with each cycle?

A) 5 to 15 cm H₂O
B) 10 to 35 cm H₂O
C) 15 to 50 cm H₂O
D) 25 to 40 cm H₂O

Question 51

Which of the following is a type of adjunctive therapy that aids in the mobilization of airway secretions through high-frequency percussive breaths applied inside the patient's airways?

A) Intrapulmonary percussive ventilation
B) Continuous positive airway pressure
C) Expiratory positive airway pressure
D) Positive expiratory pressure

Question 52

Bronchial hygiene therapy for patients with Duchenne muscular dystrophy or spinal muscular atrophy is most appropriate with which of the following?

A) Intermittent positive-pressure breathing
B) Incentive spirometry
C) Mechanical insufflation-exsufflation
D) Positive expiratory pressure

Question 53

An assessment of outcome for a patient receiving mask continuous positive airway pressure +8 cm H₂O should include which of the following?

A) Cardiac output testing
B) Pulse oximetry
C) Intracranial pressure measurement
D) Pulmonary function testing

Question 54

A patient with moderate kyphoscoliosis has bilateral lower lobe pneumonia. An assessment reveals impending respiratory failure.Which of the following machines should be used to deliver intermittent positive-pressure breathing to this patient?

A) Bird Mark 10
B) Bird Mark 14
C) Puritan Bennett AP-5
D) Puritan Bennett PR-2

Question 55

Which of the following therapies can be used as an alternative to endotracheal intubation and continuous ventilation for patients requiring short-term ventilatory support?

A) Continuous positive airway pressure
B) Expiratory positive airway pressure
C) Intermittent positive-pressure breathing
D) Intrapulmonary percussive ventilation

Question 56

What is the function of the counterweight plug and magnet in the Acapella Flutter type of device?

A) Creates positive and negative pressure in the chest
B) Provides high-frequency external chest wall oscillations
C) Creates oscillations that are transmitted into the lungs
D) Creates positive pressure throughout the respiratory cycle

Question 57

To apply positive airway pressure to a manual resuscitator bag during patient transport,which of the following are most appropriate?
1)Spring-loaded valve
2)Underwater seal
3)Magnetic valve
4)Weighted ball

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