Deck 16: Bronchial Hygiene Therapy

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?

A)Continuation of the therapy
B)Add a mucolytic before therapy.
C)Discontinue therapy because of intolerance.
D)Perform the therapy with the patient in a modified position.

Answer 1

Continuation of the 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

A)I and II
B)III and IV
C)I,II,III,and IV
D)I,III,and IV

Answer 2

I,II,III,and IV

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:

A)positioning.
B)postural drainage therapy.
C)chest clapping.
D)bronchodilator therapy.

Answer 3

postural drainage therapy.

Question 4

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

A)Increased cerebral perfusion
B)Chest pain
C)Fatigue
D)Headaches

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?

A)Stop the therapy,allow the patient to rest,and continue the therapy.
B)The patient should be suctioned and then the therapy should be continued.
C)The patient should be comforted and the therapy should be shortened slightly.
D)A decision should be made to modify or stop therapy.

Question 6

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

A)Trendelenburg.
B)Lateral.
C)Supine.
D)Prone.

Question 7

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

A)inspiration.
B)the posterior portion of the chest.
C)expiration.
D)areas of the chest not percussed.

Question 8

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

A)Postural drainage therapy
B)Positive airway pressure therapy
C)Directed cough
D)Unilateral chest expansion

Question 9

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

A)Turning
B)Postural drainage
C)External manipulation of the thorax
D)Suctioning

Question 10

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

A)10-15 ml per day.
B)15-20 ml per day.
C)20-25 ml per day.
D)25-30 ml per 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?

A)Postural drainage therapy
B)Forced expiratory technique
C)Positive expiratory pressure therapy
D)Positioning

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?

A)Stop therapy,return patient to original resting position,administer or increase oxygen delivery while contacting physician.Administer physician-ordered bronchodilators.
B)Stop therapy,clear airway and suction as needed,administer oxygen,maintain airway,return patient to previous resting position,and contact physician immediately.
C)Stop therapy,return patient to previous resting position,allow patient to rest,continue therapy with patient in the modified position,document heart rhythm in the patient's chart.
D)Stop therapy,return patient to previous resting position,administer or increase oxygen delivery while contacting 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?

A)Administer 100% oxygen,stop therapy immediately,return the patient to original resting position,and consult the physician.
B)Administer 100% oxygen and consult the physician.
C)Administer 100% oxygen and continue the therapy with the patient flat in bed.
D)Stop therapy immediately and return patient to original resting position.

Question 14

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

A)The foot of the bed elevated 12 inches with the patient rotated one-quarter turn from supine,left side up
B)The foot of the bed elevated 18 to 20 inches and the patient directly lying of the left side
C)The foot of the bed elevated 12 inches with the patient rotated one-quarter turn from supine,right side up
D)The foot of the bed elevated 18 to 20 inches and the patient lying supine

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?

A)Position the patient prone with the head of the bed flat.
B)Position the patient on the left side with the foot of the bed elevated 18 to 20 inches,and on the right side with the foot of the bed elevated 18 to 20 inches.
C)Position the patient supine with the foot of the bed elevated 18 to 20 inches.
D)Position the patient prone with the foot of the bed elevated 18 to 20 inches.

Question 16

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

A)PDT should be continued.
B)the procedure is not justified.
C)clapping should be done in conjunction with PDT.
D)a bronchodilator should be given before PDT.

Question 17

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

A)three,two,twelve
B)two,three,eighteen
C)two,three,twelve
D)three,three,eighteen

Question 18

What is the only absolute contraindication to a directed cough?

A)Increased intracranial pressure
B)Increased potential for aspiration
C)Untreated pneumothorax
D)There are no absolute contraindications.

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?

A)Administer 100% oxygen,stop therapy immediately,return patient to original resting position,and consult physician.
B)Stop therapy,clear airway and suction as needed,administer oxygen,maintain airway,return patient to previous resting position,and contact physician immediately.
C)Stop therapy,administer oxygen,maintain airway,and return the patient to previous resting position.
D)Administer oxygen,maintain airway,and contact physician immediately.

Question 20

Lifting should be performed with the ________________

A)back.
B)legs.
C)arms.
D)fingers.

Question 21

Which technique (s)include(s)removal of retained secretions,atelectasis,and prophylaxis of pulmonary infections and as routine care for patients with cystic fibrosis?

A)PEP therapy
B)Flutter valve therapy
C)High frequency chest wall oscillation therapy
D)All of these

Question 22

Before initiating PEP therapy,the respiratory care practitioner verifies the physician's order for PEP therapy.Upon review of the patient's chart,it is noted that the patient has an acute sinusitis and a history of epistaxis.What should this tell the practitioner about the patient?

A)The patient may have cystic fibrosis also and the PEP therapy should be given with a mucolytic drug.
B)The patient should be set in the Fowler's position before the therapy is initiated.
C)A drug with alpha effects should be given before proceeding with the therapy.
D)The patient should be carefully evaluated before PEP therapy is initiated.

Question 23

How does the Respironics Coughassistᵀᴹ MI-E simulate a cough to help the patient?

A)The device chatters during exhalation
B)Increases the FRC following a larger than normal tidal breath
C)This rapid shift from positive to negative pressure
D)It provides the patient a breath hold and decreases intrathoracic pressure

Question 24

A patient has severe hypoxemia despite high levels of oxygen.To help alleviate the hypoxemia the patient is positioned with the good lung down.How does this work?

Question 25

A patient who is receiving postural drainage and percussion desaturates during therapy,complains of dizziness,and states he cannot tolerate the treatment any longer.What should the practitioner do?

Question 26

What type of therapy is being given by the application of positive pressure (10 to 15 cm H₂O)during active exhalation to increase functional residual capacity (FRC)following a larger than normal tidal breath?

A)Positive expiratory pressure therapy
B)Flutter valve therapy
C)High frequency chest wall oscillation therapy
D)Forced expiration technique

Question 27

What is the ideal breathing pattern for PEP therapy?

A)The patient should take a larger than normal tidal breath (but not to TLC),and then exhale forcefully against the resistance to FRC.The patient should cough after each PEP breath.
B)The patient should take a larger than normal tidal breath (but not to TLC),and then exhale actively,but not forcefully,against the resistance to FRC.The patient should be relaxed,and diaphragmatic breathing should be emphasized.The patient should take between 10 and 20 PEP breaths and then cough.
C)The patient should take normal tidal breath and then exhale actively,but not forcefully,against the resistance to RV.The patient should be relaxed,and diaphragmatic breathing should be emphasized.The patient should take between 10 and 20 PEP breaths and then cough.
D)The patient should take a deep breath to TLC,and then exhale forcefully against the resistance to FRC.The patient should be relaxed,and diaphragmatic breathing should be emphasized.The patient should take between 10 and 20 PEP breaths and rest.The patient should cough only if necessary.

Question 28

A patient with cystic fibrosis is going to be sent home.The physician wants the practitioner to recommend bronchial hygiene at home.The patient has an active lifestyle and both parents have arthritis and cannot perform percussion and postural drainage (PPD)on the patient.What should be recommended for the patient?