Deck 39: Lung Expansion Therapy

Question 1

Which of the following situations is a contraindication for incentive spirometry?
I)a patient whose vital capacity is less than 10 ml/kg
II)a patient who cannot cooperate or follow instructions
III)an unconscious patient

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

Answer 1

D

Question 2

How can the transpulmonary pressure gradient be increased?
I)increasing alveolar pressure
II)decreasing pleural pressure
III)decreasing transthoracic pressure

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

Answer 2

A

Question 3

Which of the following groups of patients is not at risk for developing postoperative atelectasis?

A)those with chronic obstructive pulmonary disease
B)those with a significant history of cigarette smoking
C)those with impaired mucociliary clearance
D)those with pneumonia

Answer 3

D

Question 4

What is the major contributing factor in the development of postoperative atelectasis?

A)uncontrolled hyperpyrexia
B)central nervous system overstimulation
C)decreased cardiac output
D)repetitive, shallow breathing

Question 5

An alert and cooperative 28-year-old woman with no prior history of lung disease underwent cesarean section 16 hours earlier. Her x-ray film currently is clear. Which of the following approaches to preventing atelectasis would you recommend for this patient?

A)incentive spirometry
B)PEEP therapy
C)deep breathing exercises
D)intermittent positive-pressure breathing therapy

Question 6

Which of the following is FALSE about flow-oriented incentive spirometry devices?

A)Inspired volume is estimated as the product of flow and time.
B)Motivation is based on keeping the indicator balls elevated.
C)They have proved less effective than volumetric systems.
D)They provide only an indirect measure of inspired volume.

Question 7

A postoperative patient using incentive spirometry complains of dizziness and numbness around the mouth after therapy sessions. What is the most likely cause of these symptoms?

A)gastric insufflation
B)hyperventilation
C)pulmonary barotrauma
D)respiratory acidosis

Question 8

In teaching a patient to perform the sustained maximal inspiration maneuver during incentive spirometry, what would you say?

A)"Exhale normally, then inhale as deeply as you can, then hold your breath for 5 to 10 seconds."
B)"Inhale as deeply as you can, then blow out as much air as you can as fast as possible."
C)"Exhale normally, then inhale as deeply as you can, then hold your breath for 10 to 20 seconds."
D)"Exhale as much as you can, then inhale as deeply as you can, then relax and let it out."

Question 9

Persistent breathing at small tidal volumes can result in which of the following?

A)reabsorption atelectasis
B)spontaneous pneumothorax
C)passive atelectasis
D)respiratory alkalosis

Question 10

Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure include which of the following?
I)incentive spirometry (IS)II.positive end-expiration pressure therapy
III)intermittent positive-pressure breathing (IPPB)IV.expiratory positive airway pressure (EPAP)

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

Question 11

Ideally, when should high-risk surgical patients be oriented to incentive spirometry?

A)postoperatively, after full recovery from the anesthesia
B)preoperatively, before undergoing the surgical procedure
C)postoperatively, while they are still in the recovery room
D)postoperatively, but no sooner than 24 hours after surgery

Question 12

Which of the outcomes would indicate improvement in a patient previously diagnosed with atelectasis who has been receiving incentive spirometry?
I)improved PaO₂
II)decreased respiratory rate
III)improved chest radiograph
IV)decreased forced vital capacity (FVC)V.tachycardia

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

Question 13

Which of the following patient categories are at high risk for developing atelectasis?
I)those who are heavily sedated
II)those with abdominal or thoracic pain
III)those with neuromuscular disorders

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

Question 14

Which of the following modes of lung expansion therapy is physiologically most normal?

A)continuous positive airway pressure
B)incentive spirometry
C)positive end-expiratory pressure
D)intermittent positive-pressure breathing therapy

Question 15

Incentive spirometry devices can generally be categorized as which of the following?
I)pressure-oriented
II)flow-oriented
III)volume-oriented

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

Question 16

Successful application of incentive spirometry depends on:

A)the use of a true volume-oriented incentive spirometry system
B)the type of surgery previously performed
C)the effectiveness of patient teaching
D)setting an easily achieved initial goal

Question 17

Which of the following are potential indications for incentive spirometry?
I)a restrictive disorder such as quadriplegia
II)abdominal surgery in a COPD patient
III)presence of pulmonary atelectasis

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

Question 18

Which of the following is not a potential hazard or complication of incentive spirometry?

A)pulmonary barotrauma
B)decreased cardiac output
C)respiratory alkalosis
D)fatigue

Question 19

Which of the following clinical findings indicate the development of atelectasis?
I)opacified areas on the chest x-ray film
II)inspiratory and expiratory wheezing
III)tachypnea
IV)diminished or bronchial breath sounds

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

Question 20

How do all modes of lung expansion therapy aid lung expansion?

A)increasing the transpulmonary pressure gradient
B)decreasing the transthoracic pressure gradient
C)increasing the pressure in the pleural space
D)decreasing the pressure in the alveoli

Question 21

Correct instruction in the technique of incentive spirometry should include which of the following?

A)use of accessory muscles at high inspiratory flows
B)diaphragmatic breathing at slow to moderate flows
C)"panting" at volumes approaching total lung capacity
D)use of accessory muscles at low inspiratory flows

Question 22

Which of the following statements is not true about intermittent positive-pressure breathing (IPPB)?

A)IPPB could cause lung overinflation.
B)IPPB could cause no expansion of regions affected by secretions.
C)Bronchial hygiene must be used in conjunction with IPPB to adequately manage secretions.
D)IPPB should be the single treatment modality for resorption atelectasis.

Question 23

Preliminary planning for intermittent positive-pressure breathing (IPPB) should include which of the following?
I)evaluating alternative approaches to the patient's problem
II)setting specific, individual clinical goals or objectives
III)conducting a baseline assessment of the patient

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

Question 24

In performing the sustained maximal inspiration maneuver during incentive spirometry, the patient should be instructed to sustain the breath for at least how long?

A)10 to 15 seconds
B)5 to 10 seconds
C)3 to 5 seconds
D)1 to 2 seconds

Question 25

Which of the following is an absolute contraindication for using intermittent positive-pressure breathing?

A)hemodynamic instability
B)active untreated tuberculosis
C)tension pneumothorax
D)recent esophageal surgery

Question 26

Which of the following patient groups should be considered for lung expansion therapy using intermittent positive-pressure breathing (IPPB)?
I)patients with clinically diagnosed atelectasis who are not responsive to other therapies
II)patients at high risk for atelectasis who cannot cooperate with other methods
III)all obese patients who have undergone abdominal surgery

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

Question 27

The short-term application of inspiratory positive pressure to a spontaneously breathing patient best defines which of the following?

A)sustained maximal inspiration
B)intermittent positive-pressure breathing
C)continuous positive iarway pressure
D)positive end-expiration pressure

Question 28

Which of the following is not a potential hazard of intermittent positive-pressure breathing?

A)increased cardiac output
B)respiratory alkalosis
C)pulmonary barotrauma
D)gastric distention

Question 29

For patients receiving incentive spirometry, what is the minimum number of sustained maximal inspirations (SMIs) per hour that you would recommend?

A)25 to 30
B)15 to 20
C)5 to 10
D)1 to 2

Question 30

What should the monitoring of patients using incentive spirometry include?
I)number of breaths per session
II)volume and flow goals achieved
III)maintenance of breath-hold
IV)patient effort and motivation

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

Question 31

Which of the following are potential desirable outcomes of intermittent positive-pressure breathing (IPPB) therapy?
I)improved oxygenation
II)increased cough and secretion clearance
III)improved breath sounds
IV)reduced dyspnea

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

Question 32

What is the minimum airway pressure at which the esophagus opens, allowing gas to pass directly into the stomach?

A)25 cm H₂O
B)20 cm H₂O
C)15 cm H₂O
D)10 cm H₂O

Question 33

Intermittent positive-pressure breathing is associated with a passive exhalation.

Question 34

What is the most common complication associated with intermittent positive-pressure breathing (IPPB)?

A)air-trapping
B)oral bleeding
C)respiratory alkalosis
D)gastric distention

Question 35

Which of the following is false about intermittent positive-pressure breathing?

A)During inspiration, pressure in the alveoli decreases.
B)The pressure gradients of normal breathing are reversed.
C)During inspiration, alveolar pressure may exceed pleural pressure.
D)Energy stored during inspiration causes a passive exhalation.

Question 36

In observing a postoperative woman conduct incentive spirometry, you note repetitive performance of the sustained maximal inspiration maneuver at a rate of about 10 to 12/min. Which of the following would you recommend to her?

A)decrease the treatment frequency to 4 times/day.
B)increase her breathing rate to 12 to 15/min.
C)take a 30-second rest period between breaths.
D)repeat the treatment every 30 minutes.

Question 37

Which of the following is NOT a potential contraindication for intermittent positive-pressure breathing?

A)hemodynamic instability
B)recent esophageal surgery
C)tension pneumothorax
D)neuromuscular disorders

Question 38

Which of the following are potential hazards of intermittent positive-pressure breathing (IPPB)?
I)air-trapping, auto-PEEP
II)hyperventilation
III)nosocomial infection
IV)increased airway resistance

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

Question 39

Which of the following is false about gastric distention with intermittent positive-pressure breathing (IPPB)?

A)Gastric distention is uncommon in alert and cooperative patients.
B)Gastric distention is most likely at high airway pressures.
C)Gastric distention is a significant risk in obtunded patients.
D)Gastric distention is a relatively harmless effect of IPPB.

Question 40

What is the optimal breathing pattern for intermittent positive-pressure breathing (IPPB) treatment of atelectasis?

A)slow, deep breaths held at end-inspiration
B)rapid, deep breaths held at end-inspiration
C)slow, shallow breaths held at end-inspiration
D)rapid, shallow breaths held at end-inspiration

Question 41

Which of the following are potential complications of continuous positive airway pressure (CPAP) therapy?
I)barotrauma
II)hyperventilation
III)gastric distention
IV)hypercapnia

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

Question 42

Which of the following mechanisms probably contribute to the beneficial effects of continuous positive airway pressure (CPAP) in treating atelectasis?
I)recruitment of collapsed alveoli
II)decreased work of breathing
III)improved distribution of ventilation
IV)increased efficiency of secretion removal

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

Question 43

Which of the following are appropriate initial settings for intermittent positive-pressure breathing given to a new patient?

A)sensitivity -2 cm H₂O; pressure 20 to 25 cm H₂O; high flow
B)sensitivity -3 to -4 cm H₂O; pressure 5 to 10 cm H₂O; moderate flow
C)sensitivity -1 to -2 cm H₂O; pressure 10 to 15 cm H₂O; moderate flow
D)sensitivity -8 cm H₂O; pressure 15 cm H₂O; moderate flow

Question 44

Which of the following are essential components of a continuous positive airway pressure (CPAP) flow system?
I)blended source of pressurized gas
II)nonrebreathing circuit with reservoir bag
III)low-pressure or disconnect alarm
IV)expiratory threshold resistor

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

Question 45

Which of the following initial flow settings would you select when setting up a continuous positive airway pressure flow-mask system for a patient with atelectasis?

A)2 to 3 times the patient's minute ventilation
B)at least 6 to 10 L/min
C)4 times the patient's minute ventilation
D)10 times the patient's V_T

Question 46

Prior to starting intermittent positive-pressure breathing (IPPB) on a new patient, what should the practitioner explain?
I)why the physician ordered the treatment
II)what the IPPB treatment will do
III)how the IPPB treatment will feel
IV)what the expected results are

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

Question 47

During administration of a continuous positive airway pressure flow mask to a patient with atelectasis, you find it difficult to maintain the prescribed airway pressure. Which of the following is the most common explanation?

A)system or mask leaks
B)outflow obstruction
C)inadequate system flow
D)inadequate trigger

Question 48

The general assessment, common to all patients for whom intermittent positive-pressure breathing (IPPB) is ordered, should include which of the following?
I)measurement of vital signs
II)appearance and sensorium
III)chest auscultation
IV)arterial blood gas analysis
V)peak expiratory flow rates

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

Question 49

When checking a patient's intermittent positive-pressure breathing (IPPB) breathing circuit before use, you notice that the device will not cycle off, even when you occlude the mouthpiece. What would be the most appropriate action in this case?

A)Secure a new IPPB ventilator.
B)Check the circuit for leaks.
C)Decrease the flow setting.
D)Increase the pressure setting.

Question 50

Which of the following are contraindications for continuous positive airway pressure (CPAP) therapy?
I)hemodynamic instability
II)hypoventilation
III)facial trauma
IV)low intracranial pressures

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

Question 51

Which of the following positions is ideal for intermittent positive-pressure breathing therapy?

A)semi-Fowler's
B)standing
C)supine
D)prone

Question 52

In administering intermittent positive-pressure breathing therapy, which of the following breathing patterns would be most desirable?

A)6 to 8 breaths/min, inspiration/expiration ratio (I:E) of 1:3
B)8 to 10 breaths/min, I:E of 1:1
C)12 to 15 breaths/min, I:E of 1:2
D)6 to 8 breaths/min, I:E of 1:1

Question 53

Which of the following should be charted in the patient's medical record after completion of an intermittent positive-pressure breathing treatment?
I)results of pre- and posttreatment assessment
II)any side effects
III)duration of therapeutic session

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

Question 54

In order to eliminate leaks in an alert patient receiving intermittent positive-pressure breathing therapy, which of the following adjuncts would you first try?

A)flanged mouthpiece
B)form-fitting mask
C)nasopharyngeal airway
D)nose clips

Question 55

In terms of machine performance, what large negative pressure swings early in inspiration indicate?

A)inadequate flow setting
B)incorrect sensitivity
C)inadequate pressure setting
D)inadequate humidity

Question 56

All of the following machine performance characteristics should be monitored during intermittent positive-pressure breathing therapy except:

A)flow setting
B)sensitivity
C)humidity output
D)peak pressure

Question 57

When adjusting the sensitivity control on an intermittent positive-pressure breathing device, which of the following parameters are you changing?

A)volume of gas delivered to the patient during inhalation
B)effort required to cycle the device "off" (end inspiration)
C)effort required to cycle the device "on" (begin inspiration)
D)maximum pressure delivered to the patient during inhalation

Question 58

All of the following parameters should be evaluated after intermittent positive-pressure breathing therapy except:

A)vital signs
B)sensorium
C)breath sounds
D)temperature

Question 59

Which of the following will make an intermittent positive-pressure breathing (IPPB) device cycle off prematurely?
I)airflow obstructed
II)kinked tubing
III)occluded mouthpiece
IV)active resistance to inhalation

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

Question 60

Which of the following are appropriate volume goals for intermittent positive-pressure breathing (IPPB) therapy?
I)10 to 15 ml/kg ideal body weight
II)at least 30% of the inspiratory capacity (IC)III.pressure level as high as 30 to 35 cm H₂O

A)I and III
B)I and II
C)II and III
D)I only

Question 61

A surgeon writes an order for lung expansion therapy for a 28-year-old 110-lb woman who has undergone lower abdominal surgery. In evaluating this patient at the bedside, you obtain a VC of 800 ml and an IC of 44% predicted. Although a chest radiograph indicates basal atelectasis, she has no problem with retained secretions. What lung expansion treatment would you recommend?

A)intermittent positive-pressure breathing at 6 to 8 breaths/min at 10 to 15 ml/kg
B)continuous positive airway pressure therapy at 10 cm H₂O for 24 hours
C)positive end-expiratory pressure therapy with bronchodilator and bronchial hygiene
D)incentive spirometry 10 times an hour at an initial volume of 500 to 600 ml

Question 62

A surgeon orders lung expansion therapy for an obtunded 68-year-old, 170-lb man who has developed atelectasis after thoracic surgery. On baseline assessment, the patient cannot perform an IC or VC maneuver, but has no evidence of retained secretions. Which of the following would you recommend?

A)intermittent positive-pressure breathing (IPPB) at 6 to 8 breaths/min at 10 to 15 ml/kg
B)continuous positive airway pressure therapy at 12 cm H₂O for 24 hours
C)positive end-expiratory pressure therapy with bronchodilator and bronchial hygiene
D)incentive spirometry 10 times an hour at an initial volume of 600 to 800 ml

Question 63

While monitoring a patient receiving +12 cm H₂O flow-mask continuous positive airway pressure, you note that the pressure drops to +6 cm H₂O during inspiration, but returns to +12 cm H₂O during exhalation. Which of the following would likely correct this problem?

A)Check and correct any mask leaks.
B)Check and correct any outflow obstruction.
C)Increase the system flow.
D)Increase the system pressure.