Deck 17: Interventions for Acute Cardiopulmonary Conditions

Question 1

Which of the following factors that contribute to functional losses in a hospitalized patient does a physical therapist have the MOST influence to improve?

A)Acute inflammation
B)Severity of illness
C)Prolonged immobilization
D)Marginal baseline function

Answer 1

C
Prolonged immobilization or bed rest can be greatly affected by a physical therapist who advocates for early mobilization in a hospital setting.Acute inflammation,severity of illness,and marginal baseline function are factors for which a physical therapist can intervene,but are less likely influenced as much as prolonged bed rest.

Question 2

Which of the following positions for a pulmonary patient MOST likely leads to pooling of secretions in the lungs and a reduced functional residual volume?

A)Prone
B)Side lying
C)Supine
D)Sitting

Answer 2

C
As an acutely ill patient lies in the supine position in a hospital bed,gravity will cause secretions to pool in the posterior aspects of the lungs.The supine position can reduce functional residual volume by up to 50%.

Question 3

Which of the following conditions would be a relative contraindication to postural drainage?

A)Increased intracranial pressure
B)Open wounds or burns on thorax
C)Rib fractures
D)Osteoporosis

Answer 3

A
Relative contraindications for postural drainage include increased intracranial pressure,hemodynamically unstable,recent esophageal anastomosis,recent spinal fusion or injury,recent head trauma,diaphragmatic hernia,and recent eye surgery.

Question 4

Which of the following conditions is LEAST likely to be a precaution for percussion and vibration airway clearance technique?

A)Osteoporosis
B)Rib fractures
C)Recent head trauma
D)Recent pacemaker placement

Question 5

The BEST method used by a physical therapist to monitor a patient during postural drainage interventions is which of the following?

A)Observe the monitor above the patient's bed that shows vital signs.
B)Ensure the patient's face is always in view of the physical therapist.
C)Have the patient wear a pulse oximeter to monitor oxygen saturation.
D)Verbally check with the patient at the end of each position.

Question 6

Which of the following breathing exercise techniques would enhance fast-twitch glycolytic muscle fibers of the diaphragm in a patient with good strength?

A)Three quick sniffs through the nose with slow relaxed exhalations.
B)Deep breathing using diaphragmatic breathing for 30 minutes,two to three times per day.
C)Manual resistance applied to the diaphragm through the inspiratory phase.
D)Reduces the number of sniffs to one at an increasingly slower pace.

Question 7

Which of the following breathing exercises would BEST facilitate air flow into poorly ventilated areas?

A)Pursed-lip breathing
B)Paced breathing
C)Inspiratory hold technique
D)Diaphragmatic controlled breathing

Question 8

Which of the following medical interventions is better administered following the provision of airway clearance techniques?

A)Optimal pain control
B)Inhaled bronchodilator
C)Inhaled antibiotics
D)None of the above

Question 9

Which of the following techniques would be BEST employed if after repeated instruction and trials,the patient is unable to understand and perform diaphragmatic breathing?

A)Stacked breathing
B)Sniffing
C)Unilateral costal breathing
D)Inspiratory hold technique

Question 10

A patient presents with upper extremity strength of two out of five manual muscle testing and the clinician desires to assist the patient in performing ventilatory movement strategies.Which of the following types of range of motion is MOST advantageous to this patient?

A)Passive range of motion
B)Active assisted range of motion
C)Active range of motion
D)Manually resisted range of motion

Question 11

Which of the following technique modifications would be MOST helpful to a patient who is inhibited by surgical pain to perform an effective cough?

A)Instruct the patient in how to splint their incision by applying pressure over it with a pillow.
B)Request the nurse to provide the patient with pain medication prior to a treatment session with the physical therapist.
C)Instruct the patient on the technique of huffing.
D)All of the above.

Question 12

Which of the following clinical findings is MOST associated with prolonged immobilization and/or sedentary lifestyle?

A)Elevated resting heart rate
B)Atelectasis
C)Hypoventilation
D)Edema

Question 13

A patient presents 2 weeks post an embolic stroke and aspiration pneumonia.She is lethargic and does not appear to follow commands consistently.Which of the following breathing techniques would BEST improve the patient's overall ventilation to lung areas on the hemiparetic side?

A)Upper chest inhibiting technique
B)Counter rotation
C)Scoop technique
D)Unilateral costal expansion

Question 14

A patient experiencing dyspnea my lean forward on supported hands.Which of the following statements provides the BEST rationale for why this position relieves dyspnea?

A)Respiratory muscle length is shortened.
B)Intra-abdominal pressure is reduced.
C)Improved respiratory accessory muscle action on the rib cage.
D)Provides a position of rest for the patient.

Question 15

Which of the following would be considered a sign of postural drainage treatment intolerance exhibited by the patient?

A)Inability to clear secretions produced by cough
B)Inability to take a deep breath
C)Slightly elevated heart rate
D)Hypertension

Question 16

Which of the following conditions is an indication for airway clearance procedures?

A)Dry,nonproductive cough
B)Dyspnea with exertion
C)Excessive pulmonary secretions
D)Acute inflammation of the lungs

Question 17

Adequate inspiratory volumes for an effective cough are noted to be at least which of the following?

A)Inspiration equivalent to tidal volume inspiration
B)40% of patient's predicted vital capacity
C)50% of patient's predicted vital capacity
D)60% of patient's predicted vital capacity

Question 18

Improved inspiratory breathing effort is achieved BEST using which of the following techniques?

A)The patient is instructed to inhale while performing shoulder extension,adduction,and internal rotation.
B)The patient is instructed to inhale while leaning forward in preparation for the movement of sit to stand.
C)The patient is instructed to inhale while performing shoulder flexion,abduction,external rotation,and slight trunk extension.
D)The patient is instructed to inhale while rolling to one side in preparation for moving from side lying to sitting on the edge of the bed.

Question 19

A patient with pulmonary infection and excessive secretions in multiple segments is able to tolerate only one or two postural drainage (PD)positions in one session.Which of the following modifications to treatment should the physical therapist implement to increase the effectiveness of this pulmonary intervention?

A)The clinician should vary the postural drainage positions in subsequent sessions in order to drain all affected lung segments.
B)Coordinate postural drainage with turning schedules for skin protection.
C)Ask the nursing staff to assist with some postural drainage positions during bathing.
D)All of the above.

Question 20

Postural drainage is BEST defined by which of the following statements?

A)Rhythmical clapping with cupped hands over the affected lung segment.
B)Clinician's hands are used to exert pressure on the patient's chest wall with oscillations at the end of deep inspiration through expiration.
C)The assumption of one or more body positions that allow gravity to assist with draining secretions from each lung segment.
D)A series of maneuvers performed by the patient to emphasize independence in secretion clearance and thoracic expansion.

Question 21

Which of the following criteria should be met before a patient in the ICU is progressed to standing and ambulation?

A)Patient is able to sit on the edge of the bed unsupported for at least 5 minutes.
B)Patient is able to perform knee extension exercise full range for 3 minutes.
C)Patient is hemodynamically stable with sitting on the edge of the bed and light exercise activity.
D)All of the above criteria need to be met.

Question 22

Which of the following educational interventions would be MOST appropriate for a patient who demonstrates poor coordination and motor learning deficits?

A)Provide the education in written materials and demonstrate to the patient what is being expected.
B)Have the patient practice the task in small segments and then progressively put the components together providing adequate feedback.
C)Adapt the environment to be less noisy and distracting.
D)When educating,speak at an adequate volume with clarity.

Question 23

If a patient is demonstrating excessive use of accessory muscles during breathing,which of the following breathing strategies would be MOST appropriate to implement with the patient?

A)Pursed-lip breathing
B)Paced breathing
C)Upper chest inhibiting technique
D)Inspiratory hold technique

Question 24

A patient who is postoperative a cholecystectomy will achieve which of the following goals by using an incentive spirometer?

A)Improved ability to perform diaphragmatic breathing.
B)Prevent or reverse atelectasis.
C)Cough stimulation.
D)All of the above.

Question 25

An assistive device capable of performing a wide range of support for the act of breathing is which of the following?

A)Mechanical percussor
B)High-frequency chest wall oscillation
C)Mechanical ventilator
D)Positive expiratory pressure

Question 26

The technique of airway suctioning is effective in removing secretions from all of the lungs areas including the small airways.

Question 27

Which of the following clinical signs would be considered a non vital sign of possible exercise intolerance?

A)Patient becomes short of breath.
B)Oxygen saturation drops below prescribed level.
C)Diaphoresis.
D)Systolic blood pressure decreases more than 10 mm Hg below resting.

Question 28

Which of the following conditions would be considered a contraindication to a Trendelenburg position for postural drainage of the lower lobes of the lungs?

A)Congestive heart failure
B)Pleural effusions
C)Pneumothorax
D)Pneumonia

Question 29

Asking a patient to provide a rating of perceived exertion or a rating of dyspnea is measuring which of the following parameters of exercise?

A)Frequency
B)Duration
C)Intensity
D)Mode

Question 30

A patient who is removed from mechanical ventilation to breathe spontaneously on supplemental O₂ for progressively longer periods of time is BEST described by which of the following mechanical ventilation weaning methods?

A)Intermittent mandatory ventilation
B)T-piece wean
C)Pressure support ventilation
D)Positive end-expiratory pressure