Question 1

A typical mechanical insufflation-exsufflation treatment session should continue until what point? I. Secretions are cleared. II. The vital capacity (VC) returns to baseline. III. The SpO₂returns to baseline.

Accepted Answer

A typical mechanical insufflation-exsufflation treatment session should continue until secretions are cleared, the vital capacity (VC) returns to baseline, and the oxygen saturation (SpO2) returns to baseline.

Question 2

What is the ideal patient position for directed coughing?

Accepted Answer

The ideal patient position for directed coughing is sitting with one shoulder rotated inward, the head and spine slightly flexed. This position allows for maximum lung expansion and facilitates the forceful expiration needed for effective coughing. Supine or prone positions are not recommended as they do not allow for proper lung expansion, and supporting the forearms or bracing the feet is not necessary for directed coughing.

Question 3

Under which of the following conditions would mechanical insufflation-exsufflation with an oronasal mask probably NOT be effective?
I.if the glottis collapses during exsufflation
II.presence of fixed airway obstruction
III.presence of a chronic neuromuscular disorder

Accepted Answer

I, IIMechanical insufflation-exsufflation is a technique used to help clear secretions from the airways, particularly in patients who have difficulty coughing due to neuromuscular disorders or other conditions. If the glottis collapses during exsufflation, the effectiveness of the technique is compromised because air cannot flow freely out of the lungs, preventing the removal of secretions. Similarly, the presence of a fixed airway obstruction would also hinder the effectiveness of this technique, as the obstruction would block the flow of air and secretions out of the airways. However, the presence of a chronic neuromuscular disorder is actually an indication for the use of mechanical insufflation-exsufflation, as these patients often have difficulty generating sufficient cough strength on their own.

Question 4

All of the following are hazards of positive airway pressure therapies (EPAP, PEP, CPAP) except:

Accepted Answer

Epistaxis is not a common hazard associated with positive airway pressure therapies. However, decreased venous return, pulmonary barotrauma, and increased intracranial pressure are potential hazards.

Question 5

A chronic obstructive pulmonary disease patient cannot develop an effective cough. Which of the following would you recommend to help this patient generate a more effective cough?
I.enhancing expiratory flow by bending forward at the waist
II.using short, expiratory bursts or the "huffing" method
III.using only moderate (as opposed to full) inspiration
IV.having the patient "tense" the neck muscles while coughing

Accepted Answer

Enhancing expiratory flow by bending forward at the waist, using short, expiratory bursts or the "huffing" method, and using only moderate inspiration can all help a patient with chronic obstructive pulmonary disease generate a more effective cough. These techniques facilitate the clearing of mucus from the airways by optimizing the mechanics of coughing. Tensing the neck muscles is not a recommended technique for improving cough effectiveness.

Question 6

Contraindications for positive airway pressure therapies include all of the following except:

Accepted Answer

Positive airway pressure therapies, such as CPAP (Continuous Positive Airway Pressure) or BiPAP (Bilevel Positive Airway Pressure), are often used in the management of sleep apnea and some types of respiratory failure. While intracranial pressure exceeding 20 mm Hg, recent facial, oral, or skull surgery or trauma, and preexisting pulmonary barotrauma like pneumothorax are contraindications due to the risk of worsening these conditions, air-trapping/pulmonary overdistention in chronic obstructive pulmonary disease (COPD) is not a contraindication. In fact, positive airway pressure therapies can be beneficial in certain COPD patients by improving ventilation and reducing the work of breathing.

Question 7

Whether using traditional methods or the FET, a period of diaphragmatic breathing and relaxation should always follow attempts at coughing. What is the purpose of this approach?

Accepted Answer

Diaphragmatic breathing and relaxation can help restore lung volume and minimize fatigue after attempts at coughing, which can be especially important for patients with respiratory conditions. This approach can also help prevent acute air-trapping in some cases. However, there is no mention of restoring the patient's SOS (status of service) or allowing time for questions in the given context.

Question 8

Which of the following is false about the FET?

Accepted Answer

Option D is false, the FET occurs at mid to low lung volumes without glottis closure. Options A, B, and C are true.

Question 9

A patient recovering from abdominal surgery is having difficulty developing an effective cough. Which of the following actions would you recommend to aid this patient in generating a more effective cough?
I.coordinating coughing with pain medication
II.using the forced expiration technique (FET)III.supplying manual epigastric compression
IV."splinting" the operative site

Accepted Answer

I. Coordinating coughing with pain medication helps by reducing pain during coughing, making it easier for the patient to cough effectively. II. The forced expiration technique (FET) aids in clearing mucus from the lungs by using a huffing technique, which can be less painful and more effective than a traditional cough for some patients. IV. "Splinting" the operative site involves supporting the area with a pillow or hands to reduce pain during coughing, encouraging more effective coughs.

Question 10

A physician orders positive expiratory pressure therapy for a 14-year-old child with cystic fibrosis. All of the following responses should be monitored on this patient except:

Accepted Answer

Minute volume (the total volume of air breathed in and out in one minute) is not directly affected by positive expiratory pressure therapy, which is primarily aimed at improving airway clearance.

Question 11

Which of the following are potential indications for positive airway pressure therapies?
I.reduce air-trapping in asthma or chronic obstructive pulmonary disease
II.help mobilize retained secretions
III.prevent or reverse atelectasis
IV.optimize bronchodilator delivery

Accepted Answer

Positive airway pressure therapies can help with reducing air-trapping in asthma or chronic obstructive pulmonary disease (I), mobilizing retained secretions (II), preventing or reversing atelectasis (III), and optimizing bronchodilator delivery (IV). Therefore, all options are potential indications for positive airway pressure therapies.

Question 12

Key consideration in teaching a patient to develop an effective cough regimen includes which of the following?
I.strengthening of the expiratory muscles
II.instruction in breathing control
III.instruction in proper positioning

Accepted Answer

Teaching an effective cough regimen should include strengthening of the expiratory muscles, instruction in breathing control, and instruction in proper positioning. All three factors are crucial for a patient to effectively cough up mucus or other secretions from their lungs. Strengthening the expiratory muscles helps to increase the strength of the cough, breathing control helps the patient to take deep breaths and exhale forcefully, and proper positioning (such as sitting up straight or leaning forward) can help to improve the effectiveness of the cough. Therefore, all three factors should be included in teaching an effective cough regimen.

Question 13

Hazards of positive airway pressure therapies associated with the apparatus used include which of the following?
I.increased work of breathing
II.claustrophobia
III.epistaxis
IV.vomiting and aspiration
V.skin breakdown and discomfort

Accepted Answer

Positive airway pressure therapies, such as CPAP (Continuous Positive Airway Pressure) or BiPAP (Bilevel Positive Airway Pressure), can lead to several issues related to the apparatus used, including increased work of breathing due to the resistance against the positive pressure, claustrophobia from wearing the mask, epistaxis (nosebleeds) from the dry or pressurized air, vomiting and aspiration if the patient vomits with the mask on, and skin breakdown and discomfort from the pressure and friction of the mask.

Question 14

What does phase 1 of autogenic drainage involve?

Accepted Answer

Phase 1 of autogenic drainage involves an inspiratory capacity maneuver, followed by breathing at low lung volumes to help loosen mucus in the smaller airways.

Question 15

Strenuous expiratory efforts in some chronic obstructive pulmonary disease (COPD) patients limit the effectiveness of coughing. Why is this so?

Accepted Answer

Strenuous expiratory efforts can increase pleural pressures, which can compress the small airways, making it more difficult to effectively clear the airways through coughing. The other options (A, B, and D) are not necessarily true for all COPD patients and do not directly relate to the limited effectiveness of coughing.

Question 16

What happens during the exsufflation phase of mechanical insufflation-exsufflation?
I.	Airway pressure is abruptly decreased to –30 to –50 cm H2O.
II.	Negative airway pressure is maintained for 2 to 3 seconds.
III.	Peak expiratory “cough” flows reach near normal values.

Accepted Answer

During the exsufflation phase of mechanical insufflation-exsufflation, airway pressure is abruptly decreased to –30 to –50 cm H2O, this negative airway pressure is maintained for 2 to 3 seconds, and peak expiratory "cough" flows can reach near normal values, effectively simulating a natural cough.

Question 17

A nurse explains to you that a certain neuromuscular patient cannot develop a good cough. Which of the following would you consider to manage this patient's clearance problem?
I.combining manual chest compression with suctioning
II.coordinating the coughing regimen with pain medication
III.using the autogenic drainage method
IV.using mechanical insufflation-exsufflation

Accepted Answer

I and IV are correct because manual chest compression with suctioning and mechanical insufflation-exsufflation are effective techniques for managing clearance problems in neuromuscular patients who cannot develop a good cough.

Question 18

Maintaining an open glottis during coughing (as with the FET) can help to minimize increases in pleural pressure and lessen the likelihood of bronchiolar collapse. Which of the following techniques can aid the practitioner in teaching the patient this maneuver?

Accepted Answer

Phonating or "huffing" during expiration helps to maintain an open glottis and can be an effective technique for teaching patients the FET maneuver. Inhaling slowly through the nose, tensing the neck muscles, and exerting effort (straining) can all be counterproductive and increase pleural pressure, leading to bronchiolar collapse.

Question 19

What is the correct sequence of actions during the active cycle of breathing (ACB) method?
I.relaxation and breathing control
II.three or four thoracic expansion exercises
III.one or two FETs (huffs)

Accepted Answer

The correct sequence for the active cycle of breathing (ACB) method starts with relaxation and breathing control (I), followed by thoracic expansion exercises (II), and then finishes with forced expiration techniques (FETs or huffs) (III), often returning to relaxation and breathing control (I) as needed. This sequence helps in loosening and moving mucus from the airways.

Question 20

During autogenic drainage, when should patients be encouraged to cough?

Accepted Answer

During autogenic drainage, patients are encouraged to cough after phase 3 only. This phase involves moving the air slowly from the lowest to the highest lung volumes to mobilize secretions from the smaller to the larger airways, where they can be coughed out effectively.

Quiz 40: Bronchial Hygiene Therapy

A typical mechanical insufflation-exsufflation treatment session should continue until what point? I. Secretions are cleared. II. The vital capacity (VC) returns to baseline. III. The SpO2 returns to baseline.

What is the ideal patient position for directed coughing?

Under which of the following conditions would mechanical insufflation-exsufflation with an oronasal mask probably NOT be effective? I.if the glottis collapses during exsufflation II.presence of fixed airway obstruction III.presence of a chronic neuromuscular disorder

All of the following are hazards of positive airway pressure therapies (EPAP, PEP, CPAP) except:

Contraindications for positive airway pressure therapies include all of the following except:

Whether using traditional methods or the FET, a period of diaphragmatic breathing and relaxation should always follow attempts at coughing. What is the purpose of this approach?

Which of the following is false about the FET?

A physician orders positive expiratory pressure therapy for a 14-year-old child with cystic fibrosis. All of the following responses should be monitored on this patient except:

Which of the following are potential indications for positive airway pressure therapies? I.reduce air-trapping in asthma or chronic obstructive pulmonary disease II.help mobilize retained secretions III.prevent or reverse atelectasis IV.optimize bronchodilator delivery

Key consideration in teaching a patient to develop an effective cough regimen includes which of the following? I.strengthening of the expiratory muscles II.instruction in breathing control III.instruction in proper positioning

Hazards of positive airway pressure therapies associated with the apparatus used include which of the following? I.increased work of breathing II.claustrophobia III.epistaxis IV.vomiting and aspiration V.skin breakdown and discomfort

What does phase 1 of autogenic drainage involve?

Strenuous expiratory efforts in some chronic obstructive pulmonary disease (COPD) patients limit the effectiveness of coughing. Why is this so?

What happens during the exsufflation phase of mechanical insufflation-exsufflation? I. Airway pressure is abruptly decreased to –30 to –50 cm H2O. II. Negative airway pressure is maintained for 2 to 3 seconds. III. Peak expiratory “cough” flows reach near normal values.

Maintaining an open glottis during coughing (as with the FET) can help to minimize increases in pleural pressure and lessen the likelihood of bronchiolar collapse. Which of the following techniques can aid the practitioner in teaching the patient this maneuver?

What is the correct sequence of actions during the active cycle of breathing (ACB) method? I.relaxation and breathing control II.three or four thoracic expansion exercises III.one or two FETs (huffs)

During autogenic drainage, when should patients be encouraged to cough?

A typical mechanical insufflation-exsufflation treatment session should continue until what point? I. Secretions are cleared. II. The vital capacity (VC) returns to baseline. III. The SpO₂returns to baseline.