Question 1

Which of the following has a direct relationship with the degree to which atelectasis can present itself with a postoperative patient?

Accepted Answer

A)  Spontaneous respiratory rate 
B)  Bradycardia 
C)  Hypocapnia 
D)  Hypothermia 
A)  Spontaneous respiratory rate 
B)  Bradycardia 
C)  Hypocapnia 
D)  Hypothermia

Question 2

Which of the following mechanisms probably contribute to the beneficial effects of continuous positive airway pressure (CPAP) in treating atelectasis?
1) Recruitment of collapsed alveoli
2) Decreased work of breathing
3) Improved distribution of ventilation
4) Increased efficiency of secretion removal

Accepted Answer

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

Question 3

Which of the following are true about gastric distention with intermittent positive-pressure breathing (IPPB)?
1) Gastric distention is uncommon in alert and cooperative patients.
2) Gastric distention is most likely at high airway pressures.
3) Gastric distention is a significant risk in obtunded patients.
4) Gastric distention is a relatively harmless effect of IPPB.

Accepted Answer

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

Question 4

Incentive spirometry devices can generally be categorized as which of the following?
1) Pressure-oriented
2) Flow-oriented
3) Volume-oriented

Accepted Answer

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

Question 5

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

Accepted Answer

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 
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 6

Which of the following are contraindications for continuous positive airway pressure (CPAP) therapy?
1) Hemodynamic instability
2) Hypoventilation
3) Facial trauma
4) Low intracranial pressures

Accepted Answer

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

Question 7

Which of the following are potential desirable outcomes of intermittent positive-pressure breathing (IPPB) therapy?
1) Improved oxygenation
2) Increased cough and secretion clearance
3) Improved breath sounds
4) Reduced pulmonary compliance

Accepted Answer

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

Question 8

The general assessment, common to all patients for whom intermittent positive-pressure breathing (IPPB) is ordered, should include which of the following?
1) Measurement of vital signs
2) Appearance and sensorium
3) Chest auscultation
4) Arterial blood gas analysis

Accepted Answer

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

Question 9

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

Accepted Answer

A)  Continuous positive airway pressure 
B)  Incentive spirometry 
C)  Positive end expiratory pressure 
D)  Intermittent positive-pressure breathing therapy 
A)  Continuous positive airway pressure 
B)  Incentive spirometry 
C)  Positive end expiratory pressure 
D)  Intermittent positive-pressure breathing therapy

Question 10

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

Accepted Answer

A)  Decrease the treatment frequency to 4 times/day. 
B)  Increase her breathing rate to 12 to 15/min. 
C)  Take a 30-sec rest period between breaths. 
D)  Repeat the treatment every 30 min. 
A)  Decrease the treatment frequency to 4 times/day. 
B)  Increase her breathing rate to 12 to 15/min. 
C)  Take a 30-sec rest period between breaths. 
D)  Repeat the treatment every 30 min.

Question 11

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

Accepted Answer

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

Question 12

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

Accepted Answer

A)  Flanged mouthpiece 
B)  Form-fitting mask 
C)  Nasopharyngeal airway 
D)  Nose clips 
A)  Flanged mouthpiece 
B)  Form-fitting mask 
C)  Nasopharyngeal airway 
D)  Nose clips

Question 13

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?

Accepted Answer

A)  Intermittent positive-pressure breathing (IPP
B)  at 6 to 8 breaths/min at 10 to 15 ml/kg 
B)  Continuous positive airway pressure therapy at 12 cm H2O for 24 hr 
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 
A)  Intermittent positive-pressure breathing (IPP
B)  at 6 to 8 breaths/min at 10 to 15 ml/kg 
B)  Continuous positive airway pressure therapy at 12 cm H2O for 24 hr 
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 14

Successful application of incentive spirometry depends on:

Accepted Answer

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. 
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 15

What should the monitoring of patients using incentive spirometry include?
1) Number of breaths per session
2) Volume and flow goals achieved
3) Maintenance of breath-hold
4) Patient effort and motivation

Accepted Answer

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

Question 16

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

Accepted Answer

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 hr after surgery 
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 hr after surgery

Question 17

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

Accepted Answer

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

Question 18

Which of the following are potential indications for incentive spirometry?
1) A restrictive disorder such as quadriplegia
2) Abdominal surgery in a COPD patient
3) Presence of pulmonary atelectasis

Accepted Answer

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

Question 19

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

Accepted Answer

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 
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 20

Prior to starting intermittent positive-pressure breathing (IPPB) on a new patient, what should the practitioner explain?
1) Why the physician ordered the treatment.
2) What the IPPB treatment will do.
3) How the IPPB treatment will feel.
4) What the expected results are.

Accepted Answer

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

Exam 42: Lung Expansion Therapy

Which of the following has a direct relationship with the degree to which atelectasis can present itself with a postoperative patient?

Incentive spirometry devices can generally be categorized as which of the following? 1) Pressure-oriented 2) Flow-oriented 3) Volume-oriented

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

Which of the following are contraindications for continuous positive airway pressure (CPAP) therapy? 1) Hemodynamic instability 2) Hypoventilation 3) Facial trauma 4) Low intracranial pressures

Which of the following are potential desirable outcomes of intermittent positive-pressure breathing (IPPB) therapy? 1) Improved oxygenation 2) Increased cough and secretion clearance 3) Improved breath sounds 4) Reduced pulmonary compliance

The general assessment, common to all patients for whom intermittent positive-pressure breathing (IPPB) is ordered, should include which of the following? 1) Measurement of vital signs 2) Appearance and sensorium 3) Chest auscultation 4) Arterial blood gas analysis

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

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

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

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 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?

Successful application of incentive spirometry depends on:

What should the monitoring of patients using incentive spirometry include? 1) Number of breaths per session 2) Volume and flow goals achieved 3) Maintenance of breath-hold 4) Patient effort and motivation

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

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

Which of the following are potential indications for incentive spirometry? 1) A restrictive disorder such as quadriplegia 2) Abdominal surgery in a COPD patient 3) Presence of pulmonary atelectasis

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

Prior to starting intermittent positive-pressure breathing (IPPB) on a new patient, what should the practitioner explain? 1) Why the physician ordered the treatment. 2) What the IPPB treatment will do. 3) How the IPPB treatment will feel. 4) What the expected results are.

History of Respiratory Care

Delivering Evidence-Based Respiratory Care

Quality, Patient Safety, and Communication, and Recordkeeping

Principles of Infection Prevention and Control

Ethical and Legal Implications of Practice

Physical Principles of Respiratory Care

E-Medicine in Respiratory Care

Fundamentals of Respiratory Care Research

The Respiratory System

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Ventilation

Gas Exchange and Transport

Solutions, Body Fluids, and Electrolytes

Acid-Base Balance

Regulation of Breathing

Bedside Assessment of the Patient

Interpreting Clinical and Laboratory Data

Interpreting the Electrocardiogram

Analysis and Monitoring of Gas Exchange

Pulmonary Function Testing

Review of Thoracic Imaging

Flexible Bronchoscopy and the Respiratory Therapist

Nutrition Assessment

Pulmonary Infections

Obstructive Lung Disease: Chronic Obstructive Pulmonary Disease Copd, Asthma, and Related Diseases

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Airway Clearance Therapy Act

Respiratory Failure and the Need for Ventilatory Support

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Physiology of Ventilatory Support

Patient Ventilator Interaction

Initiating and Adjusting Invasive Ventilatory Support

Noninvasive Ventilation

Extracorporeal Life Support Ecls

Monitoring the Patient in the Intensive Care Unit

Discontinuing Ventilatory Support

Neonatal and Pediatric Respiratory Care

Patient Education and Health Promotion

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