Question 1

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

Accepted Answer

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." 
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 2

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

Accepted Answer

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 
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 3

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

Accepted Answer

A)  Incentive spirometry 
B)  PEEP therapy 
C)  Deep breathing exercises 
D)  Intermittent positive-pressure breathing therapy 
A)  Incentive spirometry 
B)  PEEP therapy 
C)  Deep breathing exercises 
D)  Intermittent positive-pressure breathing therapy

Question 4

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

Accepted Answer

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

Question 5

Which of the following should be charted in the patient's medical record after completion of an intermittent positive-pressure breathing treatment?
1) Results of pretreatment and posttreatment assessment
2) Any side effects
3) Duration of therapeutic session

Accepted Answer

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

Question 6

Which of the following are potential complications of continuous positive airway pressure (CPAP) therapy?
1) Barotrauma
2) Hyperventilation
3) Gastric distention
4) Hypercapnia

Accepted Answer

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

Question 7

Which of the following are appropriate volume goals for intermittent positive-pressure breathing (IPPB) therapy?
1) 10 to 15 ml/kg ideal body weight
2) At least 30% of the inspiratory capacity (IC)
3) Pressure level as high as 30 to 35 cm H2O

Accepted Answer

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

Question 8

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

Accepted Answer

A)  Uncontrolled hyperpyrexia 
B)  Central nervous system overstimulation 
C)  Decreased cardiac output 
D)  Repetitive, shallow breathing 
A)  Uncontrolled hyperpyrexia 
B)  Central nervous system overstimulation 
C)  Decreased cardiac output 
D)  Repetitive, shallow breathing

Question 9

Preliminary planning for intermittent positive-pressure breathing (IPPB) should include which of the following?
1) Evaluating alternative approaches to the patient's problem
2) Setting specific, individual clinical goals or objectives
3) Conducting a baseline assessment of the patient
4) Taking a chest x-ray

Accepted Answer

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

Question 10

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

Accepted Answer

A)  Semi-Fowler's 
B)  Standing 
C)  Supine 
D)  Prone 
A)  Semi-Fowler's 
B)  Standing 
C)  Supine 
D)  Prone

Question 11

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

Accepted Answer

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 
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 12

Which of the following are essential components of a continuous positive airway pressure (CPAP) flow system?
1) Blended source of pressurized gas
2) Nonrebreathing circuit with reservoir bag
3) Low-pressure or disconnect alarm
4) Expiratory threshold resistor

Accepted Answer

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

Question 13

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

Accepted Answer

A)  Inadequate flow setting 
B)  Incorrect sensitivity 
C)  Inadequate pressure setting 
D)  Inadequate humidity 
A)  Inadequate flow setting 
B)  Incorrect sensitivity 
C)  Inadequate pressure setting 
D)  Inadequate humidity

Question 14

When checking a patient's intermittent positive-pressure breathing (IPPB) 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?

Accepted Answer

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

Question 15

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?

Accepted Answer

A)  System or mask leaks 
B)  Outflow obstruction 
C)  Inadequate system flow 
D)  Inadequate trigger 
A)  System or mask leaks 
B)  Outflow obstruction 
C)  Inadequate system flow 
D)  Inadequate trigger

Question 16

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

Accepted Answer

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 
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

Question 17

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

Accepted Answer

A)  Hemodynamic instability 
B)  Active untreated tuberculosis 
C)  Tension pneumothorax 
D)  Recent esophageal surgery 
A)  Hemodynamic instability 
B)  Active untreated tuberculosis 
C)  Tension pneumothorax 
D)  Recent esophageal surgery

Question 18

Which of the following are the hazards and complications of incentive spirometry?
1) Hyperventilation
2) Fatigue
3) Discomfort secondary to inadequate pain control
4) Barotrauma

Accepted Answer

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

Question 19

Which of the following are true about intermittent positive-pressure breathing?
1) During inspiration, pressure in the alveoli decreases.
2) The pressure gradients of normal breathing are reversed.
3) During inspiration, alveolar pressure may exceed pleural pressure.
4) Energy stored during inspiration causes a passive exhalation.

Accepted Answer

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

Question 20

Which of the following machine performance characteristics should be monitored during intermittent positive-pressure breathing therapy?
1) Flow setting
2) Sensitivity
3) Humidity output
4) Peak pressure

Accepted Answer

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

Exam 42: Lung Expansion Therapy

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

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

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

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

Which of the following should be charted in the patient's medical record after completion of an intermittent positive-pressure breathing treatment? 1) Results of pretreatment and posttreatment assessment 2) Any side effects 3) Duration of therapeutic session

Which of the following are potential complications of continuous positive airway pressure (CPAP) therapy? 1) Barotrauma 2) Hyperventilation 3) Gastric distention 4) Hypercapnia

Which of the following are appropriate volume goals for intermittent positive-pressure breathing (IPPB) therapy? 1) 10 to 15 ml/kg ideal body weight 2) At least 30% of the inspiratory capacity (IC) 3) Pressure level as high as 30 to 35 cm H2O

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

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

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

Which of the following are essential components of a continuous positive airway pressure (CPAP) flow system? 1) Blended source of pressurized gas 2) Nonrebreathing circuit with reservoir bag 3) Low-pressure or disconnect alarm 4) Expiratory threshold resistor

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

When checking a patient's intermittent positive-pressure breathing (IPPB) 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?

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?

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

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

Which of the following are the hazards and complications of incentive spirometry? 1) Hyperventilation 2) Fatigue 3) Discomfort secondary to inadequate pain control 4) Barotrauma

Which of the following machine performance characteristics should be monitored during intermittent positive-pressure breathing therapy? 1) Flow setting 2) Sensitivity 3) Humidity output 4) Peak pressure

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

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Gas Exchange and Transport

Solutions, Body Fluids, and Electrolytes

Acid-Base Balance

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Bedside Assessment of the Patient

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Interpreting the Electrocardiogram

Analysis and Monitoring of Gas Exchange

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Filters

Which of the following are appropriate volume goals for intermittent positive-pressure breathing (IPPB) therapy? 1) 10 to 15 ml/kg ideal body weight 2) At least 30% of the inspiratory capacity (IC) 3) Pressure level as high as 30 to 35 cm H₂O