How can we help?

You can also find more resources in our Help Center.

306 terms

Procedures 101 finals

STUDY
PLAY
What is the normal range for PaO2? (include unit of measurement
80-100mmHg
A post-operative pt is on a 5 Lpm nasal cannula. A physician has written an order for a blood gas. After the gas has been analyzed the results are as follow:
pH7.40 PCO 40mmHg
HCO3 34mEq/l PaO2 50mmHg
What FiO2 and device would you need to change the pt to in order to correct the ABG to normal?
100% nonrebreather
What is the principle of which mist tents work to produce an aerosol
Babbington principle
What is the mass of aerosol that reaches the lungs
respirable mass
Normally, when using a 50psi flowmeter to power a SVN, what should the flow be set at?
6-10 Lpm
What is the preferred method for delivering aerosolized bronchodilators to intubated, mechanically ventilated pts
MDI
What are some types of passover humidifiers?
I. simple reservoir
II. membrane
III. wick
IV. bubble humidifier
I, II, and III only
Which of the following methods can assess therapeutic effective of aerosolized bronchodilator medication?
A. peak flow meter
B. spirometer
C. breath sounds
D. all the above
All the above
Which of the following methods can be used to minimize harmful effects of environmental exposure to ribavirin or pentamidine aerosols?
I. use an isolation booth or tent with HEPA filtered exhaust
II. have health care professional wear a HEPA filtered mask.
III. Use negative pressure room with adequate air exchange
I, II and III only
What is the recommended dosage of continuous nebulization of albuterol?
10 mg/hr
To ensure delivery of the proper drug dosage with a MDI, which of the following must be done before used?
I. The cannister valve stem must be cleaned with a pin.
II. The cannister should be warmed
III. The cannister should be shakened well
IV. The cannister should be primed
II, III, and IV only
When assessing a pt's response to bronchodilator therapy, notice a decrease in wheezing accompanied by an overall decrease in the intensity of breath sounds. Which of the following is most likely.
Increase in bronchial constriction.
When using water traps to help minimize the problems caused by condensation in heated humidifier ventilator cicuit, where would you place the traps?
in both the expiratory and inspiratory limbs, at low points in the circuit.
Board Exam question:::While preparing to analyze the O2 concentration on a pt's aerosol mask, you notice there is water in the aerosol tubing. What effect does this have on the operation of the device?
Increases the FiO2
Which of the following depends on the pt's inspiratory effort to dispense the dose?
dry powder inhaler
To minimize a patient's infection risk between drug treatments with a SVN, what should you do?
Rinse the SVN with sterile water, air dry
How long should you instruct a patient to wait between puffs while using an MDI?
1 minute
Which of the following setting adjusts aerosol particle size in an ultrasonic nebulizer?
frequency
The aerosol ouput (in mg/L) of an ultrasonic nebulizer depends mainly on which of the following?
signal amplitude
Physician orders bland water aerosol administration to a patient with an intact upper airway. Which of the following airway appliances could you use to meet this goal?
I. tracheostomy collar
II. face tent
III. Venturi mask
IV. aerosol mask
II and IV only
Advantages of the dry powder inhaler delivery system include any of the following except:
A: easy to use
B: no propellants required
C: no-hand breath coordination
D: unaffected by humidity
unaffected by humidity
What is the propellant used in the manufacturing of today's MDI?
Hydrofluoroalkane
The breath hold improves aerosol deposition by approximately how much percentage?
10%
Which of the following would be correct instructions for a patient being taught the proper use of a DPI?
I. Place mouthpeice 4 cm from mouth
II. Exhale slowly to FRC
III. Inhale slowly
IV. Repeat until dose is completed
II and IV only
What type of breath would you instruct patient to perform while taking a SVN treatment?
Normal tidal breathing
To monitor a patient for possibility of reactive bronchospasm during aerosol drug therapy, what should you do?
I. Measure pre and post peak flow
II. Auscultation for abnormal breath sounds
III Carefully observe the patient's response
IV. Communicate with the patient during treatment
I, II, III and IV
What is used to produce aerosol particles in an ultrasonic nebulizer?
piezoelectric crystal
Board Exam question: You are instructing a patient about the proper procedure for using an MDI. You would instruct the patient to activate the medication in the inhaler?
just after inspiration has begun
What is the most common device used to generate bland aerosols?
Large-volume jet nebulizer
Which of the following is FALSE about heated humidifier condensate?
It poses minimal infection risk
Before inspiration and actuation of a metered dose inhaler, the patient should exhale to which of the following?
functional residual capacity
What happens as the pressure or flow delivered through a small volume nebulizer increases?
I. Treatment time becomes shorter
II. Particle size becomes smaller
III. Aerosol output increases
I, II, and III
What is the primary mechanism for deposition of large particles (>5 microns) in the respiratory tract?
inertial impaction
Which of the following devices generates aerosol only during inspiration?
breath actuated nebulizer
Which type of humidifier "traps" the patient's body heat and expired water vapor to raise the humidity of inspired gas?
heat-moisture exchanger
What type of breathing would you instruct a patient to perform when teaching the use of a dry powder inhaler?
inhale deeply and forcefully
The temperature of gas delivered to a patient's airway by a servo-controlled heated humidifier should be maintained at what temperatures?
35 *C
Bubble humidifiers are of limited effectiveness at flows below which of the following flow rates?
4 Lpm
Board Exam question: A patient with acute exacerbation of asthma is not responding to the standard dose and frequency of aerosolized bronchodilator and is now receiving small volume nebulizer every 30 minutes. Which of the following would you recommend to the patient's physician at this time?
Consider continuous nebulization of the drug
Indications for warming inspired gases include all of the following except:
a. treating a patient whose airways are reactive to cold
b. providing humidification when the upper airway is bypassed
c. treating a patient with a low body temperature
d. reducing upper airway inflammation or swelling
reducing upper airway inflammation or swelling
A design that increases surface area and enhances evaporation by incorporating an absorbent material partially submerged in a water reservoir that is surrounded by a heating element best describes what type of humidifier?
wick
Which of the following are systems for aerosol drug delivery?
I. dry powder inhalers
II. metered dose inhalers
III. small volume nebulizers
IV. bubble humidifier
I, II and IV only
Which of the following creates aerosol particles in a small volume nebulizer?
baffle
Board Exam question: Which of the following devices would be most indicated in the treatment of a patient with large amounts of thick secretions?
ultrasonic nebulizer
Board Exam Question: A physician has ordered the antiviral agent ribavirin to be administered to an infant with bronchiolitis and RSV. Which of the following devices would you recommend in this situation?
small-particle aerosol generator
To protect against obstructed or kinked tubing, simple bubble humidifiers incorporate which of the following?
pressure relief valve
After administering a 30-minute continuous aerosol treatment to an elderly patient with chronic bronchitis, you note increased wheezing and a general increase in the intensity of breath sounds. Which of the following has probably occurred?
airflow has impoved
Which of the following patients might you recommend bland aerosol therapy administration?
I. patient with upper airway swelling (edema)
II. patient with a bypassed upper airway
III. patient who must provide a sputum specimen
I, II and III
What is the minimum peak flow rate that must be generated to successfully use a dry powder inhaler?
60 Lpm
What is the primary problem with manually refilling heated humidifier reservoir?
cross-contamination and infection
A patient has been supported by a mechanical ventilator using a heat-moisture exchanger for the last 3 days. Suctioning reveals an increase in the amount and tenacity of secretions. Which of the following actions is indicated?
Switch the patient to a heated humifider
What characteristics of sputum should be inspected after aerosol therapy
sputum induction?
I. color
II. volume
III. odor
IV. consistency
I,II,III, and IV
The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol?
output
Which of the following techniques will increase aerosol deposition and sedimentation in the lungs?
breath hold
What type of breathing technique would you instruct your patient to perform when teaching a metered dose inhaler?
slow and deep inhalations
A physician orders bland water aerosol administration to a patient with a tracheostomy. Which of the following airway devices could you use to meet this goal?
I. tracheostomy mask
II. face tent
III. T-piece (Brigg's adapter)
IV. aerosol mask
I and III only
Which of the following defines an aerosol?
suspension of liquid or solid particles in a gas
Where do particles in the 5-10 micron range deposit?
upper airway
What are some problems common to mist tents?
I. heat retention
II. CO2 buildup
III. hypothermia
I, II only
Why are zone valves into a hospital piping system?
I. to terminate oxygen flow in case of fire
II. to allow selective maintenance without shutting the entire system down
III. To allow variable pressure reduction throughout the system
I and II only
Which of the following is the most common type of DISS safety system?
Ohio Diamond Quick connect system
The clinical use for nitrous oxide is which of the following?
anesthesia gas
What is the minimum backup an acute care facility must have for oxygen supply?
One times daily usage
To clean the cylinder valve of foreign material, what should you do?
Quickly open and close the valve
Which of the following cylinders have a threaded valve outlet?
H tank
A Thorpe tube measures flow in:
liters per minute
The gauge on an E cylinder of O2 reads 800 psi. About how long will the cylinder contents last at a flow of 3LPM?
1 hour 15 minutes
Which of the following devices are approved for storage of medical oxygen?
I. high pressure cylinders
II. Large bulk reservoirs
III. Cryogenic containers
I, II, and III
What cylinder factor is used to calculate duration of flow for an H cylinder filled with air?
3.14
Board Exam question: The respiratory therapist is setting up a portable liquid oxygen system for a patient with chronic lung condition who attends church each week. The patient is using a 2 L/min nasal cannula, and the portable oxygen container holds 4 lb. of oxygen. The therapist should explain to the patient that the oxygen supply will last for approximately what length of time?
11.5 h
If you have to deliver oxygen to a patient from a bedside outlet station, which of the following devices should you select?
Thorpe tube
What cylinder factor is used to calculate duration of flow for an E cylinder filled with oxygen?
0.28
The most commonly used oxygen tank for patient transportation in the acute care setting is:
E tank
A gas cylinder color coded yellow should contain which of the following gases?
Air
You are planning to transport a patient via ambu bag at 10 LPM to another acute care facility. The transport time is approximately 1 hour and 30 minutes. How many full E tanks (2000 psi) would you need to take with you?
2
Which of the following is true when there is downstream resistance with a compensated Thorpe Tube?
The float will not change and the actual flow is what the reading indicates
Which type of centrally located gas supply systems is most common in an acute care facility ?
Liquid bulk O2 system
Board Exam Question: Which of the following devices should be selected to administer nebulized bronchodilator therapy in the home?
air compressor
In clinical practice, which of the following should be done to identify the contents of a gas cylinder?
I. Inspect the cylinder threads
II. Inspect the color of the tank
III. Read the cylinder label
IV. Analyze the gas
II and III only
Board Exam question: A patient is recieving oxygen via simple mask at 6 LPM from a Bourdon gauge flowmeter. When the respiratory therapist repositions the patient, the patient becomes cyanotic. The flowmeter reveals a flow of 6 LPM. The practitioner's most appropriate initial action is to:
check the tubing to the oxygen mask for kinks
Which of the following gases can be used in treatment of hypoxemic respiratory failure of neonates when mechanical ventilation and traditional therapies are not successful?
nitric oxide
What is the most common and least expensive method for commercial production of medical oxygen?
Fractional distillation of air
Which of the following methods of oxygen production is commonly used in home care oxygen equipment?
physical seperation
What is the approximate duration of flow for 12 lbs of liquid oxygen running at 3 LPM?
23 hrs
Which of the following gases in conjunction with oxygen aids in management in severe airway obstructions?
helium
Which of the following is true with Bourdon gauges when there is downstream resistance?
flow output decreases
If you were to go on a local transport that required you to place a cylinder on the side, which of the following would be the the device of choice?
E tank with a Bourdon gauge
A gas cylinder that is color coded brown should contain which of the following gases?
helium
By what means is medical air produced for use in the hospital?
compression of atmospheric air
The gauge of an H cylinder reads 2000 psi. About how long would the cylinder contents last at a flow of 6 LPM?
17 hours 30 minutes
What is the fire risk for medical oxygen?
I. Flammable
II. Nonflammable
III. Supports combustion
IV. no fire risk
II and III only
Which of the following cylinders have a yoke connector and a valve stem?
a. E tank
b. AA tank
c. D tank
d. all of the above
all of the above
What device is used to reduce the pressure and control the flow of a medical gas?
Regulator
What is the standard method in measuring the contents in a gas filled cylinder?
Read the pressure gauge
Helium is most effective for therapeutic use when mixed with which of the following oxygen concentrations?
20%
Board Exam question: A patient is receiving from an "E" cylinder at 4 L/min through a nasal cannula. The cylinder pressure is 1900 psig. How long will the cylinder run until it is empty?
2.2 hr
At approximately what pressure would a cylinder be 3/4 full?
1500 psi
A gas cylinder that is color coded green should contain which of the following gases?
oxygen
Which of the following mechanisms do all medical gas cylinders use to avoid excessively high pressure buildup in the cylinder?
Pressure relief in the valve stem
To accurately determine the amount of oxygen remaining in a liquid filled cylinder, what would you do?
Weigh the contents of the cylinder
Which of the following are considered therapeutic medical gases?
I. Oxygen
II. Nitrogen
III. Heliox
IV. Nitrous oxide
I and III only
The pressure of O2 or air in a bulk supply O2 system must be reduced to a working pressure of:
50 psi
Which type of relief valve is most commonly used in the valve system of E cylinders?
Fusible plug
Which type of index safety system uses a yoke-type connection?
Pin Index Safety System
To ensure a stable FiO2 under varying patient demand, what must an O2
delivery system do?
maintain flows at least equal to patient's inspiratory demand
A 27 year old patient is receiving O2 via nasal cannula at 5 LPM. What is the approximate FiO2 the patient is receiving?
40%
In which of the following clinical situations would you recommend hyperbaric O2 therapy?
I. CO poisoning
II. Respiratory or Cardiac arrest
III.Decompression sickness
IV.Cyanide poisoning
I, III and IV only
What does 2 atmospheric pressure absolute (ATA) equal in mmHg?
1520 mmHg
A patient with a transtrachel catheter is receiving O2 at 2 LPM. When you enter the room to check the patient's oxygenation status, you notice the patient is cyanotic and in moderate distress. What is the most likely problem with the device?
Obstruction from secretions
An ambu bag is used to provide oxygen during cardiac arrest.
True
You enter a patient's room and the patient is wearing a nonrebreather. You notice the bag collapses when the patient inhales. What is the appropriate action to take?
Increase the flow to the bag
Temperature and FiO2 must be monitored when using an oxyhood for an infant.
True
What is the approximate FiO2 that can be delivered with a partial rebreather mask?
60-65%
Low flow O2 delivery systems contain all of the following devices except:
a. Nasal Cannula
b. Partial Rebreather
c. Air Entrainment mask
d. Simple Mask
Air Entrainment mask
Board Exam question:
A doctor orders 40% O2 via air entrainment nebulizer for a patient with a minute volume of 12 LPM. What is the minimum nebulizer input flow required to meet the patient's inspiratory demand?
10 Lpm
Which of the following flows is the minimum setting for a infant receiving oxygen by an oxyhood?
7 Lpm
Board Exam question:
A physician has ordered a controlled FiO2 concentration of a patient with a tracheostomy tube. Which would be the appropriate device for the patient?
Air/O2 Blending system with T-piece
A patient with chronic hypercapnia placed on 60% O2 becomes lethargic and difficult to arouse. What is the probable cause of this response?
Oxygen induced hypoventilation
Which of the following would require humidification of oxygen gas via bubble humidifier?
4 LPM nasal cannula
A patient is wearing a Venturi mask oxygen device delivering 30%. The flowmeter is set at 9 LPM. What is the approximate total flow of the device?
79 Lpm
What is the initial oxygen device of choice for a COPD patient?
Nasal Cannula
In which of the following conditions would you initially seek to provide the
highest FiO2 possible?
I. CO poisoning
II. Cyanide poisoning
III. Severe shock or trauma
I, II, and III
What is the minimum flow setting for a simple mask being worn by an adult?
5 Lpm
What FiO2 changes occur when the air entraiment port is fixed and the jet orifice increases in size?
FiO2 increases
Board Exam Question:
A patient receiving 40% O2 through an air entrainment nebulizer mask set at 6LPM input flow becomes tachypneic. Simultaneously, you notice the patient's SpO2 has fallen from 91% to 87%. Which of the following actions would be most appropriate at this time?
Increase the flow to 10 LPM
A physician orders a 70% He and 30% O2 mixture to reduce the work of breathing in a patient having an acute asthma attack. Which of the following devices would be appropriate in this case?
Nonrebreather
A physician orders O2 for a patient with documented chronic hypercapnia and hypoxemia (PaO2=47 mmHg). What is the most appropriate action in this case?
Administer O2 to achieve a PaO2 between 50-60 mmHg
A patient who requires a fixed FiO2 is receiving a 70% FiO2 via air entrainment nebulizer. At 15 LPM O2 input flow, the device is unable to meet the inspiratory demand of the patient. What would be the next appropriate action?
Switch to a tandem set-up
You set up a nasal cannula with a humidifier. The flow is set at 5 LPM. Upon entering the room for a nebulizer treatment, you notice the pop-off alarm is sounding. What should be your initial action to correct the problem?
check for kinks in the tubing
A physician has requested delivery of a stable, low O2 concentration to an alert patient. Which of the following devices would be best suited for the patient?
Air Entrainment Mask
Heliox is used to treat hypoxemic respiratory failure in infants when traditional therapies are unsuccessful.
False
Physiologic effects of hyperbaric O2 therapy include all of the following except:
a. Bubble reduction
b. Neovascularization
c. Systemic vasodilation
d. Hyperoxygenation
c. Systemic vasodilation
What is the most common complication of hyperbaric oxygen therapy?
Ear or Sinus trauma
A medical indication for the use of heliox mixtures may be necessary in the management of which of the following?
large airway obstruction
What is the key functional difference between a partial and nonrebreather mask?
The nonrebreather has a one way valve flap between the reservoir bag and the mask
A physician wants a stable FiO2 of 50% for a newborn patient with moderate hypoxemia. Which of the following would you recommend?
Oxyhood with blender and a heated humidifier
Delivery systems that only provide a portion of the patient's inspiratory demands are referred to as what?
Low flow system
During hyperbaric O2 therapy at 3 ATA, what is the approximate half life of carbon monoxide in the blood?
20 minutes
Which of the following devices is the most appropriate oxygen device for a COPD patient?
Venturi Mask
You are giving a 80% he and 20% O2 mixture to an asthmatic patient with a compensated Thorpe tube set at 8 LPM. What is the actual flow being delivered to the patient?
14 LPM
Which of the following statements is false about low flow oxygen devices?
The greater the patient's inspiratory flow, the higher the FiO2
Retinopathy of prematurity that results from oxygen toxicity may result in which of the following?
Blindness
Which of the following devices is a low flow device that can deliver 40-55%
simple mask
Directing a cool O2 mixture to an infant can cause which of the following?
apnea
You connect an air entrainment nebulizer to an ET tube of a COPD patient. When the patient inhale the mist disappears from the reservoir tubing. Which of the following would you do next?
Increase the flow
Which of the following are specific clinical objectives of oxygen therapy?
I. Decrease symptoms caused by chronic hypoxemia
II. Decrease the workload hypoxemia poses on the cardiac and pulmonary systems
III.Correct document arterial hypoxemia
I, II and III
Primary safety concerns in the application of hyperbaric O2 therapy include which all of the following except?
a. Sudden decompression
b. Electrical Fires
c. CO2 accumulation
d. Pneumothorax
c. CO2 accumulation
What is the problem of flows greater than 15 LPM in an Oxyhood?
a. Production of distressful noises
The air entrainment ports of a Venturi mask are partially obstructed by patient's bedding. Which of the following can you expect to change in total FiO2 delivered?
FiO2 will increase
What is the air:oxygen ratio for a patient receiving 60% air entrainment nebulizer?
1:1
Which of the following would indicate a need for O2 therapy?
I. SaO2 < 90%
II. PaCO2 > 45 mmHg
III. PaO2 < 60 mmHg
I and III only
An O2 delivery device takes a separate pressurized air and O2 input source, then mixes the gases with a precision valve. Which of the following devices are described?
O2 blending system
Board Exam Question:
A 52 year old man enters the emergency room complaining of severe chest pain and exhibits signs of central cyanosis. Which of the following is the appropriate initial device for O2 delivery?
Nonrebreather at 10 LPM
A 45 year old patient with congestive heart failure is receiving O2 through a 40% air entrainment mask. With an O2 output of 8 LPM, calculate total flow.
32 LPM
Bradycardia is termed as a heart rate less than 60 beats per minute.
True
The term that refers to a pulse strength that varies with inspiration is:
Pulsus paradoxus
A tracheal deviation away from the pathology with hyper-resonant percussion note will indicate which of the following conditions?
pneumothorax
Subglottic swelling caused from post extubation trauma may require would produce which of the breath sounds?
stridor
Vibrations felt on the chest is termed:
fremitus
An abnormally low red blood cell count is indicative of what condition?
anemia
Acid fast stain is used to test for Pseudomonas aeruginosa.
False
What is the oxygen carrying capacity of hemoglobin?
1.34 ml/gm
How many sites should be auscultated when listening to breath sounds?
10
A patient who exhibits a wasted appearance and weak muscles can be best described as
cachexia
What is the term for infection acquired in the hospital?
nosocomial
When performing a nebulizer treatment, you notice the patient heart rates had increased by 25 beats per minute. What should you do next?
stop the treatment
What are the blood cells that carry hemoglobin and oxygen?
erythrocytes
Response to temperature changes in the body is regulated by which of the following:
hypothalamus
Purse-lip breathing prevents airway collapse in patients with obstructive lung disease.
True
What is the first step in equipment processing for reuse on another patient?
cleaning the equipment
Hypokalemia is defined as a decrease in which of the following ions:
potassium
The test used to identify the bacteria present in sputum is called:
Sputum Culture
Elevated blood pressure is termed:
hypertension
What is the minimum recommended time for handwashing in the health care environment?
15 seconds
Anterior protrusion of the sternum is called:
Pectus Carinatum
Barrel Chest is an increase in AP diameter commonly seen in which of the following types of patients?
Chronic obstructive Pulmonary disease
Cyanosis is caused by which of the following abnormalities?
hypoxia
Which of the following breath sounds will be heard in the presence of fluid in the alveoli?
fine rales
Cessation of breathing is called:
apnea
What type of test gives a measurement of all important cellular components that make up the blood?
Complete Blood Count
Which of the following dyspnea grades would a patient have if they were short of breath at rest?
Grade V
All of the following treatments may be appropriate for fine rales except:
a. oxygen
b. diuretics
c. IPPB
d. suction
d. suction
Which of the following respiratory therapy modalities would aid in clearing rhonchi?
Cough
Tachycardia is defined as a heart rate greater than:
100 bpm
The sweat chloride test evaluates for cystic fibrosis.
True
Which of the indicates consolidation where an E sounds like an A?
Egophony
The percussion note that makes a booming sound heard with emphysema and pneumothorax is called:
hyper-resonance
Which of the following is not considered a clinical sign of a disorder?
Dyspnea
The narrowing or constriction of a bronchial airway will produce which of the following lung sounds?
Wheeze
A serum glucose of 65 mg/dL is indicative of hyperglycemia.
False
The first treatment of choice for wheezes is which of the following?
bronchodilator
The normal red blood cell count is:
4-6 mill/cubic mm
The loss of muscle tone that commonly occurs in paralysis patients that hinders the ability to cough is called:
Atrophy
Which of the following types of white blood cells are increased during allergic reactions and during an asthma attack?
eosinophils
Which of the following disease/disorders can cause asymmetrical chest movement?
a. atelectasis
b. pneumothorax
c. mainstem intubation
d. all of the above
all of the above
The normal hemoglobin count is:
12-16 g/dL
Elements required by the body for metabolism are closely associated with kidney function are called:
electrolytes
What is the most common route of pathogen transmission in the hospital setting?
indirect contact transmission
Which of the following is considered the primary source of infection in the health care setting?
humans
Which of the following respiratory rates would be considered normal?
12 breaths per minute
What vaccination does OSHA require hospital employers to provide?
Hepatitis B
Abnormal breath sounds are termed as vesicular breath sounds.
False
Which of the following diseases is transmitted primarily by airborne transmission?
tuberculosis
The term defined as difficulty breathing except in the upright position is called:
Orthopnea
Which of the following blood pressure measurements would be considered normal?
115/75
Which of the following is the most common source of patient infections?
Large Volume Nebulizers
Nasal flaring and retractions are common bedside assessments that indicate respiratory distress in infants.
True
What measurement is obtained by spinning whole blood in a centrifuge to get the ratio of red blood cells to total blood?
hematocrit
sputum color with the indication =Brown
Sputum= Old blood/Tar
sputum color with the indication =Green
Stagnant Sputum, commonly seen in Pts with CF
sputum color with the indication =Clear
Sputum=normal
sputum color with the indication =Pink/frothy
Sputum=pulmonary edema
sputum color with the indication =Bright red
Sputum=Active bleeding
sputum color with the indication =Yellow
Sputum=Presence of WBC, infection
sputum color with the indication =Mucoid
Sputum=White/gray, as seen in patients with chronic bronchitis
Match the lab value with it's normal value= Sweat Chloride
Normal Lab value=<60 mEq/L
Match the lab value with it's normal value=White Blood Cell
Normal Lab value=4,500-11,500/cu mm
Match the lab value with it's normal value=Hematocrit
Normal Lab value=40-50%
Match the lab value with it's normal value=Serum Glucose
Normal Lab value=70-110mg/dL
Match the lab value with it's normal value=Potassium
Normal Lab value=3.5-5.0 mEq/L
Match the lab value with it's normal value=Sodium
Normal Lab value=135-145 mEq/L
Match the lab value with it's normal value=Chloride
Normal Lab value=98-106 mEq/L
Match the lab value with it's normal value=Total CO2
22-29 mEq/L
Which of the following are clinical indications for the use of CPAP?
I. first line treatment of atelectasis
II. Cardiogenic pulmonary edema
III. Obstructive sleep apnea
IV. Severe hypoxemia
II, III, and IV only
A patient has a desired goal of 2500 ml for incentive spirometry. While performing incentive spirometry, the patient achieves 725 ml X 10 breaths. What is your recommendation at this time?
Switch patient to IPPB therapy
Correct instruction in the technique of incentive spirometry should include which of the following?
diaphragmatic breathing at slow to moderate flows
Which of the following is FALSE regarding IPPB?
During inspiration, pressure of the alveoli decreases
All of the following are used to calculate a patient's goal with incentive spirometer except?
a. weight
b. height
c. age
d. sex
weight
Which of the following clinical findings indicate the development of atelectasis?
I. opacified areas on the chest X-ray
II. inspiratory and expiratory wheezing
III. tachypnea
IV. inspiratory crackles
I, III, and IV only
Persistent breathing at small volumes can result in which of the following?
Passive atelectasis
Which of the following settings will increase lung volume delivered to a patient on the IPPB?
Increasing the pressure
All of the following parameters should be evaluated after IPPB therapy except:
a. heart rate
b. blood pressure
c. breath sounds
d. temperature
temperature
** When checking a patient's IPPB breathing circuit prior to use, you notice the device will not cycle off, even when you occlude the mouthpiece. What would be the most appropriate action at this time?
Check the circuit for leaks
Which of the following breath sounds would most likely indicate atelectasis?
Late inspiratory crackles
Successful application of incentive spirometry depends on:
the effectiveness of patient teaching
Which of the following is not a potential contraindication for IPPB?
a. hemoptysis
b. recent esophageal surgery
c. tension pneumothorax
d. neuromuscular disorders
neuromuscular disorders
What is the major contributing factor in the development in post-operative atelectasis?
Repetitive, shallow breathing
Which of the following body positions is ideal for IPPB therapy?
Semi-Fowlers
**An alert and cooperative 28 year old patient with no history of lung disease underwent a cesarean section 16 hours earlier. Her X-ray film is clear. Which of the following approaches to preventing atelectasis would you recommend for this patient?
a. CPAP
b. PEP therapy
c. deep breathing exercises
d. IPPB
deep breathing exercises
Lung expansion methods that increase the transpulmonary pressure gradients by decreasing pleural pressure includes which of the following?
a. Incentive spirometry
b. Positive Expiratory Pressure therapy
c. Intermittent Positive Pressure Breathing
d. Continuous Positive Airway Pressure therapy
Incentive spirometry
** 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 distention
b. hyperventilation
c. pulmonary barotrauma
d. respiratory acidosis
hyperventilation
Ideally, when should patients be oriented to incentive spirometry?
preoperatively, before undergoing surgical procedure
Which of the following is not usually a complication associated with IPPB?
a. air-trapping
b. hypoxia
c. decreased venous return
d. gastric distention
hypoxia
All of the following are factors that contribute to beneficial effect of CPAP except:
a. Recruitment of alveoli
b. Decrease work of breathing
c. Improves distribution of ventilation
d. Decreases transpulmonary pressure gradient
Decreases transpulmonary pressure gradient
Which of the following lung expansion modalities mimic normal physiological breathing?
a. Continuous Positive Airway Pressure
b. Incentive Spirometry
c. Positive End Expiratory Pressure
d. Intermittent Positive Pressure Breathing
Incentive Spirometry
According to AARC Clinical Practice Guidelines, what is the percentage of volume goal must a patient achieve in order to prevent and treat atelectasis with incentive spirometer?
33%
Which of the following conditions are potential indications for incentive spirometry?
I. a restrictive disorder such as quadriplegia
II. post operative COPD patient
III. diagnosis of pulmonary atelectasis
I, II, and III
In teaching a patient to perform a sustained maximal inspiration maneuver during IS, what would you say to the patient?
Exhale normally, then inhale as deeply as you can, then hold your breath 5-10 seconds
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 incisions
III. those with neuromuscular disorders
I, II, and III
When delivering a positive pressure, a decrease in lung compliance will result in what change in lung volume?
Decrease in lung volumes
Which of the following are appropriate initial settings in IPPB therapy of a new patient?

a. sensitivity -2 cmH2O, pressure 20-25 cmH2O, high flow

b. sensitivity -3 to -4 cmH2O, pressure 5-10 cmH2O, moderate flow

c. sensitivity -1 to -2 cmH2O, pressure 10-15 cmH2O, moderate flow

d. sensitivity -8 cmH2O, pressure 15cmH2O, moderate flow
sensitivity -1 to -2 cmH2O, pressure 10-15 cmH2O, moderate flow
Incentive spirometry can generally be classified as which of the following types:
I. pressure oriented
II. volume oriented
III. flow oriented
II and III only
For patients receiving IS, what is the minimum number of sustained maximal inspirations per hour would you recommend?
5-10
In performing a sustained maximal inspiration during incentive spirometry, the patient should be instructed to do a breath hold of how long after each inhalation?
5-10 seconds
The short term and multiple frequency 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 airway pressure
d. positive end expiratory pressure
intermittent positive pressure breathing
Which of the following patient groups would IPPB not be indicated?

a. patients with diagnosed atelectasis who are not responsive to traditional therapies

b. patients who have the inability to follow demands

c. all obese patients who have undergone abdominal surgery

d. neurologically impaired postoperative patient
all obese patients who have undergone abdominal surgery
How do all modalities of hyperinflation therapy aid in lung expansion?
Increasing the transpulmonary pressure gradient
Which of the following is NOT a potential hazard or complication of incentive spirometry?

a. pulmonary barotrauma in emphysematic lungs

b. decreased cardiac output

c. respiratory alkalosis

d. fatigue
decreased cardiac output
When a patient exhales and the machine fails to cycle off, what adjustment needs to be made on the machine?
decrease sensitivity
Which of the following are desirable outcomes of IPPB?
I. Improved vital capacity
II. Enhanced cough
III. Improved breath Sounds
IV. Increased secretion clearance
I, II, III, and IV
Which of the following devices would would be the first choice for eliminating leaks with IPPB therapy?
a. flanged mouthpiece
b. nose clips
c. form fitting mask
d. oral airway
nose clips
Partial airway obstruction can result in all of the following except:
a. increased work of breathing
b. air-trapping and overdistention
c. increased expiratory flows
d. ventilation/perfusion imbalances
increased expiratory flows
Contraindications for positive airway pressure therapies include all of the following except:
a. intracranial pressure exceeding 20 mm Hg
b. recent facial, oral, or skull surgery or trauma
c. untreated pulmonary barotrauma
d. acute hyperventilation
acute hyperventilation
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
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
I, II, and III only
A patient with a neuromuscular disorder causing generalized muscle weakness is having difficulty developing an effective cough. Which of the following cough phases are primarily affected in this patient?
a. irritation
b. inspiration
c. compression
d. expulsion
inspiration
Soon after you initiate postural drainage in a Trendelenburg position, the patient develops a vigorous and productive cough. Which of the following actions would be appropriate at this time?
Move the patient to the sitting position until the cough subsides
The airway clearance technique that uses a pneumatic device to deliver compressed gas minibursts to the airway at rates above 100/min best describes which of the following?
a. intrapulmonary percussive ventilation
b. active cycle of breathing
c. acapella
d. High frequency chest wall oscillation
e. intermittent positive pressure breathing
intrapulmonary percussive ventilation
Which of the following measurements represent the presence of copious mucus production?
a. 5 ml per day
b. 30 ml per day
c. 10 ml/day
d. 20 ml/day
30 ml per
A patient recovering from anesthesia after abdominal surgery is having difficulty developing an effective cough. Which of the following phases of the cough reflex would cause a weak, ineffective cough in this patient?
a. irritation
b. inspiration
c. compression
d. expulsion
irritation
What type of patient would benefit most from mechanical insufflation-exsufflation?
Amyotrophic Lateral Sclerosis
What is the movement of small volumes of air back and forth in the respiratory tract at high frequencies (12 to 25 Hz) called?
oscillation
Patients can control a flutter valve's pressure by changing what?
their expiratory flow
Which of the following conditions alter normal mucociliary clearance?
a. I, II, and III
b. I and II only
c. I and III only
d. II and III only
I, II, and III
Indications for directed coughing include all of the following except to:
a. enhance other bronchial hygiene therapies
b. help patients with tuberculosis clear secretions
c. help prevent postoperative pulmonary complications
d. obtain sputum specimens for diagnostic analysis
help patients with tuberculosis clear secretions
All of the following conditions impair secretion clearance by affecting the cough reflex except:
a. muscular dystrophy
b. amyotrophic lateral sclerosis
c. chronic bronchitis
d. cerebal palsy
chronic bronchitis
Which of the following should be charted after completing a postural drainage treatment?
I. amount and consistency of sputum produced
II. patient tolerance of procedure
III. position(s) used (including time)
IV. any adverse effects observed
I, II, III, and IV
If tolerated, a specified postural drainage position should be maintained for at least how long?
3-15 minutes
While reviewing the chart of a patient receiving postural drainage therapy, you notice that the patient tends to undergo mild desaturation during therapy (a drop in SpO2 from 93% to 89%). Which of the following would you recommend to manage this problem?
a. Increase the patient's FIO2 during therapy
b. Discontinue the postural drainage therapy entirely
c. Discontinue the percussion and vibration only
d. Decrease the frequency of treatments
Increase the patient's FIO2 during therapy
All of the following occur(s) during the compression phase of a cough except?
a. Expiratory muscle contraction
b. Closing of the glottis
c. Drop in alveolar pressures
d. Rise in pleural pressure
Drop in alveolar pressures
Primary objectives for turning include all of the following except to:
a. promote lung expansion
b. prevent retentions of secretions
c. reduce risk of aspiration
d. improve oxygenation
promote lung expansion
Which of the following is NOT a hazard or complication of postural drainage therapy?
a. cardiac arrhythmias
b. increased intracranial pressure
c. acute hypotension
d. pulmonary barotraumas
pulmonary barotraumas
What is the proper procedure for manual percussion therapy?
hands cupped, thumbs in, percussing in a circular motion over affected areas
A physician orders postural drainage for a patient with pneumonia in the right middle lobe. When doing postural drainage, which of the following positions would you recommend for this patient?
head down, on left side, half rotated to the right
Which of the following methods would you recommend for bronchial hygiene therapy for a patient with asthma/mucus plugging?
a. Positive expiratory pressure device
b. percussion and postural drainage
c. acapella
d. all of the above
all of the above
All of the following are hazards of positive airway pressure therapies except:
a. decreased venous return
b. epistaxis
c. pulmonary barotrauma
d. increased intracranial pressure
epistaxis
The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following?
a. Coughing techniques
b. Postural Drainage therapy
c. Hyperinflation therapy
d. Purse-lip breathing exercise
Postural Drainage therapy
If a patient's chest radiograph shows infiltrates in the posterior basal segments of the lower lobes, what postural drainage position would you recommend?
head down, patient prone with a pillow under abdomen
All of the following are goals of bronchial hygiene therapy except:
a. prevent and treat atelectasis
b. help mobilize retained secretions
c. Improve pulmonary gas exchange
d. Reduce work of breathing
prevent and treat atelectasis
A normal cough reflex includes which of the following phases?
I. irritation
II. inspiration
III. decompression
IV. expulsion
I, II, and IV only
A physician orders postural drainage for a patient with post-overdose aspiration pneumonia in the anterior segments of the upper lobes. Which of the following positions would you recommend for this patient?
patient supine with a pillow under knees, bed flat
All of the following laboratory data are essential in assessing a patient's need for bronchial hygiene therapy except:
a. chest radiograph
b. pulmonary function tests
c. hematology results
d. ABG results/ oxygen saturation
hematology results
All of the following are typical of high-frequency external chest wall compression therapy except:
a. 30-minute therapy sessions
b. oscillations at 5 to 25 Hz
c. one to six sessions per day
d. long inspiratory oscillations
long inspiratory oscillations
A patient about to receive postural drainage and percussion is attached to an electrocardiograph (ECG) monitor and is receiving both intravenous (IV) solutions and O2 (through a nasal cannula). Which of the following actions would be appropriate for this patient?
Inspect and adjust the equipment to ensure function during therapy
All of the following are considered bronchial hygiene therapies except:
a. percussion and postural drainage
b. incentive spirometry
c. intrapulmonary percussive ventilation
d. High frequency chest wall oscillation
incentive spirometry
Properly performed chest vibration is applied at what point?
throughout expiration
Which of the following is/are necessary for normal airway clearance?
I. patent airway
II. functional mucociliary escalator
III. effective cough
I, II, and III
Which of the following airway clearance techniques would you recommend for a 15-month-old infant with cystic fibrosis?
postural drainage, percussion, and vibration
All of the following drug categories can impair mucociliary clearance in intubated patients except:
a. general anesthetics
b. bronchodilators
c. opiates
d. narcotics
bronchodilators
All of the following can provoke a cough except?
a. anesthesia
b. foreing body in airway
c. infection
d. smoke
anesthesia
In setting up a postural drainage treatment schedule for a postoperative patient, which of the following information would you try to obtain from the patient's nurse?
I. patient's medication schedule
II. patient's meal schedule
III. location of surgical incision
I, II, and III
During chest physical therapy, a patient has an episode of hemoptysis. Which of the following actions would be appropriate at this time?
a. Put the patient in a sitting position and have him or her cough strenuously
b. Place the patient in a head-down position and call the nurse
c. Immediately perform nasotracheal suctioning of the patient
d. Stop therapy, sit the patient up, give O2, and contact the physician.
Stop therapy, sit the patient up, give O2, and contact the physician
In theory, how does positive expiratory pressure (PEP) help to move secretions into the larger airways?
a. II and III only
b. I and II only
c. I, II, and III
d. I and III only
I and II only
When assessing the potential need for postoperative bronchial hygiene for a patient, all of the following factors are relevant except:
a. patient's age and respiratory history
b. nature and duration of current surgery
c. number of prior surgical procedures
d. type of anesthesia (e.g., local versus general)
number of prior surgical procedures
What is the ideal patient position for directed coughing?
a. sitting with one shoulder rotated inward, the head and spine slightly flexed
b. supine, with knees slightly flexed and feet braced
c. prone, with the head and spine slightly flexed
d. supine, with forearms relaxed and feet supported
sitting with one shoulder rotated inward, the head and spine slightly flexed
Absolute contraindications for postural drainage include which of the following?
I. Unstable head and neck injury
II. active hemorrhage with hemodynamic instability
III. Pain from surgery
I and II only
Postural drainage should be considered in all of the following situations except:
a. in all patients with chronic obstructive pulmonary disease
b. in patients who expectorate more than 25 ml of sputum per day
c. in the presence of atelectasis caused by mucus plugging
d. in patients with cystic fibrosis and bronchiectasis
in all patients with chronic obstructive pulmonary disease