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1.  Which of the following is characteristic of high frequency external (vest) chest wall compression/oscillation therapy?


A. large air-pulse volumes required
B. 90 minute therapy sessions
C. ten to twenty sessions/day
D. oscillations applied at 5-25 Hz


2.  For patient receiving incentive spirometry, what is the minimum number of sustained maximum inspirations per hour you would recommend?


A. 4-6
B. 8-10
C. 15-20
D. 25-30


3.  Which of the following conditions is an absolute contraindication against IPPB therapy?


A. congestive heart failure
B. bacterial pneumonia
C. tension pneumothorax
D. acute hypercapnia


4.  A postop patient receiving incentive spirometry treatments complains of dizziness and tingling in the extremities following therapy. Which of the following is the most likely cause of these symptoms?


A. the patient is hypoxemic
B. the patient is inhaling too rapidly
C. the patient is hyperventilating
D. the patient is breathing too slow


5.  A patient should be placed in which of the following positions to facilitate drainage of secretions from the anterior segment of the left lower lobe?


A. prone position with a pillow under the hips
B. supine Trendelenburg with a pillow under the hips
C. right (right side down) lateral decubitus position
D. left (left side down) lateral decubitus position


6.  Successful application of incentive spirometry depends mainly on:


A. the use of a true volume-oriented IS system
B. the effectiveness of patient teaching
C. the type of surgery previously performed
D. setting an easily achieved initial goal


7.  Following administration of a bland aerosol treatment, auscultation reveals rhonchi throughout middle and upper lung fields. You should:


A. encourage the patient to cough
B. recommend administration of a bronchodilator
C. recommend discontinuation of therapy
D. discontinue the treatment and administer oxygen


8.  Which of the following is NOT a potential hazard of IPPB?


A. decreased cardiac output
B. pulmonary barotrauma
C. renal insufficiency
D. gastric insufflation
9.  During an IPPB treatment, you hear a ‘pop’ sound, followed by a continuous high-pitched noise. The patient complains that the machine does not cycle off as usual. What could be done to correct the problem?


A. increase the terminal flow setting
B. tighten the O2 supply hose on the machine
C. reattach the nebulizer line to the nebulizer
D. put nose clips on the patient


10.  The normal range of negative pressure to use when suctioning children is:


A. -80 to -100 mm Hg
B. -60 to -80 mm Hg
C. -100 to -120 mm Hg
D. -150 to -200 mm Hg


11.  During the administration of an IPPB treatment, the patient complains of chest pain on the right side and becomes tachypneic. You notice that the right side is not expanding as much as the left. What is the likely problem?


A. patient is anxious
B. a pneumothorax
C. machine pressure too high
D. pneumonia


12.  A patient complains that his breathing is more difficult after receiving a heated bland aerosol treatment to help loosen/clear inspissated secretions. Which of the following could account for the patient’s symptoms?


A. development of pulmonary edema
B. spasm of the laryngeal muscles
C. airway irritation causing bronchospasm
D. aspiration of gastric contents


13.  A patient is receiving IPPB therapy via pressure-cycled ventilator with a mouthpiece. You observe that the patient is exhaling, but after triggering on the ventilator fails to cycle off. Which of the following should be done to correct this problem?


A. use a flanged mouthpiece or mask
B. increase the sensitivity
C. use the expiratory timer
D. ask the patient to exhale more forcefully

14.  Head-down positioning would be contraindicated for a patient with:


A. cystic fibrosis
B. right heart failure
C. bronchiectasis
D. ciliary dyskinesia


15.  During an intermittent positive-pressure breathing (IPPB) treatment, the inspiratory time can be extended by:


A. decreasing the sensitivity
B. increasing the sensitivity
C. decreasing the flow
D. increasing the flow


16.  You need to suction a 7-month-old intubated infant. After assembling the needed equipment and following all precautions you begin the procedure. For this patient, what are the appropriate pressure and time limits for this procedure?


A. pressure range of -40 to -60 mm Hg, limit time to 30 seconds
B. pressure range of -80 to -100 mm Hg, limit time to < 10-15 seconds
C. pressure range of -100 to -120 mm Hg; apply until all secretions cleared
D. pressure range of -60 to -80 mm Hg, limit time to < 10-15 seconds


17.  Your patient is on a ventilator in the volume control mode. After you perform endotracheal suctioning, which of the following would indicate effective clearance of retained secretions?


A. lower peak pressure
B. smaller VT
C. lower plateau pressure
D. decreased inspiratory time


18.  A 30 year-old male was found supine and unresponsive. In the ER it was confirmed he had aspirated while on his back. After the patient is transferred to ICU his physician orders postural drainage and percussion every 4 hours. What is the best position to place him in to drain the affected area?


A. prone with a pillow under his hips
B. prone with feet elevated 30 degrees
C. supine with a pillow under his hips
D. supine with feet elevated 30 degrees


19.  You need to perform nasotracheal suctioning on a patient with retained secretions. As compared to suctioning via a tracheal airway, which of the following complications are unique to this procedure?


A. hypotension
B. gagging/aspiration
C. hypoxemia
D. increased ICP


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