1. When suctioning an adult patient using a DISS wall-mounted regulator system with collection bottle, you would initially set the vacuum pressure at:
A. -12 to -15 in Hg
B. -80 to -100 mm Hg
C. -5 to -7 in Hg
D. -100 to -120 mm Hg
DISS wall-mounted regulator suction systems are calibrated in mm Hg. When suctioning an adult patient using a bedside regulator suction system, you would initially set the vacuum pressure at -100 to -120 mm Hg. Always use the lowest amount of vacuum needed to effectively remove the secretions.
The correct answer is: -100 to -120 mm Hg
2. In which of the following clinical situations would a patient benefit most from deep breathing exercises?
A. myasthenic crisis
B. postop cholecystectomy
C. exacerbation of COPD
D. status asthmaticus
Deep breathing exercises, including incentive spirometry, are designed to prevent or treat postoperative atelectasis and help patients clear secretions by enhancing cough effectiveness. Although certain breathing exercises may aid in the management of stable COPD and asthma, they are not indicated during acute exacerbations of these conditions. Nor are breathing exercises indicated during a myasthenic crisis, when respiratory muscle paralysis often requires assisted ventilation to sustain life.
The correct answer is: postop cholecystectomy
3. What size suction catheter would you select to suction a patient with a 9.0 mm ID tracheostomy tube?
A. 10 Fr
B. 12 Fr
C. 14 Fr
D. 16 Fr
The external diameter of a suction catheter generally should never exceed 1/2 the internal diameter of the airway (2/3rd in infants). To quickly estimate the correct size, double the internal diameter (ID) of the ET tube and select the next smallest catheter size. In this case 2 x 9 = 18, next smallest catheter size = 16 Fr.
The correct answer is: 16 Fr
4. During postural drainage therapy, a patient’s heart rate remains stable at 92/min and the SpO2 is 97%. However, after you pre-oxygenate the patient and begin nasotracheal suctioning, the patient’s heart rate suddenly drops to 40/min. The most likely reason for this is:
A. severe mucus plugging
B. hypoxemia during suctioning
C. a vago-vagal reflex
D. postural hypotension
Sudden and severe bradycardia during suctioning is most often associated with strong vagal stimulation due to mechanical manipulation of the airway (a vago-vagal re ex). Hypoxemia (which would tend to cause tachycardia) is unlikely here due to pre-oxygenation.
The correct answer is: a vago-vagal reflex
5. If tolerated, a specified postural drainage position should be maintained for at least:
A. 3-5 minutes
B. 5-10 minutes
C. 10-20 minutes
D. 20-30 minutes
If tolerated, a specified drainage position should be maintained for at least 5-10 minutes, and longer if good sputum production results. During therapy, the therapist should observe the patient for signs of ill effects, and monitor the vital signs as needed. In general, total treatment time should not exceed 30-40 minutes.
The correct answer is: 5-10 minutes
6. You are about to suction an infant who has a 3.0 mm (ID) endotracheal tube in place. What is the MAXIMUM size catheter you would use in this case?
A. 6 Fr
B. 8 Fr
C. 5 Fr
D. 10 Fr
Too large a suction catheter can cause atelectasis and worsen hypoxemia. To help avoid this problem, the external diameter of catheters generally should never exceed 1/2 the internal diameter of the airway (2/3rd in infants). To quickly estimate the correct size, double the internal diameter (ID) of the ET tube and select the next smallest catheter size. In this case 2 x 3 = 6, next smallest catheter size = 5 Fr.
The correct answer is: 5 Fr
7. If a patient’s chest X-ray shows infiltrates in the posterior segments of the lower lobes, postural drainage should be performed in which of the following positions?
A. head down, patient prone with a pillow under her abdomen
B. head down, patient supine with a pillow under her knees
C. patient prone with a pillow under her head, bed at
D. patient supine with a pillow under her knees, bed at
The proper position to drain the posterior basal segments of the lower lobes is the prone Trendelenburg position (patient prone, head down 25° or more, with a pillow under the abdomen).
The correct answer is: head down, patient prone with a pillow under her abdomen
8. To increase a patient’s maximum expiratory ow when using a cough assist or mechanical in-exsufflation (MI-E) device, you would:
A. increase the inspiratory time
B. decrease the expiratory pressure
C. increase the expiratory time
D. increase the inspiratory pressure
Increasing the inspiratory or expiratory time does not affect the maximum expiratory flow achieved with a cough assist or MI-E device. To increase the maximum expiratory flow you can increase either the inspiratory or expiratory pressure, or both. Either change will increase the difference between alveolar and airway opening pressures, thereby enhancing flow (flow = ΔP/ resistance)
The correct answer is: increase the inspiratory pressure
9. Postural drainage would best be indicated for a patient with:
A. pleural effusion
D. cystic brosis
Postural drainage is used to help patients with retained secretions who have difficulty clearing them on their own. The best examples of patients likely to have this problem are those with cystic fibrosis, bronchiectasis or COPD with retained secretions. However, postural drainage (with directed coughing) is only one of airway clearance strategies and should only be chosen if it best meets the goals of treatment, is acceptable to the patient and is the most cost-effective option. Postural drainage cannot remove fluid that resides outside the lungs (pleural effusion) and there is no current evidence to support its application in patents with either asthma or those with pneumonia not complicated by retained secretions.
The correct answer is: cystic fibrosis
10. In discussing the goals of IPPB therapy with a postoperative patient, which of the following explanations would be most appropriate?
A. “This will prevent pneumonitis.”
B. “This will help you take deep breaths.”
C. “This will prevent atelectasis.”
D. “This will increase your intrathoracic pressure.”
When instructing a patient on any aspect of their therapy, it is important to do so in a supportive, plain language and non-threatening manner. Of the choices given, only “This will help you take deep breaths” fulfills these criteria.
The correct answer is: “This will help you take deep breaths.”
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