A normal cough reflex includes which of the following phases? 1. Irritation 2. Inspiration 3. Compression 4. Expulsion

Which of the following are necessary for normal airway clearance? 1. Patent airway 2. Functional mucociliary escalator 3. Effective cough 4. Normal pulmonary compliance

Which of the following can provoke a cough? 1. Anesthesia 2. Foreign bodies 3. Infection 4. Irritating gases

Which of the following occur(s) during the compression phase of a cough? 1. Expiratory muscle contraction 2. Opening of the glottis 3. Rapid drop in alveolar pressure

Retention of secretions can result in full or partial airway obstruction. Mucus plugging can result in which of the following? 1. Hypoxemia 2. Atelectasis 3. Shunting

Partial airway obstruction can result in which of the following? 1. Increased work of breathing 2. Air trapping or overdistention 3. Increased expiratory flows 4. Ventilation/perfusion ratio (V/Q ) imbalances

A patient with abdominal muscle weakness is having difficulty developing an effective cough. Which of the following phases of the cough reflex are primarily affected in this patient? 1. Irritation 2. Inspiration 3. Compression 4. Expulsion

A patient recovering from anesthesia after abdominal surgery is having difficulty developing an effective cough. Which of the following phases of the cough reflex are primarily affected in this patient?

A patient with a tracheostomy tube is having difficulty developing an effective cough. Which of the following phases of the cough reflex is primarily affected in this patient?

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?

Which of the following can impair mucociliary clearance in intubated patients? 1. Use of respiratory stimulants 2. Tracheobronchial suctioning 3. Inadequate humidification 4. High inspired oxygen concentrations

Which of the following drug categories can impair mucociliary clearance in intubated patients? 1. General anesthetics 2. Bronchodilators 3. Opiates 4. Narcotics

Conditions that can affect airway patency and cause abnormal clearance of secretions include which of the following? 1. Foreign bodies 2. Tumors 3. Inflammation 4. Bronchospasm

Which of the following conditions alter normal mucociliary clearance? 1. Bronchospasm 2. Cystic fibrosis (CF) 3. Ciliary dyskinesia 4. Asthma

Conditions that can lead to bronchiectasis include which of the following? 1. Chronic airway infection 2. Muscular dystrophy 3. Foreign body aspiration 4. Obliterative bronchiolitis

Which of the following conditions impair secretion clearance by affecting the cough reflex? 1. Muscular dystrophy 2. Amyotrophic lateral sclerosis 3. Chronic bronchitis 4. Cerebral palsy

Which of the following are goals of airway clearance therapy? 1. Help reverse the underlying disease process. 2. Help mobilize retained secretion. 3. Improve pulmonary gas exchange. 4. Reduce the work of breathing.

Which of the following acutely ill patients is least likely to benefit from application of chest physical therapy?

Which of the following conditions are associated with chronic production of large volumes of sputum? 1. Bronchiectasis 2. Pulmonary fibrosis 3. Cystic fibrosis 4. Chronic bronchitis

In general, chest physical therapy can be expected to improve airway clearance when a patient’s sputum production exceeds what volume?

Which of the following measures would you use to ask patients for the presence of copious mucus production?

What are the best documented preventive uses of airway clearance therapy? 1. Prevent retained secretions in the acutely ill. 2. Maintain lung function in cystic fibrosis. 3. Prevent postoperative pulmonary complications.

When assessing the potential need for postoperative airway clearance for a patient, which of the following factors are relevant? 1. Patient’s age and respiratory history 2. Nature and duration of current surgery 3. Number of prior surgical procedures 4. Type of anesthesia (e.g., local vs. general)

Which of the following laboratory data are essential in assessing a patient’s need for airway clearance therapy? 1. Chest radiograph 2. Pulmonary function tests 3. Hematology results 4. ABGs/oxygen saturation

Key considerations in initial and ongoing patient assessment for chest physical therapy include which of the following? 1. Posture and muscle tone 2. Breathing pattern and ability to cough 3. Sputum production 4. Cardiovascular stability

Which of the following clinical signs indicate that a patient is having a problem with retained secretions? 1. Copious amounts of sputum production 2. Labored breathing 3. Development of a fever 4. Increased inspiratory and expiratory crackles

Which of the following are considered airway clearance therapies? 1. Postural drainage and percussion 2. Incentive spirometry 3. Positive airway pressure 4. Percussion, vibration, and oscillation

The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following?

Postural drainage should be considered in which of the following situations? 1. In patients with chronic obstructive lung disease 2. In patients who expectorate more than 25 to 30 ml sputum per day 3. In the presence of atelectasis caused by mucus plugging 4. In patients with cystic fibrosis or bronchiectasis

Absolute contraindications for postural drainage include which of the following? 1. Head and neck injury (until stabilized) 2. Active hemorrhage with hemodynamic instability 3. Uncontrolled airway at risk for aspiration

Which of the following are hazards or complication of postural drainage therapy? 1. Cardiac arrhythmias 2. Increased intracranial pressure 3. Acute hypotension 4. Pulmonary barotraumas

Primary objectives for turning include which of the following? 1. Prevent postural hypotension. 2. Promote lung expansion. 3. Prevent retention of secretions. 4. Improve oxygenation.

Which of the following is the only absolute contraindication to turning?

Which of the following are true of postural drainage? 1. It is most effective in disorders causing excessive sputum. 2. It is most effective in head-down positions greater than 25 degrees. 3. It requires adequate systemic hydration to be effective. 4. It improves mucociliary clearance in normal subjects.

In which of the following patients would you consider modifying any head-down positions used for postural drainage? 1. A patient with unstable blood pressure 2. A patient with a cerebrovascular disorder 3. A patient with systemic hypertension 4. A patient with orthopnea

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? 1. Patient’s medication schedule 2. Patient’s meal schedule 3. Location of surgical incision

A patient about to receive postural drainage and percussion is attached to an electrocardiographic (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?

Which of the following are mandatory components of the preassessment for postural drainage? 1. Vital signs 2. Bedside pulmonary function tests 3. Auscultation

If a patient’s chest radiograph shows infiltrates in the posterior basal segments of the lower lobes, what postural drainage position would you recommend?

A physician orders postural drainage for a patient with an abscess in the right middle lobe. Which of the following positions would you recommend for this patient?

A physician orders postural drainage for a patient with aspiration pneumonia in the superior segments of the left lower lobe. Which of the following positions would you recommend for this patient?

A physician orders postural drainage for a patient with aspiration pneumonia in the anterior segments of the upper lobes. Which of the following positions would you recommend for this patient?

If tolerated, a specified postural drainage position should be maintained for at least how long?

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% to 90%). Which of the following would you recommend to manage this problem?

Why is strenuous patient coughing during postural drainage in a head-down position contraindicated?

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?

Which of the following would indicate a successful outcome for postural drainage therapy? 1. Decreased sputum production 2. Normalization in ABGs 3. Improved breath sounds 4. Improvement in chest radiograph

Which of the following responses indicate that postural drainage should be terminated? 1. Severe tachycardia 2. Complaint of discomfort 3. Irregular blood pressure 4. Severe bradycardia

Which of the following should be charted after completing a postural drainage treatment? 1. Amount and consistency of sputum produced 2. Patient tolerance of procedure 3. Position(s) used (including time) 4. Any untoward effects observed

Percussion should not be performed over which of the following areas? 1. Surgery sites 2. Bony prominences 3. Fractured ribs

Properly performed chest vibration is applied at what point?

Directed coughing is useful in helping to maintain airway clearance in which of the following cases? 1. Bronchiectasis 2. Acute asthma 3. Cystic fibrosis 4. Spinal cord injury

Indications for directed coughing include which of the following? 1. Enhance other airway clearance therapies. 2. Help patients with tuberculosis clear secretions. 3. Help prevent postoperative pulmonary complications. 4. Obtain sputum specimens for diagnostic analysis.

Which of the following are contraindications for directed coughing? 1. The presence of infection spread by droplet nuclei 2. Elevated intracranial pressure or intracranial aneurysm 3. Reduced coronary artery perfusion 4. Necrotizing pulmonary infection

For which of the following patients directed coughing might be contraindicated? 1. Patient with poor coronary artery perfusion 2. Postoperative upper-abdominal surgery patient 3. Long-term care patient with retained secretions 4. Patient with an acute unstable spinal injury

What factors can hinder effective coughing? 1. Artificial airways 2. Neuromuscular disease 3. Systemic overhydration 4. Pain or fear of pain

Key consideration in teaching a patient to develop an effective cough regimen includes which of the following? 1. Strengthening of the expiratory muscles 2. Instruction in breathing control 3. Instruction in proper positioning

What is the ideal patient position for directed coughing?

A patient recovering from abdominal surgery is having difficulty developing an effective cough. Which of the following actions would you recommend to aid this patient in generating a more effective cough?

Strenuous expiratory efforts in some chronic obstructive pulmonary disease (COPD) patients limit the effectiveness of coughing. Why is this so?

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? 1. Enhancing expiratory flow by bending forward at the waist 2. Using short, expiratory bursts or the “huffing” method 3. Using only moderate (as opposed to full) inspiration 4. Having the patient “tense” the neck muscles while coughing

A nurse explains to you that a certain neuromuscular patient cannot develop a good cough. Which of the following would you consider to manage this patient’s clearance problem? 1. Combining manual chest compression with suctioning 2. Coordinating the coughing regimen with pain medication 3. Using the autogenic drainage method 4. Using mechanical insufflation-exsufflation

Which of the following are true about the FET? 1. It causes less bronchiolar collapse than traditional coughing. 2. It occurs from mid to low lung volume without glottis closure. 3. It has a period of diaphragmatic breathing and relaxation. 4. It occurs from mid to high lung volume without glottis closure.

Maintaining an open glottis during coughing (as with the FET) can help to minimize increases in pleural pressure and lessen the likelihood of bronchiolar collapse. Which of the following techniques can aid the practitioner in teaching the patient this maneuver?

Whether using traditional methods or the FET, a period of diaphragmatic breathing and relaxation should always follow attempts at coughing. What is the purpose of this approach?

What is the correct sequence of actions during the active cycle of breathing (ACB) method? 1. Relaxation and breathing control 2. Three or four thoracic expansion exercises 3. One or two FETs (huffs)

During autogenic drainage, when should patients be encouraged to cough?

What does phase 1 of autogenic drainage involve?

What happens during the exsufflation phase of mechanical insufflation-exsufflation? 1. Airway pressure is abruptly decreased to 30 to 50 cm H2O. 2. Negative airway pressure is maintained for 2 to 3 sec. 3. Peak expiratory “cough” flows reach near normal values.

A typical mechanical insufflation-exsufflation treatment session should continue until what point? 1. Secretions are cleared. 2. The vital capacity (VC) returns to baseline. 3. The SpO2 returns to baseline.

Under which of the following conditions would mechanical insufflation-exsufflation with an oronasal mask probably be effective? 1. If the glottis collapses during exsufflation 2. Presence of fixed airway obstruction 3. Presence of a chronic neuromuscular disorder

Which of the following are potential indications for positive airway pressure therapies? 1. Reduce air trapping in asthma or chronic obstructive pulmonary disease. 2. Help mobilize retained secretions. 3. Prevent or reverse atelectasis. 4. Optimize bronchodilator delivery.

Contraindications for positive airway pressure therapies include which of the following? 1. Intracranial pressure exceeding 20 mm Hg 2. Recent facial, oral, or skull surgery or trauma 3. Preexisting pulmonary barotrauma (e.g., pneumothorax) 4. Air trapping/pulmonary overdistention in chronic obstructive pulmonary disease

Which of the following are hazards of positive airway pressure therapies (EPAP, PEP, CPAP)? 1. Decreased venous return 2. Epistaxis 3. Pulmonary barotrauma 4. Increased intracranial pressure

What duration of time and pressure is recommended when using MIE devices to clear airways secretions in adults?

A physician orders positive expiratory pressure therapy for a 14-year-old child with cystic fibrosis. Which of the following responses should be monitored on this patient? 1. Peak flow or forced expiratory volume in 1 sec (FEV1) per forced vital capacity percentage 2. Patient’s minute volume 3. Quantity and character of sputum 4. Breath sounds

Which of the following best describes positive expiratory pressure (PEP) therapy?

In theory, how does positive expiratory pressure (PEP) help to move secretions into the larger airways? 1. Filling underaerated segments through collateral ventilation 2. Preventing airway collapse during expiration 3. Causing bronchodilation during inspiration

Proper instructions for positive expiratory pressure include which of the following? 1. Take in a breath that is larger than normal, but do not fill lungs completely. 2. Exhale forcefully and maintain an expiratory pressure of 10 to 20 cm H2O. 3. After 10 to 20 breaths, take two or three “huff”’ coughs, and rest as needed. 4. Repeat the cycle 8 to 10 times, not to exceed 30 min.

A physician orders bronchodilator drug therapy in combination with positive expiratory pressure (PEP). Which of the following methods could you use to provide this combined therapy? 1. Attach a dry powder inhaler in-line with the PEP apparatus. 2. Attach a metered dose inhaler to the system’s one-way valve inlet. 3. Place a small volume nebulizer in-line with the PEP apparatus.

What is the movement of small volumes of air back and forth in the respiratory tract at high frequencies (12 to 25 Hz) called?

Which of the following parts are required to conduct high-frequency external chest wall compression? 1. Variable air-pulse generator 2. Expiratory flow resistor with one-way valve 3. Nonstretch inflatable thoracic vest

Which of the following are typical of high-frequency external chest wall compression therapy? 1. 30-min therapy sessions 2. Long inspiratory oscillations 3. One to six sessions per day 4. Oscillations at 20 to 25 Hz

Which of the following determines effectiveness of high-frequency external chest wall compression therapy? 1. Compression frequency 2. Largest volumes 3. Flow bias

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?

Which of the following is true about exercise and airway clearance? 1. Exercise can enhance mucus clearance. 2. Exercise can improve pulmonary function. 3. Exercise can improve matching. 4. Exercise can cause desaturation in some patients.

Patients can control a flutter valve’s pressure by changing what?

Advantages of the flutter valve over other airway clearance methods include which of the following? 1. Good patient acceptance 2. Greater effectiveness 3. Full portability 4. Independent use

Which of the following are advantages of the Acapella over the flutter? 1. It can customize frequency. 2. It can be used in any posture. 3. It is more portable. 4. It can customize flow resistance.

Which of the following should be considered when selecting an airway clearance strategy? 1. Patient’s goals, motivation, and preferences 2. Effectiveness and limitations of technique or method 3. Patient’s age, ability to learn, and tendency to fatigue 4. Need for assistants, equipment, and cost

Which of the following airway clearance techniques would you recommend for a 15-month-old infant with cystic fibrosis?

Which of the following airway clearance techniques would you recommend for a patient with a neurologic abnormality (bulbar palsy) and intact upper airway? 1. Postural drainage, percussion, and vibration 2. Positive expiratory pressure therapy 3. Mechanical insufflation-exsufflation

In assessing an adult outpatient for airway clearance therapy, you notice the following: (1) no history of cystic fibrosis or bronchiectasis, (2) sputum production of 30 to 50 ml/day, (3) an effective cough, and (4) good hydration. Which of the following would you recommend?

Which of the following is the most appropriate airway clearance method for an infant with cystic fibrosis?