Kacmarek: Egan's Fundamentals of Respiratory Care, 10th Edition

Chapter 39: Lung Expansion Therapy

Test Bank

MULTIPLE CHOICE

1. Persistent breathing at small tidal volumes can result in which of the following?
a. reabsorption atelectasis
b. spontaneous pneumothorax
c. compression atelectasis
d. respiratory alkalosis

ANS: C
Compression atelectasis is primarily caused by persistent use of small tidal volumes by the
patient.

DIF: Recall REF: p. 946 OBJ: 1

2. Which of the following patient categories are at high risk for developing atelectasis?
1. those who are heavily sedated
2. those with abdominal or thoracic pain
3. those with neuromuscular disorders
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: D
Patients who have difficulty taking deep breaths without assistance include those with
significant obesity, those with neuromuscular disorders, those under heavy sedation, and those
who have undergone upper abdominal or thoracic surgery.

DIF: Recall REF: p. 946 OBJ: 1

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

a. uncontrolled hyperpyrexia
b. central nervous system overstimulation
c. decreased cardiac output

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 Test bank 39-2

d. repetitive, shallow breathing

ANS: D
Most postoperative patients also have problems coughing effectively because of their reduced
ability to take deep breaths.

DIF: Recall REF: p. 946 OBJ: 1

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

ANS: D
An ineffective cough impairs normal clearance mechanisms and increases the likelihood of
retained secretions and gas absorbtion atelectasis in the patient with excessive mucus
production. For this reason, patients with a history of lung disease that causes increased
mucus production (e.g., chronic bronchitis) are most prone to develop complications in the
postoperative period. Similarly, a significant history of cigarette smoking should alert the
respiratory therapist to the high risk for respiratory complications with surgery.

DIF: Recall REF: p. 946 OBJ: 2

5. Which of the following clinical findings indicate the development of atelectasis?

1. opacified areas on the chest x-ray film
2. inspiratory and expiratory wheezing
3. tachypnea
4. diminished or bronchial breath sounds
a. 1, 3, and 4
b. 1, 2, 3, and 4
c. 1 and 4
d. 2, 3, and 4

ANS: A
When the atelectasis involves a more significant portion of the lungs, the patient’s respiratory
rate will increase proportionally. Bronchial-type breath sounds may be present as the lung
becomes more consolidated with atelectasis. Diminished breath sounds are common when
excessive secretions block the airways and prevent transmission of breath sounds. The chest
film is often used to confirm the presence of atelectasis.

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 Test bank 39-3

DIF: Recall REF: p. 947 OBJ: 3

6. How do all modes of lung expansion therapy aid lung expansion?

a. increasing the transpulmonary pressure gradient
b. decreasing the transthoracic pressure gradient
c. increasing the pressure in the pleural space
d. decreasing the pressure in the alveoli

ANS: A
All modes of lung expansion therapy increase lung volume by increasing the transpulmonary
pressure (PL) gradient.

DIF: Recall REF: p. 947 OBJ: 4

7. How can the transpulmonary pressure gradient be increased?

1. increasing alveolar pressure
2. decreasing pleural pressure
3. decreasing transthoracic pressure
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: A
PL gradient can be increased by either (1) decreasing the surrounding Ppl (Figure 39-1, A) or
(2) increasing the Palv.

DIF: Recall REF: p. 947 OBJ: 4

8. Lung expansion methods that increase the transpulmonary pressure gradients by increasing
alveolar pressure include which of the following?
1. incentive spirometry (IS)
2. positive end-expiration pressure therapy
3. intermittent positive-pressure breathing (IPPB)
4. expiratory positive airway pressure (EPAP)
a. 1 and 2
b. 2, 3, and 4
c. 1 and 3
d. 1, 2, 3, and 4

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 Test bank 39-4

ANS: B
Positive-pressure lung expansion therapies may apply pressure during inspiration only (as in
IPPB), during expiration only (as in positive expiratory pressure [PEP] and EPAP), or during
both inspiration and expiration (CPAP).

DIF: Recall REF: p. 947 OBJ: 4

9. Which of the following modes of lung expansion therapy is physiologically most normal?
a. continuous positive airway pressure
b. incentive spirometry
c. positive end-expiratory pressure
d. intermittent positive-pressure breathing therapy

ANS: B
Although all these approaches are used in lung expansion therapy, it should be clear that those
methods that decrease Ppl (e.g., incentive spirometry) have more of a physiologic effect than
those that raise Palv and often are most effective.

DIF: Recall REF: p. 947 OBJ: 4

10. An alert and cooperative 28-year-old woman with no prior history of lung disease underwent
cesarean section 16 hours earlier. Her x-ray film currently is clear. Which of the following
approaches to preventing atelectasis would you recommend for this patient?
a. incentive spirometry
b. PEEP therapy
c. deep breathing exercises
d. intermittent positive-pressure breathing therapy

ANS: A
For the patient at high risk for atelectasis (e.g., the upper abdominal surgery patient), incentive
spirometry is usually used.

DIF: Application REF: p. 948 OBJ: 4

11. Which of the following are potential indications for incentive spirometry?
1. a restrictive disorder such as quadriplegia
2. abdominal surgery in a COPD patient
3. presence of pulmonary atelectasis
a. 1 and 2
b. 2 and 3
c. 1 and 3

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 Test bank 39-5

d. 1, 2, and 3

ANS: D
Indications for incentive spirometry are listed in Box 39-1.

DIF: Recall REF: p. 948 OBJ: 5

12. Which of the following situations is a contraindication for incentive spirometry?

1. a patient whose vital capacity is less than 10 ml/kg
2. a patient who cannot cooperate or follow instructions
3. an unconscious patient
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: D
Incentive spirometry is a simple and relatively safe modality. For this reason,
contraindications are few (Box 39-2).

DIF: Recall REF: p. 950 OBJ: 5

13. Which of the following is not a potential hazard or complication of incentive spirometry?
a. pulmonary barotrauma
b. decreased cardiac output
c. respiratory alkalosis
d. fatigue

ANS: B
Box 39-3.

DIF: Recall REF: p. 950 OBJ: 5

14. 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 insufflation
b. hyperventilation
c. pulmonary barotrauma
d. respiratory acidosis

ANS: B

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 Test bank 39-6

Dizziness and numbness around the mouth are the most frequently reported symptoms
associated with respiratory alkalosis.

DIF: Application REF: p. 950 OBJ: 5

15. Incentive spirometry devices can generally be categorized as which of the following?
1. pressure-oriented
2. flow-oriented
3. volume-oriented
a. 3
b. 1 and 2
c. 1, 2, and 3
d. 2 and 3

ANS: D
Incentive spirometry devices can generally be categorized as volume or flow oriented.

DIF: Recall REF: p. 950 OBJ: 5

16. Which of the following is FALSE about flow-oriented incentive spirometry devices?
a. Inspired volume is estimated as the product of flow and time.
b. Motivation is based on keeping the indicator balls elevated.
c. They have proved less effective than volumetric systems.
d. They provide only an indirect measure of inspired volume.

ANS: C
No evidence to date indicates that one type is more beneficial than the other.

DIF: Recall REF: p. 951 OBJ: 5

17. Which of the outcomes would indicate improvement in a patient previously diagnosed with
atelectasis who has been receiving incentive spirometry?
1. improved PaO2
2. decreased respiratory rate
3. improved chest radiograph
4. decreased forced vital capacity (FVC)
5. tachycardia
a. 1, 2, and 3
b. 1, 3, and 4
c. 1, 2, 3, 4, and 5
d. 3, 4, and 5

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 Test bank 39-7

ANS: A
Box 39-4.

DIF: Recall REF: p. 951 OBJ: 6

18. Ideally, when should high-risk surgical patients be oriented to incentive spirometry?
a. postoperatively, after full recovery from the anesthesia
b. preoperatively, before undergoing the surgical procedure
c. postoperatively, while they are still in the recovery room
d. postoperatively, but no sooner than 24 hours after surgery

ANS: B
This approach provides an opportunity to orient high-risk patients to the procedure before
undergoing surgery, thereby increasing the likelihood of success when incentive spirometry is
provided after surgery.

DIF: Recall REF: p. 951 OBJ: 6

19. Successful application of incentive spirometry depends on:

a. the use of a true volume-oriented incentive spirometry system
b. the type of surgery previously performed
c. the effectiveness of patient teaching
d. setting an easily achieved initial goal

ANS: C
Successful incentive spirometry requires effective patient teaching.

DIF: Recall REF: p. 951 OBJ: 6

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

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 Test bank 39-8

ANS: A
The patient should be instructed to inspire slowly and deeply to maximize the distribution of
ventilation.

DIF: Recall REF: p. 951 OBJ: 6

21. Correct instruction in the technique of incentive spirometry should include which of the
following?
a. use of accessory muscles at high inspiratory flows
b. diaphragmatic breathing at slow to moderate flows
c. “panting” at volumes approaching total lung capacity
d. use of accessory muscles at low inspiratory flows

ANS: B
Correct technique calls for diaphragmatic breathing at slow-to-moderate inspiratory flows.

DIF: Recall REF: p. 951 OBJ: 6

22. In performing the sustained maximal inspiration maneuver during incentive spirometry, the
patient should be instructed to sustain the breath for at least how long?
a. 10 to 15 seconds
b. 5 to 10 seconds
c. 3 to 5 seconds
d. 1 to 2 seconds

ANS: B
Instruct the patient to sustain his or her maximal inspiratory volume for 5 to 10 seconds.

DIF: Recall REF: p. 951 OBJ: 6

23. In observing a postoperative woman conduct incentive spirometry, you note repetitive
performance of the sustained maximal inspiration maneuver at a rate of about 10 to 12/min.
Which of the following would you recommend to her?
a. Decrease the treatment frequency to 4 times/day.
b. Increase her breathing rate to 12 to 15/min.
c. Take a 30-second rest period between breaths.
d. Repeat the treatment every 30 minutes.

ANS: C
Some patients in the early postoperative stage may need to rest for 30 seconds to 1 minute
between maneuvers.

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 Test bank 39-9

DIF: Analysis REF: p. 951 OBJ: 6

24. For patients receiving incentive spirometry, what is the minimum number of sustained
maximal inspirations (SMIs) per hour that you would recommend?
a. 25 to 30
b. 15 to 20
c. 5 to 10
d. 1 to 2

ANS: C
An incentive spirometry regimen should probably aim to ensure a minimum of 5 to 10 SMI
maneuvers each hour

DIF: Recall REF: p. 951 OBJ: 6

25. What should the monitoring of patients using incentive spirometry include?
1. number of breaths per session
2. volume and flow goals achieved
3. maintenance of breath-hold
4. patient effort and motivation
a. 1, 3, and 4
b. 2, 3, and 4
c. 1, 2, 3, and 4
d. 3 and 4

ANS: C
Box 39-5.

DIF: Recall REF: p. 951 OBJ: 6

26. The short-term 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-expiration pressure

ANS: B

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 Test bank 39-10

Intermittent positive-pressure breathing refers to the application of inspiratory positive

pressure to a spontaneously breathing patient as an intermittent or short-term therapeutic
modality.

DIF: Recall REF: p. 952 OBJ: 6

27. Which of the following is false about intermittent positive-pressure breathing?

a. During inspiration, pressure in the alveoli decreases.
b. The pressure gradients of normal breathing are reversed.
c. During inspiration, alveolar pressure may exceed pleural pressure.
d. Energy stored during inspiration causes a passive exhalation.

ANS: A
Ppl may actually exceed atmospheric pressure during a portion of inspiration.

DIF: Recall REF: p. 952 OBJ: 6

28. Intermittent positive-pressure breathing is associated with a passive exhalation.

a. True
b. False

ANS: A
As with spontaneous breathing, the recoil force of the lung, stored as potential energy during
the positive pressure breath, causes a passive exhalation.

DIF: Recall REF: p. 952 OBJ: 6

29. Which of the following patient groups should be considered for lung expansion therapy using
intermittent positive-pressure breathing (IPPB)?
1. patients with clinically diagnosed atelectasis who are not responsive to other therapies
2. patients at high risk for atelectasis who cannot cooperate with other methods
3. all obese patients who have undergone abdominal surgery
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

ANS: A

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 Test bank 39-11

IPPB may be useful for patients with clinically diagnosed atelectasis not responsive to other
therapies, such as incentive spirometry and chest physiotherapy. In addition, IPPB may be
useful for patients who are at high risk for atelectasis and not able to cooperate with more
simple techniques such as IS.

DIF: Recall REF: p. 952 OBJ: 2

30. Which of the following statements is not true about intermittent positive-pressure breathing
(IPPB)?
a. IPPB could cause lung overinflation.
b. IPPB could cause no expansion of regions affected by secretions.
c. Bronchial hygiene must be used in conjunction with IPPB to adequately manage
secretions.
d. IPPB should be the single treatment modality for gas absorbtion atelectasis.

ANS: D
In either case, IPPB should not be used as a single treatment modality for the patient with gas
absorbtion atelectasis due to excessive airway secretions. Applying positive pressure to the
lung in such cases is likely to cause overinflation of the lung regions not affected by secretions
and minimal or no expansion of the affected lung segments. Bronchial hygiene with humidity
therapy must be used in conjunction with IPPB for the most optimal results in such cases.

DIF: Recall REF: p. 952 OBJ: 5

31. What is the optimal breathing pattern for intermittent positive-pressure breathing (IPPB)
treatment of atelectasis?
a. slow, deep breaths held at end-inspiration
b. rapid, deep breaths held at end-inspiration
c. slow, shallow breaths held at end-inspiration
d. rapid, shallow breaths held at end-inspiration

ANS: A
The optimal breathing pattern to reinflate collapsed lung units with IPPB consists of slow,
deep breaths that are sustained or held at end-inspiration.

DIF: Recall REF: p. 952 OBJ: 6

32. Which of the following is NOT a potential contraindication for intermittent positive-pressure
breathing?
a. hemodynamic instability
b. recent esophageal surgery

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 Test bank 39-12

c. tension pneumothorax
d. neuromuscular disorders

ANS: D
Box 39-6.

DIF: Recall REF: p. 955 OBJ: 5

33. Which of the following is an absolute contraindication for using intermittent positive-pressure
breathing?
a. hemodynamic instability
b. active untreated tuberculosis
c. tension pneumothorax
d. recent esophageal surgery

ANS: C
Box 39-6.

DIF: Recall REF: p. 955 OBJ: 5

34. What is the most common complication associated with intermittent positive-pressure
breathing (IPPB)?
a. air-trapping
b. oral bleeding
c. respiratory alkalosis
d. gastric distention

ANS: C
The most common complication associated with IPPB is the inducement of respiratory
alkalosis.

DIF: Recall REF: p. 954 OBJ: 5

35. What is the minimum airway pressure at which the esophagus opens, allowing gas to pass
directly into the stomach?
a. 25 cm H2O
b. 20 cm H2O
c. 15 cm H2O
d. 10 cm H2O

ANS: B

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 Test bank 39-13

Normally, the esophagus does not open until a pressure of about 20 cm H2O has been reached.

DIF: Recall REF: p. 955 OBJ: 6

36. Which of the following is false about gastric distention with intermittent positive-pressure
breathing (IPPB)?
a. Gastric distention is uncommon in alert and cooperative patients.
b. Gastric distention is most likely at high airway pressures.
c. Gastric distention is a significant risk in obtunded patients.
d. Gastric distention is a relatively harmless effect of IPPB.

ANS: D
Gastric distention represents the greatest risk in patients receiving IPPB at high pressures.

DIF: Recall REF: p. 955 OBJ: 5

37. Which of the following is not a potential hazard of intermittent positive-pressure breathing?
a. increased cardiac output
b. respiratory alkalosis
c. pulmonary barotrauma
d. gastric distention

ANS: A
See Box 39-7.

DIF: Application REF: p. 955 OBJ: 5

38. Which of the following are potential hazards of intermittent positive-pressure breathing
(IPPB)?
1. air-trapping, auto-PEEP
2. hyperventilation
3. nosocomial infection
4. increased airway resistance
a. 1, 2, 3, and 4
b. 2 and 4
c. 2, 3, and 4
d. 3 and 4

ANS: A
See Box 39-7.

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 Test bank 39-14

DIF: Recall REF: p. 955 OBJ: 5

39. 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
a. 1 and 3
b. 1 and 2
c. 1, 2, and 3
d. 2 and 3

ANS: C
Effective IPPB requires careful preliminary planning, individualized patient assessment and
implementation, and thoughtful follow-up. In all three phases of the process, the respiratory
therapist should work closely with the prescribing physician to determine patient need, select
the appropriate therapeutic approach, and assess patient progress toward predefined clinical
outcomes.

DIF: Recall REF: p. 955 OBJ: 6

40. Which of the following are potential desirable outcomes of intermittent positive-pressure
breathing (IPPB) therapy?
1. improved oxygenation
2. increased cough and secretion clearance
3. improved breath sounds
4. reduced dyspnea
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

ANS: D
Box 39-8 lists potential accepted and desired outcomes of IPPB therapy.

DIF: Recall REF: p. 955 OBJ: 6

41. The general assessment, common to all patients for whom intermittent positive-pressure
breathing (IPPB) is ordered, should include which of the following?
1. measurement of vital signs
2. appearance and sensorium

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 Test bank 39-15

3. chest auscultation
4. arterial blood gas analysis
5. peak expiratory flow rates
a. 1 and 4
b. 2 and 5
c. 3 and 4
d. 1, 2, and 3

ANS: D
The general assessment, common to all patients for whom IPPB is ordered, includes (1)
measurement of vital signs, (2) observational assessment of the patient’s appearance and
sensorium, and (3) breathing pattern and chest auscultation. The more focused assessment is
individualized according to the identified clinical goals.

DIF: Application REF: p. 955 OBJ: 2

42. When checking a patient’s intermittent positive-pressure breathing (IPPB) breathing 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?
a. Secure a new IPPB ventilator.
b. Check the circuit for leaks.
c. Decrease the flow setting.
d. Increase the pressure setting.

ANS: B
Because pressure-cycled IPPB devices will not end inspiration if leaks in the system occur, it
is important to check the patency of the patient’s breathing circuit before each use.

DIF: Application REF: p. 956 OBJ: 5

43. Prior to starting intermittent positive-pressure breathing (IPPB) on a new patient, what should
the practitioner explain?
1. why the physician ordered the treatment
2. what the IPPB treatment will do
3. how the IPPB treatment will feel
4. what the expected results are
a. 1, 2, 3, and 4
b. 2 and 4
c. 2, 3, and 4
d. 1, 3, and 4

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 Test bank 39-16

ANS: A
(1) Why the physician ordered the treatment, (2) what the treatment does, (3) how it will feel,
and (4) what are the expected results should be explained to the patient.

DIF: Recall REF: p. 956 OBJ: 6

44. Which of the following positions is ideal for intermittent positive-pressure breathing therapy?
a. semi-Fowler's
b. standing
c. supine
d. prone

ANS: A
For best results, the patient should be in a semi-Fowler’s position.

DIF: Recall REF: p. 956 OBJ: 6

45. In order to eliminate leaks in an alert patient receiving intermittent positive-pressure breathing
therapy, which of the following adjuncts would you first try?
a. flanged mouthpiece
b. form-fitting mask
c. nasopharyngeal airway
d. nose clips

ANS: D
To eliminate airway leaks in the alert patient, an initial trial of nose clips may be needed until
the technique is understood and the treatment can be performed without them.

DIF: Recall REF: p. 956 OBJ: 6

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

ANS: C
The machine should be set so that a breath can be initiated with minimal patient effort.

DIF: Recall REF: p. 956 OBJ: 6

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 Test bank 39-17

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

ANS: C
A sensitivity or trigger level of 1 to 2 cm H2O is adequate for most patients. Initially, system
pressure is set to between 10 and 15 cm H2O.

DIF: Recall REF: p. 956 OBJ: 6

48. In administering intermittent positive-pressure breathing therapy, which of the following

breathing patterns would be most desirable?
a. 6 to 8 breaths/min, inspiration/expiration ratio (I:E) of 1:3
b. 8 to 10 breaths/min, I:E of 1:1
c. 12 to 15 breaths/min, I:E of 1:2
d. 6 to 8 breaths/min, I:E of 1:1

ANS: A
Generally, the goal is to establish a breathing pattern consisting of about 6 breaths/min, with
an expiratory time of at least 3 to 4 times longer than inspiration (I:E ratio of 1:3 to 1:4 or
lower).

DIF: Recall REF: p. 956 OBJ: 6

49. 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
a. 1 and 3
b. 1 and 2
c. 2 and 3
d. 1

ANS: B

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 Test bank 39-18

Most clinical centers strive to achieve an IPPB tidal volume of 10 to 15 ml/kg of body weight
or at least 30% of the patient’s predicted IC. If the initial volumes fall short of this goal and
the patient can tolerate it, the pressure is gradually raised until the goal is achieved. Pressures
as high as 30 to 35 cm H2O may be needed to achieve this end when lung compliance is
reduced.

DIF: Recall REF: p. 957 OBJ: 6

50. All of the following parameters should be evaluated after intermittent positive-pressure
breathing therapy except:
a. vital signs
b. sensorium
c. breath sounds
d. temperature

ANS: D
The general follow-up evaluation of the patient’s clinical status should focus on determining
any pertinent changes in vital signs, sensorium, and breath sounds, with emphasis on
identifying possible untoward effects.

DIF: Recall REF: p. 957 OBJ: 6

51. 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 pre and posttreatment assessment
2. any side effects
3. duration of therapeutic session
a. 2 and 3
b. 1 and 3
c. 1 and 2
d. 1, 2, and 3

ANS: D
A succinct but complete account of the treatment session, including the pre-assessment and
post-assessment results, must be entered in the patient’s medical record according to the
approved institutional protocol. Any untoward patient responses must also immediately be
reported to responsible personnel, to include at least the prescribing physician and attending
nurse.

DIF: Recall REF: p. 957 OBJ: 6

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 Test bank 39-19

52. All of the following machine performance characteristics should be monitored during
intermittent positive-pressure breathing therapy except:
a. flow setting
b. sensitivity
c. humidity output
d. peak pressure

ANS: C
Box 39-9.

DIF: Recall REF: p. 957 OBJ: 6

53. In terms of machine performance, what large negative pressure swings early in inspiration
indicate?
a. inadequate flow setting
b. incorrect sensitivity
c. inadequate pressure setting
d. inadequate humidity

ANS: B
In terms of machine performance, large negative pressure swings early in inspiration indicate
an incorrect sensitivity or trigger setting.

DIF: Analysis REF: p. 957 OBJ: 6

54. Which of the following will make an intermittent positive-pressure breathing (IPPB) device
cycle off prematurely?

1. airflow obstructed
2. kinked tubing
3. occluded mouthpiece
4. active resistance to inhalation
a. 1 and 2
b. 1 and 3
c. 1, 3, and 4
d. 1, 2, 3, and 4

ANS: D
Alternatively, an IPPB device may cycle off prematurely when airflow is obstructed. Kinked
tubing, an occluded mouthpiece, and active resistance to inhalation by the patient are the most
common causes of this problem.

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 Test bank 39-20

DIF: Recall REF: p. 957 OBJ: 6

55. Which of the following mechanisms probably contribute to the beneficial effects of
continuous positive airway pressure (CPAP) in treating atelectasis?
1. recruitment of collapsed alveoli
2. decreased work of breathing
3. improved distribution of ventilation
4. increased efficiency of secretion removal
a. 1, 2, and 4
b. 2 and 3
c. 1 and 4
d. 1, 2, 3, and 4

ANS: D
Exactly how CPAP helps resolve atelectasis is unknown. However, the following factors
probably contribute to its beneficial effects: (1) the recruitment of collapsed alveoli via an
increase in FRC, (2) a decreased work of breathing due to increased compliance or
elimination of autopositive end-expiratory pressure (PEEP), (3) an improved distribution of
ventilation through collateral channels (e.g., Kohn pores), and (4) an increase in the efficiency
of secretion removal.

DIF: Recall REF: p. 958 OBJ: 6

56. Which of the following are contraindications for continuous positive airway pressure (CPAP)
therapy?
1. hemodynamic instability
2. hypoventilation
3. facial trauma
4. low intracranial pressures
a. 1 and 3
b. 2 and 3
c. 1, 2, and 3
d. 2, 3, and 4

ANS: C

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 Test bank 39-21

The patient who is hemodynamically unstable is not likely to tolerate CPAP for even a short
period of time. The patient who is suspected of having hypoventilation is not a good candidate
for CPAP because it does not ensure ventilation. Other problems that may indicate that CPAP
is not an appropriate therapy include nausea, facial trauma, untreated pneumothorax, and
elevated intracranial pressure.

DIF: Recall REF: p. 958 OBJ: 5

57. Which of the following are potential complications of continuous positive airway pressure
(CPAP) therapy?
1. barotrauma
2. hyperventilation
3. gastric distention
4. hypercapnia
a. 1 and 3
b. 2 and 3
c. 1, 3, and 4
d. 2, 3, and 4

ANS: A
The increased work of breathing caused by the apparatus can lead to hypoventilation and
hypercapnia. In addition, because CPAP does not augment spontaneous ventilation, patients
with an accompanying ventilatory insufficiency may hypoventilate during application.
Barotrauma is a potential hazard of CPAP and is more likely to occur in the patient with
emphysema and blebs. Gastric distention may occur, especially if CPAP pressures above 15
cm H2O are needed.

DIF: Recall REF: p. 958-959 OBJ: 5

58. 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
a. 3 and 4
b. 1, 2, and 4
c. 1 and 4
d. 1, 2, 3, and 4

ANS: D

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 Test bank 39-22

A breathing gas mixture from an oxygen blender flows continuously through a humidifier into
the inspiratory limb of a breathing circuit. A reservoir bag provides reserve volume if the
patient’s inspiratory flow exceeds that of the system. The patient breathes in and out through a
simple valveless T-piece connector. A pressure alarm system with manometer monitors the
CPAP pressure at the patient’s airway. The alarm system can warn of either low (usually due
to a disconnection) or high system pressure. The expiratory limb of the circuit is connected to
a threshold resistor, in this case a water column (H).

DIF: Recall REF: p. 959 OBJ: 4

59. 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?
a. system or mask leaks
b. outflow obstruction
c. inadequate system flow
d. inadequate trigger

ANS: A
The most common problem with positive airway pressure therapies is system leaks.

DIF: Application REF: p. 960 OBJ: 6

60. While monitoring a patient receiving +12 cm H2O flow-mask continuous positive airway
pressure, you note that the pressure drops to +6 cm H2O during inspiration, but returns to +12
cm H2O during exhalation. Which of the following would likely correct this problem?
a. Check and correct any mask leaks.
b. Check and correct any outflow obstruction.
c. Increase the system flow.
d. Increase the system pressure.

ANS: C
Flow is adequate when the system pressure drops no more than 1 to 2 cm H2O during
inspiration.

DIF: Analysis REF: p. 960 OBJ: 6

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 Test bank 39-23

61. A surgeon writes an order for lung expansion therapy for a 28-year-old 110-lb woman who
has undergone lower abdominal surgery. In evaluating this patient at the bedside, you obtain a
VC of 800 ml and an IC of 44% predicted. Although a chest radiograph indicates basal
atelectasis, she has no problem with retained secretions. What lung expansion treatment would
you recommend?
a. intermittent positive-pressure breathing at 6 to 8 breaths/min at 10 to 15 ml/kg
b. continuous positive airway pressure therapy at 10 cm H2O for 24 hours
c. positive end-expiratory pressure therapy with bronchodilator and bronchial
hygiene
d. incentive spirometry 10 times an hour at an initial volume of 500 to 600 ml

ANS: D
For the patient having no difficulty with secretions, if the VC exceeds 15 ml/kg of lean body
weight, or the IC is greater than 33% of predicted, incentive spirometry is given.

DIF: Analysis REF: p. 960 OBJ: 6

62. A surgeon orders lung expansion therapy for an obtunded 68-year-old, 170-lb man who has
developed atelectasis after thoracic surgery. On baseline assessment, the patient cannot
perform an IC or VC maneuver, but has no evidence of retained secretions. Which of the
following would you recommend?
a. intermittent positive-pressure breathing (IPPB) at 6 to 8 breaths/min at 10 to 15
ml/kg
b. continuous positive airway pressure therapy at 12 cm H2O for 24 hours
c. positive end-expiratory pressure therapy with bronchodilator and bronchial
hygiene
d. incentive spirometry 10 times an hour at an initial volume of 600 to 800 ml

ANS: A
If either the VC or IC is less than these threshold levels, IPPB is initiated, with the pressure
gradually manipulated from the initial setting to deliver at least 15 ml/kg.

DIF: Analysis REF: p. 960 OBJ: 6

63. Which of the following has a direct relationship between the degree to which atelectasis can
present itself with a post-operative patient?
a. spontaneous respiratory rate
b. bradycardia
c. hypocapnia
d. hypothermia

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 Test bank 39-24

ANS: A
There is a direct relationship between the spontaneous respiratory rate and the degree of
atelectasis present. Typically, as the atelectasis progresses, the respiratory rate increases
proportionally.

DIF: Recall REF: p. 946 OBJ: 1

64. 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
a. 1 and 2
b. 2 and 3
c. 1, 2, and 3
d. 1, 2, 3, and 4

ANS: D
Hyperventilation and respiratory alkalosis, discomfort secondary to inadequate pain control,
pulmonary barotrauma, exacerbation of bronchospasm and fatigue are the hazards and
complications of incentive spirometry.

DIF: Recall REF: p. 950 OBJ: 5

65. A 59 year old COPD patient comes to the hospital with upper abdominal surgery. The
physician diagnoses the patient with pulmonary atelectasis. The patient has a vital capacity of
25 ml/ kg. Which of the following lung expansion therapy will you recommend to assist this
patient’s atelectasis?
a. incentive spirometry
b. IPPB
c. CPAP
d. EPAP

Indications for incentive spirometry is pulmonary atelectasis, COPD, and upper

abdominal surgery. Since the patient’s VC is greater than 15 ml/kg, the patient may
begin with incentive spirometry as the mode of treatment

ANS: A DIF: Analysis REF: p. 949 OBJ: 2

66. Which of the following possesses the most significant risk for hypoventilation?
a. IPPB

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Test bank 39-25

b. IS
c. IPAP/EPAP
d. CPAP

ANS: D
Providing continuous positive airway pressure (CPAP) can cause smaller tidal volumes and
may cause issues with hypoventilation.

DIF: Recall REF: p. 958 OBJ: 5

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.