1. Bronchopulmonary Hygiene CRT 3? = 2% RRT 3?

2. Upper Lobes –bed flat or sitting RML or LLingula –foot of bed elevated 15° Lower Lobes –Foot of bed elevated 30° 12-14 inches 18 inches

3. Review of Postural Drainage Positions

4. A 34-year-old patient with bronchiectasis wishes to continue an appropriate pulmonary hygiene program while maintaining full-time employment as an accountant. Which of the following would best assist this patient in attaining this goal? A. ultrasonic nebulizer B. IPPB with bronchodilator C. MDI with bronchodilator D. Flutter ® mucous clearance device

5. While performing postural drainage on a patient who is in a head-down position, the patient appears dyspneic due to severe prolonged coughing. The respiratory therapist should A. perform percussion. B. turn the patient. C. administer oxygen. D. place the patient in Fowler's position.

6. The respiratory therapist is reviewing the most recent report from a patient's PA chest radiograph. The right heart border can be identified and the right diaphragm is obscured. How should the patient be positioned for postural drainage and percussion over the affected area? A. supine with pillow under the knees B. lying on left side with head down 15 degrees and rotated 1/4 turn backward C. in a semi-Fowler's position D. in a prone position with head down 25 degrees

7. The respiratory therapist is caring for a 75- year-old female who has had a cough productive of purulent sputum for 5 years. She was diagnosed with a Mycobacterium avium complex lower respiratory tract infection 3 years earlier. Her chest radiograph shows ring shadows and dilated and thickened airways, configured like tramlines, in the right middle lobe. In addition to antibiotic therapy, which of the following should the respiratory therapist recommend? A. transtracheal aspiration B. postural drainage C. diagnostic bronchoscopy D. respiratory isolation

8. A patient with a history of chronic bronchitis complains of shortness of breath following chest surgery. The patient is receiving 30% O 2 by mask. Rhonchi in the right lower lobe are heard on auscultation. Which of the following should the therapist recommend? A. PEP with incentive spirometry B. ultrasonic nebulizer therapy C. acetylcysteine (Mucomyst) therapy D. chest percussion

9. Which of the following is (are) necessary for normal airway clearance? I. Patent airway II. Functional mucociliary escalator III. Effective cough A. I and II B. I, II, III C. II and III D. II

10. 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? I. Irritation II. Inspiration III. Compression IV. Expulsion A. I, II, and III B. II and IV C. II, III, and IV D. III and IV

11. All of the following are goals of bronchial hygiene therapy except which one? A. Reverse the underlying disease process B. Help mobilize retained secretion C. Improve pulmonary gas exchange D. Reduce the work of breathing

12. Which of the following clinical signs indicate that a patient is having a problem with retained secretions? I. Lack of sputum production II. Labored breathing III. Development of a fever IV. Increased crackles and rhonchi A. II and IV B. I, II, and III C. III and IV D. I, II, III, and IV

13. The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following? A. Breathing exercises B. Postural drainage therapy C. Hyperinflation therapy D. Directed coughing

14. Postural drainage should be considered in all of the following situations except which one? A.In patients with pleural effusion B.In patients who expectorate more than 25 to 30 mL sputum per day C.In the presence of atelectasis caused by mucous plugging D.In patients with cystic fibrosis or bronchiectasis

15. If tolerated, a specified postural drainage position should be maintained for at least how long? A. 1 to 2 minutes B. 3 to 5 minutes C. 20 to 30 minutes D. 3 to 15 minutes

16. While reviewing the chart of a patient receiving postural drainage therapy, you notice that the patient tends to undergo mild desaturation during therapy. 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.

17. Properly performed chest vibration is applied at what point? A. Throughout inspiration B. At the end of expiration C. At the start of inspiration D. Throughout expiration

18. A physician orders postural drainage for a patient with consolidation in the right middle lobe. Which of the following positions would you recommend for this patient? A.Head down, patient prone with a pillow under abdomen B.Head down, patient supine with a pillow under knees C.Patient supine with a pillow under knees, bed flat D.Head down, patient half-rotated to left, right lung up

19. The End

20. Compared with the inside diameter of a tracheostomy tube, the outside diameter of the suction catheter should be less than A. 1/8 as large. B. 1/5 as large. C. 1/4 as large. D. 1/2 as large.

21. A patient receiving mechanical ventilation requires frequent suctioning. He has a history of developing PVCs during suctioning procedures. The respiratory therapist should I. limit the duration of the suctioning. II. increase the F I O 2 before, during, and after suctioning. III. observe the patient's ECG monitor while suctioning. IV. request an anti-arrhythmic medication for the patient. A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only

22. The respiratory therapist is assessing a patient with COPD who has been receiving PEP therapy for 4 days. Which of the following outcomes indicates therapy should continue? A. positive subjective response B. stable vital signs C. increased exercise tolerance D. unchanged SpO 2 values

23. A patient with cystic fibrosis was involved in a motor vehicle crash and is being monitored for possible increases in intracranial pressure. Airway clearance has been ordered per protocol. Which of the following are appropriate for this patient? I. postural drainage and percussion II. oscillatory PEP III. in-exsufflator IV. high frequency chest vest A. I and II only B. I and III only C. II and IV only D. III and IV only EXPLANATIONS: I. False. Postural drainage and percussion in a head-down position are contraindicated in a patient with possible increased ICP. II. True. Oscillatory PEP, administered through the Acapella and Flutter ® valves, is an acceptable airway clearance technique because it does not require a head-down position. III. False. An in- exsufflator is primarily used for patients with neuromuscular diseases. It may cause airway collapse in patients with obstructive disease. The in- exsufflator may agitate the patient and may increase intracranial pressure. IV. True. A high frequency chest vest is an acceptable airway clearance technique for this patient because it does not require a head-down position. (h) A. Incomplete and incorrect response included. (h) B. Incorrect response. (c) C. Correct response. (h) D. Incomplete and incorrect response included.

24. A patient with a persistent dry cough suddenly starts producing copious amounts of pus-like, yellow, mucoid sputum. Which of the following actions should the respiratory therapist take? A. Request an order for aerosolized acetylcysteine (Mucomyst). B. Notify the physician a draining lung abscess is suspected. C. Obtain an order for postural drainage and percussion. D. Perform nasotracheal suctioning. EXPLANATIONS: (u) A. Aerosolized Mucomyst may precipitate bronchospasm and may increase secretions, possibly making it difficult for the patient to clear all the secretions. (c) B. Sputum, secondary to a lung abscess, is characterized by its sudden onset and production of pus-like, yellow, mucoid sputum. (h) C. There is no indication for postural drainage and percussion. There is the potential for contaminating the rest of the lungs with the infected secretions. (u) D. Nasotracheal suctioning is traumatic and could cause vomiting. Suctioning would only be indicated if the patient were unable to clear the secretions.

25. A patient with bronchiectasis has received postural drainage. Based on the results of auscultation, sputum production, and the chest radiograph, the therapy was deemed ineffective. Which of the following should the respiratory therapist recommend? A. volume-oriented IPPB therapy B. incentive spirometry C. turning and mobilization D. PEP and increased hydration EXPLANATIONS: (u) A. Secretion clearance would not improve directly with hyperinflation maneuvers. (u) B. Secretion clearance would not improve directly with hyperinflation maneuvers. (u) C. Since postural drainage has failed, there is no reason to anticipate turning and mobilization, a similar procedure, would be effective. (c) D. These are secondary methods for secretion clearance and would be indicated when postural drainage is ineffective.

26. Which of the following conditions alter normal mucociliary clearance? I. Bronchospasm II. Cystic fibrosis III. Ciliary dyskinesia A. I, II, III B. I and II C. I and III D. II and III

27. 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.Patient prone with a pillow under abdomen, bed flat B.Head down, patient prone with a pillow under abdomen C.Head down, patient supine with a pillow under knees D.Patient supine with a pillow under knees, bed flat