Deck 24: Performing Chest Physiotherapy

Question 1

The nurse receives a prescription for postural drainage using Trendelenburg's position.On which patients should the nurse question the prescription? (Select all that apply.)

A) Patient with a history of gastroesophageal reflux disease (GERD)
B) Postoperative patient with a distended abdomen
C) Patient with blood pressure of 180/100
D) Patient with bronchiectasis on chest x-ray examination

Answer 1

Patient with a history of gastroesophageal reflux disease (GERD)
Postoperative patient with a distended abdomen
Patient with blood pressure of 180/100

Question 2

The nurse is planning to perform postural drainage on a patient who is receiving continuous tube feedings.What should the nurse do before performing the treatment? (Select all that apply.)

A) Stop the tube feedings for 1 to 2 hours before and after postural drainage.
B) Check for residual feeding in the patient's stomach and hold treatment if greater than 100 mL.
C) Give the prescribed inhaled bronchodilator 20 minutes before the procedure.
D) Auscultate all lung fields,assess vital signs,and draw arterial blood gas (ABG)levels.

Answer 2

Check for residual feeding in the patient's stomach and hold treatment if greater than 100 mL.
Give the prescribed inhaled bronchodilator 20 minutes before the procedure.

Question 3

A patient who is very frail and thin with osteoporosis has just undergone abdominal surgery.The nurse anticipates that which technique will be used to control respiratory secretions in this patient?

A) Forceful coughing
B) Percussion
C) Vibration
D) Shaking

Answer 3

Forceful coughing

Question 4

The patient is complaining of feeling congested.After assessing the patient,the nurse places the patient in the proper position and claps his or her cupped hands against the patient's thorax.He or she does this because he or she is aware that ______________ assists in loosening retained secretions from the airway.

A) warmth
B) percussion
C) massage
D) therapeutic touch

Question 5

The nurse is teaching a caregiver how to perform postural drainage at home for a patient with chronic bronchitis.What instruction should the nurse provide?

A) Plan to perform postural drainage three times a day about 1 hour after meals.
B) Don't give any pain medication within 2 hours of performing postural drainage.
C) Perform postural drainage 20 minutes after the patient uses the inhaler.
D) Encourage the patient to remain in each position for 30 minutes to adequately drain the area.

Question 6

The nurse auscultates the patients' lung fields and notes congestion in several patients.The nurse anticipates that postural drainage may be used for the patient with which condition?

A) Congestive heart failure (CHF)with pulmonary edema
B) History of cigarette smoking with recent hemoptysis
C) Chronic bronchitis with frequent coughing
D) Pulmonary embolism after a long international flight

Question 7

The nurse is teaching a patient how to use a positive expiratory pressure (PEP)device.What instruction should the nurse give to the patient?

A) Take a full deep breath in and fill your lungs.
B) Hold your breath for 5 to 10 seconds after placing the mouthpiece in your mouth.
C) Cough forcefully to clear your lungs while maintaining a tight seal on the mouthpiece.
D) Exhale slowly for 3 to 4 seconds through the device while it vibrates.

Question 8

The nurse receives a prescription for a high-frequency chest wall oscillation (HFCWO)vest airway clearance system on several patients.The nurse should question the prescription on the patient with which condition?

A) Chronic bronchitis
B) Asthma
C) Cystic fibrosis
D) Pleural effusion

Question 9

The system that lines the internal lumen of the tracheobronchial tree and consists of a thin layer of mucus that constantly is propelled toward the larynx by cilia is called the _____________.

A) normal flora
B) peristaltic system
C) mucociliary transport system
D) humidification system

Question 10

The nurse is reviewing medical records on several patients.Which findings reported in the chart indicate the need for postural drainage? (Select all that apply.)

A) Atelectasis reported on chest x-ray examination
B) Thick,sticky,tenacious,green secretions noted in the nurse's notes
C) Multiple rib fractures noted on chest x-ray examination
D) Chest x-ray report indicating pneumonia with collapse of right lower lobe

Question 11

Percussion and vibration are prescribed on a patient with retained pulmonary secretions.Which action by the student nurse should the nursing instructor question?

A) Performs percussion for 3 to 5 minutes in each position as tolerated
B) Uses the wrist and elbow to create movement when performing percussion
C) While the patient inhales,gently pushes down and vibrates the chest wall with the flat part of the hand
D) Repeats the vibration three times and then instructs the patient to take a deep breath and cough while exhaling

Question 12

A patient has received instructions on the use of a positive expiratory pressure (PEP)device.Which action by the patient indicates an understanding of the teaching?

A) Complains of not being able to use an aerosol medication with the device
B) Turns the frequency adjustment dial to medium resistance
C) After completing one cycle,repeats for 2 more breaths
D) After removing the mouthpiece,performs 1 to 2 forceful exhalations and "huff" coughs

Question 13

A patient has retained secretions in the right and left lower lobe superior bronchi.A nurse is demonstrating to the caregiver how to perform percussion and vibration.Which action by the nurse is appropriate?

A) Positioning the patient in a chair leaning forward on a table
B) Asking the patient to lie flat on the stomach with a pillow under the stomach
C) Assisting the patient to the right side with the arm overhead and the feet elevated
D) Asking the patient to lie on the left side with the head elevated

Question 14

The nurse receives prescriptions on several patients for chest percussion,vibration,and shaking.The nurse is aware that chest physiotherapy manoeuvres are indicated for which patient?

A) 18-year-old who sustained thoracic trauma from a motor vehicle accident
B) 75-year-old with osteoporosis who is underweight
C) 15-year-old with cystic fibrosis
D) 20-year-old with a fractured clavicle

Question 15

The health care provider prescribes percussion on a patient to help clear airway secretions.Which action by the nurse is appropriate?

A) Performing percussion over the ribs,while avoiding the clavicles and sternum
B) Administering pain medication before performing the percussion because the vibrations will be painful
C) Performing percussion during exhalation only with the flat part of the palm
D) Creating a rocking motion by slightly leaning on the patient's chest

Question 16

The nurse is teaching the family of a patient with cystic fibrosis how to use a high-frequency chest wall oscillation (HFCWO)vest.The nurse informs the family that this device will do which of the following? (Select all that apply.)

A) Allow patient to perform other tasks while receiving therapy.
B) Improve patient adherence to chest physiotherapy.
C) Assist in the removal of secretions from the lungs.
D) Decrease the viscosity of mucus so coughing it up will be easier.
E) None of the above

Question 17

The nurse positions the patient flat on the back with a small pillow under the knees to drain the right and left _____________________.

A) anterior upper lobe bronchi
B) anterior lower lobe bronchi
C) posterior upper lobe bronchi
D) posterior lower lobe bronchi