Chapter 24 Performing Chest Physiotherapy

Chapter 24  Performing Chest Physiotherapy

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. The nurse receives orders on several patients for chest percussion, vibration, and shaking. The nurse is aware that chest physiotherapy maneuvers 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

ANS: C
Chest physiotherapy (CPT) and coughing maneuvers assist with airway clearance of mucus in patients with retained tracheobronchial secretions. Secretions accumulate in the airways of patients with bronchitis, asthma, cystic fibrosis (CF), pneumonia, and bronchiectasis. Thoracic trauma, osteoporosis, and fracture of rib cage structures such as the clavicle contraindicate percussion, vibration, and shaking.

DIF: Cognitive Level: Comprehension REF: Text reference: pp. 613-614 |Text reference: p. 617
OBJ: Determine the need to modify or discontinue CPT maneuvers, including contraindications and individual variations. TOP: Indications for CPT
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. 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 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

ANS: C
Secretions accumulate in patients with bronchitis, asthma, cystic fibrosis, pneumonia, and bronchiectasis. Contraindications for postural drainage include pulmonary edema associated with congestive heart failure, active hemoptysis, and pulmonary embolism.

DIF: Cognitive Level: Analyzing REF: Text reference: pp. 613-614
OBJ: Determine the need to modify or discontinue CPT maneuvers, including contraindications and individual variations.
TOP: Contraindications and Indications for Postural Drainage
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. The nurse is teaching family members 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 3 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.

ANS: C
Patients receiving inhaled bronchodilators, nebulizers, or aerosol treatments should have postural drainage performed 20 minute after such therapy. If a patient’s pain is 4 or greater, analgesics should be administered 20 minutes before CPT maneuvers. Pain control is essential for the patient to actively participate and cough forcefully to clear the airways. Treatments should not overlap with meals. Avoid postural drainage 1 to 2 hours before and after meals. The patient should maintain each position for 10 to 15 minutes.

DIF: Cognitive Level: Applying REF: Text reference: p. 618
OBJ: Explain how to prepare the patient and the family for the performance of each CPT maneuver.
TOP: Teaching Considerations KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

4. The nurse receives orders for an Acapella device on several patients. The nurse should question the order on the patient with which condition?
a.
Chronic bronchitis
b.
Asthma
c.
Cystic fibrosis (CF)
d.
Pleural effusion

ANS: D
The Acapella device is a respiratory rehabilitation device designed to aid sputum clearance. Patients with chronic conditions such as cystic fibrosis, chronic bronchitis, and asthma appear to receive the greatest benefit from this type of treatment. CPT is contraindicated in patients with pleural effusion.

DIF: Cognitive Level: Applying REF: Text reference: p. 614
OBJ: Perform the outlined CPT maneuvers, including standard and modified versions.
TOP: Acapella Device KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

5. The nurse is teaching a patient how to use an Acapella 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.

ANS: D
Instruct the patient to try not to cough and to exhale slowly for 3 to 4 seconds through the device while it vibrates. The patient should be instructed to take in a breath that is larger than normal, but not to fill the lungs completely—about 75% of inspiratory capacity. Hold the breath for 2 to 3 seconds, and try not to cough.

DIF: Cognitive Level: Applying REF: Text reference: p. 620
OBJ: Describe discharge teaching and planning related to the use of each CPT maneuver in the home setting. TOP: Acapella Device
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity