Question 1

Which of the following would be associated with the distal airway and alveolar weakening clinical scenario?
1) Depressed diaphragm on chest radiograph
2) Use of accessory muscles of inspiration
3) Rhonchi and wheezing
4) Increased PEFR

A) 1, 2
B) 1, 3
C) 1, 2, 3
D) 1, 3, 4

1, 2

Accepted Answer

When distal airway and alveolar weakening is present, air trapping occurs, resulting in the depressed diaphragm on the chest radiograph and use of accessory muscles of inspiration.

Question 2

Which of the following protocols would be indicated when a patient with increased alveolar-capillary membrane thickening has increased opacity on the chest radiograph, bronchial breath sounds, and a dull percussion note?

A) Aerosolized medication protocol
B) Lung expansion protocol
C) Oxygen therapy protocol
D) Bronchopulmonary hygiene protocol

Lung expansion protocol

Accepted Answer

Increased opacity on the chest radiograph, bronchial breath sounds, and a dull percussion note would result from increased lung density. Therapeutic hyperinflation modalities via the lung expansion protocol would be indicated.

Question 3

When a patient has acute MI, which of the following protocols should the respiratory therapist initiate?&#10;A) Hyperinflation therapy protocol&#10;B) Oxygen therapy protocol&#10;C) Bronchopulmonary hygiene therapy protocol&#10;D) Aerosolized medication therapy protocol

Accepted Answer

Acute myocardial infarction is one of the clinical indicators specified on the oxygen therapy protocol. Oxygen therapy will reduce myocardial work.

Question 4

When performing a therapist-driven protocol (TDP), the severity assessment determines:&#10;A) the frequency of performing a treatment modality.&#10;B) the baseline dyspnea index.&#10;C) the number of hospital days covered by the insurance carrier.&#10;D) how urgently the physician wants the patient treated.

Accepted Answer

Under a protocol, the severity assessment refers to the frequency of treatment. If the patient worsens, therapy must be up-regulated; if the patient improves, therapy must be down-regulated.

Question 5

Which of the following is (are) associated with the alveolar consolidation clinical scenario?
1) Increased opacity on the chest radiograph
2) Decreased FRC
3) Bronchial breath sounds
4) Hyperresonant percussion note

A) 3
B) 2, 4
C) 1, 2, 3
D) 1, 2, 3, 4

Accepted Answer

A patient with bronchospasm would have increased airway resistance and air trapping. The air trapping would result in a hyperresonant percussion note.

Question 6

Which of the following is (are) associated with the alveolar consolidation clinical scenario?
1) Increased opacity on the chest radiograph
2) Decreased FRC
3) Bronchial breath sounds
4) Hyperresonant percussion note

A) 3
B) 2, 4
C) 1, 2, 3
D) 1, 2, 3, 4

Accepted Answer

Alveolar consolidation would cause decreased lung volume resulting in a decreased FRC. Opaque lung fields would appear on the chest radiograph. Bronchial breath sounds would be expected with alveolar consolidation.

Question 7

Postural drainage, percussion, and vibration are part of what TDP?&#10;A) Lung expansion protocol&#10;B) Bronchopulmonary hygiene therapy protocol&#10;C) Aerosolized medication therapy protocol&#10;D) Oxygen therapy protocol

Accepted Answer

Postural drainage, percussion, and vibration are treatment modalities in the bronchopulmonary hygiene therapy protocol. Increased hydration, cough and deep breathing, incentive spirometry, and suctioning are among other treatment options in this protocol.

Question 8

An obese patient had upper abdominal surgery 2 days earlier. He has a weak nonproductive cough and a pulse oximeter (SpO₂ ) reading of 84% on room air. Which therapist-driven protocol(s) should be implemented?
1) Bronchopulmonary hygiene therapy
2) Lung expansion
3) Oxygen therapy
4) Aerosolized medication therapy

A) 1
B) 3, 4
C) 2, 3
D) 1, 3, 4

Accepted Answer

Upper abdominal surgery is specified as one of the clinical indications for implementation of the lung expansion protocol. The oxygen therapy protocol would be indicated since the SpO₂ is less than 90% on room air.

Question 9

A TDP can be started after:&#10;A) the nurse finishes his or her assessment.&#10;B) the treatment option is selected.&#10;C) a physician's order for the TDP is received.&#10;D) authorization is received from the patient's insurance carrier.

Accepted Answer

A physician must order a TDP before the respiratory therapist can initiate the ordered protocol.

Question 10

Which of the following pathophysiologic mechanisms would be expected in the excessive bronchial secretions clinical scenario?
1) Decreased ventilation/perfusion ratio
2) Increased airway resistance
3) Stimulation of the deflation reflex
4) Stimulation of the irritant reflex

A) 1, 2
B) 1, 4
C) 1, 2, 3
D) 1, 2, 4

Accepted Answer

When excessive bronchial secretions are present, the ventilation/perfusion ratio is decreased. Increased airway resistance would result from the excessive secretions which would stimulate the irritant reflex.

Question 11

According to the aerosolized medication therapy protocol, the respiratory therapist may select medications from all of the following categories EXCEPT _____ agents.&#10;A) antiinflammatory&#10;B) sympathomimetic&#10;C) parasympatholytic&#10;D) antimicrobial

Accepted Answer

The answer of According to the aerosolized medication therapy protocol,...

Deck 9: The Therapist-Driven Protocol Program and the Role of the Respiratory Therapist