Deck 24: Performing Chest Physiotherapy

Question 1

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

Answer 1

percussion
Percussion involves clapping the chest wall with cupped hands.It sets up vibrations in the chest to dislodge retained secretions from the airway.

Question 2

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.

Answer 2

Allow patient to perform other tasks while receiving therapy.
Improve patient adherence to chest physiotherapy.
Assist in the removal of secretions from the lungs.
Decrease the viscosity of mucus so coughing it up will be easier.

Question 3

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 _____________.

Answer 3

mucociliary transport system
In the normal lung,the mucociliary transport system clears the airways of excessive mucus and inhaled particles.This system lines the internal lumen of the entire tracheobronchial tree and consists of a thin layer of mucus that is constantly being propelled toward the larynx by cells that have hairlike projections called cilia.

Question 4

To move secretions from small distal airways into larger central airways,the nurse would use ________________ and _______________.

Question 5

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

Question 6

A patient has received instructions on the use of an Acapella device.Which action by the patient indicates an understanding of the teaching?

A)Complains of not being able to use an aerosol drug 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 7

The health care provider orders 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 8

The _______________ provides positive expiratory pressure (PEP)with oral airway oscillations.

Question 9

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

Question 10

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 levels (ABG).

Question 11

A patient has retained secretions in the right and left lower lobe superior bronchi.A nurse is demonstrating to family members 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 12

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.

Question 13

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.

Question 14

Percussion and vibration is ordered 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 3 times and then instructs the patient to take a deep breath and cough while exhaling.

Question 15

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

Question 16

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

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

Question 17

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

Question 18

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

Question 19

________________ is positioning the patient so that the position of the lung segment to be drained allows gravity to have its greatest effect.

Question 20

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