Lung Expansion Therapy

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| By One_militantmind
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Lung Expansion Therapy - Quiz

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Questions and Answers
  • 1. 

    While there a number of different modalities used to administer lung expansion therapy, they all have one thing in common: _______.

    • A.

      None of them use a source of pressurized gas

    • B.

      They all use a source of pressurized gas

    • C.

      All of them increase the patient's lung volume by increasing the transpulmonary pressure gradient

    • D.

      They all increase the patient's lung volume by decreasing the transpulmonary pressure gradient

    Correct Answer
    C. All of them increase the patient's lung volume by increasing the transpulmonary pressure gradient
    Explanation
    All of the different modalities used to administer lung expansion therapy increase the patient's lung volume by increasing the transpulmonary pressure gradient. This means that they create a pressure difference between the inside of the lungs and the outside, which helps to expand the lungs and increase their volume. This pressure difference can be achieved through various methods, such as positive pressure ventilation or the use of devices like incentive spirometers. Regardless of the specific modality used, the goal is to increase the transpulmonary pressure gradient and ultimately expand the lungs.

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  • 2. 

     Historically, the modality first used for lung expansion therapy was _______.

    • A.

      CPAP

    • B.

      PEEP

    • C.

      PEP

    • D.

      IPPB

    Correct Answer
    D. IPPB
    Explanation
    Historically, the modality first used for lung expansion therapy was IPPB (Intermittent Positive Pressure Breathing). IPPB involves delivering intermittent bursts of positive pressure to the lungs, helping to expand and improve lung function. This technique was commonly used before the development of other modalities such as CPAP (Continuous Positive Airway Pressure), PEEP (Positive End-Expiratory Pressure), and PEP (Positive Expiratory Pressure).

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  • 3. 

    Positive expiratory pressure (PEP) _______.

    • A.

      Utilizes pressurized gas sources

    • B.

      Prevents airway collapse during expiration

    • C.

      Requires that patients forcefully exhale

    • D.

      Decreases pressure within the airways

    Correct Answer
    C. Requires that patients forcefully exhale
    Explanation
    Positive expiratory pressure (PEP) requires that patients forcefully exhale. This technique involves the use of a device that generates resistance during expiration, forcing the patient to exhale with more force than normal. By doing so, PEP helps to keep the airways open and prevent collapse, improving ventilation and aiding in the clearance of mucus and secretions. This technique is commonly used in respiratory therapy to treat conditions such as chronic obstructive pulmonary disease (COPD) and cystic fibrosis.

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  • 4. 

    Incentive spirometry is performed using devices which provide _______.

    • A.

      Patients with assistance for their work of breathing

    • B.

      Visual cues so patients can see that the desired flow or volume has been achieved

    • C.

      Negative pressure swings early in inspiration

    • D.

      Rising C02 levels after therapy

    Correct Answer
    B. Visual cues so patients can see that the desired flow or volume has been achieved
    Explanation
    Incentive spirometry is performed using devices which provide visual cues so patients can see that the desired flow or volume has been achieved. This means that the devices have features that allow patients to visually monitor and track their breathing efforts, ensuring that they are achieving the desired flow or volume as part of their therapy. This visual feedback can be helpful for patients to gauge their progress and adjust their breathing techniques accordingly.

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  • 5. 

     _______ allows patients to perform sustained maximal inspiration (SMI) without added resistance while presenting a visual quantitation of the inspiratory effort. 

      • A.

        IPPB equipment

      • B.

        Pressure-cycled ventilator

      • C.

        CPAP

      • D.

        An incentive spirometer

      Correct Answer
      D. An incentive spirometer
      Explanation
      An incentive spirometer allows patients to perform sustained maximal inspiration (SMI) without added resistance while presenting a visual quantitation of the inspiratory effort. This device helps patients improve their lung function by encouraging deep breathing and expanding their lung capacity. It is commonly used after surgery or in patients with respiratory conditions to prevent complications such as atelectasis and pneumonia. By providing visual feedback, the incentive spirometer motivates patients to achieve their maximum inspiratory effort and helps healthcare providers monitor their progress.

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    1. 6. 

      When positive pressure is applied to the pharynx, the esophagus can open and gas can pass directly into the stomach. The pressure at which this esophageal opening pressure occurs somewhere between _______ cm H2O. Pharyngeal pressures exceeding this range may cause gastric distention.  

        • A.

          5 - 10

        • B.

          10 - 15

        • C.

          15 - 20

        • D.

          20 - 25

        Correct Answer
        D. 20 - 25
      1. 7. 

        If a patient is already hypotensive or if compensation is not possible, the administration of IPPB therapy _______.

        • A.

          Can provide improved venous return

        • B.

          assists the patient by decreasing airway resistance

        • C.

          Tends to increase cardiac output

        • D.

          Can drastically lower cardiac output

        Correct Answer
        D. Can drastically lower cardiac output
        Explanation
        If a patient is already hypotensive or if compensation is not possible, the administration of IPPB therapy can drastically lower cardiac output. This means that the therapy can cause a significant decrease in the amount of blood pumped by the heart in a given time period. This can be detrimental to the patient's overall cardiovascular function and may worsen their hypotension.

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      2. 8. 

        Incentive spirometry (IS) enhances lung expansion _______.

        • A.

          Through a spontaneous and sustained decrease in pleural pressure

        • B.

          Through sustained mechanically enhanced positive airway pressure

        • C.

          By increasing alveolar pressure

        • D.

          by applying negative pressure during inspiration

        Correct Answer
        A. Through a spontaneous and sustained decrease in pleural pressure
        Explanation
        Incentive spirometry (IS) is a technique used to improve lung function and prevent complications after surgery or in individuals with respiratory conditions. It involves deep breathing exercises using a device called a spirometer. By using the device, the individual is able to take slow, deep breaths, which helps to expand the lungs and increase lung capacity. This expansion is achieved through a spontaneous and sustained decrease in pleural pressure, which allows for improved air exchange in the alveoli and better oxygenation of the blood.

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      3. 9. 

        The _______ consists of a deep inspiration, the glottis closing, the diaphragm and other muscles of respiration contracting, and high interpulmonic pressure being achieved.  

          • A.

            Alveolar collapse

          • B.

            Cough maneuver

          • C.

            Raising of the transpulmonary pressure gradient

          • D.

            Increase of pulmonary vascular resistance

          Correct Answer
          B. Cough maneuver
          Explanation
          The cough maneuver refers to the process of forcefully expelling air from the lungs to clear the airways. It involves a deep inspiration, closing of the glottis (the opening between the vocal cords), contraction of the diaphragm and other respiratory muscles, and the generation of high interpulmonic pressure. This combination of actions helps to expel mucus, irritants, or foreign particles from the respiratory system, aiding in clearing the airways and promoting effective breathing.

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        1. 10. 

          Depending on the goals of therapy and condition of the patient, IPPB treatments typically last from _______ minutes. 

            • A.

              15 - 20

            • B.

              10 - 25

            • C.

              10 - 15

            • D.

              5 - 15

            Correct Answer
            A. 15 - 20
            Explanation
            IPPB (Intermittent Positive Pressure Breathing) treatments are used in respiratory therapy to help patients improve their lung function. The duration of these treatments depends on the goals of therapy and the condition of the patient. The correct answer, 15 - 20 minutes, suggests that IPPB treatments typically last for this duration. This duration allows enough time for the therapy to be effective in improving lung function without causing excessive strain or fatigue on the patient.

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          1. 11. 

            The single overall clinical goal of _______ therapy is to provide patients with a significantly larger VT at a physiologically advantageous inspiratory-to-expiratory pattern than the they can produce with spontaneous ventilation.

            • A.

              IS

            • B.

              PEEP

            • C.

              CPAP

            • D.

              IPPB

            Correct Answer
            D. IPPB
            Explanation
            IPPB stands for Intermittent Positive Pressure Breathing. The goal of IPPB therapy is to provide patients with a significantly larger VT (tidal volume) at a physiologically advantageous inspiratory-to-expiratory pattern than they can produce with spontaneous ventilation. This therapy involves delivering intermittent positive pressure breaths to help improve lung function and oxygenation in patients with respiratory conditions. By providing a larger VT, IPPB therapy helps to improve ventilation and oxygenation in patients who are unable to achieve adequate breathing on their own.

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          2. 12. 

             Lung expansion therapies which _______ are closer to natural circumstances.

            • A.

              Decrease pleural pressure

            • B.

              Raise alveolar pressure

            • C.

              Compress the lung's vascular beds

            • D.

              Increase pulmonary vascular resistance

            Correct Answer
            A. Decrease pleural pressure
            Explanation
            Lung expansion therapies that decrease pleural pressure help to create conditions that are closer to natural circumstances. Pleural pressure refers to the pressure within the pleural space, which is the space between the lungs and the chest wall. By decreasing pleural pressure, these therapies help to expand the lungs and increase their capacity, allowing for improved ventilation and oxygenation. This mimics the natural process of breathing and promotes better lung function.

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          3. 13. 

            The clinical situations indicating a need for incentive spirometry include:

            • A.

              surgical procedure involving upper abdomen or thorax

            • B.

              conditions predisposing to development of atelectasis

            • C.

              Presence of neuromuscular disease involving respiratory muscles

            • D.

              All of the above

            Correct Answer
            D. All of the above
            Explanation
            The correct answer is "all of the above." This means that all of the clinical situations mentioned, including surgical procedures involving the upper abdomen or thorax, conditions predisposing to the development of atelectasis, and the presence of neuromuscular disease involving respiratory muscles, indicate a need for incentive spirometry. Incentive spirometry is a technique used to improve lung function and prevent complications such as atelectasis, and it is beneficial in these specific clinical situations.

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          4. 14. 

             With _______ therapy, the pressure generated by a threshold resistor is independent of flow, and can be set to provide specific expiratory pressures independent of flow, usually between 10 to 20 cm H20.

            • A.

              PEEP

            • B.

              EPAP

            • C.

              CPAP

            • D.

              PEP

            Correct Answer
            B. EPAP
            Explanation
            EPAP stands for expiratory positive airway pressure. It is a type of therapy where the pressure generated by a threshold resistor is independent of flow. This means that regardless of how fast or slow the patient exhales, the pressure remains constant. EPAP is used to provide specific expiratory pressures, typically between 10 to 20 cm H20. It helps to keep the airways open and improve oxygenation during expiration.

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          5. 15. 

            The successful administration of effective IPPB therapy primarily requires _______. 

              • A.

                Appropriate coughing and breathing instruction

              • B.

                A pressure-limited machine to accomplish maximal inspiration and a means of measuring VT

              • C.

                An informed, and cooperative patient who meets the criteria for therapy

              • D.

                All of the above

              Correct Answer
              D. All of the above
              Explanation
              The successful administration of effective IPPB therapy primarily requires appropriate coughing and breathing instruction, a pressure-limited machine to accomplish maximal inspiration and a means of measuring VT, and an informed and cooperative patient who meets the criteria for therapy. All of these factors are essential for the therapy to be successful. Without appropriate instruction, the patient may not be able to effectively perform the therapy. The pressure-limited machine and measurement of VT are necessary to ensure the therapy is being administered correctly. Additionally, an informed and cooperative patient is crucial as they need to understand the therapy and actively participate in it.

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            1. 16. 

               If IPPB is to be successful, it must _______.

              • A.

                Increase alveolar distending pressure

              • B.

                Decrease alveolar distending pressure

              • C.

                increase negative alveolar pressure

              • D.

                Decrease the patient's tidal volumes

              Correct Answer
              A. Increase alveolar distending pressure
              Explanation
              To ensure the success of IPPB (Intermittent Positive Pressure Breathing), it is crucial to increase alveolar distending pressure. This pressure helps to keep the alveoli in the lungs open during inhalation, allowing for efficient gas exchange. By increasing alveolar distending pressure, IPPB can effectively deliver oxygen to the lungs and remove carbon dioxide, promoting proper respiratory function. This is essential for patients who may have difficulty breathing on their own or require assistance in maintaining adequate ventilation.

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            2. 17. 

              Positive pressure increases the transpulmonary pressure gradient by _______.

              • A.

                Decreasing cardiac output

              • B.

                raising the pressure inside the alveoli

              • C.

                Lowering the pressure inside the alveoli

              • D.

                Increasing pleural pressure

              Correct Answer
              B. raising the pressure inside the alveoli
              Explanation
              Positive pressure in the alveoli refers to a higher pressure inside the alveoli compared to the atmospheric pressure. This positive pressure increases the transpulmonary pressure gradient, which is the difference in pressure between the alveoli and the pleural space. The transpulmonary pressure gradient is necessary for proper lung expansion and ventilation. By raising the pressure inside the alveoli, the transpulmonary pressure gradient is increased, allowing for better lung function and gas exchange.

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            3. 18. 

              Incentive spirometry (IS) is a technique that is _______.

              • A.

                Often questioned regarding its cost-effectiveness

              • B.

                Heavily dependent on proper equipment performance

              • C.

                Effective and appropriate for prophylactic bronchial hygiene

              • D.

                All of the above

              Correct Answer
              C. Effective and appropriate for prophylactic bronchial hygiene
              Explanation
              Incentive spirometry (IS) is a technique that is effective and appropriate for prophylactic bronchial hygiene. This means that IS is both successful in preventing respiratory infections and suitable for maintaining the cleanliness of the bronchial tubes. It is not only questioned regarding its cost-effectiveness or dependent on proper equipment performance, but it is also considered an effective and appropriate method for bronchial hygiene.

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            4. 19. 

              The patient on breathes through a pressurized circuit against a threshold resistor, with pressures (during both inspiration and expiration) maintained between 5 to 20 cm H20. 

                • A.

                  CPAP

                • B.

                  IPPB

                • C.

                  PEEP

                • D.

                  PEP

                Correct Answer
                A. CPAP
                Explanation
                CPAP stands for Continuous Positive Airway Pressure. It is a treatment method used to help patients with breathing difficulties, particularly those with sleep apnea. In CPAP, the patient breathes through a pressurized circuit against a threshold resistor, which helps to keep the airway open and prevent collapse. The pressures during both inspiration and expiration are maintained between 5 to 20 cm H20. CPAP is commonly used to treat conditions such as sleep apnea, where it helps to improve the quality of sleep and reduce symptoms like snoring and daytime fatigue.

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              1. 20. 

                _______ can occur when a high transpulmonary pressure gradients causes gross overdistension (too high a volume at too high a pressure). 

                  • A.

                    Pleural edema

                  • B.

                    Barotrauma

                  • C.

                    Decreased cardiac output

                  • D.

                    Atelectasis

                  Correct Answer
                  B. Barotrauma
                  Explanation
                  Barotrauma can occur when there is a high transpulmonary pressure gradient, leading to overdistension of the lungs. This happens when there is too much volume of air or gas at a high pressure, causing damage to the lung tissue. Barotrauma is commonly seen in conditions such as mechanical ventilation, scuba diving, or high-altitude flying, where there is a significant change in pressure. It can result in pneumothorax (air in the pleural space), pneumomediastinum (air in the mediastinum), or other complications.

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                1. 21. 

                  _______ therapy is defined as the therapeutic application, usually via a mask or mouthpiece, of inspiratory positive pressure to the airway of a spontaneously breathing patient on an intermittent or short-term basis by an trained respiratory care practitioner (RCP). 

                    • A.

                      IS

                    • B.

                      CPAP

                    • C.

                      IPPB

                    • D.

                      PEEP

                    Correct Answer
                    C. IPPB
                    Explanation
                    IPPB stands for intermittent positive pressure breathing, which is a type of therapy that involves the application of inspiratory positive pressure to the airway of a spontaneously breathing patient. This therapy is typically delivered using a mask or mouthpiece and is administered on an intermittent or short-term basis by a trained respiratory care practitioner. CPAP, on the other hand, stands for continuous positive airway pressure, which is a different type of therapy that involves the continuous application of positive pressure to the airway to keep it open. PEEP stands for positive end-expiratory pressure, which is a technique used in mechanical ventilation to maintain positive pressure in the airways at the end of expiration. Therefore, the correct answer is IPPB.

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                  1. 22. 

                    Air trapping associated with IPPB therapy generally occurs _______.

                    • A.

                      If the pressures are set too low

                    • B.

                      When insufficient time is provided for exhalation during therapy

                    • C.

                      When the inspiratory time is shortened

                    • D.

                      All of the above

                    Correct Answer
                    B. When insufficient time is provided for exhalation during therapy
                    Explanation
                    Air trapping associated with IPPB therapy generally occurs when insufficient time is provided for exhalation during therapy. This means that the patient is not given enough time to fully exhale before the next inhalation, leading to a buildup of air in the lungs. This can cause discomfort and difficulty breathing for the patient. It is important to ensure that enough time is allowed for exhalation during IPPB therapy to prevent air trapping.

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                  2. 23. 

                     Lung expansion therapies are primarily administered to prevent or treat atelectasis, and those at highest risk for atelectasis are _______. 

                      • A.

                        Patients with high blood pressure

                      • B.

                        Patients with COPD

                      • C.

                        Post operative patients

                      • D.

                        Elderly patients

                      Correct Answer
                      A. Patients with high blood pressure
                      Explanation
                      Patients with high blood pressure are at highest risk for atelectasis because they may have compromised lung function due to their condition. High blood pressure can lead to decreased blood flow to the lungs, which can result in reduced oxygen levels and impaired lung expansion. This can increase the likelihood of atelectasis, a condition where the lung or a portion of it collapses. Lung expansion therapies, such as deep breathing exercises and incentive spirometry, help to improve lung function and prevent atelectasis in these patients.

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                    1. 24. 

                      In order to help prevent atelectasis and accumulation of bronchial secretions, incentive spirometry is used to ensure that the lungs are maximally inflated _______ in a way that assures optimal distribution of ventilation.

                      • A.

                        As frequently as hourly

                      • B.

                        Every two hours

                      • C.

                        Every four hours

                      • D.

                        Four times a day

                      Correct Answer
                      A. As frequently as hourly
                      Explanation
                      Incentive spirometry is a technique used to encourage deep breathing and prevent lung complications such as atelectasis and bronchial secretions. By using the incentive spirometer as frequently as hourly, the lungs are maximally inflated regularly, ensuring optimal distribution of ventilation. This frequent use helps to prevent the collapse of lung tissue and promotes the clearance of secretions, maintaining lung function and preventing complications.

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                    2. 25. 

                      The guidelines for appropriate administration of incentive spirometry (SMI) include patients: 

                        • A.

                          Whose lungs have retained secretions

                        • B.

                          With acute atelectasis

                        • C.

                          With a respiratory rate of greater than 25 per minute

                        • D.

                          with an FVC greater than 15 ml/kg

                        Correct Answer
                        D. with an FVC greater than 15 ml/kg
                        Explanation
                        Incentive spirometry (SMI) is a breathing exercise that helps improve lung function and prevent complications such as atelectasis (collapse of the lung). It is typically recommended for patients who have retained secretions in their lungs or have acute atelectasis. However, it is not recommended for patients with a respiratory rate greater than 25 per minute, as they may not be able to effectively perform the exercise. Additionally, patients with a forced vital capacity (FVC) greater than 15 ml/kg have good lung function and can benefit from incentive spirometry.

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                      • Current Version
                      • Mar 22, 2023
                        Quiz Edited by
                        ProProfs Editorial Team
                      • Sep 13, 2016
                        Quiz Created by
                        One_militantmind
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