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

1. none of them use a source of pressurized gas
2. they all use a source of pressurized gas
3. all of them increase the patient's lung volume by increasing the transpulmonary pressure gradient
4. they all increase the patient's lung volume by decreasing the transpulmonary pressure gradient

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

1. CPAP
2. PEEP
3. PEP
4. IPPB

3. Positive expiratory pressure (PEP) _______.

1. utilizes pressurized gas sources
2. prevents airway collapse during expiration
3. requires that patients forcefully exhale
4. decreases pressure within the airways

4. Incentive spirometry is performed using devices which provide _______.

1. patients with assistance for their work of breathing
2. visual cues so patients can see that the desired flow or volume has been achieved
3. negative pressure swings early in inspiration
4. rising C02 levels after therapy

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

1. IPPB equipment
2. pressure-cycled ventilator
3. CPAP
4. an incentive spirometer

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.

1. 5 to 9
2. 10 to 15
3. 16 to 19
4. 20 to 25

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

1. can provide improved venous return
2. assists the patient by decreasing airway resistance
3. tends to increase cardiac output
4. can drastically lower cardiac output

8. Incentive spirometry (IS) enhances lung expansion _______.

1. through a spontaneous and sustained decrease in pleural pressure
2. through sustained mechanically enhanced positive airway pressure
3. by increasing alveolar pressure
4. by applying negative pressure during inspiration

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

1. alveolar collapse
2. cough maneuver
3. raising of the transpulmonary pressure gradient
4. increase of pulmonary vascular resistance

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

1. 3 to 5
2. 6 to 14
3. 15 to 20
4. 25 to 30

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.

1. IS
2. PEEP
3. CPAP
4. IPPB

12. Lung expansion therapies which _______ are closer to natural circumstances.

1. decrease pleural pressure
2. raise alveolar pressure
3. compress the lung's vascular beds
4. increase pulmonary vascular resistance

13.The clinical situations indicating a need for incentive spirometry include:

1. surgical procedure involving upper abdomen or thorax
2. conditions predisposing to development of atelectasis
3. presence of neuromuscular disease involving respiratory muscles
4. all of the above

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.

1. PEEP
2. EPAP
3. CPAP
4. PEP

15. The successful administration of effective IPPB therapy primarily requires _______.

1. appropriate coughing and breathing instruction
2. a pressure-limited machine to accomplish maximal inspiration and a means of measuring VT
3. an informed, and cooperative patient who meets the criteria for therapy
4. all the above

16. If IPPB is to be successful, it must _______.

1. increase alveolar distending pressure
2. decrease alveolar distending pressure
3. increase negative alveolar pressure
4. decrease the patient's tidal volumes

17. Positive pressure increases the transpulmonary pressure gradient by _______.

1. decreasing cardiac output
2. raising the pressure inside the alveoli
3. lowering the pressure inside the alveoli
4. increasing pleural pressure

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

1. often questioned regarding its cost-effectiveness
2. heavily dependent on proper equipment performance
3. effective and appropriate for prophylactic bronchial hygiene
4. all the above

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.

1. CPAP
2. PEP
3. IS
4. EPAP

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

1. pleural edema
2. barotrauma
3. decreased cardiac output
4. atelectasis

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).

1. IS
2. CPAP
3. IPPB
4. PEEP

22. Air trapping associated with IPPB therapy generally occurs _______.

1. if the pressures are set too low
2. when insufficient time is provided for exhalation during therapy
3. when the inspiratory time is shor10ed
4. all the above

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

1. patients with high blood pressure
2. patients with COPD
3. postoperative patients
4. elderly patients

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.

1. as frequently as hourly
2. once every two hours
3. once every four hours
4. three times a day

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

1. whose lungs have retained secretions
2. with acute atelectasis
3. with a respiratory rate of greater than 25 per minute
4. with an FVC greater than 15 ml/kg

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