Download Review questions for IPPB part I

IPPB part I review questions 5/6/2017 12:47:50 AM page 1
1.
Name:
Review questions for IPPB part I
Date:
2007
IPPB:
a.
b.
c.
d.
e.
f.
immediate positive pressure breathing
intermittent positive pressure breathing
pressurized gas into a mask or mouthpiece
used to replace SMI by IS or segmental breathing
all but a
all but b
2.
SMI:
a.
b.
c.
means sustained maximal inspiration
is the same maneuver we use with incentive spirometer
both
3.
The breath of the IPPB ends when:
a. the preset time for the breath is over
b. the preset pressure is reached
c. the PIP is reached
d. all but a
e. all but b
4.
The PIP we select for IPPB will be based on:
a. The amount of the Vt we want to give
b. The compliance of the patient’s lung
c. Both
5.
Can we give inhaled medication with the IPPB?
a. If it has a inline SVN, yes
b. If it has an inline MDI, yes
c. No
6.
How does the inspiratory phase for IPPB start?
a. The PIP is reached
b. A negative pressure in the hose trips the machine on
7.
What event ends the inspiratory phase for IPPB?
a. The PIP is reached
b. A negative pressure in the hose trips the machine on
8.
Describe what happens to the flow of gas once the Peak pressure is reached.
a. The machine’s inspiratory flow rate slows and eventually stops
b. The machine’s inspiratory flow stops immediately
c. The machine’s expiratory flow starts immediate
d. Both b and c
9.
What is the function of the line that interfaces the mushroom valve and the main circuit line?
a. As the main circuit is pressurized, the mushroom valve gets pressure too
b. As the main circuit loses pressure at the end of the breath, the mushroom valve loses
pressure too.
c. As long as there is pressure in the line, the exhalation port is closed
d. All of these
e. All but c
10. Differentiate between the mushroom drive line and the drive line for the SVN.
a. The mushroom drive line keeps the exhalation port closed during inspiration
b. The mushroom drive line keeps the exhalation port open during inspiration
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c.
d.
e.
The SVN gets gas for nebulization during the inspiratory time
Both a and c
Both b and c
11. If the IPPB sensitivity knob is set correctly, the patient need only create what pressure to trigger on
the inspiratory phase?
a. + 15 cmH20
b. + 20 cmH20
c. + 2 cmH20
d. -2 cmH20
12. If the peak pressure is set at 20, at what pressure will the inspiratory phase end?
a. + 15 cmH20
b. + 20 cmH20
c. - 20 cmH20
d. -2 cmH20
13. Identify the acceptable rate of the IPPB?
a. 12-15 bpm
b. 10-12 bpm
c. 8-10 bpm
d. 6-8 bpm
14. Why do we not use the same rate that we would use to bag a patient?
a. Because this is positive pressure and the manual resuscitator bag is not
b. Because this is not a VT, but a SMI
c. Both a and b
15.
Explain how IPPB and IS differ:
a. IPPB creates positive pressure in the thorax
b. IPPB creates a breath that is 15 ml/kg IBW
c. IS is cheaper and easier to use
d. A and c
e. A, b and c
16. Explain how IPPB and IS are the same:
a. They both create positive pressure in the thorax
b. They both create positive pressure in the airway
c. They are both forms of SMI
17. Explain how IPPB and manual resuscitator are the same :
a. They both create positive pressure in the thorax
b. They both create positive pressure in the airway
c. They are both used to deliver VT at rates of 10-12 bpm
d. Both a and b
e. A, b and c
18. During normal breathing, the person’s diaphragm drops:
a. which makes the volume of the chest get larger
b. Which makes the volume of the chest get smaller
c. the pressure in the lung goes lower than the atmosphere and the air enters the airways.
d. Both a and c
e. Both b and c
19. During a normal breath the negative pressure in the thorax:
a. Creates a suction that pulls blood back into the heart
b. Helps the cardiac output
c. Has no effect on the cardiac output
d. Both a and b
20. If a patient has post op atelectasis does he need IPPB?
a. Yes
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b.
No, not if he can get 12-15 ml/Kg IBW with IS
21. Your patient whose PaC02 is rising and his Pa02 is falling even on a NRM, has a rapid shallow
respiratory rate. Could you manage him with a IPPB while someone gets the mechanical ventilatory
ready?
a. Yes
b. No
22. Your patient gets an X-ray and he has a pneumothorax on the Right side. He is breathing rapid and
shallow. Could you manage him with IPPB?
a. No
b. Yes
23. Your patient has a PEFR of 350 before IPPB with .63 mg levalbuterol in normal saline. After the
IPPB his PEFR is 375. Is the IPPB working?
a. Yes
b. No
24. [refer to the above question] If this patient had gotten Tobie in the IPPB instead of levalbuterol,
would you expect the PEFR to rise?
a. yes
b. no
25. If your patient has been on IS Q 2 for a couple of days and cannot move more than 10 ml/kg IBW,
and his atelectasis is spreading, does he need IPPB?
a. Yes
b. No, increase the frequency of the IS to Q 1 for two more days
26. If your patient is wheezing and has crackles and rhonchi, does he need IPPB?
a. Yes
b. No
c. Only if IS, SVN , deep breathing, turning and cough, or chest PT doesn’t mobilize
secretions or deliver medications
27. Three days after getting IPPB with .3 metaproterenol and 2 ml 20% acetylcystiene, your patient’s Xray shows that the atelectasis is resolved. Did the IPPB do this?
a. Yes
b. No
28. Your patient has asthma, for what hazard of IPPB is she most at risk?
a. Increased air trapping
b. Increased chance of pneumothorax due to air trapping
c. Decreased cardiac output
d. Hemoptysis
e. Both a and b
f. Both c and d
29. Your patient got a GSW in the neck and has suffered a ruptured trachea and a ruptured esophagus.
Would you suggest IPPB at this time?
a. No
b. Yes
30. Your patient has active pulmonary TB. For what hazard of IPPB is she most at risk?
a. Increased ICP
b. Air trapping
c. Decreased Cardiac output
d. Hemoptysis
31. Your patient is getting IPPB at PIP of 18 cm H20 at a VT of 20 cml/kg IBW. He is getting 1.25 mg of
levalbuterol in 5 mg. of ipratropium bromide. In the first 3 minutes of the treatment his HR went
from 85 to 106 bpm. What do you recommend?
a. Decrease the PIP to 15 to decrease the excessive airway pressure that is hampering cardiac
output
b. Stop the treatment and call the doctor
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c.
d.
Stop the treatment and wait for a few minutes, if the HR returns to 80s then restart the
IPPB at the same PIP and VT but at a lower rate
Stop the treatment and wait for a few minutes, if the HR returns to 80s then restart the
IPPB at a lower PIP and VT
32. Your patient got a GSW in the chest and has chest tubes for his pneumothorax. If it is indicated,
could he safely get IPPB?
a. Yes, the pneumothorax is treated
b. No, he has a pneumothorax
33. Your patient is getting IPPB with a PIP 22 cmH20 to get a VTof 30 ml/Kg IBW, what do you
suggest?
a. Increase the PIP to increase the VT
b. Decrease the PIP to decrease the VT
c. Decrease the PIP before he swallows air and vomits
34. Your patient just has facial surgery. Would you suggest an IPPB to keep atelectasis at bay?
a. No, we could do the same with IS
b. No, this type of patient is better off not coughing; he is not at risk for atelectasis anyway
c. No, we don’t want to put the patient’s head and face tissue under any positive pressure at
this time
d. Both b and c
35. Your patient has been on the IPPB for 3 or 4 minutes with a VT 30 ml/kg IBW and a rate of 10 bpm.
She c/o fingers tingling and dizziness. What is happening?
a. Her cardiac output is down
b. Her C02 is up
c. Her C02 is down
d. Her cerebral blood vessels are constricted
e. Both b and d
f. Both c and d
36. What do you recommend to correct the above situation?
a. Stop the treatment and call the doctor
b. Stop the treatment for a few minutes and decrease the PIP to get a VT of 15 ml/kg
c. Stop the treatment for a few minutes and ask the patient to breath at 6-8 bpm
37. Your patient is getting IPPB with .5 mg ipratropium bromide. After a few breaths, he stops the
treatment and tells you that his chest is tight. You hear bilateral expiratory wheezing. What do you
recommend?
a. Let him wait for the cholinergic blocker to relieve the bronchospasm
b. Add 2.5 mg albuterol to the cholinergic blocker to relieve the bronchospasm
c. Wait for the cardiac output to return to normal and then start the treatment at a lower RR.
38. Your patient, who is ordered on IPPB, has a rapid, thready pulse and a capillary refill of about 3
seconds. Would the IPPB help or hamper at this point?
a. Would help
b. Might hamper the venous return to the heart
c. No effect on this patient good or bad
39. Your patient, who has an intracranial pressure monometer in his head has an ICP higher than
normal. Would the IPPB help or hamper at this point?
a. Would help
b. Might hamper blood flow from the head
40. Your patient, who has lung cancer, has been coughing up bloody sputum all afternoon. Would you
recommend IPPB?
a. Yes
b. No
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41. IPPB causes decreased cardiac output by:
a. Decreasing the amount of blood that returns to the heart
b. Increasing the amount of blood that returns to the heart
42. If a patient’s cardiac output goes down, the patient will respond by:
a. Bradycardia
b. Tachycardia
c. No effect on the HR
43. If you give IPPB at a VT of 20 ml/kg IBW, you would:
a. Expect to increase the FRC and resolve the atelectasis
b. Need to increase the IC because this is not enough
c. Could increase the VT with the IPPB a little without worrying
d. Need to decrease the VT because we worry about barotrauma
e. A and c
f. A but d
44. If you don’t wash your hands prior to giving an IPPB treatment, your patient is at increased risk of
what hazard?
a. Pneumonia
b. Pneumothorax
c. Decreased cardiac output
45. If you give IPPB at a VT of 46 ml/kg IBW, you would:
a. Be creating excessively high airway pressure
b. Put the patient at risk for barotrauma
c. Hampering the cardiac out unnecessarily
d. All of these hazards are possible at this VT
46. During the IPPB treatment, you listen to BBS and hear that the lower lobes have increased air
movement. Did you expect this?
a. Yes
b. No
47. How would you assess your patient after an IPPB treatment is complete:
a. Vital Signs for improvement or for decreased cardiac output
b. BBS for improvement or for air trapping
c. Sensorium for 02 induced hypoventilation or apnea
d. All of these
48. While breathing spontaneously we maintain an I:E of 1:1.5, but on the IPPB we need to:
a. Do 1:1
b. Do 1:2 or 1:3 at least
49. How do you check the VT during the IPPB?
a. Listen to the basal BBS
b. Read the return VT on the Wright’s spirometer
c. Read the return VT on the venti-comp bag
d. All of these
50. Why do you check the VT during IPPB?
a. We need at least 15 ml/kg IBW for a good SMI
b. We need to keep lower than 45 ml/Kg IBW to prevent barotrauma
c. Both
d.
51. [refer to above question] Explain your answer:
a. The IPPB sent the air to the lower lobes
b. The IPPB delivered the medication to the lower lobes to break up the excessive mucous
c. The IPPB hampered the cardiac output and did more harm that good
d. a and b
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52. During an IPPB breath, the positive pressure in the airway:
i. Is transmitted to the thorax
ii. Helps the blood return to the heart
iii. Impedes the blood returning to the heart
iv. Can decrease the cardiac output
v. Has no effect on the cardiac output
a. i, ii,
b. i, v
c. i, iii, iv
d. ii and iv