CRE Respiratory Therapy & Intervention Techniques 3 — Questions and Answers
Question 1: When using a dry powder inhaler (DPI), which patient technique error most commonly reduces drug delivery to the lungs?
- Exhaling forcefully before inhalation
- Inhaling too slowly and with insufficient force (Correct answer)
- Shaking the device before use
- Waiting 30 seconds between puffs
Correct answer: Inhaling too slowly and with insufficient force
DPIs require a rapid, forceful inspiratory flow (usually >60 L/min) to de-aggregate the powder into respirable particles; slow inhalation leaves drug in the device.
Question 2: A respiratory educator is teaching a patient how to perform autogenic drainage (AD). Which description best explains the technique?
- Forcefully coughing from full lung capacity several times in succession
- Using controlled breathing at different lung volumes to mobilize mucus by varying airflow velocity (Correct answer)
- Applying positive expiratory pressure through a mask to splint the airways open
- Lying in Trendelenburg position while a therapist claps on the chest
Correct answer: Using controlled breathing at different lung volumes to mobilize mucus by varying airflow velocity
Autogenic drainage uses tidal breathing at low, middle, and high lung volumes to create shear forces that progressively loosen and move mucus centrally without coughing.
Question 3: Which inhaled corticosteroid (ICS) side effect is most directly related to local oropharyngeal deposition of the drug?
- Adrenal suppression
- Osteoporosis
- Oropharyngeal candidiasis (Correct answer)
- Cataracts
Correct answer: Oropharyngeal candidiasis
Topical deposition of ICS in the oropharynx suppresses local immunity and promotes Candida albicans overgrowth; rinsing and spitting after use reduces this risk.
Question 4: In a patient receiving volume-controlled ventilation, a sudden increase in peak airway pressure with no change in plateau pressure most likely indicates:
- Decreased lung compliance
- Pneumothorax
- Increased airway resistance (e.g., bronchospasm or secretions) (Correct answer)
- Increased lung compliance
Correct answer: Increased airway resistance (e.g., bronchospasm or secretions)
A rise in peak pressure without a change in plateau pressure reflects increased resistance in the conducting airways, not a change in lung tissue compliance.
Question 5: Which is the correct sequence for performing a directed (huff) cough technique?
- Deep breath → glottis closes → explosive cough
- Deep breath → 2–3-second breath hold → open glottis → forced exhalation ('huff') (Correct answer)
- Shallow breath → closed glottis → short forceful burst
- Exhale fully → hold → rapid deep inhalation
Correct answer: Deep breath → 2–3-second breath hold → open glottis → forced exhalation ('huff')
The huff cough (forced expiration technique) uses a deep breath, a brief hold to distribute air, then a rapid exhalation with an open glottis to mobilize secretions while minimizing airway collapse.
Question 6: A patient with neuromuscular disease has a peak cough flow (PCF) of 180 L/min. What intervention is most appropriate to assist secretion clearance?
- Pursed-lip breathing exercises
- Manually assisted cough or mechanical insufflation-exsufflation (MI-E) (Correct answer)
- High-frequency chest wall oscillation alone
- Incentive spirometry three times daily
Correct answer: Manually assisted cough or mechanical insufflation-exsufflation (MI-E)
A PCF below 270 L/min is ineffective for clearing secretions; MI-E (CoughAssist) augments inspiratory volume and expiratory flow in patients with weak respiratory muscles.
Question 7: Which ventilator mode delivers a set tidal volume but allows the patient to breathe spontaneously between mandatory breaths without the ventilator assisting those breaths?
- Assist-Control (AC)
- Synchronized Intermittent Mandatory Ventilation (SIMV) (Correct answer)
- Pressure Support Ventilation (PSV)
- Continuous Positive Airway Pressure (CPAP)
Correct answer: Synchronized Intermittent Mandatory Ventilation (SIMV)
SIMV delivers mandatory breaths at a set rate and tidal volume synchronized to the patient's effort; any additional spontaneous breaths receive no ventilator support unless PS is added.
CRE Respiratory Therapy & Intervention Techniques 3
When using a dry powder inhaler (DPI), which patient technique error most commonly reduces drug delivery to the lungs?