What is the role of NPPV in cystic fibrosis patients? A. NPPV ...

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What is the role of NPPV in cystic fibrosis patients?
 
  A. NPPV has no role in the treatment of cystic fibrosis.
  B. It reduces the need for intubation when these patients have pneumonia.
  C. NPPV is used in lung transplantation candidates who deteriorate before surgery.
  D. NPPV facilitates the removal of tracheobronchial secretions in these patients.

Question 2

A patient who enters the emergency department has an exacerbation of COPD complicated by pneumonia. The patient is hemodynamically stable, demonstrates a strong cough, and has ABG data consistent with respiratory failure. Which of the following therapeutic interventions would be appropriate at this time?
 
  A. endotracheal intubation and a T-piece
  B. endotracheal intubation and invasive positive-pressure ventilation
  C. negative pressure ventilation
  D. noninvasive positive-pressure ventilation

[raenoj]

Answer to Question 1

ANS: C (page 369)
Cognitive Level: Recall
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: NPPV has been used mainly as a bridge to transplantation for patients with cystic fibrosis who deteriorate. These patients may remain severely hypercapnic and require aggressive management of secretion removal. However, NPPV enables avoidance of intubation.
D. Incorrect response: See explanation C

Answer to Question 2

ANS: D (page 367)
Cognitive Level: Application
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: In the setting of an exacerbation of COPD, NPPV consisting of pressure support and positive end-expiratory pressure, or bilevel positive airway pressure (BiPAP), is well-suited to avert respiratory failure, endotracheal intubation, and invasive positive-pressure ventilation. Clinical evidence justifies the use of NPPV for COPD exacerbations when complicated by pneumonia, do-not-resuscitate situations, or postoperative or postextubation respiratory failure.

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