SAN PEDRO COLLEGE COMPETENCY APPRAISAL - OXYGENATION

Name: __________________________ Date: _____________

1. A patient who is breathing room air and in a coma as a result of acute carbon monoxide
poisoning has a PaO2 of 95 torr and PaCO2 of 30 torr. Which of the following changes in the
treatment plan should you recommend?
A) administer high concentrations of oxygen

B) initiate mechanical ventilation

C) initiate chest percussion and postural drainage

D) administer mask CPAP

Ans: A

Response:
In this case, the PaO2 is misleading because it represents only dissolved oxygen (CO alters
oxyhemoglobin saturations but not PaO2). The immediate history and finding of coma is a
sufficient basis to recommend administration of high concentrations of oxygen to eliminate
the carbon monoxide. In addition, notice that a ventilator is not needed, since the patient is
able to breathe well enough to have a PaCO2 of 30.

2. IPPB treatments are sometimes given to patients with emphysema to

A) lower the diaphragm

B) abolish the cough reflex

C) decrease the work of breathing

D) increase FRC

Ans: C

Response:
IPPB is used on patients who can not or will not take a deep breath. Its primary function is to
assist the patient by taking over most of work needed to increase alveolar ventilation and take
deep breaths.

3. Which of the following conditions is an indication for the use of CPAP?

A) tension pneumothorax

B) pulmonary embolism

C) pulmonary edema

D) asthma

Ans: C

Response:
CPAP can help overcome the shunting and hypoxemia common in both cardiogenic and
noncardiogenic pulmonary edema. In cardiogenic pulmonary edema, CPAP can help decrease
venous return and thus decrease pulmonary blood flows and pressures. In noncardiogenic
pulmonary edema (e.g., ARDS), CPAP (or PEEP) opens collapsed alveoli and improves the
V/Q ratio.

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4. The primary aim in treating cardiogenic pulmonary edema is to:

A) increase venous return to the heart

B) decrease right heart and systemic venous pressures

C) decrease left heart and pulmonary vascular pressures

D) increase pulmonary fluid and blood volume

Ans: C

Response:
The primary aim in treating cardiogenic pulmonary edema is to decrease left heart and
pulmonary vascular pressures.

5. Despite an intensive regimen of incentive spirometry, chest percussion, and nasotracheal

suctioning, a postoperative patient continues to exhibit clinical manifestations of atelectasis
due to large airway obstruction. The best treatment approach in this case is:
A) intubation and mechanical ventilation

B) bedside therapeutic bronchoscopy

C) transtracheal aspiration

D) aerosol therapy with acetylcystine

Ans: B

Response:
Should conservative measures fail in treating atelectasis due to large airway obstruction,
therapeutic bronchoscopy is indicated. This procedure can usually be performed at the bedside
with conscious sedation. Note that data are collected and analyzed in the item, and you are
expected to pick the plan that best matches the data and analysis provided.

6. You should initiate O2 therapy in all of the following cases EXCEPT:

A) treating carbon monoxide poisoning

B) decreasing myocardial work

C) treating absorption atelectasis

D) treating arterial hypoxemia

Ans: C

Response:
Indications for O2 therapy include: documented hypoxemia, acute care situations in which
hypoxemia is common (e.g., shock, trauma, CO poisoning), acute myocardial infarction (to
decrease myocardial workload), and short-term therapy for patients likely to develop
hypoxemia (e.g., during post-anesthesia recovery). Absorption atelectasis is a potential hazard
of supplemental O2 therapy.

7. A patient who just suffered a severe closed head injury is being supported in the CMV mode
of ventilatory support. Which of the following goals should you recommend for the initial 24–
48 hours of ventilatory support?
A) allow as much spontaneous breathing as possible (IMV)

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B) maintain a high mean pressure using PEEP at 10–15 cm H2O

C) maintain a PaCO2 of 50–60 torr (deliberate hypoventilation)

D) maintain a PaCO2 of 25–30 torr (deliberate hyperventilation)

Ans: D

Response:
In patients with recent closed head trauma and increased intracranial pressure (ICP), deliberate
25–30 torr during the first 24–48 hours of care is indicated to help reduce ICP. Knowing that a
low PaCO2 causes cerebral vasoconstriction is required to select the best answer.

8. You are reviewing a postoperative patient's care plan. The physician has changed the patient's
therapy from incentive spirometry to IPPB. The most likely goal for this change is to:
A) deliver aerosolized bronchodilators

B) improve inadequate alveolar oxygenation

C) prevent lower lobe atelectasis

D) treat progressive respiratory muscle weakness

Ans: D

Response:
IPPB is used instead of incentive spirometry when a patient can not or will not take a deep
breath. The only scenario that fits this indication for IPPB is progressive respiratory muscle
weakness, which would lead to a patient being unable to take a deep breath.

9. Which of the following would you recommend for a patient who has emphysema with chronic
PaCO2 retention and hypoxemia at rest?
A) CPAP

B) incentive spirometry

C) oxygen via nonrebreathing mask

D) low-flow oxygen

Ans: D

Response:
Patients with emphysema may hypoventilate when given moderate to high concentrations of
oxygen (due to elimination of their hypoxic drive). It is therefore recommended that
hypoxemic COPD patients receive no more oxygen than needed to raise their PaO2 to the 55–
60 torr range. Normally, this can be achieved using low-flow (1–2 L/min) oxygen or an air-
entrainment mask that will control the FIO2.

10. Which of the following would be considered objective data to use in the assessment of a
patient in order to formulate a respiratory care plan?
A) dyspnea

B) accessory muscle use

C) airway obstruction

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D) bronchodilator thearpy

Ans: B

Response:
Dyspnea is the patient's subjective sensation of difficulty breathing. Accessory muscle use is
an objective observation you make of the patient. Airway obstruction is your assessment of
the problem, and bronchodilator therapy is a component of your recommended plan.

11. Which of the following is the first step in respiratory care protocol application?
A) observe universal precautions at all times

B) review medical records

C) check physician order for respiratory care protocol

D) perform initial patient evaluation

Ans: C

Response:
As with any prescribed therapy, the first step in respiratory care protocol application is always
to check and review the physician's order.

12. All of the following are potential sources of data for identifying patient care-related problems
in a comprehensive quality improvement program EXCEPT:
A) analysis of department budgeting

B) audit of patient medical records

C) examination of incident reports

D) review of patient ratings and complaints

Ans: A

Response:
Audits of patient records, review of incident reports, and assessment of patient ratings and
complaints can all provide date relevant to a quality improvement program. A department's
budget would not normally be a key consideration when investigating the causes of patient
care-related issues.

13. Which of the following could be used as quality assurance outcome criteria to assess the
effectiveness of bronchial hygiene therapy?

I. change in sputum production

II. change in chest X-ray
III. patient subjective response to therapy
IV. change in ABG values or oxygen saturation
A) I and II only

B) II and IV only

C) I, III, and IV only

D) I, II, III, and IV

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Ans: D

Response:
All of these data could be used as quality assurance outcome criteria. Remember, outcome
criteria for quality assurance can include both objective and subjective data. If objective data
support improvement, but the patient does not feel any better, that is valuable information that
must be considered in the analysis and plan.

14. As part of your department's quality improvement program, you identify an infection control
problem. Which of the following should be investigated as potential causes of this problem?

I. lack of proper training

II. equipment or supply deficiencies
III. failure to follow set procedures
A) II only

B) III only

C) I and III only

D) I, II, and III

Ans: D

Response:
Lack of proper training, equipment or supply deficiencies, and failure of staff to follow set
procedures should be investigated as potential causes of an infection control problem.

15. Which of the following mechanisms is the best way to objectively assess the effectiveness of
therapy in a quality assurance program?
A) assess the post-treatment status of patients on one or more pre-defined criteria

B) survey a sample of patients who received the specified therapy to determine their
satisfaction
C) compare pre- and post-treatment patient status on one or more pre-defined criteria

D) analyze morbidity and mortality statistics for patients receiving the specified therapy

Ans: C

Response:
Although all these measures provide some indication of therapy effectiveness, comparison of
patients before and after treatment on pre-defined criteria is the best and most objective
measure of individual impact..

16. Which of the following is true regarding patients in the early stages of an asthmatic attack?
A) they all exhibit respiratory alkalosis

B) they always have moderate hypoxemia

C) they have decreased expiratory flows

D) they never respond to beta adrenergics

Ans: C

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Response:
Patients in the early stages of an asthmatic attack characteristically exhibit decreased
expiratory flows. SOME (not all) will also exhibit respiratory alkalosis and have moderate
hypoxemia. Most will respond to beta adrenergics.

17. A comatose drug overdose patient breathing room air has a PaO2 of 65 torr and PaCO2 of 70
torr. Which of the following treatment plans would be best for this patient?
A) administer a high concentration of oxygen

B) intubate and initiate mechanical ventilation

C) administer mask CPAP

D) IV administration of a stimulant

Ans: B

Response:
The patient is suffering from hypercapnic respiratory failure with the hypoxemia due to
hypoventilation. Therefore, mechanical ventilation is needed to increase the patient's minute
ventilation and return his PaCO2 to normal. In addition, data indicates the patient is suffering
from a drug overdose, which further reinforces the need for airway protection (intubation) and
ventilatory support.

18. The therapeutic objective in the management of a patient who has a head trauma and is
receiving ventilatory support is to:
A) lower the minute ventilation

B) increase intrathoracic pressure

C) reduce intracranial pressure

D) release air from the pleural space

Ans: C

Response:
Because high intracranial pressure (ICP) can cause permanent brain damage, the therapeutic
objective is to reduce the ICP. This can be accomplished by deliberate hyperventilation.
Reducing the PaCO2 causes cerebral vasoconstriction, which in turn can minimize edema and
swelling.

19. Which of the following conditions is an NOT an indication for the use of PEEP?
A) atelectasis

B) pulmonary embolism

C) pulmonary edema

D) pulmonary shunting

Ans: B

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Response:
PEEP (positive end-expiratory pressure) can help overcome the shunting and hypoxemia
common in with atelectasis. In cardiogenic pulmonary edema, PEEP can help decrease
venous return and thus decreases pulmonary blood flows and pressures. In noncardiogenic
pulmonary edema (e.g., ARDS), PEEP opens collapsed alveoli and improves the V/Q ratio.
PEEP is not indicated in the management of pulmonary embolism.

20. Which of the following patients can benefit most from intermittent use of noninvasive positive
pressure ventilation (NPPV)?
A) a patient with muscular dystrophy

B) a patient with pulmonary edema

C) a high cervical spine injury patient

D) a patient with a drug overdose

Ans: A

Response:
Patients who can benefit from NPPV generally fall into one of two categories or types. Type 1
patients have conditions in which cessation of ventilation could lead to imminent death. This
category includes both acutely ill patients (asthma, acute exacerbation of COPD, pulmonary
edema) and those requiring long-term 24-hour support (some quadriplegics, idiopathic
hypoventilation syndrome). Type 2 patients generally require only intermittent support.
Examples of patients in this category include those with chronic neuromuscular and chest wall
diseases, such as muscular dystrophy and kyphoscoliosis.

21. Relative contraindications against using noninvasive positive pressure ventilation (NPPV)
include all of the following EXCEPT:
A) severe upper airway dysfunction

B) copious secretions that require suctioning

C) FIO2 requirements exceeding 40%

D) muscular weakness or fatigue

Ans: D

Response:
Relative contraindications to NPPV include severe upper airway dysfunction, copious
secretions that cannot be cleared by spontaneous or assisted cough, or oxygen concentration
requirements exceeding 40%.

22. Absolute contraindications against using noninvasive positive pressure ventilation (NPPV)
include all of the following EXCEPT:
A) facial burns or trauma

B) need for airway protection

C) copious secretions

D) active upper GI bleeding

Ans: C

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Response:
Absolute contraindications against using NPPV include: need for immediate intubation,
hemodynamic instability, active cardiac arrhythmias or ischemia, active upper gastrointestinal
bleeding, uncooperative patient, facial burns or trauma, and the need for airway protection.

23. Despite an intensive regimen of incentive spirometry, chest percussion, and nasotracheal
suctioning, a 180 lb male postoperative patient continues to exhibit signs of atelectasis. His
best and most recent bedside vital capacity measurement was 600 mL. The best treatment
approach in this case would be:
A) intubation and mechanical ventilation

B) intermittent positive pressure breathing

C) transtracheal aspiration

D) aerosol therapy with acetylcystine (Mucomyst)

Ans: B

Response:
Should conservative measures fail in treating atelectasis, intermittent positive pressure
breathing (IPPB) may be indicated before more invasive techniques such as bronchoscopy are
tried.

24. Which of the following modes of ventilatory support is indicated when a precise I:E ratio
must be maintained?
A) assist-control ventilation

B) intermittent mandatory ventilation

C) control mode ventilation

D) pressure support ventilation

Ans: C

Response:
Controlled ventilation is the preferred mode of ventilatory support when one needs to
maintain a precise I:E ratio (as during inverse ratio pressure control ventilation). This mode is
also sometimes used in patients with an unstable or changing ventilatory drive.

25. Indications for O2 therapy includes all of the following EXCEPT:

A) treating carbon monoxide poisoning

B) decreasing myocardial work

C) treating hypoxemia caused by hypoventilation

D) treating arterial hypoxemia

Ans: C

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Response:
Indications for O2 therapy include: documented hypoxemia, acute care situations in which
hypoxemia is common (e.g., shock, trauma, CO poisoning), acute myocardial infarction (to
decrease myocardial workload) and short-term therapy for patients likely to develop
hypoxemia (e.g., post-anesthesia recovery). Hypoxemia caused by hypoventilation should be
treated by increasing alveolar ventilation, not increasing the FIO2.

26. Which of the following drug categories would you select if the goal of therapy was to achieve
bronchodilation with minimal cardiac side effects?
A) alpha-adrenergic

B) beta-2 adrenergic

C) cholinergic

D) beta-1 adrenergic

Ans: B

Response:
Beta-2 stimulation causes bronchodilation and vasodilation, mainly by relaxation of smooth
muscle. Drugs that stimulate beta-2 receptors are preferred for bronchodilation because fewer
cardiac side effects accompany their use.

27. You would recommend PEEP to achieve which of the following therapeutic goals?
A) decreased functional residual capacity

B) decreased physiological shunting

C) increased inspiratory capacity

D) increased pulmonary blood flow

Ans: B

Response:
Physiologic shunting occurs when blood travels past nonventilated alveoli, which results in
hypoxemia that does not respond well to O2 therapy (refractory hypoxemia). By recruiting or
opening up these nonventilated alveoli, PEEP tends to decrease physiologic shunting and
overcome refractory hypoxemia.

28. After confirming the physician's order, your next step in implementing a respiratory care
treatment protocol is to:
A) formulate a treatment plan

B) set physician notification criteria

C) review the relevant medical literature

D) conduct an initial patient evaluation

Ans: D

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Response:
After confirming the physician's order, your next step in implementing a respiratory care
treatment protocol is to perform an initial patient evaluation. This includes: (1) reviewing the
medical record, (2) initiating patient contact (using universal precautions) and (3) assessing
the patient (e.g., vital signs; chest inspection, palpation, percussion, auscultation; bedside
spirometry; pulse oximetry; and other diagnostic evaluations as needed, such as arterial blood
gases.

29. A respiratory therapist formulates a protocol-based management plan for a patient that
includes the following: indications, therapy, precautions/contraindications, frequency,
monitoring and assessment (including adverse effects), and planned modifications to achieve
optimal efficacy. What essential elements are missing from this management plan?

I. protocol integration into overall patient management

II. specific therapeutic goals and objectives
III. explicit criteria for discontinuing the therapy
A) II and III only

B) I and III only

C) I and II only

D) I, II and III

Ans: D

Response:
An appropriate protocol-based management plan should include the following critical
elements: indications, therapeutic objectives, therapy (including where appropriate delivery
method, frequency, medication dose), precautions/ contraindications, patient/family education
(where appropriate), means to monitor therapy (including adverse effects), means to assess
efficacy of therapy (patient outcomes), planned modifications to achieve optimal efficacy and
outcome, and criteria to discontinue therapy. In addition the plan should identify the physician
and other appropriate health care personnel involved and be properly integrated into the
patient's overall management.

30. change in chest x-ray

III. patient subjective response to therapy
IV. change in ABG values or oxygen saturation
A) I and II only

B) II and IV only

C) I, III and IV only

D) I, II, III and IV

Ans: D

Response:
Quality assurance outcome criteria to assess the effectiveness of bronchial hygiene therapy
could include any of the following: change in sputum production; change in breath sounds of
the affected lung fields; changes in the chest x-ray; changes in arterial blood gas values or
oxygen saturation; and the patient's subjective response to therapy.

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31. Aspects of respiratory care that are typically addressed in a comprehensive quality
improvement program include which of the following?

I. effectiveness of care
II. appropriateness of care
III. cost-efficiency of care
A) II only

B) III only

C) I and II only

D) I, II and III

Ans: D

Response:
A comprehensive quality improvement program should be designed to (1) provide ongoing
monitoring of both the quality and appropriateness of respiratory care; (2) assure that
respiratory care methods and procedures are cost-efficient; (3) assure that respiratory care
methods and procedures are effective; and (4) identify, rank, and resolve patient care-related
problems.

32. You are responsible for developing quality assurance criteria for bronchial hygiene therapy.
Which of the following components should be included in these criteria?

I. therapeutic goals
II. appropriateness of care
III. therapy effectiveness
A) I and II only

B) II and III only

C) I and III only

D) I, II and III

Ans: D

Response:
Successful implementation of the quality improvement plan demands that the respiratory care
service develop criteria addressing the therapeutic goals, appropriateness, and means of
evaluating the effectiveness of each specific high-utilization and high-risk procedure.

33. The primary indication for aerosolized ribavirin (Virazole) is in the treatment of:
A) viral hepatitis

B) herpes zoster

C) respiratory syncytial virus

D) influenza A and B

Ans: C

Response:
Ribavirin (Virazole) is a broad spectrum antiviral agent that can be used to treat respiratory
syncytial virus (RSV). Influenza A and B are also susceptible to ribavirin.

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34. Clinical indications for cool bland water aerosols include:

I. post extubation
II. post bronchoscopy
III. pneumonia
IV. croup
A) II, III and IV only

B) I, II, III and IV

C) I, II and IV only

D) I and III only

Ans: C

Response:
Cool water aerosols are used for their soothing effect on inflammed tissues of the upper
airway of patients following removal of an artificial airway (extubation), following fiberoptic
bronchoscopy, and in the management of the inflammatory obstruction seen in laryngitis or
croup. The lower temperature of these aerosols may help decrease the swelling and tissue
edema common in these situations.

35. If a physician's goal were to facilitate the mobilization of respiratory tract secretions in a
hospitalized patient with an ineffective cough, which of the following airway clearance
techniques would you recommend?
A) relaxation positioning

B) inspiratory resistive breathing

C) pursed-lip breathing

D) postural drainage and percussion

Ans: D

Response:
The airway clearance technique best suited to help mobilize secretions in a patient with an
ineffective cough is postural drainage (perhaps combined with percussion). Postural drainage
facilitates the mobilization of secretions by patient positioning, using gravity to aid their
removal. This is accomplished by simply placing the segmental bronchus to be drained in a
vertical position relative to gravity.

36. In implementing a respiratory care protocol, you must notify the physician
A) prior to beginning each step in the protocol

B) whenever a notification criterion is triggered

C) after completing each step in the protocol

D) whenever planned modifications are needed

Ans: B

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Response:
A medically acceptable respiratory care protocol must include a description of decision-points
and end-points where the physician must be notified. Only when these points (called
notification criteria) are triggered is it necessary to contact the physician. In a well-designed
protocol, one need not contact the physician either before or after each protocol step, nor
when making PLANNED modifications to the therapy.

37. A patient with severe COPD who is receiving oxygen must be observed closely because
which of the following may occur?
A) hypoventilation

B) pneumothorax

C) bronchospasm

D) pulmonary edema

Ans: A

Response:
Many patients with COPD have chronically elevated PCO2 levels. Consequently, their
primary respiratory drive originates not from excessive PCO2 levels, as normally occurs, but
rather because of a low PO2. This is known as the hypoxic drive. FIO2s in excess of 30 to 35%
in such patients can increase PO2 levels to the point where their hypoxic drive and overall
breathing is depressed resulting in hypoventilation.

38. Which of the following would be the most important data utilized to assess a patient's ability
to perform metered dose inhaler (MDI) aerosol therapy?
A) overall general appearance

B) stable vital signs

C) exercise tolerance

D) capacity to follow instructions

Ans: D

Response:
To perform complex tasks such as using an MDI correctly, a patient must be fully oriented
and able to follow instructions.

39. All of the following would be acceptable quality assurance criteria for assessing the
appropriateness of care for protocol-based bronchodilator therapy EXCEPT:
A) the patient must be diagnosed as having reversible airway obstruction

B) the patient must have exhibited signs of bronchospasm not associated with heart failure

C) the patient must show a significant improvement in FEV1% (> 15%) after treatment

D) drug dosing and deliver mode should follow the criteria specified in the protocol

Ans: C

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Response:
Requiring the patient to show improvement is a therapeutic effectiveness criterion, not an
appropriateness criterion. All other criteria are suitable for assessing the appropriateness of
care for protocol-based bronchodilator therapy, i.e., appropriate diagnosis, appropriate signs
or symptoms and appropriate procedure or protocol.

40. For which of the following purposes are breathing exercises NOT indicated?
A) to improve the efficiency of alveolar ventilation

B) to improve cardiopulmonary exercise tolerance

C) to improve the delivery of therapeutic aerosols

D) to reverse the progression of chronic disease

Ans: D

Response:
Purposes of breathing exercises include: 1) increasing awareness and promoting better use of
the diaphragm; 2) diminishing/eliminating inefficient accessory muscles use; 3) preventing or
minimizing episodes of dyspnea; 4) improving the efficiency of alveolar ventilation; 5)
improving cough effectiveness; 6) improving delivery of aerosols; 7) improving the
strength/endurance of the respiratory muscles; and 8) improving fitness and cardiopulmonary
exercise tolerance.

41. Two days after a cholecystectomy, a 56-year-old patient who weighs 64 kg (140 lb) is
diagnosed with atelectasis. Treatment has included hourly deep breathing with a volume-
oriented incentive spirometer. Which of the following would indicate a poor response to the
prescribed therapy?
A) a decreased P(A-a)O2

B) vesicular breath sounds

C) a decreased respiratory rate

D) a reduced inspiratory capacity

Ans: D

Response:
Incentive spirometry is used to help increase the patient's inspiratory capacity and treat or
prevent atelectasis. Therefore, a reduced inspiratory capacity in a patient receiving incentive
spirometry indicates that the goal of the therapy is not being met. All other findings are
positive indicators for incentive spirometry.

42. Your patient is receiving aerosolized bronchodilators to treat her asthma. What is the best way
to determine whether this treatment is achieving the desired goal?
A) Measure the patient's MIP before-and-after treatment

B) Measure the patient's inspiratory capacity before-and-after treatment

C) Measure the patient's FEV1% before-and-after treatment

D) Calculate the patient's minute alveolar ventilation

Ans: C

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Response:
The best way to determine the effectiveness of bronchodilator therapy at the bedside is to
measure the patient's forced expiratory flows before and after treatment. Either the FEV1% or
the peak expiratory flow rate (PEFR) can be used, although the FEV1% is a more reliable and
valid measure. In general, an improvement of at least 15% between the pre- and post-test
values is needed to indicate reversibility of the obstruction with the bronchodilator.

43. All of the following would indicate a successful outcome for postural drainage therapy
EXCEPT:
A) decreased sputum production

B) normalization in ABGs

C) improved breath sounds

D) improvement in chest X-ray

Ans: A

Response:
Criteria indicating a positive response to postural drainage therapy include 1) change in
sputum production, 2) improvement in breath sounds of lung fields being drained, 3)
improvement in vital signs, 4) improvement in chest x-ray, 5) improvement in arterial blood
gas values or oxygen saturation, 6) increased compliance/lower PIP (on ventilator), and 7)
patient's subjective improvement.

44. On reviewing the results of the attending physician's physical examination of a postoperative
patient's chest, you note 'dull percussion note and bronchial breath sounds - left and right LL.'
Which of the following should be considered for this patient's respiratory care plan?

I. lung expansion therapy

II. bronchial hygiene therapy
III. oxygen therapy
A) I only

B) II only

C) I and III only

D) I, II and III

Ans: C

Response:
The patient likely has either pulmonary infiltrates, atelectasis or consolidation of the affected
areas. Options to consider in formulating a respiratory care plan for this patient should include
lung expansion and oxygen therapy.

45. Which of the following therapeutic strategies can help minimize the likelihood of a patient
developing postoperative atelectasis?

I. early mobilization
II. frequent positional changes
III. deep breathing/coughing
A) II and III only

B) I, II and III

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C) I and II only

D) II only

Ans: B

Response:
The best treatment for postoperative atelectasis is prevention. The likelihood of postoperative
atelectasis can be minimized by early mobilization of the patient, frequent positional changes,
and a vigorous regimen of deep breathing and coughing.

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