Unit7: Ch 29 (Porth's 5th Ed) - Structure and Function of the Respiratory System

Question 1

1. As a result of dehydration, a client’s epithelial cells are producing insufficient amounts
   of mucus. Consequently, the client’s mucociliary blanket is compromised. Which of the
   following changes would the care provider anticipate as a direct result of this change?
   A) Impaired function of the client’s cilia
   B) Decreased levels of oxygen saturation
   C) Increased amounts of bacteria in the lungs
   D) Increased carbon dioxide levels

Answer 1

Ans: C
Feedback:
The primary role of the mucociliary blanket is to trap foreign particles and bacteria and
thus prevent their entry into the lungs. Impaired ciliary function may result in an
inadequate mucociliary blanket, but the opposite relationship is unlikely. Decreased
oxygen and increased carbon dioxide levels may eventually result, but not as a direct or
immediate consequence.

Question 2

2. A 21-year-old male client has suffered a head injury during a crash on his motorcycle,
   and a deficit that assessments have revealed is an impaired swallowing mechanism. He
   has also developed aspiration pneumonia. Which of the following statements most
   accurately captures an aspect of his condition?
   A) His vocal folds are likely not performing their normal function.
   B) His epiglottis is covering his larynx.
   C) His vocal folds have been compromised.
   D) His tracheobronchial is intermittently obstructed.

Answer 2

Ans: A
Feedback:
The vocal folds contribute to blocking of the airways during swallowing; compromise to
this function is likely to allow food to enter the lungs. The epiglottis is performing its
normal, protective role against aspiration when it covers the larynx, and the vocal folds
contribute to sound enunciation, not swallowing or protection against aspiration.
Tracheobronchial obstruction would not contribute to aspiration

Question 3

3. A male, lifetime smoker has died because of chronic obstructive pulmonary disease.
   Which of the following phenomena regarding his alveoli would his care team expect in
   the weeks prior to his death?
   A) Proliferation of natural killer (NK) cells in the alveolar lumen
   B) Large numbers of alveolar macrophages in septal connective tissue
   C) The presence of tubercles in the interalveolar spaces
   D) Compensatory regeneration of type I alveolar cells

Answer 3

Ans: B
Feedback:
Smokers often retain large numbers of carbon-filled macrophages in their septal
connective tissue. NK cell proliferation is not a noted phenomenon in the alveoli, and
tubercles are associated specifically with tuberculosis infection. Type I alveoli are
incapable of regeneration.

Question 4

4. Reviewing pathology for an exam on pulmonary vasculature, the nursing student states
   that blood enters the right side of the heart via the vena cavae, then to the right atrium,
   right ventricle, and then which vessel carries the deoxygenated blood into the
   pulmonary system?
   A) Pulmonary capillaries
   B) Pulmonary artery
   C) Pulmonary vein
   D) Ductus arteriosus

Answer 4

Ans: B
Feedback:
Deoxygenated blood leaves the right heart through the pulmonary artery. Return of
oxygenated blood to the heart occurs by way of the pulmonary vein, which empties into
the left atrium.

Question 5

5. The nurse is hearing diminished breath sounds and a “grating” sound during
   respirations. This is consistent with excess collection of fluid in the pleural cavity. The
   medical term for this is
   A) pleurisy.
   B) pleural effusion.
   C) pneumothorax.
   D) poor lung compliance.

Answer 5

Ans: B
Feedback:
Pleural effusion is used to describe an abnormal collection of fluid or exudates in the
pleural cavity. Pleurisy is an inflammation in the pleural space, and pneumothorax is an
abnormal collection of air in the pleural space

Question 6

6. Which of the following statements best conveys an aspect of the respiratory pressures
   that govern ventilation?
   A) Intrapleural pressure slightly exceeds that of the inflated lung.
   B) The chest wall exerts positive pressure on the lungs that contributes to expiration.
   C) The lungs are prevented from collapsing by constant positive intrapulmonary
   pressure.
   D) Negative intrapleural pressure holds the lungs against the chest wall.

Answer 6

Ans: D
Feedback:
Negative intrapleural pressure holds the lungs in place against the chest wall and
prevents their natural elastic properties from causing them to collapse. Intrapleural
pressure is negative in relation to the inflated lung, and the chest wall exerts negative
pressure on the lungs that keeps them from contracting and contributes to inspiration.
Intrapulmonary pressure oscillates between positive and negative relative to
atmospheric pressure with expiration and inspiration.

Question 7

7. The emergency department is awaiting the arrival of a spinal cord–injured patient.
   Knowing the innervation of the diaphragm, a patient with which type of injury may be
   in need of immediate mechanical ventilation? Injury to the
   A) C4 area.
   B) C7 area.
   C) T1 area.
   D) T4 area.

Answer 7

Ans: A
Feedback:
The diaphragm is the principal muscle of inspiration. It is innervated by the phrenic
nerve roots, which arise from the cervical level of the spinal cord, mainly from C4 but
also C3 and C5

Question 8

8. A client who presented with shortness of breath and difficulty climbing stairs has been
   diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli.
   Upon assessment of the lungs, what clinical manifestations should the nurse expect?
   A) Rapid, deep breaths
   B) Wheezing throughout lung fields
   C) Short, shallow breaths
   D) Pursed-lip breaths with slow, steady breaths

Answer 8

Ans: C
Feedback:
Scarring diminishes the elasticity of the lung tissue, resulting in noncompliant lungs that
are more difficult to inflate. In order to maintain a sufficient tidal volume and oxygen
level with the lungs that require extra work to expand, the individual must take
shallower, more rapid breaths. The effort and time required for him to breathe deeply
would detract from his ability to bring in enough air.

Question 9

9. A female patient is requiring supplementary oxygen by face mask due to her reduced
   lung compliance. Which of the following pathophysiological processes is most likely a
   contributor to her low lung compliance?
   A) The woman’s lungs have more recoil than a healthy person’s.
   B) Her type II alveolar cells are producing a slight excess of surfactant.
   C) Turbulent airflow is taking place in the patient’s large airways.
   D) Her thoracic cage is less flexible than when she was healthy

Answer 9

Ans: D
Feedback:
Impaired thoracic cage flexibility can be a contributor to reduced lung compliance.
Increased recoil and a modest excess of surfactant would increase lung compliance, and
turbulent flow in the airways is a normal, not pathological, finding.

Question 10

10. While working in the newborn ICU, the nurses receive a call that an infant, gestational
    age of 23 weeks, is being air flighted to the level 3 trauma nursery. The priority
    intervention for this infant would be
    A) insertion of an umbilical line for fluids.
    B) intubation and mechanical ventilation.
    C) insertion of a feeding tube.
    D) insertion of an intraventricular catheter

Answer 10

Ans: B
Feedback:
The type II alveolar cells that produce surfactant do not begin to mature until 26th to
27th week of gestation; consequently, many premature infants have difficulty in
producing sufficient amounts of surfactant. This can lead to alveolar collapse and severe
respiratory distress. The only answer (B) to facilitate respiratory is mechanical
ventilation. IV fluids and nutrition are important but not a priority of airway/breathing
problems. There is no indication that the infant has increased ICP and would need an
intraventricular catheter.

Question 11

11. A 60-year-old male hospital patient with a diagnosis of chronic obstructive pulmonary
    disease (COPD) is undergoing lung function tests to gauge the progression of his
    disease. Which of the following aspects of the lung volumes will the respiratory
    therapist be most justified in using to guide interpretation of the test results?
    A) Vital capacity will equal the patient’s combined inspiratory reserve, expiratory
    reserve, and tidal volume.
    B) Vital capacity will equal the total lung capacity.
    C) Resting tidal volume will exceed that of tidal volume during activity.
    D) Expiratory reserve will equal residual lung volume.

Answer 11

Ans: A
Feedback:
Vital capacity is determined by combining inspiratory reserve, expiratory reserve, and
tidal volume. Total lung capacity always exceeds vital capacity, given that it is not
possible to completely empty the lungs. Tidal volume becomes wider during exercise,
and expiratory reserve is neither equal to nor synonymous with residual volume.

Question 12

12. A 71-year-old woman is dependent on oxygen therapy and bronchodilators due to her
    diagnosis of emphysema. Which of the following pathological processes occur as a
    result of her emphysema? Select all that apply.
    A) Decreased elastic recoil due to alveolar damage
    B) Decreased residual lung volume due to impaired alveolar ventilation
    C) Increased anatomical dead space due to reduced tidal volume
    D) Increased alveolar dead space due to incorrect intrapleural pressure

Answer 12

Ans: A, C, D
Feedback:
In lung pathology such as emphysema, large amounts of air are trapped at the end of a
given breath, a situation that corresponds to increased residual volume and decreased
vital capacity. Elastic recoil would tend to suffer, and both alveolar and anatomical dead
space consequently increase

Question 13

13. The physician mentions the patient has developed alveolar dead space. The nurse
    recognizes that this means
    A) air that is moved in and out of the lungs with each breath.
    B) air that cannot participate in gas exchange and remains in the main bronchus.
    C) air is trapped in the conducting airways.
    D) alveoli are ventilated but not perfused.

Answer 13

Ans: D
Feedback:
Alveolar dead space results from alveoli that are ventilated but not perfused.

Question 14

14. Due to complications, a male postoperative patient has been unable to mobilize
    secretions for several days following surgery and develops atelectasis. Which of the
    following processes would his care team anticipate with relation to his health problem?
    A) Vasodilation in the alveolar vessels in the affected region of his lung
    B) Increased workload for the left side of the patient’s heart
    C) Increased blood flow to the area of atelectasis
    D) Directing blood flow away from the lung regions that are hypoxic

Answer 14

Ans: D
Feedback:
Regional hypoxia, such as with a diagnosis of atelectasis, is associated with
vasoconstriction and redirection of blood away from, not toward, the affected area of the
lung. This also contributes to an increased workload for the right side of the heart.

Question 15

15. A 44-year-old woman has developed calf pain during a transatlantic flight. She is
    extremely short of breath upon arrival at her destination. She was subsequently
    diagnosed with a pulmonary embolism (PE) that resolved with anticoagulant therapy.
    Which of these statements best characterizes the underlying problem of her PE?
    A) Ventilation was occurring, but perfusion was inadequate causing shortness of
    breath.
    B) The combination of normal perfusion but compromised ventilation caused
    hypoxia.
    C) She developed a transient anatomic shunt resulting in impaired oxygenation.
    D) Impaired gas diffusion across alveolar membranes resulted in dyspnea and
    hypoxia.

Answer 15

Ans: A
Feedback:
Impaired blood flow to a portion of the lung, such as with a PE, is associated with
ventilation without perfusion, rather than perfusion without ventilation. The situation is
not related to an anatomic shunt or impaired diffusion across alveolar membranes.

Question 16

16. Following a winter power outage, a client who had been using a home gasoline
    generator began to experience dizziness and headaches and was diagnosed with carbon
    monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon
    monoxide poisoning?
    A) To increase the amount of oxygen carried in the dissolved state
    B) To increase the production of unbound hemoglobin
    C) To stimulate the release of oxygen at the capillaries
    D) To remove bound CO from hemoglobin

Answer 16

Ans: A
Feedback:
While increased alveolar PO2 improves the oxygen saturation of hemoglobin, carbon
monoxide occupies the hemoglobin sites usually available for oxygen. With much of the
blood composed, temporarily, of carboxyhemoglobin, it is necessary to rely upon
alternate means to deliver oxygen to the tissues. Plasma’s normally low carrying
capacity for dissolved oxygen can be increased by administration of 100% oxygen in the
high atmospheric pressure of a hyperbaric chamber

Question 17

17. Which of the following situations is most likely to result in an increased binding affinity
    of hemoglobin for oxygen?
    A) A client is in respiratory acidosis, with a low pH.
    B) Three of four binding sites on a client’s hemoglobin molecule are occupied by
    oxygen.
    C) A client’s body temperature is elevated as a result of an infectious process.
    D) An increase in 2,3-diphosphoglycerate enhances the loading of oxygen.

Answer 17

Ans: B
Feedback:
As each binding site on a hemoglobin molecule is occupied, the affinity of the
remaining sites for oxygen binding is increased. Increased affinity is associated with
alkalosis, not acidosis, and fever causes reduced affinity. Exercise increases the
unloading of oxygen, a situation characterized by low affinity.

Question 18

18. A nurse in a respiratory unit of a hospital is providing care for a client with end-stage
    lung disease. Consequently, measurement of the client’s arterial blood gases indicates
    increased PCO2. Which of the following associated consequences would the nurse
    anticipate?
    A) A shift to the left of the oxygen–hemoglobin dissociation curve
    B) Lower than normal production of HCO3
    C) Higher than normal production of H+
    D) An absence of carbaminohemoglobin

Answer 18

Ans: C
Feedback:
As a result of the combination of water and carbon dioxide, hydrogen ions are produced
along with bicarbonate. This would be associated with a shift to the right of the
oxygen–hemoglobin dissociation curve, increased bicarbonate output, and higher than
normal levels of carbaminohemoglobin.

Question 19

19. Which of the following neurological patients is most likely to have abnormalities in
    breathing regulation?
    A) A 23-year-old male who has an injury to his frontal lobe following a sports injury
    B) A 45-year-old female with a spinal cord injury at C7 following a motor vehicle
    accident
    C) A 34-year-old male with damage to his upper and lower pons following a blow to
    the back of the head
    D) A 66-year-old male with temporal lobe infarcts secondary to a stroke

Answer 19

Ans: C
Feedback:
The respiratory center is located in the pons. Damage to the temporal lobe, frontal lobe,
or spinal cord at C7 is less likely to affect respiration.

Question 20

20. A nurse in an acute medical unit is providing care for a number of patients with a
    variety of diagnoses. Which of the following patients most likely exhibits risk factors
    for impaired coughing? A patient with
    A) an injury to her cerebellum.
    B) a nasogastric (NG) tube attached to suction.
    C) a diagnosis of viral pneumonia.
    D) diagnosis of diabetes mellitus and morbid obese.

Answer 20

Ans: B
Feedback:
An NG tube can inhibit the closing of the upper airways that is required for normal
coughing. Pneumonia, obesity, diabetes, and injury to the cerebellum are unlikely to
affect the ability to cough

Question 21

21. As part of a public health initiative, a nurse is teaching a group of older adults a bout
    ways to promote and maintain their health. Recognizing that the common cold i s a
    frequent source of ailment, the nurse i s addressing this health problem. Which of the
    following teaching points about the common cold is most accurate?
    A) “You shouldn’t be taking antibiotics for a cold until your doctor has confir med
    exactly which bug is causing your cold.”
    B) “It’s important to both cover your mouth when you cough or sneeze a nd
    encourage others t o do so, since most colds are spread by inhaling the germs.”
    C) “Scientists don’t yet know exactly what virus causes the cold, and there is not
    likely to be a vaccine until this is known.”
    D) “Use caution when choosing over-the-counter drugs for your cold; most people do
    best with rest and antifever medications.”

Answer 21

Ans: D
Feedback:
The efficacy of over-the-counter cold remedies is minimal, and all have a risk of
unwanted side effects; rest and antipyretics are normally sufficient since cold viruses are
normally self-limiting. No cold-causing virus will respond to antibiotics, and most colds
are spread by the fingers. There is no one specific virus that causes the common cold,
and numerous different viruses cause similar symptoms

Question 22

22. Which of the following patients who presented to a walk-in medical clinic is most l ikely
    to be diagnosed with rhinosinusitis rather than a common cold?
    A) A man complaining of of general fatigue, a headache, and facial pain with a
    temperature of 100.9°F
    B) A woman presenting with malaise, lethargy, and copious nasal secretions
    C) A man with a dry, stuffy nasopharynx, a sore throat, and a temperature of 98.9°F
    D) A woman complaining of generalized aches and who has a hoarse voice and
    reddened, painful upper airways

Answer 22

Ans: A
Feedback:
Fever and facial pain are more commonly associated with rhinosinusitis rather than the
common cold. The other noted symptoms are indicative of the common cold rather than
rhinosinusitis.

Question 23

23. A child with rhinosinusitis should be monitored for complications. Which o f the
    following assessment findings would alert the nurse that a complication is developing?
    A) Purulent nasal discharge
    B) Temperature of 100.8°F
    C) Periorbital edema
    D) Complaints of headache

Answer 23

Ans: C
Feedback:
Expected s/s of acute viral rhinosinusitis include facial pain, headache, purulent nasa l
discharge, decreased sense of smell, and fever. Complications can lead to intracrania l
and orbital wall problems. Facial swelling over the involved sinus, abnormal extraoc ular
movements, protrusion of the eyeball, periorbital edema, or changes in mental sta tus
may indicate intracranial complications.

Question 24

24. A family physician is performing patient teaching about the influenza virus with eac h
    patient who has come to the clinic to receive that year’s vaccine. Which of the following
    statements by the patient best reflects an accurate understanding of the flu virus?
    A) “I could come down with viral or bacterial pneumonia as a result of a bad f lu
    bug.”
    B) “I know my vaccination is especially important since there aren’t any drugs that can treat the flu once I get sick with it.”
    C) “The emphasis on bundling up, staying warm, and drinking lots of fluids is
    outdated and actually ineffective.”
    D) “Like all vaccines, it is ideal if everyone in a population gets immunized against
    the flu.

Answer 24

Ans: A
Feedback:
Viral and bacterial pneumonia are known sequelae of influenza. Antiviral drugs do exist
for the flu, and the efficacy of staying warm and increasing fluid consumption have
been demonstrated. The flu vaccine is recommended for higher risk individuals, and
guidelines do not indicate the need for all individuals to be vaccinated.

Question 25

25. A pneumonia that occurs 48 hours or more after admission to the hospital is considered
A) community-acquired pneumonia.
B) hospital-acquired pneumonia.
C) viral pneumonia.
D) immunocompromised pneumonia

Answer 25

Ans: B
Feedback:
Hospital-acquired pneumonia is defined as a lower respiratory tract infection that wa s
not present or incubating on admission to the hospital. Usually, infections occurring 48
hours or more after admission are considered hospital acquired. Community-acquire d
pneumonia is diagnosed within 48 hours after admission. Most hospital-acquire d
pneumonia is bacterial.

Question 26

26. A nurse is providing care for an older, previously healthy adult male who has bee n
    diagnosed today with pneumococcal pneumonia. Which of the following signs a nd
    symptoms is the nurse most likely to encounter?
    A) The man will be hypotensive and febrile and may manifest cognitive changes.
    B) The patient will have a cough producing clear sputum, and he will have fai nt
    breath sounds and fine crackles.
    C) The patient will have copious bloody sputum and diffuse chest pain and may lose
    his cough reflex.
    D) The patient will lack lung consolidation and will have little, if any, sput um
    production.

Answer 26

Ans: B
Feedback:
The typical onset of pneumococcal pneumonia involves production of clear sputum,
along with faint breath sounds and fine crackles. The patient is less likely to be
hypotensive, have copious bloody sputum, or have chest pain. A lack of lung
consolidation or sputum production is more closely associated with atypical
pneumonias.

Question 27

27. A client with a newborn infant is also the caregiver for her 75-year-old mother, w ho
    lives with them and who has diabetes. The client requests pneumonia vaccinations for
    her entire household. Which vaccine is most likely to be effective for the baby?
    A) Since the baby’s immune system is mature at birth, regular vaccine is appropriate.
    B) There is no effective vaccine for newborn infants.
    C) The 23-valent vaccine will be effective.
    D) No vaccine is necessary for the baby if the nursing mother is immunized

Answer 27

Ans: B
Feedback:
S. pneumoniae capsular polysaccharides would be especially appropriate for the client
and her diabetic, elderly mother but is not effective in the immune system of anyone
younger than 2 years old. Fortunately, a newer, 7-valent vaccine was designed to protect
infants as young as 7 months. However, because their immune system is immature, the
antibody response to most flu shots is poor or inconsistent in children younger than 2
years of age.

Question 28

28. A 66-year-old male presents to the emergency room accompanied by his wife who
    claims that he has been acting confused. The man is complaining of a sudden onset of
    severe weakness and malaise and has a dry cough and diarrhea. His temperature is
    102.8°F, and his blood work indicates his sodium level at 126 mEq/L (nor mal 135 to
    145 mEq/L). Based on this assessment, the nurse suspects the patient has
    A) bronchopneumonia.
    B) Mycoplasma pneumonia
    C) Legionella pneumonia.
    D) pneumococcal pneumonia.

Answer 28

Ans: C
Feedback:
Confusion, dry cough, diarrhea, and hyponatremia are associated with Legionna ire
disease and less so with bronchopneumonia, Mycoplasma pneumonia, or pneumococca l
pneumonia.

Question 29

29. A health educator is performing a health promotion workshop with the staff of a large ,
    urban homeless shelter, and a component of the teaching centers around tuberculosi s.
    One of the staff members comments, “Anyone who’s had contact with tuberculosi s in
    the past can give it to any of the other residents of the shelter, even if they didn’t get sick
    themselves.” How could the educator best respond to this comment?
    A) “Many people do manage to fight off the infection, but you’re right: they can still
    spread it by coughing or sneezing.”
    B) “If someone has been previously exposed to tuberculosis, they are particularly
    infectious because they are often unaware of the disease.”
    C) “Actually, people who have the latent form of the disease won’t be sick and can’t
    spread it either.”
    D) “There isn’t any real risk of them spreading it, but we would like to vaccinate
    everyone who’s had any contact with it in the past.”

Answer 29

Ans: C
Feedback:
Contact with M. tuberculosis without the development of progressive primary
tuberculosis results in a latent infection that is not communicable. Vaccination is not a
common intervention in the United States.

Question 30

30. When educating a student who lives in a crowded apartment and diagnosed with
    tuberculosis, the college school nurse will emphasize,
    A) “Once your fever goes away, you can stop taking the streptomycin injection.”
    B) “If isoniazid makes you nauseous, we can substitute something milder.”
    C) “To destroy this bacterium, you must strictly adhere to a long-term drug regimen.”
    D) “You will have to wear an N95 mask while on campus at all times.”

Answer 30

Ans: C
Feedback:
Success of chemotherapy for prophylaxis and treatment of tuberculosis depends on strict
adherence to a lengthy drug regimen that includes isoniazid (INH), rifampi n,
ethambutol, pyrazinamide, and streptomycin (or some combination of these).

Question 31

31. Around 3 weeks after razing an old chicken house, a 71-year-old retired farmer ha s
    developed a fever, nausea, and vomiting. After ruling out more common health
    problems, his care provider eventually made a diagnosis of histoplasmosis. Which of the
    following processes is most likely taking place?
    A) Toxin production by Histoplasma capsulatum is triggering an immune response.
    B) Antibody production against the offending fungi is delayed by the patient’s age
    and the virulence of the organism.
    C) Spore inhalation initiates an autoimmune response that produces the associated
    symptoms.
    D) Macrophages are able to remove the offending fungi from the bloodstream but
    can’t destroy them.

Answer 31

Ans: D
Feedback:
Disseminated histoplasmosis results from the inability of macrophages of the
reticuloendothelial system to destroy the fungi. Fungi do not produce toxins, and
antibody production and autoimmune responses are not involved in the pathophysiology
of this fungal infection.

Question 32

32. A 62-year-old female smoker is distraught at her recent diagnosis of small cell lung
    cancer (SCLC). How can her physician most appropriately respond to her?
    A) “I’m sure this is very hard news to hear, but be aware that with aggressive
    treatment, your chances of beating this are quite good.”
    B) “This is very difficult to hear, and we have to observe to see if it spreads
    because that often happens.”
    C) “I’m very sorry to have to give you this news; I’d like to talk to you about surgical
    options, however.”
    D) “This is a difficult diagnosis to receive, but there is a chance that the cancer may
    go into remission.”

Answer 32

Ans: B
Feedback:
Metastases are common with SCLC. Survival rates are very low; surgical options do not
exist; and remission is very unlikely

Question 33

33. A patient with small cell lung cancer (SCLC) has developed a paraneoplastic syndrome
    called Cushing syndrome. Based on this new complication, the nurse will likely asse ss
    which of the following clinical manifestations of Cushing syndrome?
    A) Weight gain, moon face, buffalo hump, and purple striae on the abdomen
    B) Bilateral edema in the arms, swollen face, and protruding eyes
    C) Severe bone/joint pain, nausea/vomiting, and polyuria
    D) Tetany, new-onset seizure activity, emotional lability, and extrapyramida l
    symptoms

Answer 33

Ans: A
Feedback:
SCLS is associated with several types of paraneoplastic syndromes, including
Cushing’s. Answer choice B refers to superior vena cava syndrome; answer choice C
refers to hypercalcemia; and answer choice D refers to tumor lysis syndrome. All of
these are complications that can occur with cancer and treatment of cancer.

Question 34

34. A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of
    an old tubercle scarring site, located in a peripheral area of his bronchiolar tissue. What
    is this client’s most likely diagnosis?
    A) Squamous cell carcinoma
    B) Small cell lung cancer
    C) Large cell carcinoma
    D) Adenocarcinoma

Answer 34

Ans: D
Feedback:
Adenocarcinoma is associated with the periphery of the lungs, often at the site of
scarring, and can occur in alveolar or bronchiolar tissue. Squamous cell carcinoma ,small cell lung cancer, and large cell carcinoma are less commonly associated with these
traits

Question 35

35. The neonatal ICU nurse is aware that type II alveolar cells produce surfactant, and they
    usually develop at how many weeks of gestation?
    A) 17 to 18 weeks
    B) 19 to 20 weeks
    C) 24 to 28 weeks
    D) 34 to 38 week

Answer 35

Ans: C
Feedback:
Type II alveolar cells begin to develop at approximately 24 weeks. These cells produc e
surfactant, a substance capable of lowering the surface tension of the air–alve oli
interface. By the 28th to 30th week, sufficient amounts of surfactant are availa ble to
prevent alveolar collapse when breathing begins

Question 36

Which of the following phenomena is most likely occurring during a child’s alveolar
stage of lung development?
A) Terminal alveolar sacs are developing, and surfactant production is beginning.
B) A single capillary network exists, and the lungs are capable of respiration.
C) The conducting airways are formed, but respiration is not yet possible.
D) Primitive alveoli are formed, and the bronchi and bronchioles become much
larger

Answer 36

Ans: B
Feedback:
During the alveolar stage of lung development from late fetal to early childhood, a
single capillary network appears, and the lungs are ready to perform respiration. The
development of alveolar sacs and production of surfactant are associated with the
saccular period, and formation of the conducting airways occurs during the
pseudoglandular period. Formation of primitive alveoli takes place during the
canalicular period.

Question 37

37. Which of the following situations would be most deserving of a pediatrician’s attention?
    A) The mother of an infant 2 days postpartum notes that her baby has intermittent
    periods of hyperventilation followed by slow respirations or even brief periods of
    apnea.
    B) A volunteer in the nursery notes that one of the infants, aged 2 weeks, appears
    unable to breathe through his mouth, even when his nose is congested.
    C) A neonate is visibly flaring her nostrils on inspiration.
    D) A midwife notes that a newborn infant’s chest is retracting on inspiration and that
    the child is grunting.

Answer 37

Ans: D
Feedback:
Retraction and grunting indicate a significant increase in the work of breathing that can
be indicative of respiratory distress syndrome, a situation that would require medical
intervention. Periods of hyperventilation interspersed with reduced breathing rates are
common during the transition to postpartum ventilation, and infants are commonly
unable to mouth breathe. Nostril flaring could be a sign of dyspnea, but it can also be a
compensatory mechanism that the infant uses to increase oxygen intake; this situation
would not be considered as serious as an infant who has chest retractions and grunting

Question 38

38. A premature infant on mechanical ventilation has developed bronchopulmonary
    dysplasia (BPD) and is showing signs and symptoms of hypoxemia, low lung
    compliance, and respiratory distress. Which of the following is the most likely
    contributor to the infant’s present health problem?
    A) High-inspired oxygen concentration and injury from positive-pressure ventilation
    B) Failure to administer corticosteroids to the infant in utero
    C) Insufficient surfactant production and insufficient surfactant therapy
    D) Insufficient supplemental oxygen therapy

Answer 38

Ans: A
Feedback:
Despite the administration of corticosteroids in utero to hasten alveolar maturati on,
premature infants suffering respiratory distress syndrome often must be treated with
supplemental oxygen and mechanical ventilation. However, overly forceful
positive-pressure ventilation (barotrauma) can lead to the chronic lung impair ment of
BPD. Surfactant therapy is a first-line defense against the development of R DS and is
also used to treat cases of BPD; additional time on a ventilator is often required as well.

Question 39

39. A 3-year-old boy has developed croup following a winter cold. His care provider would
    recognize which of the following microorganisms and treatments is most likely to
    be effective?
    A) Respiratory syncytial virus treated with intubation
    B) Parainfluenza virus treated with a mist tent and oxygen therapy
    C) Haemophilus influenza treated with appropriate antibiotics
    D) Staphylococcus aureus treated with bronchodilators and mist tent

Answer 39

Ans: B
Feedback:
The majority of croup cases are caused by parainfluenza viruses, and common treatment
modalities are humidified air or mist tents as well as supplementary oxygen. Respiratory
syncytial virus accounts for some croup diagnoses, but intubation is not normally
required. Haemophilus influenza is responsible for epiglottitis, while Staphylococc us
aureus is not commonly responsible for croup

Question 40

40. The nurse caring for a male child with respiratory problems is concerned he may be
    developing respiratory failure. Upon assessment, the nurse knows that which of the
    following are clinical manifestations of respiratory failure? Select all that apply.
    A) Severe accessory muscle retractions
    B) Nasal flaring
    C) Grunting on expiration
    D) Inspiratory wheezes heard
    E) Swollen glottis

Answer 40

Ans: A, B, C
Feedback:
Children with impending respiratory failure due to airway or lung disease have rapid
breathing; exaggerated use of the accessory muscles; retractions, which are more
pronounced in the child than in an adult because of more compliant chest; nasal flaring;
and grunting during expiration. Inspiratory wheezes are usually associated with asthma. Swollen glottis can occur with strep throat.