Egan’s Fundamentals of Respiratory Care 10th Edition by Robert M. Kacmarek – Test Bank

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INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS

 

Egan’s Fundamentals of Respiratory Care 10th Edition by Robert M. Kacmarek – Test Bank

 

Sample  Questions

 

Chapter 07: Computer Applications in Respiratory Care

Test Bank

 

MULTIPLE CHOICE

 

  1. For which of the following is there the most interest in using eHealth applications to improve health outcomes in a cost effective manner?
a. lung cancer
b. pediatric heart disease
c. chronic diseases
d. heart attack victims

 

 

ANS:  C

Thus, there is much interest addressing the historically disjointed, misallocated processes of chronic disease management through advances in eHealth technologies, to improve health outcomes in a cost-effective manner.

 

DIF:    Recall             REF:   p. 131            OBJ:   1

 

  1. Which of the following describes emerging computer applications to help treat tobacco use and dependence (the leading preventable cause of death and chronic diseases in the United States)?
a. eHarmony
b. eHealth
c. AOL
d. Clinivision

 

 

ANS:  B

Emerging applications of computer technology, or eHealth applications, are exciting new treatment components for tobacco use and dependence. With the extensive reach of the Internet and the demonstrated efficacy of some applications, the potential impact on health outcomes is immense. More than 10 million Internet users have searched for online information about how to quit smoking.

 

DIF:    Recall             REF:   p. 130-131     OBJ:   1

 

  1. Which of the following is included in the purposes of Telemedicine?
a. e-mailing
b. promote access to patient data and information
c. allow access to patient’s family members remotely
d. acquire patient assessment information in order to skip a patient homecare visit

 

 

ANS:  B

Telemedicine is the use of telecommunication and computer technology to promote access to diagnosis, monitoring, clinical decision support, and treatment for patients at medically underserved sites that are distant from health care providers.

 

DIF:    Application    REF:   p. 130            OBJ:   1

 

  1. Hospital-based applications for clinical decision support include:
  2. cardiac ischemia
  3. decreasing fluid given in resuscitation efforts
  4. appropriate tidal volume and plateau pressure monitoring in acute respiratory distress syndrome
  5. decreasing exacerbations in asthma patients
a. 1 and 2
b. 1, 2 and 3
c. 1, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  C

Clinical decision support have also resulted in decreased unnecessary hospital admissions for inappropriately diagnosed cardiac ischemia, appropriately decreased tidal volume and more consistent monitoring of plateau pressure in patients with acute respiratory distress syndrome, and decreased exacerbations in asthma patients.

 

DIF:    Application    REF:   p. 130            OBJ:   1

 

  1. Computerized reminders increase:
  2. the proportion of indicated influenza vaccinations
  3. adherence to medications
  4. necessary hospital admissions for appropriately diagnosed cardiac ischemia
a. 2 only
b. 3 only
c. 2 and 3 only
d. 1, 2 and 3

 

 

ANS:  D

Computerized reminders increased the proportion of indicated influenza vaccinations, and rates of screening, counseling, and adherence to medications. They have also resulted in decreased unnecessary hospital admissions for inappropriately diagnosed cardiac ischemia.

OBJ : 1

DIFF: Application

 

DIF:    Application    REF:   p. 130            OBJ:   1

 

  1. Clinical decision support is particularly useful in:
a. preventive care
b. influenza care
c. respiratory therapy
d. post-trauma care

 

 

ANS:  A

Clinical decision support is associated with improvements in clinicians’ performance, decreased unnecessary care, and adherence to evidence-based clinical practice guidelines. They are particularly useful in preventive care.

 

DIF:    Application    REF:   p. 130            OBJ:   1

 

  1. Respiratory Care Practitioners use evidence-based patient driven protocols to:
a. Extend the length of stay.
b. Allocate and titrate respiratory care services.
c. Resist automation of treatment based on patient data.
d. Avoid confrontation with nurses regarding patient care.

 

 

ANS:  B

Practitioners use evidence-based patient-driven protocols to extend the length of stay, allocate and titrate respiratory care services, resist automation of treatment based on patient data, avoid confrontation with nurses regarding patient care.

 

DIF:    Application    REF:   p. 130            OBJ:   2

 

  1. What system is capable of point-of-care patient charting using a hand-held computer?
a. CliniVision MPC
b. Microsoft Flow
c. IBM Ready Now
d. Word Perfect

 

 

ANS:  A

RCMIS, such as CliniVision MPC and MediLinks, provide point-of-care mobile, charting capabilities via hand-held computers, with wireless transmission of data to hospital information systems.

 

DIF:    Application    REF:   p. 135            OBJ:   1

 

  1. Which of the following is NOT an advantage of a wireless hand-held computer for charting patient care?
a. Documentation is more legible.
b. Documentation is available to others more quickly.
c. It is less expensive.
d. There is improved fulfillment of physicians’ orders.

 

 

ANS:  C

Wireless hand-held computers offer several advantages in comparison to nonwireless systems and paper charts. Hand-held computers facilitate the organization and assignment of workload and the fulfillment of physicians’ orders, and improve documentation. Documentation of patient assessment then becomes immediately available to other members of the health care team in the hospital information system. Moreover, by comparison, computerized documentation is more legible.

 

DIF:    Application    REF:   p. 130-131     OBJ:   1

 

  1. In what automated respiratory care protocol has it been shown that use of a hand-held computer helped shorten the patient’s stay in the intensive care unit?
a. ventilator initiation
b. ventilator weaning
c. high-flow oxygen therapy
d. airway care and intubation

 

 

ANS:  B

An automated protocol for discontinuation of mechanical ventilation with use of a hand-held computer has been associated with a shortened time to the first spontaneous breathing trial and a decreased length of stay in the intensive care unit.

 

DIF:    Application    REF:   p. 130            OBJ:   1

 

  1. Computers are often used to interpret which of the following tests in respiratory care patients?
a. chest radiograph
b. CBC and electrolytes
c. pulmonary function testing
d. EEG testing

 

 

ANS:  C

Computer algorithms use standard reference predicted values to aid in the interpretation of pulmonary function tests (PFTs), including spirometry, lung volume, diffusing capacity, and bronchodilator response.

 

DIF:    Application    REF:   p. 132            OBJ:   1

 

  1. In what area are computers used to apply quality assurance measures in respiratory care departments?
a. arterial blood gas analyzers
b. oxygen delivery systems
c. interpreting ECGs
d. equipment cleaning and sterilization

 

 

ANS:  A

Computer-assisted quality assurance in a blood gas laboratory is a critically important function in a respiratory care department, because the accuracy and precision of blood gas data influence clinical decisions and patient safety.

 

DIF:    Application    REF:   p. 132            OBJ:   1

 

  1. What respiratory care equipment uses microprocessors for monitoring and control of complex data?
a. oxygen flowmeters
b. pulse oximeters
c. mechanical ventilators
d. water sealed spirometers

 

 

ANS:  C

Mechanical ventilators predominantly use microprocessors for monitoring and control of complex data.

 

DIF:    Application    REF:   p. 129            OBJ:   1

 

  1. Which of the following is considered an emerging application of information technology that may improve national health care issues in the future?
a. HIPAA
b. a nationally available electronic health record
c. medical ID bracelets
d. the national database for organ donors

 

 

ANS:  B

In the aftermath of Hurricane Katrina and in the face of a flu pandemic threat, many have begun to focus attention on the development of a seamless network of transferable, widely accessible, electronic health records.

 

DIF:    Application    REF:   p. 135            OBJ:   1

 

  1. In what way do computers assist smokers who want to quit?
a. by providing internet sites with smoking cessation plans
b. by measuring blood carbon monoxide levels
c. by providing genetic information on the risk of smoking
d. by allowing smokers to order low risk cigarettes through the internet

 

 

ANS:  A

Multifaceted, Internet-based, tobacco cessation programs that assess the needs of and tailor treatment to the characteristics of individual patients have demonstrated good outcomes.

 

DIF:    Application    REF:   p. 130-131     OBJ:   1

 

  1. What program offers access to medically underserved communities through the use of telephones and computer-based education?
a. Telecare
b. teletreatment
c. telemedicine
d. Teleheart

 

 

ANS:  C

Telemedicine is the use of telecommunication and computer technology to promote access to diagnosis, monitoring, clinical decision support, and treatment for patients at medically underserved sites that are distant from healthcare providers.

 

DIF:    Recall             REF:   p. 130            OBJ:   1

 

  1. Which of the following patients would benefit the most from a disease management program?
a. patient with pneumonia
b. patient with a sinus infection
c. patient with hay fever
d. patient with COPD

 

 

ANS:  D

Management of chronic diseases, such as asthma and COPD, presents a grave challenge to our U.S. healthcare system.

 

DIF:    Application    REF:   p. 131-132     OBJ:   1

 

  1. Clinical decision support systems perform all the following tasks except:
a. match individual patients with proper drug doses
b. provide standing patient care orders
c. remind patients of when to reorder meds
d. provide directions to the best local pharmacy

 

 

ANS:  D

Clinical decision support systems match the characteristics of individual patients and their clinical interventions, drugs, and diagnostic tests to databases of scientific evidence and drug calculations and then generate tailored recommendations, reminders, or even standing orders

 

DIF:    Application    REF:   p. 130            OBJ:   1

 

  1. What Web site is known for well-respected rigorously conducted systematic evidence-based reviews and provides free access to abstracts and summaries pertaining to relevant clinical questions?
a. cochrane.org
b. medsearch.org
c. hotmail.com
d. systemview.org

 

 

ANS:  A

For example, the Cochrane Collaboration (www.cochrane.org), well respected for rigorously conducted systematic evidence-based reviews, provides free access to abstracts and summaries pertaining to relevant clinical questions, including those related to “Airways.”

 

DIF:    Recall             REF:   p. 133            OBJ:   2

 

  1. What search engine looks for scholarly publications in a wide range of fields and includes peer-reviewed manuscripts, abstracts, theses, and books from academic publishers, professional societies, and university libraries?
a. medline.org
b. Google Scholar
c. minimed.org
d. cochrane.org

 

 

ANS:  B

Google Scholar (scholar.google.com) is a search engine for scholarly publications in a wide range of fields. It includes peer-reviewed manuscripts, abstracts, theses, and books from academic publishers, professional societies, and university libraries

 

DIF:    Recall             REF:   p. 133            OBJ:   2

 

  1. What is the name of the search engine sponsored by the National Library of Medicine for information on health care?
a. PubMed
b. HotMed
c. Up-to-date-Med
d. NationalMedline

 

 

ANS:  A

PubMed (www.pubmed.com) is the National Library of Medicine’s free search engine for health information.

 

DIF:    Recall             REF:   p. 133            OBJ:   2

 

  1. What is the name of the database often purchased and used by hospitals and university libraries to provide key research information on a large variety of medical topics?
a. SPAN
b. OVID
c. CINUP
d. MITO

 

 

ANS:  B

OVID is an extensive collection of Web-based information resources, including databases, journals, books, and searching software. In the United States, medical libraries and large hospitals almost universally purchase and use OVID in some form.

 

DIF:    Recall             REF:   p. 134            OBJ:   2

 

  1. Which of the following devices would be most useful for point-of-care access to data bases related to evidence-based care?
a. laptop
b. desktop
c. personal digital assistant (PDA)
d. pocket file (PF)

 

 

ANS:  C

A hand-held computer, also known as a personal digital assistant or PDA, is an effective tool for rapid information retrieval at the point of care to aid in clinical decisions and treatment plans. Hand-held computers interface with computers, networks, and each other via wireless technology or synchronization software. Users can use these devices to access medical records, medication references and interaction checks, calculators, textbooks, and medical evidence. Indeed, the National Library of Medicine has developed MEDLINE Database on Tap and PubMed for Hand-helds to deliver up-to-date medical evidence at the point of care. Table 7-2 presents additional information sources available via hand-held computers.

 

DIF:    Application    REF:   p. 135            OBJ:   2

 

  1. What is the name of the database management system for documenting and reporting clinical educational activities for nursing and the allied health professions?
a. DataARC
b. DataFILE
c. DataBASE
d. DataNOW

 

 

ANS:  A

DataARC (www.dataarc.ws) is a secure, password-protected, and Web-based database management system for documenting and reporting clinical educational activities for nursing and the allied health professions, including respiratory care.

 

DIF:    Recall             REF:   p. 140            OBJ:   1

 

  1. You are conducting a research project and you need a software program to analyze the data collected. Which of the following would be most useful?
a. ADDC
b. SPSS
c. SOS
d. DADD

 

 

ANS:  B

Statistical software programs, such as SPSS, SAS, and Statistica, are instrumental in research. In the hands of respiratory therapists with knowledge of statistics, these powerful programs can perform laborious and complex statistical tests for descriptive, analytical, and inferential analyses and reporting.

 

DIF:    Recall             REF:   p. 142            OBJ:   1

 

  1. What is the name of the software that monitors the computer use of individuals and reports the results to a central database?
a. Spyware
b. Eyeball
c. FOCUS
d. FISH

 

 

ANS:  A

Spyware is a broad class of software that monitors the actions of computer users and reports information back to a central database.

 

DIF:    Recall             REF:   p. 136            OBJ:   1

 

  1. Microprocessors can benefit mechanical ventilation by doing which of the following?
  2. equilibrate measured values with target values on a breath-by-breath basis
  3. control ventilator alarms
  4. archive the history of set and measured values
  5. change clinician set parameters as needed
a. 1 and 3 only
b. 1 and 4 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

ANS:  C

Microprocessors can equilibrate measures of values with target values, control ventilator alarms, and archive the history of set and measured values, but they cannot change ventilator setting on its own.

 

DIF:    Application    REF:   p. 129            OBJ:   1

 

  1. Conventional mechanical ventilators using microprocessors are closed-loop, which:
a. equilibrate measured values with target values
b. adapt to the patient’s needs instantly
c. always use neutrally adjusted ventilation
d. do not limit pressure or flow to the patient

 

 

ANS:  A

Proportional assist ventilation and neutrally adjusted ventilatory assist, aim to enhance the patient-ventilator synchrony via automation that is highly responsive to the patient.

 

DIF:    Application    REF:   p. 129            OBJ:   1

 

  1. All of the following are advantages of computerized ventilator charting applications, except:
a. improve the consistency of ventilator charting
b. improve the accuracy of ventilator charting
c. automate ventilator charting with verification by respiratory therapist
d. other clinicians not allowed to monitor their progress

 

 

ANS:  D

Computerized ventilator charting applications have the potential to improve the quality and consistency of ventilator charting. Automated ventilator charting, verified, in turn, by respiratory therapists, takes that a step further, with the potential to improve completeness, accuracy, and consistency, as well as efficiency. However, the therapist still has to do all the charting.

OBJ : 1

DIFF: Application

 

DIF:    Application    REF:   p. 129            OBJ:   1

 

  1. How have new applications in diagnostics changed the way hemodynamic monitoring is done?
a. Pulmonary artery catheters became obsolete.
b. Computers now can calculate cardiac output using the thermodilution technique.
c. Clinicians now rely solely on noninvasive measures.
d. Swan-ganz catheters became obsolete.

 

 

ANS:  B

In hemodynamic monitoring via pulmonary artery catheters, computers calculate cardiac output, using the thermodilution technique. The thermistor port of the pulmonary artery catheter is linked to a computer.

 

DIF:    Application    REF:   p. 132            OBJ:   1

 

  1. The AARC online benchmarking system is valuable in all of the following functions of respiratory care, except:
a. allowing managers to compare the performance of their department to similar departments
b. helping to demonstrate the productivity of the department, as well as establish best practices
c. increasing efforts to implement evidence-based interventions and improve patient outcomes
d. helping monitor equipment cost and insurance compensations

 

 

ANS:  D

Benchmarking is valuable in everything mentioned, except it doesn’t monitor equipment or deal with insurance compensations

 

DIF:    Application    REF:   p. 137            OBJ:   1

 

  1. To safeguard against infiltration by malicious software, hospitals use:
a. worms
b. spyware
c. firewalls
d. trojan horses

 

 

ANS:  C

To safeguard against infiltration by malicious software, hospitals and healthc are organizations use firewalls that filter the exchange of data between the Internet and local networks by verifying users` identification, passwords, and registered Internet addresses and restricting certain types of communication.

 

DIF:    Application    REF:   p. 142            OBJ:   3

 

  1. Which of the following are ways health care workers and facilities conform to HIPPA regulations concerning securing patient confidentiality within electronic medical records?
  2. refraining from sharing passwords
  3. accessing electronic personal health information on a need to know basis
  4. utilizing thumbprint protected security
  5. allowing only close family members to view personal health information in the hospital computer
a. 1 and 2 only
b. 1, 3, and 4 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

ANS:  C

To emphasize two important points concerning electronic personal health information, users of hospital and respiratory care information management systems and researchers must refrain from sharing passwords and access personal health information only on a need-to-know basis. Some respiratory care information management systems, for example, now feature thumbprint protected security.

 

DIF:    Application    REF:   p. 142-143     OBJ:   3

Chapter 09: The Cardiovascular System

Test Bank

 

MULTIPLE CHOICE

 

  1. The apex of the heart (tip of the left ventricle) lies just above the diaphragm at a level corresponding to which intercostal space?
a. fourth
b. fifth
c. sixth
d. seventh

 

 

ANS:  B

The apex of the heart is formed by the tip of the left ventricle and lies just above the diaphragm at the level of the fifth intercostal space.

 

DIF:    Application    REF:   p. 204            OBJ:   1

 

  1. What is the loose membranous sac that encloses the heart?
a. endocardium
b. mesothelium
c. myocardium
d. pericardium

 

 

ANS:  D

The heart resides within a loose, membranous sac called the parietal pericardium.

 

DIF:    Recall             REF:   p. 205            OBJ:   1

 

  1. Tissue layers making up the heart wall include which of the following?
  2. endocardium
  3. epicardium
  4. myocardium
a. 1, 2, and 3
b. 2 and 3
c. 2 only
d. 1 and 3

 

 

ANS:  A

The heart wall consists of three layers: (1) the outer epicardium, (2) the middle myocardium, and (3) the inner endocardium.

 

DIF:    Application    REF:   p. 205            OBJ:   1

 

  1. Most of the muscle mass of the heart is located in which chamber?
a. left atrium (LA)
b. left ventricle (LV)
c. right atrium (RA)
d. right ventricle (RV)

 

 

ANS:  B

The two lower heart chambers, or ventricles, make up the bulk of the heart’s muscle mass and do most of the pumping that circulates the blood (Figure 9-2). The mass of the left ventricle is approximately two thirds larger than that of the right ventricle and has a spherical appearance when viewed in anteroposterior cross section.

 

DIF:    Application    REF:   p. 205            OBJ:   2

 

  1. The mitral (bicuspid) valve does which of the following?
a. prevents atrial backflow during ventricular contraction
b. separates the right atrium and the left atrium
c. separates the right atrium and the right ventricle
d. separates the right ventricle and the pulmonary artery

 

 

ANS:  A

The valve between the left atrium and ventricle is the bicuspid, or mitral, valve. The AV valves close during systole (contraction of the ventricles), thereby preventing backflow of blood into the atria.

 

DIF:    Application    REF:   p. 208            OBJ:   1

 

  1. Narrowing of the mitral valve (mitral stenosis) results in which of the following?
a. increased afterload on left ventricle
b. increased preload on right ventricle
c. increased pulmonary congestion
d. systemic hypertension

 

 

ANS:  C

Stenosis is a pathologic narrowing or constriction of a valve outlet, which causes increased pressure in the affected chamber and vessels. Both conditions affect cardiac performance. For example, in mitral stenosis, high pressures in the left atrium back up into the pulmonary circulation. This can cause pulmonary edema.

 

DIF:    Application    REF:   p. 208            OBJ:   1

 

  1. The semilunar (pulmonary and aortic) valves do which of the following?
a. cause almost the entire afterload for the ventricles
b. consist of two half-moon or crescent-shaped cusps
c. prevent arterial backflow during ventricular relaxation
d. separate the ventricles from their arterial outflow tracts

 

 

ANS:  D

A set of semilunar valves separates the ventricles from their arterial outflow tracts (Figure 9-3). Consisting of three half-moon–shaped cusps attached to the arterial wall, these valves prevent backflow of blood into the ventricles during diastole (or when the heart’s chambers fill with blood).

 

DIF:    Application    REF:   p. 208            OBJ:   1

 

  1. What are the first arteries to branch off the ascending aorta?
a. brachiocephalic
b. carotid
c. coronary
d. subclavian

 

 

ANS:  C

Two main coronary arteries, a left and a right, arise from the root of the aorta.

 

DIF:    Recall             REF:   p. 208            OBJ:   1

 

  1. What are the major branches of the left coronary artery?
  2. anterior descending
  3. circumflex
  4. coronary sinus
  5. posterior descending
a. 1, 2, and 3
b. 2 and 4
c. 1 and 2
d. 2 and 3

 

 

ANS:  C

An anterior descending branch courses down the anterior sulcus to the apex of the heart. A circumflex branch moves along the coronary sulcus toward the back and around the left atrial appendage.

 

DIF:    Recall             REF:   p. 208            OBJ:   1

 

  1. The branches of the left coronary artery DO NOT supply which area of the heart?
a. majority of the interventricular septum
b. majority of the left ventricle
c. majority of the left atrium
d. sinus node

 

 

ANS:  D

In combination, the branches of the left coronary artery normally supply most of the left ventricle, the left atrium, and the anterior two thirds of the interventricular septum.

 

DIF:    Application    REF:   p. 208            OBJ:   1

 

  1. Before draining into the right atrium, where do the large veins of the coronary circulation gather together?
a. coronary sinus
b. left posterior coronary vein
c. right coronary sulcus
d. thebesian veins

 

 

ANS:  A

These veins gather together into a large vessel called the coronary sinus, which passes left to right across the posterior surface of the heart. The coronary sinus empties into the right atrium.

 

DIF:    Application    REF:   p. 208            OBJ:   1

 

  1. Mixing of venous blood with arterial blood (a right-to-left shunt) occurs normally because of which of the following?
  2. congenital cardiac defects
  3. bronchial venous drainage
  4. thebesian venous drainage in the heart
a. 1, 2, and 3
b. 2 and 3
c. 1 only
d. 2 only

 

 

ANS:  B

Because the thebesian veins bypass, or shunt, around the pulmonary circulation, this phenomenon is called an anatomical shunt. When combined with a similar bypass in the bronchial circulation (see Chapter 7), these normal anatomical shunts account for approximately 2% to 3% of the total cardiac output.

 

DIF:    Application    REF:   p. 208-209     OBJ:   1

 

  1. What is the ability of myocardial tissue to propagate electrical impulses?
a. automaticity
b. conductivity
c. contractility
d. excitability

 

 

ANS:  A

Inherent rhythmicity or automaticity is the unique ability of the cardiac muscle to initiate a spontaneous electrical impulse.

 

DIF:    Application    REF:   p. 209            OBJ:   2

 

  1. What makes it impossible for the myocardium to go into tetany?
a. absolute refractory period
b. automaticity
c. cardiac myofibrils
d. intercalated discs

 

 

ANS:  A

Unlike those of other muscle tissues, however, cardiac contractions cannot be sustained or tetanized because myocardial tissue exhibits a prolonged period of inexcitability after contraction. The period during which the myocardium cannot be stimulated is called the refractory period.

 

DIF:    Application    REF:   p. 209            OBJ:   2

 

  1. Intercalated disks in the myocardium perform a very important function. Which of the following describes that function?
a. absolute refractory period
b. automaticity
c. contractility
d. electrical conduction

 

 

ANS:  D

Cardiac fibers are separated by irregular transverse thickenings of the sarcolemma called intercalated discs. These discs provide structural support and aid in electrical conduction between fibers.

 

DIF:    Recall             REF:   p. 209            OBJ:   2

 

  1. What in essence is Frank-Starling’s law of the heart?
a. the greater the stretch, the stronger the contraction.
b. the less the afterload, the greater the ejection fraction
c. describes the inverse relationship between diameter and resistance to flow
d. curves show the hysteresis variations between systole and diastole

 

 

ANS:  A

According to Frank-Starling law, the more a cardiac fiber is stretched, the greater the tension it generates when contracted.

 

DIF:    Recall             REF:   p. 209            OBJ:   2

 

  1. Which vessels in the body act like faucets, controlling the flow of blood into the capillary beds?
a. arteries
b. arterioles
c. veins
d. venules

 

 

ANS:  B

Just as faucets control the flow of water into a sink, the smaller arterioles control blood flow into the capillaries. Arterioles provide this control by varying their flow resistance. For this reason, arterioles are often referred to as resistance vessels.

 

DIF:    Recall             REF:   p. 211            OBJ:   1

 

  1. Why are the vessels of the venous system, particularly the small venules and veins, termed capacitance vessels?
a. They transmit and maintain the head of perfusion pressure.
b. They can alter their capacity to maintain adequate perfusion.
c. They determine the afterload on the left ventricle.
d. They maintain a constant environment for the body’s cells.

 

 

ANS:  B

By quickly changing its holding capacity, the venous system can match the volume of circulating blood to that needed to maintain adequate perfusion. Accordingly, the components of the venous system, especially the small, expandable venules and veins, are termed capacitance vessels.

 

DIF:    Application    REF:   p. 211            OBJ:   1

 

  1. Which of the following mechanisms facilitates venous return to the heart?
  2. sodium/potassium pump
  3. sympathetic venomotor tone
  4. cardiac suction
  5. skeletal muscle contraction
a. 1 and 2
b. 2, 3, and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  B

The following four mechanisms combine to aid venous return to the heart: (1) sympathetic venous tone, (2) skeletal muscle pumping, or “milking” (combined with venous one-way valves), (3) cardiac suction, and (4) thoracic pressure differences caused by respiratory efforts.

 

DIF:    Application    REF:   p. 211            OBJ:   1

 

  1. What circulatory system is referred to as a low-pressure, low-resistance system?
a. left heart
b. pulmonary vascular bed
c. right heart
d. systemic vascular bed

 

 

ANS:  B

The right side of the heart provides the pressures needed to drive blood through the low-resistance, low-pressure pulmonary circulation.

 

DIF:    Application    REF:   p. 211            OBJ:   1

 

  1. Which of the following equations would you use to compute total peripheral resistance (CO = cardiac output)?
a. (mean aortic pressure ´ right atrial pressure) ¸ CO
b. (mean aortic pressure/right atrial pressure) ´ CO
c. (mean aortic pressure – right atrial pressure) ¸ CO
d. (right atrial pressure – mean aortic pressure) ¸ CO

 

 

ANS:  C

SVR = (mean aortic pressure – right atrial pressure)/CO

 

DIF:    Analysis         REF:   p. 212            OBJ:   3

 

  1. Which of the following statements is true?
a. Pulmonary vascular resistance (PVR) is equal to systemic resistance.
b. Pulmonary vasculature is a high-pressure, high-resistance circulation.
c. Systemic vascular resistance (SVR) is less than PVR.
d. SVR is normally approximately 10 times higher than PVR.

 

 

ANS:  D                    DIF:    Analysis         REF:   p. 212            OBJ:   3

 

  1. Which of the following equations best portrays the factors determining mean arterial blood pressure?
a. mean arterial pressure = cardiac output ¸ vascular resistance
b. mean arterial pressure = cardiac output ´ vascular resistance
c. mean arterial pressure = right atrial pressure – aortic pressure
d. mean arterial pressure = vascular resistance ¸ cardiac output

 

 

ANS:  B

Average blood pressure in the circulation is directly related to both cardiac output and flow resistance.

Mean arterial pressure = cardiac output ´ vascular resistance

 

DIF:    Analysis         REF:   p. 212            OBJ:   3

 

  1. Mean arterial blood pressure can be regulated by changing which of the following?
  2. capacity of the circulatory system
  3. effective volume of circulating blood
  4. tone of the capacitance vessels (veins)
a. 1 and 2
b. 2
c. 1, 2, and 3
d. 3

 

 

ANS:  C

All else being constant, mean arterial pressure is directly related to the volume of blood in the vascular system and inversely related to its capacity. A change in the tone of the capacitance vessels alters their capacity.

Mean arterial pressure = volume/capacity

 

DIF:    Application    REF:   p. 212            OBJ:   4

 

  1. During exercise, cardiac output increases dramatically, but mean arterial blood pressure rises very little. Why is this so?
a. Venules constrict, increasing vascular resistance.
b. Arterioles dilate, decreasing vascular capacity.
c. Arterioles constrict, increasing vascular resistance.
d. Muscle vessels dilate, increasing vascular capacity.

 

 

ANS:  D

For example, when exercising, the circulating blood volume undergoes a relative increase, but blood pressure remains near normal. This is because the skeletal muscle vascular beds dilate, causing a large increase in system capacity.

 

DIF:    Application    REF:   p. 212            OBJ:   4

 

  1. During blood loss due to hemorrhage, perfusing pressures can be kept near normal until the volume loss overwhelms the system. Why is this so?
a. Arteries constrict, increasing vascular resistance.
b. Arterioles dilate, decreasing vascular capacity.
c. Muscle vessels dilate, increasing vascular capacity.
d. Venules constrict, decreasing vascular capacity.

 

 

ANS:  D

When blood loss occurs, as with hemorrhage, system capacity is decreased by constricting the venous vessels. Thus, perfusing pressures can be kept near normal until the volume loss overwhelms the system.

 

DIF:    Application    REF:   p. 212            OBJ:   6

 

  1. The underlying goal of the body’s cardiovascular control mechanisms is to ensure that all tissues receive which of the following?
a. blood flow according to their mass
b. blood flow according to their size
c. equivalent amounts of blood flow
d. perfusion according to their metabolic needs

 

 

ANS:  D

The goal is to maintain adequate perfusion to all tissues according to their needs.

 

DIF:    Application    REF:   p. 212            OBJ:   4

 

  1. The cardiovascular system regulates perfusion mainly by altering which of the following?
a. capacity and resistance of blood vessels
b. rate of cardiac contractions
c. strength of cardiac contractions
d. volume of cardiac contractions

 

 

ANS:  A

The cardiovascular system regulates blood flow mainly by altering the capacity of the vasculature and the volume of blood it holds.

 

DIF:    Application    REF:   p. 212            OBJ:   4

 

  1. What is the primary function of local or intrinsic cardiovascular control mechanisms?
a. alter local blood flow according to tissue needs
b. alter the rate of cardiac contractions
c. maintain a basal level of systemic vascular tone
d. control the capacity of the venous reservoir

 

 

ANS:  A

Local, or intrinsic, controls operate independently, without central nervous control. Intrinsic control alters perfusion under normal conditions to meet metabolic needs.

 

DIF:    Application    REF:   p. 213            OBJ:   4

 

  1. Central, or extrinsic, control of the cardiovascular system occurs through the action of which of the following?
  2. autonomic nervous system
  3. circulating humoral agents
  4. local metabolites
a. 1, 2, and 3
b. 2 and 3
c. 3
d. 1 and 2

 

 

ANS:  D

Central, or extrinsic, control involves both the central nervous system and circulating humoral agents.

 

DIF:    Application    REF:   p. 213            OBJ:   4

 

  1. Central control of vasomotor tone has its greatest impact on which of the following vessels?
  2. arterioles (resistance vessels)
  3. veins (capacitance vessels)
  4. microcirculation (exchange vessels)
a. 2 and 3
b. 1 and 2
c. 3 only
d. 1, 2, and 3

 

 

ANS:  B

Central control mainly affects the high-resistance arterioles and capacitance veins.

 

DIF:    Application    REF:   p. 213            OBJ:   4

 

  1. Variations in blood flow to the brain are governed primarily by which of the following?
a. central neural innervation
b. circulation of humoral agents
c. local metabolic control mechanisms
d. local myogenic control mechanisms

 

 

ANS:  C

Metabolic control involves the relationship between vascular smooth muscle tone and the level of local cellular metabolites. The vascular tone in the brain is the most sensitive to changes in the local metabolite levels, particularly those of CO2 and pH.

 

DIF:    Application    REF:   p. 213            OBJ:   4

 

  1. Variations in blood flow to the heart are governed primarily by which of the following?
  2. local metabolic control mechanisms
  3. local myogenic control mechanisms
  4. central neural innervation
a. 1, 2, and 3
b. 2 and 3
c. 1 only
d. 1 and 3

 

 

ANS:  B

The vasculature of the heart shows a strong response to both myogenic and metabolic factors.

 

DIF:    Application    REF:   p. 213            OBJ:   4

 

  1. Which portion of the nervous system is mainly responsible for the central control of the blood flow?
a. higher brain centers
b. parasympathetic nervous system
c. somatic (voluntary) nervous system
d. sympathetic nervous system

 

 

ANS:  D

Central control of blood flow is achieved primarily by the sympathetic division of the autonomic nervous system

 

DIF:    Application    REF:   p. 213            OBJ:   4

 

  1. Central mechanisms cause contraction and increased resistance to blood flow mainly through which of the following?
a. adrenergic stimulation and the release of norepinephrine
b. cholinergic stimulation and the release of acetylcholine
c. cholinergic stimulation and the release of norepinephrine
d. stimulation of specialized a-adrenergic receptors

 

 

ANS:  A

Smooth muscle contraction and increased flow resistance are mostly caused by adrenergic stimulation and the release of norepinephrine.

 

DIF:    Application    REF:   p. 213            OBJ:   4

 

  1. Smooth muscle relaxation and vessel dilation are caused mainly by which of the following?
  2. action of local metabolites
  3. cholinergic stimulation
  4. stimulation of b-adrenergic receptors
a. 1 and 3
b. 2 and 3
c. 1 and 2
d. 1, 2, and 3

 

 

ANS:  B

Smooth muscle relaxation and vessel dilation occur as a result of stimulation of cholinergic or specialized ß-adrenergic receptors.

 

DIF:    Application    REF:   p. 213            OBJ:   4

 

  1. Which of the following formulas is used to calculate the total amount of blood pumped by the heart per minute, or cardiac output?
a. blood pressure ´ SV
b. rate ´ SV
c. SV ¸ rate
d. SV ´ vascular resistance

 

 

ANS:  B

Cardiac output = heart rate ´ stroke volume

 

DIF:    Analysis         REF:   p. 213            OBJ:   6

 

  1. What is an approximate normal resting cardiac output for a healthy adult?
a. 75 ml/min
b. 500 ml/min
c. 2000 ml/min
d. 5000 ml/min

 

 

ANS:  D

A normal resting cardiac output of approximately 5 L/min can be calculated by substituting a normal heart rate (70 contractions/min) and stroke volume (75 ml, or 0.075 L, per contraction).

Cardiac output = 70 beats/min ´ 0.075 L/beat = 5.25 L/min

 

DIF:    Analysis         REF:   p. 213            OBJ:   6

 

  1. Which of the following factors determine cardiac stroke volume?
  2. ventricular preload
  3. ventricular afterload
  4. ventricular contractility
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

Stroke volume is affected chiefly by intrinsic control of three factors: (1) preload, (2) afterload, and (3) contractility.

 

DIF:    Application    REF:   p. 214            OBJ:   5

 

  1. Stroke volume can be calculated using which formula?
a. ejection fraction ´ heart rate
b. end-diastolic volume – end-systolic volume
c. ejection fraction ´ end-systolic volume
d. cardiac output ¸ end-diastolic volume

 

 

ANS:  B

Stroke volume = EDV – ESV

 

DIF:    Application    REF:   p. 214            OBJ:   7

 

  1. Given a stroke volume of 40 ml and an end-diastolic volume (EDV) of 70 ml, what is the patient’s ejection fraction (EF)?
a. 0.57
b. 1.75
c. 67
d. 2800

 

 

ANS:  A

Given a stroke volume of approximately 40 ml, and a EDV of 70 ml, the ejection fraction can be calculated as follows:

EF = SV/EDV= 40 ml/70 ml = 0.57, or 57%

 

DIF:    Analysis         REF:   p. 214            OBJ:   7

 

  1. What is a normal cardiac ejection fraction?
a.
b.
c.
d.

 

 

ANS:  D

Thus, on each contraction, the normal heart ejects approximately two thirds of its stored volume. Decreases in ejection fraction are normally associated with a weakened myocardium and decreased contractility.

 

DIF:    Application    REF:   p. 214            OBJ:   7

 

  1. The heart’s ability to vary stroke volume based solely on changes in end-diastolic volume is based on what mechanism?
a. automaticity
b. autoregulation
c. Bohr equation
d. Frank-Starling law

 

 

ANS:  D

The heart’s ability to change stroke volume solely according to the EDV is an intrinsic regulatory mechanism based on the Frank-Starling law.

 

DIF:    Application    REF:   p. 214            OBJ:   5

 

  1. What does the Frank-Starling law of the heart state?
a. The less cardiac fibers stretch, the greater is the stroke volume.
b. The more cardiac fibers stretch, the greater the stroke volume.
c. The more cardiac fibers stretch, the greater the heart rate.
d. The more cardiac fibers stretch, the less the stroke volume.

 

 

ANS:  B

Because the EDV corresponds to the initial stretch, or tension, placed on the ventricle, the greater the EDV (up to a point), the greater is the tension developed on contraction, and vice versa.

 

DIF:    Application    REF:   p. 214            OBJ:   5

 

  1. Which of the following are true of the force against which the left ventricle must pump?
  2. referred to as left ventricular afterload
  3. equivalent to systemic vascular resistance
  4. helps to determine left ventricular stroke volume
a. 1 and 3
b. 1 and 2
c. 1, 2, and 3
d. 2 and 3

 

 

ANS:  C

A major factor affecting stroke volume is the force against which the heart must pump. This is called afterload. In clinical practice, left ventricular afterload equals the SVR. In other words, the greater the resistance to blood flow, the greater is the afterload.

 

DIF:    Application    REF:   p. 214            OBJ:   8

 

  1. Which of the following would have a negative impact on cardiac contractility?
  2. acidosis
  3. digitalis
  4. hypoxia
  5. norepinephrine
a. 1, 2, and 3
b. 2 and 4
c. 4 only
d. 1 and 3

 

 

ANS:  D

Profound hypoxia and acidosis impair myocardial metabolism and decrease cardiac contractility.

 

DIF:    Application    REF:   p. 215            OBJ:   5

 

  1. Changes in the rate of cardiac contractions are affected primarily by changes in which of the following?
a. sympathetic or parasympathetic tone
b. ventricular afterload
c. ventricular contractility
d. ventricular preload

 

 

ANS:  A

Those factors affecting heart rate are mainly of central origin (i.e., neural or hormonal).

 

DIF:    Application    REF:   p. 215            OBJ:   4

 

  1. Where are the central centers responsible for regulating the cardiovascular system located?
a. aortic bodies
b. brainstem
c. carotid arteries
d. cerebral hemispheres

 

 

ANS:  B

Central control of cardiovascular function occurs via interaction between the brainstem and selected peripheral receptors.

 

DIF:    Application    REF:   p. 216            OBJ:   4

 

  1. What is the affect on the cardiovascular medullary centers when the cerebral carbon dioxide is low?
a. excitatory
b. inhibitory
c. no affect
d. increased vascular tone

 

 

ANS:  B

The cardiovascular centers also are affected by local chemical changes in the surrounding blood and cerebrospinal fluid. For example, decreased levels of carbon dioxide tend to inhibit the medullary centers.

 

DIF:    Application    REF:   p. 216            OBJ:   5

 

  1. In order to function effectively, the central cardiovascular control center must receive signals regarding changes in blood volume or pressure. From where do these signals come?
a. central chemoreceptors
b. hypothalamus
c. peripheral baroreceptors
d. skeletal muscles

 

 

ANS:  C

The greater the blood pressure, the greater is the stretch and the higher is the rate of neural discharge from the peripheral baroreceptors to the cardiovascular centers in the medulla.

 

DIF:    Application    REF:   p. 216            OBJ:   4

 

  1. Considering the negative feedback system for the control of blood pressure, when a blood pressure rise is noted in the arterial receptors, what is the expected response?
a. arterial vasoconstriction
b. decreased inotropic state
c. increased heart rate
d. venoconstriction

 

 

ANS:  B

In the case of the arterial receptors, a rise in blood pressure increases aortic and carotid receptor stretch, and thus the discharge rate. The increased discharge rate causes an opposite response by the medullary centers (i.e., a depressor response). Venomotor tone decreases, blood vessels dilate, and heart rate and contractility both decrease.

 

DIF:    Application    REF:   p. 218            OBJ:   5

 

  1. Vascular low-pressure baroreceptors have their greatest impact on which system?
a. central chemoreceptors
b. endocrine
c. exocrine
d. renin-angiotensin

 

 

ANS:  D

The low-pressure atrial and venous baroreceptors regulate plasma volume mainly through their effects on the following:

  • renal sympathetic nerve activity
  • release of antidiuretic hormone (ADH), also called vasopressin
  • release of atrial natriuretic factor (ANF)
  • renin-angiotensin-aldosterone system

 

DIF:    Application    REF:   p. 218            OBJ:   4

 

  1. What factor stimulates the carotid and aortic chemoreceptors?
a. high carbon dioxide levels
b. high oxygen levels
c. high pH levels
d. high 2,3-DPG levels

 

 

ANS:  A

They are strongly stimulated by decreased oxygen tensions, although low pH or high levels of carbon dioxide also can increase their discharge rate.

 

DIF:    Application    REF:   p. 219            OBJ:   4

 

  1. What are the major effects of peripheral chemoreceptor stimulation?
a. decreased drive to breathe
b. decreased production of erythropoietin
c. vasoconstriction and increased heart rate
d. vasodilation and increased stroke volume

 

 

ANS:  C

It is important for the respiratory therapist to know that the major cardiovascular effects of chemoreceptor stimulation are vasoconstriction and increased heart rate.

 

DIF:    Application    REF:   p. 219            OBJ:   4

 

  1. Significant loss of blood volume causes an increase in which of the following?
  2. vascular tone
  3. secretion of antidiuretic hormone (ADH)
  4. heart rate
a. 1, 2, and 3
b. 2 and 3
c. 1 and 3
d. 1 and 2

 

 

ANS:  A

As the blood loss becomes more severe (20%), atrial receptor activity decreases further. This increases the intensity of sympathetic discharge from the cardiovascular centers. Plasma ADH and heart rate continue to climb, as does peripheral vasculature tone.

 

DIF:    Application    REF:   p. 220            OBJ:   5

 

  1. During the normal events of the cardiac cycle, which of the following statements is true?
a. Electrical depolarization follows mechanical contraction.
b. Electrical depolarization precedes mechanical contraction.
c. Heart sounds precede electrical depolarization.
d. Heart sounds precede cardiac valve opening or closing.

 

 

ANS:  B

The P wave signals atrial depolarization. Within 0.1 second, the atria contract, causing a slight rise in both atrial and ventricular pressures (the a waves).

 

DIF:    Application    REF:   p. 221            OBJ:   8

 

  1. Immediately following the P wave of the electrocardiogram, an A wave appears on both the left and right heart pressure graphs. This A wave corresponds to which of the following?
a. atrial contraction
b. atrioventricular valve closure
c. semilunar valve closure
d. ventricular contraction

 

 

ANS:  A

The P wave signals atrial depolarization. Within 0.1 second, the atria contract, causing a slight rise in both atrial and ventricular pressures (the A waves).

 

DIF:    Analysis         REF:   p. 221            OBJ:   8

 

  1. The first heart sound is associated with what mechanical event of the cardiac cycle?
a. atrioventricular valve closure
b. atrioventricular valve opening
c. semilunar valve closure
d. semilunar valve opening

 

 

ANS:  A

As soon as ventricular pressures exceed those in the atria, the atrioventricular valves close. Closure of the mitral valve occurs first, followed immediately by closure of the tricuspid valve. This marks the end of ventricular diastole, producing the first heart sound on the phonocardiogram.

 

DIF:    Application    REF:   p. 221            OBJ:   8

 

  1. Opening of the semilunar valves occurs when which of the following occurs?
a. The pressures in the arteries exceed those in the ventricles.
b. The pressures in the atria exceed those in the ventricles.
c. The pressures in the ventricles exceed those in the aorta and pulmonary artery.
d. The pressures in the ventricles exceed those in the atria.

 

 

ANS:  C

Within 0.05 second, ventricular pressures rise to exceed those in the aorta and pulmonary artery. This opens the semilunar valves.

 

DIF:    Application    REF:   p. 221            OBJ:   8

 

  1. Toward the end of systole, as repolarization starts (indicated by the T wave), the ventricles begin to relax. Which of the following will occur next?
a. rapid rise in ventricular pressures
b. arterial pressures exceed ventricular pressures
c. closure of the atrioventricular valves
d. opening of semilunar valves

 

 

ANS:  B

Toward the end of systole, as repolarization starts (indicated by the T wave), the ventricles begin to relax. Consequently, ventricular pressures drop rapidly. When arterial pressures exceed those in the relaxing ventricles, the semilunar valves shut.

 

DIF:    Analysis         REF:   p. 221            OBJ:   8

 

  1. The semilunar valves close when which of the following occurs?
a. The pressures in the arteries exceed those in the ventricles.
b. The pressures in the ventricles and arteries become equal.
c. The pressures in the atria exceed those in the ventricles.
d. The pressures in the ventricles exceed those in the atria.

 

 

ANS:  A

Toward the end of systole, as repolarization starts (indicated by the T wave), the ventricles begin to relax. Consequently, ventricular pressures drop rapidly. When arterial pressures exceed those in the relaxing ventricles, the semilunar valves shut.

 

DIF:    Application    REF:   p. 221            OBJ:   8

 

  1. The second heart sound is associated with what mechanical event of the cardiac cycle?
a. atrioventricular valve closure
b. atrioventricular valve opening
c. semilunar valve closure
d. semilunar valve opening

 

 

ANS:  C

Closure of the semilunar valves generates the second heart sound.

 

DIF:    Application    REF:   p. 221            OBJ:   8

 

  1. The dicrotic notch recorded in the aorta immediately follows what mechanical event of the cardiac cycle?
a. closure of the aortic valve
b. closure of the atrioventricular valves
c. isovolume contraction
d. opening of the aortic valve

 

 

ANS:  A

Rather than immediately dropping off, aortic and pulmonary pressures rise again after the semilunar valves close. Note the feature termed the dicrotic notch, which is caused by the elastic recoil of the arteries. This recoil provides the extra “push” that helps maintain the head of pressure created by the ventricles.

 

DIF:    Application    REF:   p. 221            OBJ:   8

 

  1. During the later stages of ventricular relaxation, the pressures in their chambers drop below those in the atria. This results in which of the following?
  2. rapid drop in atrial pressures
  3. opening of the atrioventricular valves
  4. rapid ventricular filling
  5. V pressure wave
a. 2 and 3
b. 1 and 2
c. 1, 2, 3, and 4
d. 2, 3, and 4

 

 

ANS:  C

As the ventricles continue to relax, their pressures drop below the pressures in the atria. This drop reopens the atrioventricular valves. As soon as the atrioventricular valves open, the blood collected in the atria rushes to fill the ventricles, causing a rapid drop in atrial pressures (the V wave).

 

DIF:    Application    REF:   p. 221            OBJ:   8

 

  1. What is a potential cause of cardiac tamponade?
a. a large pericardial effusion
b. blockage of the left ventricle
c. excessive amount of fluid the pleural space
d. clots in the superior vena cava

 

 

ANS:  A

A large pericardial effusion may affect the pumping function of the heart resulting in a cardiac tamponade. A cardiac tamponade will compress the heart muscle leading to a serious drop in blood flow to the body that may ultimately lead to shock and death.

 

DIF:    Application    REF:   p. 205            OBJ:   1

 

  1. What is the cause of a myocardial infarction?
a. decreased perfusion to the pulmonary artery
b. partial or complete obstruction of a coronary artery
c. blockage in one or more of the great vessels
d. narrowing of part of the aorta

 

 

ANS:  B

Partial obstruction of a coronary artery may lead to tissue ischemia (decreased oxygen supply), a clinical condition called angina pectoris. Complete obstruction may cause tissue death or infarct, a condition called Myocardial Infarction (MI).

 

DIF:    Application    REF:   p. 208            OBJ:   1

 

  1. An abnormal amount of fluid can accumulate between the layers of the pericardium resulting in which of the following?
a. pericardial effusion
b. pulmonary embolism
c. atrial fibrillation
d. premature ventricular contractions

 

 

ANS:  A

Abnormal amount of fluid can accumulate between the layers resulting in a pericardial effusion.

 

DIF:    Recall             REF:   p. 205            OBJ:   1

 

  1. What is the role of the left and right ventricle?
a. supply the body with blood
b. increase the concentration of red blood cells in the blood
c. the forward movement of the blood
d. draining of blood into the right atrium

 

 

ANS:  C

The responsibility of the right and left ventricle is the forward movement of blood

 

DIF:    Application    REF:   p. 205            OBJ:   2

 

  1. What is the role of the dense connective tissue termed anuli fibrosi cordis in the function of the heart?
a. provides an anchoring structure for the heart valves, and also electrically isolates the atria from the ventricle
b. allows the blood to enter the left atrium from the right atrium before birth
c. pulls in the right ventricular wall, aiding its contraction
d. separate the right and left ventricle

 

 

ANS:  A

It provides an anchoring structure for the heart valves, it also electrically isolates the atria from the ventricle

 

DIF:    Application    REF:   p. 205            OBJ:   2

Chapter 21: Nutrition Assessment

Test Bank

 

MULTIPLE CHOICE

 

  1. What is the primary purpose of nutrition assessment?
a. to identify how much weight the patient needs to lose
b. to identify the patient’s ideal body weight
c. to develop a nutrition care plan
d. to identify the proper caloric intake for the patient

 

 

ANS:  C

The purpose of nutrition assessment is to gather data to develop a nutrition care plan that will ensure adequate nutrition for health and well-being when implemented

 

DIF:    Recall             REF:   p. 477            OBJ:   1

 

  1. Which of the following is NOT considered part of the anthropometric assessment?
a. body mass index
b. activity level
c. history of weight loss
d. triceps skinfold

 

 

ANS:  B

Box 21-1 gives an overview of the information to incorporate into a nutrition assessment.

 

DIF:    Recall             REF:   p. 477            OBJ:   1

 

  1. If your patient is 2 m in height and weighs 80 kg, what is his body mass index (BMI)?
a. 40
b. 30
c. 20
d. 15

 

 

ANS:  C

The formula used to calculate BMI is as follows for measurements in kilograms and meters:

BMI = Weight (kg)

Height (m)2

 

DIF:    Application    REF:   p. 478            OBJ:   2

 

  1. What is the normal BMI for adults?
a. 15.5 to 20.6 kg/m2
b. 18.5 to 24.9 kg/m2
c. 20.6 to 25.9 kg/m2
d. 22.5 to 26.0 kg/m2

 

 

ANS:  B

A healthy weight may be confirmed by a BMI of between 18.5 and 24.9 kg/m2 for adults or a BMI-for-age between the 10th and 85th percentiles for children.

 

DIF:    Recall             REF:   p. 478            OBJ:   2

 

  1. Obesity is defined as a BMI over what value?
a. 20 kg/m2
b. 25 kg/m2
c. 30 kg/m2
d. 35 kg/m2

 

 

ANS:  C

Obesity is defined as a BMI greater than 30 kg/m2 in the adult and greater than the 95th percentile in boys and girls aged 2 to 20 years.

 

DIF:    Recall             REF:   p. 478            OBJ:   2

 

  1. Which of the following statements is NOT true regarding kwashiorkor?
a. occurs with a long-term loss of protein
b. often causes facial and limb edema
c. child often has a pot belly
d. may occur in combination with marasmus

 

 

ANS:  A

Kwashiorkor results from the more sudden lack of protein and calories, as in the first-born infant weaned suddenly on the arrival of a new sibling, when a diet of nutrient-rich breast milk is traded for a nutrient-poor cereal-based diet. The protruding belly and edematous face and limbs, characteristics of kwashiorkor, result from a lack of circulating proteins needed to maintain fluid balance and to transport fat out of the liver.

 

DIF:    Application    REF:   p. 479            OBJ:   2

 

  1. Protein-energy malnutrition may be reflected in reduced values for each of the following except:
a. albumin levels
b. lymphocyte count
c. transferrin
d. red blood cell count

 

 

ANS:  D

Protein-energy malnutrition may be reflected in low values for albumin, transferrin, transthyretin, retinol-binding protein, and total lymphocyte count.

 

DIF:    Recall             REF:   p. 481            OBJ:   3

 

  1. Which of the following blood tests is most useful for day to day monitoring of long-term trends in the nutrition status of the patient?
a. albumin levels
b. total white blood cell count
c. hematocrit
d. serum potassium levels

 

 

ANS:  A

The general availability and stability of albumin levels from day to day make it one of the most useful tests for assessing long-term trends (Table 21-2).

 

DIF:    Recall             REF:   p. 480            OBJ:   4

 

  1. Your male patient has a creatinine excretion level of 8 mg/kg body weight/day. What does this indicate?
a. It is normal.
b. There is mild muscle wasting.
c. There is moderate muscle wasting.
d. There is severe muscle wasting.

 

 

ANS:  D

Predicted values are based on gender and height, with reference values of approximately 18 mg/kg body weight/day for women to approximately 23 mg/kg body weight/day for men. Values of 60% to 80% of predicted indicate a mild deficit of muscle mass; 40% to 60% indicate a moderate deficit, and less than 40% of predicted suggests a severe depletion of muscle mass.

 

DIF:    Application    REF:   p. 481            OBJ:   4

 

  1. Which of the following complications is LEAST likely to influence creatinine excretion?
a. sepsis
b. trauma
c. hypoxemia
d. diet

 

 

ANS:  C

Factors that influence creatinine excretion, and thus complicate interpretation of this index, include age, diet, exercise, stress, trauma, fever, and sepsis.

 

DIF:    Recall             REF:   p. 481            OBJ:   4

 

  1. What is the recommended measurement for nitrogen balance?
a. blood urea nitrogen
b. serum urea nitrogen
c. urinary nitrogen
d. urinary urea nitrogen

 

 

ANS:  C

Urinary nitrogen is the recommended value to use in determining nitrogen balance.

 

DIF:    Recall             REF:   p. 481            OBJ:   4

 

  1. What changes in lung function are associated with malnutrition?
a. reduced VC
b. increased TLC
c. increased RV
d. decreased FRC

 

 

ANS:  A

Weakness of the diaphragm and other muscles of inspiration can lead to a reduced vital capacity and peak inspiratory pressures.

 

DIF:    Recall             REF:   p. 484            OBJ:   4

 

  1. Your patient is reported to be cachexic. Which of the following physical findings would support this statement?
a. The patient’s belly is swollen.
b. The patient has facial edema.
c. The patient’s ribs protrude.
d. The patient’s hair falls out easily.

 

 

ANS:  C

Patients with persistent malnutrition will often appear very thin to the point that their ribs and bony structures of the chest are very visible. The patient is said to be cachexic in such cases.

 

DIF:    Recall             REF:   p. 482            OBJ:   5

 

  1. What is the classic measure of energy expenditure?
a. basal oxygen consumption
b. basal metabolic rate (BMR)
c. resting caloric uptake
d. resting carbon dioxide production

 

 

ANS:  B

The classic measure of energy expenditure is the BMR.

 

DIF:    Recall             REF:   p. 486            OBJ:   5

 

  1. When is the basal metabolic rate (BMR) best obtained?
a. after 10 hours of fasting
b. while walking on a treadmill
c. on rising in the morning
d. 1 hour after lunch

 

 

ANS:  A

Obtained after 10 hours of fasting, the BMR measures the number of calories (kcal) expended at rest per square meter of body surface per hour (kcal/m2/hr).

 

DIF:    Recall             REF:   p. 486            OBJ:   5

 

  1. What procedure is used to overcome the limitations associated with estimating resting energy expenditures?
a. measuring blood glucose before and after exercise
b. monitoring body temperature during heavy exercise
c. indirect calorimetry
d. the Douglas procedure

 

 

ANS:  C

To overcome the limitations of estimating formulas, energy needs can be measured at the bedside. To do so, a procedure called indirect calorimetry is used.

 

DIF:    Recall             REF:   p. 486            OBJ:   5

 

  1. Which of the following statements is FALSE regarding energy needs?
a. They vary with state of health.
b. They vary with activity level.
c. They are increased with obese patients.
d. They increase with sepsis.

 

 

ANS:  C

Of course, energy needs vary according to activity level and state of health. Energy needs of sick patients can be significantly higher than predicted normal values. Energy needs for obese individuals are less because adipose tissue uses less energy than does muscle. Energy needs should be reevaluated and adjusted whenever weight changes more than 5 to 10 lb.

 

DIF:    Recall             REF:   p. 486            OBJ:   5

 

  1. In which of the following patients would indirect calorimetry be indicated?
  2. patients who are difficult to wean from mechanical ventilation
  3. patients with morbid obesity
  4. patients with a high level of stress
a. 1
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

Specific clinical conditions supporting the need for indirect calorimetry as a tool in nutrition assessment are listed in Box 21-4.

 

DIF:    Application    REF:   p. 489            OBJ:   8

 

  1. Which of the following pieces of equipment is NOT needed to perform indirect calorimetry?
a. oxygen analyzer
b. Tissot spirometer
c. Douglas bag
d. nitrogen analyzer

 

 

ANS:  D

Indirect calorimetry can be performed with a Douglas bag, a Tissot spirometer, and CO2 and O2 gas analyzers.

 

DIF:    Recall             REF:   p. 489            OBJ:   8

 

  1. What probably represents the most significant problem while performing calorimetry on a patient being mechanically ventilated?
a. compensating for mechanical dead space
b. leaks in the circuit
c. volume compression during inspiration
d. high PEEP levels

 

 

ANS:  B

Perhaps the most significant problem in performing indirect calorimetry on mechanically ventilated patients is the presence of leaks (circuit, tracheal tube cuff, chest tubes).

 

DIF:    Recall             REF:   p. 489            OBJ:   8

 

  1. What does the RQ represent?
a. matching of respiration to perfusion
b. ratio of the moles of CO2 produced to O2 consumed
c. ratio of O2 consumed to kilograms of ideal body weight
d. ratio of calories consumed to CO2 produced

 

 

ANS:  B

The second step in metabolic assessment is to interpret the RQ. The RQ is the ratio of moles of CO2 expired to moles of O2 consumed.

 

DIF:    Recall             REF:   p. 489-490     OBJ:   10

 

  1. Which of the following has an RQ of 1.0?
a. fat
b. carbohydrates
c. protein
d. soy

 

 

ANS:  B

Carbohydrates have an RQ of 1.0, protein has an RQ of 0.82, and fat has an RQ of 0.7.

 

DIF:    Recall             REF:   p. 490            OBJ:   10

 

  1. Which of the following is associated with primary protein-energy malnutrition (PEM)?
a. poor diet due to living in a Third World country
b. anorexia
c. malabsorption
d. severe infection

 

 

ANS:  A

PEM has adverse effects on respiratory musculature and the immune response. PEM may be either primary or secondary. Primary PEM results from inadequate intake of calories and/or protein and is typically seen only in developing countries.

Secondary PEM is due to underlying illness. Illness may cause (1) decreased caloric or protein intake (e.g., anorexia, dysphagia); (2) increased nutrient losses (e.g., malabsorption or diarrhea); and/or (3) increased nutrient demands (e.g., injury or infection). As many as 50% of hospital patients may have secondary PEM.

 

DIF:    Recall             REF:   p. 491            OBJ:   3

 

  1. Which of the following diseases is/are associated with protein-energy malnutrition (PEM)?
  2. asthma
  3. emphysema
  4. cancer
a. 1
b. 1 and 2
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  C

This type of PEM usually manifests itself as a gradual wasting process, as seen in chronic diseases such as cancer and emphysema. The primary clinical sign is progressive weight loss.

 

DIF:    Recall             REF:   p. 491            OBJ:   12

 

  1. Which of the following illnesses is NOT associated with acute catabolic disease?
a. trauma
b. sepsis
c. burns
d. pulmonary embolism

 

 

ANS:  D

This type of protein-energy malnutrition typically occurs with acute catabolic disease, such as in sepsis, burns, or trauma.

 

DIF:    Recall             REF:   p. 491            OBJ:   12

 

  1. Zinc deficiencies are associated with all the following except:
a. poor blood clotting
b. impaired wound healing
c. bronchospasm
d. reduced immunity

 

 

ANS:  C

Zinc deficiencies can impair clotting, slow wound healing, and impair immunity.

 

DIF:    Recall             REF:   p. 491            OBJ:   13

 

  1. Magnesium deficiencies are associated with all the following except:
a. reduced diaphragm strength
b. neurologic abnormalities
c. cardiac abnormalities
d. liver enlargement

 

 

ANS:  C

Magnesium deficiencies can result in cardiac, vascular, neurologic, and electrolyte abnormalities (hypocalcemia, hypokalemia), as well as in decreases in respiratory muscle strength.

 

DIF:    Recall             REF:   p. 491            OBJ:   13

 

  1. Which of the following is associated with acute cardiac muscle weakness and potential cardiopulmonary failure?
a. hyperkalemia
b. hypophosphatemia
c. hypernatremia
d. low folic acid levels

 

 

ANS:  B

Severe hypophosphatemia can result in decreased muscle strength and contractility and acute cardiopulmonary failure.

 

DIF:    Recall             REF:   p. 491            OBJ:   13

 

  1. Which of the following abnormalities in the respiratory system is/are associated with malnutrition?
  2. reduced hypoxic drive
  3. reduced airway clearance
  4. loss of lung surfactant
a. 1
b. 1 and 2
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

Specific effects of malnutrition on the respiratory system are listed in Box 21-9.

 

DIF:    Recall             REF:   p. 492            OBJ:   12

 

  1. Which of the following statements is NOT true regarding malnutrition in patients with chronic obstructive pulmonary disease (COPD)?
a. Use of a nasal cannula may contribute to the problem.
b. Depression is common and may reduce appetite.
c. A high work of breathing increases caloric needs.
d. Vitamin deficiencies increased the need for oxygen.

 

 

ANS:  D

Box 21-10 summarizes the factors contributing to malnutrition in COPD patients.

 

DIF:    Application    REF:   p. 492            OBJ:   17

 

  1. Ideally, approximately what percent of a patient’s estimated calorie needs should be provided by protein?
a. 20%
b. 40%
c. 50%
d. 60%

 

 

ANS:  A

Ideally, approximately 20% of a patient’s estimated calorie needs should be provided by protein.

 

DIF:    Recall             REF:   p. 496            OBJ:   14

 

  1. What effect does high carbohydrate intake have on metabolism?
a. increases CO2 production
b. reduces oxygen consumption
c. increases caloric needs
d. reduces protein catabolism

 

 

ANS:  A

For the patient with pulmonary disease or those requiring mechanical ventilation, high carbohydrate loads can cause problems. High carbohydrate loads increase CO2 production and the RQ, resulting in increased ventilatory demand, O2 consumption, and work of breathing.

 

DIF:    Recall             REF:   p. 499            OBJ:   14

 

  1. What percent of the patient’s caloric intake should come from fat in most circumstances?
a. 10% to 15%
b. 20% to 30%
c. 30% to 40%
d. 40% to 50%

 

 

ANS:  B

Ideally, approximately 20% of a patient`s estimated calorie needs should be provided by proteins. For critically ill patients, 50% to 60% of the total daily calories can be in the form of simple carbohydrate and the remaining calories (20% to 30%) should be provided from fat.

 

DIF:    Recall             REF:   p. 496            OBJ:   14

 

  1. Which of the following situations is NOT an indication for enteral nutritional support?
a. burns over 30% of the body surface area
b. persistent inability to eat orally
c. severe pancreatitis
d. renal failure

 

 

ANS:  D

Box 21-12 provides guidelines for initiating nutrition support as recommended by the American Society for Parenteral and Enteral Nutrition (ASPEN).

 

DIF:    Recall             REF:   p. 497            OBJ:   15

 

  1. Which of the following is NOT a reason to use enteral feeding over parenteral?
a. reduced incidence of stress ulcers
b. enteral route may avoid intestinal atrophy
c. enteral causes less hypoglycemia
d. enteral is safer and cheaper

 

 

ANS:  C

Enteral feedings are the route of choice: “If the gut works, use it.” The enteral route is safer and cheaper to use than the parenteral route. Enteral feeding stimulates gut hormones, subjects nutrients to the absorptive and metabolic controls of the intestinal tract and liver, and produces less hyperglycemia (providing for better immune function) than the parenteral route. In addition, the buffering capacity of enteral feeding can improve resistance against stress ulcers. Finally, enteral feeding maintains a more normal intestinal mucosa than the parenteral route (the intestinal mucosa may undergo atrophy during parenteral nutrition).

 

DIF:    Application    REF:   p. 494            OBJ:   15

 

  1. What tube feeding method is associated with an increased risk of aspiration?
a. bolus
b. intermittent
c. continuous drip
d. pressurized

 

 

ANS:  A

There is an increased risk of aspiration associated with bolus feedings because of the rapid infusion of formula into the stomach.

 

DIF:    Recall             REF:   p. 494            OBJ:   16

 

  1. What tube feeding method must be used when the food substance is delivered beyond the pylorus?
a. bolus
b. intermittent
c. continuous drip
d. pressurized

 

 

ANS:  C

Because the small bowel lacks storage capacity, feedings delivered beyond the pylorus must be provided by the continuous drip method.

 

DIF:    Recall             REF:   p. 494            OBJ:   15

 

  1. Why raise the head of the bed during tube feedings?
a. It reduces the time needed.
b. It improves absorption.
c. It reduces the risk of aspiration.
d. It is easier for the caregiver.

 

 

ANS:  C

The two most important ways to minimize the likelihood of aspiration are (1) to raise the head of the bed at least 45 degrees and (2) to deliver the feeding beyond the pylorus using the continuous drip method.

 

DIF:    Recall             REF:   p. 494            OBJ:   16

 

  1. Which of the following metabolism issues is NOT associated with systemic inflammatory response syndrome (SIRS)?
a. hypoglycemia
b. protein catabolism
c. increased macronutrient requirement
d. triglyceride intolerance

 

 

ANS:  A

Metabolism in SIRS is characterized by increased total caloric requirements, hyperglycemia, triglyceride intolerance, increased net protein catabolism, and increased macronutrient and micronutrient requirements.

 

DIF:    Recall             REF:   p. 494            OBJ:   17

 

  1. What are the primary goals of nutritional support during mechanical ventilation?
  2. avoid loss of lean body mass
  3. avoid lung infection
  4. keep muscles of breathing strong enough for weaning
a. 1
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

During acute illness, proper nutrition helps prevent the loss of lean body mass. After the resolution of the acute phase of illness, good nutrition helps the muscles regain strength and improves the likelihood of successful ventilator weaning.

 

DIF:    Recall             REF:   p. 496            OBJ:   17

 

  1. Which of the following statements is NOT true with regard to nutritional support of the patient with advanced chronic obstructive pulmonary disease?
a. Provide low-calorie options.
b. Provide high-protein nutrition.
c. Provide small, frequent meals.
d. Provide good patient education.

 

 

ANS:  A

Given the positive link between dietary intake and knowledge of diet and health, good patient education is critical. Patients should be taught to select easy to consume calorically dense foods (Box 21-13). Emphasis should be placed on small, frequent feedings with the use of high-calorie, high-protein nutritional supplements encouraged.

 

DIF:    Recall             REF:   p. 497            OBJ:   17

 

  1. Which of the following pulmonary diseases is similar to chronic obstructive pulmonary disease with regard to metabolic abnormalities?
a. asthma
b. cystic fibrosis
c. pulmonary fibrosis
d. acute respiratory distress syndrome

 

 

ANS:  B

The same disturbance may cause pancreatic insufficiency. Metabolic problems in cystic fibrosis are similar to those in the patient with chronic obstructive pulmonary disease, with reduced intake and increased metabolic needs.

 

DIF:    Application    REF:   p. 489            OBJ:   17

 

  1. Which of the following instructions must be followed to prepare a patient for indirect calorimetry?
  2. suction the patient 30 mins before the test
  3. fasting 10 hours before test
  4. avoid physical activity 4 hours before the test
  5. 24-hour urine urea nitrogen collection
a. 1 and 2
b. 2, 3, and 4
c. 4
d. 1, 2, 3 and 4

 

 

ANS:  B

Fasting in required because if feeding in continued result will reflect the patient’s energy expenditure in response to feeing and may be high if patient is being overfed. It may also register high if there has been recent physical activity. The UUN collection is used if determination of carbohydrate, fat and protein utilization is desired.

 

DIF:    Recall             REF:   p. 489            OBJ:   9

 

  1. Which of the following tools for nutritional assessment requires the patient to maintain a daily record of food intake for a 3- or 7-day period?
a. The 24-hour recall.
b. Usual intake recall.
c. Food frequency questionnaire.
d. Food diary.

 

 

ANS:  D

Keeping a dietary history allows the patient to arrive with a history already recorded so the patient interview can reveal other dietary practices.

 

DIF:    Recall             REF:   p. 482            OBJ:   6

 

  1. All of the following are nutritional goals for the management of a cystic fibrosis patient, except:
a. Maximize nutritional intake.
b. Meet clinical and psychological needs.
c. Avoid caloric dense foods.
d. Encourage mineral and vitamin supplementation.

 

 

ANS:  C

All of the following are nutritional goals for the management of a cystic fibrosis patient, except: Rationale is: Use of calorically dense nutritional supplements consumed throughout the day have proved useful in achieving weight gain.

 

DIF:    Recall             REF:   p. 498            OBJ:   17

Chapter 31: Neonatal and Pediatric Respiratory Disorders

Test Bank

 

MULTIPLE CHOICE

 

  1. Another name for respiratory distress syndrome (RDS) is:
a. hyaline membrane disease
b. transient tachypnea of the newborn
c. type II RDS
d. persistent pulmonary hypertension

 

 

ANS:  A

Respiratory distress syndrome, or hyaline membrane disease, is a disease of prematurity.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. What are the major factors in the pathophysiology of RDS?
  2. qualitative surfactant deficiency
  3. increased alveolar surface area
  4. increased small airways compliance
  5. presence of the ductus arteriosus
a. 1 and 2
b. 1 and 3
c. 1, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  C

The major factors in the pathophysiology of RDS are qualitative surfactant deficiency, decreased alveolar surface area, increased small airways compliance, and the presence of the ductus arteriosus.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. Which of the following factors is associated with an increase in the incidence of RDS?
a. maternal heart disease
b. maternal diabetes
c. maternal asthma
d. long labor

 

 

ANS:  B

Maternal factors that impair fetal blood flow, such as abruptio placentae and maternal diabetes, also may lead to RDS.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. In preterm infants, adequate amounts of surfactant are present; however, it is trapped inside type II cells.
a. True
b. False

 

 

ANS:  A

In preterm infants adequate amounts of surfactant are present in the lung; however, the surfactant is trapped inside type II cells.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. What is the first clinical sign of RDS in the newborn infant?
a. cyanosis
b. wheezing
c. hypertension
d. tachypnea

 

 

ANS:  D

Tachypnea usually occurs first.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. Which of the following clinical signs is not consistent with the onset of RDS?
a. grunting
b. retractions
c. nasal flaring
d. cyanosis

 

 

ANS:  D

After tachypnea, worsening retractions, paradoxical breathing, and audible grunting are observed. Nasal flaring also may be seen.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. What diagnostic parameter is most often used to confirm the diagnosis of RDS?
a. arterial blood gases
b. chest radiograph
c. pulmonary function test
d. serum enzymes

 

 

ANS:  B

Definitive diagnosis of RDS usually is made with chest radiography.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. Which of the following findings on the chest radiograph is not typical for RDS?
a. hyperinflation
b. air bronchograms
c. diffuse hazy infiltrates
d. bilateral reticulogranular densities

 

 

ANS:  A

Diffuse, hazy, reticulogranular densities with the presence of air bronchograms with low lung volumes are typical of RDS. The reticulogranular pattern is caused by aeration of respiratory bronchioles and collapse of the alveoli. Air bronchograms appear as aerated, dark, major bronchi surrounded by the collapsed or consolidated lung tissue.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. Which of the following treatments is the least useful for the treatment of RDS?
a. CPAP
b. surfactant replacement therapy
c. high-frequency ventilation
d. bronchial hygiene techniques

 

 

ANS:  D

Continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) are the traditional support modes used to manage RDS. Surfactant replacement therapy and high-frequency ventilation (HFV) have been added to these traditional approaches.

 

DIF:    Recall             REF:   p. 681            OBJ:   1

 

  1. You are caring for an infant with RDS. Nasal CPAP has been used; however, the infant suddenly deteriorates and is demonstrating severe hypoxemia on an FIO2 of 0.60. What should be done next?
a. Increase the CPAP.
b. Intubate the infant and begin mechanical ventilation.
c. Switch to nasal CPAP.
d. Increase the FIO2.

 

 

ANS:  B

Mechanical ventilation with PEEP should be initiated if oxygenation does not improve with CPAP or if the patient is apneic or acidotic.

 

DIF:    Application    REF:   p. 683            OBJ:   1

 

  1. What is the maximum PIP that should be used with mechanical ventilation of larger premature infants to prevent volutrauma?
a. 25 cm H2O
b. 30 cm H2O
c. 40 cm H2O
d. 50 cm H2O

 

 

ANS:  B

For minimization of the potential for volutrauma, the PIP should be kept at less than 30 cm H2O for larger premature infants and even lower PIP for more immature infants.

 

DIF:    Recall             REF:   p. 683            OBJ:   1

 

  1. The current standard of care is delivery surfactant replacement to all infants with RDS.
a. True
b. False

 

 

ANS:  A

The current standard of care is to deliver replacement surfactant to all infants with RDS.

 

DIF:    Recall             REF:   p. 683            OBJ:   1

 

  1. In which infants is the surfactant administered as rescue?
a. infants delivered prematurely
b. infants with failure on CPAP trial
c. infants with diagnosis of RDS
d. infants with congenital heart disease

 

 

ANS:  C

Surfactant replacement therapy also is used as both prophylactic and rescue treatment (of infants who already have RDS).

 

DIF:    Recall             REF:   p. 683            OBJ:   1

 

  1. What is believed to be the cause of transient tachypnea of the newborn (TTN)?
a. persistent hypoxemia
b. immature surfactant
c. delayed clearance of fetal lung fluid
d. persistent fetal circulation

 

 

ANS:  C

The cause of TTN is unclear, but it is most likely related to delayed clearance of fetal lung liquid.

 

DIF:    Recall             REF:   p. 683-684     OBJ:   2

 

  1. Most infants with transient tachypnea are born premature.
a. True
b. False

 

 

ANS:  B

Most infants with TTN are born at term without any specific predisposing factors in common.

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. Mothers of infants with transient tachypnea tend to have longer labor intervals and a higher incidence of failure to progress in labor.
a. True
b. False

 

 

ANS:  A

Mothers of neonates who have TTN tend to have longer labor intervals and a higher incidence of failure to progress in labor.

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. What radiographic finding is common in infants with transient tachypnea?
a. low lung volumes
b. bilateral perihilar lymphadenopathy
c. hyperinflation
d. mucus plugging

 

 

ANS:  C

The chest radiographic findings, which may initially be indistinguishable from those of pneumonia, are hyperinflation, which is secondary to air-trapping, and perihilar streaking.

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. What treatment usually causes improvement in the initial treatment of transient tachypnea of the newborn?
a. mechanical ventilation with PEEP
b. oxygen with low FIO2
c. bronchodilators
d. mucolytics

 

 

ANS:  B

Infants with TTN usually respond readily to a low FIO2 by infant oxygen hood or nasal cannula

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. What treatment is indicated for infants with transient tachypnea requiring higher FIO2?
a. frequent turning of the infant
b. oxygen
c. mechanical ventilation
d. CPAP

 

 

ANS:  D

Infants requiring a higher FIO2 may benefit from CPAP.

OBJ 2

DIFF: Recall

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. What treatment may improve lung fluid clearance in the infant with transient tachypnea?
a. CPAP
b. oxygen
c. mechanical ventilation
d. frequent turning of the infant

 

 

ANS:  D

Because the retention of lung fluid may be gravity dependent, frequent changes in the infant’s position may help speed lung fluid clearance.

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. Which statements about TTN are true?
  2. TTN and neonatal pneumonia have similar clinical signs.
  3. The need for mechanical ventilation in TTN is rare.
  4. A small number of infants with TTN eventually have persistent pulmonary hypertension.
  5. Intravenous administration of antibiotics should be considered.
a. 1 and 2
b. 1 and 3
c. 1, 2, and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

Because TTN and neonatal pneumonia have similar clinical signs, intravenous administration of antibiotics should be considered for at least 3 days after appropriate culture samples are obtained. The need for mechanical ventilation is rare and probably indicates a complication. Clearing of the lungs evident on both a chest radiograph and with clinical improvement usually occurs within 24 to 48 hours. A small number of infants with TTN eventually have persistent pulmonary hypertension.

 

DIF:    Recall             REF:   p. 684            OBJ:   2

 

  1. Meconium-stained amniotic fluid is common among infants of less than 37 weeks’ gestational age.
a. True
b. False

 

 

ANS:  B

Meconium aspiration syndrome (MAS) is a disease of term and near-term infants.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. Normally, meconium is not passed by the infant until after birth.
a. True
b. False

 

 

ANS:  A

Meconium normally is not passed until after delivery.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. What percentage of births will present with meconium-stained amniotic fluid?
a. 2%
b. 12%
c. 25%
d. 50%

 

 

ANS:  B

Amniotic fluid stained with meconium is found in approximately 12% of all births.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. Which of the following is not a problem with the typical case of meconium aspiration syndrome?
a. lung tissue damage
b. pulmonary obstruction
c. hypovolemia
d. pulmonary hypertension

 

 

ANS:  C

Meconium aspiration syndrome involves three primary problems: pulmonary obstruction, lung tissue damage, and pulmonary hypertension.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. What is associated with ball-valve obstruction in meconium aspiration syndrome?
a. volutrauma
b. atelectrauma
c. hypertension
d. hypotension

 

 

ANS:  A

Ball-valve obstruction causes air-trapping and can lead to volutrauma.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. Which of the following clinical findings is NOT usually seen in meconium aspiration syndrome?
a. tachypnea and grunting
b. irregular pulmonary densities on the chest film
c. metabolic acidosis
d. respiratory alkalosis

 

 

ANS:  D

Infants with MAS typically have gasping respirations, tachypnea, grunting, and retractions. The chest radiograph usually shows irregular pulmonary densities, which represent areas of atelectasis, and hyperlucent areas, which represent hyperinflation due to air trapping.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. Which of the following blood gas alteration is usually seen in meconium aspiration syndrome?
a. hypoxemia and respiratory acidosis
b. hypoxemia and mixed respiratory and metabolic alkalosis
c. hypoxemia and normal acid-base balance
d. hypoxemia and mixed respiratory and metabolic acidosis

 

 

ANS:  A

Arterial blood gases typically show hypoxemia with mixed respiratory and metabolic acidosis.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. Which of the following should be done early in the treatment of the non-vigorous infant with meconium aspiration syndrome?
a. suctioning
b. mask CPAP
c. antibiotics
d. vasopressors

 

 

ANS:  A

In the presence of meconium-stained amniotic fluid, once delivery is complete and if the infant is depressed and requires intubation for resuscitation, an ET tube should be inserted immediately, and suction should be applied directly to the ET tube.

 

DIF:    Recall             REF:   p. 684            OBJ:   3

 

  1. Which of the following ventilatory modalities has been associated with a lesser rate of air leak in MAS?
  2. IMV
  3. SIMV
  4. HFV
  5. CPAP
a. 1
b. 1 and 2
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  C

Evidence suggests that both HFV and synchronous intermittent mechanical ventilation decrease the risk of air leak.

 

DIF:    Recall             REF:   p. 685            OBJ:   3

 

  1. Which of the following have been implicated in the origin of bronchopulmonary dysplasia (BPD)?
  2. oxygen toxicity
  3. malnutrition
  4. mechanical ventilation
a. 1
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

Immaturity, genetics, malnutrition, oxygen toxicity, and mechanical ventilation all have been implicated in the origin of BPD.

 

DIF:    Recall             REF:   p. 685            OBJ:   4

 

  1. What factor is not associated with the new description of BPD?
a. improvements in ventilator management
b. use of surfactant
c. use of HFV
d. postnatal steroid therapy

 

 

ANS:  C

This change in the pathological characteristics of BPD is thought related to improvements in ventilator management, the use of surfactant, and processes that interrupt alveolar development (e.g., postnatal steroid therapy).

 

DIF:    Recall             REF:   p. 685            OBJ:   4

 

  1. What clinical finding is typically seen with BPD infants?
a. areas of air-trapping on the chest film
b. areas of consolidation on the chest film
c. hypoxemia and hypercapnia
d. hypocapnia

 

 

ANS:  C

Progressive vascular leakage and areas of atelectasis and emphysema develop in the lungs, and progressive pulmonary damage occurs. The chest radiograph for severe disease will show areas of atelectasis, emphysema, and fibrosis diffusely intermixed throughout the lung (Figure 31-5). Arterial blood gas measurements reveal varying degrees of hypoxemia and hypercapnia secondary to airway obstruction, air-trapping, pulmonary fibrosis, and atelectasis.

 

DIF:    Recall             REF:   p. 686            OBJ:   4

 

  1. What is the best strategy in the management of BPD?
a. adequate fluid management
b. prevention
c. aggressive mechanical ventilation
d. PEEP

 

 

ANS:  B

The best management of BPD is prevention.

 

DIF:    Recall             REF:   p. 686            OBJ:   4

 

  1. Which of the following therapies has little effect on long-term outcome such as mortality and duration of oxygen therapy in infants with BPD?
a. diuretics
b. steroids
c. antibiotics
d. bronchodilators

 

 

ANS:  B

Steroid therapy has little effect on long-term outcome such as mortality and duration of oxygen therapy.

 

DIF:    Recall             REF:   p. 687            OBJ:   4

 

  1. Which of the following is not associated with apnea episodes in premature infants?
a. Apnea lasts longer than 15 seconds.
b. Apnea is associated with cyanosis.
c. Apnea is associated with bradycardia.
d. Apnea lasts longer than 1 minute.

 

 

ANS:  D

Apneic spells are abnormal if (1) they last longer than 15 seconds or (2) they are associated with cyanosis, pallor, hypotonia, or bradycardia.

 

DIF:    Recall             REF:   p. 687            OBJ:   5

 

  1. Which of the following is NOT associated with causing apnea in premature infants?
a. gender
b. intracranial lesion
c. gastroesophageal reflux
d. impaired oxygenation

 

 

ANS:  A

Table 31-2.

 

DIF:    Recall             REF:   p. 687            OBJ:   5

 

  1. Treatment of the premature infant with apnea includes all the following except:
a. tactile stimulation
b. theophylline
c. transfusion
d. bronchial hygiene

 

 

ANS:  C

Table 31-3 outlines current treatment strategies for infants with apnea.

 

DIF:    Recall             REF:   p. 688            OBJ:   5

 

  1. Infants who have apnea of prematurity are at greater risk of SIDS than other infants.
a. True
b. False

 

 

ANS:  B

Infants who have apnea of prematurity are not at higher risk of SIDS than are other infants.

 

DIF:    Recall             REF:   p. 688            OBJ:   5

 

  1. What physiologic abnormality is believed to be the cause of persistent pulmonary hypertension in the newborn (PPHN)?
a. right-to-left shunting
b. high cardiac output
c. high pulmonary vascular resistance
d. metabolic acidosis

 

 

ANS:  C

The common denominator in PPHN is a return to fetal circulatory pathways, usually because of high PVR.

 

DIF:    Recall             REF:   p. 688            OBJ:   6

 

  1. Normally the PVR/SVR ratio is greater than 1 in the fetus.
a. True
b. False

 

 

ANS:  A

This condition produces a PVR/SVR ratio greater than 1.

 

DIF:    Recall             REF:   p. 688            OBJ:   6

 

  1. What are the three fundamental pathophysiologic events that explain PPHN?
  2. vascular spasm
  3. hypoxemia
  4. increased muscle wall thickness
  5. decreased cross-sectional area
a. 1
b. 1 and 2
c. 1 and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

There are three fundamental types of PPHN: vascular spasm, increased muscle wall thickness, and decreased cross-sectional area of pulmonary vessels.

 

DIF:    Recall             REF:   p. 688            OBJ:   6

 

  1. Which of the following factors may stimulate pulmonary vascular spasm and cause persistent pulmonary hypertension in the newborn?
  2. hypoxemia
  3. hypoglycemia
  4. hypotension
  5. pain
a. 1
b. 1 and 2
c. 1, 2, 3, and 4
d. 4

 

 

ANS:  C

Vascular spasm is an acute event that can be triggered by many different conditions, including hypoxemia, hypoglycemia, hypotension, and pain.

 

DIF:    Recall             REF:   p. 688            OBJ:   6

 

  1. Infants with persistent pulmonary hypertension usually have hypoxemia out of proportion to the lung disease detected by radiography.
a. True
b. False

 

 

ANS:  A

Hypoxemia out of proportion to the lung disease detected with chest radiography or PaCO2 measurement.

 

DIF:    Recall             REF:   p. 688            OBJ:   6

 

  1. Treatment of the infant with persistent pulmonary hypertension may include all the following except:
a. ECMO
b. high-frequency ventilation
c. nitric oxide
d. theophylline

 

 

ANS:  D

Initial therapy for PPHN is removal of the underlying cause, such as administration of oxygen for hypoxemia, surfactant for RDS, glucose for hypoglycemia, and inotropic agents for low cardiac output and systemic hypotension. If correction of the underlying problem does not correct the hypoxemia, the infant needs intubation and mechanical ventilation. Because pain and anxiety may contribute to PPHN, the infant may need sedation and, frequently, paralysis. If these measures do not improve oxygenation, the next step is HFV. This mode of ventilation allows a higher FRC without a large tidal volume. Inhaled nitric oxide is now considered the next intervention. Should all of these modalities fail to improve oxygenation, the infant may be a candidate for extracorporeal membrane oxygenation (ECMO).

 

DIF:    Recall             REF:   p. 688            OBJ:   6

 

  1. Which of the following is an example of an internal obstruction to the infant’s airway?
a. hemangiomas
b. neck mass
c. tracheoesophageal fistula
d. laryngomalacia

 

 

ANS:  D

Internal obstruction includes common problems, such as laryngomalacia, that cause obstructive apnea.

 

DIF:    Recall             REF:   p. 689            OBJ:   6

 

  1. Which of the following is the most common type of esophageal atresia?
a. esophageal atresia with a proximal fistula
b. esophageal atresia with a distal fistula
c. intact esophagus with an H fistula
d. esophageal atresia without either fistula

 

 

ANS:  B

The most common of these malformations is esophageal atresia with a distal fistula, which comprises 85% to 90% of all tracheoesophageal fistulas.

 

DIF:    Recall             REF:   p. 689            OBJ:   6

 

  1. The pathophysiologic abnormalities associated with congenital diaphragmatic hernia include all the following except:
a. malformation of the left ventricle
b. lung hypoplasia
c. pulmonary hypertension
d. unusual anatomy of the inferior vena cava

 

 

ANS:  A

The pathophysiologic mechanism is a complex combination of lung hypoplasia, including decreased alveolar count and decreased pulmonary vasculature, pulmonary hypertension, and unusual anatomy of the inferior vena cava.

 

DIF:    Recall             REF:   p. 689            OBJ:   7

 

  1. Clinical findings associated with congenital diaphragmatic hernia include all the following except:
a. severe cyanosis
b. decreased breath sounds
c. displaced heart sounds
d. hepatomegaly

 

 

ANS:  D

Physical examination may yield the following findings: scaphoid abdomen (because the abdominal contents are in the thorax), decreased breath sounds, displaced heart sounds (because the heart is pushed away from the hernia), and severe cyanosis (from lung hypoplasia and pulmonary hypertension).

 

DIF:    Recall             REF:   p. 690            OBJ:   7

 

  1. Which of the following diagnostic tools serves to confirm the diagnosis of CDH?
a. sweat test
b. fluoroscopy
c. chest radiography
d. ultrasound

 

 

ANS:  C

The diagnosis is established with chest radiography.

 

DIF:    Recall             REF:   p. 690            OBJ:   7

 

  1. The mortality rate for infants with congenital diaphragmatic hernia is usually low.
a. True
b. False

 

 

ANS:  B

Despite all these advanced therapies, the mortality for this disease is high.

 

DIF:    Recall             REF:   p. 690            OBJ:   7

 

  1. Which of the following is the most common defect of the abdominal wall?
a. inguinal hernia
b. omphalocele
c. gastroschisis
d. agenesis of abdominal muscles

 

 

ANS:  B

Large defects in the abdominal wall can cause severe respiratory compromise. The most common of these defects is omphalocele.

 

DIF:    Recall             REF:   p. 690            OBJ:   8

 

  1. Which of the following are common neuromuscular defect that affect infants?
  2. spinal muscular atrophy
  3. congenital myasthenia gravis
  4. myotonic dystrophy
  5. poliomyelitis
a. 1
b. 1, 2, and 3
c. 1 and 3
d. 1, 2, and 4

 

 

ANS:  B

Many diseases of poor neuromuscular control affect newborns. These include spinal muscular atrophy, congenital myasthenia gravis, myotonic dystrophy, and many others.

 

DIF:    Recall             REF:   p. 690            OBJ:   8

 

  1. Which of the following defects is not associated with tetralogy of Fallot?
a. ventricular septal defect
b. right ventricular hypoplasia
c. pulmonary stenosis
d. dextroposition of the aorta

 

 

ANS:  B

Tetralogy of Fallot is a defect that includes (1) obstruction of right ventricular outflow (pulmonary stenosis), (2) ventricular septal defect (a hole between the right and left ventricles), (3) dextroposition of the aorta, and (4) right ventricular hypertrophy.

 

DIF:    Recall             REF:   p. 690            OBJ:   8

 

  1. Children with tetralogy of Fallot are at risk for sudden death from arrhythmia later in life.
a. True
b. False

 

 

ANS:  A

Children with this defect are at increased risk of sudden death of arrhythmia later in life.

 

DIF:    Recall             REF:   p. 692            OBJ:   8

 

  1. Which of the following is the most likely diagnosis in the newborn with severe cyanosis at birth?
a. persistent pulmonary hypertension
b. tetralogy of Fallot
c. transposition of the great vessels
d. ventricular septal defect

 

 

ANS:  C

Transposition of the great arteries is the heart disease that most frequently causes severe cyanosis.

 

DIF:    Recall             REF:   p. 692            OBJ:   9

 

  1. Which of the following is NOT true regarding ventricular septal defects in infants?
a. are quite common
b. usually cause right-to-left shunting
c. may cause congestive heart failure
d. usually do not appear immediately after birth

 

 

ANS:  B

A simple ventricular septal defect usually causes left-to-right shunting and congestive heart failure.

 

DIF:    Recall             REF:   p. 692            OBJ:   9

 

  1. How soon after birth does the ductus typically close?
a. 1 to 2 days
b. 3 to 4 days
c. 5 to 7 days
d. 10 days

 

 

ANS:  C

Closure of the ductus normally occurs 5 to 7 days after the birth of term infants.

 

DIF:    Recall             REF:   p. 692            OBJ:   9

 

  1. In left ventricular outflow obstructions, systemic blood flow depends on patency of the ductus arteriosus.
a. True
b. False

 

 

ANS:  A

Systemic blood flow depends on patency of the ductus arteriosus.

 

DIF:    Recall             REF:   p. 693            OBJ:   9

 

  1. Most infants with hypoplastic left heart syndrome do not need to be supported with mechanical ventilation.
a. True
b. False

 

 

ANS:  B

Most infants with these defects need support with mechanical ventilation.

 

DIF:    Recall             REF:   p. 693            OBJ:   9

 

  1. In which of the following defects is heart transplantation an accepted option for treatment?
a. interrupted aortic arch
b. coarctation of the aorta
c. hypoplastic left heart syndrome
d. none of the above

 

 

ANS:  C

Hypoplastic left heart syndrome has three accepted treatments: comfort care (allowing the infant to die), a palliative surgical procedure (Norwood), and transplantation.

 

DIF:    Recall             REF:   p. 693            OBJ:   9

 

  1. Sudden infant death syndrome (SIDS) is the most common cause of death in infants under the age of 1 year.
a. True
b. False

 

 

ANS:  A

SIDS is the leading cause of death (40%) among infants younger than 1 year in the United States.

 

DIF:    Recall             REF:   p. 693            OBJ:   10

 

  1. Which of the following maternal characteristics is NOT associated with an increased frequency of SIDS?
a. younger than 20 years
b. low socioeconomic status
c. cigarette smoking
d. history of asthma

 

 

ANS:  D

Factors associated with increased frequency of SIDS are presented in Box 31-1.

 

DIF:    Recall             REF:   p. 693            OBJ:   10

 

  1. Which of the following infant characteristics is associated with an increased risk of SIDS?
a. female gender
b. preterm birth
c. high APGAR score
d. full-term birth

 

 

ANS:  B

An infant who dies of SIDS typically is a preterm African-American boy born to a poor mother younger than 20 years who received inadequate prenatal care.

 

DIF:    Recall             REF:   p. 694            OBJ:   10

 

  1. It is not difficult to differentiate death from SIDS from death by intentional suffocation.
a. True
b. False

 

 

ANS:  B

It is difficult to differentiate death of SIDS from death of intentional suffocation.

 

DIF:    Recall             REF:   p. 694            OBJ:   10

 

  1. The American Academy of Pediatrics recommends that infants be placed in either the supine or the side-lying position for the first 6 months of life to reduce the risk of SIDS.
a. True
b. False

 

 

ANS:  A

The American Academy of Pediatrics recommends that infants be placed in either the supine or the side-lying position for the first 6 months of life and reducing soft objects in the infant’s sleeping environment.

 

DIF:    Recall             REF:   p. 694            OBJ:   10

 

  1. Which of the following findings is not associated with gastroesophageal reflux (GER) disease?
a. stridor
b. apnea
c. reactive airways disease
d. syncope

 

 

ANS:  D

Respiratory problems caused by gastroesophageal reflux include reactive airways disease, aspiration pneumonia, laryngospasm, stridor, chronic cough, choking spells, and apnea.

 

DIF:    Recall             REF:   p. 694            OBJ:   11

 

  1. Which of the following are used to diagnose GER?
  2. esophageal pH testing
  3. chest radiograph
  4. upper GI contrast studies
  5. gastric scintiscanning
a. 1
b. 1, 2, and 3
c. 1 and 3
d. 1, 3, and 4

 

 

ANS:  D

GER disease can be diagnosed with esophageal pH testing, upper gastrointestinal contrast studies, and gastric scintiscanning.

 

DIF:    Recall             REF:   p. 694            OBJ:   11

 

  1. Bronchiolitis is an acute infection of the lower respiratory tract usually caused by bacterial organisms.
a. True
b. False

 

 

ANS:  B

Bronchiolitis is an acute infection of the lower respiratory tract, usually caused by the respiratory syncytial virus (RSV).

 

DIF:    Recall             REF:   p. 694            OBJ:   12

 

  1. The following diseases are commonly associated with bronchiolitis most likely to result in respiratory failure except:
a. infant with congenital heart failure
b. infant with BPD
c. child with cystic fibrosis
d. pneumonia

 

 

ANS:  D

Those most prone to respiratory failure as a consequence of bronchiolitis are very young and immunodeficient and have comorbidity, such as congenital heart disease, bronchopulmonary dysplasia, cystic fibrosis, or childhood asthma.

 

DIF:    Recall             REF:   p. 694-695     OBJ:   12

 

  1. Which of the following findings is not typical for infants with bronchiolitis?
a. stridor
b. wheezing
c. dyspnea
d. tachypnea

 

 

ANS:  A

After a few days, signs of respiratory distress develop, particularly dyspnea and tachypnea. Progressive inflammation and narrowing of the airways cause inspiratory and expiratory wheezing and increase airway resistance.

 

DIF:    Recall             REF:   p. 695            OBJ:   12

 

  1. Which of the following groups of infants should receive passive immunization for RSV?
  2. chronic lung disease
  3. infants born less than 32 weeks’ gestational age
  4. infants with congenital heart disease
  5. infants with retinopathy of prematurity
a. 1
b. 1, 2, and 3
c. 1 and 3
d. 1, 3, and 4

 

 

ANS:  B

Passive immunization is now recommended for infants younger than 2 years of age who are requiring medical therapy for chronic lung disease, infants born less than 32 weeks’ gestational age, and infants with congenital heart disease who have cardiovascular compromise.

 

DIF:    Recall             REF:   p. 695            OBJ:   12

 

  1. Which of the following therapies is considered controversial in the management of the infant with severe bronchiolitis?
a. hydration
b. oxygen
c. bronchodilator therapy
d. CPAP

 

 

ANS:  C

Because bronchiolitis and childhood asthma have similar symptoms, a trial course of bronchodilator therapy with a b-agonist may be useful if airway obstruction is relieved after administration. This practice is controversial, and practitioners should assess the efficacy of all bronchodilator therapy before continuing.

 

DIF:    Recall             REF:   p. 695            OBJ:   12

 

  1. Which of the following statements is TRUE about croup?
  2. caused by viral organism
  3. most common form of airway obstruction in children aged 6 months to 6 years
  4. causes subglottic swelling and obstruction
  5. most often caused by parainfluenza virus
a. 1 and 3
b. 2, 3, and 4
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

Croup is a viral disorder of the upper airway that normally results in subglottic swelling and obstruction. Termed laryngotracheobronchitis, viral croup is usually caused by the parainfluenza virus and is the most common form of airway obstruction in children between 6 months and 6 years of age.

 

DIF:    Recall             REF:   p. 695            OBJ:   13

 

  1. Which of the following clinical signs is NOT common with croup?
a. stridor
b. murmur
c. coughing
d. cyanosis

 

 

ANS:  B

The child typically has slow, progressive inspiratory and expiratory stridor and a barking cough. As the disease progresses, dyspnea, cyanosis, exhaustion, and agitation occur.

 

DIF:    Recall             REF:   p. 695            OBJ:   13

 

  1. Which of the following is the most common radiographic finding that suggests the presence of croup?
a. thumb sign
b. flail chest
c. sail sign
d. steeple sign

 

 

ANS:  D

Classic croup manifests on an anteroposterior radiograph as characteristic subglottic narrowing of the trachea, called the steeple sign.

 

DIF:    Recall             REF:   p. 695            OBJ:   13

 

  1. Which of the following clinical findings suggests the child with croup should be hospitalized?
  2. stridor at rest
  3. suprasternal retractions
  4. cyanosis on room air
  5. harsh breath sounds
a. 1
b. 1 and 2
c. 1, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

If there is stridor at rest (accompanied by harsh breath sounds, suprasternal retractions, and cyanosis with breathing of room air), hospitalization is indicated.

 

DIF:    Recall             REF:   p. 695            OBJ:   13

 

  1. Which of the following treatments is least likely to be needed in the treatment of the child with croup?
a. oxygen
b. mechanical ventilation
c. aerosolized racemic epinephrine
d. budesonide

 

 

ANS:  B

Progressive worsening of the clinical signs despite treatment indicates the need for intubation and mechanical ventilation.

 

DIF:    Recall             REF:   p. 695            OBJ:   13

 

  1. What modality is believed to be the cause of a decrease in the reported incidence of epiglottitis over the past decade?
a. vaccine
b. better diet
c. improved epidemiology reporting
d. better quality of air

 

 

ANS:  A

Evidence suggests that the incidence of epiglottitis is decreasing among children, probably because of the use of vaccines.

 

DIF:    Recall             REF:   p. 696            OBJ:   13

 

  1. Which of the following clinical findings is NOT typically seen in patients with epiglottitis?
a. high fever
b. stridor
c. croupy barking cough
d. drooling

 

 

ANS:  C

The patient does not have a croupy bark but instead has a muffled voice.

 

DIF:    Recall             REF:   p. 696            OBJ:   13

 

  1. Which of the following is the most common radiographic finding that suggests the presence of epiglottitis?
a. thumb sign
b. flail chest
c. sail sign
d. steeple sign

 

 

ANS:  A

Lateral neck radiographic results (Figure 31-9) indicate the epiglottis is markedly thickened and flattened (thumb sign).

 

DIF:    Recall             REF:   p. 696            OBJ:   13

 

  1. Which of the following therapies is LEAST likely to be needed in the child with epiglottitis?
a. tracheostomy
b. pressure support with low-level CPAP
c. high FIO2
d. humidity therapy

 

 

ANS:  A

Tracheostomy may be needed if the patient’s condition warrants it; however, this procedure is rarely used.

 

DIF:    Recall             REF:   p. 697            OBJ:   13

 

  1. A 2 year old boy is in severe respiratory distress. The child is drooling and has labored breathing. Stridor is heard. RR is 42 and HR is 140. What should be done next?
a. Intubate.
b. Provide 100% oxygen on non-rebreather mask.
c. Administer racemic epinephrine.
d. Place on CPAP with low PSV.

 

 

ANS:  A

The clinical picture, particularly the age, level of distress, stridor and drooling, suggest that this patient apparently has epiglottitis, a severe swelling of the tissue around the glottis. Given the potential for additional swelling and complete airway closure, this patient should be intubated for airway protection.

 

DIF:    Analysis         REF:   p. 697            OBJ:   13

 

  1. What is the likely diagnosis of a 18-month old patient in moderate respiratory distress with a one-week history of a low-grade fever and chills, barking cough, and an AP chest radiograph which shows a steeple sign?
a. pulmonary interstitial emphysema
b. bronchopulmonary dysplasia
c. epiglottis
d. croup

 

 

ANS:  D

A child typically has slow, progressive inspiratory and expiratory stridor and a barking coup. As the disease progresses, dyspnea, cyanosis, exhaustion and agitation occur.

 

DIF:    Analysis         REF:   p. 695            OBJ:   13

 

  1. Patients with cystic fibrosis often have trouble with the digestion of fats and have deficiency of the fat-soluble vitamins.
a. True
b. False

 

 

ANS:  A

These patients often have deficiencies of the fat-soluble vitamins A, D, E, and K and have large amounts of undigested fat in the stool (steatorrhea).

 

DIF:    Recall             REF:   p. 697            OBJ:   14

 

  1. What is the leading cause of death among patients with cystic fibrosis?
a. pancreatic disease
b. lung disease
c. gastrointestinal disease
d. diabetes

 

 

ANS:  B

Complications of lung disease are the leading cause of death among patients with cystic fibrosis.

 

DIF:    Recall             REF:   p. 697            OBJ:   14

 

  1. Which test is commonly used to confirm the diagnosis of cystic fibrosis?
a. sweat chloride
b. chest radiograph
c. lung diffusion capacity
d. serum enzyme levels

 

 

ANS:  A

In evaluation of a child, a sweat chloride level greater than 60 mEq/L confirms the diagnosis of cystic fibrosis.

 

DIF:    Recall             REF:   p. 697            OBJ:   14

 

  1. What therapy has been shown to reduce the incidence of bronchiectatic exacerbations in the patient with cystic fibrosis?
a. autogenic lung drainage
b. inhaled tobramycin
c. chest physical therapy
d. bronchodilator therapy

 

 

ANS:  B

When inhaled tobramycin is used twice daily every other month, there is a marked reduction in the number of bronchiectatic exacerbations.

 

DIF:    Recall             REF:   p. 698            OBJ:   14

 

  1. What therapy has been shown to reduce the rate of loss of lung function in patients with cystic fibrosis?
a. high doses of ibuprofen
b. continuous oxygen therapy
c. corticosteroids
d. inhaled DNase

 

 

ANS:  A

High doses of the antiinflammatory drug ibuprofen reduce the rate of lung function loss in patients younger than 13 years.

 

DIF:    Recall             REF:   p. 697            OBJ:   14