GAS EXCHANGE 360

Which statement regarding bronchiectasis is true? A. It is common in cystic fibrosis. B. It often leads to lung carcinoma. C. It is classified according to stage of spread. D. The most common bacterial pathogen is Streptococcus pneumoniae.

A Rationale Cystic fibrosis is associated with 50% of the cases of bronchiectasis. There is no current research to support a connection between these conditions. Bronchiectasis can be classified according to bronchial shape: saccular (with cavity-like dilatations) or cylindrical, and with widening of the bronchial walls. A fusiform shape is a combination of saccular and cylindrical changes. H. influenzae is the most common cause of bacterial infections (29% to 70%), followed by pseudomonas aeruginosa (12% to 31%).

Areas of the lung that have little ventilation and thus little oxygen will cause the blood vessels of that area to A. Vasoconstrict B. Vasodilate C. Stabilize D. Clot off

A Rationale The lungs match the blood flow with ventilation and oxygen delivery to the alveoli to optimize oxygen delivery to the bloodstream. The area of lung tissue with little ventilation will constrict. Areas of lung tissue with more ventilation will experience vasodilation. Ventilation and resulting oxygenation will normally result in a change in order to allow for adaptation. Clotting is not a result of ventilation or oxygenation.

Which cellular change is seen with chronic bronchitis? A. Increased eosinophils B. Decreased CD8 T lymphocytes C. Decreased interleukin-8 levels D. Atrophy of bronchial glands

A Rationale There is a thirtyfold increase in eosinophils. Chronic bronchitis is characterized with increased interleukin-8 and CD8 T lymphocytes. There is hypertrophy of bronchial glands and goblet cells.

What type of cells make up the alveoli and are involved in gas exchange? A. Type I pneumocytes B. Type II pneumocytes C. Alveolar macrophages D. Goblet cells

A Rationale Type I cells (pneumocytes) make up the alveoli. Type II cells make surfactant. Alveolar macrophages, which act as a defense mechanism by phagocytizing particles in the alveoli. Goblet cells are involved in mucus production.

The pathogenesis of adult respiratory distress syndrome (ARDS) involves which of the following? (Select all that apply.) A. Injury to the alveolar-capillary membrane B. Increased alveolar-capillary permeability C. Decreased lung compliance D. Alveolar wall thickening E. Collapse of the lung

A B C Rationale Injury to the alveolar-capillary membrane, increased alveolar-capillary permeability, and alveolar edema and the resulting decreased lung compliance are characteristic of adult respiratory distress syndrome. Alveolar wall thickening is not characteristic of adult respiratory distress syndrome. A collapsing of a lung is characteristic of atelectasis.

Which condition presents a problem with lung diffusion? (Select all that apply.) A. Pneumonia B. Pulmonary edema C. Interstitial lung disease D. Small cell (oat cell) carcinoma E. Squamous cell epidermoid carcinoma

A B C Rationale Patients with problems with diffusion include those with pneumonia, pulmonary edema, and interstitial lung disease. Small cell (oat cell) carcinoma and squamous cell epidermoid carcinoma present obstruction problems.

he pathogenesis of pneumonia includes the inhalation of microbial agents and the resulting of which of the following? (Select all that apply.) A. Inflammation B. Lung consolidation C. Formation of exudates D. Alveolar wall thickening E. Decreased lung compliance

A B C Rationale Pneumonia presents with pulmonary inflammation. Alveolar air spaces fill with exudative fluid, and inflammatory cells invade alveolar septa. With pneumonia lung consolidation occurs. Alveolar exudates are characteristic of pneumonia. Alveolar wall thickness is not affected by pneumonia. Lung compliance is not affected by pneumonia.

Dead space includes which of the following dimensions? (Select all that apply.) A. Anatomic B. Alveolar C. Physiologic D. Cartilaginous E. Airway resistance .

A B C Rationale Dead space includes three dimensions: Anatomic dead space includes the volume of nonusable gas (not used in gas exchange) in the conducting airways from the nose down to the respiratory bronchioles. Alveolar dead space is composed of ventilated, but unperfused or underperfused, areas of the lung and is often referred to as wasted ventilation. Alveolar dead space increases with the development of pulmonary emboli owing to decreased perfusion. Physiologic dead space (functional dead space) is the sum of the anatomic dead space and alveolar dead space. Approximately one-third of each breath occupies dead space. Cartilaginous is not a type of dead space. Airway resistance is not a type of dead space but is primarily determined by the diameter of the airway

he pathogenesis of tuberculosis includes the entrance of mycobacteria into the lungs and the resulting of which of the following? (Select all that apply.) A. Calcification B. Ghon tubercles C. Formation of granulomas D. Activation of macrophages E. Antigen-antibody complexes

A B C D Rationale Calcification of walled off fibrotic areas occurs. Ghon tubercles are characteristic of tuberculosis. Granulomas refers to inflammatory proteins that wall off the mycobacteria. Mycobacteria enter into the lung tissue, where the bacteria are ingested by macrophages. Tuberculosis does not involve antigen-antibody complexes.

The characteristics of bronchiolitis include which of the following? (Select all that apply.) A. Thick, tenacious mucus B. Wheezing C. Crackles D. Bradypnea E. Ear pain

A B C E Rationale Common clinical features include tenacious sputum, wheezing due to bronchospasm, crackles, and otitis media associated with S. pneumoniae. Increased rather than decreased respirations are noted.

Acute bronchitis can be caused by which of the following? (Select all that apply.) A. Influenza A B. Adenovirus C. Coxsackie virus D. Pseudomonas aeruginosa E. Staphylococcus pneumoniae

A B C E Rationale Influenza A, adenovirus, Coxsackie virus, and Staphylococcus pneumoniae can cause acute bronchitis. Pseudomonas aeruginosa does not cause acute bronchitis.

Abnormal fluid accumulations in the pleural space affect the lung function by causing which of the following? (Select all that apply.) A. Dyspnea B. Dry cough C. Pleuritic pain D. Expiratory grunting E. Localized diminished breath sounds

A B C E Rationale Pleural effusion causes dyspnea, dry cough, pleuritic pain, and diminished breath sounds over effusion. Grunting on expiration is not associated with pleural effusion.

What occurs during an acute asthma attack? (Select all that apply.) A. Sputum is often thick, tenacious, scant, and viscid. B. Bronchoconstriction occurs. C. Residual lung volume increases. D. Tidal volume remains unchanged. E. Forced expiratory volumes decrease.

A B C E Rationale Sputum is often thick, tenacious, scant, and viscid. Bronchospasm are experienced during asthma attacks. Air becomes trapped because of the inflammatory changes that occur so increasing residual lung volume. Forced expiratory volumes decrease during asthma attacks. Tidal does not remain constant during an asthma attack.

Which are major obstructive airway diseases? (Select all that apply.) A. Asthma B. Bronchitis C. Pneumonia D. Emphysema E. Bronchiectasis

A B D E Rationale Asthma is an inflammatory lung disease characterized by (a) airway obstruction that is reversible (but not completely in some patients). The swelling of bronchial mucosa is associated with obstruction, respiratory distress, and wheezing is known as asthmatic bronchitis. Acute bronchitis differs from bronchiolitis in the size of the airways affected (i.e., trachea and bronchi as opposed to the small bronchioli). Emphysema is a form of chronic obstructive pulmonary disease (COPD) that results from destruction of alveoli and small airways. Bronchiectasis is characterized by recurrent infection and inflammation of bronchial walls, which leads to persistent dilation of the medium-sized bronchi and bronchioles, the three main pathogenic mechanisms are bronchial wall thickening from airway inflammation, bronchial lumen obstruction, and traction on the airways from thick secretions. Pneumonia is not a major obstructive airway disease, but rather results in a decreased in lung compliance.

The purpose of the upper respiratory system is which of the following? (Select all that apply.) A. Filtering of inspired gas B. Warming of inspired gas C. Exchange of inspired gas D. Humidification of inspired gas E. Conduction of air towards the alveoli

A B D E Rationale The nose filters air as it enters into the upper airway. The nose and upper airways warm the air as it passes across the membranes. As the air is taken through the upper airways, it picks up moisture from the mucous membranes of the nose and sinuses. The airways are designed to conduct the air to the lower airways. Gas exchange occurs in the alveoli, not in the upper respiratory system.

Pulmonary function testing for restrictive diseases reveals which of the following to be decreased? (Select all that apply.) A. Vital capacity B. Respiratory rates C. Total lung capacity D. Diffusing capacity E. Forced expiratory flow .

A C D Rationale In restrictive diseases there is limitation of chest expansion, resulting in decreased vital, total lung, and diffusing capacities. Respiratory rates and forced expiratory flow are not characteristically decreased with restrictive respiratory diseases

Which is a classification of emphysema? (Select all that apply.) A. Centriacinar B. Parenchyma C. Panacinar D. Paraseptal E. Bullae

A C D Rationale Three major classifications of emphysema exist including centriacinar (also called centrilobular), which is associated with both smoking and chronic bronchitis and destroys the respiratory bronchioles; panacinar (also called panlobular), which destroys the alveoli; and paraseptal, which affects the peripheral lobules. Parenchyma is a type of lung tissue. Emphysema can result in the presence of blebs or bullae in the lungs.

Which clinical manifestation suggests epiglottitis? (Select all that apply.) A. Assumes "sniffing dog" position B. White patches on tonsils C. Throat is "cherry red" D. Reports dysphagia E. Sounds hoarse

A C D E Rationale Common signs and symptoms of epiglottitis include "sniffing dog" position, which provides the best airway patency; oropharynx that is edematous and cherry red; refusal of food due to difficulty swallowing; and dysphonia (hoarseness). White patches would be seen in strep throat.

The portion of the brain that is responsible for neural control of the respiratory system is which of the following? (Select all that apply.) A. Medulla oblongata B. Cerebellum C. Frontal lobe D. Thalamus E. Pons Rationale

A E The medullary respiratory center within the brainstem consists of two groups of widely dispersed neurons that function as a unit to regulate breathing. The pneumotaxic center of the upper pons appears to influence the rate of respiration and ends inspiration by inhibition of the inspiratory ramp, with increasing action potentials in a crescendo fashion. The cerebellum is associated with receiving auditory and visual information. The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual responses. The thalamus controls your sensory integration and motor integration.

A 56-year-old normally healthy patient at the clinic is diagnosed with bacterial community-acquired pneumonia. Before treatment is prescribed, the nurse asks the patient about an allergy to amoxicillin. erythromycin. sulfonamides. cephalosporins.

Answer: B Rationale: Outpatient drug therapy options for a healthy person with community-acquired pneumonia will be consist of macrolides (erythromycin) or doxycycline. If the patient is allergic to macrolides, doxycycline would be prescribed.

A patient's arterial blood gas (ABG) results include the following: pH 7.32, PaO2 84 mm Hg, PaCO2 49 mm Hg, and SaO2 84%. For what should the nurse assess the patient? a-Tetany b-Tachypnea c-Pleural friction rub d-Kussmaul respirations

Answer: B Rationale: The arterial blood gas analysis indicates respiratory acidosis. Tachypnea is defined as a rapid respiratory rate and indicates respiratory distress. Tetany occurs in metabolic alkalosis. A pleural friction rub is a creaking or grating sound heard during auscultation of the lungs and indicates inflamed pleural surfaces that are rubbing together. Kussmaul respirations are commonly seen in metabolic acidosis and are abnormally deep, very rapid sighing respirations.

A patient with metabolic alkalosis has an SpO2 of 93% and a shift to the left in the oxygen-hemoglobin dissociation curve. Which action by the nurse is appropriate? a-Administer supplemental oxygen because less oxygen is dissolved in the blood. b-Discontinue supplemental oxygen because more oxygen is released to the tissues. c-Administer supplemental oxygen because oxygen is not readily released to the tissues. d-Discontinue supplemental oxygen because more oxygen is dissolved in the blood.

Answer: C Rationale: When the oxygen dissociation curve shifts to the left, blood picks up oxygen more readily in the lungs but delivers oxygen less readily to the tissues. Alkalosis can cause a shift to the left. Patients may be given higher concentrations of oxygen until alkalosis normalizes. This helps to compensate for decreased oxygen unloading in the tissues.

Twenty-four hours after a patient had a tracheostomy, the tube is accidentally dislodged after a coughing episode. Which of the following actions should the nurse take first? Call the health care provider. Place the obturator in the tracheostomy tube. Position the patient in a semi-Fowler's position. Grasp the retention sutures to spread the tracheostomy opening.

Answer: D Rationale: All of the actions are indicated. However, the nurse should first grasp the retention sutures to spread the tracheostomy opening.

The nurse is caring for a patient with pneumonia. If a pleural effusion is developing, the nurse would expect which finding? Barrel shaped chest Paradoxical respirations Hyperresonance on percussion Localized decreased breath sounds

Answer: D Rationale: Clinical manifestations of pleural effusion include diminished breath sounds over the affected area, decreased movement of the chest on the affected side, dullness to percussion, dyspnea, cough, and occasional sharp and nonradiating chest pain that is worse on inhalation.

The nurse would interpret an induration of 5 mm resulting from tuberculin skin testing as a positive finding in which patient? A patient with a history of illegal IV drug use A patient with diabetes and end-stage kidney disease A patient who immigrated from India 3 months ago A patient who is human immunodeficiency virus- infected

Answer: D Rationale: Induration of 5 mm in an HIV-infected person is considered a positive reaction.

Which statement is true regarding asthma? A. There is decreased responsiveness to environmental stimuli. B. It is characterized by airway inflammation. C. It involves irreversible airway obstruction. D. Extrinsic asthma has adult onset.

B Rationale Asthma is characterized by airway inflammation. There is increased airway responsiveness to stimuli. The resulting airway obstruction is usually reversible. Extrinsic asthma is child-onset asthma.

Tachycardia, decreased or absent breath sounds on the affected side, hyperresonance, and sudden chest pain on the affected side are clinical manifestations of A. Sarcoidosis B. Pneumothorax C. Hypersensitivity pneumonitis D. Adult respiratory distress syndrome

B Rationale Clinical features of a pneumothorax include tachycardia, decreased or absent breath sounds on the affected side, hyperresonance, and sudden chest pain on the affected side. General symptoms of hypersensitivity pneumonitis may include chills, sweating, shivering, myalgias, nausea, lethargy, headache, and malaise. The patient may or may not have a fever. Respiratory symptoms may include dyspnea at rest, dry cough, tachypnea, and chest discomfort. Physical findings may include cyanosis (a late sign) and crackles (rales) in the lung bases. Sarcoidosis is characterized by malaise, fatigue, weight loss, feverchest discomfort, dyspnea of insidious onset, and a dry, nonproductive cough. The clinical features of ARDS usually include a history of a precipitating event that has led to a low blood volume state ("shock" state) 1 or 2 days prior to the onset of respiratory failure. The patient may complain of sudden marked respiratory distress. Early signs and symptoms include a slight increase in pulse rate, dyspnea, and a low PaO2. The initial presenting sign may be shallow, rapid breathing.

What physiologic abnormality is characteristic of emphysema? A. Collapse of the proximal airways B. Trapping of air in the distal air sacs C. Widespread occurrence of bronchial plugs D. Extensive inflammation of the lower airways

B Rationale Emphysema leads to a loss of elastic tissue in the lung, which leads to a decrease in the size of the smaller bronchioles. The loss of lung tissue leads to a loss of radial traction, which normally holds the airway open, and to increasing pressure around the outside of the airway lumen, which in turn increases airway resistance and decreases air flow. Emphysema would affect distal airways. Asthma, not emphysema, results in mucus plug formation. Emphysema is not characterized by inflammation.

Which results in an increase in lung compliance? A. Pneumonia B. Emphysema C. Pulmonary fibrosis D. Pulmonary edema

B Rationale Emphysema makes the lung compliance increase because of a loss of alveoli. Pneumonia, pulmonary fibrosis, and pulmonary edema make the lung stiffer and decrease respiratory function.

What describes an asthma that is common in children and adolescents, with bronchospasm occurring within 3 minutes of physical exertion? A. Occupational-induced B. Exercise-induced C. Cardiac-induced D. Drug-induced

B Rationale Exercise-induced asthma (bronchospasm that occurs after activity or exercise) is common in children and adolescents. Occupational-induced asthma results from exposure to allergens and mimics extrinsic asthma. Cardiac-induced asthma results from bronchospasm precipitated by congestive heart failure. Drug-induced asthma occurs after reaction to medication.

A common radiologic diagnostic manifestation of fibrotic restrictive disease is the appearance of A. Distended alveoli B. A honeycomb lung C. Destruction of acini D. Constrictive bronchi

B Rationale Lung destructive pattern manifested by loss of alveolar walls appears as a honeycomb lung radiographically. Distended alveoli, destruction of acini, and constrictive bronchi are not generally associated with fibrotic restrictive long disease.

Which is a true statement regarding the airways? A. There are three main bronchi. B. Cough receptors lie at the carina. C. The carina is in the right main stem bronchus. D. There are six secondary or lobar branches from the bronchi.

B Rationale The majority of cough receptors lie at the carina. The trachea divides into the two main bronchi. The carina is located at the point where the trachea divides. The two main bronchi branch into five secondary or lobar branches.

Which major cartilage structure is often referred to as the Adam's apple? A. Cricoid cartilage B. Thyroid cartilage C. Arytenoid cartilage D. Tracheal cartilage

B Rationale The thyroid cartilage is shield shaped and often referred to as the Adam's apple. The cricoid cartilage lies below the thyroid cartilage and is the narrowest point in the airway of a child. Each vocal cord is attached anteriorly to the thyroid cartilage and posteriorly to the arytenoid cartilage. Tracheal cartilage are C-shaped rings surrounding the trachea acting as a support system.

In extrinsic asthma the immune system responds to the presence of allergens by causing A. Bronchodilation B. Bronchoconstriction C. Decreased cough reflex D. Decreased sputum production

B Rationale Vagal stimulation leads to edema, mucus hypersecretion, and bronchoconstriction. Asthma results in bronchconstriction. Some patients have only a chronic dry cough, and others have a productive cough. Especially in children, cough is often the earliest sign of exacerbation of asthma. Hypertrophy of mucosal glands and goblet cells leads to increased mucous production; the mucus then combines with purulent exudate to form bronchial plugs.

What is the name of the structure of long hairs that filter air? A. Cilia B. Vibrissae C. Columnar epithelium D. Convoluted turbinates

B Rationale Vibrissae filter the air and are large hairlike projections. Cilia beat in a sweeping motion like oars rowing a boat and move mucus upward. Columnar epithelium lines the trachea and bronchi. The convoluted turbinates are cone-shaped bones located in the nasal cavity that are highly vascular. Their blood flow forms an efficient heat exchanger.

Which structures are located within the larynx? (Select all that apply.) A. Acinus B. Cartilage C. Epiglottis D. Vocal cords E. Estachian tube

B C D

Which pathogenetic change is associated with acute bronchitis? (Select all that apply.) A. Mast cell-induced inflammation B. Swelling from exudation of fluid C. Decreased mucous production D. Loss of ciliary function E. Inflamed airways

B D E Rationale Swelling from exudation of fluid, loss of ciliary function, and inflamed airways are observed in acute bronchitis. Asthma is associated with release of inflammatory chemicals from mast cells in the airways. There is increased mucous production with acute bronchitis.

When emphysema is a result of a α1-Antitrypsin disorder, assessment data is likely to include which of the following? (Select all that apply.) A. Caucasian B. Client age younger than 50 C. Elevated levels of α1-Antitrypsin D. No history of cigarette smoking E. Enzyme levels that are below normal

B D E Rationale When emphysema occurs in young to middle-aged adults or before the age of 50 in a smoker, it may be associated with a deficiency of α1-antitrypsin activity in the lung. Cigarette smoking is not always a risk factor when this hereditary disorder is present. α1-Antitrypsin deficiency is a hereditary disorder characterized by low serum levels (25 to 50 mg/dl). Research does not currently support race as being a risk factor. α1-Antitrypsin deficiency is a hereditary disorder characterized by low serum levels (25 to 50 mg/dl).

Which medication that may be required for status asthmaticus? (Select all that apply.) A. β-Blockers B. Epinephrine C. Oral corticosteroids D. Terbutaline (Brethine) E. Aminophylline (Phyllocontin) Rationale Epinephrine, terbutaline (Brethine), or aminophylline (Phyllocontin) may be required. β-Blockers are contraindicated in asthma, because they worsen bronchospasm. Intravenous corticosteroids are most appropriate (versus oral corticosteroids).

B D E Which medication that may be required for status asthmaticus? (Select all that apply.) A. β-Blockers B. Epinephrine C. Oral corticosteroids D. Terbutaline (Brethine) E. Aminophylline (Phyllocontin) Rationale Epinephrine, terbutaline (Brethine), or aminophylline (Phyllocontin) may be required. β-Blockers are contraindicated in asthma, because they worsen bronchospasm. Intravenous corticosteroids are most appropriate (versus oral corticosteroids).

What value is consistent with acute respiratory failure? A. PaO2 of 100 mm Hg B. PaCO2 of 40 mm Hg C. pH less than 7.3 D. PaCO2 of 30 mm Hg

C Rationale A pH less than 7.3 is consistent with acute respiratory failure. A value consistent with acute respiratory failure includes a PaO2 less than 60 mm Hg and a PaCO2 greater than 50 mm Hg. Hypercapnia rather than hypocapnia is consistent with acute respiratory failure.

Destruction of bronchial walls from dilation of airway sacs is a result of A. Aspergillus fumigatus B. Cor pulmonale C. Bronchiectasis D. Cyanosis

C Rationale Bronchiectasis is the destruction of bronchial walls from dilation of airway sacs. Aspergillus fumigatus is a mold that can cause infection. Cor pulmonale is congestive heart failure. Cyanosis is a symptom of decreased oxygenation and is manifested by bluish or pallor of the skin.

Which statement regarding oxygen and carbon dioxide is true? A. Carbon dioxide is less soluble than oxygen. B. Oxygen diffuses more quickly than carbon dioxide. C. Carbon dioxide is carried in three forms in the blood. D. The capillary beds do not allow for the exchange of carbon dioxide.

C Rationale Carbon dioxide is carried in four forms in the blood. Carbon dioxide is more soluble and is diffused more quickly than oxygen. The capillary beds surround the alveoli and allow for easy exchange of O2 and CO2.

Which restrictive disease is associated with the formation of an antigen-antibody complex, causing fibrosis of the lung? A. Sarcoidosis B. Pneumoconiosis C. Hypersensitivity pneumonitis D. Diffuse interstitial lung disease

C Rationale Causative dust acts as an antigen, which combines with serum antibodies in the alveolar walls, leading to type III hypersensitivity reaction. Sarcoidosis is associated with the development of multiple, uniform, noncaseating epithelioid granulomas that affect multiple organ systems, most commonly the lymph nodes and lung tissue. Pneumoconiosis is defined as parenchymal lung disease caused by the inhalation of inorganic dust particles. Diffuse interstitial lung disease is associated with thickening of the alveolar interstitium.

COPD type A is referred to as A. Chronic bronchitis B. Bronchiectasis C. Emphysema D. Asthma

C Rationale Emphysema is also referred as COPD type A, or the pink puffer. Chronic bronchitis is referred to as type B COPD. Bronchiectasis is associated with recurrent inflammation of the bronchial walls; it is not commonly associated with COPD. Asthma is an inflammatory lung disease.

What is the primary cause of airway obstruction in patients with chronic bronchitis? A. Thinning bronchial smooth muscle B. Hyperventilation C. Mucous plugs D. Infection

C Rationale Hypertrophy of mucosal glands and goblet cells leads to increased mucous production; the mucus then combines with purulent exudate to form bronchial plugs. Thickening of bronchial smooth muscle occurs. Hyperventilation is not related to airway obstruction. While infection may be evident, it is not the cause of airway obstruction.

What situation occurs with hypoventilation? A. The amount of air entering the alveoli increases. B. It is a normal response to high altitude. C. The PaCO2 exceeds 45 mm Hg. D. Hypocapnia occurs.

C Rationale Hypoventilation results in a PaCO2 exceeding 45 mm Hg. Hypoventilation occurs when delivery of air into the alveoli is insufficient to meet the need to provide oxygen and remove carbon dioxide. A normal response to high altitude is hyperventilation. Hypoventilation results in hypercapnia

Which is a characteristic of intrinsic (non-allergic) asthma? A. The prognosis is better than that of extrinsic (allergic) asthma. B. The onset is usually in adolescence. C. Attacks are often severe. D. It is IgE-mediated.

C Rationale Intrinsic asthma attacks may be often and are often severe. Intrinsic asthma has a less favorable prognosis, is adult onset and develops in middle age, and is not IgE-mediated.

Gas exchange occurs in which of the respiratory system's structures? A. Sinuses B. Trachea C. Alveoli D. Bronchi

C Rationale The alveoli allow air to come in indirect contact with the bloodstream through the pulmonary capillary system. This alveolar membrane, which is one cell thick, allows carbon dioxide to diffuse into the alveoli from the bloodstream and oxygen to diffuse to the bloodstream from the alveoli. Sinuses are hollow spaces found in the skull. The trachea is a structure that allows passage of gases to and from the gas exchange units (alveoli). Bronchi are branches of the conducting airways that allow passage of gases to and from the gas exchange units (alveoli).

The lungs are normally fully developed by what year of age? A. 15 B. 10 C. 8 D. 5

C Rationale The lungs are normally fully developed by the eighth year of life. The other ages are too old or too young.

A current diagnosis of tuberculosis requires a A. Chest x-ray B. Positive Mantoux test C. Positive sputum culture for acid-fast bacillus D. Presentation of typical symptoms including night sweats

C Rationale Three consecutive morning sputum specimens are obtained to identify the slow-growing acid-fast bacillus and confirm a current diagnosis of tuberculosis. A chest ray is used to confirm nodules with infiltrates in the lung apex and posterior segments of the upper lobes; not the definitive diagnostic result. The Mantoux test does not distinguish between current disease and past infection. Presentation of symptoms is not considered a definitive indication of the disease.

The major risk factor for the development of lung cancer is A. Age B. Heredity C. Cigarette smoking D. Asbestos exposure

C Rationale Tobacco smoking is the major cause (85%) of lung cancer, with approximately 160,000 deaths reported per year. While individuals older than 50 years of age have an increased risk for developing lung cancer; it is not comparable to that of a history of tobacco smoking. A family history that includes non-tobacco use related lung cancer doe have an impact on the risk for developing lung cancer; it is not comparable to that of a history of tobacco smoking. Working under conditions of asbestos exposure increases the risk for developing lung cancer; it is not comparable to that of a history of tobacco smoking.

Which lung zone has continuous perfusion throughout the cardiac cycle? A. Zone 1 B. Zone 2 C. Zone 3 D. Zone 4

C Rationale Zone 3 has continuous perfusion through the entire cardiac cycle. Pulmonary arterial pressure is greater than pulmonary venous pressure. Zone 1 reflects blood flow through the apices and is minimal. The alveolar pressure is higher than capillary pressure. Zone 2 has pulmonary arterial pressure greater than the pressure inside the alveoli during ventricular systole. Zone 2 has intermittent perfusion. There is no recognized Zone 4.

Which is a true statement regarding the mechanics of breathing? A. During inspiration the muscles relax. B. During exhalation the muscles contract. C. Atelectasis occurs when bronchi collapse. D. Functional residual capacity is the air remaining in alveoli.

D

Which statement is true regarding cystic fibrosis? A. It is autosomal-dominant. B. It affects endocrine glands. C. It is common in African Americans. D. It is the most common genetic disease in the United States.

D Rationale Cystic fibrosis is the most common genetic disease in the United States. It is autosomal recessive, not dominant. It affects exocrine, not endocrine, glands. Cystic fibrosis affects primarily Caucasians.

The most common cause of chronic bronchitis is A. Bacterial infection B. Chemical irritants C. Viral infection D. Smoking

D Rationale Smoking causes 90% of chronic bronchitis cases. Chronic bronchitis may be caused by bacterial infection , chemical irritants, or viral infection, but these are not the leading causes.

Tubercular bacilli are transmitted by contract with infected A. Blood B. Sputum C. Body fluids D. Airborne droplets

D Rationale Tuberculosis is an airborne disease spread by droplets. Tubercular bacilli are not transmitted via infected blood, sputum, or body fluids.

Which is an upper airway structure? A. Trachea B. Larynx C. Bronchi D. Oropharynx

D The oropharynx is an upper airway structure. The trachea, larynx, and bronchi are lower airway structures.

Compliance of the lung is the measure of A. The lung's ability to be inflated B. Gas exchange at the alveoli C. The lung's dead space D. Shunting

Rationale Compliance is the measure of resistance of the lung to being inflated. If the lung is stiff, it is said to have too little compliance and the lung is difficult to inflate. Gas exchange at the alveoli level involves perfusion. Dead space is not defined in terms of compliance. Pulmonary shunting is a physiological condition which results when the alveoli of the lung are perfused with blood as normal, but ventilation (the supply of air) fails to supply the perfused region.