Chapter 25: Structure and Function of the Pulmonary System My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 25: Structure and Function of the Pulmonary System

Test Bank

MULTIPLE CHOICE

1. The nasopharynx is lined with a ciliated mucosal membrane with a highly vascular blood supply. The nurse is discussing the functions of this membrane. Which information should be included? One function of the membrane is to:

a.

Absorb air

b.

Humidify air

c.

Cool air

d.

Exchange gases

ANS: B

These structures are lined with a ciliated mucosa that warms and humidifies inspired air and removes foreign particles from it.

Air is not absorbed, it is humidified.

Air is warmed, not cooled.

Gas exchange occurs in the alveoli.

REF: p. 659

2. The nurse is describing the slit-shaped space between the true vocal cords. What term should the nurse use?

a.

Glottis

b.

Epiglottis

c.

Larynx

d.

Carina

ANS: A

The slit-shaped space between the true vocal cords forms the glottis.

The slit-shaped space between the true vocal cords forms the glottis, not the epiglottis.

The slit-shaped space between the true vocal cords forms the glottis, not the larynx.

The slit-shaped space between the true vocal cords forms the glottis, not the carina.

REF: p. 659

3. After entering a room of chemical fog, a 20-year-old male cannot stop sneezing. Which of the following structures is primarily responsible for his sneezing?

a.

Upper respiratory tract mucosa

b.

Irritant receptors in the trachea and large airways

c.

Irritant receptors in the nostrils

d.

Upper respiratory nasal hairs and turbinates

ANS: C

The irritant receptors in the nostrils are responsible for sneezing.

The irritant receptors in the nostrils are responsible for sneezing, not the upper respiratory tract mucosa.

The irritant receptors in the nostrils are responsible for sneezing, not those in the trachea.

The irritant receptors in the nostrils are responsible for sneezing, not the turbinates.

REF: p. 660

4. A newborn is in respiratory distress and requires ventilation. Tests reveal that he does not produce surfactant due to the absence of:

a.

Mucus-producing cells

b.

Type II alveolar cells

c.

Alveolar macrophages

d.

Goblet cells

ANS: B

Surfactant is produced by the type II alveolar cells.

Surfactant is produced by the type II alveolar cells, not mucus-producing cells.

Surfactant is produced by the type II alveolar cells, not alveolar macrophages.

Surfactant is produced by the type II alveolar cells, not goblet cells.

REF: p. 663

5. The nurse is describing the movement of blood into and out of the capillary beds of the lungs to the body organs and tissues. What term should the nurse use to describe this process?

a.

Perfusion

b.

Ventilation

c.

Diffusion

d.

Circulation

ANS: A

Perfusion is the movement of blood into and out of the capillary beds of the lungs to body organs and tissues.

Ventilation is the movement of air into and out of the lungs.

Diffusion is the movement of gases between air spaces in the lungs and the bloodstream.

Circulation is the movement of blood throughout the blood stream.

REF: p. 659

6. Which principle should the nurse remember while planning care for a patient with respiratory problems? Diffusion of respiratory gases takes place at the:

a.

Alveolocapillary membrane

b.

Visceral pleurae

c.

Parietal pleurae

d.

Respiratory center

ANS: B

Diffusion of respiratory gases takes place across the alveolocapillary membrane.

The visceral pleurae are the linings of the lung; gas exchange does not occur here.

The parietal pleurae are the linings of the lung; gas exchange does not occur here.

The respiratory center is where impulses to the respiratory muscles are generated.

REF: p. 672

7. Students in a histology class are assigned to identify regions of the lung. The slide shows a basement membrane, capillary lumen, and macrophages. The students are looking at the:

a.

Trachea

b.

Bronchioles

c.

Alveoli

d.

Bronchus

ANS: C

The alveoli contain a basement membrane, a capillary lumen, and macrophages.

The trachea does not contain these substances.

The bronchioles do not contain these substances.

The bronchus does not contain these substances.

REF: p. 662

8. A nurse recalls the pleural membranes are examples of _____ membranes.

a.

Mucous

b.

Serous

c.

Synovial

d.

Peritoneal

ANS: B

The pleural membranes are serous membranes.

The pleural membranes are serous membranes, not mucous membranes, which are found in the mouth.

The pleural membranes are serous membranes, not synovial, which are found in joints.

The pleural membranes are serous membranes, not peritoneal, which are found in the bowel.

REF: p. 663

9. A nurse is teaching about the functions of the pulmonary system. Which information should the nurse include? One of the functions of the pulmonary system is the:

a.

Expelling of bacteria

b.

Exchange of gases between the environment and blood

c.

Movement of blood into and out of the capillaries

d.

Principle mechanism for cooling of the heart

ANS: B

The pulmonary system promotes exchange of gases between the environment and the blood.

One of the functions of the pulmonary system is exchange of gases, not the expelling of bacteria.

One of the functions of the pulmonary system is exchange of gases, not the movement of blood into and out of the capillaries.

One of the functions of the pulmonary system is exchange of gases, not cooling the heart.

REF: p. 660

10. A 42-year-old male was involved in a motor vehicle accident during which he suffered a severe head injury. He died shortly after the accident from loss of respiration. The nurse suspects the area of the brain most likely involved is the:

a.

Cerebral cortex

b.

Thalamus

c.

Basal ganglia

d.

Brainstem

ANS: D

The respiratory center in the brainstem controls respiration by transmitting impulses to the respiratory muscles, causing them to contract and relax.

The cerebral cortex does not control respiration.

The thalamus does not control respiration.

The basal ganglia do not control respiration.

REF: p. 665

11. The pulmonologist talks about the receptors that respond to increased pulmonary capillary pressure. What term will indicate the nurse understands? They are called:

a.

Irritant receptors

b.

Chemoreceptors

c.

Stretch receptors

d.

J receptors

ANS: D

J-receptors (juxtapulmonary capillary receptors) are located near the capillaries in the alveolar septa. They are sensitive to increased pulmonary capillary pressure, which stimulates them to initiate rapid, shallow breathing, hypotension, and bradycardia.

The J-receptors respond to capillary changes, not the irritant receptors.

The J-receptors respond to capillary changes, not the chemoreceptors.

The J-receptors respond to capillary changes, not the stretch receptors.

REF: p. 665

12. While reviewing the results of the pulmonary functions test, the nurse is aware that the maximum amount of gas that can be displaced (expired) from the lung is called:

a.

Vital capacity (VC)

b.

Total lung capacity

c.

Functional capacity

d.

Residual volume

ANS: A

VC is the amount of air that can be forcibly expired after a maximal inspiration.

VC is the amount of air that can be forcibly expired after a maximal inspiration. Total lung capacity is the volume of lung capacity at full inhalation.

VC is the amount of air that can be forcibly expired after a maximal inspiration. Functional capacity is not a term used to describe function tests.

VC is the amount of air that can be forcibly expired after a maximal inspiration. Residual volume is the amount of air remaining after exhalation.

REF: p. 669

13. The nurse is describing the receptors in the lung that decrease ventilatory rate and volume when stimulated. Which receptors is the nurse discussing?

a.

Carbon dioxide receptors

b.

Baroreceptors

c.

Stretch receptors

d.

Chemoreceptors

ANS: C

Stretch receptors decrease ventilatory rate and volume when stimulated.

Stretch receptors, not carbon dioxide receptors, decrease ventilatory rate and volume when stimulated.

Stretch receptors decrease ventilatory rate and volume when stimulated; baroreceptors regulate blood pressure.

Stretch receptors decrease ventilatory rate and volume when stimulated; chemoreceptors increase the rate and depth of respiration.

REF: p. 666

14. The pulmonologist is presenting a workshop over the lungs. Which information should be included? The lung receives parasympathetic innervation by the _____ nerve.

a.

Vagus

b.

Phrenic

c.

Brachial

d.

Pectoral

ANS: A

Parasympathetic innervations for the lung are via the vagus nerve.

Parasympathetic innervations for the lung are via the vagus nerve, not the phrenic.

Parasympathetic innervations for the lung are via the vagus nerve, not the brachial.

Parasympathetic innervations for the lung are via the vagus nerve, not the pectoral.

REF: p. 666

15. While planning care for a patient with respiratory difficulty and retaining too much carbon dioxide, which principle should the nurse recall? _______ would be stimulated in an attempt to maintain a normal homeostatic state.

a.

Irritant receptors

b.

Stretch receptors

c.

Peripheral chemoreceptors

d.

Central chemoreceptors

ANS: D

Chemoreceptors monitor arterial blood indirectly by sensing changes in the pH of cerebrospinal fluid (CSF). The central chemoreceptors are sensitive to very small changes in the pH of CSF and can maintain a normal PaCO2.

Chemoreceptors monitor arterial blood indirectly by sensing changes in the pH of CSF. The central chemoreceptors are sensitive to very small changes in the pH of CSF and can maintain a normal PaCO2. Irritant receptors sense the need to expel unwanted substances.

Chemoreceptors monitor arterial blood indirectly by sensing changes in the pH of CSF. The central chemoreceptors are sensitive to very small changes in the pH of CSF and can maintain a normal PaCO2. Stretch receptors decrease ventilatory rate and volume when stimulated.

Chemoreceptors monitor arterial blood indirectly by sensing changes in the pH of cerebrospinal fluid (CSF). The central chemoreceptors are sensitive to very small changes in the pH of CSF and can maintain a normal PaCO2. The peripheral chemoreceptors become the major stimulus to ventilation when the central chemoreceptors are reset.

REF: p. 666

16. If an individual with respiratory difficulty were retaining too much carbon dioxide, which of the following compensatory responses would the nurse expect to be initiated?

a.

Increase in respiratory rate

b.

Decrease in ventilation rate

c.

Increase in tidal volume

d.

Vasodilation of the pulmonary arterioles

ANS: A

To rid the body of excess carbon dioxide, the rate and depth of respiration are increased.

A decrease in ventilation rate would increase carbon dioxide.

An increase in tidal volume would not decrease carbon dioxide.

Vasodilation of the pulmonary arterioles will not rid the body of carbon dioxide.

REF: p. 666

17. During inspiration, muscular contraction of the diaphragm causes air to move into the lung. The mechanisms that drive air movement during inspiration are a(n):

a.

Decrease in intra-alveolar pressure and shortening of the rib cage

b.

Decrease in the size of the thorax and alveolar expansion

c.

Increase in the size of the thorax and a decrease in intrapleural pressure

d.

Increase in atmospheric pressure and intrapleural pressure

ANS: C

Inspiration occurs due to an increase in the size of the thorax and a decrease in intrapleural pressure.

The rib cage lengthens, not shortens.

The size of the thorax increases, not decreases.

Intrapleural pressure decreases, not increases.

REF: p. 667

18. A nurse remembers the majority of total airway resistance occurs in the:

a.

Bronchi

b.

Nose

c.

Oral pharynx

d.

Diaphragm

ANS: B

One-half to two-thirds of total airway resistance occurs in the nose.

One-half to two-thirds of total airway resistance occurs in the nose, not the bronchi.

One-half to two-thirds of total airway resistance occurs in the nose, not the oral pharynx.

One-half to two-thirds of total airway resistance occurs in the nose, not the diaphragm.

REF: p. 668

19. The pressure required to inflate an alveolus is inversely related to:

a.

Wall thickness

b.

Surface tension

c.

Minute volume

d.

Alveolar radius

ANS: D

The radius of the alveoli is inversely related to the pressure required to inflate it.

It is the radius that is related to the pressure, not the wall thickness.

It is the radius that is related to the pressure, not the surface tension.

It is the radius that is related to the pressure, not the minute volume.

REF: p. 667

20. An aide asks a nurse how surfactant works. How should the nurse respond? Surfactant facilitates alveolar distention and ventilation by:

a.

Decreasing thoracic compliance

b.

Attracting water to the alveolar surface

c.

Decreasing surface tension in alveoli

d.

Increasing diffusion in alveoli

ANS: C

Surfactant decreases surface tension in alveoli, allowing the lungs to inflate.

Surfactant decreases surface tension; it does not decrease thoracic compliance.

Surfactant decrease surface tension; it does not attract water.

Surfactant does not increase diffusion.

REF: p. 667

21. Which principle should the nurse remember while planning care for a patient with a respiratory problem? Under most circumstances, increased work of breathing results in:

a.

Increased partial pressure of O2 in the lungs

b.

Increased oxygen consumption

c.

Decreased PaCO2

d.

Alterations in alveolar perfusion

ANS: B

An increase in the work of breathing can result in a marked increase in oxygen consumption.

An increase in the work of breathing can result in a marked increase in oxygen consumption, not in partial pressure.

An increase in the work of breathing can result in a marked increase in oxygen consumption; it may not lower CO2.

An increase in the work of breathing can result in a marked increase in oxygen consumption; it would not alter alveolar perfusion.

REF: p. 669

22. Which of the following terms should the nurse use when there is a balance between outward recoil of the chest wall and inward recoil of lungs at rest?

a.

Functional residual capacity (FRC) is reached.

b.

Vital capacity (VC) is reached.

c.

Total lung capacity (TLC) is reached.

d.

Residual volume (RV) is reached.

ANS: A

Balance between the outward recoil of the chest wall and inward recoil of the lungs occurs at the resting level, the end of expiration, where the FRC is reached.

VC is the amount of air that can be forcibly expired after a maximal inspiration.

TLC is not reflected by outward and inward recoil.

RV is the air that remains trapped in the alveoli.

REF: p. 668

23. What is the partial pressure of oxygen in the lung given the following conditions?

Percentage of oxygen in air: 20

Barometric pressure: 700 mm Hg

a.

111 mm Hg

b.

124 mm Hg

c.

131 mm Hg

d.

140 mm Hg

ANS: D

The partial pressure of oxygen is equal to the percentage of oxygen in the air, 20, times the total pressure (700 mm Hg), or 140 mm Hg (700 0.20 = 140).

The partial pressure of oxygen is equal to the percentage of oxygen in the air, 20, times the total pressure (700 mm Hg), or 140 mm Hg (700 0.20 = 140).

The partial pressure of oxygen is equal to the percentage of oxygen in the air, 20, times the total pressure (700 mm Hg), or 140 mm Hg (700 0.20 = 140).

The partial pressure of oxygen is equal to the percentage of oxygen in the air, 20, times the total pressure (700 mm Hg), or 140 mm Hg (700 0.20 = 140).

REF: p. 670

24. A pulmonologist is discussing the base of the lungs with staff. Which information should be included? At the base of the lungs:

a.

Alveolar gas pressure exceeds arterial perfusion pressure.

b.

Arterial perfusion pressure and alveolar gas pressure are less than at the apex.

c.

Arterial perfusion pressure exceeds alveolar gas pressure.

d.

Arterial perfusion and alveolar gas pressure are equal.

ANS: C

In the base of the lungs, both arterial and venous pressures are greater than alveolar pressure, and blood flow is not affected by alveolar pressure.

In the base of the lungs, both arterial and venous pressures are greater than alveolar pressure, and blood flow is not affected by alveolar pressure. It is in the apex that alveolar pressure exceeds pulmonary arterial and venous pressures.

In the base of the lungs, both arterial and venous pressures are greater than alveolar pressure, and blood flow is not affected by alveolar pressure. It is in the apex that alveolar pressure exceeds pulmonary arterial and venous pressures.

In the base of the lungs, both arterial and venous pressures are greater than alveolar pressure, and blood flow is not affected by alveolar pressure. In zone II, also part of the apex, alveolar pressure is greater than venous pressure, but not arterial pressure.

REF: p. 671

25. While auscultating a patients lungs, a nurse recalls the alveoli in the apexes of the lungs are _____ than alveoli in the bases.

a.

Larger

b.

More numerous

c.

More compliant

d.

Less perfused

ANS: A

The alveoli in the upper portions, or apexes, of the lungs contain a greater residual volume of gas and are larger and less numerous than those in the lower portions.

The alveoli in the upper portions, or apexes, of the lungs contain a greater residual volume of gas and are larger and less numerous, not more, than those in the lower portions.

The alveoli in the upper portions, or apexes, of the lungs contain a greater residual volume of gas and are larger and less numerous than those in the lower portions. The apexes are less compliant.

The apexes of the lungs are better perfused.

REF: p. 671

26. A patient asks how oxygen is transported in the body. What is the nurses best response? Most of the oxygen (O2) is transported:

a.

Dissolved in the plasma

b.

Bound to hemoglobin

c.

In the form of carbon dioxide (CO2)

d.

As a free-floating molecule

ANS: B

Most O2 is transported bound to hemoglobin.

Most O2 is transported bound to hemoglobin; only a small amount is dissolved in plasma.

O2 is not transported in the form of CO2.

O2 is transported bound to hemoglobin, not as a free-floating molecule.

REF: p. 672

27. If a patients hemoglobin concentration (Hb) is 14 g/100 ml and arterial oxygen saturation (SaO2) is 98%, what would be his arterial oxygen content? Remember that 1.34 ml O2 is the maximum amount of oxygen that can be transported per gram of hemoglobin.

Hint: O2 content = (1.34 Hb) SaO2

a.

13.72 ml O2 per 100 ml blood

b.

15.38 ml O2 per 100 ml blood

c.

18.76 ml O2 per 100 ml blood

d.

19.30 ml O2 per 100 ml blood

ANS: C

18.76 is the product of 14 1.34.

18.76 is the product of 14 1.34.

18.76 is the product of 14 1.34.

18.76 is the product of 14 1.34.

REF: p. 672

28. In a patient with acidosis or a fever, the nurse would expect the oxyhemoglobin dissociation curve to shift:

a.

To the right, causing more O2 to be released to the cells

b.

To the left, allowing less O2 to be released to the cells

c.

Downward, allowing less O2 to dissolve in the plasma

d.

Upward, allowing more O2 to dissolve in the plasma

ANS: A

The oxyhemoglobin dissociation curve is shifted to the right by acidosis (low pH) and hypercapnia (increased PaCO2).

The oxyhemoglobin dissociation curve is shifted to the right, not the left, by acidosis (low pH) and hypercapnia (increased PaCO2); more, not less, O2 is released to cells.

The oxyhemoglobin dissociation curve is shifted to the right, not downward, by acidosis (low pH) and hypercapnia (increased PaCO2).

The oxyhemoglobin dissociation curve is shifted to the right, not upward, by acidosis (low pH) and hypercapnia (increased PaCO2).

REF: p. 673

29. A patient wants to know how carbon dioxide is transported in the body. How should the nurse respond? Carbon dioxide (CO2) is mainly transported in the blood:

a.

Attached to oxygen (O2)

b.

Dissolved in red blood cells

c.

Combined with albumin

d.

In the form of bicarbonate

ANS: D

CO2 is carried in the blood as bicarbonate.

CO2 is carried in the blood as bicarbonate, not attached to O2.

CO2 is carried in the blood as bicarbonate, not dissolved in red blood cells.

CO2 is carried in the blood as bicarbonate, not combined with albumin.

REF: p. 673

30. A consequence of alveolar hypoxia is:

a.

Reactive vasodilation

b.

Local bronchoconstriction

c.

Decreased respiratory rate

d.

Pulmonary artery vasoconstriction

ANS: D

Alveolar hypoxia can result in permanent pulmonary artery vasoconstriction.

A consequence of alveolar hypoxia is pulmonary artery vasoconstriction, not reactive vasodilation.

A consequence of alveolar hypoxia is pulmonary artery vasoconstriction, not local bronchoconstriction.

A consequence of alveolar hypoxia is pulmonary artery vasoconstriction, not a decreased respiratory rate.

REF: p. 675

31. An 80-year-old male presents to his primary care provider reporting difficulty breathing. Pulmonary function tests reveal that he has increased residual volume. A nurse suspects the most likely cause of this disorder is _____ in lung compliance.

a.

An increase

b.

A decrease

c.

No change

d.

An absence

ANS: A

The patient is experiencing an increase in lung compliance. Increased compliance indicates that the lungs or chest wall is abnormally easy to inflate and has lost some elastic recoil.

Decreased compliance is seen in acute breathing disorders.

The patient will see increased compliance.

The patient will see an increase in compliance.

REF: p. 675

MULTIPLE RESPONSE

1. A nurse is teaching staff about the respiratory bronchi. Which information should the nurse include? __________ may be found in the walls of the respiratory bronchi? (Select all that apply,)

a.

Smooth muscle

b.

Surfactant-producing glands

c.

Goblet cells

d.

Ciliated cells

e.

Epithelial lining

ANS: A, C, D, E

The bronchial walls have three layers: an epithelial lining, a smooth muscle layer, and a connective tissue layer. The epithelial lining of the bronchi contains single-celled exocrine glandsthe mucus-secreting goblet cellsand ciliated cells. Surfactant-producing glands are found in the alveoli.

REF: p. 600

COMPLETION

1. _____ seconds is required for oxygen (O2) concentration to equilibrate (equalize) across the alveolocapillary membrane.

ANS: .25

REF: p. 672

2. ____% of oxygen (O2) enters the bloodstream bound to hemoglobin

ANS: 97

REF: p. 672

3. A pulmonologist, while presenting a seminar on partial pressures of oxygen, would include which statement? At sea level, the partial pressure of oxygen is approximately ___% (round to the nearest whole number).

ANS:

21

At sea level, the air is made up of oxygen (20.9%).

REF: p. 670

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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