Kacmarek: Egan's Fundamentals of Respiratory Care, 10th

Edition Chapter 25: Pleural Diseases

Test Bank

MULTIPLE CHOICE

1. How much pleural fluid does a normal healthy adult have in each hemithorax?
a. 5 mL
b. 8 mL
c. 12 mL
d. 16 mL
2. Which of the following statements about pleural fluid is FALSE?
a. Fluid can move easily between each hemithorax.
b. Normal protein concentration is between 1.3 and 1.4 g/dL.
c. The total volume is approximately 16 mL.
d. Total protein concentration is similar to that of interstitial fluid elsewhere in the
body.

3. At what point is intrapleural pressure most negative?

a. end exhalation
b. FRC
c. inspiration
d. maximal expiration

4. Pleural fluid with a total protein concentration of less than 50% of the serum total protein
level is one of the indications of transudative pleural effusion.
a. True
b. False

5. What is the most common cause of pleural effusion in the clinical setting?
a. acute renal failure
b. congestive heart failure
c. liver disease
d. lung cancer
6. The pleural effusions associated with heart failure are rarely drained.
a. True
b. False

7. Nephrotic syndrome causes pleural effusion by increasing oncotic pressure in the blood as a
result of a protein leak into the urine.
a. True
b. False
 8. A patient with nephritic syndrome is noted to have a large right-sided pleural effusion and a
small to medium-sized left-sided pleural effusion. What would explain this finding? a. The
nephrosis is complicated by CHF.
b. The nephrosis is complicated by pulmonary emboli.
c. This is a common finding in patients with nephrosis.
d. This just a complicated case of nephrosis.

9. Pleural effusion is a complication of ascites in fewer than 10% of the cases.

a. True
b. False

10. What is the most common cause of pleural effusion that occurs due to lymphatic obstruction
within the mediastinum?
a. cancer that has metastasized to the mediastinum
b. hepatic hydrothorax
c. malignant pleural effusion
d. tuberculous pleurisy

11. Exudative pleural effusions have more protein and inflammatory cells present compared to
transudative effusions.
a. True
b. False

12. Most pleural effusions are transudative.

a. True
b. False

13. What is a common cause of persistent fever in intensive care unit (ICU) patients with
pneumonia?
a. congestive heart failure
b. most exudative effusions
c. parapneumonic effusions
d. transudative effusions

14. What is a common complication of pleurodynia (pleural pain)?

a. atelectasis
b. insomnia
c. pneumonia
d. pneumothorax

15. Which of the following conditions is most closely associated with exudative pleural effusion?
a. cirrhosis of the liver
b. congestive heart failure
c. nephrotic syndrome
d. tuberculosis
16. What is the most likely cause of a large unilateral pleural effusion in a 70 year old patient?
a. congestive heart failure
b. malignancy
c. pneumonia
d. tuberculosis

17. What type of pleural problem is most likely to develop from rupture of the thoracic duct?
a. chylothorax
b. hemothorax
c. hydrothorax
d. pneumothorax

18. What is the most common cause of a chylothorax?

a. chest trauma
b. malignancy
c. pulmonary embolism
d. surgery
19. What is the most common cause of hemothorax?
a. chest trauma
b. malignancy
c. pulmonary embolism
d. surgery

20. What is a common clinical finding even with small pleural effusions?
a. air bronchograms
b. arrhythmias
c. dyspnea
d. tachycardia

21. What diagnostic procedure or technique is most commonly used to diagnose the presence of a
pleural effusion?
a. chest radiography
b. pleuroscopy
c. thoracentesis
d. thoracoscopy
22. What anatomical position is most likely to show the presence of a small pleural effusion in the
upright chest radiograph?
a. apical regions
b. costophrenic angles
c. fissures
d. subdiaphragmatic region

23. What diagnostic procedure or technique is most sensitive for the identification of pleural
effusion?
a. chest radiography
b. computed tomography
c. pleurodesis
d. thoracoscopy
24. Which of the following is NOT a typical complication of thoracentesis?
a. infection
b. intercostal artery laceration
c. rib fracture
d. pneumothorax

25. What agent has proved to be the most successful in pleurodesis?

a. mixture of saline and Mucomyst
b. acetaminophen in suspension
c. saline solution mixed with heparin
d. talc suspended in saline

26. Pleural effusions that occur secondarily to _____ are most often treated with pleurodesis.
a. ascites
b. congestive heart failure
c. malignancy
d. nephrotic syndrome

27. Primary spontaneous pneumothorax occurs in a patient with no previous underlying lung
disease.
a. True
b. False

28. Describe a secondary spontaneous pneumothorax.

a. pneumothorax that occurs secondary to cardiac complications
b. pneumothorax that occurs without trauma or any underlying disease
c. pneumothorax that results from nonpenetrating chest trauma
d. pneumothorax that results from underlying lung disease

29. Chest pain occurs in only a small percentage of patients with a pneumothorax.
a. True
b. False

30. Dyspnea occurs in the majority of patients with a pneumothorax.

a. True
b. False

31. What are the functions of a chest tube in a patient with chest trauma that causes bleeding and
pneumothorax?
1. to measure the rate of bleeding
2. to improve ventilation
3. to allow lung reexpansion
a. 1 and 2
b. 2 and 3
c. 3
d. 1, 2, and 3
32. What size of chest tube would you use in the management of trauma related pneumothoraces?
a. large
b. medium
c. small
d. size is immaterial

33. Chest tubes should be directed toward the base of the lung to evacuate a pneumothorax.
a. True
b. False

34. Iatrogenic pneumothorax is the most common type of traumatic pneumothorax.

a. True
b. False
35. In what age group is a primary spontaneous pneumothorax most commonly seen?
a. under 15 years
b. 18 to 25 years
c. 35 to 45 years
d. over 60 years

36. What is the primary risk factor associated with spontaneous pneumothoraces?
a. cigarette smoking
b. heavy exercise
c. obesity
d. urban living

37. What underlying lung disease is most often present in a patient with secondary spontaneous
pneumothorax?
a. asthma
b. chronic obstructive pulmonary disease (COPD)
c. interstitial pulmonary fibrosis
d. pneumonia
38. Which of the following findings on a radiologic report would indicate the presence of a
tension pneumothorax?
a. bilateral inversion of diaphragm, long narrow heart, flattened ribs
b. blunting of costophrenic angles, marked interstitial infiltrates, apical free air
c. contralateral mediastinal shift, diaphragmatic depression, flattening of ribs
d. ipsilateral mediastinal shift, sail-shape noted right hemithorax, marked interstitial

39. At what anatomic position should an 18-gauge IV catheter be placed to relieve a tension
pneumothorax?
a. just inferior to the second rib
b. just inferior to the third rib
c. just superior to the second rib
d. just superior to the fourth rib
40. A quick diagnosis based on clinical presentation can significantly improve the survival rates
in patients with tension pneumothorax.
a. True
b. False

41. What complication often occurs following rapid lung reexpansion due to the evacuation of air
or fluid from the pleural space?
a. arrhythmias
b. pulmonary edema
c. pulmonary emboli
d. systemic hypotension

42. What is the primary tool used to diagnosis a pneumothorax?

a. chest radiography
b. computed tomography
c. PET scan
d. ultrasonography

43. If accurate sizing on a pneumothorax is desired, what diagnostic technique would be most
appropriate?
a. chest radiography
b. computed tomography
c. PET scan
d. ultrasonography

44. The administration of oxygen to a patient with a pneumothorax will speed the rate at which
resolution occurs once the leak has stopped.
a. True
b. False

45. Which of the following could be early warning signs that a pneumothorax is enlarging?
1. decreased pulse oximetry reading
2. development of a fever
3. increased respiratory rate
4. mental confusion
a. 1, 2, and 3
b. 1 and 3
c. 2
d. 1, 2, 3, and 4

46. When using a small-bore catheter with a one-way valve such as a HeimLich valve, how can
you determine definitively that there is or is not a small air leak?
a. Connect to an underwater seal.
b. Increase the FIO2 and note clinical changes.
c. Listen for air movement.
d. Watch the valve to see if it moves.
47. What method of chest tube removal has been associated with the lowest level of
pneumothorax recurrence?
a. Clamp the chest tube for 4 hours; if chest radiograph is good, remove the tube.
b. Clamp chest tube for 24 hours; if clinically stable, remove the tube.
c. Remove the chest tube as soon as the air leak resolves.
d. Remove the chest tube 48 hours after the air leak resolves.

48. For which type of pneumothorax is pleurodesis most commonly indicated?

a. iatrogenic
b. bronchopleural fistula
c. spontaneous
d. traumatic

49. Which of the following procedures would you recommend to assess her situation at this time?
a. chest x-ray
b. auto-peep maneuver
c. measure her compliance manually
d. CT scan of the chest

50. The chest radiograph showed the presence a meniscus in the right chest together with a blunted
right costophrenic angle. Which of the following procedures would you recommend at this
point to treat Ms. Paul?
a. anterior chest tube thoracotomy
b. chest needle decompression
c. video-assisted thoracoscopy (VAT)
d. posterior chest tube thoracotomy

51. Forty-eight hours after the chest tube insertion Ms. Paul remains on mechanical ventilation.
While assessing the chest tube system you note small bubbles in the water seal chamber
generated during peak inspiration. This is an indication of which of the following:

a. normal functioning of the water seal chamber

b. bronchopleural fistula
c. low water level in the chamber
d. high suction pressure from the suction chamber