Test Bank Clinical Manifestations and Assessment of Respiratory Disease Mid Part

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Chapter 13: Asthma

Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 7th
Edition
MULTIPLE CHOICE
1. Which of the following are associated with extrinsic asthma?

1. Animal dander
2. Mold
3. Emotional stress
4. Male gender
a. 1, 2
b. 2, 3
c. 1, 2, 3
d. 1, 3, 4
ANS: A
Extrinsic asthma, also called allergic asthma, is triggered by exposure to a specific allergen.
Environmental factors, including exposure to mold and pet dander, can trigger asthmatic
reactions.
REF: pp. 204-205
2. What term is used to describe the situation when an initial asthmatic response occurs within 1
hour of exposure to an allergen followed by a delayed asthmatic response hours later?
a. Deferred dyspneic respT oE
nsSeTBANKSELLER.COM
b. Asynchronous activation response
c. Biphasic response
d. Bipolar response
ANS: C
In extrinsic asthma, individuals may experience an early asthmatic response that may then be
followed hours later by a late asthmatic response. This is termed a biphasic response.
REF: pp. 204-205
3. Which of the following factors are associated with intrinsic asthma?

1. Emotional stress
2. Cockroach allergen
3. GERD
4. Dust mites
a. 2, 4
b. 1, 3
c. 2, 3, 4
d. 1, 2, 3, 4
ANS: B
Emotional stress and gastroesophageal reflux disease (GERD) are associated with intrinsic
asthma.
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REF: pp. 203-205
4. If a beta2-agonist agent and an anticholinergic agent were administered concurrently to a

patient during an acute asthma episode, what result would be expected?
a. Bronchial smooth muscle contraction will occur.
b. Airway edema will increase.
c. The medications oppose each other, resulting in no airway changes.
d. Bronchial smooth muscle relaxation will occur.
ANS: D
Beta2-agonists and anticholinergic medications may both be required to treat a severe asthma
episode and can be administered concurrently. Both of these medications are considered to be
reliever medications in asthma management.
REF: pp. 206-207
5. After the inhalation of a bronchodilator, what percentage change in peak expiratory flow
(PEFR) would be required to demonstrate reversible airflow limitation consistent with
asthma?
a. –20%
b. –10%
c. +10%
d. >20%
ANS: D
After a bronchodilator, an improvement of 20% or greater in the PEFR would demonstrate
positive airway response to the bronchodilator, consistent with asthma.
REF: pp. 206-207
6. Which of the following would be expected when a chest assessment is performed on a patient
during an asthmatic episode?
1. Inverse I:E ratio
2. Decreased vocal fremitus
3. Increased vesicular breath sounds
4. Hyperresonant percussion note
a. 1, 4
b. 2, 4
c. 2, 3, 4
d. 1, 2, 3, 4
ANS: B
Because of air trapping, which occurs during an asthma episode, decreased vocal (and tactile)
fremitus and a hyperresonant percussion note would be expected.
REF: p. 209
7. Which of the following ABG values would be consistent with ventilatory failure with
hypoxemia in a patient with severe status asthmaticus?
1. Increased PaCO2
2. Decreased SaO2

3. Increased pH
4. Decreased pH
a. 1, 2
b. 2, 3
c. 1, 2, 4
d. 1, 3, 4
ANS: C
During a severe asthmatic episode, the PaCO2 will increase, the pH will decrease, and the
SaO2 will fall. Swift action must to taken to aggressively treat the patient.
REF: p. 210
8. A sputum sample from a patient has been sent to the laboratory for analysis. Which of the
following findings could help confirm the diagnosis of extrinsic asthma?
a. Increased IgE level
b. Increased erythrocyte count
c. Colonization of P. aeruginosa
d. Decreased IgE level
ANS: A
Patients with extrinsic asthma will demonstrate increased immunoglobulin E (IgE) levels.
REF: p. 210
9. What findings on a chest radiograph would be expected during a prolonged asthma episode?
1. Depressed diaphragm
2. Increased anterior-posTteErS
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3. Asymmetrical lung inflation
4. Translucent lung fields
a. 1, 2
b. 3, 4
c. 1, 2, 4
d. 1, 2, 3, 4
ANS: C
Because of the air trapping that occurs during an asthma attack, the lungs are hyperinflated.
The diaphragm is depressed or flattened by the trapped air and the anterior-posterior diameter
would be increased. A more subtle change would be darkened lung fields caused by the
increased air within the alveoli.
REF: p. 211
10. What is the name for the microscopic structures formed from the breakdown of eosinophils in
allergic asthma?
a. Charlene-Lichty crystals
b. Charcot-Leyden crystals
c. Colleen-Lyndahl clusters
d. Charles-Lahr casts
ANS: B

In allergic asthma, the airway mucosa is infiltrated with eosinophils and inflammatory cells.
When the eosinophils break down, microscopic crystals, called Charcot-Leyden crystals,
form.
REF: pp. 201-202
11. At what age does asthma severity peak in males?

a. 1 and 3 years
b. 5 and 7 years
c. 18 and 20 years
d. 30 and 32 years
ANS: B
Asthma is more prevalent in young boys than young girls. Asthma severity peaks between
ages 5 and 7 years and continues to lessen significantly during puberty.
REF: pp. 202-203
12. All of the following symptoms are commonly associated with asthma EXCEPT recurrent:
a. cough.
b. chest tightness.
c. fever.
d. wheeze.
ANS: C
A recurrent cough, recurrent chest tightness, and recurrent wheeze are symptoms associated
with asthma.
REF: pp. 206-207
13. What is the term for an inspiratory fall in systolic blood pressure exceeding 10 mm Hg?
a. Pulsus paradoxus
b. Stage I hypotension
c. Swanson’s phenomenon
d. Hoover’s sign
ANS: A
Pulsus paradoxus is defined as an inspiratory fall in systolic blood pressure greater than 10
mm Hg. It can occur with the large intrapleural pressure swings than may happen during a
severe asthmatic episode and is associated with a life-threatening situation.
REF: p. 209
14. How many components of care are included in the NAEPP-EPR-3 asthma management
guidelines?
a. 3
b. 4
c. 5
d. 6
ANS: B

According to the NAEPP-EPR-3, there are four components of care: assessment and
monitoring, patient education, control of triggers/factors impacting asthma control, and
pharmacologic treatments.
REF: pp. 200-201
15. Which of the following is the acronym for the bronchospasm and airway inflammation
resulting from the aspergillus fungus?
a. ABPA
b. AGA
c. ACOS
d. AEC
ANS: A
Allergic bronchopulmonary aspergillosis (ABPA) is associated in patients with cystic fibrosis
and asthma. It can result in wheezing, cough, shortness of breath, and decreased exercise
tolerance.
REF: pp. 206-207

Chapter 16: Pneumonia

Edition
MULTIPLE CHOICE
1. When a patient has pneumonia, which of the following would be found in the alveolar
effusion fluids?
1. Mucus
2. Serum fluid
3. Saliva
4. Red blood cells
a. 1, 3
b. 2, 4
c. 2, 3
d. 1, 2, 3, 4
ANS: B
During the inflammatory processes found with pneumonia, the effusion fluids in the alveoli
will contain serum fluid, red blood cells, and polymorphonuclear leukocytes and
macrophages. Saliva is found in the mouth, and mucus is found in the airways. Neither will be
found in the alveoli.
REF: pp. 252-254
2. A patient has a bacterial pnTeE

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atEkLilL
lsEthRe.inCvOadMing bacteria?
a. Macrophages
b. Red blood cells
c. Polymorphonuclear leukocytes
d. Serum fluid
ANS: C
Polymorphonuclear leukocytes enter the alveoli to engulf and kill the invading bacteria.
Serum fluid and red blood cells will be found in the alveoli but do not kill the bacteria.
Macrophages will be found in the alveoli and remove any cellular and bacterial debris.
REF: pp. 252-254
3. Which of the following can cause pneumonia?

1. Bacteria
2. Viruses
3. Prions
4. Fungi
a. 1, 2
b. 2, 3
c. 1, 2, 4
d. 1, 2, 3, 4
ANS: C

Many types of bacteria, viruses, and fungi can cause pneumonia. Prions are associated with
some neurologic conditions, but not pneumonia.
REF: pp. 252-254
4. If a patient has pneumonia, which of the following can increase the risk of life-threatening
illness or death?
1. Weakened immune system
2. COPD
3. Marfan’s syndrome
4. Heart disease
a. 1, 3
b. 2, 4
c. 1, 2, 3
d. 1, 2, 4
ANS: D
A weakened immune system can make the patient less able to naturally fight off an infection.
The chronic damage found with COPD (chronic obstructive pulmonary disease [emphysema
and chronic bronchitis]) makes the lungs and airways more prone to infection and less able to
recover from infection. Heart disease can adversely affect lung function and decrease oxygen
delivery to the body. Marfan’s syndrome is not associated with pneumonia or lung function.
REF: pp. 252-254
5. Overall, most cases of pneumonia are caused by:

a. viruses.
b. gram-negative bacteria.
c. protozoa.
d. fungi.
ANS: A
About half of all pneumonia cases are caused by viruses.
REF: pp. 256-257
6. Which of the following pulmonary infections is most commonly seen in patients with AIDS?
a. Anaerobic
b. Pneumocystis jiroveci
c. Streptococcus pneumoniae (Diplococcus pneumoniae)
d. Legionella pneumophila
ANS: B
Historically, the fungus Pneumocystis jiroveci has caused most cases of pneumonia in AIDS
patients. Because AIDS patients have a compromised immune system, they are prone to many
other infectious organisms.
REF: pp. 256-257
7. A 28-year-old patient who has dogs, parakeets, and cats as pets has been admitted with
pneumonia. It is suspected that she acquired the infection from one of her pets. What
organism is likely to be found in her sputum?

a. Bacteroides melaninogenicus
b. Staphylococcus aureus
c. Chlamydia psittaci
d. Haemophilus influenzae
ANS: C
C. psittaci bacteria are found in the feces of parakeets and other birds. When parakeet feces
are dried, aerosolized, and inhaled, pneumonia can result. Although the other organisms can
cause pneumonia, they are not associated with household pets.
REF: pp. 256-257
8. Ventilator-acquired pneumonia (VAP) is defined as pneumonia that develops:

a. between 24 and 48 hours after endotracheal intubation.
b. more than 48 to 72 hours after endotracheal intubation.
c. less than 24 hours after mechanical ventilation is started.
d. more than 48 to 72 hours after mechanical ventilation is started.
ANS: B
When a patient is intubated and develops pneumonia more than 48 to 72 hours later, he or she
is found to have VAP. The patient may not actually need mechanical ventilation. The likely
cause of the pneumonia is microaspiration of oral secretions around the endotracheal tube
cuff.
REF: pp. 257-258
9. A patient has a pleural effusion related to her pneumonia. Which of the following should the
respiratory therapist recomTmEeS
ndTtB
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a. Hyperinflation therapy
b. Supplemental oxygen
c. Thoracentesis
d. Percussion and postural drainage
ANS: C
The thoracentesis procedure involves placing a needle through the chest wall to withdraw the
pleural effusion fluid. This allows the lung to reexpand. Although the other listed options may
be used in the care of a patient with pneumonia, they will not help to remove the pleural fluid.
REF: pp. 263-264
10. Physical assessment findings on a patient with pneumonia would include all of the following
EXCEPT:
a. bradycardia.
b. whispered pectoriloquy.
c. dull percussion note.
d. increased vocal fremitus.
ANS: A
Patients with pneumonia usually have tachycardia, not bradycardia. Whispered pectoriloquy,
dull percussion note, and increased vocal fremitus are all the result of alveolar consolidation.
REF: pp. 252-254

11. A patient has bilateral pneumonia. What findings can be expected on the CT scan?
1. Depressed diaphragms
2. Elongated heart
3. Air bronchograms
4. Consolidation
a. 3, 4
b. 1, 2
c. 2, 3, 4
d. 1, 2, 3, 4
ANS: A
Frequently, the CT scan results on a patient with pneumonia will show air bronchograms and
consolidation because the alveoli are filled with fluids while the airways are patent. Depressed
diaphragms and elongated heart are seen in patients with COPD because of air trapping.
REF: p. 252 | p. 255
12. All of the following are considered to be normal causative agents for community-acquired
pneumonia (CAP) EXCEPT:
a. staphylococcal pneumonia.
b. Haemophilus influenza.
c. Legionella pneumophila.
d. Candida albicans.
ANS: D
Staphylococcal pneumonia, Haemophilus influenza, and Legionella pneumophila are all
causes of community-acquT
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infection.
REF: pp. 253-254

Chapter 24: Pleural Effusion and Empyema

Edition
MULTIPLE CHOICE
1. The anatomic alteration caused by a pleural effusion is:

a. pulmonary fibrosis.
b. separation of the visceral and parietal pleura.
c. adhesion of the visceral and parietal pleura.
d. pulmonary edema.
ANS: B
A pleural effusion causes the separation (not adhesion) of the visceral and parietal pleura.
REF: p. 336
2. The major pathologic and structural changes associated with a significant pleural effusion
include all of the following EXCEPT:
a. diaphragm elevation.
b. atelectasis.
c. compression of the great vessels.
d. lung compression.
ANS: A
A large effusion could cause the diaphragm to be depressed, not elevated.
REF: p. 336
3. Which of the following are associated with a transudative pleural effusion?

1. Thin and watery fluid
2. Fluid has a lot of cellular debris
3. Fluid has high protein count
4. Few blood cells
a. 2, 3
b. 1, 4
c. 1, 2, 3
d. 1, 3, 4
ANS: B
A transudative pleural effusion is thin and watery with few blood cells, little cellular debris,
and a low protein count.
REF: p. 336
4. A patient has malignant mesothelioma related to chronic asbestos exposure. What would his
pleural effusion fluid likely show on laboratory analysis?
1. Erythrocytes
2. Lymphocytes
3. Normal mesothelial cells

4. Malignant mesothelial cells

a. 1, 4
b. 2, 3
c. 2, 3, 4
d. 1, 2, 3, 4
ANS: C
Asbestos is known to cause mesothelioma, a cancer of the mesothelial cells lining the lungs
and chest wall (the visceral and parietal pleura). The pleural effusion fluid, in this case, will
show a mix of normal and abnormal mesothelial cells and lymphocytes.
REF: p. 338
5. An adult patient with a large pleural effusion requires placement of a thoracostomy tube.
Which of the following statements are true regarding thoracostomy tube placement?
1. The tube is placed in the 2nd to 3rd intercostal space.
2. The tube is placed in the 4th to 5th intercostal space.
3. The tube is placed in the midclavicular line.
4. The tube is placed in the midaxillary line.
a. 1, 4
b. 2, 3
c. 1, 3
d. 2, 4
ANS: D
Because fluid pools at the base of the lung, the chest tube is placed in the 4th to 5th intercostal
space in the midaxillary line.
REF: p. 340
6. Treatment of an empyema usually includes:

a. pleurodesis.
b. thoracostomy tube insertion.
c. lobectomy.
d. pneumonectomy.
ANS: B
The treatment of an empyema may require placement of a thoracostomy tube.
REF: p. 338
7. A patient has a pleural effusion from an unknown cause. A fluid sample has been taken for
analysis. To help identify the cause of the effusion, all of the following tests should be
performed EXCEPT:
a. specific gravity.
b. biochemical makeup.
c. cytologic examination.
d. bacterial culture.
ANS: A
Specific gravity is a measurement of the density of fluids and would not be indicated in
evaluating the cause of a pleural effusion.

REF: pp. 340-341
8. A respiratory therapist is assisting a physician who is performing a thoracentesis. It is

suspected that the patient has a chylothorax. How would the pleural effusion be described?
a. Milky white
b. Straw colored
c. Red
d. Green
ANS: C
In a chylothorax, the fluid in the pleural cavity would appear to be milky white.
REF: p. 338
9. During a chest assessment on a patient with a large pleural effusion, which of the following
would be expected?
1. Increased tactile and vocal fremitus
2. Hyperresonant percussion note
3. Diminished breath sounds
4. Tracheal shift
a. 1
b. 1, 2
c. 3, 4
d. 1, 3, 4
ANS: C
A tracheal shift and diminiT
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reRf.
inC
diO
ngMs consistent with a large pleural
effusion.
REF: p. 339
10. While reviewing an upright chest radiograph of a patient with a pleural effusion, the
respiratory therapist observes a fluid density in the right lung area that extends upward around
the anterior, lateral, and posterior thoracic walls. What is this characteristic sign called?
a. Meniscus sign
b. Scarf sign
c. Transudate sign
d. Kerley B lines
ANS: A
A meniscus sign is seen in a pleural effusion when fluid extends upward around the anterior,
lateral, and posterior thoracic walls.
REF: p. 339
11. Which of the following are chest radiograph findings associated with a large pleural effusion?
1. Blunting of the costophrenic angle
2. Fluid level on the affected side
3. Mediastinal shift toward the unaffected side
4. Elevated hemidiaphragm on the affected side
a. 1, 3

b. 2, 4
c. 1, 2, 4
d. 1, 2, 3
ANS: D
Typical radiographic findings in a large pleural effusion include blunting of the costophrenic
angle, fluid level on the affected side, and mediastinal shift to the unaffected side.
REF: p. 339
12. What percentage of patients with bacterial pneumonia are likely to develop pleural effusion?
a. Up to 10%
b. Up to 20%
c. Up to 30%
d. Up to 40%
ANS: D
It is estimated that up to 40% of patents with bacterial pneumonia have an accompanying
pleural effusion.
REF: p. 338
13. In the absence of surgery or trauma, what does the presence of blood in the pleural fluid most
likely signify?
a. Malignant disease
b. Fungal disease
c. Chylothorax
d. Tuberculosis
ANS: A
In the absence of trauma or surgery, blood in the pleural fluid most likely results from
malignant disease. A pulmonary embolization and infarction may also cause blood in the
pleural fluid.
REF: p. 341
14. What is the most common cause of a chylothorax?

a. Thoracic duct trauma
b. Abdominal tumor
c. GERD
d. Pyloric stenosis
ANS: A
When the thoracic duct is damaged by trauma, a chylothorax can result. Thoracic duct trauma
is the most common cause of a chylothorax.
REF: p. 338

Chapter 28: Acute Respiratory Distress Syndrome

Edition
MULTIPLE CHOICE
1. All of the following materials will be found in the alveoli of a patient with ARDS EXCEPT:
a. leukocytes.
b. cellular debris.
c. fibrin.
d. hyaline membrane.
ANS: A
The presence of leukocytes in the alveoli is not associated with ARDS.
REF: p. 395
2. A patient has a prolonged case of ARDS. What changes would be expected in the patient’s
alveolar cells?
a. Multiplication of the type I cells
b. Influx of macrophages
c. Hyperplasia and swelling of the type II cells
d. Development of emphysema
ANS: C
With a prolonged case of ARDS, the patient’s alveoli show hyperplasia and swelling of the
type II cells.
REF: p. 395
3. Which of the following pulmonary changes are associated with ARDS?

1. Abnormal surfactant
2. Interstitial edema
3. Decreased shunt
4. Narrowing of the alveolar-capillary membrane
a. 1, 2
b. 3, 4
c. 1, 3
d. 1, 2, 3
ANS: A
A patient with ARDS will have abnormal pulmonary surfactant and interstitial edema.
REF: p. 395
4. What is the reason for the elevated risk of developing ARDS associated with massive blood
transfusions?
a. Shock (hypovolemia)
b. Receiving the wrong blood type
c. Fat emboli

d. Blockages in pulmonary blood vessels

ANS: D
With massive transfusions, aggregated cells in stored blood can occlude or damage the small
pulmonary blood vessels.
REF: p. 397
5. ARDS can result from the inhalation of all of the following EXCEPT:
a. FIO2 >0.60 for prolonged exposure.
b. nitrogen dioxide.
c. very dry air.
d. chlorine gas.
ANS: C
Inhaling very dry air may be irritating to the upper airway but will not cause ARDS.
REF: p. 397
6. Which of the following are causes of ARDS?

1. Liver failure
2. Heroin abuse
3. Septicemia
4. Goodpasture’s syndrome
a. 1, 4
b. 2, 3
c. 2, 3, 4
d. 1, 2, 3, 4
ANS: C
Heroin abuse, septicemia, and Goodpasture’s syndrome are among the causes that can lead to
ARDS.
REF: p. 397
7. Which of the following are recommended to treat alveolar consolidation and atelectasis
associated with ARDS?
1. Aerosolized bronchodilator medications
2. Continuous positive airway pressure (CPAP)
3. Chest percussion and postural drainage
4. Positive end-expiratory pressure (PEEP)
a. 4
b. 1, 2
c. 1, 3
d. 2, 4
ANS: D
Lung expansion measures, including CPAP and PEEP, will help offset alveolar consolidation
and atelectasis associated with ARDS.
REF: p. 399

8. Which of the following are current ventilatory strategies in the treatment of ARDS?
1. Large tidal volume
2. Small tidal volume
3. Rapid respiratory rates
4. Slow respiratory rates
a. 2
b. 3
c. 1, 4
d. 2, 3
ANS: D
Currently, small tidal volumes and high respiratory rates are recommended ventilatory
strategies in ARDS treatment.
REF: p. 400
9. What initial tidal volume setting on the ventilator would be recommended for a 70-kg adult
male with ARDS?
a. 350 mL
b. 420 mL
c. 560 mL
d. 700 mL
ANS: C
The suggested guideline for calculating the patient’s tidal volume is to start at 8 mL/kg of
ideal body weight (8 mL/kg  70 kg = 560 mL).
REF: p. 400
10. All of the following would be low–tidal volume ventilation goals in a patient with ARDS,
EXCEPT:
a. decrease barotrauma.
b. maintain plateau pressure >30 cm H2O.
c. decrease high transpulmonary pressures.
d. reduce overdistention of the lungs.
ANS: B
With the low tidal volume strategy, the plateau pressure should be <30 cm H2O, not
maintained at levels exceeding 30 cm H2O.
REF: p. 400
11. Breath sounds associated with ARDS include:

1. vesicular.
2. bronchovesicular.
3. crackles.
4. bronchial.
a. 4
b. 1, 2
c. 3, 4
d. 2, 3, 4

ANS: C
Bronchial breath sounds and crackles are commonly heard during the chest assessment of a
patient with ARDS.
REF: p. 398
12. Which of the following clinical manifestations are associated with ARDS?
1. Normal or decreased pulmonary capillary wedge pressure (PCWP)
2. Increased CVP
3. Intercostal retractions
4. Cyanosis
a. 1, 2
b. 3, 4
c. 2, 3, 4
d. 1, 2, 3, 4
ANS: D
Clinical manifestations of ARDS may include low or normal PCWP, increased CVP,
intercostal retractions, and cyanosis.
REF: p. 398
13. The chest radiograph finding indicative of severe ARDS is:

a. “ground-glass” appearance of the lungs.
b. pleural effusion.
c. bilateral hyperinflation of the lungs.
d. tracheal deviation.
ANS: A
A “ground-glass” appearance is seen on the chest radiograph when severe ARDS is present.
REF: p. 399
14. According to the Berlin definition of ARDS, what does a PaO2/FIO2 ratio of 150 mm Hg
indicate for a patient on mechanical ventilation with a PEEP of 10 cm H2O?
a. Normal lungs
b. Mild ARDS
c. Moderate ARDS
d. Severe ARDS
ANS: C
Moderate ARDS is present when the PaO2/FIO2 ratio falls between 100 and 199 mm Hg.
REF: p. 397
15. What is the most common cause of ARDS?

a. Sepsis
b. Fat embolism
c. Inhalation of irritants
d. Aspiration of gastric contents
ANS: A

Sepsis is the most common cause of ARDS.
REF: p. 397
16. When would symptoms of ARDS associated with a fat embolism from a long bone fracture be
most likely to develop?
a. 2 to 4 hours following the fracture
b. 4 to 12 hours following the fracture
c. 12 to 48 hours following the fracture
d. 48 to 96 hours following the fracture
ANS: C
Between 12 and 48 hours after the fracture of a long bone, the symptoms of ARDS related to a
fat embolism from the fracture would begin to appear.
REF: p. 397

Chapter 44: Atelectasis

Edition
MULTIPLE CHOICE
1. What definition of atelectasis would best fit that of a premature newborn with respiratory
distress syndrome (RDS)?
a. Partial or total collapse of previously expanded lung regions
b. Free pleural air compressed the lungs
c. Enlarged heart causing compression of the lungs
d. The lungs remaining unexpanded since birth
ANS: D
A premature newborn with RDS will have atelectasis because the lungs remain unexpanded
since birth. In most instances, atelectasis would be defined as the partial or total collapse of
previously expanded lung regions. Free pleural air and an enlarged heart are examples of
causes of atelectasis but are not definitions for it.
REF: p. 553
2. Examples of the types of surgical procedures that often result in atelectasis include all of the
following EXCEPT:
a. open heart surgery.
b. craniotomy.
c. gallbladder removal.
d. splenectomy.
ANS: B
A craniotomy or other head surgery does not increase the risk for atelectasis. Thoracic surgery
(e.g., open heart surgery) and upper abdominal surgery (e.g., gallbladder removal or
splenectomy) increase the risk for atelectasis.
REF: p. 553
3. Which of the following is the least commonly found type of postoperative atelectasis?
a. Primary lobule
b. Lung segment
c. Lung lobe
d. Entire lung
ANS: D
Atelectasis of an entire lung rarely occurs. Atelectasis of the primary lobule (alveoli) is the
most common type of atelectasis. Lung segment atelectasis is a fairly common occurrence.
Lung lobe atelectasis is a less common occurrence.
REF: p. 553
4. All of the following conditions can lead to atelectasis EXCEPT:

a. chronic obstructive pulmonary disease (COPD).

b. acute respiratory distress syndrome (ARDS).

c. pleural effusion.
d. pneumothorax.
ANS: A
COPD does not usually lead to atelectasis. All of the other listed conditions are restrictive in
nature and can lead to atelectasis.
REF: p. 554
5. Which of the following is (are) precipitating factor(s) that can decrease the patient’s ability to
generate a negative intrapleural pressure?
1. Supine position
2. Large tidal volume on the mechanical ventilator
3. Malnutrition
4. Obesity
a. 4
b. 1, 3, 4
c. 1, 2, 3
d. 1, 2, 3, 4
ANS: B
A small tidal volume on the mechanical ventilator and all of the other listed options can
decrease a patient’s ability to generate a negative intrapleural pressure.
REF: p. 554
6. Which of the following areTpEreScT

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aiM
ned secretions that commonly lead to
atelectasis?
1. Asthma
2. General anesthesia
3. Gastric aspiration
4. Smoking history
a. 1, 4
b. 2, 3
c. 2, 3, 4
d. 1, 2, 3, 4
ANS: D
All of the listed options are precipitating factors for retained secretions that can lead to
atelectasis.
REF: p. 554
7. A patient has a tumor blocking the left mainstem bronchus. What additional factor would
favor the development of atelectasis?
a. Breathing a nitric oxide mix (iNO)
b. Breathing a helium/oxygen mix (heliox)
c. Breathing a high percentage of oxygen
d. Breathing a low percentage of oxygen
ANS: C

Alveolar degassing can occur if the patient has inhaled a high oxygen percentage and the
bronchus is then blocked. When all of the oxygen is absorbed from the alveoli, they will
develop atelectasis.
REF: p. 554
8. After open heart surgery, a patient has developed bronchitis with increased secretions and
atelectasis. What respiratory therapy procedure(s) should initially be recommended?
1. Chest physical therapy
2. Continuous positive airway pressure (CPAP)
3. Incentive spirometry
4. Inhaled sympathomimetic medication
a. 3
b. 2, 4
c. 1, 3
d. 1, 2, 4
ANS: C
Chest physical therapy will help to mobilize the secretions to avoid mucus plugs. Incentive
spirometry will encourage the patient to inhale deeply to open up areas of atelectasis. The
short-term use of CPAP may be needed if incentive spirometry is not effective.
Sympathomimetic medications will not reduce secretions or treat atelectasis.
REF: pp. 556-557
9. A 40-year-old patient was in a motor vehicle accident. Among his injuries and related
problems are three broken ribs on the right side, pleural fluid in the right pleural space, and
atelectasis of both lungs. WThEaS
t sThB
ouAldNK
beSdEoL
neLtE
oRh.
elC
pOwM
ith the atelectasis problem?
1. Adequate pain management
2. Mechanical ventilation to stabilize the broken ribs
3. Remove the pleural fluid
4. Selective intubation of the right mainstem bronchus
a. 1, 3
b. 2, 4
c. 1, 2, 3
d. 1, 2, 3, 4
ANS: A
Adequate pain management will help the patient to mobilize and take in a deep breath to
cough effectively. Removal of the pleural fluid will enable the lung to reexpand. Mechanical
ventilation would only be needed if the patient had a flail chest. Selective right bronchial
intubation could lead to atelectasis of the left lung.
REF: pp. 556-557
10. Which of the following patients should be placed on short-term mechanical ventilation
because of the high risk of postoperative atelectasis?
a. Appendectomy
b. Tracheostomy
c. Bronchoscopy for tumor biopsy
d. Cardiac surgery

ANS: D
Most patients who have cardiac surgery are placed on mechanical ventilation until it is shown
that they are stable and awake enough to wean from the ventilator. None of the other
procedures should require ventilator support for the patient.
REF: p. 557
11. After gastric bypass surgery, a patient is showing tachypnea. What is the best explanation for
this?
a. Diaphragmatic apraxia
b. Postoperative pain
c. Low-grade fever
d. Anesthetic sedation
ANS: B
Postoperative pain will limit the depth of a patient’s breath. As a result, the patient breathes
faster than normal. Diaphragmatic apraxia and anesthetic sedation will lead to shallow
breathing and a slow respiratory rate. A low-grade fever does not usually lead to tachypnea.
REF: p. 553
12. Common chest assessment findings in a patient with atelectasis include:

1. increased tactile fremitus.
2. dull percussion note.
3. crackles.
4. bronchial breath sounds.
a. 4
b. 1, 2
c. 3, 4
d. 1, 2, 3, 4
ANS: D
Bronchial breath sounds and crackles are commonly heard in a patient with atelectasis.
Increased tactile fremitus and a dull percussion note are also commonly found because there is
less air in the lungs.
REF: p. 555
13. All of the following would be found in a patient with atelectasis EXCEPT:
a. normal shunt fraction.
b. whispered pectoriloquy.
c. chest radiograph shows increased density in areas of atelectasis.
d. diminished breath sounds.
ANS: A
The shunt fraction is increased in a patient with atelectasis. All of the other listed findings will
be found in a patient with atelectasis.
REF: p. 555

14. A patient with atelectasis is being monitored by bedside spirometry. What findings would
correspond with atelectasis?
1. Decreased IC
2. Increased PEFR
3. Decreased VC
4. Increased DLCO
a. 2
b. 1, 3
c. 1, 2, 4
d. 1, 2, 3, 4
ANS: B
A patient with atelectasis will have a decreased IC (inspiratory capacity) and VC (vital
capacity) because there is less air in the lungs to blow out. The PEFR (peak expiratory flow
rate) and DLCO (diffusion of lung carbon monoxide) values will also be decreased.
REF: p. 555
15. After surgery, a patient must lie supine in bed. Because of this, atelectasis is thought to have
developed. What chest radiograph finding would confirm this?
a. Depression of the hemidiaphragms
b. Pulmonary interstitial emphysema (PIE)
c. Increased density in both upper lobe areas
d. Increased density in both posterior lower lobe areas
ANS: D
If atelectasis develops in a supine patient, the chest radiograph will show increased density in
both posterior lower lobe aTreEaS
s TB
wheAreNtK
heSaEteLleLcE
taR
si.
sCisOloMcated. Depression of the
hemidiaphragms and PIE are associated with lung hyperinflation. A supine patient is unlikely
to develop atelectasis in the upper lobes and show increased density in those areas.
REF: p. 556
16. Precipitating factors for retained secretions include all of the following EXCEPT:
a. decreased mucociliary transport.
b. excessive secretions.
c. overhydration.
d. general anesthesia.
ANS: C
Precipitating factors for retained secretions include (1) decreased mucociliary transport, (2)
excessive secretions, (3) inadequate hydration, (4) weak or absent cough, (5) general
anesthesia, (6) smoking history, (7) gastric aspiration, and (8) certain preexisting conditions.
REF: p. 554
17. Several pathophysiologic mechanisms operating simultaneously may lead to an increased

ventilatory rate. These may include all of the following EXCEPT:
a. stimulation of central chemoreceptors.
b. decreased lung compliance–increased ventilatory rate relationship.
c. stimulation of J receptors.

d. pain.
ANS: B
Several pathophysiologic mechanisms operating simultaneously may lead to an increased
ventilatory rate: stimulation of peripheral chemoreceptors (hypoxemia), decreased lung
compliance–increased ventilatory rate relationship, stimulation of J receptors, pain, anxiety, or
fever.
REF: p. 555
18. The respiratory therapist is performing chest assessment on a post-op cholecystectomy patient
who has developed cough, fever, and tachypnea. Which of the following would the therapist
expect to find confirming the suspicion of post-op atelectasis in this patient?
a. Decreased tactile and vocal fremitus
b. Hyperresonant percussion note
c. Bronchial breath sounds
d. Wheezes
ANS: C
Chest assessment findings in atelectasis include: increased tactile and vocal fremitus, dull
percussion note, bronchial breath sounds, diminished breath sounds (common when
atelectasis is caused by mucous plugs), and crackles (usually heard initially in the dependent
lung regions and during late inspiration). Wheezing would not be expected.
REF: p. 555

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Chapter 13: Asthma

1. Which of the following are associated with extrinsic asthma?

REF: pp. 204-205

REF: pp. 204-205

3. Which of the following factors are associated with intrinsic asthma?

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REF: pp. 203-205

4. If a beta2-agonist agent and an anticholinergic agent were administered concurrently to a

REF: pp. 206-207

REF: pp. 206-207

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REF: pp. 201-202

11. At what age does asthma severity peak in males?

REF: pp. 202-203

REF: pp. 206-207

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REF: pp. 200-201

REF: pp. 206-207

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Chapter 16: Pneumonia

REF: pp. 252-254

2. A patient has a bacterial pnTeE

REF: pp. 252-254

3. Which of the following can cause pneumonia?

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REF: pp. 252-254

REF: pp. 252-254

5. Overall, most cases of pneumonia are caused by:

REF: pp. 256-257

REF: pp. 256-257

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REF: pp. 256-257

8. Ventilator-acquired pneumonia (VAP) is defined as pneumonia that develops:

REF: pp. 257-258

REF: pp. 263-264

REF: pp. 252-254

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REF: p. 252 | p. 255

REF: pp. 253-254

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Chapter 24: Pleural Effusion and Empyema

1. The anatomic alteration caused by a pleural effusion is:

3. Which of the following are associated with a transudative pleural effusion?

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4. Malignant mesothelial cells

6. Treatment of an empyema usually includes:

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REF: pp. 340-341

8. A respiratory therapist is assisting a physician who is performing a thoracentesis. It is

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

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Chapter 28: Acute Respiratory Distress Syndrome

3. Which of the following pulmonary changes are associated with ARDS?

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d. Blockages in pulmonary blood vessels

6. Which of the following are causes of ARDS?

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11. Breath sounds associated with ARDS include:

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