Description
Human Anatomy and Physiology 9th Edition Marieb Hoehn Test Bank
| ISBN-13: | 9780321743268 |
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Below you will find some free nursing test bank questions from this test bank:
Chapter 22. The Respiratory System
SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.
Figure 22.1
Using Figure 22.1, match the following:
1) Main (primary) bronchus.
Answer: D
Diff: 1 Page Ref: 802; Fig. 22.1
2) Pharynx.
Answer: A
Diff: 1 Page Ref: 802; Fig. 22.1
3) Larynx.
Answer: B
Diff: 1 Page Ref: 802; Fig. 22.1
4) Carina of trachea.
Answer: E
Diff: 1 Page Ref: 802; Fig. 22.1
5) Trachea.
Answer: C
Diff: 1 Page Ref: 802; Fig. 22.1
1
Figure 22.2
Using Figure 22.2, match the following:
6) Tidal volume.
Answer: B
Diff: 1 Page Ref: 822; Fig. 22.16
7) Inspiratory reserve volume.
Answer: A
Diff: 1 Page Ref: 822; Fig. 22.16
8) Residual volume.
Answer: D
Diff: 1 Page Ref: 822; Fig. 22.16
9) Expiratory reserve volume.
Answer: C
Diff: 1 Page Ref: 822; Fig. 22.16
10) Air that does not participate in the exchange of gases.
Answer: D
Diff: 2 Page Ref: 822; Fig. 22.16
2
MATCHING. Choose the item in column 2 that best matches each item in column 1.
Match the following:
11) No exchange of gases occurs here.
Answer: C
Diff: 1 Page Ref: 810
12) Secrete a fluid containing surfactant.
Answer: E
Diff: 1 Page Ref: 811
13) Where the respiratory zone of the lungs begins.
Answer: D
Diff: 1 Page Ref: 811
14) Composed of simple squamous epithelium.
Answer: B
Diff: 1 Page Ref: 811
15) Terminates in alveoli.
Answer: A
Diff: 1 Page Ref: 811
16) Composed of cuboidal cells.
Answer: E
Diff: 2 Page Ref: 811
17) The respiratory membrane is composed of fused basement membrane of the capillary walls and
.
Answer: B
Diff: 2 Page Ref: 811
A) Alveolar duct
B) Type I cells
C) Segmental bronchi
D) Respiratory bronchioles
E) Type II cells
Match the following:
18) TV + IRV + ERV + RV Answer: A
Diff: 2 Page Ref: 822; Fig. 22.16
A) Total lung capacity
3
19) ERV + RV
Answer: A
Diff: 2 Page Ref: 822; Fig. 22.16
20) TV + IRV + ERV Answer: C
Diff: 2 Page Ref: 822; Fig. 22.16
21) TV + IRV Answer: B
Diff: 2 Page Ref: 822; Fig. 22.16
A) Functional residual capacity
B) Inspiratory capacity
C) Vital capacity
TRUE/FALSE. Write ʹTʹ if the statement is true and ʹFʹ if the statement is false.
22) Ventilation perfusion coupling means that more blood flows past functional alveoli than past nonfunctional alveoli.
Answer: True False
Diff: 1 Page Ref: 826-27 Fig 22.19
23) The olfactory mucosal lining of the nasal cavity contains the receptors for the sense of smell.
Answer: True False
Diff: 1 Page Ref: 805
24) The functions of the nasal conchae are to enhance the air turbulence in the cavity and to increase the mucosal surface area exposed to the air.
Answer: True False
Diff: 1 Page Ref: 805-806
25) The lungs are perfused by two circulations: the pulmonary and the bronchial. The pulmonary circulation is for oxygenation of blood. The bronchial circulation supplies blood to the lung structures (tissue).
Answer: True False
Diff: 1 Page Ref: 815-816
26) Changes in arterial pH can modify respiration rate and rhythm even when carbon dioxide and oxygen levels are normal.
Answer: True False
Diff: 3 Page Ref: 832
27) Intrapleural pressure is normally about 4 mm Hg less than the pressure in the alveoli.
Answer: True False
Diff: 1 Page Ref: 817
28) During normal quiet breathing, approximately 750 ml of air moves into and out of the lungs with each breath.
Answer: True False
Diff: 1 Page Ref: 822; Fig. 22.16
29) The alveolar ventilation rate is the best index of effective ventilation.
Answer: True False
Diff: 1 Page Ref: 823
4
30) In chronic bronchitis, mucus production is decreased and this leads to the inflammation and fibrosis of the
mucosal lining of the bronchial tree.
Answer: True False
Diff: 1 Page Ref: 840
31) Labored breathing is termed dyspnea.
Answer: True False
Diff: 1 Page Ref: 839
32) The largest amount of carbon dioxide is transported in the bloodstream in the form of carbonic anhydrase.
Answer: True False
Diff: 1 Page Ref: 832
33) Increased temperature results in decreased O2 unloading from hemoglobin.
Answer: True False
Diff: 1 Page Ref: 828-829
34) The paired lungs occupy all of the thoracic cavity.
Answer: True False
Diff: 1 Page Ref: 815
35) Valsalvaʹs maneuver involves closing off the glottis (preventing expiration) while contracting the muscles of expiration, causing an increase in intra-abdominal pressure.
Answer: True False
Diff: 1 Page Ref: 809
36) Smoking diminishes ciliary action and eventually destroys the cilia.
Answer: True False
Diff: 1 Page Ref: 809
37) Tracheal obstruction is life threatening.
Answer: True False
Diff: 1 Page Ref: 809
38) The parietal pleura lines the thoracic wall.
Answer: True False
Diff: 1 Page Ref: 816
39) The average individual has 500 ml of residual volume in his lungs.
Answer: True False
Diff: 1 Page Ref: 822; Fig. 22.16
40) Atelectasis (lung collapse) renders the lung useless for ventilation.
Answer: True False
Diff: 2 Page Ref: 817
5
41) The Hering-Breuer reflex is a potentially dangerous response that may cause overinflation of the lung.
Answer: True False
Diff: 2 Page Ref: 838
42) Strong emotions and pain acting through the limbic system activate sympathetic centers in the hypothalamus, thus modulating respiratory rate and depth by sending signals to the respiratory centers.
Answer: True False
Diff: 2 Page Ref: 837-838
43) As carbon dioxide enters systemic blood, it causes more oxygen to dissociate from hemoglobin (the Haldane effect), which in turn allows more CO2 to combine with hemoglobin and more bicarbonate ions to be generated (the Bohr effect).
Answer: True False
Diff: 2 Page Ref: 829
44) Daltonʹs law states that the total pressure exerted by a mixture of gases is the sum of the pressures exerted independently by each gas in the mixture.
Answer: True False
Diff: 2 Page Ref: 824
45) Oxygenated hemoglobin releases oxygen more readily when the pH is more basic.
Answer: True False
Diff: 3 Page Ref: 828-829
46) Nasal conchae mainly work on inhalation to warm and moisten air. They serve minor functions for exhalation.
Answer: True False
Diff: 1 Page Ref: 805-806
47) Under certain conditions, the vocal folds act as a sphincter that prevents air passage.
Answer: True False
Diff: 1 Page Ref: 808
MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.
48) The main site of gas exchange is the .
A) alveolar sacs B) alveoli
C) alveolar duct D) respiratory bronchiole
Answer: B
Diff: 2 Page Ref: 811
49) The loudness of a personʹs voice depends on the .
A) thickness of vestibular folds
B) length of the vocal folds
C) strength of the intrinsic laryngeal muscles
D) force with which air rushes across the vocal folds
Answer: D
Diff: 1 Page Ref: 808-809
6
50) The walls of the alveoli are composed of two types of cells, type I and type II. The function of type II is to
.
A) secrete surfactant B) trap dust and other debris
C) replace mucus in the alveoli D) protect the lungs from bacterial invasion
Answer: A
Diff: 1 Page Ref: 811
51) Complete the following statement using the choices below. Air moves out of the lungs when the pressure inside the lungs is .
A) less than the pressure in the atmosphere B) greater than the pressure in the atmosphere
C) equal to the pressure in the atmosphere D) greater than the intra-alveolar pressure
Answer: B
Diff: 2 Page Ref: 819
52) Unlike inspiration, expiration is a passive act because no muscular contractions are involved. Expiration, however, depends on two factors. Which of the choices below lists those two factors?
A) the recoil of elastic fibers that were stretched during inspiration and the inward pull of surface tension due to the film of alveolar fluid
B) the expansion of respiratory muscles that were contracted during inspiration and the lack of surface
tension on the alveolar wall
C) the negative feedback of expansion fibers used during inspiration and the outward pull of surface tension
due to surfactant
D) combined amount of CO2 in the blood and air in the alveoli
Answer: A
Diff: 2 Page Ref: 819
53) Which of the following maintains the patency (openness) of the trachea?
A) surface tension of water B) surfactant production
C) C-shaped cartilage rings D) pseudostratified ciliated epithelium
Answer: C
Diff: 1 Page Ref: 816
54) Intrapulmonary pressure is the .
A) pressure within the pleural cavity
B) pressure within the alveoli of the lungs
C) negative pressure in the intrapleural space
D) difference between atmospheric pressure and respiratory pressure
Answer: B
Diff: 1 Page Ref: 817
55) The relationship between gas pressure and gas volume is described by .
A) Boyleʹs law B) Henryʹs law C) Charlesʹ law D) Daltonʹs law
Answer: A
Diff: 1 Page Ref: 817
56) The statement, ʺin a mixture of gases, the total pressure is the sum of the individual partial pressures of gases in the mixtureʺ paraphrases .
A) Henryʹs law B) Boyleʹs law C) Daltonʹs law D) Charlesʹ law
Answer: C
Diff: 1 Page Ref: 824
7
57) Surfactant helps to prevent the alveoli from collapsing by .
A) humidifying the air before it enters
B) warming the air before it enters
C) interfering with the cohesiveness of water molecules, thereby reducing the surface tension of alveolar fluid
D) protecting the surface of alveoli from dehydration and other environmental variations
Answer: C
Diff: 1 Page Ref: 821
58) For gas exchange to be efficient, the respiratory membrane must be .
A) at least 3 micrometers thick
B) 0.5 to 1 micrometer thick
C) between 5 and 6 micrometers thick
D) The thickness of the respiratory membrane is not important in the efficiency of gas exchange.
Answer: B
Diff: 1 Page Ref: 825
59) With the Bohr effect, more oxygen is released because a(n) .
A) decrease in pH (acidosis) strengthens the hemoglobin-oxygen bond
B) decrease in pH (acidosis) weakens the hemoglobin-oxygen bond
C) increase in pH (alkalosis) strengthens the hemoglobin-oxygen bond
D) increase in pH (alkalosis) weakens the hemoglobin-oxygen bond
Answer: B
Diff: 1 Page Ref: 829
60) The most powerful respiratory stimulus for breathing in a healthy person is .
A) loss of oxygen in tissues B) increase of carbon dioxide
C) acidosis D) alkalosis
Answer: B
Diff: 1 Page Ref: 835
61) The local matching of blood flow with ventilation is .
A) the Bohr effect B) the Haldane effect
C) chloride shifting D) ventilation-perfusion coupling
Answer: D
Diff: 2 Page Ref: 826-827
62) In the plasma, the quantity of oxygen in solution is .
A) only about 1.5% of the oxygen carried in blood
B) about equal to the oxygen combined with hemoglobin
C) greater than the oxygen combined with hemoglobin
D) not present except where it is combined with carrier molecules
Answer: A
Diff: 1 Page Ref: 828
8
63) Which of the following statements is incorrect?
A) During fetal life, lungs are filled with fluid.
B) Respiratory rate is lowest in newborn infants.
C) Descent of the diaphragm results in abdominal breathing. D) The chest wall becomes more rigid with age.
Answer: B
Diff: 1 Page Ref: 841
64) Which of the choices below describes the forces that act to pull the lungs away from the thorax wall and thus collapse the lungs?
A) the natural tendency for the lungs to recoil and the surface tension of the alveolar fluid
B) compliance and transpulmonary pressures
C) the natural tendency for the lungs to recoil and transpulmonary pressures
D) compliance and the surface tension of the alveolar fluid
Answer: A
Diff: 2 Page Ref: 817
65) Which of the following counteracts the movement of bicarbonate ions from the RBC?
A) the Bohr effect B) the Haldane effect
C) chloride shifting D) release of hydrogen ion
Answer: C
Diff: 2 Page Ref: 832
66) Which of the following is not a form of lung cancer?
A) adenocarcinoma B) Kaposiʹs sarcoma
C) small cell carcinoma D) squamous cell carcinoma
Answer: B
Diff: 1 Page Ref: 841
67) Which of the following is not an event necessary to supply the body with O 2 and dispose of CO2?
A) pulmonary ventilation B) blood pH adjustment
C) internal respiration D) external respiration
Answer: B
Diff: 1 Page Ref: 817, 825, 827
68) The major nonelastic source of resistance to air flow in the respiratory passageways is .
A) surfactant B) surface tension C) friction D) air pressure
Answer: C
Diff: 2 Page Ref: 820
69) Which of the following determines lung compliance?
A) airway opening B) flexibility of the thoracic cage
C) muscles of inspiration D) alveolar surface tension
Answer: D
Diff: 2 Page Ref: 820-821
9
70) Tidal volume is air .
A) remaining in the lungs after forced expiration B) exchanged during normal breathing
C) inhaled after normal inspiration D) forcibly expelled after normal expiration
Answer: B
Diff: 1 Page Ref: 821; Fig. 22.16
71) Which of the choices below determines the direction of respiratory gas movement?
A) solubility in water B) partial pressure gradient
C) the temperature D) molecular weight and size of the gas molecule
Answer: B
Diff: 1 Page Ref: 826
72) Possible causes of hypoxia include .
A) too little oxygen in the atmosphere B) obstruction of the esophagus
C) taking several rapid deep breaths D) getting very cold
Answer: A
Diff: 1 Page Ref: 829
73) The lung volume that represents the total volume of exchangeable air is the .
A) tidal volume B) vital capacity
C) inspiratory capacity D) expiratory reserve volume
Answer: B
Diff: 1 Page Ref: 822; Fig. 22.16
74) Because the lungs are filled with fluid during fetal life, which of the following statements is true regarding respiratory exchange?
A) Respiratory exchanges are made through the ductus arteriosus. B) Respiratory exchanges are not necessary.
C) Respiratory exchanges are made through the placenta.
D) Because the lungs develop later in gestation, fetuses do not need a mechanism for respiratory exchange.
Answer: C
Diff: 1 Page Ref: 841-842
75) Which of the following is not a stimulus for breathing?
A) rising carbon dioxide levels B) rising blood pressure
C) arterial Po2 below 60 mm Hg D) acidosis resulting from CO2 retention
Answer: B
Diff: 2 Page Ref: 835-836
76) Respiratory control centers are located in the .
A) midbrain and medulla B) medulla and pons
C) pons and midbrain D) upper spinal cord and medulla
Answer: B
Diff: 1 Page Ref: 834-835
10
77) The amount of air that can be inspired above the tidal volume is called .
A) reserve air B) expiratory capacity
C) inspiratory reserve D) vital capacity
Answer: C
Diff: 2 Page Ref: 821; Fig. 22.16
78) Which statement about CO2 is incorrect?
A) Its concentration in the blood is decreased by hyperventilation.
B) Its accumulation in the blood is associated with a decrease in pH.
C) More CO2 dissolves in the blood plasma than is carried in the RBCs. D) CO2 concentrations are greater in venous blood than arterial blood.
Answer: C
Diff: 2 Page Ref: 828-832
79) Oxygen and carbon dioxide are exchanged in the lungs and through all cell membranes by .
A) osmosis B) diffusion C) filtration D) active transport
Answer: B
Diff: 1 Page Ref: 828
80) Select the correct statement about the pharynx.
A) The pharyngeal tonsil is located in the laryngopharynx.
B) The auditory tube drains into the nasopharynx.
C) The laryngopharynx blends posteriorly into the nasopharynx.
D) The palatine tonsils are embedded in the lateral walls of the nasopharynx.
Answer: B
Diff: 1 Page Ref: 806
81) The larynx contains .
A) the thyroid cartilage
B) a cricoid cartilage also called the Adamʹs apple
C) an upper pair of avascular mucosal folds called true vocal folds
D) lateral cartilage ridges called false vocal folds
Answer: A
Diff: 1 Page Ref: 807-808
82) Which respiratory-associated muscles would contract if you were to blow up a balloon?
A) diaphragm would contract, external intercostals would relax
B) internal intercostals and abdominal muscles would contract
C) external intercostals would contract and diaphragm would relax
D) diaphragm contracts, internal intercostals would relax
Answer: B
Diff: 1 Page Ref: 819
83) How is the bulk of carbon dioxide carried in blood?
A) chemically combined with the amino acids of hemoglobin as carbaminohemoglobin in the red blood cells
B) as the bicarbonate ion in the plasma after first entering the red blood cells
C) as carbonic acid in the plasma
D) chemically combined with the heme portion of hemoglobin
Answer: B
Diff: 1 Page Ref: 829-832
11
84) Which of the choices below is not a role of the pleura?
A) allows the lungs to inflate and deflate without friction
B) helps divide the thoracic cavity into three chambers
C) helps limit the spread of local infections
D) aids in blood flow to and from the heart because the heart sits between the lungs
Answer: D
Diff: 2 Page Ref: 816
85) Which of the following incorrectly describes mechanisms of CO2 transport?
A) 7-10% of CO2 is dissolved directly into the plasma
B) 20% of CO2 is carried in the form of carbaminohemoglobin
C) as bicarbonate ion in plasma
D) attached to the heme part of hemoglobin
Answer: D
Diff: 1 Page Ref: 829-830
86) Factors that influence the rate and depth of breathing include .
A) thalamic control B) voluntary cortical control
C) stretch receptors in the alveoli D) temperature of alveolar air
Answer: B
Diff: 1 Page Ref: 835-838
87) Which of the following provide the greatest surface area for gas exchange?
A) alveolar sacs B) alveoli
C) respiratory bronchioles D) alveolar ducts
Answer: B
Diff: 2 Page Ref: 811-812
88) The respiratory membrane is a combination of .
A) respiratory bronchioles and alveolar ducts
B) alveolar and capillary walls and their fused basement membranes
C) atria and alveolar sacs
D) respiratory bronchioles and alveolar sacs
Answer: B
Diff: 2 Page Ref: 811-812
89) Gas emboli may occur because a .
A) person holds his breath too long
B) diver holds his breath upon ascent
C) pilot holds her breath upon descent
D) person breathes pure oxygen in a pressurized chamber
Answer: B
Diff: 2 Page Ref: 836
12
90) Inspiratory capacity is .
A) the total amount of air that can be inspired after a tidal expiration
B) the total amount of exchangeable air
C) functional residual capacity
D) air inspired after a tidal inhalation
Answer: A
Diff: 2 Page Ref: 822; Fig. 22.16
91) Which center is located in the pons?
A) pontine respirator group (PRG) B) expiratory center
C) inspiratory center D) pacemaker neuron center
Answer: A
Diff: 2 Page Ref: 834-835
92) The nose serves all the following functions except .
A) as a passageway for air movement B) as the direct initiator of the cough reflex
C) warming and humidifying the air D) cleansing the air
Answer: B
Diff: 2 Page Ref: 803
93) A premature baby usually has difficulty breathing. However, the respiratory system is developed enough for survival by .
A) 17 weeks B) 24 weeks C) 28 weeks D) 36 weeks
Answer: C
Diff: 2 Page Ref: 841-842
94) Which of the following statements is true regarding the respiratory rate of a newborn?
A) The respiratory rate of a newborn is slow.
B) The respiratory rate of a newborn varies between male and female infants.
C) The respiratory rate of a newborn is approximately 30 respirations per minute.
D) The respiratory rate of a newborn is, at its highest rate, approximately 40-80 respirations per minute. Answer: D
Diff: 2 Page Ref: 841-842
95) Select the correct statement about the neural mechanisms of respiratory control.
A) The pons is thought to be instrumental in the smooth transition from inspiration to expiration.
B) The dorsal respiratory group neurons depolarize in a rhythmic way to establish the pattern of breathing.
C) The pontine respirator group (PRG) continuously stimulates the medulla to provide inspiratory drive. D) The ventral respiratory group is contained within the pons.
Answer: A
Diff: 2 Page Ref: 834
96) Which of the choices below is not a factor that promotes oxygen binding to and dissociation from hemoglobin?
A) partial pressure of oxygen B) temperature
C) partial pressure of carbon dioxide D) number of red blood cells
Answer: D
Diff: 2 Page Ref: 828-829
13
97) The factors responsible for holding the lungs to the thorax wall are .
A) the smooth muscles of the lung
B) the diaphragm and the intercostal muscles alone
C) the visceral pleurae and the changing volume of the lungs
D) surface tension from pleural fluid and negative pressure in the pleural cavity
Answer: D
Diff: 3 Page Ref: 816
98) The erythrocyte count increases after a while when an individual goes from a low to a high altitude because the
.
A) temperature is lower at higher altitudes
B) basal metabolic rate is higher at high altitudes
C) concentration of oxygen and/or total atmospheric pressure is higher at higher altitudes
D) concentration of oxygen and/or total atmospheric pressure is lower at high altitudes
Answer: D
Diff: 2 Page Ref: 838-839
99) Most inspired particles such as dust fail to reach the lungs because of the .
A) ciliated mucous lining in the nose B) abundant blood supply to nasal mucosa
C) porous structure of turbinate bones D) action of the epiglottis
Answer: A
Diff: 2 Page Ref: 803-805
100) Which of the following is not possible?
A) Gas flow equals pressure gradient over resistance.
B) Pressure gradient equals gas flow over resistance. C) Resistance equals pressure gradient over gas flow.
D) The amount of gas flowing in and out of the alveoli is directly proportional to the difference in pressure or pressure gradient between the external atmosphere and the alveoli.
Answer: B
Diff: 3 Page Ref: 820
101) Select the correct statement about the physical factors influencing pulmonary ventilation.
A) A decrease in compliance causes an increase in ventilation.
B) A lung that is less elastic will require less muscle action to perform adequate ventilation.
C) As alveolar surface tension increases, additional muscle action will be required. D) Surfactant helps increase alveolar surface tension.
Answer: C
Diff: 3 Page Ref: 820-821
102) Select the correct statement about oxygen transport in blood.
A) During normal activity, a molecule of hemoglobin returning to the lungs carries one molecule of O2. B) During conditions of acidosis, hemoglobin is able to carry oxygen more efficiently.
C) Increased BPG levels in the red blood cells enhance oxygen-carrying capacity.
D) A 50% oxygen saturation level of blood returning to the lungs might indicate an activity level higher than
normal.
Answer: D
Diff: 3 Page Ref: 828-829
14
103) Which of the disorders below is characterized by destruction of the walls of the alveoli producing abnormally
large air spaces that remain filled with air during exhalation?
A) pneumonia B) tuberculosis C) emphysema D) coryza
Answer: C
Diff: 2 Page Ref: 839-840
104) Which of the following does not influence hemoglobin saturation?
A) temperature B) BPG C) carbon dioxide D) nitric oxide
Answer: D
Diff: 2 Page Ref: 828-829
SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.
105) Type II alveolar cells secrete .
Answer: surfactant
Diff: 1 Page Ref: 811
106) The law of partial pressure is called law.
Answer: Daltonʹs
Diff: 1 Page Ref: 824
107) The law that applies to the amount of CO2 you could dissolve in a Pepsi is called law.
Answer: Henryʹs
Diff: 1 Page Ref: 824
108) The Bohr effect refers to the unloading of in a RBC due to declining pH.
Answer: oxygen
Diff: 1 Page Ref: 829
109) A disorder characterized by permanent enlargement of the alveoli accompanied by destruction of the alveolar walls is .
Answer: emphysema
Diff: 2 Page Ref: 829-830
110) The cartilaginous flap that closes the trachea during swallowing is called the .
Answer: epiglottis
Diff: 1 Page Ref: 808
111) The archway in the back of the throat is called the .
Answer: fauces
Diff: 1 Page Ref: 806
112) Terminal bronchioles are lined with epithelium.
Answer: cuboidal
Diff: 1 Page Ref: 810-811
15
113) How is alveolar gas exchange affected by emphysema and pneumonia?
Answer: With pneumonia, if the lungs become edematous, the thickness of the exchange membrane may increase dramatically, restricting gas exchange, and body tissues begin to suffer from hypoxia. With emphysema, the lungs become progressively less elastic and more fibrous, which hinders both inspiration and expiration. Gas exchange remains adequate initially, but muscular activity must be enlisted to expire. Additionally, a symptom of emphysema is fusion of alveoli, resulting in less surface area for gas exchange.
Diff: 2 Page Ref: 839-840, 848
114) Briefly differentiate between atmospheric pressure, intrapulmonary pressure, and intrapleural pressure. Which of these is always negative in a healthy individual during normal breathing? What happens if intrapleural pressure becomes equal to atmospheric pressure?
Answer: Atmospheric pressure is the pressure exerted by gases of the atmosphere. Intrapulmonary pressure is the pressure within the alveoli of the lungs. Intrapleural pressure is the pressure within the intrapleural space. Intrapleural pressure is negative relative to the other two during normal inspiration/expiration. Equalization of the intrapleural pressure with atmospheric pressure or intrapulmonary pressure immediately causes lung collapse.
Diff: 3 Page Ref: 816-817
115) The contraction of the diaphragm and the external intercostal muscles begins inspiration. Explain exactly what happens, in terms of volume and pressure changes in the lungs, when these muscles contract.
Answer: With contraction of the diaphragm, the height of the thoracic cavity increases. Contraction of the intercostal muscles expands the diameter of the thorax. With an increase in volume of the thorax, the intrapulmonary volume increases, causing a drop in pressure relative to atmospheric pressure. Air rushes into the lungs along this pressure gradient until intrapulmonary and atmospheric pressures are equal.
Diff: 2 Page Ref: 817-9; Fig 22.13
116) What is the chloride shift and why does it occur?
Answer: The chloride shift is an ionic exchange process whereby chloride ions move from the plasma into the erythrocytes to counterbalance the net positive charge left within the erythrocytes by the rapid outrush of negative bicarbonate ions whenever blood CO2 rises.
Diff: 2 Page Ref: 832
117) If a baby is born at 28 weeksʹ gestation, what major problem will the doctors look for?
Answer: The type II alveolar cells may not have fully developed; therefore, there is the possibility of lung collapse, resulting in severe breathing difficulties.
Diff: 2 Page Ref: 842
118) How is it possible to change the pitch of our voice from high to low?
Answer: Usually, the tenser the vocal folds, the faster they vibrate and the higher the pitch. To produce deep tones, the glottis widens, and to produce high-pitched tones, the glottis becomes a slit. Intrinsic laryngeal muscles control the true vocal folds and the size of the glottis.
Diff: 3 Page Ref: 808-809
16
119) The partial pressure gradient for oxygen (in the body) is much steeper than that for carbon dioxide. Explain
how equal amounts of these two gases can be exchanged (in a given time interval) in the lungs and at the tissues.
Answer: Equal amounts of O2 and CO2 can be exchanged in the lungs and at the tissues because CO 2 solubility in plasma and alveolar fluid is 20 times greater than that of O 2.
Diff: 3 Page Ref: 826
120) Define anatomical dead space. What is the relationship between anatomical and alveolar dead space? Which value is likely to increase during lung pathology?
Answer: Anatomical dead space is the space in the conducting respiratory passageways. Alveolar dead space is the space in nonfunctional alveoli. Anatomical dead space and alveolar dead space together make up the total dead space. Alveolar dead space will increase during lung pathology.
Diff: 3 Page Ref: 822-823
121) Distinguish among anemic, ischemic, histotoxic, and hypoxemic hypoxia.
Answer: Anemic hypoxia reflects poor oxygen delivery resulting from too few RBCs or RBCs that contain abnormal or too little Hb. Ischemic hypoxia results when blood circulation is impaired or blocked. Histotoxic hypoxia occurs when body cells are unable to use O2 even though adequate amounts are delivered. Hypoxemia hypoxia is indicated by reduced arterial PO2.
Diff: 2 Page Ref: 829
ESSAY. Write your answer in the space provided or on a separate sheet of paper.
122) Timothy has been having difficulty breathing since he had pneumonia last month. Recently he had severe pain in his chest and back, and his breathing was extremely irregular. The doctor at the emergency room told him that one of the lobes of his lung had collapsed. How could this happen?
Answer: Timothy suffered a pneumothorax, or lung collapse, most likely caused by a rupture of the visceral pleura as a result of coughing during his bout with pneumonia. The pneumothorax was large enough to cause atelectasis, or collapse, of one of his lobes, but not the remainder of his lung.
Diff: 3 Page Ref: 817
123) While having a physical examination, a young male informed his doctor that at age 8 he had lobar pneumonia and pleurisy in his left lung. The physician decided to measure his VC. Describe the apparatus and method used for taking this measurement. Define the following terms used in the description of lung volumes: TV, IRV, ERV, RV, and VC.
Answer: His vital capacity (VC) was measured using a spirometer. As he breathed into a handheld device, the speed and volume of air flow was calculated from the output of a pressure transducer. Tidal volume
(TV) is the amount of air that moves into and out of the lungs with normal breathing. Inspiratory reserve volume (IRV) is the amount of air that can be forcibly inhaled beyond the tidal volume. The expiratory reserve volume (ERV) is the amount of air that can be evacuated from the lungs over and above a tidal expiration. Residual volume (RV) is the amount of air that remains in the lungs even after the most strenuous expiration. Vital capacity (VC) is the total amount of exchangeable air.
Diff: 3 Page Ref: 821-822
124) Jane had been suffering through a severe cold and was complaining of a frontal headache and a dull, aching pain at the side of her face. What regions are likely to become sites of secondary infection following nasal infection?
Answer: Following nasal infection, the paranasal sinuses can become infected.
Diff: 2 Page Ref: 806
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125) A smoker sees his doctor because he had a persistent cough for months and is short of breath after very little
exertion. What diagnosis will the doctor make and what can the person expect if he does not quit smoking?
Answer: The person is suffering from chronic bronchitis, which causes the dyspnea and coughing. If he does not stop smoking, he can expect frequent pulmonary infections, more coughing, and progressively worse dyspnea (all symptoms of chronic obstructive pulmonary disease). Ultimately, he can expect to develop hypoxemia, CO2 retention, and respiratory acidosis. He may develop emphysema or lung cancer.
Diff: 3 Page Ref: 839-841
126) After a long scuba diving session on a Caribbean reef, Carl boards a plane to Dallas. He begins to feel pain in his elbow on the flight back to Dallas. What is happening to him?
Answer: Carl is experiencing the bends due to several problems: (1) Applying Boyleʹs law, a lot of gas was forced into Carlʹs bloodstream during the dive and there was not sufficient time to decompress the excess before he boarded the plane. (2) The plane is not pressurized to sea level, which further reduced atmospheric pressure holding the gases in suspension (Henryʹs law). Carl should be to be transported to a hyperbaric chamber to be repressurized. This will reduce the volume of the gas bubbles in his arm so that normal circulation can resume.
Diff: 3 Page Ref: 817, 824-825
127) A patient was admitted to the hospital with chronic obstructive pulmonary disease. His P O2 was 55 and PCO2 was 65. A new resident orders 54% oxygen via the venturi mask. One hour later, after the oxygen was placed, the nurse finds the patient with no respiration or pulse. She calls for a Code Blue and begins cardiopulmonary resuscitation (CPR). Explain why the patient stopped breathing.
Answer: In people who retain carbon dioxide because of pulmonary disease, arterial PCO2 is chronically elevated and chemoreceptors become unresponsive to this chemical stimulus. In such cases, declining P O2 levels act on the oxygen-sensitive peripheral chemoreceptors and provide the principle respiratory stimulus,
or the so-called hypoxic drive. Pure oxygen will stop a personʹs breathing, because his respiratory stimulus (low PO2 levels) would be removed.
Diff: 3 Page Ref: 840
128) While dining out in a restaurant a man suddenly chokes on a piece of meat. The waitress is also a student nurse and comes to the manʹs aid. She asks him if he can talk. The man responds by shaking his head no and
grabbing at his neck. What is the significance of the manʹs inability to talk?
Answer: Speech involves the intermittent release of expired air and opening and closing of the glottis. Because the man is unable to speak, this indicates that he is choking on a piece of food that suddenly closed off air at or below the glottis.
Diff: 3 Page Ref: 808
129) How will the lungs compensate for an acute rise in the partial pressure of CO2 in arterial blood?
Answer: Respiratory rate will increase.
Diff: 2 Page Ref: 836
130) A patient with tuberculosis is often noncompliant with treatment. Explain why this may happen.
Answer: Noncompliance may occur because of the length of treatment. Treatment entails a 12-month course of antibiotics. Once the patient begins to feel better and the clinical symptoms dissipate, the patient may stop taking the medication.
Diff: 3 Page Ref: 840-841
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131) John has undergone surgery and has developed pneumonia. He also has a history of emphysema. Which
symptoms and signs would the nurse expect to find?
Answer: 1. The patient may have dyspnea.
2. The patient may have hypoxemia because of increased secretions in the lungs.
3. The patient may use his accessory muscles to assist breathing.
4. The patient may have a productive cough.
5. The patientʹs breath sounds may have rales (crackles).
Diff: 3 Page Ref: 839-840
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