Chapter 20: Pulmonary Edema
Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th
Edition
MULTIPLE CHOICE
1. As pulmonary edema progressives, the fluid moves in which of the following sequences?
a. Peribronchial interstitial spaces, bronchi, trachea
b. Alveoli, bronchioles, bronchi
c. Bronchioles, bronchi, trachea
d. Pulmonary capillaries, alveoli, bronchioles
ANS: B
Pulmonary edema results from excessive movement of fluid from the pulmonary vascular system to
the extravascular system and air spaces of the lungs. Fluid first seeps into the perivascular and
peribronchial interstitial spaces; depending on the degree of severity, fluid may progressively move
into the alveoli, bronchioles, and bronchi.
2. Pulmonary edema produces:
a. a restrictive pulmonary disorder.
b. an obstructive pulmonary disorder.
c. both a restrictive and obstructive disorders.
d. obstructive cardiac
disease. ANS: A
Pulmonary edema produceNs a rRes trIic
U S NtivGe TpBul.mCon OaMry disorder.
3. The major pathologic or structural changes seen in the lungs with pulmonary edema include:
1. atelectasis.
2. bronchospasm.
3. high surface tension of alveolar fluids.
4. alveolar flooding.
a. 1, 4
b. 2, 3
c. 1, 2, 3
d. 1, 3, 4
ANS: D
Major pathologic or structural changes seen in the lungs with pulmonary edema include atelectasis,
high surface tension of alveolar fluids, and alveolar flooding. Bronchospasm is not associated with
pulmonary edema.
4. Which of the following are causes of cardiogenic pulmonary edema?
1. Myocardial infarction
2. Mitral valve disease
3. Allergic reaction to drugs
4. Congenital heart defects
a. 1, 3
b. 1, 2, 4
, c. 2, 3, 4
d. 1, 2, 3
ANS: B
Allergic reaction to drugs can cause noncardiogenic pulmonary edema. The other listed options,
and others, can cause cardiogenic pulmonary edema.
5. What is the normal hydrostatic pressure in the pulmonary capillaries?
a. 0 to 5 mm Hg
b. 5 to 10 mm Hg
c. 10 to 15 mm Hg
d. 15 to 20 mm Hg
ANS: C
Ordinarily, hydrostatic pressure of about 10 to 15 mm Hg tends to move fluid out of the
pulmonary capillaries into the interstitial space.
6. Which of the following are risk factors for coronary heart disease?
1. Elevated homocysteine level
2. Elevated vitamin E level
3. Hypertension
4. Diabetes mellitus
a. 1
b. 2, 3
c. 2, 3, 4
d. 1, 3, 4
ANS: D
N R I G B.C M
The vitamin E level does not U S the
affect N coronary
T O
arteries. Several factors can lead to CHD,
including elevated homocysteine level, hypertension, and diabetes mellitus.
7. Which of the following are considered noncardiogenic causes of increased
capillary permeability?
1. Therapeutic lung radiation
2. Cigarette smoke
3. Acute respiratory distress syndrome (ARDS)
4. Inhaled phosgene
a. 1, 2
b. 2, 3
c. 1, 3, 4
d. 2, 3, 4
ANS: C
Among the many causes of noncardiogenic pulmonary edema are therapeutic lung radiation,
ARDS, and inhaled phosgene. Cigarette smoke is associated with lung cancer and chronic
obstructive pulmonary disease but does not cause increased capillary permeability.
8. Lymphatic insufficiency could be caused by:
1. lung transplantation.
2. lymphangitic carcinomatosis.
3. removal of pleural fluid.
, 4. decreased oncotic pressure.
a. 1, 2
b. 3, 4
c. 1, 2, 4
d. 2, 3, 4
ANS: A
Lymphatic insufficiency could be caused by lung transplantation and lymphangitic
carcinomatosis. Although the rapid removal of pleural fluid and decreased oncotic pressure
can lead to pulmonary edema, they are not associated with lymphatic insufficiency.
9. Management of cardiogenic pulmonary edema includes giving a patient which of the
following types of medications?
1. Reduction of systemic vascular resistance
2. Positive inotropic medication
3. Preload reducing medication
4. Positive chronotropic medication
a. 1, 4
b. 2, 3
c. 3, 4
d. 1, 2, 3
ANS: D
The therapeutic intervention to address the patient’s circulatory systems has the following three
main goals: (1) reduction of pulmonary venous return (preload reduction); (2) reduction of systemic
vascular resistance (afterload reduction); and (3) inotropic support (treatment of reduced cardiac
contractility). A positive chronotropic medication would
N URt inS
increase heart rate. This is no Idica
G NB.C
tedTin the trOeatment of cardiogenic pulmonary
edema.
10. A patient has a decreased oncotic pressure. What can be done to increase it?
a. Implement a high-salt diet.
b. Administer albumin.
c. Administer milrinone.
d. Administer morphine sulfate.
ANS: B
Giving albumin will increase oncotic pressure. A low-salt diet will decrease fluid retention to
increase hydrostatic pressure. Morphine sulfate acts as a vasodilator. Milrinone is a positive
inotropic agent and vasodilator. It reduces afterload and preload and increases cardiac output.
11. A patient with pulmonary edema is cyanotic and complaining of difficulty breathing. What
should be recommended by the respiratory therapist?
a. Provide supplemental oxygen.
b. Begin mechanical ventilation.
c. Have the patient use pursed-lip breathing.
d. Begin bronchopulmonary hygiene therapy.
ANS: A
, Cyanosis indicates hypoxemia. Giving supplemental oxygen will help to correct the
hypoxemia and decrease the patient’s work of breathing. Mechanical ventilation is not yet
indicated. Pursed-lip breathing may help the breathing of a patient with an obstructive lung
problem. Bronchopulmonary hygiene therapy is not indicated because there is no sign of a
secretion problem.
12. Mask CPAP is used with pulmonary edema patients because it:
1. decrease vascular congestion.
2. reduce work of breathing.
3. it is less expensive than mechanical ventilation.
4. improves lung compliance.
a. 1, 3
b. 1, 2, 4
c. 2, 3, 4
d. 1, 2, 3
ANS: C
While CPAP may be less expensive than mechanical ventilation mask CPAP is used because it
decreases vascular congestion, reduces work of breathing, and improves lung compliance. These
things improve oxygenation and may preclude the need for mechanical ventilation.
13. A patient with cardiogenic pulmonary edema has had intravascular catheters placed for
monitoring purposes. Which of the following values would be expected?
1. Decreased SV
2. Increased PCWP
3. Increased CVP NURSINGTB.COM
4. Decreased RAP
a. 2, 3
b. 1, 4
c. 1, 2, 3
d. 2, 3, 4
ANS: C
A patient with cardiogenic pulmonary edema will have a decreased SV (stroke volume),
increased PCWP (pulmonary capillary wedge pressure), and increased CVP (central venous
pressure). The RAP (right atrial pressure) is the same as the CVP and will be increased, not
decreased.
14. A patient with cardiogenic pulmonary edema would be expected to have which of the
following chest radiograph findings?
1. Depressed diaphragms
2. Pleural effusion
3. Cardiomegaly
4. Bilateral “butterfly” pattern fluffy infiltrates
a. 1
b. 2, 3
c. 2, 3, 4
d. 1, 2, 3
Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th
Edition
MULTIPLE CHOICE
1. As pulmonary edema progressives, the fluid moves in which of the following sequences?
a. Peribronchial interstitial spaces, bronchi, trachea
b. Alveoli, bronchioles, bronchi
c. Bronchioles, bronchi, trachea
d. Pulmonary capillaries, alveoli, bronchioles
ANS: B
Pulmonary edema results from excessive movement of fluid from the pulmonary vascular system to
the extravascular system and air spaces of the lungs. Fluid first seeps into the perivascular and
peribronchial interstitial spaces; depending on the degree of severity, fluid may progressively move
into the alveoli, bronchioles, and bronchi.
2. Pulmonary edema produces:
a. a restrictive pulmonary disorder.
b. an obstructive pulmonary disorder.
c. both a restrictive and obstructive disorders.
d. obstructive cardiac
disease. ANS: A
Pulmonary edema produceNs a rRes trIic
U S NtivGe TpBul.mCon OaMry disorder.
3. The major pathologic or structural changes seen in the lungs with pulmonary edema include:
1. atelectasis.
2. bronchospasm.
3. high surface tension of alveolar fluids.
4. alveolar flooding.
a. 1, 4
b. 2, 3
c. 1, 2, 3
d. 1, 3, 4
ANS: D
Major pathologic or structural changes seen in the lungs with pulmonary edema include atelectasis,
high surface tension of alveolar fluids, and alveolar flooding. Bronchospasm is not associated with
pulmonary edema.
4. Which of the following are causes of cardiogenic pulmonary edema?
1. Myocardial infarction
2. Mitral valve disease
3. Allergic reaction to drugs
4. Congenital heart defects
a. 1, 3
b. 1, 2, 4
, c. 2, 3, 4
d. 1, 2, 3
ANS: B
Allergic reaction to drugs can cause noncardiogenic pulmonary edema. The other listed options,
and others, can cause cardiogenic pulmonary edema.
5. What is the normal hydrostatic pressure in the pulmonary capillaries?
a. 0 to 5 mm Hg
b. 5 to 10 mm Hg
c. 10 to 15 mm Hg
d. 15 to 20 mm Hg
ANS: C
Ordinarily, hydrostatic pressure of about 10 to 15 mm Hg tends to move fluid out of the
pulmonary capillaries into the interstitial space.
6. Which of the following are risk factors for coronary heart disease?
1. Elevated homocysteine level
2. Elevated vitamin E level
3. Hypertension
4. Diabetes mellitus
a. 1
b. 2, 3
c. 2, 3, 4
d. 1, 3, 4
ANS: D
N R I G B.C M
The vitamin E level does not U S the
affect N coronary
T O
arteries. Several factors can lead to CHD,
including elevated homocysteine level, hypertension, and diabetes mellitus.
7. Which of the following are considered noncardiogenic causes of increased
capillary permeability?
1. Therapeutic lung radiation
2. Cigarette smoke
3. Acute respiratory distress syndrome (ARDS)
4. Inhaled phosgene
a. 1, 2
b. 2, 3
c. 1, 3, 4
d. 2, 3, 4
ANS: C
Among the many causes of noncardiogenic pulmonary edema are therapeutic lung radiation,
ARDS, and inhaled phosgene. Cigarette smoke is associated with lung cancer and chronic
obstructive pulmonary disease but does not cause increased capillary permeability.
8. Lymphatic insufficiency could be caused by:
1. lung transplantation.
2. lymphangitic carcinomatosis.
3. removal of pleural fluid.
, 4. decreased oncotic pressure.
a. 1, 2
b. 3, 4
c. 1, 2, 4
d. 2, 3, 4
ANS: A
Lymphatic insufficiency could be caused by lung transplantation and lymphangitic
carcinomatosis. Although the rapid removal of pleural fluid and decreased oncotic pressure
can lead to pulmonary edema, they are not associated with lymphatic insufficiency.
9. Management of cardiogenic pulmonary edema includes giving a patient which of the
following types of medications?
1. Reduction of systemic vascular resistance
2. Positive inotropic medication
3. Preload reducing medication
4. Positive chronotropic medication
a. 1, 4
b. 2, 3
c. 3, 4
d. 1, 2, 3
ANS: D
The therapeutic intervention to address the patient’s circulatory systems has the following three
main goals: (1) reduction of pulmonary venous return (preload reduction); (2) reduction of systemic
vascular resistance (afterload reduction); and (3) inotropic support (treatment of reduced cardiac
contractility). A positive chronotropic medication would
N URt inS
increase heart rate. This is no Idica
G NB.C
tedTin the trOeatment of cardiogenic pulmonary
edema.
10. A patient has a decreased oncotic pressure. What can be done to increase it?
a. Implement a high-salt diet.
b. Administer albumin.
c. Administer milrinone.
d. Administer morphine sulfate.
ANS: B
Giving albumin will increase oncotic pressure. A low-salt diet will decrease fluid retention to
increase hydrostatic pressure. Morphine sulfate acts as a vasodilator. Milrinone is a positive
inotropic agent and vasodilator. It reduces afterload and preload and increases cardiac output.
11. A patient with pulmonary edema is cyanotic and complaining of difficulty breathing. What
should be recommended by the respiratory therapist?
a. Provide supplemental oxygen.
b. Begin mechanical ventilation.
c. Have the patient use pursed-lip breathing.
d. Begin bronchopulmonary hygiene therapy.
ANS: A
, Cyanosis indicates hypoxemia. Giving supplemental oxygen will help to correct the
hypoxemia and decrease the patient’s work of breathing. Mechanical ventilation is not yet
indicated. Pursed-lip breathing may help the breathing of a patient with an obstructive lung
problem. Bronchopulmonary hygiene therapy is not indicated because there is no sign of a
secretion problem.
12. Mask CPAP is used with pulmonary edema patients because it:
1. decrease vascular congestion.
2. reduce work of breathing.
3. it is less expensive than mechanical ventilation.
4. improves lung compliance.
a. 1, 3
b. 1, 2, 4
c. 2, 3, 4
d. 1, 2, 3
ANS: C
While CPAP may be less expensive than mechanical ventilation mask CPAP is used because it
decreases vascular congestion, reduces work of breathing, and improves lung compliance. These
things improve oxygenation and may preclude the need for mechanical ventilation.
13. A patient with cardiogenic pulmonary edema has had intravascular catheters placed for
monitoring purposes. Which of the following values would be expected?
1. Decreased SV
2. Increased PCWP
3. Increased CVP NURSINGTB.COM
4. Decreased RAP
a. 2, 3
b. 1, 4
c. 1, 2, 3
d. 2, 3, 4
ANS: C
A patient with cardiogenic pulmonary edema will have a decreased SV (stroke volume),
increased PCWP (pulmonary capillary wedge pressure), and increased CVP (central venous
pressure). The RAP (right atrial pressure) is the same as the CVP and will be increased, not
decreased.
14. A patient with cardiogenic pulmonary edema would be expected to have which of the
following chest radiograph findings?
1. Depressed diaphragms
2. Pleural effusion
3. Cardiomegaly
4. Bilateral “butterfly” pattern fluffy infiltrates
a. 1
b. 2, 3
c. 2, 3, 4
d. 1, 2, 3
