Test Bank For Mosbys Respiratory Care Anatomy and Physiology 3rd Edition Foundations for Clinical Practice Will Beachey All Chapters Covered.

Chapter 1: The Airways and Alveoli Test Bank MULTIPLE CHOICE 1. Which of the following structures is responsible for substantially increasing the surface area of the nasal cavity? a. Nasal septum b. Nares c. Turbinates d. Nasal fossae ANS: C The convoluted design of the turbinates greatly increases the surface area of the nasal cavity. DIF: Recall REF: 4 2. What type of epithelium covers the posterior two-thirds of the nasal mucosa? a. Squamous b. Squamous, nonciliated c. Pseudostratified, ciliated columnar d. Pseudostratified, ciliated columnar with mucus-secreting glands ANS: D Squamous, nonciliated epithelium lines the anterior third of the nose; pseudostratified, ciliated columnar epithelium interspersed with many mucus-secreting glands covers the posterior twothirds, including the turbinates. This mucus-secreting epithelium is called the respiratory mucosa. DIF: Recall REF: 4 3. Which of the following are the main functions of the nose? I. Humidification II. Heating III. Filtering IV. Immunity a. I, II b. III, IV c. I, II, III d. I, II, III, IV ANS: C The main functions of the nose are the humidification, heating, and filtering of inspired air. DIF: Recall REF: 4 4. What size particles do not gain entry to the lower airways due to the filtering capacity of the nose? a. >2 mm b. >3 mm c. >4 mm d. >5 mm ANS: D The nose is so efficient as a filter that most particles larger than 5 mm in diameter do not gain entry to the lower airways. DIF: Recall REF: 5 5. When an endotracheal tube is introduced to a patient requiring mechanical ventilation, which of the following functions of the nose is lost? a. Air-conditioning b. Antibacterial c. Antiinflammatory d. Bactericidal ANS: A The process of intubation involves the insertion of an artificial airway, or endotracheal tube through the nose or mouth and into the trachea (Figure 1-4), which means the air-conditioning function of the nose is lost, and unmodified cool, dry gas directly enters the trachea. This places a heavy burden on the tracheal mucosa, which is not designed to accommodate cool, dry gases. DIF: Application REF: 5 6. Which of the following are lymphoid tissues present in the pharynx? I. Adenoid tonsils II. Nasal tonsils III. Palatine tonsils IV. Lingual tonsils a. I, II b. III, IV c. I, II, III d. I, III, IV ANS: D These tissues include the pharyngeal (adenoid), palatine, and lingual tonsils (see Figure 1-3). DIF: Recall REF: 5 7. Routine evaluation of the ventilator circuit on a patient in the ICU reveals that there are no water droplets condensed on the inner surface of the ventilator’s inspiratory tube and that secretions in the endotracheal tube are thick and difficult to remove when suction is applied. The best therapy to resolve this situation is: a. Supply artificial heat and humidity b. Extubate the patient c. Increase water intake to the patient d. Change the ventilator circuit ANS: A Bypassing the upper airway in this manner would introduce cool, dry gas directly into the lower trachea unless heat and artificial humidity are supplied to the endotracheal tube. DIF: Analysis REF: 6 8. What are considered the goals of humidification in mechanical ventilation regarding temperature and relative humidity (RH)? a. 35°C to 37°C and 100% RH b. 35°C to 37°C and 80% RH c. 32°C to 34°C and 80% RH d. 32°C to 34°C and 100% RH ANS: D The goal of humidification in mechanical ventilation is to duplicate the heat and humidity conditions that would normally exist at this point in the nonintubated trachea: approximately 32°C to 34°C and 100% relative humidity. DIF: Recall REF: 6 9. Which of the following pairs of reflexes is responsible for preventing aspiration of foreign material into the lungs? a. Laryngeal and pharyngeal b. Laryngeal and carinal c. Pharyngeal and carinal d. Laryngeal and vocal cord ANS: A Deeply unconscious persons sometimes lose the pharyngeal and laryngeal reflexes and aspirate foreign material into their lungs. DIF: Recall REF: 6 10. After a tracheal tube is in place, which action will form a seal between the tracheal wall and tube to minimize aspiration of pharyngeal contents? a. The tip of the tube is placed against the carina. b. The tip of the tube is wedged into the right mainstem bronchus. c. The cuff is inflated. d. No action is required. ANS: C Once it is in place, the cuff is inflated to form a seal between the tracheal wall and tube to minimize aspiration of pharyngeal contents. DIF: Application REF: 6 11. Even if the endotracheal cuff is properly inflated, pharyngeal secretions will eventually migrate past the cuff into the lower airway. This event could make mechanically ventilated patients susceptible to the development of which of the following disorders? a. Asthma b. Ventilator-associated pneumonia c. Bronchitis d. Tracheitis ANS: B However, even if the cuff is properly inflated, pharyngeal secretions eventually migrate past the cuff into the lower airway, For this reason, mechanically ventilated patients, in whom endotracheal intubation is required, are susceptible to the development of lung infections, or so-called ventilator-associated pneumonia (VAP). DIF: Application REF: 6 12. In a deeply unconscious patient, what is the most common threat to upper airway patency? a. Cervical spine movement b. Bulbar paralysis c. Neural compromise d. Soft tissue obstruction ANS: D Deep unconsciousness may relax pharyngeal muscles enough to allow the base of the tongue to rest against the posterior wall of the pharynx, occluding the upper airway; this is called soft tissue obstruction and is the most common threat to upper airway patency. DIF: Application REF: 6 13. A 15-year-old patient is brought to the emergency room with severe respiratory distress after aspirating a coin. Which of the following signs is the most suggestive of complete airway obstruction? a. Low-pitched snoring sound b. Inspiratory effort without sound or air movement c. Increased work of breathing d. Suprasternal retractions ANS: B Partial upper airway obstruction produces a low-pitched snoring sound as inspired air vibrates the base of the tongue against the posterior wall of the pharynx. Complete obstruction causes strong inspiratory efforts without sound or air movement. Soft tissues between the ribs and above the sternum may be sucked inward (intercostal and suprasternal retractions) as the person struggles to inhale. DIF: Application REF: 6 14. Which of the following maneuvers best describes the sniffing position? a. Extending neck and extending jaw b. Extending neck and applying pressure on the forehead c. Extending neck and pulling chin d. Pulling chin and flexing neck ANS: C Both forms of soft tissue upper airway obstruction can be easily eliminated by extending the neck and pulling the chin anteriorly (see Figure 1-5, C). This maneuver pulls the tongue forward out of the airway and aligns the oral and nasal cavities with the pharynx-larynx axis. This is sometimes called the sniffing position.