Neonatal and Pediatric Respiratory Care, 5th Edition, Brian K. Walsh Test Bank
TEST BANK
Table of Contents
Chapter 1. Fetal Lung Development
Chapter 2. Fetal Gas Exchange and Circulation
Chapter 3. Antenatal Assessment and High-Risk Delivery
NEONATAL & PEDIATRIC
Chapter 4. Examination and Assessment of the Neonatal and Pediatric Patient
Chapter 5. Pulmonary Function Testing and Bedside Pulmonary Mechanics
Chapter 6. Radiographic Assessment
RESPIRATORY CARE Chapter 7. Pediatric Flexible Bronchoscopy
Chapter 8. Invasive Blood Gas Analysis and Cardiovascular Monitoring
5th Edition, Walsh
Chapter 9. Noninvasive Monitoring in Neonatal and Pediatric Care
Chapter 10. Oxygen Administration
Chapter 11. Aerosols and Administration of Inhaled Medications
Chapter 12. Airway Clearance Techniques and Hyperinflation Therapy
Chapter 13. Airway Management
Chapter 14. Surfactant Replacement Therapy
Chapter 15. Noninvasive Mechanical Ventilation and Continuous Positive Pressure of the Neonate
Chapter 16. Noninvasive Mechanical Ventilation of the Infant and Child
Chapter 17. Invasive Mechanical Ventilation of the Neonate and Pediatric Patient
Chapter 18. Administration of Gas Mixtures
Chapter 19. Extracorporeal Membrane Oxygenation
Chapter 20. Pharmacology
Chapter 21. Thoracic Organ Transplantation
Chapter 22. Neonatal Pulmonary Disorders
Chapter 23. Surgical Disorders in Childhood that Affect Respiratory Care
Chapter 24. Congenital Cardiac Defects
Chapter 25. Pediatric Sleep-Disordered Breathing
Chapter 26. Pediatric Airway Disorders and Parenchymal Lung Diseases
Chapter 27. Asthma
Chapter 28. Cystic Fibrosis
Chapter 29. Acute Respiratory Distress Syndrome
Chapter 30. Shock
Chapter 31. Pediatric Trauma
Chapter 32. Disorders of the Pleura
Chapter 33. Neurological and Neuromuscular Disorders
Chapter 34. Pediatric Emergencies
Chapter 35. Home Care of the Postpartum Family
Chapter 36. Quality and Safety
TEST BANK
, a. Embryonal
Chapter 1: Fetal Lung Development b. Saccular
Walsh: Neonatal & Pediatric Respiratory Care 5th Edition Test Bank (2020) c. Canalicular
d. Alveolar
MULTIPLE CHOICE ANS: A
The initial structures of the pulmonary tree develop during the embryonal stage. Errors in
1. Which of the following phases of human lung development is characterized by the formation development during this time may result in laryngeal, tracheal, or esophageal atresia or
of a capillary network around airway passages? stenosis. Pulmonary hypoplasia, an incomplete development of the lungs characterized by an
a. Pseudoglandular abnormally low number and/or size of bronchopulmonary segments and/or alveoli, can
b. Saccular
develop during the pseudoglandular phase. If the fetus is born during the canalicular phase
c. Alveolar
d. Canalicular (i.e., prematurely), severe respiratory distress can be expected because the inadequately
developed airways, along with insufficient and immature surfactant production by alveolar
ANS: D type II cells, gives rise to the constellation of problems known as infant respiratory distress
The canalicular phase follows the pseudoglandular phase, lasting from approximately 17 syndrome.
weeks to 26 weeks of gestation. This phase is so named because of the appearance of vascular
channels, or capillaries, which begin to grow by forming a capillary network around the air REF: p. 6
passages. During the pseudoglandular stage, which begins at day 52 and extends to week 16
of gestation, the airway system subdivides extensively and the conducting airway system 4. Which of the following mechanisms is (are) responsible for the possible association between
develops, ending with the terminal bronchioles. The saccular stage of development, which oligohydramnios and lung hypoplasia?
takes place from weeks 29 to 36 of gestation, is characterized by the development of sacs that
later become alveoli. During the saccular phase, a tremendous increase in the potential gas- I. Abnormal carbohydrate metabolism
exchanging surface area occurs. The distinction between the saccular stage and the alveolar II. Mechanical restriction of the chest wall
stage is arbitrary. The alveolar stage stretches from 39 weeks of gestation to term. This stage III. Interference with fetal breathing
is represented by the establishment of alveoli. IV. Failure to produce fetal lung liquid
a. I and III only
REF: pp. 3-5 b. II and III only
c. I, II, and IV only
2. Regarding postnatal lung growth, by approximately what age do most of the alveoli that will d. II, III, and IV only
be present in the lungs for life develop? ANS: D
a. 6 months Oligohydramnios, a reduced quantity of amniotic fluid present for an extended period of time,
b. 1 year
with or without renal anomalies, is associated with lung hypoplasia. The mechanisms by
c. 1.5 years
d. 2 years which amniotic fluid volume influences lung growth remain unclear. Possible explanations for
reduced quantity of amniotic fluid include mechanical restriction of the chest wall,
ANS: C interference with fetal breathing, or failure to produce fetal lung liquid. These clinical and
Most of the postnatal formation of alveoli in the infant occurs over the first 1.5 years of life. experimental observations possibly point to a common denominator, lung stretch, as being a
At 2 years of age, the number of alveoli varies substantially among individuals. After 2 years major growth stimulant.
of age, males have more alveoli than do females. After alveolar multiplication ends, the
alveoli continue to increase in size until thoracic growth is completed. REF: pp. 6-7
REF: p. 6 5. What is the purpose of the substance secreted by the type II pneumocyte?
a. To increase the gas exchange surface area
3. The respiratory therapist is evaluating a newborn with mild respiratory distress due to tracheal b. To reduce surface tension
stenosis. During which period of lung development did this problem develop? c. To maintain lung elasticity
d. To preserve the volume of the amniotic fluid
, ANS: B
Chapter 2: Fetal Gas Exchange and Circulation
The primary role of mammalian surfactant is to lower the surface tension within the alveolus,
Test Bank
specifically at the air–liquid interface. This allows the delicate structure of the alveolus to
expand when filled with air. Without surfactant, the alveolus remains collapsed because of the
high surface tension of the moist alveolar surface. Surfactant is composed predominantly of MULTIPLE CHOICE
an intricate blend of phospholipids, neutral lipids, and proteins.
1. Which of the following embryonic germ layers gives formation to the respiratory system?
REF: p. 8 a. Endoderm
b. Mesoderm
6. Which of the following tests of the amniotic fluid have been shown to be sensitive indicators c. Ectoderm
of lung maturity? d. Periderm
a. Levels of prednisone
ANS: A
b. Levels of epidermal growth factor
c. Levels of prostaglandins The respiratory system—pharynx, lungs, and epithelial lining of the trachea and lungs—
d. Levels of phosphatidylglycerol and phosphatidylcholine originates in the endoderm. Refer to Box 2-1 in the textbook to see the list of various tissue
systems found in the three embryonic layers.
ANS: D
Of clinical relevance during late gestation, analysis of amniotic fluid for the concentration of REF: p. 13
phosphatidylglycerol and phosphatidylcholine has been shown to be a sensitive indicator of
the state of fetal lung maturity. 2. What is the function of Wharton’s jelly inside the umbilical cord?
a. To help provide nutrition to the fetus
REF: p. 8 b. To prevent the vessels inside the cord from kinking
c. To help protect the fetus
d. To regulate the temperature between the fetus and the mother
ANS: B
Wharton's jelly, a gelatinous substance inside the umbilical cord, helps protect the vessels of
the fetus and may prevent the cord from kinking.
REF: p. 13
3. Which of the following organs is considered to be the first to form?
a. Heart
b. Brain
c. Lungs
d. Kidneys
ANS: A
The heart is considered to be the first complete organ formed. By 8 weeks of gestation, the
normal fetal heart is fully functional, complete with all chambers, valves, and major vessels.
REF: p. 14
4. A pregnant woman is coming for an early prenatal evaluation and wants to know if she can
listen to the baby’s heartbeat. How early can the fetal heartbeat be detected?
a. Day 8
b. Day 22
, c. Day 45 REF: p. 18
d. Day 60
7. How long after birth should it take for the ductus arteriosus to close completely?
ANS: B
a. 24 hours
By day 22 cardiac contractions are detectable and bidirectional tidal blood flow begins.
b. 48 hours
c. 96 hours
REF: p. 14 d. 1 week
5. Which of the following anatomic structures is a (are) fetal shunt(s)? ANS: C
Because the pressure in the aorta also increases and becomes greater than the pressure in the
I. Foramen ovale pulmonary artery, the amount of shunting through the ductus arteriosus decreases. The
II. Sinus venosus functional closure of the ductus arteriosus occurs as a result of being exposed to an increased
III. Ductus venosus PO2, a decrease in PVR leading to the reduction in blood pressure within the ductal lumen, a
IV. Ductus arteriosus decrease in the local production of prostaglandins, and a reduction in the number of
a. III only prostaglandin receptors within the tissue of the ductus arteriosus. Normally, constriction of the
b. I, III, and IV only ductus arteriosus starts to occur at birth, and 20% of the ductus closes within 24 hours, with
c. I, II, and IV only 80% closed in 48 hours, and 100% by 96 hours after birth.
d. II, III, and IV only
ANS: B REF: p. 18
Figure 2-6 in the textbook illustrates fetal circulation and the three shunts present in the fetus
that close soon after birth. They include (1) the foramen ovale, the opening between the right
atrium and the left atrium, which enables oxygenated blood to flow to the left side of the fetal
heart; (2) the ductus venosus, which appears continuous with the umbilical vein and shunts
30% to 50% of oxygen-rich blood around the liver; and (3) the ductus arteriosus, which
allows most of the pulmonary arterial blood flow to bypass the nonfunctioning fetal lungs and
enter the aorta.
REF: p. 17
6. Which of the following events causes cessation of right-to-left shunt through the foramen
ovale?
a. Increased levels of PO2 in the blood of the neonate
b. Decreased levels of PCO2 in the blood of the newborn
c. Increased systemic vascular resistance
d. Removal of the placenta, causing lowered blood volume returning to the right side
of the fetal heart
ANS: C
Once the cord is clamped and the PVR decreases, pressures in the right side of the heart
decrease and pressures in the left side increase. Because the foramen ovale flap allows blood
to flow only from right to left, it closes when the pressures in the left atrium become greater
than those in the right atrium. Closing the foramen ovale further facilitates the increase of
blood flow to the lungs during the transitional period and is necessary to maintain normal
extrauterine circulation.
TEST BANK
Table of Contents
Chapter 1. Fetal Lung Development
Chapter 2. Fetal Gas Exchange and Circulation
Chapter 3. Antenatal Assessment and High-Risk Delivery
NEONATAL & PEDIATRIC
Chapter 4. Examination and Assessment of the Neonatal and Pediatric Patient
Chapter 5. Pulmonary Function Testing and Bedside Pulmonary Mechanics
Chapter 6. Radiographic Assessment
RESPIRATORY CARE Chapter 7. Pediatric Flexible Bronchoscopy
Chapter 8. Invasive Blood Gas Analysis and Cardiovascular Monitoring
5th Edition, Walsh
Chapter 9. Noninvasive Monitoring in Neonatal and Pediatric Care
Chapter 10. Oxygen Administration
Chapter 11. Aerosols and Administration of Inhaled Medications
Chapter 12. Airway Clearance Techniques and Hyperinflation Therapy
Chapter 13. Airway Management
Chapter 14. Surfactant Replacement Therapy
Chapter 15. Noninvasive Mechanical Ventilation and Continuous Positive Pressure of the Neonate
Chapter 16. Noninvasive Mechanical Ventilation of the Infant and Child
Chapter 17. Invasive Mechanical Ventilation of the Neonate and Pediatric Patient
Chapter 18. Administration of Gas Mixtures
Chapter 19. Extracorporeal Membrane Oxygenation
Chapter 20. Pharmacology
Chapter 21. Thoracic Organ Transplantation
Chapter 22. Neonatal Pulmonary Disorders
Chapter 23. Surgical Disorders in Childhood that Affect Respiratory Care
Chapter 24. Congenital Cardiac Defects
Chapter 25. Pediatric Sleep-Disordered Breathing
Chapter 26. Pediatric Airway Disorders and Parenchymal Lung Diseases
Chapter 27. Asthma
Chapter 28. Cystic Fibrosis
Chapter 29. Acute Respiratory Distress Syndrome
Chapter 30. Shock
Chapter 31. Pediatric Trauma
Chapter 32. Disorders of the Pleura
Chapter 33. Neurological and Neuromuscular Disorders
Chapter 34. Pediatric Emergencies
Chapter 35. Home Care of the Postpartum Family
Chapter 36. Quality and Safety
TEST BANK
, a. Embryonal
Chapter 1: Fetal Lung Development b. Saccular
Walsh: Neonatal & Pediatric Respiratory Care 5th Edition Test Bank (2020) c. Canalicular
d. Alveolar
MULTIPLE CHOICE ANS: A
The initial structures of the pulmonary tree develop during the embryonal stage. Errors in
1. Which of the following phases of human lung development is characterized by the formation development during this time may result in laryngeal, tracheal, or esophageal atresia or
of a capillary network around airway passages? stenosis. Pulmonary hypoplasia, an incomplete development of the lungs characterized by an
a. Pseudoglandular abnormally low number and/or size of bronchopulmonary segments and/or alveoli, can
b. Saccular
develop during the pseudoglandular phase. If the fetus is born during the canalicular phase
c. Alveolar
d. Canalicular (i.e., prematurely), severe respiratory distress can be expected because the inadequately
developed airways, along with insufficient and immature surfactant production by alveolar
ANS: D type II cells, gives rise to the constellation of problems known as infant respiratory distress
The canalicular phase follows the pseudoglandular phase, lasting from approximately 17 syndrome.
weeks to 26 weeks of gestation. This phase is so named because of the appearance of vascular
channels, or capillaries, which begin to grow by forming a capillary network around the air REF: p. 6
passages. During the pseudoglandular stage, which begins at day 52 and extends to week 16
of gestation, the airway system subdivides extensively and the conducting airway system 4. Which of the following mechanisms is (are) responsible for the possible association between
develops, ending with the terminal bronchioles. The saccular stage of development, which oligohydramnios and lung hypoplasia?
takes place from weeks 29 to 36 of gestation, is characterized by the development of sacs that
later become alveoli. During the saccular phase, a tremendous increase in the potential gas- I. Abnormal carbohydrate metabolism
exchanging surface area occurs. The distinction between the saccular stage and the alveolar II. Mechanical restriction of the chest wall
stage is arbitrary. The alveolar stage stretches from 39 weeks of gestation to term. This stage III. Interference with fetal breathing
is represented by the establishment of alveoli. IV. Failure to produce fetal lung liquid
a. I and III only
REF: pp. 3-5 b. II and III only
c. I, II, and IV only
2. Regarding postnatal lung growth, by approximately what age do most of the alveoli that will d. II, III, and IV only
be present in the lungs for life develop? ANS: D
a. 6 months Oligohydramnios, a reduced quantity of amniotic fluid present for an extended period of time,
b. 1 year
with or without renal anomalies, is associated with lung hypoplasia. The mechanisms by
c. 1.5 years
d. 2 years which amniotic fluid volume influences lung growth remain unclear. Possible explanations for
reduced quantity of amniotic fluid include mechanical restriction of the chest wall,
ANS: C interference with fetal breathing, or failure to produce fetal lung liquid. These clinical and
Most of the postnatal formation of alveoli in the infant occurs over the first 1.5 years of life. experimental observations possibly point to a common denominator, lung stretch, as being a
At 2 years of age, the number of alveoli varies substantially among individuals. After 2 years major growth stimulant.
of age, males have more alveoli than do females. After alveolar multiplication ends, the
alveoli continue to increase in size until thoracic growth is completed. REF: pp. 6-7
REF: p. 6 5. What is the purpose of the substance secreted by the type II pneumocyte?
a. To increase the gas exchange surface area
3. The respiratory therapist is evaluating a newborn with mild respiratory distress due to tracheal b. To reduce surface tension
stenosis. During which period of lung development did this problem develop? c. To maintain lung elasticity
d. To preserve the volume of the amniotic fluid
, ANS: B
Chapter 2: Fetal Gas Exchange and Circulation
The primary role of mammalian surfactant is to lower the surface tension within the alveolus,
Test Bank
specifically at the air–liquid interface. This allows the delicate structure of the alveolus to
expand when filled with air. Without surfactant, the alveolus remains collapsed because of the
high surface tension of the moist alveolar surface. Surfactant is composed predominantly of MULTIPLE CHOICE
an intricate blend of phospholipids, neutral lipids, and proteins.
1. Which of the following embryonic germ layers gives formation to the respiratory system?
REF: p. 8 a. Endoderm
b. Mesoderm
6. Which of the following tests of the amniotic fluid have been shown to be sensitive indicators c. Ectoderm
of lung maturity? d. Periderm
a. Levels of prednisone
ANS: A
b. Levels of epidermal growth factor
c. Levels of prostaglandins The respiratory system—pharynx, lungs, and epithelial lining of the trachea and lungs—
d. Levels of phosphatidylglycerol and phosphatidylcholine originates in the endoderm. Refer to Box 2-1 in the textbook to see the list of various tissue
systems found in the three embryonic layers.
ANS: D
Of clinical relevance during late gestation, analysis of amniotic fluid for the concentration of REF: p. 13
phosphatidylglycerol and phosphatidylcholine has been shown to be a sensitive indicator of
the state of fetal lung maturity. 2. What is the function of Wharton’s jelly inside the umbilical cord?
a. To help provide nutrition to the fetus
REF: p. 8 b. To prevent the vessels inside the cord from kinking
c. To help protect the fetus
d. To regulate the temperature between the fetus and the mother
ANS: B
Wharton's jelly, a gelatinous substance inside the umbilical cord, helps protect the vessels of
the fetus and may prevent the cord from kinking.
REF: p. 13
3. Which of the following organs is considered to be the first to form?
a. Heart
b. Brain
c. Lungs
d. Kidneys
ANS: A
The heart is considered to be the first complete organ formed. By 8 weeks of gestation, the
normal fetal heart is fully functional, complete with all chambers, valves, and major vessels.
REF: p. 14
4. A pregnant woman is coming for an early prenatal evaluation and wants to know if she can
listen to the baby’s heartbeat. How early can the fetal heartbeat be detected?
a. Day 8
b. Day 22
, c. Day 45 REF: p. 18
d. Day 60
7. How long after birth should it take for the ductus arteriosus to close completely?
ANS: B
a. 24 hours
By day 22 cardiac contractions are detectable and bidirectional tidal blood flow begins.
b. 48 hours
c. 96 hours
REF: p. 14 d. 1 week
5. Which of the following anatomic structures is a (are) fetal shunt(s)? ANS: C
Because the pressure in the aorta also increases and becomes greater than the pressure in the
I. Foramen ovale pulmonary artery, the amount of shunting through the ductus arteriosus decreases. The
II. Sinus venosus functional closure of the ductus arteriosus occurs as a result of being exposed to an increased
III. Ductus venosus PO2, a decrease in PVR leading to the reduction in blood pressure within the ductal lumen, a
IV. Ductus arteriosus decrease in the local production of prostaglandins, and a reduction in the number of
a. III only prostaglandin receptors within the tissue of the ductus arteriosus. Normally, constriction of the
b. I, III, and IV only ductus arteriosus starts to occur at birth, and 20% of the ductus closes within 24 hours, with
c. I, II, and IV only 80% closed in 48 hours, and 100% by 96 hours after birth.
d. II, III, and IV only
ANS: B REF: p. 18
Figure 2-6 in the textbook illustrates fetal circulation and the three shunts present in the fetus
that close soon after birth. They include (1) the foramen ovale, the opening between the right
atrium and the left atrium, which enables oxygenated blood to flow to the left side of the fetal
heart; (2) the ductus venosus, which appears continuous with the umbilical vein and shunts
30% to 50% of oxygen-rich blood around the liver; and (3) the ductus arteriosus, which
allows most of the pulmonary arterial blood flow to bypass the nonfunctioning fetal lungs and
enter the aorta.
REF: p. 17
6. Which of the following events causes cessation of right-to-left shunt through the foramen
ovale?
a. Increased levels of PO2 in the blood of the neonate
b. Decreased levels of PCO2 in the blood of the newborn
c. Increased systemic vascular resistance
d. Removal of the placenta, causing lowered blood volume returning to the right side
of the fetal heart
ANS: C
Once the cord is clamped and the PVR decreases, pressures in the right side of the heart
decrease and pressures in the left side increase. Because the foramen ovale flap allows blood
to flow only from right to left, it closes when the pressures in the left atrium become greater
than those in the right atrium. Closing the foramen ovale further facilitates the increase of
blood flow to the lungs during the transitional period and is necessary to maintain normal
extrauterine circulation.
