Test Bank - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
TEST BANK
Neonatal and Pediatric Respiratory Care
Brian K. Walsh
5th Edition
, Test Bank - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
Table of Contents
Section 1: Fetal Development Assessment, and Delivery
1. Fetal Lung Development
2. Fetal Gas Exchange and Circulation
3. Antenatal Assessment and High-Risk Delivery
Section 2: Assessment and Monitoring of the Neonatal and Pediatric Patient
4. Examination and Assessment of the Neonatal and Pediatric Patient
5. Pulmonary Function Testing and Bedside Pulmonary Mechanics
6. Radiographic Assessment
7. Pediatric Flexible Bronchoscopy
8. Invasive Blood Gas Analysis and Cardiovascular Monitoring
9. Noninvasive Monitoring in Neonatal and Pediatric Care
Section 3: Therapeutic Procedures for Treatment of Neonatal and Pediatric Disorders
10. Oxygen Administration
11. Aerosols and Administration of Inhaled Medications
12. Airway Clearance Techniques and Hyperinflation Therapy
13. Airway Management
14. Surfactant Replacement Therapy
15. Noninvasive Mechanical Ventilation and Continuous Positive Pressure of the Neonate
16. Noninvasive Mechanical Ventilation of the Infant and Child
17. Invasive Mechanical Ventilation of the Neonate and Pediatric Patient
18. Administration of Gas Mixtures
19. Extracorporeal Membrane Oxygenation
20. Pharmacology
21. Thoracic Organ Transplantation
Section 4: Neonatal and Pediatric Disorders: Presentation, Diagnosis, and Treatment
22. Neonatal Pulmonary Disorders
23. Surgical Disorders in Childhood that Affect Respiratory Care
24. Congenital Cardiac Defects
25. Pediatric Sleep-Disordered Breathing
26. Pediatric Airway Disorders and Parenchymal Lung Diseases
27. Asthma
28. Cystic Fibrosis
29. Acute Respiratory Distress Syndrome
30. Shock
31. Pediatric Trauma
32. Disorders of the Pleura
33. Neurological and Neuromuscular Disorders
Section 5: Neonatal and Pediatric Transient and Ambulatory Care
34. Transport of Infants and Children
35. Home Care
36. Quality and Safety
, Test Bank - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
Chapter 1: Fetal Lung Development
Walsh: Neonatal & Pediatric Respiratory Care 5th Edition Test Bank (2020)
MULTIPLE CHOICE
1. Which of the following phases of human lung development is characterized by the formation
of a capillary network around airway passages?
a. Pseudoglandular
b. Saccular
c. Alveolar
d. Canalicular
ANS: D
The canalicular phase follows the pseudoglandular phase, lasting from approximately 17
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
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
develops, ending with the terminal bronchioles. The saccular stage of development, which
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-
exchanging surface area occurs. The distinction between the saccular stage and the alveolar
stage is arbitrary. The alveolar stage stretches from 39 weeks of gestation to term. This stage
is represented by the establishment of alveoli.
REF: pp. 3-5
2. Regarding postnatal lung growth, by approximately what age do most of the alveoli that will
be present in the lungs for life develop?
a. 6 months
b. 1 year
c. 1.5 years
d. 2 years
ANS: C
Most of the postnatal formation of alveoli in the infant occurs over the first 1.5 years of life.
At 2 years of age, the number of alveoli varies substantially among individuals. After 2 years
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: p. 6
3. The respiratory therapist is evaluating a newborn with mild respiratory distress due to tracheal
stenosis. During which period of lung development did this problem develop?
, Test Bank - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
a. Embryonal
b. Saccular
c. Canalicular
d. Alveolar
ANS: A
The initial structures of the pulmonary tree develop during the embryonal stage. Errors in
development during this time may result in laryngeal, tracheal, or esophageal atresia or
stenosis. Pulmonary hypoplasia, an incomplete development of the lungs characterized by an
abnormally low number and/or size of bronchopulmonary segments and/or alveoli, can
develop during the pseudoglandular phase. If the fetus is born during the canalicular phase
(i.e., prematurely), severe respiratory distress can be expected because the inadequately
developed airways, along with insufficient and immature surfactant production by alveolar
type II cells, gives rise to the constellation of problems known as infant respiratory distress
syndrome.
REF: p. 6
4. Which of the following mechanisms is (are) responsible for the possible association between
oligohydramnios and lung hypoplasia?
I. Abnormal carbohydrate metabolism
II. Mechanical restriction of the chest wall
III. Interference with fetal breathing
IV. Failure to produce fetal lung liquid
a. I and III only
b. II and III only
c. I, II, and IV only
d. II, III, and IV only
ANS: D
Oligohydramnios, a reduced quantity of amniotic fluid present for an extended period of time,
with or without renal anomalies, is associated with lung hypoplasia. The mechanisms by
which amniotic fluid volume influences lung growth remain unclear. Possible explanations for
reduced quantity of amniotic fluid include mechanical restriction of the chest wall,
interference with fetal breathing, or failure to produce fetal lung liquid. These clinical and
experimental observations possibly point to a common denominator, lung stretch, as being a
major growth stimulant.
REF: pp. 6-7
5. What is the purpose of the substance secreted by the type II pneumocyte?
a. To increase the gas exchange surface area
b. To reduce surface tension
c. To maintain lung elasticity
d. To preserve the volume of the amniotic fluid
, Test Bank - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
ANS: B
The primary role of mammalian surfactant is to lower the surface tension within the alveolus,
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
an intricate blend of phospholipids, neutral lipids, and proteins.
REF: p. 8
6. Which of the following tests of the amniotic fluid have been shown to be sensitive indicators
of lung maturity?
a. Levels of prednisone
b. Levels of epidermal growth factor
c. Levels of prostaglandins
d. Levels of phosphatidylglycerol and phosphatidylcholine
ANS: D
Of clinical relevance during late gestation, analysis of amniotic fluid for the concentration of
phosphatidylglycerol and phosphatidylcholine has been shown to be a sensitive indicator of
the state of fetal lung maturity.
REF: p. 8
, Test Bank - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
Chapter 2: Fetal Gas Exchange and Circulation
Test Bank
MULTIPLE CHOICE
1. Which of the following embryonic germ layers gives formation to the respiratory system?
a. Endoderm
b. Mesoderm
c. Ectoderm
d. Periderm
ANS: A
The respiratory system—pharynx, lungs, and epithelial lining of the trachea and lungs—
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.
REF: p. 13
2. What is the function of Wharton’s jelly inside the umbilical cord?
a. To help provide nutrition to the fetus
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
, Test Bank - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
c. Day 45
d. Day 60
ANS: B
By day 22 cardiac contractions are detectable and bidirectional tidal blood flow begins.
REF: p. 14
5. Which of the following anatomic structures is a (are) fetal shunt(s)?
I. Foramen ovale
II. Sinus venosus
III. Ductus venosus
IV. Ductus arteriosus
a. III only
b. I, III, and IV only
c. I, II, and IV only
d. II, III, and IV only
ANS: B
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 - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
REF: p. 18
7. How long after birth should it take for the ductus arteriosus to close completely?
a. 24 hours
b. 48 hours
c. 96 hours
d. 1 week
ANS: C
Because the pressure in the aorta also increases and becomes greater than the pressure in the
pulmonary artery, the amount of shunting through the ductus arteriosus decreases. The
functional closure of the ductus arteriosus occurs as a result of being exposed to an increased
PO2, a decrease in PVR leading to the reduction in blood pressure within the ductal lumen, a
decrease in the local production of prostaglandins, and a reduction in the number of
prostaglandin receptors within the tissue of the ductus arteriosus. Normally, constriction of the
ductus arteriosus starts to occur at birth, and 20% of the ductus closes within 24 hours, with
80% closed in 48 hours, and 100% by 96 hours after birth.
REF: p. 18
TEST BANK
Neonatal and Pediatric Respiratory Care
Brian K. Walsh
5th Edition
, Test Bank - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
Table of Contents
Section 1: Fetal Development Assessment, and Delivery
1. Fetal Lung Development
2. Fetal Gas Exchange and Circulation
3. Antenatal Assessment and High-Risk Delivery
Section 2: Assessment and Monitoring of the Neonatal and Pediatric Patient
4. Examination and Assessment of the Neonatal and Pediatric Patient
5. Pulmonary Function Testing and Bedside Pulmonary Mechanics
6. Radiographic Assessment
7. Pediatric Flexible Bronchoscopy
8. Invasive Blood Gas Analysis and Cardiovascular Monitoring
9. Noninvasive Monitoring in Neonatal and Pediatric Care
Section 3: Therapeutic Procedures for Treatment of Neonatal and Pediatric Disorders
10. Oxygen Administration
11. Aerosols and Administration of Inhaled Medications
12. Airway Clearance Techniques and Hyperinflation Therapy
13. Airway Management
14. Surfactant Replacement Therapy
15. Noninvasive Mechanical Ventilation and Continuous Positive Pressure of the Neonate
16. Noninvasive Mechanical Ventilation of the Infant and Child
17. Invasive Mechanical Ventilation of the Neonate and Pediatric Patient
18. Administration of Gas Mixtures
19. Extracorporeal Membrane Oxygenation
20. Pharmacology
21. Thoracic Organ Transplantation
Section 4: Neonatal and Pediatric Disorders: Presentation, Diagnosis, and Treatment
22. Neonatal Pulmonary Disorders
23. Surgical Disorders in Childhood that Affect Respiratory Care
24. Congenital Cardiac Defects
25. Pediatric Sleep-Disordered Breathing
26. Pediatric Airway Disorders and Parenchymal Lung Diseases
27. Asthma
28. Cystic Fibrosis
29. Acute Respiratory Distress Syndrome
30. Shock
31. Pediatric Trauma
32. Disorders of the Pleura
33. Neurological and Neuromuscular Disorders
Section 5: Neonatal and Pediatric Transient and Ambulatory Care
34. Transport of Infants and Children
35. Home Care
36. Quality and Safety
, Test Bank - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
Chapter 1: Fetal Lung Development
Walsh: Neonatal & Pediatric Respiratory Care 5th Edition Test Bank (2020)
MULTIPLE CHOICE
1. Which of the following phases of human lung development is characterized by the formation
of a capillary network around airway passages?
a. Pseudoglandular
b. Saccular
c. Alveolar
d. Canalicular
ANS: D
The canalicular phase follows the pseudoglandular phase, lasting from approximately 17
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
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
develops, ending with the terminal bronchioles. The saccular stage of development, which
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-
exchanging surface area occurs. The distinction between the saccular stage and the alveolar
stage is arbitrary. The alveolar stage stretches from 39 weeks of gestation to term. This stage
is represented by the establishment of alveoli.
REF: pp. 3-5
2. Regarding postnatal lung growth, by approximately what age do most of the alveoli that will
be present in the lungs for life develop?
a. 6 months
b. 1 year
c. 1.5 years
d. 2 years
ANS: C
Most of the postnatal formation of alveoli in the infant occurs over the first 1.5 years of life.
At 2 years of age, the number of alveoli varies substantially among individuals. After 2 years
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: p. 6
3. The respiratory therapist is evaluating a newborn with mild respiratory distress due to tracheal
stenosis. During which period of lung development did this problem develop?
, Test Bank - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
a. Embryonal
b. Saccular
c. Canalicular
d. Alveolar
ANS: A
The initial structures of the pulmonary tree develop during the embryonal stage. Errors in
development during this time may result in laryngeal, tracheal, or esophageal atresia or
stenosis. Pulmonary hypoplasia, an incomplete development of the lungs characterized by an
abnormally low number and/or size of bronchopulmonary segments and/or alveoli, can
develop during the pseudoglandular phase. If the fetus is born during the canalicular phase
(i.e., prematurely), severe respiratory distress can be expected because the inadequately
developed airways, along with insufficient and immature surfactant production by alveolar
type II cells, gives rise to the constellation of problems known as infant respiratory distress
syndrome.
REF: p. 6
4. Which of the following mechanisms is (are) responsible for the possible association between
oligohydramnios and lung hypoplasia?
I. Abnormal carbohydrate metabolism
II. Mechanical restriction of the chest wall
III. Interference with fetal breathing
IV. Failure to produce fetal lung liquid
a. I and III only
b. II and III only
c. I, II, and IV only
d. II, III, and IV only
ANS: D
Oligohydramnios, a reduced quantity of amniotic fluid present for an extended period of time,
with or without renal anomalies, is associated with lung hypoplasia. The mechanisms by
which amniotic fluid volume influences lung growth remain unclear. Possible explanations for
reduced quantity of amniotic fluid include mechanical restriction of the chest wall,
interference with fetal breathing, or failure to produce fetal lung liquid. These clinical and
experimental observations possibly point to a common denominator, lung stretch, as being a
major growth stimulant.
REF: pp. 6-7
5. What is the purpose of the substance secreted by the type II pneumocyte?
a. To increase the gas exchange surface area
b. To reduce surface tension
c. To maintain lung elasticity
d. To preserve the volume of the amniotic fluid
, Test Bank - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
ANS: B
The primary role of mammalian surfactant is to lower the surface tension within the alveolus,
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
an intricate blend of phospholipids, neutral lipids, and proteins.
REF: p. 8
6. Which of the following tests of the amniotic fluid have been shown to be sensitive indicators
of lung maturity?
a. Levels of prednisone
b. Levels of epidermal growth factor
c. Levels of prostaglandins
d. Levels of phosphatidylglycerol and phosphatidylcholine
ANS: D
Of clinical relevance during late gestation, analysis of amniotic fluid for the concentration of
phosphatidylglycerol and phosphatidylcholine has been shown to be a sensitive indicator of
the state of fetal lung maturity.
REF: p. 8
, Test Bank - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
Chapter 2: Fetal Gas Exchange and Circulation
Test Bank
MULTIPLE CHOICE
1. Which of the following embryonic germ layers gives formation to the respiratory system?
a. Endoderm
b. Mesoderm
c. Ectoderm
d. Periderm
ANS: A
The respiratory system—pharynx, lungs, and epithelial lining of the trachea and lungs—
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.
REF: p. 13
2. What is the function of Wharton’s jelly inside the umbilical cord?
a. To help provide nutrition to the fetus
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
, Test Bank - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
c. Day 45
d. Day 60
ANS: B
By day 22 cardiac contractions are detectable and bidirectional tidal blood flow begins.
REF: p. 14
5. Which of the following anatomic structures is a (are) fetal shunt(s)?
I. Foramen ovale
II. Sinus venosus
III. Ductus venosus
IV. Ductus arteriosus
a. III only
b. I, III, and IV only
c. I, II, and IV only
d. II, III, and IV only
ANS: B
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 - Neonatal and Pediatric Respiratory Care 5th Edition (Walsh, 2019)
REF: p. 18
7. How long after birth should it take for the ductus arteriosus to close completely?
a. 24 hours
b. 48 hours
c. 96 hours
d. 1 week
ANS: C
Because the pressure in the aorta also increases and becomes greater than the pressure in the
pulmonary artery, the amount of shunting through the ductus arteriosus decreases. The
functional closure of the ductus arteriosus occurs as a result of being exposed to an increased
PO2, a decrease in PVR leading to the reduction in blood pressure within the ductal lumen, a
decrease in the local production of prostaglandins, and a reduction in the number of
prostaglandin receptors within the tissue of the ductus arteriosus. Normally, constriction of the
ductus arteriosus starts to occur at birth, and 20% of the ductus closes within 24 hours, with
80% closed in 48 hours, and 100% by 96 hours after birth.
REF: p. 18
