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NEONATAL AND PEDIATRIC RESPIRATORY CARE 6TH
EDITION
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,Neonatal And Pediatric Respiratory Care, 6th Edition, Brian K. Walsh 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
Chapter 4. Examination And Assessment Of The Neonatal And Pediatric Patient
Chapter 5. Pulmonary Function Testing And Bedside Pulmonary Mechanics
Chapter 6. Radiographic Assessment
Chapter 7. Pediatric Flexible Bronchoscopy
Chapter 8. Invasive Blood Gas Analysis And Cardiovascular Monitoring
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
,Chapter 1: Fetal Lung Development
Walsh: Neonatal & Pediatric Respiratory Care 6th Edition Test Bank (2024)
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
ANSWER: 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.
REFER TO; PAGE. 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
ANSWER: 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.
REFER TO; PAGE. 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?
, a. Embryonal
b. Saccular
c. Canalicular
d. Alveolar
ANSWER: 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.
REFER TO; PAGE. 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
ANSWER: 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.
REFER TO; PAGE. 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
, ANSWER: 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.
REFER TO; PAGE. 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
ANSWER: 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.
REFER TO; PAGE. 8
,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
ANSWER: 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.
REFER TO; PAGE. 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
ANSWER: 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.
REFER TO; PAGE. 13
3. Which Of The Following Organs Is Considered To Be The First To Form?
a. Heart
b. Brain
c. Lungs
d. Kidneys
ANSWER: 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.
REFER TO; PAGE. 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
d. Day 60
ANSWER: B
By Day 22 Cardiac Contractions Are Detectable And Bidirectional Tidal Blood Flow Begins.
REFER TO; PAGE. 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
ANSWER: 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.
REFER TO; PAGE. 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
ANSWER: 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.
, REFER TO; PAGE. 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
ANSWER: 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.
REFER TO; PAGE. 18
,Chapter 3: Antenatal Assessment And High Risk Delivery
Test Bank
Multiple Choice
1. A Pregnant Woman Has Been Diagnosed With Pregestational Diabetes. Which Of The
Following Risk Factors Should The Therapist Be Aware At The Time Of Delivery?
a. Unexplained Abruption Placenta
b. Oligohydramnios
c. Microcephaly
d. Fetal Malformations
ANSWER: C
Adverse Fetal Outcomes Include Unexplained Fetal Death In The Third Trimester Of
Pregnancy And Major Fetal Structural Malformations. Close Surveillance Of The Maternal
Metabolism And Close Fetal Biophysical Evaluation Have Significantly Decreased The Risk
Of Fetal Death As Well As The Necessity Of Delivering A Fetus Prematurely Because Of
Abnormal Test Results. The Rate Of Fetal Structural Malformations In Infants Born To
Pregestational Diabetic Women Can Be As High As 10% To 15% Compared With A Rate Of
1% To 2% For Infants Of Otherwise Normal Women. The Most Frequently Encountered
Defects Include Malformations Of The Cardiovascular System, Including Both The Heart And
Great Vessels, And The Central Nervous System, Including The Brain And Spinal Cord. No
Amount Of Maternal Metabolic Surveillance Or Fetal Biophysical Assessment After The
Period Of Fetal Organogenesis Will Decrease This Risk. Therefore, It Is Recommended
Strongly That Women With Diabetes Mellitus Receive Counseling And Treatment With The
Goal Of Achieving Optimal Glycemic Control Before They Become Pregnant.
REFER TO; PAGE. 22
2. The Respiratory Therapist Is Attending A Term Labor Of A Woman Diagnosed With
Gestational Diabetes. The Baby Is Very Large For Gestational Age. What Other Metabolic
Disturbances Should Be Considered?
I. Hyperglycemia
II. Hypocalcemia
III. Hyperkalemia
IV. Hypoglycemia
a. Ii And Iv Only
b. I, Ii, And Iii Only
c. I And Iii Only
d. Ii, Iii, And Iv Only
ANSWER: D
Poor Blood Sugar Control In These Women Is Associated With An Increased Risk Of
Macrosomia (Birth Weight Greater Than 4000 G), Traumatic Vaginal Delivery, Preterm
Delivery, And A Small Risk Of Fetal Death In Some Women. After Delivery, The Infants
Are At Increased Risk For Metabolic Disturbances In The Neonatal Period; These Include
Hypoglycemia, Hypocalcemia, Hyperkalemia, Hyperbilirubinemia, And Idiopathic
Respiratory Distress Syndrome.
REFER TO; PAGE. 22
, 3. Which Of The Following Microorganisms Often Affect Pregnancy Outcome?
a. Group B Streptococcus
b. Haemophilus Influenzae
c. Mycobacterium Tuberculosis
d. Hepatitis C Virus
ANSWER: A
A Number Of Infectious Agents Can Affect Pregnancy Outcome. Among The Most Important
In The United States Are Group B Streptococcus (Gbs), Herpes Simplex Virus (Hsv),
Human Immunodeficiency Virus (Hiv), And Hepatitis B Virus (Hbv). As Many As 10% To
40% Of Pregnant Women Are Colonized With Gbs. Their Infants Are At Risk For Death Or
Severe Morbidity If They Are Born Prematurely Or After Prolonged Rupture Of The Fetal
Membranes.
REFER TO; PAGE. 23
4. What Is Generally Accepted As A Safe Limit For Alcohol Consumption During Pregnancy
To Avoid The Development Of Fetal Alcohol Syndrome?
a. One To Two 8-Ounce Drinks Per Day Are Considered Acceptable.
b. Four To Five 8-Ounce Drinks Per Week Are Considered Safe.
c. Three To Four 12-Ounce Drinks Per Week Are Considered Reasonable.
d. No Safe Range Of Alcohol Consumption Is Deemed Safe During Pregnancy.
ANSWER: D
Alcohol Is A Potent Teratogen, An Agent Or Factor That Causes Malformation In The
Fetus. Fetal Alcohol Syndrome, Associated With Maternal Use Of Alcohol In Pregnancy, Is
Characterized By Mental Retardation And Prenatal And Postnatal Growth Restriction, As
Well As By Brain, Cardiac, Spinal, And Craniofacial Anomalies. It Is Usually Seen Among
Children Of Women Who Consume Four To Six Alcoholic Drinks Daily Throughout
Pregnancy. However, No Safe Range Of Alcohol Consumption During Pregnancy Exists.
REFER TO; PAGE. 24
5. What Is The Average Birth Weight Difference Between Infants Born Of Mothers Who
Smoke And Those Born Of Nonsmoking Mothers?
a. Infants Born Of Mothers Who Smoke Tend To Be About 200 G Lighter Than
Infants Born Of Mothers Who Do Not Smoke.
b. Infants Born Of Mothers Who Smoke Are Generally About 400 G Lighter Than
Infants Born Of Nonsmoking Mothers.
c. Infants Born Of Mothers Who Smoke Are Predisposed To Weigh Approximately
600 G Less Than Infants Born Of Mothers Who Do Not Smoke.
d. Infants Of Mothers Who Smoke Are Likely To Be Born About 800 G Lighter
Than Those Born Of Mothers Who Do Not Smoke.
ANSWER: A
The Mean Birth Weight Of Infants Of Women Who Smoke During Pregnancy Is About 200
G Less Than That Of Infants Of Nonsmokers.
REFER TO; PAGE. 24
6. A Woman With A Long History Of Smoking Is Now In The Last Part Of The Third
Trimester Of Her Pregnancy. She Is At High Risk For Which Of The Following
Conditions?
