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  • November 13, 2023
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  • neonatal and pediatric
  • neonatal
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Test Bank for Neonatal and Pediatric
Respiratory Care, 6th Edition
by Brian K. Walsh

,Chapter 1: Fetal Lung Development
Test Bank
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?
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 anomTaElieSsT
, iB
sAasNsoKcS
iaE
teLdLwEitR
h .luCnO
gMhypoplasia. 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
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

7. Approximately how much fetal lung fluid is secreted daily?
a. About 150 to 200 ml
b. About 250 to 300 ml
c. About 350 to 400 ml
d. About 450 to 500 ml

ANS: B

Fetal lungs are secretory organs that make breathing-like movements but serve no respiratory function before
birth. They secrete
about 250 to 300 ml of liquid per day.


8. The lung bud emerges from which of the following structures?
a. The pharynx
b. The foregut
c. The mesenchyme
d. The tubular epithelium

ANS: A

The embryonal phase includes primitive lung development and is generally regarded to encompass the first 2
months of gestation.
The lung begins to emerge as a bud from the pharynx 26 days after conception.

,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 varioustissue
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 TthE
eScoTrdBA
froNm
KSkiEnkLiL
ngE.

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
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.

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

,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
ANS: 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.

REF: p. 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
ANS: 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.

REF: p. 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
ANS: 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.

REF: p. 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.
ANS: 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 drinksTdEaS
ilyTtBhA
roN
ugKhSoE
utLpL
reEgR
na.nC
cyO. M
However, no safe range of alcohol
consumption during pregnancy exists.

REF: p. 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.
ANS: A
The mean birth weight of infants of women who smoke during pregnancy is about 200 g less
than that of infants of nonsmokers.

REF: p. 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?

, I. Premature rupture of membranes
II. Placental abruption
III. Placenta previa
IV. Sudden infant death syndrome
a. II and IV only
b. I, II, and III only
c. I and III only
d. I, II, III, and IV
ANS: D
Smoking is associated with a higher incidence of preterm premature rupture of membranes
(rupture of the membranes before the onset of labor—before 37 weeks of gestation), placental
abruption (separation of the placenta before birth of the newborn), and placenta previa (the
placenta partially or completely covers the cervix), and risk of infant death from sudden infant
death syndrome, (the unexplained death of an infant under 1 year of age).

REF: p. 24

7. Which of the following conditions are associated with preeclampsia?

I. Multiparity
II. Proteinuria
III. Generalized edema
IV. Hypertension
a. II and III
b. I, II, and III
c. I, III, and IV
d. II, III, and IV
ANS: D
Preeclampsia is a pregnancy-specific multisystem disorder traditionally diagnosed as the onset
or exacerbation of hypertension, proteinuria, and edema in the second half of pregnancy. It
complicates approximately 5% to 8% of pregnancies.

REF: p. 24

8. What is the main potential problem associated with the premature rupture of membranes?
a. Fetal dehydration
b. Fetal infection
c. Maternal hypotension
d. Maternal renal failure
ANS: B
In utero, the fetus is contained in the sterile fluid-filled amniotic sac. If the membranes that
compose the external lining of the amniotic sac rupture before term (before 37 weeks of
gestation) or before the onset of normal labor at term, the fetal environment is no longer
sterile, increasing the risk of fetal infection.

REF: p. 25

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