Neonatal and Pediatric Respiratory Care 6th Edition Test Bank
Chapter 01: Fetal Lung Development
Walsh: Neonatal and Pediatric Respiratory Care, 6th Edition
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 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.
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. 2 years
d. 3 years
ANS: C
Most of the postnatal formation of alveoli in the infant occurs over the first 2 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.
, Neonatal and Pediatric Respiratory Care 6th Edition Test Bank
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, give rise to the constellation of problems known as infant respiratory distress
syndrome.
4. Which of the following mechanisms 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.
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.
, Neonatal and Pediatric Respiratory Care 6th Edition Test Bank
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.
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 02: Fetal Gas Exchange and Circulation
Walsh: Neonatal and Pediatric Respiratory Care, 6th Edition
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.
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
, Neonatal and Pediatric Respiratory Care 6th Edition Test Bank
d. To regulate the temperature between the fetus and the mother
ANS: B
Wharton’s jelly, a gelatinous substance inside the umbilical cord, helps protects the vessels of
the fetus and may prevent the cord from kinking.
3. A pregnant woman is coming for an early prenatal evaluation and wants to know which organ
is the first to completely form. What organ would you tell her?
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.
4. A pregnant woman is coming for an early prenatal evaluation and wants to know if she can
listen to the baby’s heartbeat. About 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.
5. Which of the following anatomic structures are fetal shunts?
I. Foramen ovale
II. Sinus venosus
III. Ductus venosus
IV. Ductus arteriosus
a. I and III only
b. I, III, and IV only
c. I, II, and IV only
d. II, III, and IV only
ANS: B
The three shunts present in the fetus that close soon after birth 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.
6. Under normal developmental conditions 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
