CHAPTER 22: Exam. Questions and Answers

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) Which of the following determines lung compliance? 1) A) flexibility of the thoracic cage B) muscles of inspiration C) airway opening D) alveolar surface tension 2) The larynx contains . 2) A) lateral cartilage ridges called false vocal folds B) the thyroid cartilage C) an upper pair of avascular mucosal folds called true vocal folds D) a cricoid cartilage also called the Adam's apple Answer: B 3) Which center is located in the pons? 3) A) expiratory B) inspiratory C) pacemaker neuron center D) pontine respirator group (PRG) 4) Possible causes of hypoxia include . 4) A) taking several rapid deep breaths B) getting very cold C) too little oxygen in the atmosphere D) obstruction of the esophagus 5. Select the correct statement about the pharynx. B) The palatine tonsils are embedded in the lateral walls of the nasopharynx. C) The laryngopharynx blends posteriorly into the nasopharynx. D) The pharyngeal tonsil is located in the laryngopharynx. E) The auditory tube drains into the nasopharynx. 5) Complete the following statement using the choices below. Air moves out of the lungs when the pressure inside the lungs is A) less than the pressure in the atmosphere. B) equal to the pressure in the atmosphere. C) greater than the intra- alveolar pressure. D) greater than the pressure in the atmosphere. 6) 6) The nose serves all the following functions except . 7) A) warming and humidifying the air B) cleansing the air C) as a passageway for air movement D) as the initiator of the cough reflex 7) How is the bulk of carbon dioxide carried in blood? 8) A) chemically combined with the heme portion of hemoglobin B) as the bicarbonate ion in the plasma after first entering the red blood cells C) chemically combined with the amino acids of hemoglobin as carbaminohemoglobin in the red blood cells D) as carbonic acid in the plasma Answer: B 8) Oxygen and carbon dioxide are exchanged in the lungs and through all cell membranes by . A) active transport B) filtration C) diffusion D) osmosis 9) The walls of the alveoli are composed of two types of cells, type I and type II. The function of type II is to _. A) replace mucus in the alveoli B) trap dust and other debris C) protect the lungs from bacterial invasion D) secrete surfactant 10) Which of the following does not influence the increase in ventilation that occurs as exercise is initiated? A) proprioceptors B) psychic stimuli C) decrease in lactic acid levels D) simultaneous cortical motor activation of the skeletal muscles and respiratory center 11) Intrapulmonary pressure is the . 12) A) negative pressure in the intrapleural space B) pressure within the pleural cavity C) pressure within the alveoli of the lungs D) difference between atmospheric pressure and respiratory pressure 12) Which of the choices below determines the direction of respiratory gas movement? 13) A) solubility in water B) partial pressure gradient C) molecular weight and size of the gas molecule D) the temperature Answer: B 13) Which of the following provide the greatest surface area for gas exchange? 14) A) alveoli B) alveolar sacs C) respiratory bronchioles D) alveolar ducts 14) Which of the following is not an event necessary to supply the body with O2 and dispose of CO2? 15) A) blood pH adjustment B) external respiration C) pulmonary ventilation D) internal respiration Explanation: 15) Unlike inspiration, expiration is a passive act because no muscular contractions are involved. Expiration, however, depends on two factors. Which of the choices below lists those two factors? A) combined amount of CO2 in the blood and air in the alveoli B) the recoil of elastic fibers that were stretched during inspiration and the inward pull of surface tension due to the film of alveolar fluid C) the negative feedback of expansion fibers used during inspiration and the outward pull of surface tension due to surfactant D) the expansion of respiratory muscles that were contracted during inspiration and the lack of surface tension on the alveolar wall Answer: B 16) 16) Tidal volume is air . 17) A) inhaled after normal inspiration B) exchanged during normal breathing C) forcibly expelled after normal expiration D) remaining in the lungs after forced expiration Answer: B 17) The most powerful respiratory stimulus for breathing in a healthy person is . 18) A) loss of oxygen in tissues B) pH (alkalosis) C) pH (acidosis) D) increase of carbon dioxide 18) Surfactant helps to prevent the alveoli from collapsing by . 19) A) interfering with the cohesiveness of water molecules, thereby reducing the surface tension of alveolar fluid B) protecting the surface of alveoli from dehydration and other environmental variations C) humidifying the air before it enters D) warming the air before it enters 19) Which of the following maintains the patency (openness) of the trachea? 20) A) cartilage rings B) surfactant C) surface tension of water D) pseudostratified ciliated epithelium Explanation: 20) Select the correct statement about the physical factors influencing pulmonary ventilation. 21) A) Surfactant helps increase alveolar surface tension. B) A lung that is less elastic will require less muscle action to perform adequate ventilation. C) As alveolar surface tension increases, additional muscle action will be required. D) A decrease in compliance causes an increase in ventilation. 21) Respiratory control centers are located in the . 22) A) upper spinal cord and medulla B) medulla and pons C) midbrain and medulla D) pons and midbrain Answer: B Explanation: 22) The amount of air that can be inspired above the tidal volume is called . 23) A) vital capacity B) reserve air C) expiratory reserve D) inspiratory reserve Explanation: 23) The lung volume that represents the total volume of exchangeable air is the . 24) A) vital capacity B) inspiratory capacity C) expiratory reserve volume D) tidal volume Explanation: 24) Which of the following does not influence hemoglobin saturation? 25) A) carbon dioxide B) temperature C) DPG D) nitric oxide Explanation: A) B) C) D) 25) A premature baby usually has difficulty breathing. However, the respiratory system is developed enough for survival by . A) 24 weeks B) 36 weeks C) 17 weeks D) 28 weeks Explanation: A) B) C) D) 26) 26) Nerve impulses from will result in inspiration. 27) A) the preoptic nucleus of the hypothalamus B) Broca's center C) the chemoreceptor center D) the ventral respiratory group Explanation: A) B) C) D) 27) The erythrocyte count increases after a while when an individual goes from a low to a high altitude because the . A) concentration of oxygen and/or total atmospheric pressure is higher at higher altitudes B) concentration of oxygen and/or total atmospheric pressure is lower at high altitudes C) temperature is lower at higher altitudes D) basal metabolic rate is higher at high altitudes Answer: B Explanation: A) B) C) D) 28) 28) Select the correct statement about oxygen transport in blood: 29) A) During conditions of acidosis, hemoglobin is able to carry oxygen more efficiently. B) Increased BPG levels in the red blood cells enhance oxygen- carrying capacity. C) A 50% oxygen saturation level of blood returning to the lungs might indicate an activity level higher than normal. D) During normal activity, a molecule of hemoglobin returning to the lungs carries one molecule of O2. Explanation: A) B) C) D) 29) Which of the choices below describes the forces that act to pull the lungs away from the thorax wall and thus collapse the lungs? A) compliance and the surface tension of the alveolar fluid B) compliance and transpulmonary pressures C) the natural tendency for the lungs to recoil and transpulmonary pressures D) the natural tendency for the lungs to recoil and the surface tension of the alveolar fluid Explanation: A) B) C) D) 30) 30) Which respiratory- associated muscles would contract if you were to blow up a balloon? 31) A) external intercostals would contract and diaphragm would relax B) internal intercostals and abdominal muscles would contract C) diaphragm contracts, internal intercostals would relax D) diaphragm would contract, external intercostals would relax Answer: B Explanation: A) B) C) D) 31) Gas emboli may occur because a . 32) A) diver holds his breath upon ascent B) pilot holds her breath upon descent C) person breathes pure oxygen in a pressurized chamber D) person holds his breath too long Explanation: A) B) C) D) 32) Which of the following statements is true regarding the respiratory rate of a newborn? 33) A) The respiratory rate of a newborn is slow. B) The respiratory rate of a newborn varies between male and female infants. C) The respiratory rate of a newborn is, at its highest rate, approximately 40- 80 respirations per minute. D) The respiratory rate of a newborn is approximately 30 respirations per minute. Explanation: A) B) C) D) 33) In the plasma, the quantity of oxygen in solution is . 34) A) only about 1.5% of the oxygen carried in dissolved form B) greater than the oxygen combined with hemoglobin C) about equal to the oxygen combined with hemoglobin D) not present except where it is combined with carrier molecules Explanation: A) B) C) D) 34) The loudness of a person's voice depends on the . 35) A) strength of the intrinsic laryngeal muscles B) length of the vocal folds C) thickness of vestibular folds D) force with which air rushes across the vocal folds Explanation: A) B) C) D) 35) The respiratory membrane is a combination of . 36) A) respiratory bronchioles and alveolar sacs B) respiratory bronchioles and alveolar ducts C) atria and alveolar sacs D) alveolar and capillary walls and their fused basement membranes Explanation: A) B) C) D) 36) Which of the following statements is incorrect? 37) A) During fetal life, lungs are filled with fluid. B) Respiratory rate is lowest in newborn infants. C) The chest wall becomes more rigid with age. D) Descent of the diaphragm results in abdominal breathing. Answer: B Explanation: A) B) C) D) 37) Which of the choices below is not a factor that promotes oxygen binding to and dissociation from hemoglobin? A) number of red blood cells B) partial pressure of carbon dioxide C) temperature D) partial pressure of oxygen Explanation: A) B) C) D) 38) Which of the disorders below is characterized by destruction of the walls of the alveoli producing abnormally large air spaces that remain filled with air during exhalation? A) emphysema B) pneumonia C) tuberculosis D) coryza Explanation: A) B) C) D) 38) 39) 39) The statement, "in a mixture of gases, the total pressure is the sum of the individual partial pressures of gases in the mixture" paraphrases . A) Henry's law B) Boyle's law C) Charles' law D) Dalton's law Explanation: A) B) C) D) 40) 40) Which of the following is not possible? 41) A) Resistance equals pressure gradient over gas flow. B) Gas flow equals pressure gradient over resistance. C) Pressure gradient equals gas flow over resistance. D) The amount of gas flowing in and out of the alveoli is directly proportional to the difference in pressure or pressure gradient between the external atmosphere and the alveoli. Explanation: A) B) C) D) 41) For gas exchange to be efficient, the respiratory membrane must be . 42) A) between 5 and 6 micrometers thick B) at least 3 micrometers thick C) 0.5 to 1 micrometer thick D) The thickness of the respiratory membrane is not important in the efficiency of gas exchange. Explanation: A) B) C) D) 42) Most inspired particles such as dust fail to reach the lungs because of the . 43) A) abundant blood supply to nasal mucosa B) porous structure of turbinate bones C) ciliated mucous lining in the nose D) action of the epiglottis Explanation: A) B) C) D) 43) Which of the following is not found on the right lobe of the lung? 44) A) middle lobe B) oblique fissure C) horizontal fissure D) cardiac notch Explanation: A) B) C) D) 44) Which of the following is not true of the respiratory tract from the medium bronchi to the aveoli? 45) A) Resistance to air flow increases due to the increase in cross- sectional diameter. B) Cartilage gradually decreases and disappears at the bronchioles. C) Lining of the tubes changes from ciliated columnar to simple squamous epithelium in the alveoli. D) Proportionally, smooth muscle decreases uniformly. Explanation: A) B) C) D) 45) Because the lungs are filled with fluid during fetal life, which of the following statements is true regarding respiratory exchange? A) Respiratory exchanges are made through the ductus arteriosus. B) Respiratory exchanges are made through the placenta. C) Respiratory exchanges are not necessary. D) Because the lungs develop later in gestation, fetuses do not need a mechanism for respiratory exchange. Answer: B Explanation: A) B) C) D) 46) 46) Which of the following is not a form of lung cancer? 47) A) squamous cell carcinoma B) small cell carcinoma C) adenocarcinoma D) Kaposi's sarcoma Explanation: A) B) C) D) 47) With the Bohr effect, more oxygen is released because a(n) . 48) A) increase in pH (alkalosis) strengthens the hemoglobin- oxygen bond B) decrease in pH (acidosis) strengthens the hemoglobin- oxygen bond C) increase in pH (alkalosis) weakens the hemoglobin- oxygen bond D) decrease in pH (acidosis) weakens the hemoglobin- oxygen bond Explanation: A) B) C) D) 48) Which of the choices below is not a role of the pleura? 49) A) aids in blood flow to and from the heart because the heart sits between the lungs B) helps limit the spread of local infections C) allows the lungs to inflate and deflate without friction D) helps divide the thoracic cavity into three chambers Explanation: A) B) C) D) 49) Which statement about CO2 is incorrect? 50) A) Its concentration in the blood is decreased by hyperventilation. B) CO2 concentrations are greater in venous blood than arterial blood. C) More CO2 dissolves in the blood plasma than is carried in the RBCs. D) Its accumulation in the blood is associated with a decrease in pH. Explanation: A) B) C) D) 50) The factors responsible for holding the lungs to the thorax wall are . 51) A) the smooth muscles of the lung B) the visceral pleurae and the changing volume of the lungs C) surface tension from pleural fluid and negative pressure in the pleural cavity D) the diaphragm and the intercostal muscles alone Explanation: A) B) C) D) 51) Select the correct statement about the neural mechanisms of respiratory control. 52) A) The dorsal respiratory group neurons depolarize in a rhythmic way to establish the pattern of breathing. B) The pons is thought to be instrumental in the smooth transition from inspiration to expiration. C) The pontine respirator group (PRG) continuously stimulates the medulla to provide inspiratory drive. D) The ventral respiratory group is contained within the pons. Answer: B Explanation: A) B) C) D) 52) Which of the choices below is not a functional process performed by the respiratory system? 53) A) transport of respiratory gases B) external respiration C) pulmonary respiration D) pulmonary ventilation Which of the following correctly describes mechanisms of CO2 transport? 54) B) 20% of CO2 is carried in the form of carbaminohemoglobin C) attached to the heme part of hemoglobin D) as bicarbonate ion in plasma E) 7—10% of CO2 is dissolved directly into the plasma 53) The relationship between the pressure and volume of gases is given by . 55) A) Boyle's law B) Charles' law C) Dalton's law D) Henry's law Explanation: A) B) C) D) 54) Factors that influence the rate and depth of breathing include . 56) A) composition of alveolar air B) thalamic control C) stretch receptors in the alveoli D) voluntary cortical control Inspiratory capacity is . 57) B) functional residual capacity C) air inspired after a tidal inhalation D) the total amount of exchangeable air E) the total amount of air that can be inspired after a tidal expiration 55) Which of the following is not a stimulus for breathing? 58) A) rising blood pressure B) rising carbon dioxide levels C) arterial Po2 below 60 mm Hg D) arterial pH resulting from CO2 retention SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question. 56) law is called the law of partial pressure. 59) alton's Explanation: 57) Oxygen unloading in a RBC due to declining pH is called the . 60) Answer: Bohr effect Explanation: Figure 22.2 Using Figure 22.2, match the following: 58) Expiratory reserve volume. 61) 59) Type II alveolar cells secrete _ _. 62) 60) is the most common lethal genetic disease in the United States. 63) ystic fibrosis Figure 22.1 Using Figure 22.1, match the following: 61) Larynx. 64) Answer: B Explanation: 62) The contraction of the diaphragm and the external intercostal muscles begins inspiration. Explain exactly what happens, in terms of volume and pressure changes in the lungs, when these muscles contract. 65) Figure 22.2 Using Figure 22.2, match the following: 63) Air that does not participate in the exchange of gases. 66) Explanation: Figure 22.1 Using Figure 22.1, match the following: 64) Pharynx. 67) 65) The trachea is lined with epithelium. 68) iliated pseudostratified columnar 66) How is it possible to change the pitch of our voice from high to low? 69) Figure 22.1 Using Figure 22.1, match the following: 67) Main (primary) bronchus. 70) 68) law would apply to the amount of CO2 you could dissolve in a Pepsi. 71) 69) The partial pressure gradient for oxygen (in the body) is much steeper than that for carbon dioxide. Explain how equal amounts of these two gases can be exchanged (in a given time interval) in the lungs and at the tissues. 72) 70) The regulates smoothing of transitions from inspiration to expiration. 73) Figure 22.2 Using Figure 22.2, match the following: 71) Inspiratory reserve volume. 74) 72) How is alveolar gas exchange affected by emphysema and pneumonia? 75) Figure 22.1 Using Figure 22.1, match the following: 73) Carina of trachea. 76) 74) The archway in the back of the throat is called the . 77) 75) What is the chloride shift and why does it occur? 78) 76) Distinguish among anemic, ischemic, histotoxic, and hypoxemic hypoxia. 79) 77) If a baby is born at 28 weeks' gestation, what major problem will the doctors look for? 80) 78) Terminal bronchioles are lined with epithelium. 81) uboidal Explanation: Figure 22.1 Using Figure 22.1, match the following: 79) Trachea. 82) Explanation: 80) The cartilaginous flap that closes the trachea during swallowing is called the _. 83) piglottis Figure 22.2 Using Figure 22.2, match the following: 81) Residual volume. 84) Explanation: 82) Define anatomical dead space. What is the relationship between anatomical and alveolar dead space? Which value is likely to increase during lung pathology? 83) Briefly differentiate between atmospheric pressure, intrapulmonary pressure, and intrapleural pressure. Which of these is always negative in a healthy individual during normal breathing? What happens if intrapleural pressure becomes equal to atmospheric pressure? 85) 86) Figure 22.2 Using Figure 22.2, match the following: 84) Tidal volume. 87) Answer: B Explanation: TRUE/FALSE. Write 'T' if the statement is true and 'F' if the statement is false. 85) The Hering- Breuer reflex is a potentially dangerous response that may cause overinflation of the lung. Answer: True False Explanation: 88) 86) The alveolar ventilation rate is the best index of effective ventilation. 89) Answer: True False Explanation: 87) Nasal conchae mainly work on inhalation to warm and moisten air. They serve minor functions for exhalation. Answer: True False Explanation: 90) 88) Under certain conditions, the vocal folds act as a sphincter that prevents air passage. 91) Answer: True False Explanation: 89) Smoking diminishes ciliary action and eventually destroys the cilia. 92) Answer: True False Explanation: 90) Tracheal obstruction is life threatening. 93) Answer: True False 91) The olfactory mucosal lining of the nasal cavity contains the receptors for the sense of smell. 94) Answer: True False 92) Apneustic breathing is characterized by prolonged inspirations. 95) Answer: True False 93) The functions of the nasal conchae are to enhance the air turbulence in the cavity and to increase the mucosal surface area exposed to the air. Answer: True False 96) 94) Increased temperature results in decreased O2 unloading from hemoglobin. 97) Answer: True False 95) Intrapleural pressure is normally about 4 mm Hg less than the pressure in the alveoli. 98) Answer: True False 96) The parietal pleura lines the thoracic wall. 99) Answer: True False 97) Labored breathing is termed dyspnea. 100) Answer: True False 98) During normal quiet breathing, approximately 750 ml of air moves into and out of the lungs with each breath. Answer: True False 101) 99) Atelectasis (lung collapse) renders the lung useless for ventilation. 102) Answer: True False 100) Dalton's law states that the total pressure exerted by a mixture of gases is the sum of the pressures exerted independently by each gas in the mixture. Answer: True False 103) 101) The lungs are perfused by two circulations: the pulmonary and the bronchial. The pulmonary circulation is for oxygenation of blood. The bronchial circulation supplies blood to the lung structures (tissue). Answer: True False 102) In chronic bronchitis, mucus production is decreased and this leads to the inflammation and fibrosis of the mucosal lining of the bronchial tree. Answer: True False 103) As carbon dioxide enters systemic blood, it causes more oxygen to dissociate from hemoglobin (the Haldane effect), which in turn allows more CO2 to combine with hemoglobin and more bicarbonate ion to be generated (the Bohr effect). Answer: True False 104) Ventilation perfusion coupling means that more blood flows past functional alveoli than past nonfunctional alveoli. Answer: True False 104) 105) 106) 107) 105) Oxygenated hemoglobin releases oxygen more readily when the pH is more basic. 108) Answer: True False Explanation: 106) Changes in arterial pH can modify respiration rate and rhythm even when carbon dioxide and oxygen levels are normal. Answer: True False 107) Strong emotions and pain acting through the limbic system activate sympathetic centers in the hypothalamus, thus modulating respiratory rate and depth by sending signals to the respiratory centers. Answer: True False 109) 110) 108) The average individual has 500 ml of residual volume in his lungs. 111) Answer: True False 109) Valsalva's maneuver involves closing off the glottis (preventing expiration) while contracting the muscles of expiration, causing an increase in intra- abdominal pressure. Answer: True False 110) The largest amount of carbon dioxide is transported in the bloodstream in the form of carbonic anhydrase. Answer: True False 112) 113) 111) The epiglottis is a smooth muscle that covers the glottis during swallowing. 114) Answer: True False Explanation: MATCHING. Choose the item in column 2 that best matches each item in column 1. Match the following: 112) Terminates in alveoli. 113) The respiratory membrane is composed of fused basement membrane of the capillary walls and . 114) No exchange of gases occurs here. 115) Composed of cuboidal cells. 116) Composed of simple squamous epithelium. 117) Secrete a fluid containing surfactant. 118) Where the respiratory zone of the lungs begins. A) Type I cells B) Type II cells C) Respiratory bronchioles D) E) Segmental bronchi 115) 116) 117) 118) 119) 120) 121) ESSAY. Write your answer in the space provided or on a separate sheet of paper. 119) A patient was admitted to the hospital with chronic obstructive pulmonary disease. His PO2was 55 and PCO2 was 65. A new resident orders 54% oxygen via the venturi mask. One hour later, after the oxygen was placed, the nurse finds the patient with no respiration or pulse. She calls for a Code Blue and begins cardiopulmonary resuscitation (CPR). Explain why the patient stopped breathing. 120) After a long scuba diving session on a Caribbean reef, Carl boards a plane to Dallas. He begins to feel pain in his elbow on the flight back to Dallas. What is happening to him? 121) How will the lungs compensate for an acute rise in the partial pressure of CO2 in arterial blood? 122) Timothy has been having difficulty breathing since he had pneumonia last month. Recently he had severe pain in his chest and back, and his breathing was extremely irregular. The doctor at the emergency room told him that one of the lobes of his lung had collapsed. How could this happen? 123) A patient with tuberculosis is often noncompliant with treatment. Explain why this may happen. 124) While having a physical examination, a young male informed his doctor that at age 8 he had lobar pneumonia and pleurisy in his left lung. The physician decided to measure his VC. Describe the apparatus and method used for taking this measurement. Define the following terms used in the description of lung volumes: TV, IRV, ERV, RV, and VC. 125) John has undergone surgery and has developed pneumonia. He also has a history of emphysema. Which assessment parameters would the nurse expect to find? 126) A smoker sees his doctor because he has a persistent cough and is short of breath after very little exertion. What diagnosis will the doctor make and what can the person expect if he does not quit smoking? 127) Jane had been suffering through a severe cold and was complaining of a frontal headache and a dull, aching pain at the side of her face. What regions are likely to become sites of secondary infection following nasal infection? 128) While dining out in a restaurant a man suddenly chokes on a piece of meat. The waitress is also a student nurse and comes to the man's aid. She asks him if he can talk. The man responds by shaking his head no and grabbing at his neck. What is the significance of the man's inability to talk?