Chapter 15 Pulmonary Disorders
1. The formation of respiratory bronchioles (i.e., acini) during the canalicular stage of fetal lung development is significant because it heralds:
2. Which of the following statements is the most accurate about what occurs during the terminal sac stage of fetal lung development?
3. A newborn infant with respiratory difficulty is diagnosed with a congenital chylothorax. A thoracentesis followed by placement of a tube thoracotomy for continuous drainage is performed. The nurse must monitor this patient closely for:
4. Lung development is completed by what age?
5. Surfactant improves lung function by:
6. Which of the following populations of infants at 36 weeks of gestation would be at increased risk for developing respiratory distress syndrome?
7. Surfactant is produced in the lungs by:
8. Early signs of respiratory disease in a neonate include:
9. Mechanically ventilated infants must be monitored for acid-base status. Prolonged, severe hypocapnia resulting in respiratory alkalosis places the infant at risk for:
10. In the delivery room a 1200-g infant at 30 weeks’ gestation shows grunting, nasal flaring, and chest wall retractions. Which of the following pulmonary pathophysiologic conditions is most likely occurring?
11. Expiratory grunting represents the infant’s attempt to:
12. To rule out group B streptococcal infection as an underlying cause of respiratory distress, which of the following studies would be most appropriate?
13. A radiographic picture of grainy lungs and prominent air bronchograms is characteristic of respiratory distress syndrome and indicates which of the following conditions?
14. Results of an infant’s arterial blood gas analysis are pH 7.25, Paco2 70, HCO3 21, base deficit –4, Pao2 50, and oxygen saturation 88%. These blood gas results are indicative of which acid-base condition?
15. An infant is being mechanically ventilated because of respiratory failure secondary to respiratory distress syndrome. Arterial blood gas results indicate a rising Paco2. Breath sounds are coarse bilaterally, with bubbling of secretions observed in the endotracheal tube. The infant is extremely restless, with “seesaw” respirations. The ventilator is consistently sounding an alarm for high inspiratory pressure. The nurse’s first action should be to:
16. By 72 hours of life, a small preterm infant who has been treated with surfactant for respiratory distress syndrome develops a grade II-VI continuous murmur at the left upper sternal border. Bilateral rales are heard on auscultation of breath sounds. Bounding peripheral pulses with a widened pulse pressure are present. Urine output is less than 2 ml/kg/hour. Blood gas analyses reveal increasing hypoxemia, hypercarbia, and metabolic acidosis with subsequent need for increased ventilatory support. These findings are most consistent with which condition?
17. Medical management of an infant with respiratory distress complicated by patent ductus arteriosus would include which of the following?
18. The clinical presentation of tachypnea, hypercarbia, tissue mottling, diminished capillary refill, and oliguria associated with patent ductus arteriosus in the preterm infant is the result of which of the following conditions?
19. Which of the following is a complication associated with patent ductus arteriosus?
20. Nursing management of a preterm infant with acute respiratory distress syndrome should be directed toward:
21. When assessing an infant with respiratory distress syndrome, the nurse calculates the infant’s urine output to be more than 5 ml/kg/hour for an 8-hour period. The nurse suspects that the increase in urine output is indicative of which of the following conditions?
22. A maternal history of chorioamnionitis, fever, premature rupture of membranes longer than 24 hours, prolonged labor with intact membranes, and excessive obstetric manipulations predisposes the infant to which of the following conditions?
23. A 39-week large-for-gestational-age infant was delivered by cesarean section. The Apgar scores were 8 and 9 at 1 and 5 minutes, respectively, and initial vital signs were stable. At 2 hours of age, the infant exhibits increased work of breathing and a pulse oximetry reading of 88% on room air. Blow-by oxygen raises the oxygen saturation to 96%. An arterial blood gas analysis reveals the following: pH 7.36, Paco2 37, HCO3 24, and Pao2 65. Appropriate management for this infant would include which of the following interventions?
24. The initial chest radiograph for a large-for-gestational-term infant delivered by caesarean section reveals diffuse haziness with prominent perihilar streaking bilaterally and fluid in the fissures. This radiographic picture is consistent with which diagnosis?
25. The underlying clinical pathology of transient tachypnea of the newborn is respiratory distress resulting from which of the following conditions?
26. Which of the following would be included in the differential diagnosis of transient tachypnea of the newborn?
27. Severe asphyxia of the full-term infant in the early neonatal period may result in which of the following conditions?
28. Central apnea is defined as:
29. The neonate’s unique response to hypoxemia and carbon dioxide retention is characterized by:
30. Which of the following nursing interventions may exacerbate apnea in preterm infants?
31. As the nurse prepares to administer a dose of caffeine to a preterm infant, the nurse determines that the infant is tachycardic, with a heart rate of 190 beats/minute. The infant is resting quietly in the incubator. The nurse should:
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