NURS PHARM EXAM II ACTUAL EXAM 2024/2025 NEWEST EXAM COMPLETE QUESTIONS WITH 100% CORRECT, Exams of Nursing

Download NURS PHARM EXAM II ACTUAL EXAM 2024/2025 NEWEST EXAM COMPLETE QUESTIONS WITH 100% CORRECT and more Exams Nursing in PDF only on Docsity!

NURS PHARM EXAM II ACTUAL EXAM 2024/2 025

NEWEST EXAM COMPLETE QUESTIONS WITH 100%

CORRECT VERIFIED ANSWERS GRADED A

During the cardiac cycle, which structure directly delivers action potential to the ventricular myocardium? a. Sinoatrial (SA) node b. Atrioventricular (AV) node c. Purkinje fibers d. Bundle branches c. Purkinje fibers Each cardiac action potential travels from the SA node to the AV node to the bundle of His (AV bundle), through the bundle branches, and finally to the Purkinje fibers and the ventricular myocardium, where the impulse is stopped. The cardiac electrical impulse normally begins spontaneously in the sinoatrial (SA) node because it: a. Has a superior location in the right atrium. b. Is the only area of the heart capable of spontaneous depolarization. c. Has rich sympathetic innervation via the vagus nerve. d. Depolarizes more rapidly than other automatic cells of the heart d. Depolarizes more rapidly than other automatic cells of the heart The electrical impulse normally begins in the SA node because its cells depolarize more rapidly than other automatic cells. What can shorten the conduction time of action potential through the atrioventricular (AV) node? a. Parasympathetic nervous system

b. Catecholamines c. Vagal stimulation d. Sinoatrial node (SA) b. Catecholamines Catecholamines speed the heart rate, shorten the conduction time through the AV node, and increase the rhythmicity of the AV pacemaker fibers. If the sinoatrial (SA) node fails, then at what rate (depolarizations per minute) can the atrioventricular (AV) node depolarize? a. 60 to 70 b. 40 to 60 c. 30 to 40 d. 10 to 20 b. 40 to 60 If the SA node is damaged, then the AV node will become the heart's pacemaker at a rate of approximately 40 to 60 spontaneous depolarizations per minute. Within a physiologic range, what does an increase in left ventricular end-diastolic volume (preload) result in? a. Increase in force of contraction b. Decrease in refractory time c. Increase in afterload d. Decrease in repolarization a. Increase in force of contraction This concept is expressed in the Frank-Starling law; the cardiac muscle, like other muscles, increases its strength of contraction when it is stretched.

As stated in the Frank-Starling law, a direct relationship exists between the _____ of the blood in the heart at the end of diastole and the _____ of contraction during the next systole. a. Pressure; force b. Volume; strength c. Viscosity; force d. Viscosity; strength b. Volume; strength As stated in the Frank-Starling law, the volume of blood in the heart at the end of diastole (the length of its muscle fibers) is directly related to the force (strength) of contraction during the next systole. What physical sign is the result of turbulent blood flow through a vessel? a. Increased blood pressure during periods of stress b. Bounding pulse felt on palpation c. Cyanosis observed on excretion d. Murmur heard on auscultation d. Murmur heard on auscultation Where flow is obstructed, the vessel turns or blood flows over rough surfaces. The flow becomes turbulent with whorls or eddy currents that produce noise, causing a murmur to be heard on auscultation, such as occurs during blood pressure measurement with a sphygomanometer. What is the initiating event that leads to the development of atherosclerosis? a. Release of the inflammatory cytokines b. Macrophages adhere to vessel walls. c. Injury to the endothelial cells that line the artery walls d. Release of the platelet-deprived growth factor c. Injury to the endothelial cells that line the artery walls Atherosclerosis begins with an injury to the endothelial cells that line the arterial walls. Possible causes

of endothelial injury include the common risk factors for atherosclerosis, such as smoking, hypertension, diabetes, increased levels of low-density lipoprotein (LDL), decreased levels of high-density lipoprotein (HDL), and autoimmunity. What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis? a. LDLs cause smooth muscle proliferation. b. LDLs cause regression of atherosclerotic plaques. c. LDLs increase levels of inflammatory cytokines. d. LDLs direct macrophages to the site in the endothelium. a. LDLs cause smooth muscle proliferation. Oxidized LDLs are toxic to endothelial cells, cause smooth muscle proliferation, and activate further immune and inflammatory responses. When endothelia cells are injured, what alteration contributes to atherosclerosis? a. The release of toxic oxygen radicals that oxidize low-density lipoproteins (LDLs). b. Cells are unable to make the normal amount of vasodilating cytokines. c. Cells produce an increased amount of antithrombotic cytokines. d. Cells develop a hypersensitivity to homocysteine and lipids. b. Cells are unable to make the normal amount of vasodilating cytokines. Injured endothelial cells become inflamed and cannot make normal amounts of antithrombotic and vasodilating cytokines. What effect does atherosclerosis have on the development of an aneurysm? a. Atherosclerosis causes ischemia of the intima. b. It increases nitric oxide. c. Atherosclerosis erodes the vessel wall. d. It obstructs the vessel.

c. Atherosclerosis erodes the vessel wall Atherosclerosis is a common cause of aneurysms because plaque formation erodes the vessel wall. What is the usual source of pulmonary emboli? a. Deep venous thrombosis b. Endocarditis c. Valvular disease d. Left heart failure a. Deep venous thrombosis Pulmonary emboli originate in the venous circulation (mostly from the deep veins of the legs) or in the right heart. Which factor can trigger an immune response in the bloodstream that may result in an embolus? a. Amniotic fluid b. Fat c. Bacteria d. Air a. Amniotic fluid Of the options available, only amniotic fluid displaces blood, thereby reducing oxygen, nutrients, and waste exchange; however, it also introduces antigens, cells, and protein aggregates that trigger inflammation, coagulation, and the immune response in the bloodstream. Superior vena cava syndrome is a result of a progressive increase of which process? a. Inflammation b. Occlusion c. Distention d. Sclerosis

b. Occlusion Superior vena cava syndrome (SVCS) is a progressive occlusion of the superior vena cava (SVC) that leads to venous distention in the upper extremities and head. What term is used to identify when a cell is temporarily deprived of blood supply? a. Infarction b. Ischemia c. Necrosis d. Inflammation b. Ischemia Coronary artery disease (CAD) can diminish the myocardial blood supply until deprivation impairs myocardial metabolism enough to cause ischemia, a local state in which the cells are temporarily deprived of blood supply. The risk of developing coronary artery disease is increased up to threefold by which factor? a. Diabetes mellitus b. Hypertension c. Obesity d. High alcohol consumption b. Hypertension Hypertension is the only factor responsible for a twofold-to-threefold increased risk of atherosclerotic cardiovascular disease. Which risk factor is associated with coronary artery disease (CAD) because of its relationship with the alteration of hepatic lipoprotein? a. Diabetes mellitus b. Hypertension

c. Obesity d. High alcohol consumption a. Diabetes mellitus Of the available options, only diabetes mellitus is associated with CAD because of the resulting alteration of hepatic lipoprotein synthesis; it increases triglyceride levels and is involved in low-density lipoprotein oxidation. Which elevated value may be protective of the development of atherosclerosis? a. Very low-density lipoproteins (VLDLs) b. Low-density lipoproteins (LDLs) c. High-density lipoproteins (HDLs d. Triglycerides c. High-density lipoproteins (HDLs Low levels of HDL cholesterol are also a strong indicator of coronary risk, whereas high levels of HDLs may be more protective for the development of atherosclerosis than low levels of LDLs. Which laboratory test is an indirect measure of atherosclerotic plaque? a. Homocysteine b. Low-density lipoprotein (LDL) c. Erythrocyte sedimentation rate (ESR) d. C-reactive protein (CRP) d. C-reactive protein (CRP) Highly sensitive CRP (hs-CRP) is an acute phase reactant or protein mostly synthesized in the liver and, of the available options, is an indirect measure of atherosclerotic plaque-related inflammation. Cardiac cells can withstand ischemic conditions and still return to a viable state for how many minutes?

a. 10 b. 15 c. 20 d. 25 c. 20 Cardiac cells remain viable for approximately 20 minutes under ischemic conditions. If blood flow is restored, then aerobic metabolism resumes, contractility is restored, and cellular repair begins. If the coronary artery occlusion persists beyond 20 minutes, then myocardial infarction (MI) occurs. Which form of angina occurs most often during sleep as a result of vasospasms of one or more coronary arteries? a. Unstable b. Stable c. Silent d. Prinzmetal d. Prinzmetal Of the options available, only Prinzmetal angina (also called variant angina) is chest pain attributable to transient ischemia of the myocardium that occurs unpredictably and almost exclusively at rest. When is the scar tissue that is formed after a myocardial infarction (MI) most vulnerable to injury? a. Between 5 and 9 days b. Between 10 and 14 days c. Between 15 and 20 days d. Between 20 and 30 days b. Between 10 and 14 days During the recovery period (10 to 14 days after infarction), individuals feel more capable of increasing activities and thus may stress the newly formed scar tissue.

An individual who is demonstrating elevated levels of troponin, creatine kinase-isoenzyme MB (CK- MB), and lactic dehydrogenase (LDH) is exhibiting indicators associated with which condition? a. Myocardial ischemia b. Hypertension c. Myocardial infarction (MI) d. Coronary artery disease (CAD) c. Myocardial infarction (MI) Cardiac troponins (troponin I and troponin T) are the most specific indicators of MI. What is the expected electrocardiogram (ECG) pattern when a thrombus in a coronary artery permanently lodges in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium? a. Prolonged QT interval b. ST elevation myocardial infarction (STEMI) c. ST depression myocardial infarction (STDMI) d. Non-ST elevation myocardial infarction (non-STEMI) b. ST elevation myocardial infarction (STEMI) Individuals with this pattern on an ECG usually have significant elevations in the ST segments and are categorized as having STEMI. How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)? a. By increasing the peripheral vasoconstriction b. By causing dysrhythmias as a result of hyperkalemia c. By reducing the contractility of the myocardium d. By stimulating the sympathetic nervous system a. By increasing the peripheral vasoconstriction

Angiotensin II is released during myocardial ischemia and contributes to the pathogenesis of a myocardial infarction (MI) in several ways. First, it results in the systemic effects of peripheral vasoconstriction and fluid retention. These homeostatic responses are counterproductive in that they increase myocardial work and thus exacerbate the effects of the loss of myocyte contractility. Angiotensin II is also locally released, where it is a growth factor for vascular smooth muscle cells, myocytes, and cardiac fibroblasts; promotes catecholamine release; and causes coronary artery spasm. A patient reports sudden onset of severe chest pain that radiates to the back and worsens with respiratory movement and when lying down. These clinical manifestations describe: a. Myocardial infarction (MI) b. Pericardial effusion c. Restrictive pericarditis d. Acute pericarditis d. Acute pericarditis Most individuals with acute pericarditis describe several days of fever, myalgias, and malaise, followed by the sudden onset of severe chest pain that worsens with respiratory movements and with lying down. Although the pain may radiate to the back, it is generally felt in the anterior chest and may be initially confused with the pain of an acute MI. Individuals with acute pericarditis also may report dysphagia, restlessness, irritability, anxiety, and weakness. Ventricular dilation and grossly impaired systolic function, leading to dilated heart failure, characterize which form of cardiomyopathy? a. Congestive b. Hypertrophic c. Septal d. Dystrophic a. Congestive

Only dilated cardiomyopathy (congestive cardiomyopathy) is characterized by ventricular dilation and grossly impaired systolic function, leading to dilated heart failure. A disproportionate thickening of the interventricular septum is the hallmark of which form of cardiomyopathy? a. Dystrophic b. Hypertrophic c. Restrictive d. Dilated b. Hypertrophic Only hypertrophic cardiomyopathy is characterized by a thickening of the septal wall, which may cause outflow obstruction to the left ventricle outflow tract. Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of cardiomyopathy? a. Infiltrative b. Restrictive c. Septal d. Hypertrophic b. Restrictive Restrictive cardiomyopathy may occur idiopathically or as a cardiac manifestation of systemic diseases, such as scleroderma, amyloidosis, sarcoidosis, lymphoma, and hemochromatosis, or a number of inherited storage diseases. Which condition is a cause of acquired aortic regurgitation? a. Congenital malformation b. Cardiac failure

c. Rheumatic fever d. Coronary artery disease (CAD) c. Rheumatic fever Rheumatic heart disease, bacterial endocarditis, syphilis, hypertension, connective tissue disorders (e.g., Marfan syndrome, ankylosing spondylitis), appetite suppressing medications, trauma, or atherosclerosis can cause acquired aortic regurgitation. What is the most common cause of infective endocarditis? a. Virus b. Fungus c. Bacterium d. Rickettsiae c. Bacterium Infective endocarditis is a general term used to describe infection and inflammation of the endocardium—especially the cardiac valves. Bacteria are the most common cause of infective endocarditis, especially streptococci, staphylococci, or enterococci. What is the most common cardiac disorder associated with acquired immunodeficiency syndrome (AIDS) a. Cardiomyopathy b. Myocarditis c. Left heart failure d. Heart block c. Left heart failure Pericardial effusion and left heart failure are the most common complications of human immunodeficiency virus (HIV) infection. Other conditions include cardiomyopathy, myocarditis,

tuberculous pericarditis, infective and nonbacterial endocarditis, heart block, pulmonary hypertension, and nonantiretroviral drug-related cardiotoxicity. A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance. Which form of heart failure may result from pulmonary disease and elevated pulmonary vascular resistance? a. Right heart failure b. Left heart failure c. Low-output failure d. High-output failure a. Right heart failure Right heart failure is defined as the inability of the right ventricle to provide adequate blood flow into the pulmonary circulation at a normal central venous pressure. This condition is often a result of pulmonary disease and the resulting elevated pulmonary vascular resistance. What cardiac pathologic condition contributes to ventricular remodeling? a. Left ventricular hypertrophy b. Right ventricular failure c. Myocardial ischemia d. Contractile dysfunction c. Myocardial ischemia Of the options available, myocardial ischemia contributes to inflammatory, immune, and neurohumoral changes that mediate a process called ventricular remodeling. What is the cause of the dyspnea resulting from a thoracic aneurysm? a. Pressure on surrounding organs b. Poor oxygenation c. Formation of atherosclerotic lesions d. Impaired blood flow

a. Pressure on surrounding organs Pressure of a thoracic aneurysm on surrounding organs cause symptoms of dysphagia (difficulty in swallowing) and dyspnea (breathlessness). What is the trigger for angina pectoris? a. Atherosclerotic lesions b. Hyperlipidemia c. Myocardial necrosis d. Myocardial ischemia d. Myocardial ischemia Angina pectoris is chest pain caused by myocardial ischemia. What factors contribute to the development of orthostatic hypotension? (Select all that apply.) a. Altered body chemistry b. Drug action of certain antihypertensive agents c. Prolonged immobility d. Effects of aging on postural reflexes e. Any condition that produces volume overload a. Altered body chemistry b. Drug action of certain antihypertensive agents c. Prolonged immobility d. Effects of aging on postural reflexes Acute orthostatic hypotension (temporary type) may result from (1) altered body chemistry, (2) drug action (e.g., antihypertensives, antidepressants), (3) prolonged immobility caused by illness, (4) starvation, (5) physical exhaustion, (6) any condition that produces volume depletion (e.g., massive diuresis, potassium or sodium depletion), and (7) venous pooling (e.g., pregnancy, extensive varicosities

of the lower extremities). Older adults are susceptible to this type of orthostatic hypotension, in which postural reflexes are slowed as part of the aging process. Which assessment findings are clinical manifestations of aortic stenosis? (Select all that apply.) a. Jugular vein distention b. Bounding pulses c. Hypotension d. Angina e. Syncope d. Angina e. Syncope The classic manifestations of aortic stenosis are angina, syncope, and heart failure. Which risk factors are associated with infective endocarditis? (Select all that apply.) a. Rheumatic fever b. Intravenous drug use c. Long-term indwelling catheterization d. Aortic regurgitation e. Heart valve disease b. Intravenous drug use c. Long-term indwelling catheterization e. Heart valve disease Risk factors for infective endocarditis include acquired valvular heart disease, intravenous drug abuse, long-term indwelling catheterization (e.g., for pressure monitoring, hyperalimentation, or hemodialysis), and recent cardiac surgery. Which event triggers congenital heart defects that cause acyanotic congestive heart failure? a. Right-to-left shunts

b. Left-to-right shunts c. Obstructive lesions d. Mixed lesions b. Left-to-right shunts Congenital heart defects that cause acyanotic congestive heart failure usually involve left-to-right shunts (see Table 33-4). Older children with an unrepaired cardiac septal defect experience cyanosis because of which factor? a. Right-to-left shunts b. Left-to-right shunts c. Obstructive lesions d. Mixed lesions a. Right-to-left shunts Older children who have an unrepaired septal defect with a left-to-right shunt may become cyanotic because of pulmonary vascular changes secondary to increased pulmonary blood flow. Which congenital heart defects occur in trisomy 13, trisomy 18, and Down syndrome? a. Coarctation of the aorta (COA) and pulmonary stenosis (PS) b. Tetralogy of Fallot and persistent truncus arteriosus c. Atrial septal defect (ASD) and dextrocardia d. Ventricular septal defect (VSD) and patent ductus arteriosus (PDA) d. Ventricular septal defect (VSD) and patent ductus arteriosus (PDA) Congenital heart defects that are related to dysfunction of trisomy 13, trisomy 18, and Down syndrome include VSD and PDA (see Table 33-2). An infant has a continuous machine-type murmur best heard at the left upper sternal border throughout systole and diastole, as well as a bounding pulse and a thrill on palpation. These clinical findings are consistent with which congenital heart defect?

a. Atrial septal defect (ASD) b. Ventricular septal defect (VSD) c. Patent ductus arteriosus (PDA) d. Atrioventricular canal (AVC) defect c. Patent ductus arteriosus (PDA) If pulmonary vascular resistance has fallen, then infants with PDA will characteristically have a continuous machine-type murmur best heard at the left upper sternal border throughout systole and diastole. If the PDA is significant, then the infant also will have bounding pulses, an active precordium, a thrill on palpation, and signs and symptoms of pulmonary overcirculation. An infant has a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. A wide fixed splitting of the second heart sound is also found. These clinical findings are consistent with which congenital heart defect? a. Atrial septal defect (ASD) b. Ventricular septal defect (VSD) c. Patent ductus arteriosus (PDA) d. Atrioventricular canal (AVC) defect a. Atrial septal defect (ASD) Because most children with ASD are asymptomatic, diagnosis is usually made during a routine physical examination by the auscultation of a crescendo-decrescendo systolic ejection murmur that reflects increased blood flow through the pulmonary valve. The location of the murmur is between the second and third intercostal spaces along the left sternal border. A wide fixed splitting of the second heart sound is also characteristic of ASD, reflecting volume overload to the right ventricle and causing prolonged ejection time and a delay of pulmonic valve closure. An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect?

a. Atrial septal defect (ASD) b. Ventricular septal defect (VSD) c. Patent ductus arteriosus (PDA) d. Atrioventricular canal (AVC) defect b. Ventricular septal defect (VSD) On physical examination, a loud, harsh, holosystolic murmur and systolic thrill can be detected at the left lower sternal border. The intensity of the murmur reflects the pressure gradient across the VSD. An apical diastolic rumble may be present with a moderate-to-large defect, reflecting increased flow across the mitral valve. Where can coarctation of the aorta (COA) be located? a. Exclusively on the aortic arch b. Proximal to the brachiocephalic artery c. Between the origin of the aortic arch and the bifurcation of the aorta in the lower abdomen d. Between the origin of the aortic arch and the origin of the first intercostal artery c. Between the origin of the aortic arch and the bifurcation of the aorta in the lower abdomen COA can occur anywhere between the origin of the aortic arch and the bifurcation of the aorta in the lower abdomen. Classic manifestations of a systolic ejection murmur heard at the left interscapular area, cool mottled skin on the lower extremities but hypertension noted in the upper extremities, and decreased or absent femoral pulse are indicative of an older child with which congenital defect? a. Tetralogy of Fallot b. Aortic stenosis c. Ventricular septum defect (SD) d. Coarctation of the aorta (OA)

d. Coarctation of the aorta (OA) Clinical manifestations of coarctation of the aorta include hypertension noted in the upper extremities with decreased or absent pulses in the lower extremities. Children may also have cool mottled skin and occasionally experience leg cramps during exercise. A systolic ejection murmur, heard best at the left interscapular area, is also considered a classic clinical manifestation of this disorder. What is the initial manifestation of aortic coarctation observed in a neonate? a. Congestive heart failure (CHF) b. Cor pulmonale c. Pulmonary hypertension d. Cerebral hypertension a. Congestive heart failure (CHF) Initially, the newborn usually exhibits symptoms of CHF. Which compensatory mechanism is spontaneously used by children diagnosed with tetralogy of Fallot to relieve hypoxic spells? a. Lying on their left side b. Performing the Valsalva maneuver c. Squatting d. Hyperventilating c. Squatting Squatting is a spontaneous compensatory mechanism used by older children to alleviate hypoxic spells. Squatting and its variants increase systemic resistance while decreasing venous return to the heart from the inferior vena cava. An infant diagnosed with a small patent ductus arteriosus (PDA) would likely exhibit which symptom? a. Intermittent murmur

b. Lack of symptoms c. Need for surgical repair d. Triad of congenital defects b. Lack of symptoms Infants with a small PDA usually remain asymptomatic Which condition is consistent with the cardiac defect of transposition of the great vessels? a. The aorta arises from the right ventricle. b. The pulmonary trunk arises from the right ventricle. c. The right ventricle pumps blood to the lungs. d. An intermittent murmur is present. a. The aorta arises from the right ventricle. Transposition of the great arteries refers to a condition in which the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. Which heart defect produces a systolic ejection murmur at the right upper sternal border that transmits to the neck and left lower sternal border? a. Coarctation of the aorta b. Pulmonic stenosis c. Aortic stenosis d. Hypoplastic left heart syndrome c. Aortic stenosis Blood flow through the stenotic area of the aorta produces a systolic ejection murmur at the right upper sternal border that transmits to the neck and left lower sternal border. Which heart defect produces a systolic ejection click at the upper left sternal border with a thrill palpated at the upper left sternal border?

a. Coarctation of the aorta (COA) b. Pulmonary stenosis (PS) c. Aortic stenosis d. Hypoplastic left heart syndrome b. Pulmonary stenosis (PS) PS results in a systolic ejection murmur at the left upper sternal border, reflecting an obstruction to flow through the narrowed pulmonary valve. A variable systolic ejection click is present in some children, as well as valvular stenosis at the upper left sternal border. PS also produces a thrill that may be palpated at the upper left sternal border. Which heart defect results in a single vessel arising from both ventricles, providing blood to both the pulmonary and systemic circulations? a. Coarctation of the aorta b. Tetralogy of Fallot c. Total anomalous pulmonary connection d. Truncus arteriosus d. Truncus arteriosus Truncus arteriosus is the failure of the large embryonic artery, the truncus arteriosus, to divide into the pulmonary artery and the aorta, which results in a single vessel arising from both ventricles, providing blood flow to the pulmonary and systemic circulations. What congenital heart defects are associated with intrauterine exposure to rubella? (Select all that apply.) a. Pulmonary stenosis (PS) b. Cardiomegaly c. Patent ductus arteriosus (PDA) d. Coarctation of aorta (COA) e. Ventricular septal defect (VSD)

a. Pulmonary stenosis (PS) c. Patent ductus arteriosus (PDA) d. Coarctation of aorta (COA) PS, PDA, and COA are congenital heart defects associated with intrauterine exposure to rubella. What is the most common cause of pulmonary edema? a. Right-sided heart failure b. Left-sided heart failure c. Mitral valve prolapse d. Aortic stenosis b. Left-sided heart failure When the left ventricle fails, filling pressures on the left side of the heart increase and cause a concomitant increase in pulmonary capillary hydrostatic pressure. Pulmonary edema usually begins to develop at a pulmonary capillary wedge pressure or left atrial pressure of how many millimeters of mercury (mm Hg)? a. 10 b. 20 c. 30 d. 40 b. 20 Pulmonary edema usually begins to develop at a pulmonary capillary wedge pressure or left atrial pressure of 20 mm Hg. Which pleural abnormality involves a site of pleural rupture that acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration? a. Spontaneous pneumothorax

b. Tension pneumothorax c. Open pneumothorax d. Secondary pneumothorax b. Tension pneumothorax In tension pneumothorax, the site of pleural rupture acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing up during expiration. As more and more air enters the pleural space, air pressure in the pneumothorax begins to exceed barometric pressure. In which type of pleural effusion does the fluid become watery and diffuse out of the capillaries as a result of increased blood pressure or decreased capillary oncotic pressure? a. Exudative b. Purulent c. Transudative d. Large c. Transudative In transudative pleural effusion, the fluid, or transudate, is watery and diffuses out of the capillaries as a result of disorders that increase intravascular hydrostatic pressure or decrease capillary oncotic pressure. Which condition is not a cause of chest wall restriction? a. Pneumothorax b. Severe kyphoscoliosis c. Gross obesity d. Neuromuscular disease a. Pneumothorax Unlike the other options that result in chest wall restriction, a pneumothorax is the presence of air or gas in the pleural space caused by a rupture in the visceral pleura (which surrounds the lungs) or the parietal pleura and chest wall.

Which condition is a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury? a. Acute respiratory distress syndrome (ARDS) b. Pneumonia Pulmonary emboli d. Acute pulmonary edema a. Acute respiratory distress syndrome (ARDS) ARDS is a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury. Which structure(s) in acute respiratory distress syndrome (ARDS) release inflammatory mediators such as proteolytic enzymes, oxygen-free radicals, prostaglandins, leukotrienes, and platelet-activating factor? a. Complement cascade b. Mast cells c. Macrophages d. Neutrophils d. Neutrophils' Activated neutrophils release a battery of inflammatory mediators, among them proteolytic enzymes, oxygen-free radicals (superoxide radicals, hydrogen peroxide, hydroxyl radicals), arachidonic acid metabolites (prostaglandins, thromboxanes, leukotrienes), and platelet-activating factor. These mediators cause extensive damage to the alveolocapillary membrane and greatly increase capillary membrane permeability. Pulmonary edema in acute respiratory distress syndrome (ARDS) is the result of an increase in: a. Levels of serum sodium and water b. Capillary permeability

c. Capillary hydrostatic pressure d. Oncotic pressure b. Capillary permeability Increased capillary permeability, a hallmark of ARDS, allows fluids, proteins, and blood cells to leak from the capillary bed into the pulmonary interstitium and alveoli. The resulting pulmonary edema and hemorrhage severely reduce lung compliance and impair alveolar ventilation. In acute respiratory distress syndrome (ARDS), alveoli and respiratory bronchioles fill with fluid as a result of which mechanism? a. Compression on the pores of Kohn, thus preventing collateral ventilation b. Increased capillary permeability, which causes alveoli and respiratory bronchioles to fill with fluid c. Inactivation of surfactant and the impairment of type II alveolar cells d. Increased capillary hydrostatic pressure that forces fluid into the alveoli and respiratory bronchioles c. Inactivation of surfactant and the impairment of type II alveolar cells Lung inflammation and injury damage the alveolar epithelium and the vascular endothelium. Surfactant is inactivated, and its production by type II alveolar cells is impaired as alveoli and respiratory bronchioles fill with fluid or collapse. Which immunoglobulin (Ig) may contribute to the pathophysiologic characteristics of asthma? a. IgA b. IgE c. IgG d. IgM b. IgE Which statement about the late asthmatic response is true? a. Norepinephrine causes bronchial smooth muscle contraction and mucus secretion. b. The release of toxic neuropeptides contributes to increased bronchial hyperresponsiveness.