Deck 35: Pulmonary Air Leak Syndromes

Question 1

Your patient with pulmonary interstitial emphysema has developed a pneumothorax. It will manifest itself clinically as:

A) equally restrictive and obstructive disorder.
B)an obstructive pulmonary disorder.
C)a restrictive pulmonary disorder.
D)a restrictive cardiac disorder.

Answer 1

a restrictive pulmonary disorder.

Question 2

Your intubated and mechanically ventilated neonatal patient has a pneumothorax of the right lung. What can be done to help the injured lung to heal?

A) Selectively place the endotracheal tube into the left mainstem bronchus.
B)Selectively place the endotracheal tube into the right mainstem bronchus.
C)Replace the endotracheal tube with a tracheostomy tube.
D)Change to continuous positive airway pressure (CPAP).

Answer 2

Selectively place the endotracheal tube into the left mainstem bronchus.

Question 3

Your neonatal patient is receiving mechanical ventilation. Which of the following is/are considered to be an important etiologic factor(s) for pulmonary air leak syndromes?
1) Long expiratory time
2) High oxygen percentage
3) Prolonged inspiratory time
4) High PIP (peak inspiratory pressure)

A)2
B)3, 4
C)1, 2, 3
D)1, 2, 3, 4

Answer 3

3, 4

Question 4

Your patient has developed pulmonary interstitial emphysema (PIE). How can this affect her lung function?
1) Increased airway resistance
2) Decreased lung compliance
3) Increased lung compliance
4) Development of persistent pulmonary hypertension of the newborn (PPHN)

A)4
B)1, 2
C)3, 4
D)1, 2, 4

Question 5

What pulmonary condition can be identified by a change in the point of maximum impulse (PMI)?

A) Pneumothorax
B)PIE
C)Pneumomediastinum
D)Meconium aspiration syndrome (MAS)

Question 6

Your patient has PIE and a pneumomediastinum. What clinical manifestations are associated with the more negative intrapleural pressures needed during an inspiration by your patient?
1) Lower thoracic areas are cyanotic
2) Substernal retractions
3) Flaring nostrils
4) Inspiratory stridor

A)1, 4
B)2, 3
C)1, 2, 3
D)1, 2, 3, 4

Question 7

During the physical exam of a patient with PIE and a pneumoperitoneum, what respiratory rate is usually found?

A) 80 to 120/min
B)>60/min
C)30 to 60/min
D)Less than 30/min

Question 8

When trapped gas causes alveolar overdistention and rupture, does where the gas initially go?
1) Both pleural spaces
2) Tissue sheaths surrounding airways and capillaries
3) Interlobular septa containing pulmonary veins
4) Pericardial sac

A)2, 3
B)1, 4
C)1, 2, 3
D)2, 3, 4

Question 9

If your patient were to develop a pneumoperitoneum, what clinical presentation would be seen?

A) Mediastinal shift toward affected area
B)Change in point of maximum impulse
C)Abdominal distension
D)Pleural effusion

Question 10

Your patient with PIE has developed a pneumopericardium. This condition can cause all of the following, EXCEPT:

A) Systemic hypotension
B)Reduced cardiac output
C)Decreased stroke volume
D)Increased cardiac index

Question 11

Your patient is suspected of having a pneumothorax and the physician is performing transillumination to assess the situation. What finding would confirm that there is a pneumothorax?

A) The trachea will be illuminated.
B)Light will shine through the hole in the lung.
C)Increased illumination on the unaffected side
D)Increased illumination on the affected side

Question 12

Your neonatal patient needs to be on a mechanical ventilator for breathing support but has PIE. What change can be made to help treat the problem?

A) Begin the bronchopulmonary hygiene therapy protocol.
B)Decrease the oxygen percentage.
C)Initiate high-frequency ventilation.
D)Insert bilateral pleural chest tubes.

Question 13

A pulmonary air leak syndrome will usually present itself within what time period?

A) At the time of birth
B)Within the first 4 to 6 hours of life
C)Less than 24 hours after birth
D)Within the first 24 to 48 hours of life

Question 14

What chest radiograph finding(s) would confirm that the patient has PIE?
1) Mediastinal shift to the unaffected side
2) Air below the diaphragms
3) Lung hyperinflation
4) Fine, bubbly appearance of the lungs

A)4
B)1, 2
C)3, 4
D)1, 3, 4

Question 15

What preexisting condition is often being treated in a premature neonate who develops a pulmonary air leak syndrome?

A) Meconium aspiration syndrome (MAS)
B)Respiratory distress syndrome (RDS)
C)Transient tachypnea of the newborn (TTN)
D)Apnea of prematurity