Question 1

Which of the following is/are considered noncardiogenic cause(s) of increased capillary permeability?
1) Therapeutic lung radiation
2) Cigarette smoke
3) Acute respiratory distress syndrome (ARDS)
4) Inhaled phosgene

Accepted Answer

Among the many causes of noncardiogenic pulmonary edema are therapeutic lung radiation, ARDS, and inhaled phosgene. Cigarette smoke is associated with lung cancer and chronic obstructive pulmonary disease but does not cause increased capillary permeability.

Question 2

The respiratory therapist is asked to evaluate a patient with suspected congestive heart failure. Which of the following laboratory tests should the respiratory therapist recommend to evaluate the patient for possible congestive heart failure?

Accepted Answer

The brain natriuretic peptide (BNP), also known as B-type natriuretic peptide or ventricular natriuretic peptide (still BNP) is an important biomarker used to help establish the diagnosis of congestive heart failure (CHF). The BNP hormone is produced by the heart and reflects how well the heart is functioning. Normally, only a low amount of BNP (<100 pg/mL) is found in blood. However, when the heart is working harder than normal over a long period of time, it releases more BNP, increasing the blood level of BNP. The other laboratory tests are not used for congestive heart failure.

Question 3

Lymphatic insufficiency could be caused by:
1) lung transplantation.
2) lymphangitic carcinomatosis.
3) removal of pleural fluid.
4) decreased oncotic pressure.

Accepted Answer

Lymphatic insufficiency could be caused by lung transplantation and lymphangitic carcinomatosis. Although the rapid removal of pleural fluid and decreased oncotic pressure can lead to pulmonary edema, they not associated with lymphatic insufficiency.

Question 4

A patient with cardiogenic pulmonary edema would be expected to have all of the following chest radiograph findings EXCEPT:

Accepted Answer

The position of the diaphragms will not be changed by pulmonary edema. The chest radiograph will often show pleural effusion, cardiomegaly, and bilateral "butterfly" pattern fluffy infiltrates, among other findings.

Question 5

Management of cardiogenic pulmonary edema includes giving a patient which of the following types of medications?
1) Afterload reducer
2) Positive inotropic medication
3) Preload reducing medication
4) Positive chronotropic medication

Accepted Answer

The therapeutic intervention to address the patient's circulatory systems has the following three main goals: (1) reduction of pulmonary venous return (preload reduction); (2) reduction of systemic vascular resistance (afterload reduction); and (3) inotropic support. A positive chronotropic medication would increase heart rate. This is not indicated in the treatment of cardiogenic pulmonary edema.

Question 6

The respiratory therapist is asked to recommend a medication to reduce afterload for a patient with cardiogenic pulmonary edema. The therapist could recommend all of the following EXCEPT:

Accepted Answer

Afterload reducers include the following:
• captopril-prevents the conversion of angiotensin I to angiotensin II. It is a potent vasodilator. Afterload and cardiac output usually improve in 10 to 15 minutes.
• enalapril (Vasotec)-is a competitive ACE inhibitor and reduces angiotensin II levels.
• nitroprusside (Nitropress)-is a potent, direct smooth muscle-relaxing agent that primarily reduces afterload.
Norepinephrine (Levophed) may be used in the management of cardiogenic pulmonary edema; however, it is a positive inotropic agent, not an afterload reducer.

Question 7

A patient has noncardiogenic pulmonary edema. What chest radiograph findings would be expected?
1) "Bat's wings" pattern fluffy infiltrates
2) Normal cardiac silhouette
3) Fluffy densities near the hilum
4) Pleural effusion

Accepted Answer

A person with noncardiogenic pulmonary edema will have a normal cardiac silhouette and fluffy densities near the hilum. The chest radiograph of a person with cardiogenic pulmonary edema will show "bat's wings" pattern fluffy infiltrates and pleural effusion.

Question 8

Pulmonary edema manifests itself clinically as a(n) _____ disorder.

Accepted Answer

Pulmonary edema manifests itself clinically as a restrictive pulmonary disorder because fluid in the lungs limits inspiration. Even if the heart is the cause of the pulmonary edema, the problem is not obstructive.

Question 9

A patient with pulmonary edema is cyanotic and complaining of difficulty breathing. What should be recommended by the respiratory therapist?

Accepted Answer

Cyanosis indicates hypoxemia. Giving supplemental oxygen will help to correct the hypoxemia and decrease the patient's work of breathing. Mechanical ventilation is not yet indicated. Pursed-lip breathing may help the breathing of a patient with an obstructive lung problem. Bronchopulmonary hygiene therapy is not indicated because there is no sign of a secretion problem.

Question 10

What is the normal hydrostatic pressure in the pulmonary capillaries?

Accepted Answer

Normal hydrostatic pressure in the pulmonary capillaries is 10 to 15 mm Hg.

Question 11

All of the following may be causes of cardiogenic pulmonary edema EXCEPT:

Accepted Answer

Pulmonary embolism may cause noncardiogenic pulmonary edema. All of the other listed options may cause cardiogenic pulmonary edema.

Question 12

A patient with cardiogenic pulmonary edema has had intravascular catheters placed for monitoring purposes. Which of the following values would be expected?
1) Decreased SV
2) Increased PCWP
3) Increased CVP
4) Decreased RAP

Accepted Answer

A patient with cardiogenic pulmonary edema will have a decreased SV (stroke volume), increased PCWP (pulmonary capillary wedge pressure), and increased CVP (central venous pressure). The RAP (right atrial pressure) is the same as the CVP and will be increased; not decreased.

Question 13

All of the following are causes of cardiogenic pulmonary edema EXCEPT:

Accepted Answer

Allergic reaction to drugs can cause noncardiogenic pulmonary edema. The other listed options, and others, can cause cardiogenic pulmonary edema.

Question 14

The major pathologic or structural changes seen in the lungs with pulmonary edema include:
1) atelectasis.
2) bronchospasm.
3) high surface tension of alveolar fluids.
4) alveolar flooding.

Accepted Answer

Major pathologic or structural changes seen in the lungs with pulmonary edema include atelectasis, high surface tension of alveolar fluids, and alveolar flooding. Bronchospasm is not associated with pulmonary edema.

Question 15

Mask CPAP is used with pulmonary edema patients because it does all of the following EXCEPT:

Accepted Answer

Although CPAP may be less expensive than mechanical ventilation, that is not why it is used. Mask CPAP is used because it decreases vascular congestion, reduces work of breathing, and improves lung compliance. These things improve oxygenation and may preclude the need for mechanical ventilation.

Question 16

All of the following are positive risk factors for coronary heart disease (CHD) EXCEPT:

Accepted Answer

The vitamin E level does not affect the coronary arteries. Several factors can lead to CHD, including elevated homocysteine level, hypertension, and diabetes mellitus.

Question 17

As pulmonary edema progressively worsens, the fluid moves in which of the following sequences?

Accepted Answer

With severe pulmonary edema, the fluid would move progressively from the pulmonary vascular system (pulmonary capillaries), to the perivascular and peribronchial interstitial spaces, to the alveoli and bronchi, where the patient may cough it out.

Question 18

A patient has a decreased oncotic pressure. What can be done to increase it?

Accepted Answer

Giving mannitol (and albumin) will increase oncotic pressure. A low-salt diet will decrease fluid retention to increase hydrostatic pressure. Morphine sulfate acts as a vasodilator.

Quiz 20: Pulmonary Edema

Which of the following is/are considered noncardiogenic cause(s) of increased capillary permeability? 1) Therapeutic lung radiation 2) Cigarette smoke 3) Acute respiratory distress syndrome (ARDS) 4) Inhaled phosgene