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WorksheetsEgan Ch. 15
Total questions: 53
Worksheet time: 2hrs 46mins
What is the effect when the deflation reflex is stimulated?
A strong inspiratory effort
Expiration is initiated
Cuts off all inspiratory signals
Stimulates the termination of expiration
Which components are located in the medulla oblongata? (Check all that apply)
Apneustic center
Dorsal respiratory group neurons (DRGs)
Pneumotaxic center
Ventral respiratory group neurons (VRGs)
Peripheral chemoreceptors
What centers are located in the pons of the brainstem?
1. Apneustic center
2. Dorsal respiratory neurons
3. Pneumotaxic center
1
2, 3
1 , 2
1, 3
all the above
In the face of chronically elevated levels of CO2, what happens to the response mediated by the central chemoreceptors?
It is accentuated or increased.
It is muted or decreased.
There is no change in the response.
There is no way to predict the body’s response.
Which of the following is indirectly responsible for minute-to-minute control of breathing?
CO2 levels
HCO3- levels
Lactate levels
Oxygen (O2) levels
The pneumotaxic center controls which of the following?
Response to changes in blood pH and PCO2
Rhythm of the full breathing cycle
When inspiration switches off (the inspiratory time)
When inspiration switches on (the expiratory time)
When given high concentrations of O2, a patient with chronic hypercapnia may develop a more serious respiratory acidosis. Which of the following might be contributing to the patient’s increased PCO2?
1. Worsening ventilation-perfusion (VV/QQ) balance
2. Desensitization of the carotid bodies
3. Removal of the hypoxic stimulus
1, 2
1
1, 3
all the above
In what manner would O2 therapy induce worsening mismatch and thus a further elevation in CO2 in a chronically hypercapnic patient?
By improving blood flow to poorly ventilated alveoli
By decreasing blood flow to poorly ventilated alveoli
Causing bronchoconstriction, which worsens gas flow to low V/Q areas
Causing bronchodilation, which improves gas flow to poorly ventilated alveoli
What receptors are associated with causing coughing, sneezing, and tachypnea when stimulated?
Irritant receptors
J receptors
Muscle spindles
Peripheral proprioceptors
Why does splashing cold water on the skin stimulate ventilation?
It decreases medullary inspiratory activity causing hyperpnea.
Hering-Breuer inflation reflex.
It increases medullary inspiratory activity causing hyperpnea.
J receptor.
Which inhibitory neuron(s) switch off the inspiratory ramp signal?
Peripheral chemoreceptors
Apneustic center
Central chemoreceptors
Pneumotaxic center
Sensory input to the dorsal respiratory neurons from the lungs, airways, and peripheral chemoreceptors is provided via which nerves?
1. Glossopharyngeal
2. Phrenic
3. Vagus
4. Trigeminal
1, 2, 3
2, 3
1, 3
all the above
A healthy 33-year-old woman relocates to an area approximately 8000 ft above sea level. On her first day, she begins to hyperventilate, but in 24 hr she shows signs of recovery. What is the probable cause of her condition?
Hypoxemia-mediated hyperventilation
Hypercapnia
Hyperoxia-mediated hyperventilation
Increased H+
Where are the peripheral chemoreceptors located?
1. In the arch of the aorta
2. In the bifurcations of carotid arteries
3. On the ventrolateral surfaces of the medulla
1, 2
1, 3
2, 3
all the above
While observing a patient’s breathing, you note that the depth and rate first increase, then decrease, followed by a period of apnea. Which of the following terms would you use in charting this observation?
Apneustic breathing
Biot’s breathing
Cheyne-Stokes breathing
Paradoxical breathing
Mr. Aisner snoring while sitting in a chair in the RT dept.
Which of the following will occur during even strenuous exercise in a normal healthy individual?
Blood gases remain stable.
The arterial PCO2 rises.
The arterial pH falls.
The arterial PO2 falls.
Which of the following can cause laryngospasm and bradycardia through a vagovagal reflex?
1. Bronchoscopy
2. Endotracheal intubation
3. Tracheal suctioning
1, 2
2, 3
1, 3
all the above
Which respond more rapidly to high levels of CO2?
Aortic chemoreceptors
Carotid chemoreceptors
Central chemoreceptors
Ventral respiratory centers
Which breathing pattern can result from a failure to switch off the brainstem inspiratory neurons?
Apnea
Apneustic breathing
Biot's breathing
Cheyne-Stokes breathing
Mr. Aisner back in the RT Dept
Biot’s respiration is most frequently observed in patients with which of the following?
Congestive heart failure
Increased intracranial pressure
Metabolic acidosis
Peripheral nerve disorders
Which of the following centers responds more strongly to high levels of CO2?
Aortic chemoreceptors
Carotid chemoreceptors
Central chemoreceptors
Ventral respiratory centers
Adjustment of respiratory muscle contractions to accommodate varying loads is regulated by which of the following?
Medullary respiratory centers
Muscle spindle fiber feedback
Pontine apneustic center
Pontine pneumotaxic center
A patient in the emergency room is displaying prolong inspiratory gasps interrupted by occasional expirations, what serious injury should be suspected on this patient?
1. Pneumotaxic center has been severed.
2. Vagus nerve has been severed.
3. Glossopharyngeal nerve has been severed.
1, 3
2, 3
1, 2
all the above
Failure to switch off the brainstem inspiratory neurons can result in which of the following?
Apnea
Apneustic breathing
Biot’s breathing
Cheyne-Stokes breathing
A patient is presenting with coughing, sneezing, and reflex bronchoconstriction. Which receptors are causing the client’s presentation?
J receptors
Central chemoreceptors
Hering-Breuer reflex
Irritant receptors
You observe a patient’s breathing pattern as very irregular, with periods of breathing interspersed with long periods of apnea. Which of the following terms would you use in charting this observation?
Apneustic breathing
Biot’s respiration
Cheyne-Stokes breathing
Kussmaul’s breathing
What does apneustic breathing indicate?
Damage to the cerebrum
Damage to the pons
Spinal cord transaction
Vagal nerve damage
The medulla oblongata contains which of the following areas?
1. Apneustic center
2. Dorsal respiratory group neurons (DRGs)
3. Pneumotaxic center
4. Ventral respiratory group neurons (VRGs)
1, 2, 4
2, 4
2, 3, 4
all the above
What stimulates the Hering-Breuer inflation reflex?
The DRG when it is time to end inspiratory efforts.
The stretch of receptors at high lung volumes.
The VRG when it is time for inspiration.
Very low lung volumes stimulate inspiration.
What has the primary responsibility for sensing and responding to changes in blood levels of CO2?
Apneustic centers
Central chemoreceptors
Peripheral chemoreceptors
Pneumotaxic center
What receptors cause a rapid shallow breathing pattern when stimulated by pulmonary disease?
Irritant receptors
J receptors
Muscle spindles
Peripheral proprioceptors
To which anatomic structures do the ventral respiratory centers send motor signals during inspiration?
1. Diaphragm
2. Larynx
3. Pharynx
4. Sternocleidomastoids
1, 2, 4
2, 3, 4
1, 2, 3
all the above
How do central chemoreceptors respond to chronically elevated levels of carbon dioxide (CO2)?
No change in the response
Increased response
No way to predict the response
Muted or decreased response
Both anemia and carbon monoxide (CO) poisoning can cause severe hypoxia, yet neither condition results in a major stimulation of breathing. Why is this so?
The peripheral chemoreceptors do not respond to low O2 content.
Anemia and CO poisoning depresses the peripheral chemoreceptors.
Anemia and CO poisoning depresses the central chemoreceptors.
Anemia and CO cause stagnant hypoxia, not hypoxemia.
What reflex is associated with the sensory stimulation of the pulmonary stretch receptors that stimulate a deeper breath upon inspiration?
Carotid
Head’s paradoxical
Hering-Breuer
J receptor
Why does it take approximately 24 hr for a full ventilatory response to develop to acute hypoxemia?
Initial cerebrospinal fluid alkalemia blunts the hypoxic ventilatory stimulus.
Peripheral chemoreceptors are slow to respond to decreased blood O2 levels.
Renal compensation for respiratory alkalosis increases chemoreceptor sensitivity.
A full ventilatory response is not possible until after the muscles become fatigued.
What is the response of a patient with chronic hypercapnia to a sudden acute rise in carbon dioxide?
In almost all of these patients, there will be no response.
The patient’s drive to breathe will be increased.
This will further depress his or her respiratory centers.
This will induce apnea and sudden death.
Coexisting arterial hypoxemia, acidemia, and high PaCO2 (i.e., asphyxia) will have what effect on the peripheral chemoreceptors?
There is a decreased drive to breathe.
There is a maximally increased drive to breathe.
There is insufficient information to make a determination.
There is virtually no response.
Which of the following can cause Cheyne-Stokes breathing?
1. Brain injuries
2. Congestive heart failure
3. Metabolic acidosis
2
1, 2
2, 3
all the above
Which of the following causes hypoxic stimulation of the carotid bodies?
1. Large decrease in arterial PO2
2. Large decrease in O2 content
3. CO poisoning
1
1, 2
1, 3
all the above
Stimulation of the irritant receptors in the lung can result in which of the following?
1. Bronchoconstriction
2. Coughing
3. Narrowing of the glottis
1, 2
1, 3
2, 3
all the above
What group of nerve cells senses and responds to changes in the chemical composition of its fluid environment?
Chemoreceptors
Gamma-efferent system
Muscle spindle fibers
Proprioceptors
How might oxygen therapy worsen ventilation/perfusion (V/Q) mismatch and increase CO2 in a chronically hypercapnic patient?
Causing bronchodilation, which improves gas flow to poorly ventilated alveoli
By improving blood flow to poorly ventilated alveoli
By decreasing blood flow to poorly ventilated alveoli
Causing bronchoconstriction, which worsens gas flow to low V/Q areas
Stimulation to increase ventilation does not occur until the PaO2 falls below what level?
90 mm Hg
80 mm Hg
70 mm Hg
60 mm Hg
Which of the following control the inhibitory neurons that switch off the inspiratory ramp signal?
1. Apneustic center
2. Pneumotaxic center
3. Pulmonary stretch receptors
1, 3
1, 2
2, 3
all the above
Where are the inspiratory and expiratory centers in the brain found?
Broca’s area
Neurons in the cerebellum
Pons
No such centers exist
While observing a patient's breathing, the RCP notes that the depth and rate increases, then decreases, followed by a period of apnea. Which term does the RCP document in the client’s medical record?
Paradoxical breathing
Apneustic breathing
Biot's breathing
Cheyne-Stokes breathing
What happens in chronic hypercapnia?
1. The central chemoreceptive response to CO2 is decreased.
2. The cerebrospinal fluid pH is restored to normal.
3. Responsiveness to increased CO2 is decreased.
1, 2
1, 3
2, 3
all the above
In patients with closed-head injuries, what may happen in the presence of hypercapnia?
High CO2 increases the risk of psychotic events.
High CO2 levels cause cerebral vasodilation and improved oxygenation.
Severe cerebral vasoconstriction results in anoxia and stroke.
Vasodilation causes increased intracranial pressure and possibly stops blood flow.
Which receptors are primarily responsible for the initial increase in ventilation that occurs at the beginning of exercise?
Carotid chemoreceptors
Irritant receptors
Proprioceptors
J receptors
In the face of hyperoxia, what is the response of the peripheral chemoreceptors to hypercapnia?
There is insufficient information.
There is virtually no response.
There is an increased drive to breathe.
There is a decreased drive to breathe.
How should O2 therapy be administered to chronically hypercapnic patients?
Give as much O2 as possible (60% to 100%).
Withhold O2 until the patient is intubated.
Give as much O2 as required to maintain adequate oxygenation.
Avoid giving any supplemental O2.
What receptors are known to cause an increase in ventilation when the patient’s limbs are moved or cold water is splashed on the patient’s face?
Irritant receptors
J receptors
Muscle spindles
Peripheral proprioceptors
