Pathophysiology 5th Edition by Lee-Ellen C. Copstead – Test Bank

 

 

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Copyright © 2013, 2010, 2005 Saunders, an imprint of Elsevier Inc. All rights reserved. 1
Chapter 3: Cell Structure and Function
Test Bank
MULTIPLE CHOICE
1. Glycolysis is the metabolic process of breaking down a glucose molecule to form
a. CO2 and H2O.
b. 2 ATP and 2 pyruvate.
c. 30 ATP.
d. oxygen.
ANS: B
Glycolysis produces a net gain of 2 ATP molecules and breaks down glucose modules to produce two pyruvate molecules.
Oxidative phosphorylation produces CO2 and H2O. Oxidative phosphorylation produces 30 ATP molecules. Oxygen is not
produced by glycolysis, but it is necessary for oxidative phosphorylation.
REF: Pg. 34
2. The benefit of glycolysis is that this phase supplies
a. ATP to meet energy needs of the body.
b. pyruvate to the citric acid cycle.
c. energy for oxidative phosphorylation
d. lactate during anaerobic conditions.
ANS: B
The benefit of glycolysis is to supply pyruvate to the citric acid cycle of cellular metabolism, which then produces much ATP.
Glycolysis only produces 2 ATP modules, which is insufficient for energy needs. Glycolysis does not supply energy for oxidative
phosphorylation. Lactate produced during prolonged anaerobic conditions builds up and can lead to lactic acidosis, which is an
undesirable outcome.
REF: Pg. 34
3. Repolarization of a neuron after a depolarizing action potential is due to
a. activation of the Na+-K+ pump.
b. influx of calcium.
c. efflux of potassium.
d. influx of sodium.
ANS: C
Repolarization is due to efflux of potassium from the cell. The Na+-K+ pump maintains cellular volume via osmotic pressure and
helps to maintain resting membrane potential. Calcium influx prolongs the action potential. Influx of sodium initiates
depolarization.
REF: Pg. 45
4. Excitable cells are able to conduct action potentials because they have
a. receptors for neurotransmitters.
b. tight junctions.
c. ligand-gated channels.
d. voltage-gated channels.
ANS: D
Voltage-gated channels respond to changes in membrane potential and are responsible for conducting action potentials. Receptors
for neurotransmitters allow neurotransmitters to bind to the cell membrane but are not directly responsible for action potentials in
excitable cells. Tight junctions are intercellular connections that help segregate proteins on the cell membrane and are not involved
in conducting action potentials. Ligand-gated channels respond to binding of a signaling molecule such as a neurotransmitter, but
are not directly responsible for action potentials in excitable cells.
REF: Pgs. 42-44
5. The resting membrane potential in nerve and skeletal muscle is determined primarily by
a. extracellular sodium ion concentration.
b. the ratio of intracellular to extracellular potassium ions.
c. activation of voltage-gated sodium channels.
d. activity of energy-dependent membrane pumps.
ANS: B
The major determinant of the resting membrane potential is the difference in potassium ion concentration across the membrane.
Extracellular sodium helps to maintain cell volume and resting membrane potential but it is not the primary determinant. Activation
of voltage-gated sodium channels help to initiate an action potential. Channels are not linked to an energy source; ions flow
passively across the cell membrane.
REF: Pgs. 42-43
Copyright © 2013, 2010, 2005 Saunders, an imprint of Elsevier Inc. All rights reserved. 2
6. An increase in extracellular potassium ion from 4.0 to 6.0 mEq/L would
a. hyperpolarize the resting membrane potential.
b. make it more difficult to reach threshold and produce an action potential.
c. hypopolarize the resting membrane potential.
d. alter the threshold potential.
ANS: C
An increase in extracellular potassium hypopolarizes the cell (makes it less negative) because more K+ ions stay inside the cell
owing to the reduced concentration gradient. Hyperpolarization of the resting membrane potential (makes it more negative) is
caused by a decrease in extracellular potassium. Hyperpolarization due to a decrease in extracellular potassium makes it more
difficult to reach threshold and produce an action potential. The threshold for action potential does not change with a change in
extracellular potassium.
REF: Pg. 43
7. GTP-binding proteins (G proteins) function to
a. activate receptors on the extracellular surface.
b. degrade second-messenger molecules.
c. activate intracellular enzyme systems.
d. synthesize ATP.
ANS: C
G-proteins activate specific target enzymes within the cell and these enzymes then produce second messenger molecules that trigger
specific intracellular function. Membrane-bound G-protein channels are a component of the cell membrane; they do not activate
other receptors on the extracellular surface. G-proteins do not degrade second messengers, but instead produce these. G-proteins do
not synthesize ATP.
REF: Pg. 49
8. Phospholipids spontaneously form lipid bilayers, because they are
a. polar.
b. charged.
c. insoluble.
d. amphipathic.
ANS: D
Phospholipids have a hydrophilic (water-loving) polar end and a hydrophobic (water-fearing) polar end. This amphipathic nature
causes the lipids to form bilayers. It is the water-loving and water-fearing nature of the end rather than simply being polar, charged,
or insoluble that forms the bilayers.
REF: Pg. 27
9. Cell-to-cell communication through secretion of chemical signals into the bloodstream to target cells throughout the body is called
_____ signaling.
a. synaptic
b. paracrine
c. endocrine
d. autocrine
ANS: C
Endocrine signaling is accomplished by specialized endocrine cells that secrete hormones that travel via the bloodstream to target
cells throughout the body. Synaptic signaling occurs at specialized junctions between the nerve cell and its target cell; the neuron
secretes a chemical neurotransmitter into a small space between the nerve and target cell. In paracrine signaling chemicals are
secreted into a localized area, and only those cells in the immediate area are affected. Autocrine signaling occurs when cells respond
to signaling molecules that they secrete and provides feedback to that cell rather than other cells.
REF: Pg. 47
10. Ribosomes are very important organelles within the cell that have the function of
a. detoxifying substances.
b. synthesizing proteins.
c. converting energy to forms that can be used.
d. coding for protein synthesis.
ANS: B
Ribosomes primary function is the synthesis of proteins. Lysosomes and peroxisomes detoxify substances. Mitochondria convert
energy to forms that can be used to drive cell reactions. The nucleus contains genomic DNA that codes for protein synthesis.
REF: Pg. 31
Copyright © 2013, 2010, 2005 Saunders, an imprint of Elsevier Inc. All rights reserved. 3
11. The cardiac drug digitalis enhances myocardial contraction, because it
a. increases intracellular calcium level in cardiac cells.
b. inhibits sodium from entering cardiac cells.
c. enhances the sodium-potassium pump.
d. increases the sodium gradient across the cell membrane.
ANS: A
Digitalis inhibits the sodium-potassium pump and allows the accumulation of intracellular sodium, decreasing the sodium gradient
across the cell membrane. This leads to less efficient calcium removal by the sodium-dependent calcium pump. Increased calcium
inside the cardiac cell leads to more forceful cardiac muscle contraction to treat congestive heart failure due to cardiac muscle
weakness.
REF: Pg. 41
12. The organelle that contains enzymes necessary for oxidative phosphorylation to produce ATP is the
a. mitochondria.
b. ribosome.
c. lysosome.
d. nucleus.
ANS: A
The inner membrane of the mitochondria contains many enzymes that promote oxidative phosphorylation which produces ATP.
Ribosomes synthesize proteins. Lysosomes and peroxisomes detoxify substances. The nucleus contains genomic DNA that codes
for protein synthesis.
REF: Pg. 32
13. Ion channels open and close in response to all the following except
a. mechanical pressure.
b. ligand binding.
c. voltage changes.
d. temperature changes.
ANS: D
No temperature change channels are present on the cell membrane. Mechanically gated channels respond to mechanical
deformation. Ligand-gated channels respond to the binding of a signaling molecule (neurotransmitter or hormone). Voltage-gated
channels respond to a change in membrane potential.
REF: Pg. 42
14. Gap junctions are connecting channels that allow passage of small molecules from one cell to the next and are especially important
for
a. distance signaling.
b. tissues requiring synchronized function.
c. communication within a cell.
d. passage of large molecules.
ANS: B
Gap junctions are especially important in tissues in which synchronized functions are required such as in cardiac muscle
contraction. Gap junctions are channels between adjacent cells, not distant cells. Gap junctions function to promote communication
not within a cell, but between adjacent cells. Gap junctions allow passage of small molecules, but not large molecules.
REF: Pg. 45
COMPLETION
15. During conditions of prolonged insufficient oxygen availability (e.g., respiratory or cardiovascular disease) anaerobic glycolysis
accumulated pyruvate can lead to _____ acidosis.
ANS:
lactic
Pyruvate is converted to lactate and released into the blood stream, resulting in lactic acidosis.
REF: Pg. 34
16. The phase of cellular metabolism in which energy is released during breakdown of nutrient sources is ________.
ANS:
catabolism
Catabolism involves energy release via breakdown of nutrient sources such as glucose to provide ATP to the cell. In contrast,
anabolism refers to energy-using processes that result in complex molecules such as fats.
REF: Pg. 34
Copyright © 2013, 2010, 2005 Saunders, an imprint of Elsevier Inc. All rights reserved. 4
17. Some individuals inherit a gene that results in dangerously high blood cholesterol due to impaired ________ of low-density
lipoproteins (LDLs).
ANS:
endocytosis
The defective gene inhibits the synthesis of LDL protein receptors on the cell membrane. This impairs endocytosis of LDL. High
levels of LDL in the blood predispose to atherosclerosis.
REF: Pg. 38

 

Copyright © 2013, 2010, 2005 Saunders, an imprint of Elsevier Inc. All rights reserved. 1
Chapter 4: Cell Injury, Aging, and Death
Test Bank
MULTIPLE CHOICE
1. An increase in organ size and function due to increased workload is termed
a. atrophy.
b. hypertrophy.
c. metaplasia
d. inflammation.
ANS: B
Increased function of an organ such as the heart or skeletal muscle results in organ hypertrophy due to cellular enlargement. Atrophy
refers to reduction in size of an organ due to cellular shrinkage. Metaplasia refers to replacement of one differentiated cell type with
another. Inflammation results from immune response rather than workload.
REF: Pg. 61
2. Apoptosis is a process that results in cellular
a. atrophy.
b. death.
c. proliferation.
d. mutation.
ANS: B
Apoptosis results in death of a cell when it is no longer needed. Atrophy refers to reduction in size of an organ due to cellular
shrinkage. Proliferation refers to growth of new cells. Mutation refers to alteration in the genetic structure of cellular DNA.
REF: Pg. 64
3. All these cellular responses are potentially reversible except
a. necrosis.
b. metaplasia.
c. atrophy.
d. hyperplasia.
ANS: A
Necrosis refers to death of cells/tissue and is not reversible. Metaplasia refers to the replacement of one differentiated cell type with
another from persistent injury and is reversible when the injury stops. Atrophy occurs due to lack of use of an organ and is
reversible. Hyperplasia is an increase in the number of cells from increased physiologic demands or hormonal stimulation and is
reversible.
REF: Pg. 62
4. Necrotic death of brain tissue usually produces _____ necrosis.
a. coagulative
b. caseous
c. liquefactive
d. fat
ANS: C
Liquefactive necrosis is produced when brain tissue dies, as it is rich in enzymes and has little connective tissue. Coagulative
necrosis occurs from ischemic injury in any tissue. Caseous necrosis occurs in lung tissue damaged by tuberculosis. Fat necrosis
occurs in adipose (fat) tissue.
REF: Pg. 64
5. The cellular response indicative of injury due to faulty metabolism is
a. hydropic swelling.
b. lactate production.
c. metaplasia.
d. intracellular accumulations.
ANS: D
Intracellular accumulations result from faulty metabolism of lipids, carbohydrates, glycogen, and proteins. Hydropic swelling results
from malfunction of the sodium-potassium pump. Lactate production results from anaerobic glycolytic pathway. Metaplasia occurs
from persistent cell injury.
REF: Pg. 58
Copyright © 2013, 2010, 2005 Saunders, an imprint of Elsevier Inc. All rights reserved. 2
6. Metaplasia is
a. the replacement of one differentiated cell type with another.
b. the transformation of a cell type to malignancy.
c. an irreversible cellular adaptation.
d. the disorganization of cells into various sizes, shapes, and arrangements.
ANS: A
Metaplasia is the replacement of one differentiated cell type with another secondary to persistent damage. Dysplasia transforms
cells to preneoplastic lesions, which may become malignant. Metaplasia is reversible when the damage is stopped. Disorganization
of cells into various sizes, shapes, and arrangements occurs in dysplasia.
REF: Pg. 61
7. The cellular change that is considered preneoplastic is
a. anaplasia.
b. dysplasia.
c. metaplasia.
d. hyperplasia.
ANS: B
Dysplastic cells have the potential to become cancerous and are therefore referred to as preneoplastic. Anaplasia, metaplasia, and
hyperplasia are not considered preneoplastic.
REF: Pg. 62
8. Somatic death refers to death
a. of a body organ.
b. of the entire organism.
c. of nerve cells.
d. secondary to brain damage.
ANS: B
Somatic death refers to death of an entire organism. Somatic death is not simply death of one body organ. Somatic death involves
death of all cells in the body. Brain death refers to death of the brain only, but organ systems can remain living with mechanical
assistance.
REF: Pg. 72
9. Coagulative necrosis is caused by
a. dissolving of dead cells and cyst formation.
b. trauma or pancreatitis.
c. lung tissue damage.
d. interrupted blood supply.
ANS: D
Coagulative necrosis results from interrupted blood supply leading to ischemic cell injury. Liquefactive necrosis results from
dissolving of dead cells and cyst formation. Fat necrosis is caused by trauma or pancreatitis. Caseous necrosis is caused by lung
tissue damage such as that caused by tuberculosis.
REF: Pgs. 63-64
10. Reperfusion injury to cells
a. results in very little cellular damage.
b. results from calcium deficiency in cells.
c. occurs following nutritional injury.
d. involves formation of free radicals.
ANS: D
Free radicals are formed when high-energy electrons partially reduce oxygen in reperfusion injury. Reperfusion injury usually
causes more cell damage than the original hypoxia. It results from calcium overload in the cells. Reperfusion injury results from
hypoxic injury, rather than from nutritional injury.
REF: Pgs. 66-67
11. Extreme cold injures cells by all the following except
a. ischemic injury from vasoconstriction.
b. peripheral nerve damage from rebound vasodilation.
c. decreased blood viscosity.
d. crystallization of cellular components.
ANS: C
Hypothermia causes increased blood viscosity, which can result in ischemic injury. Initial vasoconstriction causes ischemic injury.
Rebound vasodilation leads to intense swelling which damages peripheral nerves. Crystallization of cellular components leads to
rupture of these components.
REF: Pg. 69
Copyright © 2013, 2010, 2005 Saunders, an imprint of Elsevier Inc. All rights reserved. 3
12. The cellular component that is most susceptible to radiation injury is the
a. membrane.
b. DNA.
c. RNA.
d. ribosomes.
ANS: B
Cellular DNA is particularly susceptible to damage from radiation via breakage of the bonds holding the linear DNA together. Cell
membranes, RNA, and ribosomes are not the most susceptible to radiation injury.
REF: Pg. 70
13. The primary effect of aging on all body systems is
a. decreased functional reserve.
b. diseased function.
c. programmed senescence.
d. senility.
ANS: A
All body systems show age-related changes that can be generally described as a decrease in functional reserve; aging leads to
inability to adapt to (internal and external) environmental changes. Not all effects of aging are considered disease; some are
considered a normal part of aging. Programmed senescence is currently only a theory of aging that states cells have a
pre-programmed number of cell divisions before they will die. Senility is an outdated term used to describe the cognitive changes
associated with dementia; dementia is a disease and is not a normal part of aging.
REF: Pg. 72
14. Carbon monoxide injures cells by
a. destruction of cellular membranes.
b. reducing oxygen level on hemoglobin.
c. promotion of free radicals.
d. crystallization of cellular organelles.
ANS: B
Carbon monoxide binds tightly to hemoglobin preventing the red blood cell from carrying adequate oxygen, leading to hypoxic
injury. Other chemicals such as carbon tetrachloride promote free radicals, which injure cells and destroy cellular membranes.
Crystallization of cellular organelles is caused by hypothermia.
REF: Pg. 69
15. Of the statements below, the accurate statement regarding nutrition and cellular health is
a. the body can generally produce elements essential for nutritional balance.
b. obese individuals are generally nutritionally healthy.
c. deficient cellular uptake by one cell type may contribute to excess nutrient
delivery to other cell types.
d. a normal BMI indicates nutritional health.
ANS: C
Deficient cellular uptake by one cell type may contribute to excess nutrient delivery to other cell types such as in diabetes mellitus.
Most of these essential nutrients must be obtained from external sources, because the cell is unable to manufacture them. Obesity
involves an excess of caloric intake. The BMI is a measure for obesity, but does not indicate if a nutritional imbalance is present.
REF: Pg. 67
MULTIPLE RESPONSE
16. Bacteria cause injury to cells by (Select all that apply.)
a. producing exotoxins.
b. producing endotoxins.
c. producing destructive enzymes.
d. reproducing inside of host cells altering cellular function.
e. evoking an immune reaction.
ANS: A, B, C, E
Bacteria function in multiple ways to cause cell injury, including producing exotoxins that interfere with cellular function,
producing endotoxins that cause fever and circulatory shock when the bacteria are lysed, producing enzymes that digest cellular
membranes, or evoking an immune response with release of chemicals (e.g., histamines, kinins, lymphokines) that can injure cells.
Bacteria do not reproduce inside host cells.
REF: Pg. 67
Copyright © 2013, 2010, 2005 Saunders, an imprint of Elsevier Inc. All rights reserved. 4
17. Viruses differ from most bacteria in that they (Select all that apply.)
a. enter the host cell.
b. directly produce free radicals.
c. use the host’s metabolic processes to survive and replicate.
d. do not induce an immune response.
e. do not produce toxins.
ANS: A, C, E
Viruses are able to enter the host cell and use host metabolic processes to survive and replicate. Viruses do not produce toxins.
Viruses do not directly produce free radicals, although these can be produced indirectly by the immune response that follows viral
infection. Both viruses and bacteria produce an immune response.
REF: Pgs. 67-68
18. Infectious injury often results from (Select all that apply.)
a. exotoxins.
b. endotoxins.
c. self-destruction of cells.
d. anti-inflammatory reactions.
e. enzymes from white blood cells.
ANS: A, B, C, E
Exotoxins produced by bacteria interfere with cellular functions. Endotoxins are a component of some bacteria; when the bacteria
are lyses, endotoxins are released, causing fever and even circulatory shock. Virally infected cells may trigger their own destruction.
Enzymes from white blood cells can harm cells in the area of inflammation. Infectious injury promotes inflammation; inflammation
can cause more damage than the infecting agent.
REF: Pgs. 67-68

 

Copyright © 2013, 2010, 2005 Saunders, an imprint of Elsevier Inc. All rights reserved. 1
Chapter 54: Burn Injuries
Test Bank
MULTIPLE CHOICE
1. It is true that second-degree, superficial partial-thickness burns
a. are less painful than third-degree burns.
b. involve only the epidermis.
c. usually heal in 7 to 21 days.
d. are rarely associated with scar formation.
ANS: C
Second-degree, superficial partial-thickness burns usually heal in 7 to 21 days. Second-degree burns are more painful than
third-degree burns, involve damage to the dermis, and can be associated with scar formation.
REF: Pg. 1093
2. The first priority when rescuing a burned individual is
a. establishing a patent airway.
b. removing his or her clothing.
c. eliminating the source of the burn.
d. covering the wounds with wet sheets.
ANS: C
The first priority in rescuing a burned individual is eliminating the source of the burn. The next priority is to establish a patent
airway. Removing the clothing is not recommended; however, dry, clean sheets or dressings should be placed over the burns.
Covering the wound is not advised, as this may cause hypothermia.
REF: Pg. 1095
3. Burn shock is the direct result of
a. hypovolemia.
b. cardiac depression.
c. infection.
d. increased capillary permeability.
ANS: D
Burn shock results from systemic capillary permeability with leakage of fluids throughout all tissues; the result is massive edema.
Hypovolemia is not the direct cause of burn shock. Burn shock does not result from cardiac depression or infection.
REF: Pgs. 1096-1097
4. Electrical injury may cause extensive damage to low-resistance tissues, particularly
a. bone and muscle.
b. nerves and blood vessels.
c. epidermis.
d. dermis and subcutaneous tissue.
ANS: B
Electrical injury may cause extensive damage to low-resistance tissues, particularly nerves and blood vessels. Bone and muscle, and
dermis and subcutaneous tissue, are not low-resistance tissues. Skin is a high-resistance tissue.
REF: Pg. 1105
5. The time between the end of burn shock and closure of the burn to less than 20% of total body surface area is called the ________
phase.
a. postshock
b. rehabilitation
c. critical
d. emergent
ANS: D
The time between the end of burn shock and closure of the burn to less than 20% of total body surface area is called the emergent
phase. Postshock is not a phase of burn wound healing. The rehabilitation phase begins when the burn size is reduced to less than
20% TBSA and the patient is able to assume self-care. There is not a critical phase of burn wound healing.
REF: Pg. 1100
6. The primary aim of burn wound management is to prevent
a. trauma to burned tissue.
b. microbial colonization of the wound.
c. the wound from drying out.
d. premature wound closure.
ANS: B
The primary aim of burn wound management is to prevent microbial colonization of the wound. A goal of wound management is to
minimize further destruction of viable tissue. It is not possible to prevent the trauma after injury, since it has already occurred.
Keeping the wound dry is not a primary aim of burn wound management. Preventing premature wound closure is not a goal of burn
wound management.
REF: Pg. 1100
Copyright © 2013, 2010, 2005 Saunders, an imprint of Elsevier Inc. All rights reserved. 2
7. The third element essential to survival after major burn injury is
a. excision of the burn followed by skin grafting.
b. frequent wound debridement to encourage wound healing.
c. hyperbaric oxygen therapy.
d. continuous topical antibiotic therapy.
ANS: A
The third element essential to survival after major burn injury is excision of the burn followed by skin grafting. Frequent wound
debridement, hyperbaric oxygen therapy, and continuous topical antibiotic therapy are not the third element essential to survival
after major burn injury.
REF: Pg. 1100
8. The most common cause of burn injuries in children is
a. house fires.
b. cigarette burns.
c. scalding with hot water.
d. contact with chemical agents.
ANS: C
The most common cause of burn injuries in children is scalding with hot water. House fires, cigarette burns, and contact with
chemical agents are not the most common causes of burn injuries in children.
REF: Pg. 1091
9. The goal of nutritional support of the burned individual is to
a. limit the glucose available to infectious organisms.
b. create a positive nitrogen balance.
c. protect the kidney from excessive protein intake.
d. avoid hyperlipidemia.
ANS: B
The goal of nutritional support of the burned individual is to create a positive nitrogen balance. Limiting the glucose available to
infectious organisms, protecting the kidney from excessive protein intake, and avoiding hyperlipidemia are not the goals of
nutritional support of the burn patient.
REF: Pg. 1100
10. A necessary intervention when managing burns associated with automobile airbag injury include
a. irrigation with water.
b. application of steroid cream.
c. IV infusion of antibiotics.
d. debridement of skin.
ANS: A
Management of burns associated with automobile airbag injury is irrigation with copious amounts of water. Application of steroid
cream, IV antibiotics, and debridement are not necessary for airbag burns.
REF: Pg. 1107
11. The majority of electrical burns in children are caused by
a. playing with electrical outlets.
b. playing with defective electrical cords.
c. biting on extension cords.
d. putting fingers in electrical sockets.
ANS: C
The majority of electrical burns in children are caused by biting on extension cords. Playing with electrical outlets, playing with
defective electrical cords, and putting fingers in electrical sockets are not the causes of the majority of electrical burns in children.
REF: Pg. 1105
12. It is true that covering a burn with cool wet sheets
a. promotes comfort.
b. facilitates healing.
c. prevents fluid loss.
d. promotes hypothermia.
ANS: D
Cool wet sheets quickly become cold wet sheets that promote hypothermia as the skin’s ability to regulate body temperature is lost.
Although cool wet sheets may initially promote comfort, they may be the cause of hypothermia the longer the sheets remain in
contact with the burned skin. Cool wet sheets do not facilitate burn healing or prevent fluid loss.
REF: Pg. 1096
Copyright © 2013, 2010, 2005 Saunders, an imprint of Elsevier Inc. All rights reserved. 3
13. The immediate management of a thermal burn victim once the fire has been extinguished is to
a. cover with blankets to prevent shock.
b. monitor for signs of respiratory impairment.
c. apply lubricant to the burn area.
d. start an IV line.
ANS: B
Excessive heat to the respiratory tract could result in obstruction; therefore, respiratory status is the main priority. Do not cover with
blankets, as this will prevent underlying heat from escaping. Do not apply anything but water to a burn. An IV line may be started
after management of respiratory status.
REF: Pg. 1096