Deck 4: Examination and Assessment of the Neonatal and Pediatric Patient

Question 1

The therapist is evaluating a newborn with an abdominal defect consisting of protrusion of the membranous sac that encloses abdominal contents through an opening in the abdominal wall into the umbilical cord. Which of the following conditions is consistent with this description?

A) Enterocolitis
B) Ascites
C) Congenital diaphragmatic hernia
D) Omphalocele

Answer 1

D
Successful abdominal examination requires a calm and quiet infant. Observe the contour of the abdomen and determine whether it is scaphoid (sunken anterior wall), flat, or distended. Distention is a significant finding characterized by tightly drawn skin through which engorged subcutaneous vessels can easily be seen. More noticeable abnormalities of the abdomen include prune belly syndrome, which is a congenital lack of abdominal musculature; omphalocele, a protrusion of the membranous sac that encloses abdominal contents through an opening in the abdominal wall into the umbilical cord; and gastroschisis, a defect in the abdominal wall lateral to the midline with protrusion of the intestines.

Question 2

Which of the following statements refers to the diagnostic procedure called transillumination?

A) Place a light source between the surface of the bed and the patient's back and orient the patient in a supine position.
B) Direct a light source toward the ipsilateral surface of the patient's thorax.
C) Position a beam of light against a patient's chest wall in a well-lit room.
D) Insert a fiberoptic light source down a patient's endotracheal tube and beyond the tube's distal tip.

Answer 2

B
With suspected pneumothorax, perform transillumination of the chest wall, using a high-energy flashlight or fiberoptic device in a darkened room. Direct the light source on the chest wall of the suspected (ipsilateral) side. A large pneumothorax will reveal an excessively pink and illuminated, usually irregular, area of light, or "glowing" area, through the chest wall when compared with the contralateral side.

Question 3

What condition would be responsible for the therapist observing a pulse oximeter indicating decreased perfusion while central blood pressure remains normal?

A) Volume depletion with compensatory peripheral vasoconstriction
B) Hypoplastic left-sided heart syndrome
C) Hypervolemia with compensatory peripheral vasodilation
D) Hypoplastic right-sided heart syndrome

Answer 3

A
A pulse oximeter will display a low pulse rate and perfusion signal as peripheral pulses and perfusion decrease. The cause of this poor perfusion status must be determined. However, if the pulse oximeter suggests decreased perfusion while central blood pressure remains normal, the cause may be volume depletion with compensatory peripheral vasoconstriction.

Question 4

While performing a physical examination on a newborn infant, the therapist notices that the point of maximal cardiac impulse is to the left of the sternal border. Which of the following conditions can cause this situation?

A) Atelectasis of the right lung
B) Bilateral pulmonary consolidation
C) Right-sided pneumothorax
D) Left main stem bronchus intubation

Question 5

The gestational age of a newborn has been evaluated to be 34 weeks. The newborn's birth weight is greater than the 90th percentile. How should the therapist classify this infant?

A) Small for gestational age
B) Average for gestational age
C) Large for gestational age
D) Very large for gestational age

Question 6

An infant arrives in the newborn nursery with an axillary body temperature of 95.6°F. Which of the following events may be responsible for this infant's temperature?

A) The neonate was in an infant warmer in the delivery room.
B) The infant was swaddled in numerous blankets.
C) The delivery room temperature was low.
D) The newborn has protracted diarrhea.

Question 7

A neonate is found to have a bounding pulse. Which of the following conditions may contribute to this finding?

A) Right-to-left shunt
B) Coarctation of the aorta
C) Left-to-right shunt
D) Patent foramen ovale

Question 8

Why is it difficult to localize auscultation findings of the thorax of a newborn?

A) Because the neonate's chest is small and sounds are difficult to differentiate
B) Because the newborn infant is frequently crying
C) Because the neonate's tidal volume is so small
D) Because the newborn's pulmonary compliance is low

Question 9

While stabilizing a preterm neonate before resuscitation, what should the therapist do to avert injury and atelectasis, and to avoid interfering with the infant's ability to establish adequate ventilation?
I) Use a bulb syringe.
II) Avoid excessive suctioning of clear fluid from the nasopharynx.
III) Use a suction catheter clearing the mouth first and then the nose.
IV) Suction using direct laryngoscopy.

A) IV only
B) I and II only
C) I, II, and III only
D) I, II, and IV only

Question 10

Why are chest retractions more prominent among neonates than among older children and adults?

A) Because neonates generate a greater subatmospheric intrapleural pressure
B) Because newborns have relatively thin and weak musculature and a less rigid thorax
C) Because neonates have a much higher respiratory rate
D) Because airway resistance through the smaller caliber airways is higher

Question 11

A newborn does not appear to respond to the extrauterine environment. Both the cry and respiratory effort are weak. Which of the following methods should the therapist use to stimulate the newborn?

A) Hold the newborn upside down.
B) Rub over the sternal area.
C) Suction the nasopharynx.
D) Gently rub the back.

Question 12

Which of the following parameters of the Apgar score provides the most important prognostic value?

A) Heart rate
B) Respiratory rate
C) Skin color
D) Muscle tone

Question 13

The therapist notices that an infant presents with irregular areas of dusky skin alternating with areas of pale skin. On the basis of this observation, which of the following conditions should the therapist anticipate this patient having?

A) Polycythemia
B) Hypotension
C) Situs inversus with dextrocardia
D) Renal insufficiency

Question 14

What measures can the therapist take to prevent heat loss and cold stress before performing resuscitation on a preterm neonate?
I) Dry the infant's skin.
II) Wrap the infant in pre-warmed blankets.
III) Remove wet linens from around the infant.
IV) Measure the neonate's body temperature.

A) IV only
B) I and II only
C) I, II, and III only
D) I, II, and IV only

Question 15

As the head of a neonate contaminated with meconium emerges at birth, the heart rate monitor indicates 120 beats per minute, and the physician notices that the infant has good muscle tone and a strong respiratory effort. What should the physician do at this time to provide airway care?

A) Intubate the infant immediately.
B) Perform pharyngeal and tracheal suctioning immediately.
C) Perform tracheal suctioning only at this time.
D) Only routine monitoring of respiratory vital signs is needed at this time.

Question 16

A physical examination is being performed on a newborn, and the therapist notices that the infant's arms do not move symmetrically. Which of the following situations could account for this problem?

A) An injury to the infant's brachial plexus may have occurred during birth.
B) The infant may have been born breach.
C) The baby was born via cesarean section.
D) The infant experienced nuchal cords during birth.

Question 17

Which of the following neonatal skin presentations at birth is associated with a high hematocrit value or polycythemia and neonatal hyperviscosity syndrome?

A) Mottling
B) Lanugo
C) Reddish blue appearance
D) Vernix

Question 18

For the purpose of assessing right-to-left shunting, as in the case of persistent pulmonary hypertension, which of the following sites would render postductal blood?
I) Right arm
II) Left arm
III) Right leg
IV) Left leg

A) I and II only
B) II only
C) III and IV only
D) II, III, and IV only

Question 19

Which of the following factors are taken into consideration when assessing the gestational age of a neonate?
I) Previous maternal pregnancies
II) Prenatal ultrasound evaluations
III) Postnatal findings based on physical and neurologic examinations
IV) Gestational duration based on the last menstrual cycle

A) I and III only
B) I, II, and III only
C) I, II, and IV only
D) II, III, and IV only

Question 20

The therapist has completed a 1-minute Apgar score. The following evaluations were obtained.
(1) The infant is pale.
(2) The heart rate is 90 beats per minute.
(3) The respiratory effort is irregular.
(4) Some muscle tone is noted.
(5) No response to nasal suctioning is found.
On the basis of these findings, what Apgar score should be assigned to this neonate?

A) 1
B) 2
C) 3
D) 5

Question 21

While auscultating a young child's thorax, the therapist hears bilateral fine crackles. Which of the following conditions can produce these adventitious sounds?

A) Pulmonary edema
B) Bronchitis
C) Croup
D) Asthma

Question 22

Which of the following components compose the past medical history section of the patient's medical history?
I) Birth weight
II) Previous mechanical ventilation
III) Recurrence of symptoms based on season
IV) Emergency department visits

A) II only
B) II and IV only
C) I, II, and IV only
D) I, II, III, and IV

Question 23

Which of the following are recommendations for infants with meconium staining?
I. No intrapartum suctioning should occur.
II. Infants who are vigorous at birth should not receive tracheal suctioning.
III. Infants who are not vigorous may receive direct laryngotracheal suctioning.
IV. Intrapartum suctioning should not occur.

A) I and II only
B) III and IV only
C) II, III, and IV only
D) I, II, and III only

Question 24

While percussing the thorax of a child during a physical examination, the therapist hears a dull percussion note over the child's right lung. Which of the following conditions may cause this physical finding?
I) Atelectasis
II) Pneumothorax
III) Pleural effusion
IV) Consolidation

A) I and II only
B) I, III, and IV only
C) II, III, and IV only
D) I, II, III, and IV

Question 25

After placing a stethoscope over a small child's trachea, the therapist hears expiratory stridor. Which of the following conditions is consistent with this finding?

A) Laryngotracheobronchitis
B) Adenotonsillar hypertrophy
C) Asthma episode
D) Tracheomalacia

Question 26

After the umbilical cord has been cut in the delivery room during the delivery of an infant who is large for gestational age, the therapist notices that the umbilical cord is large and fat. Which of the following maternal conditions is likely present?

A) Congestive heart failure
B) Renal insufficiency
C) Diabetes mellitus
D) Hypertension

Question 27

Head bobbing, nasal flaring, and grunting are exhibiting signs of which of the following?

A) Respiratory distress
B) Hypoxemia
C) Hypercapnia
D) Acidemia

Question 28

During a physical examination of a child's chest, the therapist perceives increased tactile fremitus over the patient's right lower lobe. Which of the following conditions may cause this physical sign?

A) Pulmonary consolidation
B) Pneumothorax
C) Mucous plug
D) Aspirated foreign object

Question 29

Which of the following components of a patient's medical history is intended to determine the presence of symptoms not identified in the history of present illness and may be related or contribute to the child's underlying condition?

A) Chief complaint
B) Past medical history
C) Review of systems
D) History of present illness

Question 30

Which of the following components compose the history of present illness section of a patient's medical history?

A) Immunizations
B) Symptoms exhibited by parents
C) Aggravating or alleviating factors
D) Symptoms resulting in hospitalizations

Question 31

Which of the following white blood cell counts constitutes the condition leukopenia?

A) Less than or equal to 3500/mm³
B) 5000 to 10,000/mm³
C) 10,000 to 20,000/mm³
D) Greater than or equal to 25,000/mm³

Question 32

The therapist notices that a preterm newborn has a grunting cry. Which of the following conditions is most consistent with this description?

A) Hypothyroidism
B) Neurologic injury
C) Respiratory distress syndrome
D) Laryngeal edema

Question 33

Which of the following pieces of information represent components of patient history for a new pediatric patient?
I) Chief complaint
II) History of present illness
III) Past medical history
IV) Occupational history

A) I and II only
B) III and IV only
C) I, II, and III only
D) I, II, III, and IV