Deck 22: Neonatal Pulmonary Disorders

Question 1

The therapist is contemplating the possibility of intubating and suctioning a nonvigorous newborn with MAS. Which of the following clinical parameters confirms the indication for the procedure?

A) Good muscle tone
B) Presence of dark green meconium on the skin
C) Heart rate <100 beats per minute
D) The AAP and AHA no longer recommend routine immediate endotracheal intubation and suctioning for nonvigorous infants

Answer 1

D
The AAP and AHA no longer recommend routine immediate endotracheal intubation and suctioning for nonvigorous infants. The care for these infants is guided by the same principles as outlined in NRP, in which intubation is indicated for inadequate respiratory effort (apnea, gasping, or poor oxygenation) or bradycardia despite bag mask ventilation, or when chest compressions are required.

Question 2

What is the typical type of airway obstruction that occurs with MAS?

A) Ball valve
B) Complete
C) No obstruction
D) Airway inflammation

Answer 2

A
If the infant has a large amount of thick meconium within the airways at the time of delivery, complete bronchiole obstruction with subsequent alveolar collapse will result. The more typical picture, however, is that of smaller amounts of meconium within amniotic fluid, causing a ball-valve effect because of partial obstruction of the airways.

Question 3

While reviewing the chest X-ray of a newborn recently delivered via cesarean section, the therapist observes the following features:
Pulmonary vascular congestion
Prominent perihilar streaking
Fluid in the interlobular fissures
Hyperexpansion
Flat diaphragm
Which of the following conditions does this patient likely have?

A) RDS
B) Persistent pulmonary hypertension of the newborn
C) Transient tachypnea of the newborn
D) Barotrauma

Answer 3

C
The chest radiograph shows pulmonary vascular congestion, prominent perihilar streaking, fluid in the interlobular fissures, hyperexpansion, and a flat diaphragm (see Figure 22-4 in the textbook). Mild cardiomegaly and pleural effusions may also be present.

Question 4

The therapist is reviewing the chest radiograph of a newborn, preterm infant and observes diffuse, fine, reticulogranular densities, which provide a ground-glass appearance. On the basis of these radiographic findings, which of the following conditions should the therapist suspect is present?

A) Persistent pulmonary hypertension of the newborn
B) Respiratory distress syndrome
C) Bronchopulmonary dysplasia
D) Pulmonary interstitial emphysema

Question 5

Which of the following is the most common bacteria isolated in early-onset infection in term and near-term infants?

A) Group B Streptococcus
B) Escherichia coli
C) Pseudomona spp.
D) Haemophilus influenza

Question 6

Which of the following risk factors contribute to the pathogenesis of BPD?
I) Lung immaturity
II) Respiratory failure
III) Oxygen supplementation
IV) Positive-pressure ventilation

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

Question 7

What is the significance of an infant with RDS demonstrating a grunt during each exhalation?

A) Resolution of the RDS
B) An effort to maintain its functional residual capacity (FRC)
C) An attempt to overcome increased airway resistance
D) Impending death

Question 8

Why does meconium staining occur predominantly in infants older than 36 weeks of gestational age?

A) Because these infants can generate strong inspiratory efforts
B) Because infants this age have significant cardiac outputs
C) Because these infants demonstrate strong peristalsis
D) Because these newborns have weak anal sphincter tone

Question 9

What ventilator settings should a therapist select for a newborn with respiratory distress syndrome?
I) PIP 25 to 30 cm H₂O
II) PEEP 4 to 6 cm H₂O
III) VT 5 to 6 mL/kg
IV) Frequency 20 to 40 breaths per minute

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

Question 10

When neonatal pneumonia is suspected, how long does an infant generally receive broad-spectrum antibiotics?

A) 24 hours
B) 48 hours
C) 72 hours
D) 96 hours

Question 11

Which of the following conditions increase the risk for developing RDS?
I) Maternal diabetes
II) Cesarean delivery
III) Multiple births
IV) Premature rupture of membranes

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

Question 12

What radiographic features is the therapist likely to see on a typical chest X-ray of an infant with MAS?

A) Ground-glass appearance
B) Complete whiteout
C) Decreased lung volume
D) Widespread patchy areas of atelectasis

Question 13

How should the therapist interpret the lack of supernatant foam appearing during the shake test?

A) The test needs to be redone.
B) The unborn infant's lungs have matured.
C) The infant's lungs are immature.
D) The patient has a 50% chance of developing RDS.

Question 14

What is the greatest risk factor for respiratory distress syndrome (RDS)?

A) Premature rupture of membranes
B) Male and white infants
C) Prematurity
D) Genetics

Question 15

Which of the following is the most common bacteria isolated in preterm infants?

A) Group B Streptococcus
B) Escherichia coli
C) Pseudomona spp.
D) Haemophilus influenza

Question 16

Which of the following therapeutic interventions is generally needed to treat transient tachypnea of the newborn (TTN)?

A) Endotracheal intubation
B) 40% oxygen hood
C) Bronchial hygiene therapy
D) Bronchodilator therapy

Question 17

When should a therapist consider intubation and mechanical ventilation for a newborn with respiratory distress?
I. Oxygen saturation less than 85% at FiO₂ $\ge$ 40% on CPAP
II. Periodic apnea
III. PaCO₂ of 60 mm Hg or higher
IV. pH <7.20

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

Question 18

When should a therapist consider CPAP for a newborn with respiratory distress?

A) Oxygen saturation cannot be kept in acceptable range by hood or cannula O₂
B) pH <7.20
C) Respiratory rate of 40 breaths per minute
D) PaO₂ 50 to 60 mm Hg

Question 19

How should the therapist interpret a lecithin-to-sphingomyelin (L:S) ratio of 2:1?

A) The presence of lung maturity
B) A gestational age of less than 28 weeks
C) The likelihood of RDS
D) Laboratory error

Question 20

Eight hours after being born, a baby presents with cyanosis despite administration of adequate ventilation, tachypnea, and retractions. Which of the following conditions should the therapist suspect is affecting this newborn?

A) RDS
B) BPD
C) PPHN
D) GBS pneumonia

Question 21

Blood samples are simultaneously obtained from both the right radial artery and the umbilical artery, and the arterial partial pressure of oxygen (PaO₂) value from the right radial artery is 20 mm Hg greater than that analyzed from the umbilical artery sample. On the basis of this finding, which of the following conditions does the neonate likely have?

A) PPHN
B) MAS
C) Neonatal pneumonia
D) RDS

Question 22

Which of the following blood gas parameters should the therapist target when managing patients with PPHN on mechanical ventilation?
I) Preductal SpO₂ maintained between 90% and 99%
II) PaCO₂ 40 to 50 mm Hg
III) pH 7.35 to 7.45
IV) PaO₂ >95 mm Hg

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

Question 23

Which of the following are considered mechanical ventilation strategies used for infants with pulmonary hemorrhage?

A) A ventilation strategy of high PEEP (up to 6-8 cm H₂O)
B) A ventilation strategy of low PEEP (1-2 cm H₂O)
C) Infrequent suctioning
D) Maintaining low mean airway pressures

Question 24

The therapist is assessing a newborn on the mechanical ventilator. The neonate shows clear signs of respiratory distress, and lung auscultation reveals shifting of the PMI toward the left and breath sounds decreased on the right. What should the therapist suspect this newborn developed?

A) Right-sided pneumothorax
B) Severe right lung atelectasis
C) Right pleural effusion
D) Left-sided atelectasis

Question 25

A newborn suspected of having a pneumothorax is rapidly deteriorating. What should the therapist suggest at this time?

A) Intubation and mechanical ventilation.
B) Mask CPAP.
C) Needle aspiration.
D) Confirm air leak with a chest X-ray and place a chest tube afterward.

Question 26

While reviewing the chest X-ray of a newborn, the therapist observes the following features: continuous diaphragm sign and linear bands of air paralleling the left side of the heart and the descending aorta with extension superiorly along the great vessels into the neck. Which of the following conditions does this patient likely have?

A) Pneumothorax
B) Cardiac tamponade
C) Pneumomediastinum
D) Pneumopericardium

Question 27

A neonate diagnosed with a pneumothorax was treated with a chest tube. After 36 hours, the therapist noticed that bubbling is present in the chest tube system. What should the therapist do at this time?

A) Suggest removal of the chest tube in 24 hours.
B) Clamp the tube and obtain a CXR.
C) Keep the chest tube until bubbling stops.
D) Remove the chest tube and obtain a follow-up CXR.

Question 28

Which of the following medications should the therapist recommend for an infant with apnea of prematurity experiencing episodes of apnea?

A) Canthine derivatives
B) Benzodiazepines
C) Antibiotics
D) Doxapram