Question 1

The therapist has been asked to measure preductal oxygen saturation.Where could the therapist place the pulse oximeter probe?&#10;A)Right thumb&#10;B)Left thumb&#10;C)Forehead&#10;D)Left earlobe

Accepted Answer

Sensor placement on right arm or head will reflect preductal values while the left arm and the lower parts of the body will reflect postductal oxygen saturation values.

Question 2

While attending to a neonatal patient in the neonatal intensive care unit (NICU),the therapist notices that a transcutaneous electrode is affixed to the upper chest of the neonate.What should the therapist do at this time?

A)The therapist should only continue monitoring the patient since the transcutaneous electrode is properly placed.
B)The therapist should reposition the electrode on the neonate's abdomen.
C)The therapist needs to move the transcutaneous electrode to the infant's right shoulder.
D)The therapist should relocate the electrode on the sternum as close as possible to the heart.

A
The site should be a highly vascular area such as the earlobe,upper chest,abdomen,thighs,or the lower back if the patient is supine;bony areas and those with limited perfusion,such as over the spine,should be avoided.

Accepted Answer

The site should be a highly vascular area such as the earlobe,upper chest,abdomen,thighs,or the lower back if the patient is supine;bony areas and those with limited perfusion,such as over the spine,should be avoided.

Question 3

A therapist is monitoring a child on the mechanical ventilator who is hemodynamically stable.The PetCO&#8322; is 48 mm Hg.If accurate,what should be the PaCO&#8322;?&#10;A)43-48 mm Hg&#10;B)45-48 mm Hg&#10;C)50-53 mm Hg&#10;D)Exactly the same as PetCO&#8322;

Accepted Answer

PetCO₂ can be used as a surrogate for the arterial partial pressure of CO₂ (PaCO₂)within physiologic limits.Normally,PetCO₂ is 2-5 mmHg below PaCO₂.The reason for this is the proportion dead-space ventilation.

Question 4

How is the percentage of functional hemoglobin that is saturated with oxygen determined via pulse oximetry?&#10;A)The percentage of red light that lands on the photodiode represents the SPo&#8322; (oxygen saturation as determined by pulse oximetry).&#10;B)The percentage of infrared light that reaches the photodetector reflects the SPo&#8322;.&#10;C)The ratio of the red and infrared light that reaches the photodiode signifies the SPo&#8322;.&#10;D)The sum of the amount of red and infrared absorbed by the tissue determines the SPo&#8322;.

Accepted Answer

A pulse oximeter sensor has two light-emitting diodes (LEDs)that function as light sources and a photodiode that measures the amount of light from the LEDs (see Figure 9-1 in the textbook).One LED emits red light,and the other diode emits infrared light.The sensor is placed over a translucent part of the body (finger,toe,earlobe,etc. ).As the light from the diodes passes through the blood and tissue,some of the light from both the red and the infrared diodes is absorbed by oxyhemoglobin.The photodiode then measures the amount of light that passes through the body without being absorbed.Because oxyhemoglobin (hemoglobin bound with oxygen)and deoxyhemoglobin (hemoglobin not bound with oxygen)absorb significantly different amounts of light,the proportion of oxyhemoglobin (expressed as a percentage)is determined (see Figure 9-2 in the textbook).

Question 5

The therapist has applied a bandage-type pulse oximetry probe too tightly to an infant's finger.What problem can be expected to occur in this situation?&#10;A)The SPo&#8322; will read erroneously low.&#10;B)The SPo&#8322; will read erroneously high.&#10;C)The monitor will display a message indicating inadequate pulse.&#10;D)The monitor will display fluctuating SPo&#8322; values between being erroneously low and high.

Accepted Answer

Correct application of the sensor is crucial to the quality of readings from the pulse oximeter.The sensors should be placed firmly to avoid falling off or motion artifact,but care should be taken to avoid overtightening and compromising local circulation.

Question 6

What is volumetric capnography able to determine?
I)Airway dead space
II)Alveolar tidal volume
III)Shunt fraction
IV)Alveolar minute volume

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

Accepted Answer

The concentration of CO₂ is plotted against exhaled tidal volume to determine relevant ventilation data such as airway dead space,alveolar tidal volume,and extrapolation of CO₂ elimination and alveolar minute ventilation.

Question 7

Where on the following normal capnogram is the end-tidal carbon dioxide (PetCO&#8322;)represented?&#10; &#10;A)A&#10;B)B&#10;C)C&#10;D)D

Accepted Answer

The normal capnogram can be divided into four phases (see Figure 9-6 in the textbook):
Phase A-B: The inspiratory phase, during which the sensor detects no carbon dioxide
Phase B-C: The initial expiratory phase, during which carbon dioxide rapidly increases as the alveoli begin to empty
Phase C-D: The completion of expiration as the alveoli empty (alveolar plateau) and show a slight increase in carbon dioxide
Phase D-E: The beginning of inspiration as the waveform returns to zero.

Question 8

While working in the NICU with a mechanically ventilated newborn who is being monitored for PetCO₂,the therapist observes the following capnogram: What interpretation should the therapist make of this capnogram?

A) This capnogram is normal.
B) The patient is receiving about 10 cm H₂O positive end-expiratory pressure.
C) The patient is rebreathing his own exhaled gas.
D) The neonate is being hyperventilated.

Accepted Answer

Rebreathing is characterized by an elevation in the A-B phase of the capnogram, with a corresponding increase in ETCO₂ . It indicates the rebreathing of previously exhaled carbon dioxide. Rebreathing can be caused by allowing an insufficient expiratory time or by inadequate inspiratory flow (see Figure 9-7 in the textbook).

Question 9

What clinical parameter is critically important to monitor when mechanical ventilation is administered?&#10;A)Blood pressure&#10;B)Heart rate&#10;C)Temperature&#10;D)Respiratory rate

Accepted Answer

In mechanically ventilated children,increasing intrathoracic pressure (by increasing positive end expiratory pressure,for example)can reduce venous return,resulting in decreased BP.

Question 10

The therapist is assessing a mechanically ventilated infant and observes that the transcutaneous electrode temperature is set between 41° C and 44° C.What action does the therapist need to take at this time?

A)The temperature range set is appropriate;therefore,no action is necessary.
B)The therapist should increase the temperature range to 47° C to 48° C.
C)The temperature of the transcutaneous electrode needs to be reduced to 36° C to 38° C.
D)The electrode needs to be repositioned and maintained at the same temperature.

Accepted Answer

Selecting a sensor temperature is important to proper operation.The temperature range is usually 41° to 44° C.Heating of the sensor requires that the site be changed on a routine basis to prevent thermal injuries.The frequency of site changes ranges from 4 to 12 hours (depending upon the device and sensor temperature)but can be reduced if necessary.

Question 11

Which of the following conditions will preclude the use of indirect calorimetry?
I)Cuffed endotracheal tubes
II)Circuit leaks
III)FiO₂ 40%
IV)HFOV

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

Accepted Answer

The answer of Which of the following conditions will preclude...

Question 12

What is the purpose of indirect calorimetry?&#10;A)To measure heat produced and lost from the body&#10;B)To calculate energy expenditure by measuring VO&#8322; and VCO&#8322;&#10;C)To calculate resting energy expenditure&#10;D)To measure gas exchange

Accepted Answer

The answer of What is the purpose of indirect calorimetry?&#10;A)To...

Question 13

The following capnogram was obtained from a newborn infant receiving mechanical ventilation.

How should the therapist evaluate this capnogram?

A)Airway obstruction
B)Hypoventilation
C)Hyperventilation
D)Increased dead space ventilation

Accepted Answer

The answer of The following capnogram was obtained from a...

Question 14

Which of the following is the main physiologic factor responsible for deriving accurate transcutaneous data?&#10;A)Heart rate&#10;B)Minute ventilation&#10;C)Peripheral perfusion&#10;D)Ventilation-perfusion ratios

Accepted Answer

The answer of Which of the following is the main...

Question 15

An infant demonstrates the following capnogram while being mechanically ventilated.

How should the therapist interpret this capnogram?

A)The patient has received a paralytic agent.
B)A paralytic agent is indicated for this patient because of the spontaneous breathing efforts represented by the downward deflections.
C)The patient may have developed a pneumothorax.
D)A leak has developed in the patient-ventilator system.

Accepted Answer

The answer of An infant demonstrates the following capnogram while...

Question 16

As the therapist applies a pulse oximeter finger probe to a neonate who is receiving supplemental oxygen,she notices that the SpO&#8322; reading is 100%.What should the therapist do in this situation?&#10;A)The therapist should continue monitoring the patient because the reading is accurate.&#10;B)The therapist should obtain an arterial blood sample to confirm P2 level.&#10;C)The therapist should switch to using a capnometer.&#10;D)The therapist should reduce the fraction of inspired oxygen.

Accepted Answer

The answer of As the therapist applies a pulse oximeter...

Question 17

Why do transcutaneous oxygen tension (PO&#8322;)and carbon dioxide tension (PCO&#8322;)values differ from PaO&#8322; and PaCO&#8322; measurements?&#10;A)Because of the lag time between the cardiac output and the time the blood reaches the transcutaneous electrode site&#10;B)Because the skin is much more permeable to oxygen than carbon dioxide&#10;C)Because oxygen is consumed and carbon dioxide is produced in transit from the left ventricle to the electrode site&#10;D)Because metabolism in the tissue consumes oxygen and produces carbon dioxide at the site of the electrode

Accepted Answer

The answer of Why do transcutaneous oxygen tension (PO&#8322;)and carbon...

Question 18

Which of the following features or characteristics apply to mainstream capnography?
I)The mainstream capnograph contains narrow tubing that can become occluded with mucus.
II)Mainstream capnography generally employs infrared spectrometers.
III)The mainstream capnograph does not add much weight to the breathing circuit.
IV)The mainstream capnograph is placed at the proximal end of the endotracheal tube.

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

Accepted Answer

The answer of Which of the following features or characteristics...

Deck 9: Noninvasive Monitoring in Neonatal and Pediatric Care