Deck 22: Neonatal Complications and Pulmonary Disorders

Question 1

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

Answer 1

A
A PaO₂ gradient between a preductal (right radial artery)and a postductal (umbilical artery)site of blood sampling >20 mm Hg suggests right-to-left shunting through the ductus arteriosus,as does an oxygenation saturation gradient >5% between preductal and postductal sites on pulse oximetry.

Question 2

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

Answer 2

C
The risk for development of RDS increases with maternal diabetes,multiple births,cesarean delivery,precipitous delivery (delivery of infant anywhere unintended),asphyxia,cold stress,and a maternal history of previously affected infants.

Question 3

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

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

Answer 3

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 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

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 6

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 7

When should a therapist consider intubation and mechanical ventilation for a newborn with respiratory distress?
I)FiO₂ > 40% to 70%
II)SpO₂ < 85%
III)CPAP of 5-10 cm H₂O
IV)pH < 7.20

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

Question 8

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 9

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 10

In addition to Group B Streptococcus,which of the following microorganisms are responsible for nosocomial pneumonia acquired after delivery?

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

Question 11

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

A)Fio₂ > 40% to 70% and SPo₂ < 85%
B)Fio₂ > 90% and SPo₂ < 95%
C)Respiratory rate of 40 breaths per minute
D)PaO₂ 50 to 60 mm Hg

Question 12

What ventilator settings should a therapist select for a newborn with respiratory distress syndrome?
I)PIP 25-30 cm H₂O
II)PEEP 3-6 cm H₂O
III)VT 5-6 mL/kg
IV)Frequency 60 breaths per minute

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

Question 13

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)Presence of coarse crackles on auscultation

Question 14

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)Patchy areas of atelectasis

Question 15

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 16

What is the incidence of respiratory distress syndrome (RDS)among infants born at less than 28 weeks of gestation?

A)30% to 40%
B)40% to 50%
C)60% to 80%
D)>80%

Question 17

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 18

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 19

While reviewing the chest X-ray of a newborn,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

Question 20

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)III and IV only

Question 21

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

A)Caffeine
B)Benzodiazepines
C)Antibiotics
D)Doxapram

Question 22

Which of the following blood gas parameters should the therapist target when managing patients with PPHN?
I)SaO₂ > 95%
II)PaCO₂ 35-45 mm Hg
III)pH 7.35-7.45
IV)PaO₂ > 95 mm Hg

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

Question 23

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 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 towards 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

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 26

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 afterwards