Deck 48: Neonatal and Pediatric Respiratory Care

Question 1

You notice paradoxical breathing. Which of the following conclusions is most consistent with this observation?

A)airway resistance (Raw) is decreased.
B)lung compliance (C_L) is increased.
C)work of breathing is increased.
D)chest-wall compliance is decreased.

Answer 1

C

Question 2

Which of the following pH values is associated with fetal asphyxia?

A)<7.1
B)<7.2
C)<7.3
D)<7.4

Answer 2

C

Question 3

Which of the following methods is useful in determining gestational age of the newborn?

A)Dubowitz
B)Adams
C)Apgar
D)Perkinson

Answer 3

A

Question 4

In which of the following conditions may bronchial hygiene therapy be considered for infants or children?
I)hyaline membrane disease
II)foreign body aspiration
III)cystic fibrosis
IV)bronchopulmonary dysplasia (BPD)

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

Question 5

What major modification from adult methods should be used when applying postural drainage to infants or small children?

A)Use longer drainage times for each lobe or segment.
B)Always administer supplemental oxygen during drainage.
C)Drain only the lower lobes and segments of the lung.
D)Drain only the upper lobes and segments of the lung.

Question 6

Which of the following aerosol devices would you recommend to administer a bronchodilator to a 15-day-old baby who is spontaneously breathing?

A)SVN
B)MDI
C)DPI
D)MDI with spacer

Question 7

Research has shown that the growing lung is more sensitive to oxygen toxicity than the adult lung.

Question 8

What is the normal arterial PO₂ in healthy infants?

A)>50 mm Hg
B)>60 mm Hg
C)>70 mm Hg
D)>80 mm Hg

Question 9

You notice in drawing (retractions) of chest-wall muscle and tissue between the ribs, and above and below the sternum, all occurring during inspiration. Which of the following conclusions is most consistent with this observation?

A)airway resistance (Raw) is decreased.
B)lung compliance (C_L) is decreased.
C)work of breathing is decreased.
D)chest-wall compliance is decreased.

Question 10

Temporary drops in the fetal heart rate during uterine contractions are known as:

A)fetal stress
B)decelerations
C)primary apnea
D)secondary bradycardia

Question 11

You detect a "bounding" peripheral pulse on a newborn infant. Based on this finding, what should you suspect?

A)patent ductus arteriosus
B)peripheral vasoconstriction
C)coarctation of the aorta
D)peripheral vasodilation

Question 12

Which of the following oxygen modalities would you recommend for a toddler needing a low FIO₂?

A)mist tent
B)cannula
C)Oxy-Hood
D)mask

Question 13

At 1 minute after birth, a newborn infant exhibits the following: heart rate of 65/min, a slow and irregular respiratory rate, some muscle flexion, a grimace when nasally suctioned, and a pink body with blue extremities. What is the infant's 1-minute Apgar score?

A)3
B)4
C)5
D)6

Question 14

The most probable explanation for the flip-flop phenomenon in the newborn is:

A)oxygen toxicity
B)right-to-left shunting
C)cardiac disease
D)reactive pulmonary vasoconstriction

Question 15

Which of the following maternal factors is/are related to the health of the fetus and the outcomes of pregnancy?
I)maternal age
II)prior maternal disease
III)maternal drug use
IV)maternal birth history

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

Question 16

Late decelerations are consistent with which of the following conditions?
I)uteroplacental insufficiency
II)umbilical cord compression
III)normal contraction
IV)maternal bradycardia

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

Question 17

You notice in the chart of an infant receiving neonatal intensive care the designation "preterm, AGA." Based on this information, what can you correctly conclude?

A)This is an infant whose weight falls between the 10th and 90th percentiles.
B)This is an infant whose weight falls between the 10th and 50th percentiles.
C)This is an infant whose weight falls between the 50th and 90th percentiles.
D)This is an infant whose weight falls between the 10th and 20th percentiles.

Question 18

Which of the following sizes (internal diameter) of endotracheal tubes would you select to intubate a 4-year-old child?

A)3 mm
B)4 mm
C)5 mm
D)7 mm

Question 19

Which of the following techniques would you recommend to assess the state of pulmonary maturity before birth?

A)blood gas analysis
B)ultrasonography
C)maternal history
D)amniocentesis

Question 20

Tachypnea in the newborn is defined as a respiratory rate greater than what level?

A)40/min
B)50/min
C)60/min
D)70/min

Question 21

Which of the following is not an inclusion criterion for neonatal ECMO?

A)reversible lung disease
B)gestational age less than 35 weeks
C)pulmonary barotrauma
D)persistent acidosis

Question 22

What FIO₂ should be used in neonates prior to endotracheal suctioning?

A)same FIO₂ on the ventilator
B)always 100%
C)FIO₂ 10% to 15% higher than FIO₂ set in the ventilator
D)low FIO₂ to prevent retinopathy of prematurity

Question 23

Which of the following may indicate a decrease in systemic vascular blood flow during high-frequency ventilation?
I)high central venous pressure (CVP)II.low CVP
III)decreased mean arterial pressure (MAP)IV.increased MAP

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

Question 24

What physiologic effect does inhaled nitric oxide have on the lung?

A)pulmonary vasoconstriction
B)pulmonary vasodilation
C)smooth muscle dilation
D)improved mucociliary clearance

Question 25

Which of the following is a common role of the respiratory therapist on a transport team?
I)mechanical ventilation
II)ECMO
III)intubation and airway management

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

Question 26

Which of the following is considered a limitation of the high-flow nasal cannula?

A)It does not meet patient's flow needs.
B)The amount of airway positive pressure cannot be measured.
C)It does not provide for appropriate CO₂ clearance.
D)It does not reduce the use of noninvasive positive-pressure ventilation.

Question 27

Which of the following vacuum settings would you use to perform nasopharyngeal or nasotracheal suctioning of a 5-year-old child?

A)-100 to -120 mm Hg
B)-80 to -100 mm Hg
C)-40 to -60 mm Hg
D)-60 to -80 mm Hg

Question 28

Which of the following mean airway pressures is considered potentially deleterious when applying positive airway pressure?

A)2 cm H₂O
B)5 cm H₂O
C)10 cm H₂O
D)15 cm H₂O

Question 29

What is the recommended dose of inhaled NO?

A)10 parts per million (ppm)
B)20 ppm
C)30 ppm
D)40 ppm

Question 30

Which of the following is not a common indication for ECMO?

A)persistent pulmonary hypertension of the newborn (PPHN)
B)respiratory distress syndrome (RDS)
C)meconium aspiration syndrome (MAS)
D)congenital diaphragmatic hernia (CDH)

Question 31

In high-frequency ventilation (HFV), CO₂ elimination depends mainly on which of the following?

A)pressure amplitude
B)mean airway pressure
C)high-frequency rate
D)sinusoidal waveform

Question 32

Signs of infant respiratory distress that indicate a potential need for continuous positive airway pressure (CPAP) include which of the following?
I)cyanosis
II)radiograph indicating hyaline membrane disease or respiratory distress syndrome
III)grunting
IV)severe retractions

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

Question 33

What initial inspiratory time range would you suggest for a term newborn infant being placed on time-cycled, pressure-limited ventilation?

A)0.25 to 0.30 second
B)0.30 to 0.50 second
C)0.50 to 0.70 second
D)0.70 to 1.00 second

Question 34

During resuscitation of a newborn, after 15 to 30 seconds of positive-pressure ventilation, what should the clinician do?

A)Evaluate the heart rate.
B)Suction the mouth, then the nose.
C)Begin chest compressions.
D)Initiate medications.

Question 35

Venoarterial is the preferred method for use of ECMO when cardiovascular support is not required.

Question 36

What V_T range should be used for mechanical ventilation of a neonate?

A)5 to 7 ml/kg
B)6 to 8 ml/kg
C)8 to 10 ml/kg
D)10 to 12 ml/kg

Question 37

What positive end-expiratory pressure level is commonly used in pediatric patients during mechanical ventilation?

A)1 to 3 cm H₂O
B)3 to 5 cm H₂O
C)5 to 8 cm H₂O
D)10 to 12 cm H₂O