Question 1

What are the reCommended initial nasal Continuous positive airway pressures reCommended by the American Association of Respiratory Care Clinical Practice Guidelines for a neonate

Accepted Answer

The American Association of Respiratory Care Clinical Practice Guidelines recommend an initial nasal CPAP of 4-5 cm H₂O for neonates.

Question 2

In the treatment of pneumonia, all of the following treatment options should be used except:

Accepted Answer

C

Question 3

What are the clinical manifestations of pneumopericardium
I.Muffled or absent heart tones
II.Decreased arterial blood pressure
III.Tachycardia
IV.Bradycardia and hypoxia
V.Pulseless electrical activity
VI.Cyanosis
VII.Hypertension

Accepted Answer

Pneumopericardium, the presence of air or gas in the pericardial cavity, can lead to muffled or absent heart tones due to the interference of air with the transmission of sound. Decreased arterial blood pressure, bradycardia, hypoxia, pulseless electrical activity, and cyanosis are also manifestations due to the compromised cardiac function and reduced oxygenation.

Question 4

What is the most effective way to treat pulmonary interstitial emphysema
I.Pressure-targeted ventilation
II.Volume-targeted ventilation
III.Hyperinflation of lungs
IV.Minimizing overdistention

Accepted Answer

The most effective way to treat pulmonary interstitial emphysema is to use volume-targeted ventilation to minimize overdistention of the lungs. This technique can also be combined with minimizing overdistention to help further reduce the risk of complications. Hyperinflation of the lungs is not recommended as it can increase the risk of barotrauma in the patient. Pressure-targeted ventilation may be effective in certain situations, but it is not the most effective approach for treating pulmonary interstitial emphysema. Therefore, the best choice is II and IV, or B.

Question 5

How does pulmonary interstitial emphysema present
I.Hypoxemia
II.Hypercapnia
III.Hypertension
IV.Episodes of apnea
V.Cyst-like formations 4-10 mm in diameter
VII.Mediastinal shift and atelectasis of Contralateral lung
VIII.Air bronchograms

Accepted Answer

Pulmonary interstitial emphysema (PIE) typically presents with hypoxemia, cyst-like formations 4-10 mm in diameter, mediastinal shift and atelectasis of the contralateral lung, and air bronchograms. Hypercapnia and episodes of apnea may also be present. Hypertension is not typically associated with PIE. Therefore, option B is the best choice as it includes all the common presentations of PIE.

Question 6

Prevention and early management of respiratory distress syndrome should progress to which of the following guidelines of care
I.Good bronchial hygiene
II.Frequent patient positioning
III.Arterial blood gas results obtained before making mechanical ventilation changes
IV.Prophylactic surfactant delivery
V.Pressure-volume loop interpretation essential
VI.Proper ventilator management
VII.Early withdrawal of noninvasive ventilation

Accepted Answer

Good bronchial hygiene, frequent patient positioning, prophylactic surfactant delivery, pressure-volume loop interpretation, and proper ventilator management are all important in the prevention and early management of respiratory distress syndrome. While obtaining arterial blood gas results is important in mechanical ventilation management, it may not necessarily need to be done before making changes. Early withdrawal of noninvasive ventilation may also not be necessary in all cases. Therefore, options III and VII are not essential guidelines for care.

Question 7

How can a registered respiratory therapist minimize pressure delivered to the lungs while administering mechanical ventilation to an infant
I.Decrease peak inspiratory pressure, increase positive end-expiratory pressure, and increase I-time.
II.Increase peak inspiratory pressure, increase positive end-expiratory pressure, and increase I-time.
III.Decrease peak inspiratory pressure, positive end-expiratory pressure, and I-time as tolerated.
IV.Use volume-targeted ventilation.
V.Avoid auto-positive end-expiratory pressure.
VI.Use Controlled mandatory ventilation, which is the preferred method over high-frequency ventilation.

Accepted Answer

Decreasing peak inspiratory pressure can help minimize lung injury by reducing the risk of barotrauma. Volume-targeted ventilation ensures that a set volume is delivered with each breath, potentially reducing the risk of volutrauma. Avoiding auto-PEEP can help prevent the buildup of excessive pressure in the lungs.

Question 8

The administration of surfactant to infants less than 28 weeks of gestation has not significantly decreased infant mortality rates associated with pneumothorax.

Accepted Answer

The administration of surfactant to premature infants, especially those less than 28 weeks of gestation, has significantly decreased infant mortality rates associated with respiratory distress syndrome (RDS), which can lead to complications such as pneumothorax. Surfactant therapy improves lung function and reduces the incidence and severity of RDS.

Question 9

Which of the following are organisms that predispose infants to pneumonia
I.Group B streptoCocci
II.StaphyloCoccus aureus
III.Cytomegalovirus
IV.Chlamydia trachomatis
V.Listeria monocytogenes
VI.Group A streptoCocci
VII.Gram-negative enteric bacteria

Accepted Answer

The organisms that predispose infants to pneumonia include Group B streptococci, Cytomegalovirus, Chlamydia trachomatis, Listeria monocytogenes, and Gram-negative enteric bacteria. Staphylococcus aureus and Group A streptococci are not commonly associated with pneumonia in infants. Therefore, option B is the best choice as it includes only the correct organisms.

Question 10

What are some of the Contributing factors for neonatal atelectasis
I.MeConium obstruction in terminal airways
II.Neurogenic pulmonary edema
III.Lung Compression from masses, tumors, or gastric Contents
IV.Emphysema
V.Respiratory failure and hypoventilation as a result of a decrease in Compliance and surfactant deficiency

Accepted Answer

Meconium obstruction in terminal airways, lung compression from masses, tumors, or gastric contents, and respiratory failure and hypoventilation as a result of a decrease in compliance and surfactant deficiency are all contributing factors for neonatal atelectasis. Neurogenic pulmonary edema is not typically listed as a contributing factor for neonatal atelectasis. Therefore, the best choice is B, which includes the three factors listed.

Question 11

Which of the following are guidelines when utilizing high-frequency jet ventilation (HFJV)
I.To increase PaCO₂, decreasing HFJV peak inspiratory pressure is the best option.
II.To increase PaCO₂, increasing HFJV peak inspiratory pressure is the best option.
III.In the presence of atelectasis, decrease positive end-expiratory pressure and add intermittent mandatory ventilation 5 to 10 breaths temporarily.
IV.In the presence of atelectasis, increase positive end-expiratory pressure and add intermittent mandatory ventilation 5 to 10 breaths temporarily.
V.In the absence of atelectasis.increase FiO₂.
VI.In the absence of atelectasis, decrease FiO₂
VII.Monitor servo pressure changes.

Accepted Answer

To increase PaCO₂, increasing HFJV peak inspiratory pressure is the best option (II) and in the presence of atelectasis, increase positive end-expiratory pressure and add intermittent mandatory ventilation 5 to 10 breaths temporarily (IV) are the guidelines when utilizing high-frequency jet ventilation (HFJV). It is not necessary to change FiO₂ in the absence of atelectasis. Also, monitoring servo pressure changes (VII) is important. Therefore, option B is the correct choice.

Question 12

Which of the following are Considered risk factors for a pneumothorax
I.Aspiration of meConium
II.Subcutaneous emphysema
III.Abdominal distention
IV.Pneumonia
V.Pulmonary interstitial emphysema
VI.Respiratory distress syndrome
VII.Mechanical ventilation

Accepted Answer

Pneumonia, respiratory distress syndrome, and mechanical ventilation are known risk factors for pneumothorax. Aspiration of meconium can also lead to respiratory complications that increase the risk of pneumothorax.

Question 13

Which of the following treatments should be used in the management of an infant who presents with a simple pneumothorax

Accepted Answer

Administering 100% oxygen can help reabsorb the air in a simple pneumothorax by reducing the size of the pneumothorax, as it increases the gradient for nitrogen reabsorption from the pleural space.

Question 14

Pneumonia presents in which of the following ways
I.Respiratory rates greater than 60 breaths/minute
II.Accessory muscle use and retractions
III.Bulging sternum
IV.Decreased heart sounds
V.Abrupt duskiness
VI.Hyperthermia
VII.Abdominal distention

Accepted Answer

Pneumonia can present with increased respiratory rates (often greater than 60 breaths/minute in infants), use of accessory muscles and retractions due to difficulty breathing, hyperthermia (fever), and abdominal distention, especially in young children who may present with abdominal symptoms. Bulging sternum, decreased heart sounds, and abrupt duskiness are not typical presentations of pneumonia.

Question 15

What are some of the causes for a pneumomediastinum
I.Airway obstruction
II.Mechanical ventilation
III.Infections
IV.Obstructive lung disease
V.Trauma
VI.Valsalva's maneuver

Accepted Answer

Pneumomediastinum can be caused by a variety of factors including airway obstruction, mechanical ventilation, infections, obstructive lung disease, trauma, and Valsalva's maneuver. These conditions can lead to increased pressure in the alveoli or airways, causing air to escape into the mediastinum.

Question 16

Clinical manifestations for respiratory distress syndrome include which of the following
I.Tachypnea
II.Posturing
III.Tachycardia
IV.Hypertension
V.External retractions
VI.Chest radiograph reveals bell-shaped thorax as a result of generalized underaeration, lung volume is reduced, and the lung parenchyma has a diffused reticulogranular pattern.
VII.Grunting

Accepted Answer

Clinical manifestations of respiratory distress syndrome (RDS) include tachypnea (rapid breathing), external retractions (using extra muscles to breathe), and grunting (a sound made to try to keep air in the lungs). These signs indicate the body's effort to increase oxygen intake and improve lung function.

Question 17

Re-intubation and mechanical ventilation should be based only on chest radiograph evidence.

Accepted Answer

Re-intubation and mechanical ventilation should not be based solely on chest radiograph evidence, but rather on a combination of clinical assessment and radiographic findings. Clinical assessment includes monitoring of respiratory rate, oxygen saturation, and other signs of respiratory distress. The decision to re-intubate and mechanically ventilate should be individualized for each patient based on their specific clinical situation, and should not rely solely on radiographic evidence.

Quiz 7: Common Neonatal Complications: Pulmonary Complications

What are the reCommended initial nasal Continuous positive airway pressures reCommended by the American Association of Respiratory Care Clinical Practice Guidelines for a neonate

In the treatment of pneumonia, all of the following treatment options should be used except:

What are the clinical manifestations of pneumopericardium I.Muffled or absent heart tones II.Decreased arterial blood pressure III.Tachycardia IV.Bradycardia and hypoxia V.Pulseless electrical activity VI.Cyanosis VII.Hypertension

What is the most effective way to treat pulmonary interstitial emphysema I.Pressure-targeted ventilation II.Volume-targeted ventilation III.Hyperinflation of lungs IV.Minimizing overdistention

How does pulmonary interstitial emphysema present I.Hypoxemia II.Hypercapnia III.Hypertension IV.Episodes of apnea V.Cyst-like formations 4-10 mm in diameter VII.Mediastinal shift and atelectasis of Contralateral lung VIII.Air bronchograms

The administration of surfactant to infants less than 28 weeks of gestation has not significantly decreased infant mortality rates associated with pneumothorax.

Which of the following are organisms that predispose infants to pneumonia I.Group B streptoCocci II.StaphyloCoccus aureus III.Cytomegalovirus IV.Chlamydia trachomatis V.Listeria monocytogenes VI.Group A streptoCocci VII.Gram-negative enteric bacteria

Which of the following are Considered risk factors for a pneumothorax I.Aspiration of meConium II.Subcutaneous emphysema III.Abdominal distention IV.Pneumonia V.Pulmonary interstitial emphysema VI.Respiratory distress syndrome VII.Mechanical ventilation

Which of the following treatments should be used in the management of an infant who presents with a simple pneumothorax

Pneumonia presents in which of the following ways I.Respiratory rates greater than 60 breaths/minute II.Accessory muscle use and retractions III.Bulging sternum IV.Decreased heart sounds V.Abrupt duskiness VI.Hyperthermia VII.Abdominal distention

What are some of the causes for a pneumomediastinum I.Airway obstruction II.Mechanical ventilation III.Infections IV.Obstructive lung disease V.Trauma VI.Valsalva's maneuver

Re-intubation and mechanical ventilation should be based only on chest radiograph evidence.