Deck 4: Respiratory Distress Syndrome

Question 1

What characteristics of the chest wall in neonates make them susceptible to signs and symptoms of respiratory distress

A)Overly Compliant chest wall
B)Higher than normal intrathoracic pressure
C)Surfactant deficiency
D)Low oxygen Consumption

Answer 1

A

Question 2

What method of ventilation allows peak inspiratory pressure to be weaned based on breath-to-breath changes in lung mechanics

A)Pressure Control ventilation
B)Volume Control ventilation
C)Volume-assured pressure support
D)Volume-targeted ventilation

Answer 2

D

Question 3

What mode of ventilation allows for Constant pressure and volume changes with lung Compliance

A)Pressure Control ventilation
B)Volume Control ventilation
C)Volume-assured pressure support
D)Pressure-regulated volume Control

Answer 3

A

Question 4

All of the following are specific issues that put preterm babies at risk after delivery except:

A)Immature tissue that is more susceptible to oxygen toxicity
B)Immature nervous system, which may not provide enough stimulation to breathe
C)Strong capillaries within the brain, which are at higher risk for rupture and bleeding
D)Surfactant-deficient lungs that make ventilation difficult and more susceptible to injury by positive pressure ventilation

Question 5

What is the physiological positive end-expiratory pressure of a healthy newborn with normal lung Compliance

A)2 cm H₂O
B)3 cm H₂O
C)4 cm H₂O
D)5 cm H₂O

Question 6

All of the following symptoms support a diagnosis of respiratory distress syndrome except:

A)Lecithin-sphingomyelin (L/S) ratio 2:1
B)Shake test positive
C)Absence or negative presence of phosphatidylglycerol (PG)
D)Surfactant-albumin (S/A) ratio less than 40 mg surfactant per 1g albumin

Question 7

What mode of ventilation delivers a Consistent tidal volume with each breath and allows the respiratory therapist to Control arterial blood gases

A)Pressure Control ventilation
B)Volume Control ventilation
C)Volume-assured pressure support
D)Pressure-regulated volume Control

Question 8

Which statement best describes optimal positive end-expiratory pressure (PEEP)

A)Pressure at which static Compliance is maximized and oxygen transport is greatest
B)PEEP levels above optimal PEEP will not cause atelectasis.
C)Will not evenly expand all alveoli at end exhalation
D)Allows for nonequal distribution of volumes during inspiration and expiration

Question 9

At what period of gestation does mature surfactant begin to appear

A)24-28 weeks
B)28-31 weeks
C)31-34 weeks
D)34-40 weeks

Question 10

Which of the following statements about respiratory distress syndrome are true

A)Higher incidences occur in males than in females.
B)Higher incidences occur in black fetuses than in white fetuses.
C)Males and females are affected equally.
D)Higher incidences occur in later gestational periods and at lower birth weights.

Question 11

AcCording to current practice, what initial settings of Continuous positive airway pressure (CPAP), peak inspiratory pressure (PIP), and inflation rate would be used for an infant who is placed on noninvasive positive pressure ventilation

A)CPAP 8 cm H₂O, PIP 12 cm H₂O, inflation rate 40, I time 0.2 seCond
B)CPAP 4 cm H₂O, PIP 16 cm H₂O, inflation rate 50, I time 0.6 seCond
C)CPAP 5 cm H₂O, PIP 15cm H₂O, inflation rate 55, I time 0.3 seCond
D)CPAP 14 cm H₂O, PIP 15 cm H₂O, inflation rate 40, I time 0.4 seCond

Question 12

Baby boy Roger is breathing spontaneously and has a heart rate greater than 100 bpm.After 1 minute, his Condition presents as follows: cyanosis and low SpO₂.What should the registered respiratory therapist Consider as this time

A)Positive pressure ventilation
B)Surfactant delivery to improve lung function
C)Continuous positive airway pressure therapy
D)Positive pressure ventilation with 2 to 3 cm of positive end expiratory pressure

Question 13

What week of gestation (wG) and birth weight Combination are Considered too premature and extremely unlikely for survival

A)Less than 24 wG; less than 600 g birth weight
B)Less than 23 wG; less than 600 g birth weight
C)Less than 23 wG; less than 500 g birth weight
D)Less than 24 wG; less than 500 g birth weight

Question 14

Which of the following cases does not indicate the need for nasal Continuous positive airway pressure

A)An infant diagnosed with respiratory distress syndrome, exhibiting signs of increased respiratory distress
B)PaCO₂ greater than 60 mm Hg and pH less than 7.25
C)PaCO₂ greater than 50 mm Hg and pH greater than or equal to 7.25
D)Inability to maintain a PaO₂ greater than 50 mm Hg with FiO₂ less than 0.60

Question 15

Dead space ventilation in infants with respiratory distress syndrome is frequently caused by which of the following

A)Increased cardiac output
B)Excess of vascularization
C)Alveolar hyperinflation
D)Decrease in alveolar-capillary membrane as a result of extreme prematurity

Question 16

What is the best way to deliver oxygen to an infant who has a weak inspiratory effort

A)Ventilator Continuous positive air way pressure
B)Nasal Continuous positive airway pressure
C)Variable-flow Continuous positive airway pressure
D)Bubble Continuous positive airway pressure

Question 17

Which statement below best describes surfactant

A)Chemical Compound that functions to stabilize the liquid interface within the alveoli and to increase surface tension
B)Is made up of mostly glyCoproteins
C)Helps reduce surface tension within lungs on exhalation D! None of the above

Question 18

In the 1950s, hyaline membrane disease was initially identified by which of the following groups of characteristics

A)Lung tissue has the Consistency of the liver, alveolar capillaries engorged, and majority of the parenchyma Collapsed
B)Pink lungs instead of dull red, underdeveloped alveolar ducts, and respiratory bronchioles
C)No evidence of aeration, nonCongested, and edematous

Question 19

Heated high-flow nasal cannula data suggested all of the following statements are true except:

A)It is more Comfortable for infants to wear.
B)It regulates temperature and humidity.
C)It increases esophageal and pharyngeal pressures in neonates.
D)It does not regulate gas flow.

Question 20

What mode of ventilation can be used to overCome resistance of the endotracheal tube during spontaneous ventilation

A)Pressure Control ventilation
B)Volume-assured pressure support
C)Pressure support ventilation
D)Volume Control ventilation

Question 21

What are the reasons to avoid excessive oxygen delivery to premature infants
I)Increased risk of brain injury as a result of instability of blood vessels
II)Increased risk of brain injury as a result of overstabilization of blood vessels in germinal matrix
III)Increased retinal damage
IV)Permanent structural damage to type 1 cells in alveoli
V)Temporary structural damage to type 1 cells in alveoli
VI)Temporary structural damage to type 2 cells in alveoli

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

Question 22

What clinical evaluations need to be assessed by the registered respiratory therapist to determine whether the peak inspiratory pressure has been set adequately in an infant who has respiratory distress syndrome
I)Exhaled tidal volume is greater than 3 mL/kg and less than 8 mL/kg.
II)pH is 7.25 to 7.35 with PaCO₂ of 45 to 55 mm Hg.
III)pH is 7.45 with PaCO₂ of 50 mm Hg.

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

Question 23

What terms are synonymous with maintaining a higher PaCO₂ to help deter lung injury in an infant
I)Hypercarbia
II)Permissive hypercapnia
III)Gentle ventilation

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

Question 24

What strategies are used to delay premature birth
I)Bedrest
II)Antibiotics
III)Terbutaline
IV)ToColytics
V)Insertion of suture around cervix to prevent from opening
VI)CortiCosteroid therapy
VII)Breathing techniques

A)I, II, III, and V
B)I, II, IV, and VII
C)I, II, IV, and VI
D)I, IV, V, and VI

Question 25

Which of the following are Complications to nasal Continuous positive airway pressure
I)Decreased cardiac output
II)Increased work of breathing
III)Decreased pulmonary vascular resistance
IV)Increased cardiac output
V)Air leak syndrome
VI)Increased pulmonary vascular resistance

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

Question 26

High-frequency jet ventilation is an independent mode of ventilation allowing effective ventilation and oxygenation at higher airway resistance than high frequency oscillatory ventilation.

Question 27

A decrease in servo pressure in high-frequency jet ventilation is an indication of what
I)Increase in lung Compliance
II)Obstructed endotracheal tube
III)Secretions in the airway
VI)Readiness for weaning of positive pressures

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

Question 28

A neonate should not be suctioned prior to the installation of surfactant.

Question 29

Noninvasive positive pressure ventilation is a closed system that helps recruit Collapsed alveoli, maintain functional residual capacity, and improve oxygenation.

Question 30

The germinal matrix has a fragile network of capillaries within the brain that are prone to rupture.What physiological changes can cause inadequate blood flow to the brain resulting in cerebral palsy
I)Rapid change in PaCO₂
II)Rapid change in blood volume
III)Rapid change in blood pressure

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

Question 31

During mechanical ventilation, functional residual capacity is adequately maintained when a chest radiograph reveals:

A)Lung inflation to the eighth posterior rib above the level of the diaphragm
B)Lung inflation to the ninth posterior rib above the level of the diaphragm
C)Lung inflation to the ninth anterior rib and below the level of the diaphragm
D)Lung inflation to the eighth and ninth posterior ribs above the level of the diaphragm

Question 32

During high-frequency oscillatory ventilation, what parameter needs to be adjusted to change ventilation
I)I-time
II)Mean airway pressure
III)ΔP
IV)Hz

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

Question 33

What neonatal ventilation value is most closely determined by peak inspiratory pressure

A)Tidal volume
B)Respiratory rate
C)Minute ventilation
D)ΔP

Question 34

Which of the following is not an indication for extubation in a neonate

A)Patient can support his or her own minute ventilation.
B)Continuous positive airway pressure short trial between 3 to 10 minutes without bradycardia
C)Continuous positive airway pressure short trial without hypoxemia (SpO₂ is less than 85%) and a decrease in FiO₂
D)Continuous positive airway pressure short trial without hypoxemia (SpO₂ is less than 85%) and an increase in FiO₂