Deck 32: Meconium Aspiration Syndrome

Question 1

Infants who are older than 42 weeks' gestation are at greater risk for MAS because they have:
1) a full bowel.
2) strong peristalsis.
3) amniotic fluid in their stomach.
4) sphincter tone.

A)1, 3
B)2, 4
C)2, 3, 4
D)1, 2, 4

Answer 1

2, 4

Question 2

What risk(s) is/are there in positive-pressure ventilation before all meconium has been removed from the airways?
1) Forcing meconium into the lower airways
2) Pneumothorax
3) Triggering persistent pulmonary hypertension of the neonate (PPHN)
4) Triggering an asthma attack

A)2
B)3
C)1, 2
D)2, 3, 4

Answer 2

1, 2

Question 3

About how many neonatal patients with MAS will require mechanical ventilation?

A) 50%
B)30%
C)10% to 15%
D)4%

Answer 3

30%

Question 4

A common finding in a neonate with MAS is a respiratory rate that is:

A) under 40/min.
B)between 40 and 60/min.
C)well over 60/min.
D)cyclical with faster and then slower breaths.

Question 5

It is highly suspected that a newborn has aspirated meconium. What actions should be immediately undertaken?
1) Instill exogenous surfactant.
2) Suction out the meconium.
3) Begin mechanical ventilation.
4) Intubate the infant.

A)2, 4
B)1, 2
C)2, 3, 4
D)1, 2, 3, 4

Question 6

How may a fetus respond when he/she becomes hypoxemic?

A) It stops making breathing efforts.
B)It makes rapid, shallow chest movements.
C)It makes very deep, gasping inspiratory movements.
D)It shows Kussmaul respirations.

Question 7

Your patient has meconium aspiration syndrome (MAS) and a chemical pneumonitis as a result. What effect(s) can this have?
1) Decreased surfactant production
2) Increased bacterial growth
3) Edema of bronchial mucosa
4) Excessive bronchial secretions

A)3
B)3, 4
C)1, 2, 4
D)1, 2, 3, 4

Question 8

Indications that a newborn has aspirated meconium include all of the following, EXCEPT:

A) high Apgar score.
B)meconium in amniotic fluid.
C)newborn is not actively breathing.
D)meconium staining on skin.

Question 9

What is the consequence of meconium aspiration if there is a "ball-valve" effect in the small airways?

A) Air trapping on exhalation
B)Apnea of prematurity
C)Air trapping on inhalation
D)Bronchiectasis

Question 10

Your patient with MAS has had a chest radiograph taken. What findings can be expected?

A) Elevated diaphragms
B)Mediastinal shift
C)Irregular densities throughout the lungs
D)Air bronchograms

Question 11

A neonate with MAS has hypoxemia. Which of the following can be a pulmonary effect of this?

A) Status asthmaticus
B)Persistent pulmonary hypertension of the newborn (PPHN)
C)Bronchopulmonary dysplasia (BPD)
D)Pulmonary fibrosis

Question 12

If mechanical ventilation is needed to support a neonate with MAS, which of the following settings is especially important?

A) High positive end-expiratory pressure (PEEP) level
B)Long exhalation time
C)High humidity level
D)Give no more than 50% oxygen

Question 13

Risk factors for the development of MAS include:
1) being post-term.
2) a mother who is hypertensive.
3) a mother who is toxemic.
4) being the first twin born.

A)1, 4
B)2, 3
C)2, 3, 4
D)1, 2, 3

Question 14

Hyperinflation is noted on the chest radiograph of your patient with MAS. What sudden development(s) must be watched for?
1) PPHN
2) Pneumothorax
3) Cardiomegaly
4) Pneumomediastinum

A)2
B)2, 4
C)1, 2, 3
D)2, 3, 4

Question 15

An infant with MAS will show what clinical manifestations associated with the more negative intrapleural pressures needed during inspiration?
1) Seesaw breathing movement
2) Breath sounds reveal rhonchi and crackles
3) Expiratory grunting
4) Cyanosis of the dependent thoracic areas

A)1, 4
B)2, 3
C)2, 3, 4
D)1, 2, 3, 4