Question 1

A premature infant is found to be &#34;bobbing&#34; her head. This is important because it can be a sign of which of the following?&#10;A) Hypoxemia&#10;B) Renal failure&#10;C) Intracranial hemorrhage&#10;D) Respiratory distress&#10;E) Septic shock

Accepted Answer

Head bobbing is a sign of respiratory distress in an infant. When in respiratory distress, the infant often uses the scalene and sternocleidomastoid accessory muscles of inspiration to assist in ventilation. When these muscles contract, the infant's head moves ("bobs") back and forth because the neck extensor muscles are not strong enough to stabilize the head.

Question 2

A premature infant is suspected of having persistent pulmonary hypertension of the newborn. How is this diagnosis confirmed?&#10;A) Arterial blood gas analysis&#10;B) Chest radiography&#10;C) Pulmonary angiography&#10;D) Echocardiography&#10;E) Cardiac catheterization

Accepted Answer

The diagnosis of PPHN should always be suspected in any infant with nonresponsive or ongoing hypoxemia and cyanosis that is out of proportion to the degree of pulmonary disease, oxygen requirement, and mean airway pressure support. The diagnosis of PPHN is confirmed by echocardiography. When PPHN is present, echocardiography demonstrates normal structural cardiac anatomy with evidence of pulmonary hypertension (e.g., flattened or displaced ventricular septum). Doppler studies show right-to-left shunting through the patent ductus arteriosus and/or foramen ovale.

Question 3

Early clinical manifestations of an infant with respiratory distress include:
1) cyanosis.
2) substernal retractions.
3) expiratory grunting.
4) apnea.

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

1, 2, 3

Accepted Answer

Early on, when an infant is having respiratory distress, he or she will show cyanosis, sternal retractions, expiratory grunting, and other signs. He or she will have apnea and other signs later on.

Question 4

A newborn is flaccid and apneic, has a cyanotic body and a heart rate of 85/min, and shows no reaction to stimulation. Her Apgar score would be:&#10;A) 8.&#10;B) 5.&#10;C) 2.&#10;D) 1.

Accepted Answer

The neonate's Apgar score of 1 is found by adding these points: heart rate of 85 = 1 point, cyanotic body = 0 points, apnea = 0 points, flaccid muscle tone = 0 points, no reaction to stimulation = 0 points.

Question 5

A premature infant has two pulse oximeters placed: one on the right hand and one on the left foot. The respiratory therapist notes that the reading on the right hand is consistently 12% greater than the reading on the left foot. Which of the following is the best interpretation of this finding?

A) The infant has left-sided intra-pulmonary shunting.
B) The infant likely has pneumonia.
C) The infant is in septic shock with systemic capillary shunting.
D) The infant has persistent pulmonary hypertension of the newborn.
E) The infant has shunting across the ductus venosus.

Accepted Answer

For the newborn in respiratory distress, pulse oximetry is often used to monitor both the preductal SpO₂ and the postductal SpO₂. To measure the preductal SpO₂, the oximeter probe is placed on the right hand or wrist; to measure the postductal SpO₂, the probe is placed on either foot. A large difference between the two readings (>10%) indicates a right-to-left shunt, and persistent pulmonary hypertension of the newborn (PPHN) is likely.

Question 6

Late clinical manifestations of an infant with respiratory distress include:
1) elevated diaphragm.
2) decreased respiratory rate.
3) CO₂ retention.
4) lethargy.

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

Accepted Answer

Late clinical manifestations that an infant is having respiratory distress include decreased respiratory rate, CO₂ retention, and other signs. He or she will have lethargy and other signs early on. Elevated diaphragm is not an early or late sign of respiratory distress.

Question 7

Which of the following can trigger apnea in the premature infant?
1) Micrognathia
2) Intracranial hemorrhage
3) REM sleep
4) Hypothermia

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

Accepted Answer

All of the listed options can trigger apnea of prematurity. See Box 31-1 for the full list of possible triggering events or conditions.

Question 8

Apnea of prematurity can be defined as:&#10;1) respiratory pause causing bradycardia.&#10;2) cycles of short breathing pauses followed by faster breathing.&#10;3) no breathing for >20 seconds.&#10;4) sudden apnea and death (crib death).&#10;A) 4&#10;B) 2&#10;C) 1, 3&#10;D) 3, 4

Accepted Answer

Apnea has two possible definitions: (1) respiratory pause causing bradycardia (or cyanosis or both) and (2) no breathing for less than 20 seconds. Apnea is usually found in a baby of less than 37 weeks' gestation. Period breathing is described as cycles of short breathing pauses followed by faster breathing. Sudden apnea and death (crib death) cases are usually associated with upper airway obstruction in an infant lying on its stomach or entangled with bed linens.

Question 9

When a neonate has PPHN, what structure(s) does the blood flow through to bypass the lungs?
1) Ductus venosus
2) Foramen ovale
3) Hypogastric arteries
4) Ductus arteriosus

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

Accepted Answer

During PPHN, blood will flow through the foramen ovale and ductus arteriosus to bypass the lungs. Fetal circulation involves blood passing through the foramen ovale, ductus arteriosus, ductus venosus, and hypogastric arteries.

Question 10

A newborn's 5-minute Apgar score is 7. How should this be interpreted?&#10;A) Normal adjustment to being born&#10;B) Moderate distress; intubate the airway and suction the lungs&#10;C) Moderate distress; administer supplemental oxygen&#10;D) Severe distress; begin bag-mask resuscitation

Accepted Answer

A 5-minute Apgar score of 7 to 10 indicates no difficulty in adjusting to extrauterine life. A score of less than 7 indicates some difficulty. Additional steps will need to be taken to resuscitate the neonate depending on the severity of the situation.

Question 11

A neonatal patient has PPHN. What may develop as a consequence of this?&#10;A) Cardiomegaly&#10;B) Pulmonary embolism&#10;C) Mucosal edema&#10;D) Cardiac tamponade

Accepted Answer

The answer of A neonatal patient has PPHN. What may...

Question 12

Respiratory causes of persistent pulmonary hypertension of the newborn (PPHN) include:
1) congenital heart disease.
2) hypoxia.
3) meconium aspiration syndrome (MAS).
4) respiratory distress syndrome (RDS).

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

Accepted Answer

The answer of Respiratory causes of persistent pulmonary hypertension of...

Question 13

Apneic episodes in a premature neonate can be caused by all of the following EXCEPT:&#10;A) epiglottitis.&#10;B) immature central nervous system.&#10;C) immature airway receptors.&#10;D) immature chemoreceptors.

Accepted Answer

The answer of Apneic episodes in a premature neonate can...

Question 14

A neonatal patient is found to have grunting on expiration. What physiologic effect does this produce? A) Increased vital capacity B) Increased PAO₂ C) Decreased PaCO₂ D) Closes the ductus arteriosus

Accepted Answer

The answer of A neonatal patient is found to have...

Question 15

A neonate in respiratory distress will often dilate his or her nostrils to:&#10;A) facilitate inspiration.&#10;B) nurse more easily.&#10;C) sneeze out amniotic fluid.&#10;D) raise the intrapleural pressure.

Accepted Answer

The answer of A neonate in respiratory distress will often...

Question 16

An infant in respiratory distress will often generate a high negative intrapleural pressure during inspiration. In comparison to an adult, this will result in all of the following EXCEPT:&#10;A) cyanosis of dependent thoracic areas.&#10;B) &#34;seesaw&#34; breathing pattern.&#10;C) alveolar hyperinflation.&#10;D) intercostal retractions.

Accepted Answer

The answer of An infant in respiratory distress will often...

Question 17

PPHN usually appears:&#10;A) in utero during the last trimester.&#10;B) within 1 hour of birth.&#10;C) within the first 12 hours of birth.&#10;D) between the 1st and 6th days of life.

Accepted Answer

The answer of PPHN usually appears:&#10;A) in utero during the...

Deck 32: Clinical Manifestations Common with Newborn and Early Childhood Respiratory Dis