Question 1

A premature infant is found to be "bobbing" her head. This is important because it can be a sign of which of the following?

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?

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.

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:

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?

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.

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

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:
1) respiratory pause causing bradycardia.
2) cycles of short breathing pauses followed by faster breathing.
3) no breathing for >20 seconds.
4) sudden apnea and death (crib death).

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

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?

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?

Accepted Answer

PPHN results in increased pulmonary vascular resistance. This will increase right ventricular afterload and can result in cardiomegaly.

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).

Accepted Answer

Respiratory factors associated with PPHN include MAS and RDS. Congenital heart disease is a cardiovascular factor associated with PPHN. Hypoxia is a fetal factor associated with PPHN. See Box 31-2 for the complete list.

Question 13

Apneic episodes in a premature neonate can be caused by all of the following EXCEPT:

Accepted Answer

Epiglottitis is an inflammation of the epiglottis caused by an infection. In severe cases, it can close off the upper airway. However, it is not associated with apnea of prematurity. All of the other listed options can lead to apnea of prematurity.

Question 14

A neonatal patient is found to have grunting on expiration. What physiologic effect does this produce?

Accepted Answer

An expiratory grunt is the sound generated when expired air is moving through a partially closed glottis. This partial closing of the glottis applies positive pressure against the alveoli. An increased PAO₂ should result. Glottis closure will not increase vital capacity, decrease PaCO₂, or close the ductus arteriosus.

Question 15

A neonate in respiratory distress will often dilate his or her nostrils to:

Accepted Answer

Dilation of the nostrils will make inspiration easier in the premature neonate. None of the other listed options are affected by dilated nostrils.

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:

Accepted Answer

Alveolar hyperinflation is associated with air trapping. A high negative intrapleural pressure can result in cyanosis of dependent thoracic areas, "seesaw" breathing pattern, and intercostal retractions.

Question 17

PPHN usually appears:

Accepted Answer

PPHN usually appears within the first 12 hours of birth. It cannot be detected in utero. Other conditions will appear quickly after birth or several days later.

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

A premature infant is found to be "bobbing" her head. This is important because it can be a sign of which of the following?

A premature infant is suspected of having persistent pulmonary hypertension of the newborn. How is this diagnosis confirmed?

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

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:

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?

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

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

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

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 newborn's 5-minute Apgar score is 7. How should this be interpreted?

A neonatal patient has PPHN. What may develop as a consequence of this?

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) .

Apneic episodes in a premature neonate can be caused by all of the following EXCEPT:

A neonatal patient is found to have grunting on expiration. What physiologic effect does this produce?

A neonate in respiratory distress will often dilate his or her nostrils to:

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:

PPHN usually appears:

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

A premature infant is found to be "bobbing" her head. This is important because it can be a sign of which of the following?

A premature infant is suspected of having persistent pulmonary hypertension of the newborn. How is this diagnosis confirmed?

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

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:

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?

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

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

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

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 newborn's 5-minute Apgar score is 7. How should this be interpreted?

A neonatal patient has PPHN. What may develop as a consequence of this?

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) .

Apneic episodes in a premature neonate can be caused by all of the following EXCEPT:

A neonatal patient is found to have grunting on expiration. What physiologic effect does this produce?

A neonate in respiratory distress will often dilate his or her nostrils to:

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:

PPHN usually appears:

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