chapter 12 & 20 FINAL ( pharmacology , airway clearance technique), Neo CH. 25, Lesson 1-5 Pediatrics Final, Neo CH. 26, practicum 3 exam review, Chapter 26 - Vicky - Fall 16, CHAPTER 10 & 11 FINAL 02 ADMINISTRATION/AERSOL FINAL, Ch. 12, Neo CH. 25,...

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Formula for uncuffed ETT for children

(age/4)+4

What 3 measures can the therapist take to prevent cold stress before performing resuscitation on a preterm neonate?

* Dry the infant's skin * Wrap the infant in pre-warmed blankets * Remove wet linens from around the infant

What 3 conditions are contraindications for a high flow nasal cannula?

* Pneumothorax * Severe upper airways obstruction * Lack of spontaneous breathing

What 3 factors are taken into consideration when assessing the gestational age of a neonate?

* Prenatal ultrasound evaluations * Postnatal findings based on the physical examinations * Gestational duration based on the last menstrual cycle

What 3 things should the therapist do to avert injury and atelectasis and to avoid interfering with the infant's ability to establish adequate ventilation while establishing a preterm neonate before resuscitation?

* Use a bulb syringe * Avoid excessive suctioning of clear fluid from the nasopharynx * Use a suction catheter clearing the mouth first and then the nose

Restrictive pattern results

- FVC and FEV1: decreased - FEV1/FVC: normal or increased - TLC: decreased - RV: normal or decreased - RV/TLC: normal or increased

Obstructive Pattern results

- FVC: normal or decreased - FEV1 and FEV1/FVC: decreased - TLC: normal or increased - RV and RV/TLC: increased

Standard spirometry consists of the following tests...

- Flow-based (pneumotach) - Flow-volume loop - FVC, FEV1, and FEV1/FVC - FEF25-75, FEF50 - Diffusing capacity of the lung for carbon monoxide (Dlco)

tests to measure lung volumes:TLC, RV, FRC and RV/TLC ratios.

- Helium dilution method - Nitrogen washout method - Plethysmography - Impulse oscillometry

Which of the following pulmonary function values characterize an obstructive lung defect?

- The forced vital capacity (FVC) may remain normal. - The forced expiratory volume in 1 second (FEV1) is decreased. - The FEV1 is decreased.

A pre- and postbronchodilator, partial expiratory pressure-volume maneuver was performed on a 9-month-old boy. The child's prebronchodilator maxFRC was 67 mL/second and the postbronchodilator maxFRC was 94 mL/second. How should the therapist interpret these data?

- The patient has demonstrated clinically significant improvement with bronchodilator administration. -

On the partial expiratory flow-volume loop shown here, identify the point depicting the "maximal expiratory flow at FRC."

- point C - The flow at the end-expiratory point of a normal resting tidal breath (FRC) is measured on the PEFV curve

Exhaled nitric oxide (eNO)

- test for asthma - Biomarker of inflammation

The recommended suction pressure for children is:

-100 to -120

The recommended suction time for neonates is:

-60 to 80

The recommended suction pressure for infants is:

-80 to -100

When weaning an infant receiving oxygen from a nasal cannula attached to a low-flow flow meter set at 100%, what range represents the recommended oxygen flow reduction from the flow meter?

0.1 to 0.2 L/minute

Which of the following are differences between cardioversion and defibrillation? 1. In cardioversion, the countershock is synchronized with the R wave. 2. In defibrillation, more energy is applied. 3. In defibrillation, the countershock is synchronized with the R wave. 4. In cardioversion, more energy is applied.

1,2

Which of the following statements best describe the condition sudden infant death syndrome (SIDS)? I. More than 70% of victims are found in the early morning hours after the nighttime sleep. II. Infants are more likely to experience SIDS in the early morning upon awakening from night time sleep. III. The American Academy of Pediatrics recommends the use of home monitors to prevent SIDS IV. SIDS occurs exclusively during the night.

1,2

In order to deliver as high a concentration of oxygen as possible with a manual resuscitator, what would you do? 1. Use the highest recommended oxygen input flow (10 to 15 L/min) 2. Use the longest possible refill time. 3. Connect an oxygen reservoir to the bag.

1,2,3

Modifiable risk factors for SIDS include: 1. Inadequate prenatal care 2. Bed sharing 3. Prone sleeping position 4. Supine sleeping position 5. Home apnea monitoring

1,2,3

Which of the following functions are served by spacer and holding chambers in conjunction with pMDIs? I. Reduction in oropharyngeal deposition of drug II. Elimination of the "cold Freon effect" III. Improvement in lower respiratory tract deposition IV. Decrease in treatment time without sacrificing efficacy

1,2,3

Which of the following drugs can be administered through an endotracheal tube during emergency life support? 1. lidocaine HCl 2. atropine sulfate 3. epinephrine HCl 4. dopamine HCl 5. nalaxone hydrochloride (Narcan)

1,2,3,5

The therapist receives an order to administer a bronchodilator in-line to an infant receiving mechanical ventilation. The order also indicates that the nebulizer must not significantly increase the patient's delivered tidal volume. Which of the following aerosol delivery devices should the therapist select? I. Vibrating mesh nebulizer II. pMDI III. Jet nebulizer IV. Ultrasonic nebulizer

1,2,4

When administering aerosol therapy to a pediatric patient, which of the following conditions can affect aerosol deposition? I. Airway diameter II. Respiratory rate III. Body weight IV. Nasal breathing

1,2,4

For which of the following condition(s) is a high-flow nasal cannula contraindicated? I. Pneumothorax II. Apnea of prematurity III. Severe upper airway obstruction IV. Lack of spontaneous breathing

1,3,4

Hazards to suctioning include: 1. bradycardia' 2. hyperoxemia 3. hypoxemia 4. atelectasis 5. improved breath sounds 6. tissue trauma and infection

1,3,4,6

Which of the following major forces opposes inspiration?

1. Airway resistance 2. and lung compliance

methods of neonatal function testing

1. Plethysmography (baby box) 2. Measuring static compliance and airway resistance 3. Measuring maximal expiratory flow by rapid thoracic compression technique 4. Thoracoabdominal motion analysis by respiratory inductance plethysmography (RIP)

A reduction in the DLCO may indicate the presence of which of the following conditions?

1. Pulmonary fibrosis 2. Pulmonary edema 3. Hematologic disorders 4. Bronchiolitis obliterans - and also: immunologic disorders scleroderma, systemic lupus erythematosus

During properly performed external chest compression on infants, how much should the sternum be compressed?

1.5 inches

What is the maximum energy level for defibrillation of children and infants?

On the basis of the bronchial provocation data presented in the following table, identify the PD20 (provocative dose that produces a 20% fall in FEV1)

10 mg/mL

By what percentage can breath holding increase particle deposition in the lungs?

10%

What is the minimum rate of external chest compressions for infants?

100

What is the proper rate of external chest compressions for children up to puberty?

100-120

normal RR for a child 6-11 years

12 to 20

When performing suctioning you should limit the procedure to what time limit?

15 seconds

What is the recommended time for chest physiotherapy (CPT) for most patients?

15-20 minutes

How many airway generations do infants have?

16-17

Calculate a patient's total arterial oxygen content given the following data: •Arterial oxygen tension (PaO2), 100 mm Hg •Arterial carbon dioxide tension (PacO2), 45 mm Hg •Arterial oxygen saturation (SaO2), 97.5% •Hemoglobin concentration ([Hb]), 15 g/dL •Cardiac output, 4.5 L/minute •Stroke volume, 55 mL/beat

19.9 vol%

Postural drainage was used as early as:

1901

The pediatric patient patient has been intubated and is requiring suctioning. How far should you advance the suction catheter for removal of secretions?

1cm

In order to decrease the risk of nasal irritation in newborns, what is the maximum flow rate recommended?

1lpm. This was the "correct" answer on the test but I disagree, it should be 2lpm. Whatever.

Contraindications for use of the high-flow nasal cannula may include all of the following except: Pneumothorax II. Apnea of prematurity III. Severe upper airway obstruction IV. Lack of spontaneous breathing

In order to decrease the risk of nasal irritation in newborns or infants, what is the maximum flow rate recommended?

What is the age group with the highest prevalence of OSA? 1 to 2 years First 6 months 2 years to 8 years 6 months to 1 year

2 years to 8 years

How should a nasal cannula be secured on an infant? I. Wrap the tubing around the ears and bring tubing in front of the patient. II. Secure the cannula to the face with latex free tape or commercial adhesive pad. III. Tie it under the chin with a slip knot. IV. Tighten the cannula behind the infant's head and tape tubing to back.

2, 4

As per the AARC clinical practice guidelines (CPG) indications for oxygen therapy in children and infants >28 days of age include: I. PaO2 of >80 torr on room air II. SaO2 of < 90% on room air III. SaO 2 of >95% on room air IV. Documented hypoxemia V. PaO2 < 60 torr on room air

2,4,5

The peak incidence of SIDS is between?

2-4 months

A 3-year-old child has been diagnosed with epiglottitis and was intubated due to severe respiratory distress. After 24 hours of antibiotics the therapist is considering extubation. What will be an acceptable leak before considering extubation? 20 cm H2O An audible leak at any pressure level is enough to consider extubation. 21-30 cm H2O 31-35 cm H2O

20 cm H2O

What percentage of children with a pulmonary contusion develop pneumonia?

20%

normal RR for a child 1-5 years

20-30

normal RR for a child 6-12 months

24-30

A neuromuscular disease evaluation of the respiratory system of a child with neuromuscular weakness include all of the following except? I. Spirometry with flow volume loop II. Polysomnography (sleep study) III. Electroencephalogram (EEG) IV. Maximal inspiratory and expiratory pressures V. Cough Peak Flow

The automatic external defibrillator will indicate that a shock is needed if it detects which of the following rhythms: 1. bradycardia 2. atrial fibrillation 3. ventricular fibrillation 4. ventricular tachycardia

3,4

90% of patients with Duchenne's muscular dystrophy (DMD) die of respiratory failure before the age of ???

Where in the ventilator circuit should a continuous jet nebulizer be placed to improve efficiency of aerosol delivery?

30 cm from the ETT in the inspiratory limb

What is the recommended upper time limit for any intubation attempt performed during CPR?

30 seconds

normal RR for a baby 0-6months

30-60

During single-rescuer CPR applied to infants or children, what is the proper ratio of compressions to ventilation?

30:2

List in order the four main components of patient assessment. 1. palpation 2. auscultation 3. percussion 4. inspection

4, 1, 3, 2

what oxygen flow is used for administering oxygen to an infant via a simple mask?

5-10

A therapist is monitoring a child on the mechanical ventilator who is hemodynamically stable. The PetCO2 is 48 mm Hg. If accurate, what should be the PaCO2?

50-53 mmHg

Which of the following ranges of oxygen flow need to be set when administering oxygen to an infant via a simple mask?

6 to 10 L/minute

The vital signs such as the heart rate and respiratory rate should be counted for what length of time in the pediatric patient?

60 seconds

A conventional jet nebulizer with a dead volume of 1 mL is filled with a 3-mL solution of albuterol. What percent of the medication is available for nebulization?

66%

An uncuffed endotracheal tube is preferred up until the age of what?

A patient has a systolic blood pressure of 100 mm Hg and a diastolic pressure of 75 mm Hg. What is this patient's mean arterial pressure?

A 3-kg neonate has lost 30% of his circulating blood volume. Approximately how much fluid should be infused to compensate for this loss?

A child with an exacerbation of asthma is a candidate for the administration of heliox. Which of the following gas delivery devices is most suitable for its administration? a. Nonrebreathing mask b. Simple mask c. Partial rebreathing mask d. Nasal catheter

Which of the following nebulizers should be suggested to improve lung dose in patients undergoing invasive mechanical ventilation? a. Vibrating mesh nebulizer b. Jet nebulizer c. Ultrasonic nebulizer d. Breath-actuated nebulizer

Why are pass-over humidifiers preferred over pneumatic nebulizer humidifiers? a. Pass-over humidifiers transmit fewer pathogens than pneumatic nebulizers. b. The fraction of inspired oxygen (FiO2) used with pass-over humidifiers is easier to control. c. Pass-over humidifiers have a smaller residual volume than pneumatic nebulizers. d. Pass-over humidifiers produce smaller particles and have a greater output.

he respiratory therapist verifies an order to administer albuterol 1.25 mg to a 2-kg infant. Why does this dose have the same safety and efficacy profile as a 2.5-mg dose in the adult? a. The deposition efficiency in the infant results in a similar lung dose per kg of the adult patient. b. The liver of the infant metabolizes 95% of the drug. Therefore, the lung deposition is similar to that of the adult. c. Albuterol targets only a minimal number of beta-2 receptors in the infant's airways. d. The infant gets a higher lung dose, but it does not produce side effects.

For which of the following types of patients would using a dry powder inhaler (DPI) for medication delivery likely be contraindicated?

A 4-year-old child

respiratory distress

A child who demonstrates head bobbing, a nasal flaring, and grunting is exhibiting signs of respiratory distress hypoxemia hypercapnia acidemia

Uteroplacental insufficiency

A fetus is undergoing a contraction stress test. Uterine contractions are stimulated by the intravenous infusion of oxytocin into the mother. The fetal p02 drops below 12 mmhg and causes the fetal heart rate to slow. Which of the following condition is likely indicated by this occurrence? placenta abruption oligohydramnios uteroplacental insufficiency nuchal cords

Left to right shunt

A neonate is found to have a bounding pulse. Which of the following conditions may contribute to this finding? low cardiac output coarctation of the aorta left-to-right shunt patent foramen ovale

Gently rub the back

A newborn does not appear to respond to the extrauterine environment. Cry is weak and the respiratory effort is not strong. Which of the following methods should the therapist use to stimulate the newborn? hold the newborn upside down rub over the sternal area suction the nasopharynx gently rub the back

Posterior basal segments of both lower lobes

A patient is positioned in Trendelenburg, prone; which of the following lung segments is being drained?

Right middle lobe

A patient is positioned with their feet elevated 12 in., a quarter turn from supine (right side elevated), what lung segment is being drained?

An injury to the infants brachial plexus may have occurred during birth.

A physical examination is being performed on a newborn and the therapist notices that the infants arms do not move symmetrically. Which of the following situations could account for this problem? an injury to the infants brachial plexus may have occurred during birth the infant may have been born breach the baby was born via cesarean section the infant experienced nuchal cords during birth

After 12 hours

A pregnant woman at 30 weeks of gestation with premature rupture of membranes has been admitted to the hospital with preterm labor. The physician has ordered betamethasone. When does the maximal benefit of atenal corticosterioid occur to reduce RDS? after 12 hours after 24 hours after 48 hours after 1 week

Microcephaly

A pregnant woman has been diagnosed with pregestaional diabeties. Which of the following risk factors should the therapist be aware of at the time of delivery? unexplained abruption placenta oligohydramnios microcephaly fetal malformations

21% and make changes utilizing preductal oximetry

A therapist is called to the labor and delivery room to assist in the resuscitation of a term newborn. If necessary, what fio2 should be used to start positive pressure ventilation?

Administer iv or ET epinephrine

A therapist is resuscitating a term newborn. The heart rate falls to 55 beats per minute. What is the best course of action? intubate and provide positive airway pressure administer IV or ET epinephrine apply bag-mask ventilation continue compressions until heart rate is greater than 60

40 to 60 breaths per minute

A therapist is resuscitating a term newborn. What should be the rate of ventilation? 20 to 30 breaths per minute 30 to 40 breaths per minute 40 to 60 breaths per minute 60 to 100 breaths per minute

hypoglycemia

A therapist treating a newborn with hypoxemia due to hypothermia should also be aware of which of the following conditions? hypercarbia hypoglycemia hypocalcemia left-to-right shunt

Oxytocin

A woman who is 41 weeks pregnant is at high risk for complication in the postpartum period. Which of the following agents will be more appropriate to induce labor? magnesium sulfate aspirin terbutaline oxytocin

I, II, III, and IV all of the above

A woman with a long history of smoking is now in the last part of the third semester of her pregnancy. She is at high risk for which of the following conditions? I. premature rupture of membranes II. placental abruption III. placenta previa IV. sudden infant death syndrome

WHICH OF THE FOLLOWING COMPONENTS COMPOSE THE HISTORY OF PRESENT ILLNESS SECTION OF A PATIENT'S MEDICAL HISTORY

AGGRAVATING OR ALLEVIATING FACTORS

5. While attending to a neonatal patient in the neonatal intensive care unit (NICU), the therapist notices that a transcutaneous electrode is affixed to the upper chest of the neonate. What should the therapist do at this time? A. The therapist should do nothing because the transcutaneous electrode is properly placed. B. The therapist should reposition the electrode on the neonate's abdomen. C. The therapist needs to move the transcutaneous electrode to the infant's right shoulder. D. The therapist should relocate the electrode on the sternum as close as possible to the heart.

ANS: A Feedback A. Correct response: A critical consideration regarding transcutaneous monitoring is the application and site selection of the sensor. The site should be a highly vascular area such as the upper chest, abdomen, and thighs, or the lower back if the patient is supine. Bony areas over the spine should be avoided. Another consideration when selecting a site is that the right side of the upper chest will give preductal oxygenation values, whereas the left side of the chest and the lower parts of the body will give postductal values. B. Incorrect response: See explanation A. C. Incorrect response: See explanation A. D. Incorrect response: See explanation A. OBJ: Application

12.What condition would be responsible for the therapist observing a pulse oximeter indicating decreased perfusion while central blood pressure remains normal? A. Volume depletion with compensatory peripheral vasoconstriction B. Hypoplastic left-sided heart syndrome C. Hypervolemia with compensatory peripheral vasodilation D. Hypoplastic right-sided heart syndrome

ANS: A Feedback A. Correct response: A pulse oximeter will display a low pulse rate and perfusion signal as peripheral pulses and perfusion decrease. The cause of this poor perfusion status must be determined. However, if the pulse oximeter suggests decreased perfusion while central blood pressure remains normal, the cause may be volume depletion with compensatory peripheral vasoconstriction. B. Incorrect response: See explanation A. C. Incorrect response: See explanation A. D. Incorrect response: See explanation A. OBJ: Recall

8.Why is it difficult to localize auscultation findings of the thorax of a newborn? A. Because the neonate's chest is small and sounds are difficult to differentiate. B. Because the newborn infant is frequently crying. C. Because the neonate's tidal volume is so small. D. Because the newborn's pulmonary compliance is low.

ANS: A Feedback A. Correct response: Auscultation of the newborn can sometimes be difficult. The newborn's chest wall is small, and sounds easily transmit from one lung region to another. Abdominal sounds may even transmit to the lungs, although bowel sounds heard from the chest in place of absent breath sounds may indicate a diaphragmatic hernia. Localizing auscultation findings in a preterm infant is frequently difficult or impossible with single-head stethoscopes. Auscultation with a double-head stethoscope has proved useful in some situations. B. Incorrect response: See explanation A. C. Incorrect response: See explanation A. D. Incorrect response: See explanation A. OBJ: Recall

14.Which of the following conditions can cause abdominal distention? I. Enterocolitis II. Ascites III. Congenital diaphragmatic hernia IV. Omphalocele A. I and II only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only

ANS: A Feedback A. Correct response: Distention is a significant finding characterized by tightly drawn skin through which engorged subcutaneous vessels can easily be seen. Distention can suggest a variety of pathologic conditions, including sepsis, obstruction, tumors, ascites, pneumoperitoneum, or necrotizing enterocolitis. Enterocolitis is a bowel infection characterized by sepsis, peritonitis, bowel perforation, and significant mortality. Any of these conditions may cause elevation of the diaphragm and therefore compromise lung expansion. B. Incorrect response: See explanation A. C. Incorrect response: See explanation A. D. Incorrect response: See explanation A. OBJ: Recall

20. Which of the following white blood cell counts constitutes the condition leukopenia? A. Less than or equal to 3500/mm3 B. 5000 to 10,000/mm3 C. 10,000 to 20,000/mm3 D. Greater than or equal to 25,000/mm3

ANS: A Feedback A. Correct response: Leukopenia refers to white blood cells less than 3500/mm3, and leukocytosis refers to white blood cells greater than 25,000/mm3, which is suggestive of infection. B. Incorrect response: See explanation A. C. Incorrect response: See explanation A. D. Incorrect response: See explanation A. OBJ: Recall

4.A physical examination is being performed on a newborn, and the therapist notices that the infant's arms do not move symmetrically. Which of the following situations could account for this problem? A. An injury to the infant's brachial plexus may have occurred during birth. B. The infant may have been born breach. C. The baby was born via cesarean section. D. The infant experienced nuchal cords during birth.

ANS: A Feedback A. Correct response: Observing the infant's overall appearance is an important aspect of the physical examination. Ideally, examine the infant lying quietly and unclothed in a neutral thermal environment. Body position and symmetry, both at rest and during muscular activity, provide valuable information regarding possible birth trauma. For example, an infant who does not move the arms symmetrically could have a broken clavicle or an injury to the brachial plexus. B. Incorrect response: See explanation A. C. Incorrect response: See explanation A. D. Incorrect response: See explanation A. OBJ: Application

11. The following capnogram was obtained from a newborn infant receiving mechanical ventilation. http://o.quizlet.com/X7.q4WOuzOkpfAS8MGPD9w_m.png How should the therapist evaluate this capnogram? A. Airway obstruction B. Hypoventilation C. Hyperventilation D. Increased dead space ventilation

ANS: A Feedback A. Correct response: Obstruction to the expiratory flow of gas will be noted as a change in the slope of the B-C phase of the capnogram. The B-C phase may diminish without a plateau. Obstruction can be caused by a foreign body in the upper airway, increased secretions in the airways, the patient having bronchospasms, or partial obstruction of the ventilator circuit. B. Incorrect response: See explanation A. C. Incorrect response: See explanation A. D. Incorrect response: See explanation A. OBJ: Application

6. The therapist is assessing a mechanically ventilated infant and observes that the transcutaneous electrode temperature is set between 43º C and 44º C. What action does the therapist need to take at this time? A. The temperature range set is appropriate; therefore, no action is necessary. B. The therapist should increase the temperature range to 47º C to 48º C. C. The temperature of the transcutaneous electrode needs to be reduced to 36º C to 38º C. D. The electrode needs to be repositioned and maintained at the same temperature.

ANS: A Feedback A. Correct response: Selecting a sensor temperature is important to proper operation. The temperature range is usually 43º C to 44º C. Thicker skin requires a higher temperature. The fact that the sensor is heated requires changing the site routinely to prevent thermal injuries. The frequency of the site changes ranges from 3 to 4 hours. Relocating the electrode can be done sooner, that is, 2 or 3 hours, if the skin at the site has a reaction or if the sensor is operated at higher temperatures. B. Incorrect response: See explanation A. C. Incorrect response: See explanation A. D. Incorrect response: See explanation A. OBJ: Application

18.A newborn who presents as pale, mottled, floppy, with little interest in feeding, and slightly irritable most likely has which of the following conditions? A. Sepsis B. Respiratory distress syndrome C. Retinopathy of prematurity D. Cri du chat

ANS: A Feedback A. Correct response: Sepsis consumes the majority of infants energy. This includes and inability to feeding and even crying in severe cases. Respiratory distress is typically very progressive and can appear the same with the exception of the infant being pale, mottled, and floppy. Without sepsis the infant will have enough energy to breath rapidly, be irritable, and have tone. B. Incorrect response: See explanation A. C. Incorrect response: See explanation A. D. Incorrect response: See explanation A. OBJ: Recall

15.Which of the following conditions are associated with scaphoid abdomen? I. Necrotizing enterocolitis II. Gastroschisis III. Prune-belly syndrome IV. Sepsis A. I and IV only B. II and III only C. I, II, and III only D. II, III, and IV only

ANS: B Feedback A. Incorrect response: See explanation B. B. Correct response: A scaphoid, hollowed, or unusually flattened abdomen may be associated with congenital diaphragmatic hernia, in which abdominal contents are misplaced into the chest through a defect in the muscular diaphragm. More noticeable abnormalities of the abdomen include prune-belly syndrome, which is a congenital lack of abdominal musculature. Omphalocele is a protrusion of the membranous sac that encloses the abdominal contents through an opening in the abdominal wall into the umbilical cord. Gastroschisis is a defect in the abdominal wall lateral to the midline with protrusion of the intestines. C. Incorrect response: See explanation B. D. Incorrect response: See explanation B. OBJ: Recall

7.Why are chest retractions more prominent among neonates than among older children and adults? A. Because neonates generate a greater subatmospheric intrapleural pressure. B. Because newborns have relatively thin and weak musculature, and a less rigid thorax. C. Because neonates have a much higher respiratory rate. D. Because airway resistance through the smaller caliber airways is higher.

ANS: B Feedback A. Incorrect response: See explanation B. B. Correct response: Chest wall retractions are more prominent and easily observed among neonates than in an older children or adults. The newborn musculature is relatively thin and weak, and the thoracic cage is less rigid. The flexible chest wall and thoracic cage of the newborn exhibit noticeable retractions as lung compliance worsens. C. Incorrect response: See explanation B. D. Incorrect response: See explanation B. OBJ: Recall

3. As the therapist applies a pulse oximeter finger probe to a neonate who is receiving supplemental oxygen, she notices that the SpO2 reading is 100%. What should the therapist do in this situation? A. The therapist should do nothing, because the reading is accurate. B. The therapist should obtain an arterial blood sample from this patient. C. The therapist should switch to using a capnometer. D. The therapist should reduce the fraction of inspired oxygen.

ANS: B Feedback A. Incorrect response: See explanation B. B. Correct response: Even when properly functioning, the pulse oximeter does not provide good information regarding hyperoxia in the neonatal patient. If the oximeter is reading an SaO2 (arterial oxygen saturation) of 100%, the arterial oxygen tension (PaO2) could be between 90 and 250 mm Hg. In such a situation, the therapist needs to obtain an arterial blood sample to determine the actual PaO2 of the patient. The risk in this situation is in not recognizing a dangerously high PaO2, which, if permitted to persist, can cause retinopathy of prematurity. C. Incorrect response: See explanation B. D. Incorrect response: See explanation B. OBJ: Application

8. Which of the following features or characteristics apply to mainstream capnography? I. The mainstream capnograph contains narrow tubing that can become occluded with mucus. II. Mainstream capnography generally employs infrared spectrometers. III. The mainstream capnograph does not add much weight to the breathing circuit. IV. The mainstream capnograph is placed at the proximal end of the endotracheal tube. A. I and II only B. II and IV only C. I, II, and III only D. I, III, and IV only

ANS: B Feedback A. Incorrect response: See explanation B. B. Correct response: Exhaled gas can be analyzed according to two methods, that is, by mainstream or sidestream capnography. Aside from other features, they differ according to how exhaled gas reaches the sample chamber. A mainstream capnograph is used with ventilated patients, and is placed at the proximal end of the endotracheal tube. This setup can be seen in Figure 11-5 in the textbook. This method generally employs infrared spectrometry. Caution must be taken because these analyzers can be a heavy addition to an infant or pediatric circuit, causing kinking or disconnecting of the endotracheal tube. Sidestream analyzers continuously aspirate a sample of gas through a small tube and into the analyzer. This method is used primarily with mass spectrometry and some infrared analyzers. It is advantageous in that it does not add much weight to the breathing circuit. However, the narrow tubing can become occluded with mucus or water, causing inaccuracies. C. Incorrect response: See explanation B. D. Incorrect response: See explanation B. OBJ: Recall

5.The therapist notices that an infant presents with irregular areas of dusky skin alternating with areas of pale skin. On the basis of this observation, which of the following conditions should the therapist anticipate this patient having? A. Polycythemia B. Hypotension C. Situs inversus with dextrocardia D. Renal insufficiency

ANS: B Feedback A. Incorrect response: See explanation B. B. Correct response: Observing skin and color often provides diagnostic clues. Mottling refers to irregular areas of dusky skin alternating with areas of pale skin. An extremely pale or mottled infant suggests hypotension or anemia. Situs inversus, or situs transversus, is a congenital condition in which the major visceral organs are reversed from their normal anatomic positions. The normal arrangement is known as situs solitus. The term situs inversus is a short form of the Latin phrase "situs inversus viscerum," meaning "inverted position of the internal organs." C. Incorrect response: See explanation B. D. Incorrect response: See explanation B. OBJ: Application

19.The therapist has placed a pulse oximeter probe on a finger of the right hand of a newborn and another pulse oximeter probe on a toe of the infant's left foot. The pulse oximeter on the right hand reads 80% and the one on the left foot indicates 65%. Which of the following disease conditions does this neonate possibly have? A. Diaphragmatic hernia B. Persistent pulmonary hypertension of the newborn C. Choanal atresia D. Suprapubic aspiration

ANS: B Feedback A. Incorrect response: See explanation B. B. Correct response: The "gold standard" for diagnosing persistent pulmonary hypertension of the newborn (PPHN) involves having the neonate breathe 100% oxygen, and after a certain time to obtain a preductal blood sample from the right radial or temporal artery, and a postductal blood sample from the umbilical artery or lower limbs. If the preductal-postductal pressure of oxygen (PO2) difference is greater than 15 mm Hg, then the infant has ductal shunting. Two pulse oximeters can also be used to measure preductal SpO2 and postductal SpO2. The preductal SpO2 is measured by placing a probe on a finger of the infant's right hand and the probe from the second oximeter on one of the toes of the newborn's left foot. A preductal-postductal SpO2 difference greater than 10% indicates ductal shunting. PPHN results when the pulmonary vascular resistance fails to decrease after birth, despite improved alveolar oxygenation and lung expansion. Despite an increase in systemic vascular resistance (with the loss of the placenta), pulmonary vascular resistance remains equal to or greater than systemic vascular resistance. This high pulmonary vascular pressure results in blood continuing to flow through the foramen ovale and ductus arteriosus. Subsequently, with the loss of placental gas exchange and the inability to increase pulmonary blood flow, arterial oxygen tension falls to low levels. If this situation is not reversed, the infant will die of severe hypoxemia. C. Incorrect response: See explanation B. D. Incorrect response: See explanation B. OBJ: Application

11.A neonate is found to have a bounding pulse. Which of the following conditions may contribute to this finding? I. Patent ductus arteriosus II. Hypoplastic left-sided heart syndrome III. Coarctation of the aorta IV. Left-to-right shunt A. I and II only B. I and IV only C. II and III only D. I, III, and IV only

ANS: B Feedback A. Incorrect response: See explanation B. B. Correct response: Weak pulses suggest low cardiac output states such as shock and hypoplastic left-sided heart syndrome. Bounding pulses are seen in infants with patent ductus arteriosus and left-to-right shunt. The bounding characteristic of the pulse results from rapid runoff of the blood into the low-resistance pulmonary circulation. This lowers the systolic blood pressure and produces a wider pulse pressure. Brachial and femoral pulses should be equal in intensity and felt simultaneously. A delayed or weak femoral pulse can indicate coarctation of the aorta. C. Incorrect response: See explanation B. D. Incorrect response: See explanation B. OBJ: Recall

10.Which of the following statements refers to the diagnostic procedure called transillumination? A. Place a light source between the surface of the bed and the patient's back, and orient the patient in a supine position. B. Direct a light source toward the ipsilateral surface of the patient's thorax. C. Position a beam of light against a patient's chest wall in a well-lit room. D. Insert a fiberoptic light source down a patient's endotracheal tube and beyond the tube's distal tip.

ANS: B Feedback A. Incorrect response: See explanation B. B. Correct response: With suspected pneumothorax, perform transillumination of the chest wall, using a high-energy flashlight or fiberoptic device in a darkened room. Direct the light source on the chest wall of the suspected (ipsilateral) side. A large pneumothorax will reveal an excessively pink and illuminated, usually irregular area of light, or "glowing" area, through the chest wall when compared with the contralateral side. C. Incorrect response: See explanation B. D. Incorrect response: See explanation B. OBJ: Recall

6.Which of the following neonatal skin presentations at birth is associated with a high hematocrit value or polycythemia and neonatal hyperviscosity syndrome? A. Mottling B. Lanugo C. Reddish blue appearance D. Vernix

ANS: C Feedback A. Incorrect response: Mottling refers to irregular areas of dusky skin alternating with areas of pale skin. An extremely pale or mottled infant suggests hypotension or anemia. B. Incorrect response: The presence of lanugo, the fine hair that covers premature infants mostly over the shoulders, back, forehead, and cheeks, indicates an even younger gestational age than one presenting with vernix. C. Correct response: A ruddy, reddish blue appearance is frequently associated with a high hematocrit value, or polycythemia (hematocrit > 65%), and neonatal hyperviscosity syndrome. The yellow color associated with mild to moderate jaundice is common among newborns after the first day of life. Jaundice on the first day of life, however, is always an indication for an immediate evaluation. D. Incorrect response: Often a grayish white cheeselike substance, called vernix caseosa, is present in the skin folds of a term infant. However, vernix is even more abundant on a preterm infant and suggests an earlier gestational age. OBJ: Recall

1. How is the percentage of functional hemoglobin that is saturated with oxygen determined via pulse oximetry? A. The percentage of red light that lands on the photodiode represents the SpO2 (oxygen saturation as determined by pulse oximetry). B. The percentage of infrared light that reaches the photodetector reflects the SpO2. C. The ratio of the red and infrared light that reaches the photodiode signifies the SpO2. D. The sum of the amount of red and infrared absorbed by the tissue determines the SpO2.

ANS: C Feedback A. Incorrect response: See explanation C. B. Incorrect response: See explanation C. C. Correct response: A pulse oximeter sensor has two light-emitting diodes (LEDs) that function as light sources and one photodiode that acts as a light receiver. One LED emits red light, and the other diode emits infrared light. As the light from the diodes passes through the blood and tissue, some of the light from both the red and infrared diodes is absorbed. The photodiode then measures the amount of light that passes through the body without being absorbed. By knowing the amount of light that is entering the body and the amount of light leaving the body, the amount of light absorbed is easily determined. This absorption of both the red and infrared light is used to determine the percentage of functional hemoglobin that is saturated with oxygen. D. Incorrect response: See explanation C. OBJ: Recall

12. An infant demonstrates the following capnogram while being mechanically ventilated. How should the therapist interpret this capnogram? A. The patient has received a paralytic agent. B. A paralytic agent is indicated for this patient because of the spontaneous breathing efforts represented by the downward deflections. C. The patient may have developed a pneumothorax. D. A leak has developed in the patient-ventilator system.

ANS: C Feedback A. Incorrect response: See explanation C. B. Incorrect response: See explanation C. C. Correct response: A stair-stepping of the D-E phase of the capnogram, caused by unequal and incomplete emptying of the lungs, and a failure to return to baseline may suggest a pneumothorax. The capnogram depicting the possible pneumothorax is presented here: D. Incorrect response: See explanation C. OBJ: Application

2. The therapist has applied a bandage-type pulse oximetry probe too tightly to an infant's finger. What problem can be expected to occur in this situation? A. The SpO2 will read erroneously low. B. The SpO2 will read erroneously high. C. The monitor displays a message indicating inadequate pulse. D. The monitor displays fluctuating SpO2 values between being erroneously low and high.

ANS: C Feedback A. Incorrect response: See explanation C. B. Incorrect response: See explanation C. C. Correct response: Application of the sensor is crucial to the quality of readings from the pulse oximeter. The sensor should be placed over a vascular area with the diodes and the photodiode directly opposite each other and in good contact with the skin. The sensors should be placed firmly to avoid falling off or motion artifact, but care should be taken to avoid overtightening and compromising the circulation. An artifact that obscures the pulse triggers the "loss of pulse" alarm on the monitor. D. Incorrect response: See explanation C. OBJ: Recall

3.An infant arrives in the newborn nursery with an axillary body temperature of 95.6º F. Which of the following events may be responsible for this infant's temperature? A. The neonate was in an infant warmer in the delivery room. B. The infant was swaddled in numerous blankets. C. The delivery room temperature was low. D. The newborn has protracted diarrhea.

ANS: C Feedback A. Incorrect response: See explanation C. B. Incorrect response: See explanation C. C. Correct response: Normal values for temperature are 97.6° F 1° F axillary and 99.6° F 1° F rectally; however, temperature on arrival in the nursery may be lower if the delivery room was cold or may be higher if the radiant warmer was operating at a higher temperature because of incorrect probe position or warmer malfunction. D. Incorrect response: See explanation C. OBJ: Application

2.The gestational age of a newborn has been evaluated to be 34 weeks. The newborn's birth weight is greater than the 90th percentile. How should the therapist classify this infant? A. Small for gestational age B. Average for gestational age C. Large for gestational age D. Very large for gestational age

ANS: C Feedback A. Incorrect response: See explanation C. B. Incorrect response: See explanation C. C. Correct response: Once gestational age is determined, weight, length, and head circumference are plotted on a standard newborn grid. Any infant whose birth weight is less than the 10th percentile for gestational age is classified as small for gestational age. Similarly, an infant whose birth weight is more than the 90th percentile is large for gestational age. When using intrauterine growth curves, considering specific charts that are race and gender specific may be necessary. Along with prematurity, abnormal gestational age and size for gestational age are associated with many neonatal disease processes. D. Incorrect response: See explanation C. OBJ: Application

10. While working in the NICU with a mechanically ventilated newborn who is being monitored for PetCO2, the therapist observes the following capnogram: http://o.quizlet.com/7gP6ZyJ7Z2UE62C9f1X1Lw_m.jpg What interpretation should the therapist make of this capnogram? A. This capnogram is normal. B. The patient is receiving about 10 cm H2O positive end-expiratory pressure. C. The patient is rebreathing his own exhaled gas. D. The neonate is being hyperventilated.

ANS: C Feedback A. Incorrect response: See explanation C. B. Incorrect response: See explanation C. C. Correct response: Rebreathing is characterized by an elevation in the A-B phase of the capnogram with a corresponding increase in PetCO2. It indicates the rebreathing of the previously exhaled carbon dioxide. Rebreathing can be caused by using an insufficient expiratory time or an inadequate inspiratory flow. D. Incorrect response: See explanation C. OBJ: Application

7. Which of the following factors is the main physiologic factor responsible for deriving accurate transcutaneous data? A. Heart rate B. Minute ventilation C. Peripheral perfusion D. Ventilation-perfusion ratios

ANS: C Feedback A. Incorrect response: See explanation C. B. Incorrect response: See explanation C. C. Correct response: The main physiologic factor relating to good correlation is good peripheral blood perfusion. The skin reacts to cold, shock, and certain drugs by contracting the superficial blood vessels and by opening the larger, deeper-lying arterioles to achieve a shunting effect. In the event of exposure to cold, capillary blood flow slows or stops to reduce the loss of body heat. Shock and certain cardiopulmonary medications will dilate the blood vessels, causing the blood pressure in the body to drop. In response to this drop in blood pressure, the body will shunt blood from the skin and toward major organs. If blood flow in the capillary bed is reduced, the capillary blood rapidly becomes more or less venous, with a considerably lower PO2 and higher PCO2. Therefore, in patients with impaired peripheral blood perfusion, large deviations may occur between central PO2/PCO2 and the transcutaneous values. D. Incorrect response: See explanation C. OBJ: Recall

9.While performing a physical examination on a newborn infant, the therapist notices that the point of maximal cardiac impulse is to the left of the sternal border. Which of the following conditions can cause this situation? A. Atelectasis of the right lung B. Bilateral pulmonary consolidation C. Right-sided pneumothorax D. Left mainstem bronchus intubation

ANS: C Feedback A. Incorrect response: See explanation C. B. Incorrect response: See explanation C. C. Correct response: The point of maximal cardiac impulse (PMI) is the position on the chest wall at which the cardiac impulse can be maximally seen. The PMI is usually seen in newborns because of the relatively thin and flexible chest wall. Typically, the PMI is relatively close to the sternal border because of the predominance of the right ventricle in the fetal period. A mediastinal shift due to a pneumothorax will move the PMI away from the affected side (ipsilateral lung) of the chest. D. Incorrect response: See explanation C. OBJ: Recall

17.After the umbilical cord has been cut in the delivery room during the delivery of a large for gestational age infant, the therapist notices that the umbilical cord is large and fat. Which of the following maternal conditions is likely present? A. Congestive heart failure B. Renal insufficiency C. Diabetes mellitus D. Hypertension

ANS: C Feedback A. Incorrect response: See explanation C. B. Incorrect response: See explanation C. C. Correct response: The umbilical cord is yellowish white with three blood vessels. The two small and thick-walled arteries and one large and thin-walled vein are easily visible on the end of a freshly cut cord. Wharton's jelly surrounds the vessels. A single umbilical artery suggests congenital anomalies, especially those of the urinary tract. The presence of meconium in the amniotic fluid causes a greenish yellow staining of the umbilical cord. The umbilical cord of a large for gestational age infant born to a diabetic mother is frequently large and fat. D. Incorrect response: See explanation C. OBJ: Recall

13. What event or activity is represented by the wavy lines appearing on the following capnogram? A. Spontaneous breathing efforts B. Patient-ventilator dyssynchrony C. Hypoventilation D. Cardiac oscillations

ANS: D Feedback A. Incorrect response: See explanation D. B. Incorrect response: See explanation D. C. Incorrect response: See explanation D. D. Correct response:

9. Where on the following normal capnogram is the end-tidal carbon dioxide (PetCO2) represented? A. A B. B C. C D. D

ANS: D Feedback A. Incorrect response: See explanation D. B. Incorrect response: See explanation D. C. Incorrect response: See explanation D. D. Correct response: A normal capnogram can be divided into four phases. Phase A-B is the inspiratory phase, during which the sensor detects no carbon dioxide because the gas exhaled at that time is atmospheric air from the anatomic dead space. Phase B-C is the initial expiratory phase, during which carbon dioxide tension rapidly increases as the alveoli begin to empty, and only remnants of dead space gas remain. Phase C-D is the completion of expiration as the alveoli empty (alveolar plateau) and shows a slight increase in carbon dioxide. Phase D-E is the beginning of inspiration as the waveform returns to zero because of the reentry into the lung of atmospheric air. Point D on the capnogram represents the end-tidal PCO2, or PetCO2. OBJ: Application

16.While performing an examination of the abdomen of a neonate, the therapist is able to palpate the infant's liver 1 to 2 cm below the right costal margin. Which of the following conditions can account for this development? A. Hepatomegaly B. Splenomegaly C. Right ventricular failure D. Normal liver position

ANS: D Feedback A. Incorrect response: See explanation D. B. Incorrect response: See explanation D. C. Incorrect response: See explanation D. D. Correct response: The liver is usually felt as a rounded edge that rolls under the lightly palpating hand. Palpation should begin in the right lower quadrant so that an enlarged liver is not missed. The liver edge is usually easily defined 1 to 2 cm below the right costal margin in newborns. Hepatomegaly may be associated with congenital heart disease, infection, or hemolytic disease. OBJ: Recall

4. Why do transcutaneous oxygen tension (PO2) and carbon dioxide tension (PCO2) values differ from PaO2 and PaCO2 measurements? A. Because of the lag time between the cardiac output and the time the blood reaches the transcutaneous electrode site B. Because the skin is much more permeable to oxygen than carbon dioxide C. Because oxygen is consumed and carbon dioxide is produced in transit from the left ventricle to the electrode site D. Because metabolism in the tissue consumes oxygen and produces carbon dioxide at the site of the electrode

ANS: D Feedback A. Incorrect response: See explanation D. B. Incorrect response: See explanation D. C. Incorrect response: See explanation D. D. Correct response: Transcutaneous measurements of PO2 and PCO2 are based on the fact that a heating element in the sensor elevates the temperature in the underlying tissue. Increasing the skin's temperature increases the capillary blood flow to the tissues, making the skin more permeable to gas diffusion. Because metabolism in the tissues (through which the blood perfuses) consumes oxygen and produces carbon dioxide, transcutaneous values differ from arterial values. Usually, the PO2 is slightly lower than in the arteries, and the PCO2 is slightly higher when measured transcutaneously. OBJ: Application

13.For the purpose of assessing right-to-left shunting, as in the case of persistent pulmonary hypertension, which of the following sites would render postductal blood? I. Right arm II. Left arm III. Right leg IV. Left leg A. I only B. II only C. I, III, and IV only D. II, III, and IV only

ANS: D Feedback A. Incorrect response: See explanation D. B. Incorrect response: See explanation D. C. Incorrect response: See explanation D. D. Correct response: When assessing right-to-left shunting, as seen with persistent pulmonary hypertension of the newborn (PPHN), the right arm, or preductal site, will have a higher saturation than the postductal site, or left arm and lower extremities. Postductal blood will have a lower saturation caused by venous admixture. Infants with PPHN have increased pulmonary vascular resistance (PVR) that prevents normal pulmonary blood flow. The increased PVR causes a right-to-left shunting of blood across the patent foramen ovale and patent ductus arteriosus. The diagnosis of PPHN is usually confirmed by echocardiography, along with analysis of blood gas samples from preductal and postductal sites. A simpler method to detect this right-to-left shunting is to use two pulse oximeters and measure preductal and postductal SpO2 (arterial oxygen saturation determined by pulse oximeter). Clinical research has revealed that arterial saturation in the right arm (preductal) of at least 3% above the lower limb (postductal) is evidence of right-to-left ductal shunting. OBJ: Application

1. Which of the following factors are taken into consideration when assessing the gestational age of a neonate? I. Previous maternal pregnancies II. Prenatal ultrasound evaluations III. Postnatal findings based on physical and neurologic examinations IV. Gestational duration based on the last menstrual cycle A. I and III only B. I, II, and III only C. I, II, and IV only D. II, III, and IV only

ANS: D Feedback A. Incorrect response: See explanation D. B. Incorrect response: See explanation D. C. Incorrect response: See explanation D. D. Correct response: Ideally, gestational age assessment is performed before the neonate is 12 hours old, to allow the greatest reliability for infants less than 26 weeks of gestational age. Evaluating gestational age requires consideration of several factors. The three main factors are as follows: • Gestational duration based on the last menstrual cycle • Prenatal ultrasound evaluation • Postnatal findings based on physical and neurologic examinations OBJ: Recall

Which of the following statements best describes central sleep apnea? Only abdominal movements occur with no airflow. Only thoracic movements occur. Paradoxical breathing movements occur. Absence of respiratory effort and airflow

Absence of respiratory effort and airflow

Which of the following conditions is the major cause of OSA in children without any predisposing factor? Pierre Robin Syndrome Macroglossia Adenotonsillar hypertrophy Choanal atresia

Adenotonsillar hypertrophy

Which age group is more often affected by periodic breathing? Adults Children Infants Newborns

Adults

Which of the following devices would be most appropriate to use for a 3-year-old patient who experiences immediate postextubation hypoxemia?

Aerosol mask

Laryngotracheobronchitis

After placing a stethoscope over a small child's trachea, the therapist hears expiratory stridor. Which of the following conditons is consistent with this finding? laryngotracheobronchitis adenotonsillar hypertrophy

What is the definition for a tension pneumothorax?

Air within the pleural space associated with hemodynamic instability.

What is volumetric capnography able to determine?

Airway dead space Alveolar tidal volume Alveolar minute volume

The following capnogram was obtained from a newborn infant receiving mechanical ventilation. How should the therapist evaluate this capnogram?

Airway obstruction *See #15 on study guide*

In addition to applying direct pressure to the puncture site immediately after the arterial puncture procedure, what can the therapist do to minimize the risk of hematoma formation in a patient who requires frequent radial arterial punctures?

Alternate arms used for arterial puncture and use other sites as well.

An FiO2 sufficient to raise the SpO2 to 90% needs to be given

While working with a preterm neonate, the therapist notices the infant become apneic, cyanotic, and hypotonic. Consequently, the therapist nudges and stimulates the infant. On the basis of this scenario, what type of episode has occurred? An epileptiform activity A resuscitative event An apparent life-threatening event Sudden infant death syndrome

An apparent life-threatening event

when conducting a pre and post bronchodilator study on a child what is the determining measurement?

An increase in peak expiratory flow (PEFR) by at least 20% demonstrates a positive response to bronchodilator therapy

The delivery room temperature was low

An infant arrives in the newborn nursery with an axillary body temperature of 95.6. which of the following events is responsible for this infants temperature? the neonate was in an infant warmer in the delivery room the infant was swaddled in numerous blankets the delivery room temp was low the newborn has protracted diarrhea

A physical examination is being performed on a newborn, and the therapist notices that the infant's arms do not move symmetrically. What could have occurred?

An injury to the infant's brachial plexus may have occurred during birth

Infants that have apnea from unknown causes or have had a sibling die from SIDS should be monitored by which of the following?

Apnea Monitor

Which of the following is used to monitor infants who have apnea or bradycardia?

Apnea Monitor

The respiratory therapist places a face mask on an infant to measure FRC. What should the therapist do to minimize the presence of air leaks and improve accuracy of the test?

Apply petroleum jelly on the edges of the mask before applying the mask to the face.

Only routine monitoring of the respiratory vital signs is needed at this tim

As the head of a neonate contaminated with meconium emerges at birth, the heart rate monitor indicates 120 beats/minute, and the physician notices that the infant has good muscle tone and strong respiratory effort. What should the physician do at this time to provide airway care? intubate the infant immediately perform pharyngeal and tracheal suctioning immediately perform tracheal suctioning only at this time only routine monitoring of respiratory vital signs is needed at this time

The respiratory therapist is looking at a flow-volume curve that displays a concave shape on the expiratory tracing. What is this change most consistent with?

Asthma

An 18-month-old patient brought to the emergency department is exhibiting signs and symptoms consistent with an acute asthma episode and is administered a beta-2 agonist to which the patient does not respond favorably. Which of the following conditions could be responsible for this patient's problem? a. Pneumonia b. Aspiration of a foreign object c. Bronchiolitis d. Croup

Pneumatic nebulizers operate according to which of the following physical tenets? a. Venturi principle b. Bernoulli principle c. Law of continuity d. Law of conservation of energy

The physician in the emergency department is attending to a 12-year-old child who has an exacerbation of asthma. The physician asks the therapist to recommend a medication that has a synergistic effect with beta-2 agonists during asthma exacerbations. Which of the following medications should the therapist recommend? a. fluticasone b. Ipratropium bromide c. Triamcinolone d. Montelukast

The respiratory therapist is treating a hypoxemic child with a nasal cannula at 3 L/min. However, after few hours the child becomes tachypneic, demonstrates shallow breathing, and becomes hypoxemic. What should the therapist do at this time? a. Switch to a partial rebreathing mask. b. Switch to an air-entrainment mask. c. Increase flow rate on the cannula to 4 L/min. d. Apply positive pressure ventilation.

The therapist notices that the reservoir bag on a partial rebreathing mask being worn by a pediatric patient collapses completely during each inspiration. What should the therapist do at this time? a. Switch to a nonrebreathing mask. b. Increase the oxygen flow to the device. c. Decrease the oxygen flow to the apparatus. d. Continue monitoring the patient as the device is operating correctly.

What is the concern when administering oxygen to a sedated infant who is wearing a nasal cannula? a. Gastric distention may develop. b. Too high of an FiO2 may be given. c. The patient may stop breathing. d. Too low of an FiO2 may be delivered.

Where does the fetal oxyhemoglobin dissociation curve reside in comparison with the normal adult oxyhemoglobin dissociation curve? a. The fetal oxyhemoglobin dissociation curve lies to the right of the adult curve. b. The fetal oxyhemoglobin dissociation curve lies to the left of the adult curve. c. The two curves have the same position and coincide with each other. d. The adult oxyhemoglobin dissociation curve lies to the left of the fetal curve.

Which of the following considerations is most important when using a large-volume nebulizer to provide oxygen and humidification to an infant in an incubator? a. Supplying the infant with adequate humidification b. Preventing a high noise level from developing c. Meeting the inspiratory flow demands of the infant d. Delivering sufficient oxygen to meet the infant's needs

Which of the following oxygen-delivery devices would be most suitable for an infant being treated for choanal atresia? a. Nasal cannula b. Oxygen hood c. Oxygen mask d. Nasal catheter

Why are pass-over humidifiers preferred over pneumatic nebulizer humidifiers? a. Pass-over humidifiers produce smaller particles and have a greater output. b. Pass-over humidifiers transmit fewer pathogens than pneumatic nebulizers. c. Pass-over humidifiers have a smaller residual volume than pneumatic nebulizers. d. The fraction of inspired oxygen (FiO2) used with pass-over humidifiers is easier to control.

what is the minimum level of oxygen tension in a child that requires oxygen administration? a. SpO2 of 95% b. PaO2 of 60 mm Hg c. PaO2 of 80 mm Hg d. SpO2 of 92%

Which of the following methods is acceptable for delivering a drug via a pMDI to an intubated neonate receiving mechanical ventilation? a. Through a T-piece b. Through a resuscitation bag c. In-line with a spacer d. In-line with the ventilator

B. NOTE: IT may be preferable to hand-ventilate the pMDI delivery of medication to the patient. If a chamber adapter is used, the infant must be removed from the circuit, the chamber placed in-line, and the infant reattached to the circuit before the pMDI is administered.

Why do transcutaneous oxygen tension (PO2) and carbon dioxide tension (PCO2) values differ from PaO2 and PaCO2 measurements?

Because metabolism in the tissue consumes oxygen and produces carbon dioxide at the site of the electrode.

Why does an infant's respiratory distress from choanal atresia seem to lessen when the infant cries? Because the infant is able to generate a stronger inspiratory effort Because accessory muscles of ventilation help stabilize the chest wall Because the anterior nares widen more Because the infant breathes more through the mouth

Because the infant breathes more through the mouth

Pneumatic nebulizers operate according to which of the following physical tenets?

Bernoulli principle

What clinical parameter is critically important to monitor when mechanical ventilation is administered?

Blood pressure

In the ER, a chest radiograph reveals dilation of the segmental and subsegmental bronchi. The patient complains of expectorating copious amounts of thick mucus and frequent lung infections over the last year. Which of the following conditions does this child likely have? Postoperative laryngotracheobronchitis Bronchiectasis Foreign body aspiration Atelectasis

Bronchiectasis

A 3-year-old child has the following clinical presentations in the ER: Profound nasal congestion and productive cough Chest auscultation revealing diffuse coarse, "sticky" crackles (sounding like Velcro) Chest radiograph revealing lung hyperinflation with flattened hemidiaphragms What pulmonary condition does this infant likely have? Bronchiolitis Bronchiectasis Supralaryngeal obstruction Primary ciliary dyskinesia

Bronchiolitis

How is airway resistance calculated?

By dividing the airway occlusion pressure by the expiratory flow

By generating high expiratory air velocities

By what mechanism are high-frequency chest compressions purported to mobilize tracheobronchial secretions?

For which of the following condition(s) is a high-flow nasal cannula contraindicated? choose all that apply I. Pneumothorax II. Apnea of prematurity III. Severe upper airway obstruction IV. Lack of spontaneous breathing ANSWERS a. II and IV only b. I and III only c. I, III, and IV only d. III and IV only

For which of the following types of patients would using a DPI for medication delivery would like be contraindicated a. a patient with COPD B. An 11 year old w stable asthma c. a 4 year old child d. a teenager able to generate a inspiratory flow of 40 lpm

How can a patient avoid the problem of terminating inhalation when a plume from a pressurized metered-dose inhaler (pMDI) impacts the oropharynx? a. Depress the nozzle only half the full distance. b. Hold the pMDI closer the mouth. c. Use a valved holding chamber. d. Instruct the patient to inspire a short, rapid breath.

When weaning an infant receiving oxygen from a nasal cannula attached to a low-flow flow meter set at 100%, what range represents the recommended oxygen flow reduction from the flow meter? a. 0.3 to 0.4 L/minute b. 0.2 to 0.3 L/minute c. 0.1 to 0.2 L/minute d. Less than 0.1 L/minute

Which of the following devices would be most appropriate to use for a 3-year-old patient who experiences immediate postextubation hypoxemia? a. Partial rebreathing mask b. Blow-by setup c. Aerosol mask d. T-piece

he respiratory therapist is administering a nebulizer with a mask to a 2-year-old child. The mask is being held away from the child's face ("blow-by") due to excessive crying. What should the RT consider doing to improve aerosol lung deposition? a. Ask the mother of the child to hold the mask and continue "blow-by" therapy. b. Change the aerosol to a pMDI. c. Comfortably hold the mask close to the face to minimize the leak. d. Change the aerosol mask to a mouthpiece.

Know the position of the three-way stopcock , what activity related to arterial line blood sampling is occurring.

C (Off position to/from patient) The therapist is keeping the stopcock in its normal operational position.

Relative to an adult's larynx, where is an infant's larynx situated? C2-3 C4-5 C1-2 C3-4

C3-4

Structurally, the infant's larynx is positioned where in the neck?

C3-C4

A 28-week-gestation newborn is demonstrating periods of apnea. In addition to ventilatory support, what other treatment can the therapist suggest? Caffeine Beta blockers Theophylline Placement of an oropharyngeal airway

Caffeine

A newborn at 28 weeks of gestation is demonstrating periods of apnea. In addition to ventilatory support, what other treatment can the therapist suggest?

Caffeine

less than or equal to 3500/mm3

Cell count for leukopenia? less than or equal to 3500/mm3 5000 to 10,000/mm3 10,000 to 20,000/mm3 greater than or equal to 25,000/mm3

Which of the following conditions will preclude the use of indirect calorimetry?

Circuit leaks & HFOV

The respiratory therapist is administering a nebulizer with a mask to a 2-year-old child. The mask is being held away from the child's face ("blow-by") due to excessive crying. What should the RT consider doing to improve aerosol lung deposition?

Comfortably hold the mask close to the face to minimize the leak.

The neonatal intensive care unit (NICU) respiratory therapy supervisor is observing a therapist obtain an arterial blood sample from an infant's radial artery and notices that the therapist has the bevel of the needle pointed upward, entering the patient's skin at a 45-degree angle and in a direction against the arterial flow. What should the supervisor do at this time?

Continue to observe procedure

According to the American Academy of Pediatrics, in addition to cessation of breathing, which of the following clinical signs is associated with central sleep apnea? Tachycardia Hypertonia Hypertension Cyanosis

Cyanosis

In which condition has ACT been widely used as a mainstay in the treatment for pulmonary complications?

Cystic Fibrosis

An aerosol treatment is being administered via a jet nebulizer. After 8 minutes the nebulizer starts "sputtering." What should the therapist do at this point? a. Tap the nebulizer cup until no more mist is produced. b. Add more diluent to the nebulizer cup. c. Allow the nebulizer to continue the treatment for 2 more minutes. d. Terminate the treatment at this time.

In order to decrease the risk of nasal irritation in newborns, what is the maximum flow rate recommended? a. 1 L/minute b. 0.5 L/minute c. 3 L/minute d. 2 L/minute

In order to guarantee the same performance of the nebulizer after repeated use, what should be suggested to the user? a. Rinse with a mixture of vinegar and sterile water and air dry. b. Rinse with sterile water and dry with a clean paper towel. c. Rinse with vinegar and air dry. d. Rinse with sterile water and air dry.

The therapist receives an order to administer a bronchodilator in-line to an infant receiving mechanical ventilation. The order also indicates that the nebulizer must not significantly increase the patient's delivered tidal volume. Which of the following aerosol delivery devices should the therapist select? . Vibrating mesh nebulizer II. pMDI III. Jet nebulizer IV. Ultrasonic nebulizer a. II and III only b. I, III, and IV only c. II, III, and IV only d. I, II, and IV only

What is the major complication associated with manual removal of foreign material from the airway and the reason that a blind finger sweep should not be performed in an unconscious patient? a. lacerating upper airway structures b. causing gagging and reflex bradycardia c. increasing the possibility of infection d. forcing the object deeper into the airway

Which of the following disorders can develop in neonates as a result of receiving concentrations of oxygen that produce a high PaO2? a. Bronchopulmonary dysplasia b. Atelectasis c. Hyperoxia d. Retinopathy of prematurity

Which of the following problems occurs as a result of absorption atelectasis? a. Pulmonary vasodilation b. Decreased alveolar pressure c. Increased partial pressure of nitrogen in the blood d. Increased intrapulmonary shunting

Which of the following ranges of oxygen flow need to be set when administering oxygen to an infant via a simple mask? a. 1 to 6 L/minute b. Less than 1 L/minute c. Greater than 10 L/minute d. 6 to 10 L/minute

Which of the following suggestions will have the most significant impact on the inhaled dose of medications with nebulizers? a. Terminating the treatment prior to "sputter" b. Increasing the flow rate powering the nebulizer c. Adding a 6 inches of tubing on the expiratory side of the nebulizer d. Using breath-enhanced nebulizers

Why should pMDIs containing steroids in particular be used with a valved holding chamber? a. To enable the patient to take a deeper breath b. To increase the dose of the medication c. To provide better lung deposition d. To reduce the risk of oral yeast infections

he therapist has evaluated a neonate's oxygenation status to be as follows: PaO2, 40 mm Hg, and SpO2 (oxygen saturation as determined by pulse oximetry), 80%. What should the therapist do at this time? a. Continue monitoring the oxygen level of the neonate. b. An FiO2 sufficient to elevate the PaO2 to 80 mm Hg should be provided. c. An FiO2 of 1.0 needs to be administered. d. An FiO2 sufficient to raise the SpO2 to 90% needs to be given.

When a conventional jet nebulizer is operated at a flow of 10 L/min versus 5 L/min, what should the respiratory therapist expect? a. The treatment time shortens. b. The particle size gets larger. c. The nebulizer will nebulize the full dose more slowly. d. The particle size remains stable.

D ?? not sure why

Where on the following normal capnogram is the end-tidal carbon dioxide (PetCO2) represented?

D- "End-tidal" point- CO2 exhalation at max point *See #13 on Study guide*

After the umbilical cord has been cut in the delivery room during the delivery of an infant who is large for gestational age, the therapist notices that the umbilical cord is large and fat. What maternal condition is likely present?

Diabetuus

An 18-month-old child has been admitted with a diagnosis of bronchiolitis due to RSV. The therapist has administered a single dose of albuterol and racemic epinephrine, but the child shows no signs of improvement. What should the therapist suggest at this time? Discontinue therapy Use albuterol every 1 hour for 4 hours and then space treatments to every 4 hours Add an inhaled corticosteroid to the albuterol every 12 hours Alternate albuterol and racemic epinephrine every 4 hours

Discontinue therapy

Expiratory reserve volume

During autogenic drainage, at which of the following levels does the patient begin breathing?

75% of the preoperative volume

During the immediate postoperative period, what should be the volume goal for incentive spirometry?

How would tricuspid stenosis be expected to influence a patient's CVP value?

Elevate it above normal

An 11-month-old child has been treated with bronchodilators for persistent wheezing without a positive clinical response. Which of the following conditions should the therapist suspect? Aspergillosis Endobronchial compression Bronchiolitis Bronchitis

Endobronchial compression

A 4-year-old child is brought into the emergency room (ER) by her parents, who state that an abrupt high fever developed along with a severe sore throat, dysphagia with drooling, and cough. In the ER the girl exhibits stridor, muffled voice without hoarseness, air hunger, and cyanosis. She also has suprasternal, substernal, and intercostal retractions, with nasal flaring, bradypnea, and dyspnea. The child is sitting upright with her chin thrust forward and her neck hyperextended in a tripod position. What condition is she likely exhibiting? Bacterial tracheitis Tracheomalacia Laryngotracheobronchitis Epiglottitis

Epiglottitis

The childhood syndrome of OSA is distinct from adult OSA. Which of the following features are common in adult OSA but infrequent or less common in pediatric OSA? Excessive daytime sleepiness Snoring REM abnormality Large neck circumference

Excessive daytime sleepiness

T/F - An advantage of an isolette over a radiant warmer is that the isolette allows for easier patient access

False

A child has been diagnosed with vocal cord dysfunction. Which of the following flow-volume loops demonstrates this condition?

Flow limitation on the inspiratory portion of the loop is characteristic of an extrathoracic obstruction

Left arm, right leg, left leg II, III, and IV

For the purpose of assessing right to left shunting, as in the case of persistent pulmonary hypertension, which of the following sites would render postductal blood? I. right arm II. left arm III. right leg IV. left leg

I, II, and IV only

For which of the following patients is incentive spirometry contraindicated? I. Uncooperative II. Physically disabled III. Grossly obese IV. Very Young

The therapist has been asked to measure preductal oxygen saturation. Where could the therapist place the pulse oximeter probe?

Forehead

Which of the following body systems is the most important to evaluate when considering differential diagnoses for ALTE? Gastrointestinal Respiratory Cardiac Neurologic

Gastrointestinal

Which of the following features or characteristics apply to mainstream capnography?

Generally employs infrared spectrometers Is placed at the proximal end of the ET tube.

A newborn does not appear to respond to the extrauterine environment, the cry is weak and the respiratory effort is not strong. What should the therapist do to stimulate the newborn?

Gently rub the back

. A respiratory therapist has been ordered to obtain a blood gas sample from a nonintubated premature baby. After selecting the best site to obtain the sample, what should the RT suggest to ameliorate the pain associated with the procedure?

Give a pacifier dipped in 24% sucrose

The therapist has evaluated a neonate's oxygenation status to be PaO2 - 40 mmHg and the SpO2 - 80%. What should the therapist do at this time?

Give an FIO2 sufficient to the raise the SpO2 to 90%

what is the parkland formula used for?

Guides resuscitation over the first 24 hours after a burn.

Which Apgar parameter provides the most important prognostic value?

Heart rate

I, II, and III only

How should a patient receiving CPT while in an intensive care unit (ICU) be monitored? I. By continuous SpO2 (oxygen saturation as determined by pulse oximetry) II. By heart rate III. By respiratory rate IV. By blood pressure

The fetus appears to be normal

How should the therapist interpret a fetal biophysical profile score of 8? the fetus requires careful evaluation and possibly immediate delivery the fetus requires another biophysical profile in 24 hours the fetus appears to be normal the data are inconclusive and the profile needs to be redone immediately

Oligohydramnios

How should the therapist interpret an amniotic fluid index less than 5 cm? polyhydramnios multihydramnios oligohydramnios anhydramnios

What factos would adversely affect the correlation between arterial puncture measurements and those from a capillary sample?

Hypotension

Which of the following functions are served by spacer and holding chambers in conjunction with pMDIs? choose all that apply I. Reduction in oropharyngeal deposition of drug II. Elimination of the "cold Freon effect" III. Improvement in lower respiratory tract deposition IV. Decrease in treatment time without sacrificing efficacy

I , II, III

Which of the following are typical daytime symptoms associated with SDB in children? I. Poor school performance II. Hypoactivity III. Inattention IV. Passive behavior I, II, and IV only I, II, III, and IV II and IV only I and III only

I and III only

Which of the following are typical features of the obstructive hypoventilation syndrome? I. Disruption of sleep architecture II. Degradation of sleep quality III. Abnormal gas exchange IV. Significant daytime symptoms I and III only II and IV only I, II, and IV only I, II, III, and IV

I, II, III, and IV

When administering aerosol therapy to a pediatric patient, which of the following conditions can affect aerosol deposition?choose all that apply I. Airway diameter II. Respiratory rate III. Body weight IV. Nasal breathing

I, II, IV

Which of the following clinical interventions are used to treat complications of sickle cell anemia? I. Supplemental oxygen II. Bronchodilators III. Diuretics IV. Red blood cell transfusions I, II, and IV only I and IV only II, III, and IV only II and III only

I, II, and IV only

Which of the following risk factors are associated with SIDS? I. Maternal cigarette smoking II. Breastfeeding III. Loose bedding IV. Bed sharing I, II, and IV only I, III, and IV only I and III only I, II, and III only

I, III, and IV only

Which of the following is volumetric capnography able to determine? Which of the following is volumetric capnography able to determine? I. Airway dead space II. Alveolar tidal volume III. Shunt fraction IV. Alveolar minute volume

I. Airway dead space II. Alveolar tidal volume IV. Alveolar minute volume

Which of the following may be detected as respirations and cause the RR to be inaccurate in impedance pneumography? I. abdomen movement II. placing the leads too high III. cardiogenic oscillations IV. postural changes

I. abdomen movement III. cardiogenic oscillations

What should the RT tell the parents to look for when the apnea alarm goes off to determine if it is a false alarm or real event? I. skin color II. loose leads III. shallow breathing IV. infant moving

I. skin color II. loose leads III. shallow breathing IV. infant moving

Which of the following features or characteristics apply to mainstream capnography? I. The mainstream capnograph contains narrow tubing that can become occluded with mucus. II. Mainstream capnography generally employs infrared spectrometers. III. The mainstream capnograph does not add much weight to the breathing circuit. IV. The mainstream capnograph is placed at the proximal end of the endotracheal tube.

II. Mainstream capnography generally employs infrared spectrometers. IV. The mainstream capnograph is placed at the proximal end of the endotracheal tube.

Fetal scalp stimulation

In lieu of obtaining a scalp blood gas sample, what can the therapist do to conduct intrapartum assessment of the fetus? fetal scalp stimulation umbilical cord blood sampling placental blood sampling biophysical profile

The therapist notices that the reservoir bag on a partial rebreathing mask being worn by a pediatric patient collapses completely during each inspiration. What should the therapist do at this time?

Increase the oxygen flow to the device

Which of the following problems occurs as a result of absorption atelectasis?

Increased intrapulmonary shunting

Which age group is more often affected by periodic breathing?

Infants

A 12-hour-old infant is experiencing respiratory distress, and the neonatologist orders a heel stick to assess the infant's oxygenation status. What action should the therapist take at this time?

Inform the physician that this procedure is inappropriate at this time.

19. What can cause methemoglobinemia?

Inhalation of nitric oxide (NO)

Which of the following radiographic techniques is best for determining the presence of a ball-valve type obstruction? Inspiratory and expiratory A-P chest X-rays Either a right or left lateral decubitus film A lateral neck radiograph A standard portable A-P chest X-ray

Inspiratory and expiratory A-P chest X-rays

WHICH OF THE FOLLOWING WBC'S CONSTITUTES THE CONDITION LEUKOPENIA

LESS THAN OR EQUAL TO 3500/ MM3

The gestational age of a newborn is estimate to be 34 weeks. The newborn's weight is greater than the 90th percentile. How should the therapist classify this infant?

Large for gestational age

A 10-month-old child has been brought into the emergency room (ER) by her parents, who state that after few days with low-grade fever, malaise, and rhinorrhea, their child presented with a "barking" cough and increased work of breathing. What condition is this child likely exhibiting? Bronchitis Epiglottitis Bronchiolitis Laryngotracheobronchitis (LTB)

Laryngotracheobronchitis (LTB)

As the therapist auscultates over an infant's larynx, he hears a very low-pitched sound. On the basis of this finding, what impression is he likely to have regarding the nature of the upper airway obstruction? Complete obstruction Moderate obstruction Severe obstruction Mild obstruction

Mild obstruction

Which of the following agents has been shown to significantly reduce bronchiolitis scores? Prednisone Theophylline Nebulized 3% hypertonic saline Dexamethasone

Nebulized 3% hypertonic saline

Tracheomalacia is a condition of dynamic tracheal collapse. Which of the following injurious events can be associated with this condition? Neonatal ventilation with high pressures Neonatal ventilation with high oxygen concentrations Tracheal trauma due to CPT Excessive use of racemic epinephrine

Neonatal ventilation with high pressures

A child with an exacerbation of asthma is a candidate for the administration of heliox. Which of the following gas delivery devices is most suitable for its administration?

Nonrebreathing mask

All of the following are important for a new pediatric patient except?I. Chief complaint II. History of present illness III. Past medical history IV. Occupational history

Occupational History

The therapist is evaluating a newborn with an abdominal defect consisting of protrusion of the membranous sac that encloses abdominal contents through an opening in the abdominal wall into the umbilical cord. What condition is consistent with this description?

Omphalocele. DUH

magnesium sulfate

Once preterm labor is diagnosed, which of the following medications should be considered as tacolyptic? magnesium sulfate sodium bicarbonate calcium carbonate epinephrine

As the head of the neonate contaminated with meconium emerges at birth, the heart rate monitor indicates 120 bpm and the physician notices that the infant has good muscle tone and a good respiratory effort. What should the physician do at this time to provide airway care?

Only routine monitoring of respiratory vital signs is needed at this time

What O2 delivery device would be most suitable for an infant being treated with choanal atresia?

Oxygen hood

DURING A PHYSICAL EXAMINATION OF A CHILD'S CHEST, THE THERAPIST PERCEIVES INCREASED TACTILE FREMITUS OVER THE PATIENT'S RIGHT LOWER LOBE. WHICH OF THE FOLLOWING CONDITIONS MAY CAUSE THIS PHYSICAL SIGN

PULMONARY CONSOLIDATION

What blood gas measurement determines how well a patient is being ventilated?

PaCO2

What is the minimum level of oxygen tension in a child that requires oxygen administration?

PaO2 of 60 mm Hg

Why are pass-over humidifiers preferred over pneumatic nebulizer humidifiers?

Pass-over humidifiers transmit fewer pathogens than pneumatic nebulizers

Which of the following is the main physiologic factor responsible for deriving accurate transcutaneous data?

Peripheral perfusion

A child presents to the emergency department with fever, tachypnea, nasal flaring, and shallow breathing. The physical exam of the chest reveals the presence of crackles, increased tactile fremitus, and dullness to percussion. What should the therapist suspect the diagnosis is? Bronchiectasis Bronchitis Bronchiolitis Pneumonia

Pneumonia

All of these can be causes for a dull percussion note being heard except for: Atelectasis, Pneumothorax, Pleural effusion, Consolidation

Pneumothorax

In which of the following conditions is the oxygen-carrying capacity reduced despite the presence of a normal arterial oxygen tension?

Polycythemia

In addition to the dorsalis pedis, which of the following arteries is involved when the modified Allen's test is performed using a foot as the potential arterial puncture site?

Posterior tibial artery

What is one of the most common arrhythmias observed as a complication from the insertion of a pulmonary artery catheter?

Premature Ventricular Contraction

Which of the following considerations is most important when using a large-volume nebulizer to provide oxygen and humidification to an infant in an incubator?

Preventing a high noise level from developing

A 7-year-old child was diagnosed with OSA due to tonsillar hypertrophy. Although adenotonsillectomy was performed, the child continues having daytime sleepiness and poor school performance. What should the therapist suggest at this time? Administer antireflux medications. Consider uvulectomy. Provide continuous positive airway pressure. Perform allergy tests to confirm that airway obstruction is due to other clinical condition.

Provide continuous positive airway pressure.

On the basis of the following waveform, in which of the following anatomic locations is the distal tip of the pulmonary artery catheter located?

Pulmonary Artery *See waveform on study guide #16*

HEAD BOBBING, NASAL FLARING, AND GRUNTING ARE EXHIBITING SIGNS OF WHICH OF THE FOLLOWING

RESPIRATORY DISTRESS

WHICH OF THE FOLLOWING COMPONENTS OF A PATIENT'S MEDICAL HISTORY IS INTENDED TO DETERMINE THE PRESENCE OF SYMPTOMS NOT IDENTIFIED IN THE HISTORY IN THE HPI AND MAY BE RELATED OR CONTRIBUTE TO THE CHILD'S UNDERLYING CONDITION

REVIEW OF SYMPTOMS

The therapist has been asked to evaluate the chest radiograph of a 3-month-old boy with atelectasis. Which pulmonary lobe has the greatest tendency to collapse in young infants? LUL RUL RML Lingula

RML

Which of the following medications should be administered to a 4-year-old child who develops postextubation stridor? Antibiotics Phenylephrine Racemic epinephrine Prednisolone

Racemic epinephrine

. What artery is considered the optimal puncture site for obtaining arterial blood samples from neonatal and pediatric patients?

Radial

What is a major risk of computed tomography (CT) in children?

Radiation exposure and malignancy risk.

With an umbilical artery catheter (UAC) in the "low position," what blood vessels should be avoided?

Renal artery

A child who demonstrates head bobbing, nasal flaring, and grunting is exhibiting

Respiratory distress

The therapist is reviewing a flow-volume loop obtained from a pediatric patient and observes decreased volume and normal flows. On the basis of this observation, how should the therapist interpret this finding?

Restrictive pattern

What disorder can develop in neonates as a result of receiving concentrations of O2 that produce a high PaO2?

Retinopathy of prematurity

Which of the following disorders can develop in neonates as a result of receiving concentrations of oxygen that produce a high PaO2?

Retinopathy of prematurity

A 30-month-old child is brought to the emergency room (ER) by the parents. The child appears to have a sore throat along with dysphagia, fever, and voice changes. The child exhibits "hot potato voice." Visualization of the posterior pharynx reveals a displaced retropharynx. What condition does this child likely have? Retropharyngeal abscess Pierre Robin syndrome Peritonsillar abscess Tonsillar enlargement

Retropharyngeal abscess

What component of a patient's history is intended to determine presence of symptoms not identified in the history of previous illness and may help find the child's underlying condition?

Review of systems

What factor influences the central venous pressure (CVP) measurement?

Right ventricular pressure Intravascular volume Systemic venous return

In order to guarantee the same performance of the nebulizer after repeated use, what should be suggested to the user?

Rinse with sterile water and air dry

African-American race, Winter season, low APGAR score, preterm birth, and Teen moms are all risk factors associated with?

SIDS

What is the leading cause of death in infants? ALTE SIDS Congenital malformations (e.g., heart defects) CSA

SIDS

the sudden death of an infant less than one year of age, which remains unexplained after a thorough investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history is the definition of?

SIDS

Which of the following statements best describes the condition sudden infant death syndrome (SIDS)? SIDS is uncommon after infants are 6 months old. More than 70% of victims are found in the late evening hours after the afternoon naps. SIDS occurs exclusively when the infant is presumed to have been asleep during the night. Infants are most likely to experience SIDS in the first 12 to 24 months of life.

SIDS is uncommon after infants are 6 months old.

According to the ATS-ERS acceptability criteria for an FVC maneuver performed on a 9-year-old child, what is considered a satisfactory exhalation time?

Satisfactory exhalation duration is 6 seconds (3 second for children <10 years old) or a plateau in the volume-time curve.

The therapist is evaluating a child in the emergency department who displays the following signs: inability to cry, ineffective cough, high-pitched inspiratory sound, and cyanosis. What should the therapist suspect? Status asthmaticus Severe or complete airway obstruction Tracheomalacia Vascular ring

Severe or complete airway obstruction

Which of the following factors is the most important determinant of high airway resistance and air trapping in small infants?

Small diameter of the airways

Switch to an air-entrainment mask.

If a blood gas sample is not obtained from an arterial stick in a premature baby without central access, what site should be considered because this blood vessel is larger than the radial artery at this age?

Temporal

An aerosol treatment is being administered via a jet nebulizer. After 8 minutes the nebulizer starts "sputtering." What should the therapist do at this point?

Terminate the treatment at this time.

II, III, and IV only

The chest physiotherapy procedure includes which of the following techniques? I. Palpation of the chest wall II. Postural drainage III. Percussion IV. Coughing

The respiratory therapist verifies an order to administer albuterol 1.25 mg to a 2-kg infant. Why does this dose have the same safety and efficacy profile as a 2.5-mg dose in the adult?

The deposition efficiency in the infant results in a similar lung dose per kg of the adult patient

Where does the fetal oxyhemoglobin dissociation curve reside in comparison with the normal adult oxyhemoglobin dissociation curve?

The fetal oxyhemoglobin dissociation curve lies to the left of the adult curve.

Large for gestational age

The gestational age of a newborn has been evaluated to be 34 weeks. The newborn's birth weight is greater than the 90th percentile. How should the therapist classify this infant? small for gestational age average for gestational age large for gestational age very large for gestational age

Pulmonary function testing has been ordered in an infant. Which of the following represents a real risk to this infant?

The infant may require sedation for up to 3 hours.

The therapist has applied a bandage-type pulse oximetry probe too tightly to an infant's finger. What problem can be expected to occur in this situation?

The monitor will display a message indicating inadequate pulse.

When a conventional jet nebulizer is operated at a flow of 10 L/min versus 5 L/min, what should the respiratory therapist expect?

The particle size remains stable

While working in the NICU with a mechanically ventilated newborn who is being monitored for PetCO2, the therapist observes the following capnogram: What interpretation should the therapist make of this capnogram?

The patient is rebreathing his own exhaled gas *See #14 on Study Guide*

While working in the NICU with a mechanically ventilated newborn who is being monitored for PetCO2, the therapist observes the following capnogram.What interpretation should the therapist make of this capnogram?

The patient is rebreathing his own exhaled gas.

An infant demonstrates the following capnogram while being mechanically ventilated. How should the therapist interpret this capnogram?

The patient may have developed a pneumo *See #16 on study guide*

How is the percentage of functional hemoglobin that is saturated with oxygen determined via pulse oximetry?

The ratio of the red and infrared light that reaches the phototiode signifies the SpO2.

No action is required b/c this reactive NST is associated with normal uteroplacental functions

The respiratory therapist is called to assist in the labor of pregnant woman whose NST reported two accelerations in fetal heart rate, each of at least 15 beats per minute and lasting at least 15 seconds, associated with maternal perception of fetal movement over a period of 20 minutes. What is the best course of action? a C-section should be scheduled as soon as possible no action is required b/c this reactive NST is associated with normal uteroplacental functions A CST should be performed before fetal stress is confirmed

The mother of an 11-month-old infant suspected of suffering from sleep-disordered breathing reports that her child sleeps 15 hours per day. What should the therapist tell her regarding the sleep duration of her infant?

The sleep duration is consistent with the infant's age.

he mother of an 11-month-old infant suspected of suffering from sleep-disordered breathing reports that her child sleeps 15 hours per day. What should the therapist tell her regarding the sleep duration of her infant? The sleep duration is consistent with a that of a 10-year-old child. The sleep duration is consistent with an infant in the first 24 hours of life. The sleep duration is consistent with a midadolescent child. The sleep duration is consistent with the infant's age.

The sleep duration is consistent with the infant's age.

The therapist is assessing a mechanically ventilated infant and observes that the transcutaneous electrode temperature is set between 41 and 44°C. What action does the therapist need to take at this time?

The temperature range set is appropriate; therefore, no action is necessary.

The therapist is assessing a mechanically ventilated infant and observes that the transcutaneous electrode temperature is set between 41° C and 44° C. What action does the therapist need to take at this time?

The temperature range set is appropriate; therefore, no action is necessary.

The therapist has completed a l minute apgar score. The following evaluations were obtained On the basis of these findings, what apgar score should be assigned to this neonate?

II, III, and IV Hypocalcemia,hyperkalemia,hypoglycemia

The therapist is attending a term labor of a woman diagnosed with gestational diabetes. The baby is very large for gestational age, what other metabolic disturbances should be considered. I. hyperglycemia II. hypocalcemia III. hyperkalemia IV. hypoglycemia

Omphalocele

The therapist is evaluating a newborn with an abdominal defect consisting of protrusions of the membranous sac that encloses abdominal contents through an opening in the abdominal wall into the umbilical cord. Which of the following conditions is consistent with this description? enterocolitis ascites congenital diaphragmatic hernia omphalocele

Hypothyroidism

The therapist notices that a preterm newborn has a grunting cry. Which of the following conditions is most consistent with this description? hypothyroidism neurologic injury respiratory distress syndrome laryngeal edema

Hypotension

The therapist notices that an infant presents with irregular areas of dusky skin alternanting with areas of pale skin. On the basis of this observation, which of the following conditions should the therapist anticipate this patients having? polycythemia hypotension situs inversus with dextrocardia renal insufficiency

As the therapist applies a pulse oximeter finger probe to a neonate who is receiving supplemental oxygen, she notices that the SpO2 reading is 100%. What should the therapist do in this situation?

The therapist should obtain an arterial blood sample to confirm P2 level.

While attending to a neonatal patient in the NICU, the therapist notices that a transcutaneous electrode is affixed to the upper chest of the neonate. What should the therapist do at this time?

The therapist should only continue monitoring the patient since the transcutaneous electrode is properly placed.

While attending to a neonatal patient in the neonatal intensive care unit (NICU), the therapist notices that a transcutaneous electrode is affixed to the upper chest of the neonate. What should the therapist do at this time?

The therapist should only continue monitoring the patient since the transcutaneous electrode is properly placed.

Why does a respiratory syncytial viral infection have little adverse effect on an older child but is often life threatening to a younger child? The older child has a better developed mucociliary escalator. The younger child has a less effective cough mechanism. The older child has a better developed immune system. The younger child has fewer respiratory bronchioles.

The younger child has fewer respiratory bronchioles.

Diagnosis of TB in children requires which of the following special considerations? Three consecutive days of gastric washings One positive respiratory washing A positive chest X-ray A positive skin test

Three consecutive days of gastric washings

Which of the following methods is acceptable for delivering a drug via a pMDI to an intubated neonate receiving mechanical ventilation?

Through a resuscitation bag

What is the purpose of indirect calorimetry?

To calculate energy expenditure by measuring VO2 and VCO2.

What is the clinical purpose for measuring the maximal inspiratory pressure (MIP)?

To evaluate the strength of respiratory muscles

Why must caution be exercised when using a face mask while performing pulmonary function testing on neonates?

To prevent trigeminal nerve stimulation

Why should pMDIs containing steroids in particular be used with a valved holding chamber?

To reduce the risk of oral yeast infections

What is the concern when administering oxygen to a sedated infant who is wearing a nasal cannula?

Too high of an FIO2 may be given

While performing auscultation on a 2-month-old child, the therapist hears wheezes equal in pitch across all regions of the chest; however, they seem loudest in the vicinity of the sternum. From which of the following anatomic structures is the wheezing likely originating? Segmental bronchi Trachea Alveoli Terminal bronchioles

Trachea

T/F - Increased intrapulmonary shunting can occur as a result of absorption atelectasis

True

T/F - Patients with polycythemia have a reduced oxygen carrying capacity despite the presence of normal arterial oxygen tension

True

T/F - pH is the negative log of the hydrogen ion concentration, therefore, as hydrogen ions decrease, pH decreases

True

A therapist has been asked to evaluate a child suspected of having foreign body aspiration. Which of the following clinical conditions would guide the therapist to the diagnosis? Unilateral wheezing Stridor Wheezing partially responsive to bronchodilators Recurrent bronchitis

Unilateral wheezing

How can a patient avoid the problem of terminating inhalation when a plume from a pressurized metered-dose inhaler (pMDI) impacts the oropharynx?

Use a valved holding chamber.

Which of the following suggestions will have the most significant impact on the inhaled dose of medications with nebulizers?

Using breath-enhanced nebulizers

which of the following statements about videoed assisted thoracoscopic surgery (VATS) in the management of empyema is true?

VATS often hastens the resolution of empyema compared with chest tube drainage alone.

Which of the following nebulizers should be suggested to improve lung dose in patients undergoing invasive mechanical ventilation?

Vibrating mesh nebulizer

Based on the various waveforms seen, know the anatomic locations when the distal tip of the pulmonary artery catheter is being advanced.

Wedged position *see waveform on study guide # 15*

Volume depletion with compensatory peripheral vasoconstriction

What condition would be responsible for the therapist observing a pulse oximeter indicating decreased perfusion while central blood pressure remains normal? volume depletion with compsensatory peripheral vasoconstriction hypoplastic left-sided heart syndrome hypervolemia with compensatory peripheral vasodilation hypoplastic right-sided heart syndrome

They attempt to prevent dynamic airway collapse.

What do postural drainage, positive expiratory pressure therapy, autogenic drainage, forced expiration techniques, and high-frequency chest compressions have in common?

No safe range of alcohol consumption is deemed safe during pregnanc

What is generally accepted as a safe limit for alcohol consumption during pregnancy to avoid the development of fetal alcohol syndrome?

Infants born of mothers who smoke tend to be about 200 g lighter than infants born of mothers who do not smoke.

What is the average birth weight difference between infants born of mothers who smoke and those born of nonsmoking mothers? 200g lighter 400g lighter 600g less than those who do not smoke 800 light

Fetal infection

What is the main potential problem associated with the premature rupture of membranes? fetal dehydration fetal infection maternal hypotension maternal renal failure

Hypoxemia

What is the most commonly cited complication of chest physiotherapy?

Amount of mucus obtained during and after treatment

What is the most important variable used to assess the efficacy of CPT?

Amniocentesis

What is the most invasive procedure to assess the fetal condition? Amniocentesis scalp fetal pH stress test needle ultrasound

Active cycle of breathing

What maneuver is characterized by having a patient forcibly exhale, from a middle to low lung volume, through an open glottis?

I, II, and III only Dry the infants skin, wrap the infant in pre warmed blankets, remove wet linens from around the infant.

What measures can the therapist take to prevent heat loss and cold stress before performing resuscitation on a preterm neonate? I. dry the infant's skin II. wrap the infant in pre-warmed blankets III. remove wet linens from around the infant IV. measure the neonate's body temperature

I, II, and III Use a bulb syringe Avoid excessive suctioning of clear fluids from the nasopharynx. Use a suction catheter clearing the mouth and then the nose

What should the therapist do to avert injury and atelectasis, and to avoid interfering with the infants ability to establish adequate ventilation, while stabilizing a preterm neonate before resuscitation? I. Use a bulb syringe II. avoid excessive suctioning of clear fluid from the nasopharynx III. use a suction catheter clearing the mouth first and then the nose IV. suction using direct laryngoscopy

To prevent the development of bronchial stenosis and granulomas

When performing endotracheal suctioning on a neonate, why should the therapist routinely avoid advancing the catheter tip beyond the distal end of the endotracheal tube?

II and III only

Which of the following aspects of IPPB treatment need to be documented in the patient's chart after the treatment? I. Blood pressure II. Peak flow III. Sensitivity setting IV. Gas flow operating the nebulizer

Aggravating or alleviating factors

Which of the following components compose the history of present illness section of a patients medical history? immunizations symptoms exhibited by parents aggravating or alleviating factors symptoms resulting in hospitalizations

I, II, and IV only Birth weight, previous mechanical ventilation, emergency department visits

Which of the following components compose the past medical history section of the patients medical history? I. birth weight II. previous mechanical ventilation III. recurrence of symptoms based on season IV. emergency department visits

review of systems

Which of the following components of a patients medical history is intended to determine the presence of symptoms not identified in the history of present illness and may be related or contribute to the child's underling condition? chief complaint past medical history review of systems history of present illness

I, III, and IV only

Which of the following components should be considered when preoperatively teaching a child how to perform incentive spirometry? I. The parents should be involved in the teaching process whenever possible. II. The patient should demonstrate how to clean the incentive spirometer. III. The reason for therapy should be explained. IV. The patient should demonstrate the proper technique to the therapist.

II, III, and IV Proteinuria, generalized edema, hypertension

Which of the following conditions are associated with preclamipsia ? I. multiparity II. preteinuria III. generalized edema IV. hypertension

meconium aspiration

Which of the following conditions is a significant problem in postterm pregnancy? infection fetal anencephaly meconium aspiration obesity

II, III, and IV only Prenatal ultrasound evaluations, postnatal findings based on physical and neurological examinations, gestational duration based on the last menstrual cycle

Which of the following factors are taken into consideration when assessing the gestational age of a neonate? I. previous maternal pregnancies II. prenatal ultrasound evaluations III. postnatal findings based on physical and neurologic examinations IV. gestational duration based on the last menstrual cycle

Premature rupture of the fetal membranes

Which of the following is responsible for up to 40% of the preterm births in the united states? cervical insufficiency premature rupture of the fetal membranes obstetrical intervention mandated by fetal jeopardy hormonal treatment during pregnancy

Intraoperative bladder of bowel injuries

Which of the following maternal complications is associated with cesarean section?

Group b streptococcus

Which of the following microorganisms often affect pregnancy outcome? group B streptococcus haemophilus influenzae mycobacterium tuberculosis hepatitis C virus

reddish blue appearance

Which of the following neonatal skin presentations at birth is associated with a high hematocrit value or polycythemia and neonatal hyperviscosity syndrome? mottling lanugo reddish blue appearance vernix

heart rate

Which of the following parameters of the Apgar score provides the most important prognostic value? heart rate respiratory rate skin color muscle tone

I, II, and III only Chief complaint, history of present illness, past medical history

Which of the following pieces of information represent components of patient history for a new pediatric patient? I. chief complaint II. history of present illness III. past medical history IV. occupational history

Cystic fibrosis

Which of the following pulmonary diseases are not chest wall deformities but are characterized by an increased anteroposterior diameter? pectus excavatum interstitial pulmonary disease pneumonia cystic fibrosis

Direct a light source toward the affected side of the patients thorax

Which of the following statements refers to the diagnostic procedure called transillumination? place a light source b/t the surface of the bed and the patient's back, and orient the patient in a supine position direct a light source toward the affected side of the patient's thorax position a beam of light against a patient's chest wall in a well-lit room insert a fiberoptic light source down a patient's endotracheal tube and beyond the tube's distal tip

Pulmonary edema

While auscualting a young childs thorax, the therapist hears bilateral fine crackles. Which of the following can produce these adventitious sounds?

Atelectasis. Pleural effusion, consolidation I, III, and IV only

While percussing the thorax of a child during a physical examination, the therapist hears a dull percussion note over the childs right lung. Which of the following conditions may cause this physical finding? I. atelectasis II. pneumothorax III. pleural effusion IV. consolidation

Because newborns have relatively thin and weak musculature and a less rigid thorax

Why are chest retractions more prominent among neonates than among older children and adults? because neonates generate a greater subatmospheric intrapleural pressure because newborns have relatively thin and weak musculature and less rigid thorax because neonates have a much higher respiratory rate because airway resistance through the small caliber airways is higher

Because the neonates chest is small and sounds are difficult to differentiate

Why is it difficult to localize auscultation findings of the thorax of a newborn? because the neonates chest is small and sounds are difficult to differentiate b/c the newborn infant is frequently crying b/c the neonate's tidal volume is so small b/c the newborn's pulmonary compliance is low

is SIDS is uncommon after 6 months of age?

Yes

A respiratory therapist has been assigned to administer ACT to a number of patients on the ward. In which of the following conditions may ACT be beneficial? a. Atelectasis b. Asthma c. Bronchiolitis d. Pneumonia

In order to decrease the risk of nasal irritation in newborns, what is the maximum flow rate recommended? a. 2 L/minute b. 0.5 L/minute c. 1 L/minute d. 3 L/minute

What is the minimum level of oxygen tension in a child that requires oxygen administration? a. PaO2 of 60 mm Hg b. SpO2 of 92% c. SpO2 of 95% d. PaO2 of 80 mm Hg

What is the most important variable used to assess the efficacy of CPT? a. Amount of mucus obtained during and after treatment b. Degree and persistence of coughing c. Quality of the chest radiograph d. Changes in the color and consistency of mucus

Which of the following benefits has been associated with the use of inhaled tobramycin? I. Improvement of FEV1 II. Eradication of Pseudomona aeruginosa III. Reduction in hospitalization IV. Reduction in parenteral use of antibiotics a. I, II, III, and IV b. I, III, and IV only c. I, II, and III only d. I and IV only

Which of the following effects constitute adverse reactions to dornase alfa (recombinant human deoxyribonuclease I (rhDNase))? I. Chest pain II. Pharyngitis III. Rash IV. Hypovolemia a. I, II, and III only b. I, III, and IV only c. II, III, and IV only d. I and IV only

While working at the bedside of a small child who has myasthenia gravis, the therapist notices a new medication order prescribing glycopyrrolate for the control of secretions. What should the therapist do at this time? a. Inform the nurse that this medication is contraindicated for patients with myasthenia gravis. b. Mention nothing because the prescription is correct. c. Inform the nurse that this medication is contraindicated in children. d. Inform the nurse that the dose is incorrect.

WHILE PERCUSSING THE THORAX OF A CHILD DURING A PHYSICAL EXAMINATION, THE THERAPIST HEARS A DULL PERCUSSION NOTE OVER THE CHILD'S RIGHT LUNG. WHICH OF THE FOLLOWING CONDITIONS MAY CAUSE THIS PHYSICAL FINDING

a. ATELECTASIS b. CONSOLIDATION c. PLEURAL EFFUSION

WHICH OF THE FOLLOWING COMPONENTS COMPOSE THE PAST MEDICAL HISTORY SECTION OF THE PATIENT'S MEDICAL HISTORY

a. BIRTH WEIGHT b.PREVIOUS MECHANICAL VENTILATION c. SYMPTOMS RESULTING IN HOSPITILIZATION

WHICH OF THE FOLLOWING PIECES OF INFORMATION REPRESENT COMPONENTS OF PATIENT HISTORY FOR A NEW PEDIATRIC PATIENT

a. CHIEF COMPLAINT b. HISTORY OF PRESENT ILLNESS c. PAST MEDICAL HISTORY

a. Mild obstruction

Tracheomalacia is a condition of dynamic tracheal collapse. Which of the following injurious events can be associated with this condition?

a. Neonatal ventilation with high pressures

WHILE AUSCULTATING A YOUNG CHILD'S THORAX, THE THERAPIST HEARS BILATERAL FINE CRACKLES. WHICH OF THE FOLLOWING CONDITIONS CAN PRODUCE THESE ADVENTITIOUS SOUNDS

a. PNEUMONIA b. PULMONARY EDEMA

Diagnosis of TB in children requires which of the following special considerations?

a. Three consecutive days of gastric washings

a. Trachea

AFTER PLACING A STETHOSCOPE OVER A SMALL CHILD'S TRACHEA, THE THERAPIST HEARS EXPIRATORY STRIDOR. WHICH OF THE FOLLOWING CONDITIONS IS CONSISTENT WITH THIS FINDING

a. VASCULAR COMPRESSION OF TRACHEA b. TRACHEOMALACIA c. BRONCHOMALACIA

a. ≤20 cm H2O

While working with a preterm neonate, the therapist notices the infant become apneic, cyanotic, and hypotonic (limp). Consequently, the therapist nudges and stimulates the infant. On the basis of this scenario, what type of episode has occurred?

acute life threatening event

which low flow device is indicated primarily for short-term administration of oxygen with high humidity, as in postextubation or postanesthesia hypoxemia?

aerosol mask

which high flow device provides 24% to 50% oxygen; provides a stable/fixed FiO2.

air entrainment mask

which high flow device can a heater can be attached to in order to provide warm humidified gas especially when the upper airway is bypassed. Can use an face tent, aerosol mask, T-piece (T-adapter or Briggs adapter), or trach collar with this device.

air entrainment nebulizer

The following capnogram was obtained from a newborn infant receiving mechanical ventilation.How should the therapist evaluate this capnogram?

airway obstruction

The infant and small child are more at risk for which of the following, than that of the adult. I. Upper airway obstruction II. Increase in both airway resistance and work of breathing III. Heat loss and cold stress IV. Low pulmonary reserve

all of the above

Which of the following is true about stridor? a. Patients with laryngomalacia or subglottic stenosis may have inspiratory stridor b. It may occur during inspiration, expiration or be biphasic c. It is high-pitched, monophonic, audible noise d. Patients with a double aortic arch compressing the trachea, or tracheomalacia, may have expiratory stridor

all of the above

estimating percent of body surface area burned is based on what?

anatomic regions representing multiples of nine.

aspiration of a foreign object

polyphonic expiratory wheezing, seasonal allergies, atopy, and wheezing are symptoms of what underlying disease?

asthma

which drug causes an arrhythmia of symptomatic bradycardia?

atropine

A respiratory therapist has been assigned to administer CPT to a patient with cystic fibrosis. What areas of the body should the RT avoid when percussing the patient? a. Areas between the scapulas b. Fractured ribs c. Intercostal spaces d. Precordium

By what percentage can breath holding increase particle deposition in the lungs? a. 15% b. 10% c. 20% d. 5%

During autogenic drainage, at which of the following levels does the patient begin breathing? a. Inspiratory reserve volume b. Expiratory reserve volume c. Total lung capacity d. Tidal volume

For which of the following condition(s) is a high-flow nasal cannula contraindicated? I. Pneumothorax II. Apnea of prematurity III. Severe upper airway obstruction IV. Lack of spontaneous breathing a. I and III only b. I, III, and IV only c. III and IV only d. II and IV only

How will excess condensate present in aerosol tubing affect the delivered FiO2? a. It will decrease the FiO2. b. It will increase the FiO2. c. It will produce an unpredictable effect on the FiO2. d. It will only affect the FiO2 if in excess of 2 mL.

On the basis of the following diagram, which of the following lung segments is being drained? Posterior basal segments of both lower lobes

The physician asks the therapist to recommend a long-acting b-agonist for a patient. Which of the following medications should the therapist recommend? a. Levalbuterol b. Formoterol c. Metaproterenol d. Terbutaline

The therapist notices that the reservoir bag on a partial rebreathing mask being worn by a pediatric patient collapses completely during each inspiration. What should the therapist do at this time? a. Switch to a nonrebreathing mask. b. Increase the oxygen flow to the device. c. Continue monitoring the patient as the device is operating correctly. d. Decrease the oxygen flow to the apparatus.

What are the main components of the traditional airway clearance techniques? I. Palpation of the chest wall II. Postural drainage III. Percussion IV. Coughing a. I and III only b. II, III, and IV only c. I, II, III, and IV d. II only

When performing endotracheal suctioning on a neonate, why should the therapist routinely avoid advancing the catheter tip beyond the distal end of the endotracheal tube? a. To decrease the chance of removing too much lung volume b. To prevent the development of bronchial stenosis and granulomas c. To minimize the risk of oxygen desaturation d. To reduce the risk of inadvertent extubation with the suction catheter

When should the therapist administer short-acting bronchodilators to improve penetration of inhaled antibiotics? a. Immediately after the antibiotic b. 15 minutes to 4 hours before each dose c. No more than 4 hours after administration of the antibiotic d. At the same time as the administration of the antibiotic

When weaning an infant receiving oxygen from a nasal cannula attached to a low-flow flow meter set at 100%, what range represents the recommended oxygen flow reduction from the flow meter? a. 0.3 to 0.4 L/minute b. 0.1 to 0.2 L/minute c. 0.2 to 0.3 L/minute d. Less than 0.1 L/minute

Which of the following agents should be considered in the rapid-sequence intubation of patients with status asthmaticus? a. Atropine b. Ketamine c. Magnesium sulfate d. Halothane

Which of the following side effects are consistent with chronic administration of theophylline? I. Nausea II. Vomiting III. Tachycardia IV. Central nervous system stimulation a. I and II only b. I, II, III, and IV c. II and III only d. III and IV only

Why does an infant's respiratory distress from choanal atresia seem to lessen when the infant cries?

b. Because the infant breathes more through the mouth

b. Bronchiectasis

b. Laryngotracheobronchitis (LTB)

Which of the following agents has been shown to significantly reduce bronchiolitis scores?

b. Nebulized 3% hypertonic saline

The therapist has been asked to evaluate the chest radiograph of a 3-month-old boy with atelectasis. Which pulmonary lobe has the greatest tendency to collapse in young infants?

b. RML

b. Retropharyngeal abscess

b. Severe or complete airway obstruction

what is the most common cause of pneumothorax in a small premature infant with respiratory distress syndrome (hyaline membrane disease)?

barotrauma from mechanical ventilation

The location for assessing the pulse of an infant is at which artery?

brachial

Which of the following arteries should be palpated in pulseless infants?

brachial

Where would you check the pulse of an unresponsive infant?

brachial artery

Palpation of a patient's chest produces a vibration of the chest wall during quiet breathing. This suggests partial obstruction of the large airways by mucus. The name of this sign is?

bronchial fremitus

When assessing the function of a chest tube draining air from the pleural space of a pediatric patient, which of the following suggests an on ongoing intrapleural air leak?

bubbling in the water seal chamber

A respiratory therapist has been assigned to administer ACT to a patient with acute lobar atelectasis. What should the RT consider to determine the length and frequency of the treatment? I. Most pediatric patients require ACTs for at least 45 minutes. II. ACT is rarely needed more than every 4 hours. III. ACT orders should be evaluated at least every 48 hours for patients in the ICU. IV. ACT for patients with atelectasis due to CF requires at least 30 to 45 minutes. a. I, II, and III only b. III and IV only c. II, III and IV only d. II and III only

For which of the following patients is incentive spirometry contraindicated? I. Uncooperative II. Physically disabled III. Grossly obese IV. Very young a. IV only b. I and II only c. I, II, and IV only d. I, II, III, and IV

What is the concern when administering oxygen to a sedated infant who is wearing a nasal cannula? a. Gastric distention may develop. b. The patient may stop breathing. c. Too high of an FiO2 may be given. d. Too low of an FiO2 may be delivered.

Which of the following clinical parameters are important to determine a positive response to ACT? I. Changes in sputum color II. Breath sounds III. Vital signs IV. Lung mechanics a. III and IV only b. I, II, and III only c. II, III and IV only d. II and III only

Which of the following effects constitute adverse reactions to dornase alfa (recombinant human deoxyribonuclease I (rhDNase))? I. Chest pain II. Pharyngitis III. Rash IV. Hypovolemia a. II, III, and IV only b. I and IV only c. I, II, and III only d. I, III, and IV only

Which of the following effects is related to activation of b-adrenergic receptor sites? a. Release of inflammatory mediators b. Skeletal muscle contraction c. Bronchial smooth muscle relaxation d. Activation of guanyl cyclase

Which of the following maneuvers is characterized by having a patient forcibly exhale, from a middle to low lung volume, through an open glottis? a. Autogenic drainage b. Positive expiratory pressure c. Active cycle of breathing d. Directed cough

Which of the following medications works to maintain the integrity of the mast cell? a. Magnesium sulfate b. Methylprednisolone c. Cromolyn sodium d. Ipratropium bromide

Which of the following ranges of oxygen flow need to be set when administering oxygen to an infant via a simple mask? a. 1 to 6 L/minute b. Less than 1 L/minute c. 6 to 10 L/minute d. Greater than 10 L/minute

in which of the following conditions is the oxygen-carrying capacity reduced despite the presence of a normal arterial oxygen tension? a. Cyanide poisoning b. Heart failure c. Polycythemia d. Carbon monoxide poisoning

Where in the ventilator circuit should a continuous jet nebulizer be placed to improve efficiency of aerosol delivery? a. 30 cm from the heated humidifier b. Between the "y" adapter and the endotracheal tube c. 30 cm from the ETT in the inspiratory limb d. In the expiratory limb

c Placement of a continuous jet nebulizer 30 cm from the ETT is more efficient than placement between the patient "y" adapter and the ETT because the inspiratory ventilator tubing acts as a spacer for the aerosol to accumulate between inspirations.

Relative to an adult's larynx, where is an infant's larynx situated?

c. C3-4

c. Discontinue therapy

Which of the following clinical interventions are used to treat complications of sickle cell anemia?

c. I, II, and IV only I. Supplemental oxygen II. Bronchodilators IV. Red blood cell transfusions

Which of the following medications should be administered to a 4-year-old child who develops postextubation stridor?

c. Prednisolone

Which of the following lateral neck radiographic presentations is characteristic of laryngotracheobronchitis?

c. Steeple sign

A therapist has been asked to evaluate a child suspected of having foreign body aspiration. Which of the following clinical conditions would guide the therapist to the diagnosis?

c. Unilateral wheezing

The second leading cause of death in patient's diagnosed with muscular dystrophy is:

cardiomyopathy

Which artery should be palpated in pulseless children older than 1 year of age?

carotid

During CPR, how can you judge if ventilation is effective?

chest rise

which of congential anomaly is commonly associated with a pneumothorax in a neonate

congenital diaphragmatic hernia

what breath sound if heard in patients with atelectasis, pulmonary fibrosis, pneumonia, and pulmonary edema?

crackles

The narrowest portion of the infant's airway is at the level of the?

cricoid cartilage

what are the anatomic boundaries for a zone II neck injury?

cricoid cartilage to the angle of the mandible

The lung disease that is most commonly associated with spontaneous pneumothorax is adolescents is:

cystic fibrosis

A patient with an excessive amount of secretions and atelectasis has been receiving ACT. What is the most commonly cited complication of ACT? a. Hypercapnia b. Tachycardia c. Alterations of blood pressure d. Hypoxemia

A respiratory therapist has been assigned to administer FET to a 5-year-old patient. Since small children are typically unable to perform such a maneuver, what should the RT do at this time? a. Try to instruct the child on how to perform FET. b. Request to cancel the order and change therapy. c. Ask the child to forcefully cough after a deep breath. d. Apply gentle chest wall compression during the expiratory phase.

How long should a patient wait to receive the maximal benefit of inhaled corticosteroids? a. 48 hours b. 1 month c. 5 days d. 1 to 2 weeks

Nebulized pentamidine should be administered in a negative pressure room and through which of the following nebulizer systems? a. Nebutech b. SPAG c. Pari LC Plus d. Respirgard II

The following postural drainage positions are shown for a pediatric patient: Which of the diagrams demonstrates the postural drainage position for draining the posterior subsegment of the apical-posterior segment of the left upper lobe? d. Image B

The following postural drainage positions are shown for an infant patient: Which of the diagrams demonstrates the postural drainage position for draining the lingular segments of the left upper lobe in an infant? a. Image B b. Image D c. Image A d. Image C

The respiratory therapist has been asked to evaluate the effectiveness of incentive spirometry in some patients during their postoperative stage. What will the RT find to be most influential on the outcome associated with IS? a. Patient's age b. Frequency of therapy c. Level of inspiratory capacity achieved by the patient d. Level of supervision and instruction of therapy

The therapist has evaluated a neonate's oxygenation status to be as follows: PaO2, 40 mm Hg, and SpO2 (oxygen saturation as determined by pulse oximetry), 80%. What should the therapist do at this time? a. Continue monitoring the oxygen level of the neonate. b. An FiO2 sufficient to elevate the PaO2 to 80 mm Hg should be provided. c. An FiO2 of 1.0 needs to be administered. d. An FiO2 sufficient to raise the SpO2 to 90% needs to be given.

To reduce the adverse effects of inhaled corticosteroids, what should the therapist recommend? a. Brush teeth after each inhalation b. Use a dry powder inhaler c. Decrease the dosage d. Use a holding chamber device

What do postural drainage, positive expiratory pressure therapy, autogenic drainage, forced expiration techniques, and high-frequency chest compressions have in common? a. They work toward increasing the functional residual capacity of patients. b. They are intended to promote the ability of patients to generate effective coughs. c. They dislodge mucus from the bronchial walls of patients. d. They attempt to prevent dynamic airway collapse.

What is the most important variable used to assess the efficacy of CPT? a. Quality of the chest radiograph b. Degree and persistence of coughing c. Changes in the color and consistency of mucus d. Amount of mucus obtained during and after treatment

Where does the fetal oxyhemoglobin dissociation curve reside in comparison with the normal adult oxyhemoglobin dissociation curve? a. The adult oxyhemoglobin dissociation curve lies to the left of the fetal curve. b. The two curves have the same position and coincide with each other. c. The fetal oxyhemoglobin dissociation curve lies to the right of the adult curve. d. The fetal oxyhemoglobin dissociation curve lies to the left of the adult curve.

Which of the following adverse effects is likely to be experienced by patients who use nonselective b2-adrenergic agonists? a. Blurred vision b. Bradycardia c. Tachypnea d. Tremor

Which of the following maneuvers is characterized by having a patient forcibly exhale, from a middle to low lung volume, through an open glottis? a. Autogenic drainage b. Directed cough c. Positive expiratory pressure d. Active cycle of breathing

Which of the following medications is most suited for the treatment of postextubation edema? a. Norepinephrine b. Ephedrine c. Fluticasone d. Racemic epinephrine

Which of the following medications works to maintain the integrity of the mast cell? a. Magnesium sulfate b. Ipratropium bromide c. Methylprednisolone d. Cromolyn sodium

Which of the following responses are considered adverse effects of inhaled corticosteroids? I. Oropharyngeal candidiasis II. Dry mouth III. Wheezing IV. Dysphonia a. I and II only b. II and III only c. II and IV only d. I, III, and IV only

respiratory therapist has been assigned to administer ACT to a number of patients on the ward. In which of the following conditions may ACT be contraindicated? I. Foreign body aspiration II. Frank hemoptysis III. Empyema IV. Untreated pneumothorax a. II and IV only b. I and IV only c. III and IV only d. I, II, III, and IV

A 3-year-old child has the following clinical presentations in the ER: Profound nasal congestion and productive cough. Chest auscultation revealing diffuse coarse, "sticky" crackles (sounding like Velcro). Chest radiograph revealing lung hyperinflation with flattened hemidiaphragms. What pulmonary condition does this infant likely have?

d. Bronchiolitis

An 11-month-old child has been treated with bronchodilators for persistent wheezing without a positive clinical response. Which of the following conditions should the therapist suspect?

d. Endobronchial compression

d. Epiglottitis

The following postural drainage positions are shown for a pediatric patient:Which of the diagrams demonstrates the postural drainage position for draining the posterior subsegment of the apical-posterior segment of the left upper lobe?

d. Image B.

Which of the following radiographic techniques is best for determining the presence of a ball-valve type obstruction?

d. Inspiratory and expiratory A-P chest X-rays

d. Pneumonia

Why does a respiratory syncytial viral infection have little adverse effect on an older child but is often life threatening to a younger child?

d. The younger child has fewer respiratory bronchioles.

what is proposed mechanism for chylothorax?

decreased in thoracic duct pressure during birth

What is the first step in basic life support?

determine unresponsiveness

The most common form of muscular dystrophy in children is?

duchenne muscular dystrophy

What is an X-linked recessive disorder?

duchenne muscular dystrophy

what findings on spirometry are not associated with inhalation injury?

elevated TLC

which drug causes an arrhythmia of asystole, PEA, and pulseless ventricular tachycardia?

epinephrine

Which phase of the respiratory cycle is manual vibration performed?

exhalation phase

Which spirometry test is a non-invasive method of measuring airway inflammation?

exhaled nitric oxide

The glottis closing over the trachea to prevent the alveoli from collapsing is referred to as?

expiratory grunting

which of the following are not part of the 6 Es of injury prevention?

exposure

devices that can meet or exceed the patient's inspiratory demand and thereby provide an accurate fractional concentration of delivered oxygen that is not affected by changes in ventilatory pattern are called?

fixed performance

which of the following is not a function of the skin?

has motor function

During a physical exam you suspect that a patient has a right-sided pneumothorax, what type of percussion note would you hear?

hyperresonant

which of the following is not a characteristic of abdominal compartment syndrome?

hypertension

Which of the following is not a method aimed at lowering intracranial pressure after head trauma?

hyperventilation

A patient with an excessive amount of secretions and atelectasis has been receiving ACT. The most commonly cited complication is _____________________________.

hypoxemia

What is the purpose of the primary survey?

identify life threatening injuries and resuscitation of the patient.

When electrodes are placed on the infant and held in place by a soft belt at the nipple line which will reveal the respiratory rate, this method of monitoring is known as. Correct!

impedance pneumography

How will excess condensate present in aerosol tubing affect the delivered FiO2?

increase

Continuous positive pressure (CPAP) improves oxygenation by:

increasing frc

The physician in the emergency department is attending to a 12-year-old child who has an exacerbation of asthma. The physician asks the therapist to recommend a medication that has a synergistic effect with beta-2 agonists during asthma exacerbation's. Which of the following medications should the therapist recommend?

ipratropium bromide

which low flow oxygen device has the greatest disadvantage of inability to stabilize the FiO2 when opening the large ports to provide care to the infant; use a nasal cannula or hood within this system.

isolette

which of the following characteristics determines that the pleural fluid is an empyema ?

lactic dehydrogenase of 150 U/dl

which drug causes an arrhythmia of premature ventricular contractions/complexes?

lidocaine

What are the two most frequently injured abdominal organs in children?

liver and spleen

which drug causes an arrhythmia of torsades de pointe?

magnesium sulfate

Cardiopulmonary exercise test (CPET)

measurements of symptoms during exercise

which device will help to bring the patien'ts saturations (SpO2) up to 90% or more?

nasal cannula

which low flow device is designed to provide greater mobility at low flow rates. FiO2 approximately ranges (24% to 40%)?

nasal cannula

What is a compensatory mechanism to help overcome airways resistance?

nasal flaring

During properly performed external chest compression on infants, how should the middle and index fingers be positioned?

nipple line

which low flow device provides 60% to 80% oxygen and consists of one-way valves?

nonrebreather

cystic fibrosis, chronic bronchitis, asthma, bronchiectasis, emphysema are all examples of what?

obstructive lung disease

Which of the following oxygen-delivery devices would be most suitable for an infant being treated for choanal atresia?

oxygen hood

which high flow device has noise levels that can cause hearing loss; nursing care is uninterrupted. Consists of clear plastic material in a boxlike design.

oxygen hood

which high flow device is a fire hazard with use of electric or batter-operated toys within this oxygen enclosure. Use with croup or post extubation edema.

oxygen mist tent

Which of the following is not a characteristic of a level 1 trauma center?

part-time emergency medicine physicians.

which low flow device provides 40% to70% oxygen, one-way valves must be removed in this system. Patient breathes a portion of their exhaled gas.

partial rebreather

what organisms must antibiotics cover after an animal bite?

pasteurella

which of the following is an indication for an emergency department thoracotomy for pediatric trauma?

penetrating injury with no signs of life for less than 15 minutes.

The act of clapping with your hand on the chest wall to facilitate removal of secretions is termed:

percussion

The use of gravity to move secretions by placing a patient into position(s) to drain a lobe or segment of the lung is termed:

postural drainage

The location for palpation of the pulse rate in a child is at which artery?

radial

What is the first diagnostic imaging study used to rule out a cervical spine injury in children?

radiography

Should the initial attempt to ventilate fail, which of the following actions would you suggest?

reposition

A child who demonstrates head bobbing, nasal flaring, and grunting is exhibiting signs of ____.

respiratory distress

What is the major reason for cardiac arrest in children?

respiratory related events

pneumonia, pneumothorax, pleural effusion, atelectasis are all examples of what?

restrictive lung disease

Which disorder can develop in neonates as a result of receiving concentrations of oxygen that produce a high PaO2?

retinopathy

what breath sound is heard when secretions are moving through large airways, clears with cough?

rhonchi

An oxygen blender is being used to deliver 50% oxygen through a jet nebulizer (LVN) for humidification to a child. How should the respiratory therapist set the jet nebulizer (LVN) in this situation?

set to 100%

which low flow device is used for medical transport of patients or in post anesthesia recovery?

simple oxygen mask

which breath sounds is a low-pitched, wet sound similar to snoring and suggests nasopharyngeal, oropharyngeal, and/or hypopharyngeal obstruction

stertor

which of the following organisms most commonly causes empyema in toddlers and school age children

streptococcus pneumoniae

which breath sounds represents narrowing of upper airway (e.g. extrathoracic as in croup) and or intrathoracic as in tracheomalacia

stridor

Following chest physiotherapy (CPT) therapy, a 3 year old child with muscular dystrophy has an excessive amount of oral secretions. Which of the following should the respiratory therapist use to quickly and safely remove the secretions.

suction device (yankauer)

what component of a patient's medical history is intended to determine the presence of symptoms not identified in the history of present illness and may be related or contribute to the child's underlying condition?

symptoms

Rate counts by observation or placing a hand on the infants chest may be inaccurate due to which of the following?

tactile stimulus

Bronchial provocation (challenge) testing

the use of: Direct: histamine and methacholine Indirect: mannitol and AMP

which of the following statement regarding the pleural space in a normal child is true?

there is a small amount of fluid in the pleural space that represents a balance of the fluid flux between the parietal and visceral pleura.

why are children less likely to develop rib fractures after thoracic trauma compared with adults?

they have higher cartilage content and incomplete ossification.

What is the most common cause of airway obstruction in unconscious patients?

tongue

Which of the following pleural fluid measurements indicated the fluid is an exudate rather than a transudate?

total protein of 5.0 /dl

A closed-system (in-line) suction catheter is preferred over the open-system (sterile) catheter for patients on a mechanical ventilator: true or false

true

The American Academy of Pediatrics (AAP) recommends that infants be placed in the supine position for the first 6 months of life to reduce the risk of SIDS: True or false

true

The best way to avoid/prevent hypoxemia or bradycardia with suction in a pediatric patient is to hyperoxygenate with 10% to 20% oxygen above set FiO2 for 30 to 60 seconds: true or false

true

what is the most common location for a traumatic esophageal injury?

upper

devices that are not capable of meeting the patient's inspiratory demand and therefore provide a fractional concentration of delivered oxygen that varies with the patient's rate and depth of ventilation and the flow rate of gas are called?

variable performance

which breath sound can be monophonic or polyphonic, heard in patients with bronchospasm or foreign body airway obstruction (FBAO)

wheezes

Voir tous les ensembles d'études

chapter 12 & 20 FINAL ( pharmacology , airway clearance technique), Neo CH. 25, Lesson 1-5 Pediatrics Final, Neo CH. 26, practicum 3 exam review, Chapter 26 - Vicky - Fall 16, CHAPTER 10 & 11 FINAL 02 ADMINISTRATION/AERSOL FINAL, Ch. 12, Neo CH. 25,...

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