Neo/Peds TEST 3

The following factors are essential when constructing a B- CPAP system except: A. A positive end-expiratory pressure/exhalation valve B. Hudson nasal prongs C. A blended gas source

A. A positive end-expiratory pressure/exhalation valve

The following pediatric respiratory disorders may be treated with a trial of NIV in the acute setting except: A. ARDS with sepsis B. Bronchiolitis C. Acute exacerbation of cystic fibrosis lung disease D. Pneumonia in a child with muscular dystrophy

A. ARDS with sepsis

A 9-year-old patient is admitted to the hospital after smoke inhalation. While receiving oxygen with a nonrebreathing mask, it is noted that the reservoir bag becomes totally deflated when the patient inspires. Which of the following actions should be taken? A. Increase the oxygen flow rate B. Decrease the oxygen flow rate C. Change to a nasal cannula D. Change to a partial rebreathing mask

A. Increase the oxygen flow rate

A 5-year-old patient with a history of asthma is admitted to the emergency department after complaining of chest tightness and wheezing. The pulse oximeter reading drops from 95% to 88%. Which of the following devices should be selected to deliver oxygen to this patient? A. Nasal cannula B. Oxygen hood C. Oxygen mist tent D. Nonrebreathing mask

A. Nasal cannula

CPAP is contraindicated in infants with which of the following congenital anomalies?A. Preoperative congenital diaphragmatic hernia B. Postoperative heart surgery C. Postoperative congenital diaphragmatic hernia

A. Preoperative congenital diaphragmatic hernia

The most important aspect of CPAP that can impact the outcome and success of CPAP is: A. The device being used to generate CPAP B. Suctioning and airway clearance techniques C. Proper bedside care and level of experience of clinicians using the CPAP device D. The physician writing the orders

A. The device being used to generate CPAP

A condition in which blood flow out of the right ventricle is obstructed because of atresia of the pulmonary valve is more consistent with which of the following defects? A.) Pulmonary atresia with intact ventricular septum B.) Coarctation of the aorta C.) Truncus arteriosus D.) Transposition of the great arteries

A.) Pulmonary atresia with intact ventricular septum

Which of the following is a risk if PVR decreases in the first days of life in infants with HLHS? A.) Pulmonary edema B.) Induce hypocapnia C.) Development of a VSD D.) Development of an ASD

A.) Pulmonary edema

Which of the following blood flow patterns occurs in complete transposition of the great arteries? A.) The systemic venous blood passes through the right heart chambers. B.) The pulmonary venous blood traverses the left side of the heart and then returns to the systemic circulation. C.) When PVR increases relative to SVR, blood flow increases through the ductus arteriosus. D.) Systemic venous blood flows to the lungs after leaving the right ventricle.

A.) The systemic venous blood passes through the right heart chambers

How should the therapist interpret a preductal-to-postductal PaO2 difference of 8 mm Hg in a neonate?

Absence of ductal shunting

The patent ductus arteriosus connects which two vessels?

Aorta and pulmonary artery

A premature infant is receiving oxygen by nasal cannula at 1.5 L/minute. The following capillary blood gas and pulse oximetry values are obtained: pH 7.37 PtccO2 41 mm Hg PcO2 43 mm Hg HcO3 23 mEq/L BE −1 mEq/L SpO2 98% Which of the following should be recommended? A. Replace the nasal cannula with an oxygen hood B. Decrease the nasal cannula flow to 1 L/minute C. Increase the nasal cannula flow to 2 L/minute D. Discontinue the nasal cannula 7. What plausible ways does HHFNC improve oxygenation? A. Nasal pharyngeal CO2 washout at flows that exceed expiratory gas flow B. Filling the nasal cavity with oxygen-enriched gas C. Positive pressure D. All of the above

B. Decrease the nasal cannula flow to 1 L/minute D. All of the above

The most common interface used to deliver CPAP to spontaneously breathing infants is: A. Infant hood B. Nasal prongs C. Nasopharyngeal endotracheal tube

B. Nasal prongs

Bedside evaluation of the degree of hypoxemia may best be accomplished by which of the following? A. Auscultation B. Pulse oximetry C. Capillary blood gas analysis D. Capillary refill time

B. Pulse oximetry

Which of the following medications is the most common preoperative treatment to minimize preductal constriction until surgical correction of coarctation of the aorta can be achieved? A.) Indomethacin B.) Prostaglandin E1 C.) Negative inotropes D.) Diuretics

B.) Prostaglandin E1

For which condition is positive pressure most likely to have a negative impact on pulmonary blood flow and cardiac output?

Bidirectional Glenn

What is the minimal flow rate that should be used to deliver oxygen through a hood to an infant? A. 5 L/minute B. 6 L/minute C. 10 L/minute D. 15 L/minute

C. 10 L/minute

Which of the following clinical indicators best describes methods for detecting early pneumothorax while monitoring infants receiving nasal CPAP? A. Persistent coughing and nasal flaring B. Widened pulse pressure C. An increased Fio2 over the first day of CPAP support D. A significant increase in respiratory distress E. Diminished bilateral breath sounds

C. An increased Fio2 over the first day of CPAP support

An absolute contraindication to a trial of NIV in a child with respiratory distress is: A. Status asthmaticus B. Absence of a nasogastric tube to ventilate the stomach C. Cardiovascular instability D. Tracheoesophageal fistula

C. Cardiovascular instability

You are called by the floor nurse to evaluate a child with cerebral palsy and pneumonia being treated with NIV who is agitated. The child's heart rate is elevated and he is moving around the bed. The best response in this situation is to: A. Reassure the nurse and the child's parents that NIV takes some time to get used to and simply observe the child over time. B. Notify the attending physician that the child is not tolerating NIV and needs to be sedated so that the NIV can be effective. C. Do a complete respiratory examination, paying attention to the child's work of breathing and vital signs before and after application of NIV. D. Replace the nasal mask interface with a full-face mask interface that covers the mouth and nose so as to prevent oral leak.

C. Do a complete respiratory examination, paying attention to the child's work of breathing and vital signs before and after application of NIV.

Physiological effects of CPAP include the following except: A. Improved respiratory system compliance and resistance B. Stabilization of the chest wall C. Increased mucus production D. Less lung injury than with mechanical ventilators

C. Increased mucus production

Which of the following methods is involved in the management of a PDA? A.) Increasing the circulating volume B.)Maintaining/optimizing the hematocrit at the low end of normal hemoglobin level C.)Administering indomethacin D.)Administering digoxin

C.) Administering indomethacin

Low signal strength on a plethysmogram may indicate which of the following? A.) Hyperperfusion B.) Increased stroke volume C.) Probe malposition D.) Decreased SVR

C.) Probe malposition

Which of the following clinical features characterizes a critical aortic stenosis in a neonate? A.) Chest radiography reveals pleural effusion and pulmonary engorgement. B.) The neonate often has metabolic alkalosis. C.) The neonate presents in cardiogenic shock with hypotension. D.) These infants are rarely symptomatic during the first month of life.

C.) The neonate presents in cardiogenic shock with hypotension.

Normal transition to extrauterine life depends on the pulmonary vascular system?

Changing from high pulmonary vascular resistance to low pulmonary vascular resistance

What are the two categories that have typically been used to classify congenital cardiac defects?

Cyanotic Acyanotic

Which of the following affects pulmonary vascular resistance? A. Changes in Pao2 B. Changes in Paco2 C. Changes in pH D. All of the above E. None of the above

D

What is a concern when using a HHFNC? A. A lack of understanding of the actual fraction of oxygen delivered B. An increased risk of developing chronic lung disease C. A lack of knowledge concerning the actual amount of positive pressure applied to the patient's airways D. A and C

D. A and C

he physician orders 32% oxygen for a 12-year-old patient with cystic fibrosis. Which of the following oxygen delivery devices would best ensure this oxygen concentration? A. Low-flow nasal cannula B. Simple mask C. Nonrebreathing mask D. Air-entrainment mask

D. Air-entrainment mask

CPAP levels greater than 8 cm H2O are commonly associated with which of the following conditions? A. Gastric distention B. Oropharyngeal leaks C. Acute pulmonary edema D. Both A and B

D. Both A and B

Early attempts to create systems to provide CPAP to spontaneously breathing infants were aimed at trying to mimic which of the following important physiological factors that affect gas delivery to the lung? A. Nasal flaring B. Chest rise C. Work of breathing D. Grunting

D. Grunting

All of the following devices are considered acceptable for measuring and delivering nasal CPAP safely to infants except: A. V-CPAP B. B-CPAP C. IF-SiPAP D. High-flow nasal cannula

D. High-flow nasal cannula

In patients with HLHS, which of the following are consequences if premature closure of the PDA occurs? A.) Metabolic alkalosis B.) Respiratory alkalosis C.) Hypertension D.) Hypoperfusion

D.) Hypoperfusion

Which of the following physiologic mechanisms needs to be in place to ensure adequate systemic perfusion in infants with HLHS? A.) Presence of an ASD B.) Presence of a mitral regurgitation C.) Adequate left atrial function D.) Presence of an PDA

D.) Presence of an PDA

Which of the following is the correct statement regarding the path of blood as it travels through the heart? A.) During ventricular diastole, blood passes through the tricuspid valve and into the left ventricle (LV). B.)During ventricular diastole, blood is ejected from the RV into the pulmonary arteries through the pulmonary valve. C.)During ventricular systole, blood is pumped from the RA into the right ventricle (RV) via the mitral valve (TV). D.)The coronary sinus drains venous blood supplying the heart muscle itself.

D.) The coronary sinus drains venous blood supplying the heart muscle itself

True or false: Current evidence supports a trial of NIV to prevent endotracheal intubation and invasive mechanical ventilation in children with acute respiratory distress.

False

True or false: The required level of monitoring for a child with long-term respiratory failure treated with nocturnal NIV in the ambulatory setting as a probable clinical benefit should include a cardiorespiratory monitor and pulse oximeter.

False

True or false: In complete transposition of the great arteries, the aorta and the pulmonary artery circulation run in series.

False In complete transposition of the great arteries, the aorta and pulmonary artery circulation run in parallel.

Identify the congenital cardiac defect depicted in the following illustration:

Hypoplastic left ventricular syndrome

The therapist is monitoring a patient in the CICU with a cardiac abnormality. They notice a narrowing pulse pressure. Which of the following could result? I. A low stroke volume II. Increased cardiac output III. Poor ventricular function IV. Impaired venous return

I, III, and IV only

Which of the following statements describe truncus arteriosus? I. It is a rare defect in which a single great artery arises from the ventricles of the heart. II. If PVR increases relative to systemic vascular resistance (SVR), more blood flows to the lungs through the truncus, decreasing systemic cardiac output. III. Oxygen should be avoided in almost all circumstances in the preoperative setting. IV. Patients may undergo complete biventricular repair in the newborn period.

I, III, and IV only

For which of the following congenital cardiac defects are considered ductal dependent, and closure of the ductus arteriosus could have catastrophic consequences for the patient? I.Tetralogy of Fallot with pulmonary atresia. II. Atrial septal defect III. Severe coarctation of the aorta IV. Hypoplastic left heart syndrome

I. Tetralogy of Fallot with pulmonary atresia III. Severe coarctation of the aorta IV. Hypoplastic left heart syndrome

The therapist is treating a child with TOF who appears to be having a "spell." What should the therapist suggest to treat this event? I. Prone positioning II. Knee-chest position to increase SVR III. Morphine sulfate IV. Oxygen

II. Knee-chest position to increase SVR III. Morphine sulfate IV. Oxygen

Which of the following clinical pathophysiologic manifestations are consistent with a large ventricular septal defect (VSD)? I. The majority of the blood flow are shunted from left right to right left. II. Shunting typically occurs during ventricular diastole, which causes left atrial enlargement. III. Chest radiography reveals an enlarged cardiac silhouette and increased pulmonary vascular markings, increasing pulmonary blood flow. IV. Thickening and fibrosing of the pulmonary veins develop, decreasing pulmonary artery pressure.

II. Shunting typically occurs during ventricular diastole, which causes left atrial enlargement. III. Chest radiography reveals an enlarged cardiac silhouette and increased pulmonary vascular markings, increasing pulmonary blood flow.

Tetralogy of Fallot consists of which four concomitant conditions? I. Truncus arteriosus II. Left ventricular hypertrophy III. Right ventricular hypertrophy IV. Overriding aorta V. Interrupted aortic arch VI. Pulmonary stenosis VII. Ventricular septal defect VIII. Right ventricular outflow tract obstruction

III, IV, VI, VII

What is the therapeutic goal of subambient oxygen therapy?

Increase the pulmonary vascular resistance

At birth, what factor causes dilation of the pulmonary vascular bed and a decrease in the pulmonary vascular resistance?

Increased PaO2

What factor is responsible for closure of the foramen ovale?

Increased pressure on the left side of the heart

Vessels that return blood to the right ventricle?

Inferior vena cava Superior vena cava Coronary sinus

A therapist monitoring an infant after a Blalock-Tausig shunt placement notices a significant drop in the end-tidal carbon dioxide (ETCO2) despite no changes in the infant's respiratory rate. How should the therapist interpret this change?

Loss of pulmonary blood flow through the shunt

Which of the following clinical manifestations is consistent with an atrial septal defect (ASD)?

The right ventricle may become hypertrophic

Why must supplemental oxygen be judiciously administered to patients with an atrioventricular canal defect?

To minimize pulmonary vascular dilation

True or false: The purpose of managing pulmonary vascular resistance in the presence of cardiac defects is to ensure the desired balance between systemic and pulmonary blood flow.

True Increasing PVR limits blood flow to the lungs, increasing blood flow to the left side of circulation and increasing cardiac output. Reducing PVR has the opposite effect, decreasing cardiac output.

Identify the following congenital cardiac anomaly

Truncus arteriosus

Increasing gradients between ETCO2 and Paco2 in patients with congenital cardiac defects are often the result of?

Ventilation-perfusion mismatch

In what particular setting has long-term use of NIV on children with cystic fibrosis been successful? a. As a bridge to transplantation b. As the routine treatment for bronchopulmonary hygiene c. As the primary indication for reduction of exacerbations d. As the primary treatment of hypoventilation

a. As a bridge to transplantation

What is considered the most effective interface option for delivering CPAP to infants? a. Binasal prongs b. Nasal mask c. Nasal pillows d. Oronasal mask

a. Binasal prongs

What is the only absolute contraindication to a trial of NIV in pediatric patients with acute respiratory distress? a. Cardiovascular instability b. Nasopharyngeal obstruction c. Inability to handle oral secretions d. Extreme agitation or anxiety

a. Cardiovascular instability

After initiating IF-CPAP in an infant at 8 cm H2O, the therapist notices a low-pressure alarm. What should be done to correct this situation? a. Correct the leak by placing a chin trap. b. Change to a smaller cannula. c. Increase the flow through the CPAP system. d. Change the flow generator.

a. Correct the leak by placing a chin trap.

For which of the following conditions is a contraindication for the use of a high-flow nasal cannula? I. Pneumothorax II. Apnea of prematurity III. Severe upper airway obstruction IV. Lack of spontaneous breathing a. I, III, and IV only b. I and III only c. II and IV only d. III and IV only

a. I Pneumothorax III Severe upper airway obstruction IV Lack of spontaneous breathing

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. Increase the flow to the device. b. Decrease the flow to the apparatus. c. Switch to a nonrebreathing mask. d. Continue monitoring the patient as the device is operating correctly.

a. Increase the flow to the device.

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

a. It will increase the FiO2.

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

a. PaO2 of 60 mm Hg

What are the primary objectives of noninvasive ventilation (NIV)? I. To increase the likelihood of successful weaning from mechanical ventilation II. To improve respiratory gas exchange III. To decrease the patient's work of breathing IV. To reduce the risk of ventilator-associated pneumonia a. I and IV only b. II and III only c. I, II, and III only d. II, III, and IV only

b. II. To improve respiratory gas exchange III. To decrease the patient's work of breathing

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

b. Polycythemia

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. Less than 0.1 L/minute b. 0.1 to 0.2 L/minute c. 0.2 to 0.3 L/minute d. 0.3 to 0.4 L/minute

b. 0.1 to 0.2 L/minute

A patient receiving PAV is noticed to increase breathing effort. Which parameters will the ventilator modify to respond to this patient's increased respiratory demand? I. Increase flow II. Increase tidal volume III. Increase pressure IV. Increase CPAP a. I and II only b. I and III only c. II, III, and IV only d. III, IV, and V only

b. I and III only I. Increase flow III. Increase pressure

A preterm infant in respiratory distress is a candidate for CPAP. To minimize the work of breathing, which device should be used? a. B-CPAP b. IF-CPAP c. Single probe CPAP d. V-CPAP

b. IF-CPAP

Which of the following conditions are contraindications for nasal CPAP? I. Pneumonia II. Tracheoesophageal fistula III. Choanal atresia IV. Atelectasis a. I and II only b. II and III only c. III and IV only d. I, II, and III only

b. II. Tracheoesophageal fistula III. Choanal atresia

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

b. Increased intrapulmonary shunting

What is the clinical significance of the IPAP-EPAP gradient in bilevel NIV? a. It represents the mean airway pressure to which the patient's lungs are exposed. b. It determines the patient's tidal volume. c. The IPAP-EPAP gradient determines the inspiratory time. d. This gradient determines the level of pressure support the patient will receive

b. It determines the patient's tidal volume.

Which of the following anatomic structures should be closely evaluated when using nasal masks in the administration of IF-CPAP? a. Tragus b. Philtrum c. Sphenoid axis d. Lower lip

b. Philtrum

Which of the following complications of CPAP can develop when an infant experiences inadvertent positive end-expiratory pressure (PEEP) from gas trapping resulting from tachypnea? a. Pulmonary hypertension b. Pneumothorax c. Atelectasis d. Diaphragmatic hernia

b. Pneumothorax

A bubble CPAP has been set up on an infant at 12 L/minute and the water column is reading 4 cm H2O. A chest X-ray reveals mild lung overdistention. What is the most feasible explanation for this finding? a. The amount of CPAP is excessive for this age group. b. The flow rate is very high and the CPAP measured at the nasal prongs is probably >4 cm H2O. c. The cannula is probably too large for the infant and causes inadvertent CPAP. d. The chest X-ray finding is consistent with the amount of CPAP set at the water chamber.

b. The flow rate is very high and the CPAP measured at the nasal prongs is probably >4 cm H2O.

In order to rinse the system of exhaled CO2 and meet the inspiratory flow rate requirements of infants placed on B-CPAP, the flow rate of humidified gas should be set at: a. 6 to 10 L/minute b. 11 to 15 L/minute c. 16 to 20 L/minute d. at least 15 L/minute

b. The flow rate is very high and the CPAP measured at the nasal prongs is probably >4 cm H2O.

How is the positive pressure level established in a bubble CPAP system? a. The therapist dials the desired CPAP level directly on the ventilator. b. The therapist immerses the distal end of the expiratory limb a certain distance below the water surface. c. The CPAP level is established by stacking adaptors with weighted balls to the distal opening of the expiratory limb d. The positive pressure is achieved by tightening a screw clamp attached to the expiratory limb until the desired pressure is achieved.

b. The therapist immerses the distal end of the expiratory limb a certain distance below the water surface.

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

b. Too high of an FiO2 may be given.

What is considered the most successful therapeutic condition where NIV can be used in children? a. Treatment of hypoxemic exacerbation of children with chronic neuromuscular disorders b. Treatment of hypercapnic exacerbation of children with chronic neuromuscular disorders c. Treatment of exacerbation of children with acute asthma attacks d. Treatment of exacerbation of children with pulmonary edema due to congenital heart defects

b. Treatment of hypercapnic exacerbation of children with chronic neuromuscular disorders

When should NIV be selected over CPAP in children with OSA? a. For every patient who is hypoxemic b. When OSA is complicated by alveolar hypoventilation and hypercarbia c. When OSA is complicated by hypoxemia d. For every patient who is hypoxemic and hypercapnic

b. When OSA is complicated by alveolar hypoventilation and hypercarbia

Which of the following outcomes are advantages of CPAP over mechanical ventilation in infants? I. Lower risk of sepsis II. Lower incidence of lung injury III. Fewer cases of chronic lung disease IV. Lower incidence of renal failure a. I and III only b. II and IV only c. I, II, and III only d. II, III, and IV only

c. I. Lower risk of sepsis II. Lower incidence of lung injury III. Fewer cases of chronic lung disease

HFNC has been ordered for a newborn at a rate of 2 L/minutes. What is the approximate nasopharyngeal pressure at this setting? a. 3 cm H2O b. 2 cm H2O c. 1 cm H2O d. 1.5 cm H2O

c. 1 cm H2O

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

c. 2 L/minute

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

c. 6 to 10 L/minute

What level of IPAP is typically sufficient to achieve the goals of NIV in pediatric patients?O a. 20 to 25 cm H2O b. 15 to 20 cm H2O c. 8 to 12 cm H2O d. 5 to 10 cm H2O

c. 8 to 12 cm H2O

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

c. Aerosol mask

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

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

Which form of CPAP has been associated with a "thoracic wiggle"? a. IF-CPAP (infant flow CPAP) b. MV-CPAP (mechanical ventilator CPAP) c. B-CPAP (bubble CPAP) d. V-CPAP (ventilator-derived CPAP)

c. B-CPAP (bubble CPAP)

Which of the following restrictive disorders are likely to respond to both to NIV and CPAP in children? I. Atelectasis II. ARDS III. Pneumonia IV. Morbid obesity a. I, II, and III only b. II and IV only c. I, III, and IV only d. II, III, and IV only

c. I, III, and IV only I. Atelectasis III. Pneumonia IV. Morbid obesity

Which of the following NIV interfaces should the therapist consider when a child complains of discomfort with a nasal mask? I. Oronasal mask II. Nasal plugs III. Helmet IV. Nasal Pillows a. I and II only b. I and III only c. II and IV only d. III and IV only

c. II and IV only II. Nasal plugs IV. Nasal Pillows

When considering NPAV devices, what is considered the most beneficial effect over NIV? a. Its effect on CO2 clearance b. Its faster restoration of oxygenation c. Its effect on cardiac filling pressures and volumes d. Its effect on spontaneous tidal volume

c. Its effect on cardiac filling pressures and volumes

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

c. Oxygen hood

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

c. Retinopathy of prematurity

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

c. Switch to an air-entrainment mask.

After increasing the level of CPAP delivered to an infant, the therapist notices that the neonate's PaCO2 rises and the PaO2 falls. What may have caused this situation? a. The FiO2 was not increased sufficiently. b. The CPAP level was not raised enough. c. The CPAP level was raised too high. d. A problem with the interface has likely developed.

c. The CPAP level was raised too high.

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

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

After initiating B-CPAP in an infant at 6 cm H2O, the therapist notices that, although "bubbling" is present, the pressure in the manometer fluctuates between 2 and 5 cm H2O. What may have caused this situation? a. The FiO2 was not increased sufficiently. b. The CPAP level was not raised enough. c. The flow through the CPAP system is too low. d. A problem with the interface has likely developed

c. The flow through the CPAP system is too low.

A child with a chronic disorder complicated by alveolar hypoventilation is placed on intermittent NIV at night. What is the primary goal of this therapy? a. To decrease the work of breathing b. To decrease the need for inserting an endotracheal tube c. To improve the quality of sleep and reduce daytime symptoms d. To improve arterial oxygenation

c. To improve the quality of sleep and reduce daytime symptoms

Weaning strategies from CPAP include which of the following? I. Decreasing CPAP to a predefined level of airway pressure and then stopping CPAP completely II. Removing CPAP for a predetermined number of hours each day and gradually increasing the amount of time off CPAP each day until it can be stopped completely III. Complete removal if vital signs stable NURSINGTB.COM IV. Stopping CPAP and starting high-flow heated humidified air/oxygen via nasal cannula a. I and III only b. II and IV only c. I, II, and III only d. I, II, and IV only

d. I. Decreasing CPAP to a predefined level of airway pressure and then stopping CPAP completely II. Removing CPAP for a predetermined number of hours each day and gradually increasing the amount of time off CPAP each day until it can be stopped completely IV. Stopping CPAP and starting high-flow heated humidified air/oxygen via nasal cannula

When nasal cannulas are used in infants at high flows, which factors determine the amount of pressure to the airways? I. Flow rate II. Size of the leak around the cannula III. Degree of the mouth opening IV. FiO2 a. I and II only b. III and IV only c. II, III, and IV only d. I, II, and III only

d. I. Flow rate II. Size of the leak around the cannula III. Degree of the mouth opening

Which of the following features are often components of CPAP systems incorporated within infant ventilators? I. Highly responsive demand flow systems II. Apnea backup breaths III. FiO2 compensation mechanisms IV. Leak compensation capabilities a. I and II only b. II and III only c. III and IV only d. I, II, and IV only

d. I. Highly responsive demand flow systems II. Apnea backup breaths IV. Leak compensation capabilities

Where in the CPAP delivery system should the pressure-relief/pop-off valve be placed to detect circuit occlusion? a. Anywhere along the exhalation limb b. Anywhere along the inspiratory limb c. Inside the ventilator d. As close to the patient's airway as possible

d. As close to the patient's airway as possible

Which of the following therapeutic interventions would be appropriate for a neonate with a respiratory rate of 65 breaths/minute while displaying paradoxical chest wall movement with suprasternal and substernal retractions, grunting, nasal flaring, and cyanosis, along with the following blood gas data: pH 7.30; PaCO2 50 mm Hg; PaO2 60 mm Hg? a. Intubation and mechanical ventilation b. High flow nasal cannula c. Extracorporeal membrane oxygenation d. Continuous positive airway pressure (CPAP)

d. Continuous positive airway pressure (CPAP)

Which of the following bilevel ventilator settings influences upper airway stability? a. IPAP b. Mode c. Respiratory rate d. EPAP

d. EPAP

Which of the following CPAP systems delivers a more consistent pressure, lowers work of breathing (WOB), is less sensitive to leaks, and is more effective at alveolar recruitment compared with other forms of CPAP? a. B-CPAP b. MV-CPAP c. V-CPAP d. IF-CPAP

d. IF-CPAP

What effect should the therapist expect to observe after successful initiation of continuous positive airway pressure (CPAP) on a neonate who has a restrictive lung disorder? a. Decreased arterial partial pressure of carbon dioxide (PaCO2) b. A lower mean airway pressure c. A normal alveolar-arterial oxygen tension difference [P(A-a)O2] gradient d. Increased lung volume

d. Increased lung volume

What is the most effective way for the therapist to promote effective triggering and prevent asynchrony with NIV? a. Optimize inspiratory flow. b. Titrate inspiratory pressure to achieve a tidal volume of 5 mL/kg. c. Set the device on spontaneous-timed mode. d. Minimize leaks around the interface.

d. Minimize leaks around the interface.

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. Nasal catheter b. Simple mask c. Partial rebreathing mask d. Nonrebreathing mask

d. Nonrebreathing mask

When a bilevel ventilator is used in the spontaneous/timed mode, at what point does the ventilator employ the timed feature? a. During exhalation b. To terminate inspiration c. Throughout the ventilatory cycle d. Only in the event of prolonged apnea

d. Only in the event of prolonged apnea

What is the most common complication associated with NIV among pediatric patients? a. Ventilator-associated pneumonia b. Gastric insufflation c. Claustrophobia d. Skin irritation caused by the interface

d. Skin irritation caused by the interface

When NIV is used to ventilate pediatric patients, which operating mode of ventilation is generally used? a. Timed b. Spontaneous c. CPAP d. Spontaneous/timed

d. Spontaneous/timed

How should a volume-regulated ventilator for NIV be adjusted to deliver the appropriate tidal volume (VT) to a pediatric patient? a. The preset VT should be equal to the patient's estimated anatomic dead space volume. b. The delivered VT should be equal to the estimated anatomic dead space divided by the patient's respiratory rate. c. The VT should be set by dividing the patient's PaCO2 by two. d. The delivered VT should be set at twice the child's physiologic VT.

d. The delivered VT should be set at twice the child's physiologic VT.

How should a therapist determine the size of the nasal prongs to effectively administer CPAP to infants? a. The prongs should occlude only 50% of the external nares diameter. b. The prongs should occlude at least 75% of the external nares diameter. c. The prongs should occlude 100% of the external nares diameter with minimal blanching. d. The prongs should occlude 100% of the external nares diameter without blanching.

d. The prongs should occlude 100% of the external nares diameter without blanching.

A patient receiving bilevel ventilation develops a small leak at the interface. What action should the therapist take at this time? a. The therapist should increase the pressure limit. b. The therapist should increase the inspiratory flow. c. The therapist should increase the length of the inspiratory time. d. The therapist should verify that the ventilator automatically compensates for this leak.

d. The therapist should verify that the ventilator automatically compensates for this leak.