Kacmarek: Egan's Fundamentals of Respiratory Care, 10th Edition

Chapter 48: Neonatal and Pediatric Respiratory Care

Test Bank

MULTIPLE CHOICE

1. Which of the following maternal factors is/are related to the health of the fetus and the
outcomes of pregnancy?
1. maternal age
2. prior maternal disease
3. maternal drug use
4. maternal birth history
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

ANS: C
Table 48-1 lists maternal conditions and specific anticipated fetal or neonatal outcomes related
to the conditions.

DIF: Recall REF: p. 1229 OBJ: 1

2. Which of the following techniques would you recommend to assess the state of pulmonary
maturity before birth?
a. blood gas analysis
b. ultrasonography
c. maternal history
d. amniocentesis

ANS: D
Lung maturation can be assessed with amniocentesis.

DIF: Recall REF: p. 1229 OBJ: 1

3. Temporary drops in the fetal heart rate during uterine contractions are known as:
a. fetal stress
b. decelerations
c. primary apnea
d. secondary bradycardia

ANS: B

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 Test bank 48-2

Temporary drops in fetal heart rate are called decelerations and can be mild (less than 15
beats/mine), moderate (15 to 45 beats/min), or severe (greater than 45 beats/min).
Decelerations are classified by their occurrence in the uterine contraction cycle.

DIF: Recall REF: p. 1229 OBJ: 1

4. Late decelerations are consistent with which of the following conditions?

1. uteroplacental insufficiency
2. umbilical cord compression
3. normal contraction
4. maternal bradycardia
a. 1 and 2
b. 2 and 3
c. 3 and 4
d. 1, 2, 3, and 4

ANS: A
A late deceleration pattern indicates impaired maternal-placental blood flow, or uteroplacental
insufficiency.

DIF: Recall REF: p. 1229 OBJ: 1

5. Which of the following pH values is associated with fetal asphyxia?

a. <7.1
b. <7.2
c. <7.3
d. <7.4

ANS: C
A pH below 7.20 may indicate that the fetus is experiencing asphyxia.

DIF: Recall REF: p. 1230 OBJ: 1

6. At 1 minute after birth, a newborn infant exhibits the following: heart rate of 65/min, a slow
and irregular respiratory rate, some muscle flexion, a grimace when nasally suctioned, and a
pink body with blue extremities. What is the infant’s 1-minute Apgar score?
a. 3
b. 4
c. 5
d. 6

ANS: C
The Apgar score is an objective scoring system used to rapidly evaluate the newborn, as
shown in Table 48-2.

DIF: Application REF: p. 1233 OBJ: 1

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 Test bank 48-3

7. Which of the following methods is useful in determining gestational age of the newborn?
a. Dubowitz
b. Adams
c. Apgar
d. Perkinson

ANS: A
Two common systems are used to determine gestational age: the Dubowitz scales and the
Ballard scales.

DIF: Recall REF: p. 1232 OBJ: 1

8. You notice in the chart of an infant receiving neonatal intensive care the designation “preterm,
AGA.” Based on this information, what can you correctly conclude?
a. This is an infant whose weight falls between the 10th and 90th percentiles.
b. This is an infant whose weight falls between the 10th and 50th percentiles.
c. This is an infant whose weight falls between the 50th and 90th percentiles.
d. This is an infant whose weight falls between the 10th and 20th percentiles.

ANS: A
Infants whose weight falls between the 10th and 90th percentiles are appropriate for
gestational age (AGA).

DIF: Application REF: p. 1232 OBJ: 1

9. Tachypnea in the newborn is defined as a respiratory rate greater than what level?
a. 40/min
b. 50/min
c. 60/min
d. 70/min

ANS: C
Infant physical assessment begins with measurement of vital signs. A normal newborn
respiratory rate is 40 to 60/min.

DIF: Recall REF: p. 1235 OBJ: 1

10. You detect a “bounding” peripheral pulse on a newborn infant. Based on this finding, what
should you suspect?
a. patent ductus arteriosus
b. peripheral vasoconstriction
c. coarctation of the aorta
d. peripheral vasodilation

ANS: A
Bounding peripheral pulses occur with major left-to-right shunting through a patent ductus
arteriosus.

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 Test bank 48-4

DIF: Recall REF: p. 1236 OBJ: 1

11. You notice paradoxical breathing. Which of the following conclusions is most consistent with
this observation?
a. Airway resistance (Raw) is decreased.
b. Lung compliance (CL) is increased.
c. Work of breathing is increased.
d. Chest-wall compliance is decreased.

ANS: C
Retractions indicate an increase in work of breathing, especially because of decreased
pulmonary compliance.

DIF: Application REF: p. 1236 OBJ: 1

12. You notice in drawing (retractions) of chest-wall muscle and tissue between the ribs, and
above and below the sternum, all occurring during inspiration. Which of the following
conclusions is most consistent with this observation?
a. Airway resistance (Raw) is decreased.
b. Lung compliance (CL) is decreased.
c. Work of breathing is decreased.
d. Chest-wall compliance is decreased.

ANS: B
Paradoxical breathing in infants differs from the adult form. Instead of drawing the abdomen
in during inspiration, the infant with paradoxical breathing tends to draw in the chest wall.
This inward movement of the chest wall may range in severity, as with retractions, and
paradoxical breathing indicates an increase in ventilatory work.

DIF: Application REF: p. 1236 OBJ: 1

13. What is the normal arterial PO2 in healthy infants?

a. >50 mm Hg
b. >60 mm Hg
c. >70 mm Hg
d. >80 mm Hg

ANS: B
In newborns older than 28 days, a PaO2 of less than 60 mm Hg or an SpO2 of less than 90%
indicates hypoxemia.

DIF: Recall REF: p. 1237 OBJ: 2

14. Research has shown that the growing lung is more sensitive to oxygen toxicity than the adult
lung.
a. True

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 Test bank 48-5

b. False

ANS: A
Research suggests that the growing lung is more sensitive to oxygen toxicity than the adult
lung.

15. The most probable explanation for the flip-flop phenomenon in the newborn is:
a. oxygen toxicity
b. right-to-left shunting
c. cardiac disease
d. reactive pulmonary vasoconstriction

ANS: D
When the FIO2 is increased to original levels, the PaO2 fails to improve, which is probably
because of reactive pulmonary vasoconstriction.

DIF: Analysis REF: p. 1239 OBJ: 2

16. Which of the following oxygen modalities would you recommend for a toddler needing a low
FIO2?
a. mist tent
b. cannula
c. Oxy-Hood
d. mask

ANS: B
Table 48-5 compares the advantages and disadvantages of standard oxygen delivery methods.

DIF: Recall REF: p. 1240 OBJ: 2

17. In which of the following conditions may bronchial hygiene therapy be considered for infants
or children?
1. hyaline membrane disease
2. foreign body aspiration
3. cystic fibrosis
4. bronchopulmonary dysplasia (BPD)
a. 2 and 4
b. 1, 3, and 4
c. 2, 3, and 4
d. 1, 2, 3, and 4

ANS: C
Secretion retention is common in children who have pneumonia, BPD, cystic fibrosis, and
bronchiectasis. Bronchial hygiene therapy can also be valuable in the initial management of
aspirated foreign bodies.

DIF: Recall REF: p. 1239 OBJ: 2

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 Test bank 48-6

18. Which of the following sizes (internal diameter) of endotracheal tubes would you select to
intubate a 4-year-old child?
a. 3 mm
b. 4 mm
c. 5 mm
d. 7 mm

ANS: C
Table 48-8 provides recommendations regarding endotracheal tube and suction catheter sizes
for infants and children.

DIF: Recall REF: p. 1244 OBJ: 2

19. Which of the following vacuum settings would you use to perform nasopharyngeal or
nasotracheal suctioning of a 5-year-old child?
a. –100 to –120 mm Hg
b. –80 to –100 mm Hg
c. –40 to –60 mm Hg
d. –60 to –80 mm Hg

ANS: B
With large infants and children, pressures in the –80 to –100 mm Hg range are generally safe
and effective.

DIF: Recall REF: p. 1245 OBJ: 2

20. What FIO2 should be used in neonates prior to endotracheal suctioning?

a. same FIO2 on the ventilator
b. always 100%
c. FIO2 10% to 15% higher than FIO2 set in the ventilator
d. low FIO2 to prevent retinopathy of prematurity

ANS: C
Most clinicians recommend raising the FIO2 by 10% to 15% for at least 1 minute before
suctioning.

DIF: Recall REF: p. 1245 OBJ: 2

21. During resuscitation of a newborn, after 15 to 30 seconds of positive-pressure ventilation,

what should the clinician do?
a. Evaluate the heart rate.
b. Suction the mouth, then the nose.
c. Begin chest compressions.
d. Initiate medications.

ANS: A

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 Test bank 48-7

Figure 48-8 describes the neonatal flow algorithm.

DIF: Recall REF: p. 1233 OBJ: 2

22. Signs of infant respiratory distress that indicate a potential need for continuous positive
airway pressure (CPAP) include which of the following?
1. cyanosis
2. radiograph indicating hyaline membrane disease or respiratory distress syndrome
3. grunting
4. severe retractions
a. 3 and 4
b. 1, 2, and 3
c. 2 and 4
d. 1, 2, 3, and 4

ANS: D
The indications for CPAP are described in Box 48-5.

DIF: Recall REF: p. 1249 OBJ: 3

23. Which of the following is considered a limitation of the high-flow nasal cannula?
a. It does not meet patient’s flow needs.
b. The amount of airway positive pressure cannot be measured.
c. It does not provide for appropriate CO2 clearance.
d. It does not reduce the use of noninvasive positive-pressure ventilation.

ANS: B
Instead of titrating levels of CPAP, the flow rate is incrementally adjusted; however, the
amount of positive pressure that the high-flow nasal cannula potentially produces cannot be
measured and inadvertent high levels may occur, particularly if the nasal cannula fits snugly
in the nares.

DIF: Recall REF: p. 1248 OBJ: 3

24. What VT range should be used for mechanical ventilation of a neonate?

a. 5 to 7 ml/kg
b. 6 to 8 ml/kg
c. 8 to 10 ml/kg
d. 10 to 12 ml/kg

ANS: B
Common target VT values are 6 to 8 ml/kg in neonates.

DIF: Recall REF: p. 1251 OBJ: 3

25. What initial inspiratory time range would you suggest for a term newborn infant being placed
on time-cycled, pressure-limited ventilation?

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 Test bank 48-8

a. 0.25 to 0.30 second

b. 0.30 to 0.50 second
c. 0.50 to 0.70 second
d. 0.70 to 1.00 second

ANS: A
Inspiratory time (TI) is set as low as 0.3 second for neonates.

DIF: Application REF: p. 1251 OBJ: 3

26. Which of the following mean airway pressures is considered potentially deleterious when
applying positive airway pressure?
a. 2 cm H2O
b. 5 cm H2O
c. 10 cm H2O
d. 15 cm H2O

ANS: D
Positive end-expiratory pressure levels of 5 to 8 cm H2O are commonly used in pediatrics.

DIF: Application REF: p. 1251 OBJ: 3

27. What positive end-expiratory pressure level is commonly used in pediatric patients during
mechanical ventilation?
a. 1 to 3 cm H2O
b. 3 to 5 cm H2O
c. 5 to 8 cm H2O
d. 10 to 12 cm H2O

ANS: C
A –Paw exceeding 15 cm H2O is considered potentially deleterious, at which point other
strategies such as high-frequency ventilation are frequently considered.

DIF: Recall REF: p. 1251 OBJ: 3

28. In high-frequency ventilation (HFV), CO2 elimination depends mainly on which of the
following?
a. pressure amplitude
b. mean airway pressure
c. high-frequency rate
d. sinusoidal waveform

ANS: A
The minute ventilation delivered with HFV has a greater dependency on alterations in tidal
volume rather than breath frequency, with tidal volume most affected by changes in pressure
or amplitude (increased pressure change or amplitude increases tidal volume).

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 Test bank 48-9

DIF: Application REF: p. 1258 OBJ: 4

29. Which of the following may indicate a decrease in systemic vascular blood flow during high-
frequency ventilation?
1. high central venous pressure (CVP)
2. low CVP
3. decreased mean arterial pressure (MAP)
4. increased MAP
a. 1 and 3
b. 2 and 3
c. 1 and 4
d. 1, 2, 3, and 4

ANS: B
Increases in CVP or decreases in MAP indicate decreases in systemic blood flow as a result of
overdistention of the lung and inappropriately high –Paw, after adequate intravascular volume
has been established.

DIF: Recall REF: p. 1258 OBJ: 4

30. What physiologic effect does inhaled nitric oxide have on the lung?
a. pulmonary vasoconstriction
b. pulmonary vasodilation
c. smooth muscle dilation
d. improved mucociliary clearance

ANS: B
Inhaled nitric oxide is a selective pulmonary vasodilator used to treat newborns who require
mechanical ventilation for hypoxic respiratory failure.

DIF: Recall REF: p. 1258 OBJ: 4

31. What is the recommended dose of inhaled NO?

a. 10 parts per million (ppm)
b. 20 ppm
c. 30 ppm
d. 40 ppm

ANS: B
The recommended inhaled NO dose is 20 ppm with an optimal response achieved when lung
inflation is maximized.

DIF: Recall REF: p. 1260 OBJ: 5

32. Venoarterial is the preferred method for use of ECMO when cardiovascular support is not
required.
a. True

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 Test bank 48-10

b. False

ANS: B
There are two types of ECMO support: venoarterial, in which both heart and lung function is
supported, and venovenous, in which only the lungs are supported.

DIF: Application REF: p. 1261 OBJ: 5

33. Which of the following is not a common indication for ECMO?

a. persistent pulmonary hypertension of the newborn (PPHN)
b. respiratory distress syndrome (RDS)
c. meconium aspiration syndrome (MAS)
d. congenital diaphragmatic hernia (CDH)

ANS: A
ECMO has been shown to improve survival in newborns with hypoxic respiratory failure
associated with PPHN, MAS, sepsis, RDS, and CDH.

DIF: Recall REF: p. 1261 OBJ: 5

34. Which of the following is not an inclusion criterion for neonatal ECMO?
a. reversible lung disease
b. gestational age less than 35 weeks
c. pulmonary barotrauma
d. persistent acidosis

ANS: B
Criteria for patient selection are listed in Box 48-12.

DIF: Recall REF: p. 1261 OBJ: 5

35. Which of the following tidal volume range would you recommend for an infant with severe
ARDS?
a. 3-4 ml/kg
b. 4-5 ml/kg
c. 6-7 ml/kg
d. >8

ANS: B
Tidal volumes > 8 ml/kg are likely to over stretch the lung, resulting in acute lung injury and
should be avoided. Patients with severe ARDS may require even lower tidal volumes in the
rate of 4 to 5 ml/kg.

DIF: Recall REF: p. 1251 OBJ: 4

36. All of the following conditions affect placental blood flow during pregnancy, except:
a. previous miscarriage

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 Test bank 48-11

b. smoking abstinence
c. previous pregnancy complications
d. history of diabetes

ANS: B
Table 48-1 outlines maternal factors that may cause maternal, fetal and neonatal
complications.

DIF: Recall REF: p. 1229 OBJ: 1

37. You are called to the NICU to assess the blood pressure of a neonate who weighs
750 g. You determine that the pressure is normal. Which of the following pressure did you
obtain?
a. 40/25
b. 45/35
c. 55/40
d. 55/25

ANS: A
Table 48-3 includes normal neonate blood pressure by weight

DIF: Application REF: p. 1236 OBJ: 1

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