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Neonatal and Pediatric Respiratory Care: A Patient Case Method, 1st Edition Test Bank

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    Chapter 1 Making Sense of Caring for Kids: A Different Approach to Respiratory Care Multiple Choice 1. W hen utilizing bag - mask ventilation on an unconscious child , what airway should initially be considered the first choice to use? A. Nasal pharyngeal airway B. Oral airway C. E ndotracheal t ube D. Nasal trumpet ANS: B 2. What is the smallest portion of a child’s airway? A. Epiglottis B. Laryngeal opening C. Cricoid ring D. Glottis ANS: C 3. What may lead to the collapse of the extrathoracic trachea? A. Increased work of breathing B. Increased inflammation C. Increased inspiratory pressure D. Increased negative pressure ANS: D 4. Which is the best position for keeping the airway open in both children and adults? A. Sniffing B. Jaw - t hrust maneuver C. Head lift – chin tilt maneuver D. Combination of jaw - thrust and head - tilt maneuvers ANS: A 5 . In newborns, w hat interalveolar connections are responsible for the lack of collateral air circulation?

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    A. Septum B. Pores of K ohn C. Lung p arenchyma D. Functional residual capacity ANS: B 6 . Which of the following options explain why infants and children have a lower pulmonary reserve than adults do ? A. Smaller hearts, more elastic recoil in the lung , chest wall noncompliant B. Larger hearts, less elastic recoil in the lung , chest wall noncompliant C. Smaller hearts, more elastic recoil in the lung , chest wall more compliant D. Larger hearts, less elastic recoil in the lung , chest wall more compliant ANS: D 7 . Why would cricoid pressure (Sellick m aneuver) be applied to a patient ? A. To aid in intubation for visualization B. To d ecrease gastric insufflation and aspiration C. To i ncrease ability to swallow D. It i s never helpful and should not be performed . ANS: B 8 . What data are imperative to obtain to make a patient assessment? A. Chief complaint , vital sign s , and blood gases B. Subjective and o bjective information C. Patient h istory and chief complaint D. Vital signs and subjective and objective information ANS: C 9 . The preverbal scale for preterm infants , known as FLACC , is used to quantify pain. What does this acronym stand for? A. Fear, L istless, A nxious, C onscious, C rying B. Fever, Limb m ovement, Anxiety, Crying, Conscious C. Facial e xpression, Leg m ovement, Activity, Cry, Consolability D. Flaccid, Listless, Awake, Conscious, Crying ANS: C

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    10 . What is the purpose of transcutaneous monitoring? A. Industry standard for assessment of pH, PaO 2 , PaCO 2 , and HCO 3 B. Accurate , simple, and noninvasive method of measuring SaO 2 C. Electrochemically measures the skin - surface PO 2 and PCO 2 by heating l ocalized area of the skin to induce hyperperfusion D. Is of no clinical use and used in lieu of arterial blood gases ANS: C 11 . What does BPCA stand for? A. Best Practice Children’s Act B. Best Pharmacological Children’s Act C. Best Practice Child Act D. Best Pharmaceuticals for Children Act ANS: D 12 . What laryngoscope blade is recommended for children younger than 3 years old? A. Macintosh b lade B. Fiberoptic blade C. Miller b lade D. Stylet blade ANS: C 13 . What laryngoscope blade should be used on an infant who weighs 10 kg ? A. Size 0 s traight B. Size 2 Miller C. Size 2 Macintosh D. Size 1 Miller ANS: D 14 . What is evidence - based medicine? A. T he ability to care for your patient from set protocols determined 10 years ago B. Delivering care from unscientific data and set procedures set forth by the hospital C. Conscientious, explicit , and judicious use of current best evidence in making decisions about the care of the individual patient D. I ntegrating many clinical experts who review best practices within a number of hospitals and determining the best mode of action to take care of you r patients ANS: C

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    True/ False 1 5. To avoid increased work of breathing , infants automatically compensate by decreasing their respiratory rate to decrease their minute ventilation. ANS: F ALSE 1 6. Infants are more susceptible than are adults to right mainstem intubation of the right lung. ANS: T RUE 1 7 . Because of their basal oxygen consumption , c hildren will desaturate more rapidly than adults will . ANS: TRUE 1 8 . Regardless of whether an injury occurred or the potential for injury was present , a medication error is an unpreventable event that occurs in the proces s of ordering or delivering a medication . ANS: FALSE 1 9 . Few respiratory medications are FDA approved for use in neonates. ANS: TRUE 20 . Aerosol - dose medication is calculated based on body size. ANS: FALSE 21 . When receiving an aerosol treatment , infants usually inhale through th eir nose regardless of whether their mouth s are open. ANS: TRUE

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    22. All published data are considered equal , to help clinicians and scientists develop and classify the quality and validity of research evidence. ANS: FALSE 23. Children do not need to meet vigorous international and federal guidelines prior to being initiat ed into a research study approved by the internal review board. ANS: FALSE Short Answer 24 . List five errors that can occur in arterial blood gas sampling. ANS: Heparin d ilution, a ir in s ample, v enous a dmixture, t emperature, m etabolism 25 . Define off - label use . ANS: Off - l abel use is when medication is prescribed and delivered for an intended use, such as age, group, or condition, other than what is documented in the proposed labeling.

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    Chapter 2 Fetal Cardiopulmonary Development Multiple Choice 1. W hat percent age of live births occur s before the 37 - week gestation period ? A. 10% B. 15% C. 12% D. 18% ANS: C 2. What measuring tool for due date estimation is effective at young gestational age as a result of size variability being minimal? A. Biparietal diameter B. Crown - r ump C. Transverse d iameter of the h ead D. Head c ircumference ANS: B 3. During whi ch lung development stage do the right and left lung buds arise from the esophagus? A. Canalicular phase B. Pseudoglandular p hase C. Saccular p hase D. Embryonic p hase ANS: D 4. Starting a t which week during the gestational period can the presence of muc u s be found in the fetal lung? A. 13 weeks B. 12 weeks C. 14 weeks D. 11 weeks ANS: A

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    5. During which gestational phase ha ve the airways begun to branch to approximately four generations? A. Embryonic p hase B. Saccular p hase C. Pseudoglandular p hase D. Canalicular phase ANS: C 6. F etal lung fluid composition consists of which of the following ? A. Very high pH, low bicarbonate and protein levels, lower sodium and high chloride concentrations B. Very low pH, low bicarbonate and protein levels, higher sodium and high chloride concentrations C. Very low pH, low bicarbonate and protein levels, lower sodium and low chloride concentrations D. Very high pH, low bicarbonate and protein levels, high sodium and low chloride concentrations ANS: B 7 . During which lung development phase does phosphatidylglycerol (PG) first appear? A. Saccular phase B. Pseudoglandular phase C. Canalicular phase D. Alveolar phase ANS: A 8 . At the end of which phase does mature surfactant begin to appear , so that the neonate is at minimal risk of pulmonary complications? A. Alveolar p hase B. Saccular phase C. Canalicular p hase D . Pseudogla n dular p hase ANS: B 9 . At which week of development is the one - chambered heart efficiently pumping blood to the embryo? A. 3 w eek s B. 5 w eek s C. 4 w eek s D. 2 w eek s ANS: C

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    1 0 . Which of the following statements is not true about the g erminal m atrix? A. The germinal matrix is a weakly supported and highly vascularized area at the surface of the lateral ventricles that is prone to hypoxic - ischemic injury . B. The germinal matrix is irregular and prone to rupture . C. The germinal matrix l eads to a low incidence of intraventricular hemorrhage in premature neonates . D. An increase in systemic blood pressure in a premature infant will increase cerebral blood flow . ANS: C 1 1 . The cerebrum controls all of the following except: A. Consciousness and higher mental thinking B. Reasoning and judgment C. I nvoluntary muscular activities and learning D. Emotions and intelligence ANS: C 1 2 . Blood return s to the fetus through which of th e following pathway s? A. U mbilical vein, ductus venosus, foreman ovale, umbilical artery B. U mbilical artery, ductus arteriosus, foreman ovale, umbilical artery C. Umbilical artery, foramen ovale, ductus arteriosus, umbilical artery D. Umbilical vein, ductus arteriosus, foramen ovale, ductus venosus , umbilical artery ANS: A 1 3 . I n fetal circulation , the ______atrium is at higher pressure than the ______ atrium . A. left/right B. right/left ANS: B 1 4 . During fetal development, w hat structure allows circulation to bypass the lungs ? A . S eptum primum B . D uctus venosus C . D uctus arteriosu s D. F oramen ovale ANS: C 1 5 . The foramen ovale connects the :

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    A. R ight ventricle to the left ventricle B. R ight atrium to the left ventricle C. R ight atrium to the left atrium D. R ight atrium to the left ventricle ANS: C 1 6 . What structure vasoconstricts after the umbilical cord is clamped? A. D uctus arteriosus B. L igamentum venosum C. F oramen ovale D. D uctus venosus ANS: D 17 . Despite increased knowledge and preventative care, what percent of all preterm births are unexplained and spontaneous ? A. 20% B. 25% C. 3 0 % D. 3 5 % ANS: C 18 . Which l ecithin - sphingomyelin (L/S) ratio designates lung maturity? A. 2:1; 5 % chance to develop respiratory distress syndrome if delivered B. 1:1; 1 % chance to develop respiratory distress syndrome if delivered C. 2:1; 2% chance to develop respiratory distress syndrome if delivered D. 1.5:1.5; 1% chance to develop respiratory distress syndrome if delivered ANS: C 19 . What simple test utilizes a sample of amniotic fluid combined with ethanol to determine lung maturity? A. S urfactant - a lbumin ratio (S/A) B. Lecithin - sphingomyelin ratio (L/S) C. TDx F etal L ung M aturity test D. Foam t est ANS: D

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    20 . What substance speeds up lung growth and reduce s the incidence of respiratory distress syndrome? A. I ndomethacin B. T erbutaline C. Tocolytic drugs D. G lucocorticoids ANS: D 2 1 . Which lung profile test is considered a simple, rapid test that is widely used and requires a low level of expertise and a small volume (1 mL) of amniotic fluid? A. Lecith in - sphingomyelin (L/S) ratio B. Shake t est C. Phosphatidylcholine (PG) p resence D. Surfactant - a lbumin (S/A) r atio ANS: D 2 2 . What lung profile test is considered less reliable and is ordered only 27% of the time in clinical practice? A. Lecithin - sphingomyelin (L/S) ratio B. Lamellar b ody c ount C. Phosphatidylcholine (PG) p resence D. Surfactant - a lbumin (S/A) r atio ANS: B True/False 23. During the first appearance o f pulmonary surfactant, t ype 1 cells also appear. ANS: F ALSE 24. Higher surface tension improves lung compliance . ANS: F ALSE 25. The a lveolar p hase is considered to end at about the first or second year of life. ANS: TRUE

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    Chapter 3 Resuscitation of the Newborn D uring Transition to Extrauterine Life Multiple Choice 1. What stage of labor does the cervix reach complete dilatation? A. Active p hase B. Latent p hase C. Deceleration p hase D. Transition p hase ANS: C 2. A ll of the following statements about fetal heart rate monitoring are true except : A. It is u sed to estimate a fetus’s tolerance of labor process . B. It is u sed to make decisions on the method and speed of the delivery . C. It i mproves neonatal outcomes . D. It h as become the standard method of care in the United States . ANS: C 3. A sinusoidal heart rate is indicative of: A. U teroplacental insufficiency B. umbilical cord compression C. A c hange in vagal tone after brief hypoxia episodes D. S evere fetal hypoxia, acidosis, or anemia ANS: D 4. Transition to the extrauterine world consists of all of the following rapid, physiologic al events except : A. E stablishment of respirations B. V asoconstriction of the pulmonary vasculature and increase in pulmonary vascular resistance C. T ransition of fetal circulation to adult circulation D. E xpansion of the lungs

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    ANS: B 5. A ne wborn presents at delivery with meconium - stained amniotic fluid and is handed to the resuscitation team. She is crying, has central cyanosis, and is moving spontaneously. Which of the following is the most appropriate first action for the team to take to resuscitate? A. D ry, stimulate, and suction the mouth and nose . B. Auscultate the lungs to evaluate aspiration of meconium . C. Intubate and suction the trachea to remove meconium . D. Place the baby on the mother’s chest . ANS: A 6. Randomized controlled trials have suggested all of the following statements regarding induced hypothermia are true except : A. I nfants with moderate - to - severe hypoxic encephalopathy may be protect ed against brain injury . B. S trict guidelines must be implemented within 12 to 24 hours following birth . C. I nfants with moderate - to - severe ischemic encephalopathy should be offered therapeutic hypothermia in a timely manner . D. Registered r espiratory t herapists must be aware of their institutional policies to provide appropriate follow - up care . ANS: B 7. What actions are usually enough to stimulate a newborn to breath e ? A. P ositioning, drying, and suctioning B. P ositioning, drying, and slapping the newborn’s buttocks C. P ositioning, drying, and vigorously rubbing the newborn’s back D. P ositioning, drying, and flicking the newborn’s arm ANS: A 8. What is the course of action when a newborn presents with secondary apnea? A. Place in sniffing position . B. Place on apnea monitor . C . I nitiate positive pressure ventilation . D. Administer medications to increase heart rate .

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    ANS: C 9 . Baby Carter presents with gasping, his h eart rate is greater than 100 bpm , and the presence of secondary apnea is seen . Initially, what is the best approach when managing this newborn? A. Biphasic p ositive a irway p ressure therapy B. Positive pressure ventilation via resuscitation bag and mask C. Oxygen t herapy D. P ositioning, drying, and vigorously rubbing the newborn’s back ANS: B 1 0 . If a newborn weighs 2.5 kg, w here should the endotracheal tube be taped ? A. 7.5 cm at the upper lip B. 8.5 cm at the upper lip C. 7.0 cm at the upper lip D. 8.0 cm at the upper lip ANS: B 1 1 . What chest compression method is recommended by the Neonatal Resuscitation Program , and gives a greater peak systolic pressure when performing CPR o n newborn s ? A. T wo - finger technique (compressing the chest with two fingers as the second hand supports the back) B. O ne finger technique (compressing the chest with one finger as the second hand supports the back) C. T wo - thumb encircling - hand technique (two thumbs with fingers encircling the chest and supporting the back) D. T wo - thumb encircling - h old technique (two thumbs with fingers encircling the chest and supporting the back) ANS: C 1 2 . What is the compressions - to - ventilation ratio that a registered respiratory therapist should use during neonatal resuscitation ? A. 2:1 B. 3:1 C. 20:2

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    D. 15:2 ANS: B 1 3 . W hat route may be used to a dminister epinephrine 1:10,000 (0.1 mg/mL) to increase heart rate ? A. Subcutaneously B. Intravenously only C. Endotracheally only D. Intravenously and e ndotracheally ANS: D 1 4 . What does the acronym APGAR stand for? A. A ssessment, pulse, grimace, appearance, resonance B. A ppearance, pulse, grimace, activity, respirations C. A ssessment, pulse, ground - glass appearance, asthma, respirations D. A ssessment, projection, grimace, auditory, respirations ANS: B 1 5 . Withholding and discontinuing resuscitation efforts may be appropriate in all of the following circumstances except : A. When the b irth weight is less than 400 grams B. When g estational age is less than 28 weeks C. When p arental agreement is obtained D. When there is an u ndetectable heart rate after 10 minutes of CPR ANS: B 16. Which of the following statements are true regarding disadvantages of self - inflating bags? I . Inability to know if a g o od seal is being obtained II . A reservoir attachment needed to achieve 100% FiO ₂ III . Ability to provide 100% FiO ₂ free - flowing dependably IV . Inability to provide 100% FiO ₂ free - flowing dependably A. I, III, IV B. II, III, IV

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    C. I, II, IV D. I and II ANS: C True/False 1 7 . During cardiopulmonary resuscitation, a newborn ’s heart rate should be assessed every 5 seconds to determine effectiveness of compressions . ANS: False 1 8 . In the presence of meconium , it is suggested to use a bulb syringe aspirator vigorously to reduce the risk of aspiration. ANS: False 1 9 . It is best to intubate and not to bag - mask ventilate a newborn when multiple unsuccessful attempts to establish an airway have occurred because h ypoxia and permanent damage will occur after 4 minutes. ANS: False

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