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: ADifferentApproach to Respiratory CareMultipleChoice1.When utilizing bag-mask ventilation on an unconscious child, what airway shouldinitiallybeconsidered the firstchoice to use?A. Nasal pharyngeal airwayB. Oral airwayC. EndotrachealtubeD. Nasal trumpetANS: B2.What is the smallest portion ofachild’s airway?A. EpiglottisB. Laryngeal openingC. Cricoid ringD. GlottisANS: C3. What may lead tothecollapse of the extrathoracic trachea?A.Increasedwork of breathingB. IncreasedinflammationC. Increasedinspiratory pressureD. Increasednegative pressureANS: D4.Whichis the bestposition for keeping the airway open in both children and adults?A. SniffingB.Jaw-thrustmaneuverC. Headlift–chin tilt maneuverD. Combination ofjaw-thrustandhead-tilt maneuversANS: A5.In newborns, whatinteralveolar connectionsare responsible for the lack of collateral air circulation?

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A. SeptumB. Pores ofKohnC. LungparenchymaD.Functional residual capacityANS: B6.Whichof the following options explainwhy infants and children have a lower pulmonary reserve thanadultsdo?A. Smaller hearts,moreelastic recoilin the lung, chest wall noncompliantB. Larger hearts,lesselastic recoilin the lung, chest wall noncompliantC. Smaller hearts,moreelastic recoilin the lung,chest wall more compliantD. Larger hearts,lesselastic recoilin the lung, chest wall more compliantANS: D7. Whywouldcricoid pressure (Sellickmaneuver)beappliedto a patient?A. To aid in intubation for visualizationB.To decrease gastric insufflation and aspirationC.To increase ability to swallowD.It is never helpful and should not be performed.ANS: B8. Whatdataareimperativeto obtainto make a patient assessment?A. Chief complaint,vital signs,andblood gasesB. Subjective andobjective informationC. Patienthistory and chief complaintD. Vital signsandsubjective and objective informationANS: C9. The preverbal scale for preterminfants,known as FLACC,is used to quantify pain. What does thisacronym stand for?A. Fear,Listless,Anxious,Conscious,CryingB. Fever, Limbmovement, Anxiety, Crying, ConsciousC. Facialexpression, Legmovement, Activity, Cry, ConsolabilityD. Flaccid, Listless, Awake, Conscious, CryingANS: C

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10. What is the purpose of transcutaneous monitoring?A.Industrystandard for assessment of pH, PaO2, PaCO2, and HCO3B. Accurate,simple, and noninvasive method of measuring SaO2C. Electrochemically measures the skin-surface PO2and PCO2by heating localized area of the skin toinduce hyperperfusionD. Is of no clinical use and used in lieu ofarterial blood gasesANS: C11. What does BPCA stand for?A. Best Practice Children’s ActB. Best Pharmacological Children’s ActC. Best Practice Child ActD. Best Pharmaceuticals for Children ActANS: D12. What laryngoscope blade is recommended for children younger than3years old?A. MacintoshbladeB. FiberopticbladeC. MillerbladeD. StyletbladeANS: C13. Whatlaryngoscope bladeshould be used on an infant who weighs 10kg?A. Size 0straightB. Size 2 MillerC. Size 2 MacintoshD. Size 1 MillerANS: D14. What is evidence-based medicine?A.The ability to care for your patient from set protocolsdetermined10years agoB. Delivering care from unscientific data and set procedures set forth by the hospitalC. Conscientious, explicit,and judicious use of current best evidence in making decisions about the careof the individual patientD.Integrating many clinical experts who review best practices within a number of hospitals anddetermining the best mode of action to take care of yourpatientsANS: C

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True/False15. To avoid increasedwork of breathing, infantsautomatically compensate bydecreasingtheirrespiratory ratetodecreasetheirminute ventilation.ANS: FALSE16. Infants are more susceptiblethanareadultsto right mainstem intubation of the right lung.ANS: TRUE17.Because oftheir basal oxygen consumption,children will desaturate more rapidly than adultswill.ANS: TRUE18.Regardless of whether an injury occurred or the potential for injury was present,amedication error isan unpreventable event that occurs in the process of ordering or delivering amedication.ANS: FALSE19. Few respiratory medications are FDA approved for use in neonates.ANS: TRUE20. Aerosol-dose medication is calculated based on body size.ANS: FALSE21. Whenreceivingan aerosol treatment,infantsusuallyinhale through their nose regardless of whethertheir mouthsareopen.ANS: TRUE

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22. All published data areconsideredequal,to help clinicians and scientists develop and classify thequality and validity of research evidence.ANS:FALSE23. Children do not need to meet vigorous international and federal guidelines prior tobeinginitiated intoa research study approved by the internal review board.ANS: FALSEShort Answer24. List five errors that can occur inarterial blood gassampling.ANS: Heparindilution,air insample,venousadmixture,temperature,metabolism25.Defineoff-label use.ANS:Off-label useis when medication is prescribed and delivered for an intended use, such as age,group, or condition, other thanwhat is documentedin the proposed labeling.

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Chapter 2Fetal Cardiopulmonary DevelopmentMultipleChoice1. What percentageof live birthsoccursbeforethe37-week gestationperiod?A. 10%B. 15%C. 12%D. 18%ANS: C2.What measuring toolfor due dateestimationis effective at young gestational ageas a result ofsizevariability being minimal?A. Biparietal diameterB.Crown-rumpC. Transversediameter of theheadD. HeadcircumferenceANS: B3.During whichlung development stagedothe right and left lung buds arise fromtheesophagus?A. Canalicular phaseB.PseudoglandularphaseC.SaccularphaseD. EmbryonicphaseANS: D4.Starting atwhich weekduring the gestational periodcan the presence of mucus be found in the fetallung?A. 13 weeksB. 12 weeksC. 14 weeksD. 11 weeksANS: A

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5.During whichgestationalphase havethe airways begun to branch toapproximatelyfour generations?A. EmbryonicphaseB. SaccularphaseC. PseudoglandularphaseD. CanalicularphaseANS: C6.Fetal lung fluid composition consists ofwhich ofthe following?A. Very high pH, low bicarbonate and protein levels, lower sodiumandhigh chloride concentrationsB. Very low pH, low bicarbonate and protein levels, higher sodiumandhigh chloride concentrationsC. Very lowpH, low bicarbonate and protein levels, lower sodiumandlow chloride concentrationsD. Very high pH, low bicarbonate and protein levels, high sodiumandlow chloride concentrationsANS: B7.During whichlung developmentphase does phosphatidylglycerol(PG)first appear?A. Saccular phaseB. Pseudoglandular phaseC. Canalicular phaseD. Alveolar phaseANS: A8.At the end of which phase doesmature surfactant begin to appear, so thatthe neonate is at minimal riskof pulmonary complications?A. AlveolarphaseB. Saccular phaseC. CanalicularphaseD. PseudoglandularphaseANS: B9.At whichweek of development is the one-chambered heart efficiently pumping blood to the embryo?A. 3weeksB. 5weeksC. 4weeksD. 2weeksANS: C

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10.Which of the followingstatementsis not true about thegerminalmatrix?A.The germinal matrix is aweakly supported and highly vascularized area at the surface of the lateralventricles that is prone to hypoxic-ischemic injury.B.The germinal matrix isirregular and prone to rupture.C.The germinal matrix leads to a low incidenceofintraventricular hemorrhage in premature neonates.D. An increase in systemic blood pressure in a premature infant will increase cerebral blood flow.ANS: C11.The cerebrum controls all of the following except:A. Consciousness and higher mental thinkingB. Reasoning and judgmentC.Involuntary muscular activities and learningD. Emotions and intelligenceANS: C12.Bloodreturnsto the fetus throughwhich ofthe followingpathways?A.Umbilical vein, ductus venosus, foreman ovale, umbilical arteryB.Umbilical artery,ductus arteriosus, foreman ovale, umbilical arteryC.Umbilical artery, foramen ovale, ductus arteriosus, umbilical arteryD.Umbilical vein, ductus arteriosus, foramen ovale,ductus venosus, umbilical arteryANS: A13.In fetal circulation,the ______atrium is at higher pressure than the ______ atrium.A. left/rightB. right/leftANS: B14.During fetal development, what structureallows circulation to bypass the lungs?A.Septum primumB. Ductus venosusC.DuctusarteriosusD.Foramen ovaleANS: C15.Theforamen ovaleconnectsthe:

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A. Right ventricle to the left ventricleB. Right atrium to the left ventricleC.Right atrium to the left atriumD. Right atrium to the left ventricleANS: C16.What structure vasoconstricts after the umbilical cord is clamped?A. Ductus arteriosusB. Ligamentum venosumC. Foramen ovaleD. Ductus venosusANS: D17.Despiteincreasedknowledge and preventative care, what percent of all preterm births are unexplainedand spontaneous?A. 20%B. 25%C. 30%D. 35%ANS:C18.Whichlecithin-sphingomyelin(L/S)ratiodesignates lung maturity?A. 2:1;5% chance to developrespiratory distress syndromeif deliveredB. 1:1;1% chance to developrespiratory distress syndromeif deliveredC. 2:1; 2% chanceto developrespiratory distress syndromeif deliveredD. 1.5:1.5;1% chance to developrespiratory distress syndromeif deliveredANS: C19.Whatsimpletestutilizes a sample of amniotic fluid combined with ethanol to determine lungmaturity?A.Surfactant-albuminratio(S/A)B.Lecithin-sphingomyelin ratio(L/S)C. TDxFetalLungMaturitytestD. FoamtestANS: D

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20. Whatsubstancespeedsup lung growth and reduces theincidence ofrespiratory distress syndrome?A. IndomethacinB.TerbutalineC. Tocolytic drugsD. GlucocorticoidsANS: D21.Whichlung profile testis considereda simple, rapid testthat iswidely usedandrequires a low levelofexpertiseand a small volume(1 mL)of amniotic fluid?A.Lecithin-sphingomyelin(L/S)ratioB. ShaketestC.Phosphatidylcholine(PG)presenceD.Surfactant-albumin(S/A)ratioANS: D22.What lung profile test isconsideredless reliable and is orderedonly27% of the time in clinicalpractice?A.Lecithin-sphingomyelin(L/S)ratioB.LamellarbodycountC.Phosphatidylcholine(PG)presenceD. Surfactant-albumin(S/A)ratioANS: BTrue/False23.During the first appearance of pulmonary surfactant, type1cells also appear.ANS: FALSE24. Higher surface tension improves lung compliance.ANS: FALSE25. Thealveolarphaseisconsidered to end at about the first or second year of life.ANS:TRUE

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Chapter 3Resuscitation of the NewbornDuringTransition to Extrauterine LifeMultipleChoice1. What stage of labor does the cervix reach complete dilatation?A. ActivephaseB. LatentphaseC. DecelerationphaseD. TransitionphaseANS: C2.All of the following statementsabout fetal heart rate monitoringare trueexcept:A.It is used to estimate a fetus’s tolerance of labor process.B.It is used to make decisions on the method and speed of the delivery.C.It improves neonatal outcomes.D.It has become the standard method of care in the United States.ANS: C3. A sinusoidal heart rate is indicative of:A.Uteroplacental insufficiencyB.umbilical cord compressionC.A change in vagal tone after brief hypoxia episodesD. Severe fetal hypoxia, acidosis, or anemiaANS: D4. Transition to the extrauterine world consists of all of the following rapid, physiologicaleventsexcept:A. Establishment of respirationsB.Vasoconstriction of the pulmonary vasculature and increase in pulmonary vascular resistanceC. Transition of fetal circulationto adult circulationD.Expansion of the lungs

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ANS: B5. A newborn presents at delivery with meconium-stained amniotic fluid and is handed to theresuscitation team. She is crying, has central cyanosis, and is moving spontaneously. Which of thefollowing is the most appropriate first action for the team to take to resuscitate?A.Dry, 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.Placethebaby onthe mother’schest.ANS: A6.Randomized controlled trials have suggestedall ofthe followingstatementsregarding inducedhypothermiaare trueexcept:A.Infants with moderate-to-severe hypoxic encephalopathy maybeprotectedagainst brain injury.B. Strict guidelines must be implemented within 12to24 hours following birth.C. Infants with moderate-to-severe ischemic encephalopathy should be offered therapeutic hypothermia ina timely manner.D.Registeredrespiratorytherapistsmust beawareof their institutional policiesto provide appropriatefollow-up care.ANS: B7.Whatactions areusually enough to stimulate anewborntobreathe?A. Positioning, drying, and suctioningB. Positioning, drying, and slapping the newborn’s buttocksC. Positioning, drying, and vigorously rubbing the newborn’s backD. Positioning, drying, and flicking the newborn’s armANS: A8.What is the course of action when a newborn presents with secondary apnea?A. Place in sniffing position.B. Place on apnea monitor.C.Initiatepositive pressure ventilation.D.Administermedications to increaseheart rate.

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ANS: C9.BabyCarterpresentswith gasping,hisheart rate is greater than 100bpm,andthe presence ofsecondary apneaisseen.Initially,what is the best approach when managingthis newborn?A.BiphasicpositiveairwaypressuretherapyB.Positive pressure ventilation via resuscitation bag and maskC. OxygentherapyD.Positioning, drying, and vigorously rubbing the newborn’s backANS: B10.If a newborn weighs 2.5kg, where should theendotracheal tubebe taped?A. 7.5 cm at the upper lipB. 8.5cm at the upper lipC. 7.0cmat the upper lipD. 8.0cmat the upper lipANS: B11.Whatchest compressionmethod is recommendedbytheNeonatalResuscitationProgram,andgives agreater peak systolic pressure when performing CPRon newborns?A.Two-finger technique (compressing the chest with two fingers as the second hand supports the back)B.One finger technique(compressing the chest withonefinger as the second hand supports the back)C.Two-thumb encircling-hand technique (two thumbs with fingers encircling the chest and supportingthe back)D.Two-thumb encircling-holdtechnique (two thumbs with fingers encircling the chest and supporting theback)ANS: C12.What is thecompressions-to-ventilationratio that aregistered respiratory therapistshoulduse duringneonatal resuscitation?A. 2:1B.3:1C. 20:2

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D. 15:2ANS: B13.What route maybe used toadministerepinephrine 1:10,000 (0.1mg/mL) to increaseheart rate?A. SubcutaneouslyB. Intravenously onlyC. EndotracheallyonlyD.IntravenouslyandendotracheallyANS:D14.What does the acronym APGAR stand for?A. Assessment, pulse, grimace, appearance, resonanceB. Appearance, pulse, grimace, activity, respirationsC. Assessment, pulse, ground-glass appearance, asthma, respirationsD. Assessment,projection, grimace, auditory, respirationsANS: B15. Withholding and discontinuing resuscitation efforts may be appropriateinall of the followingcircumstancesexcept:A.When the birth weightisless than400 gramsB.When gestational ageisless than28 weeksC.When parental agreement is obtainedD.When there is an undetectableheart rateafter 10 minutes of CPRANS:B16. Which of the following statements aretrueregardingdisadvantagesof self-inflating bags?I. Inability to know if a good seal is being obtainedII. A reservoir attachment needed to achieve 100% FiO₂III. Ability to provide 100% FiO₂free-flowing dependablyIV. Inability to provide 100% FiO₂free-flowing dependablyA. I, III, IVB. II, III, IV

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C. I, II, IVD. I and IIANS: CTrue/False17.During cardiopulmonary resuscitation, anewborn’s heart rateshouldbeassessed every5secondstodetermine effectiveness of compressions.ANS: False18. In the presence of meconium,it is suggested to useabulb syringe aspirator vigorously to reduce therisk of aspiration.ANS: False19.It is best to intubate and not to bag-maskventilatea newborn when multiple unsuccessful attemptstoestablish an airwayhave occurredbecausehypoxia and permanent damage will occur after 4 minutes.ANS: False

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