What are true regarding the anatomic and physiology differences between adults and infants?
I) Infants have a proportionally larger tongue.
II) Infants have a proportionally larger epiglottis.
III) Infants have a proportionally larger body surface area
IV) The infants trachea is only a third the diameter of the adult's.
v) Infants have a higher
While reviewing a patient's chart before her delivery, you note the previous history shows PARA 3-1-0-2.
One previous birth is not living.
What PARA means:
(P- prior term pregnancies, A- premature deliveries, R- abortions/miscarriages, A- living children)
Identify what are included in the Ballard gestational age assessment.
Ear recoil,
sole creases,
skin appearance,
presence of lanugo.
Upon examination of a newborn, you find thick vernix covering the infant, gelatinous translucent skin, thick lanugo over the body, faint red lines on the soles of the feet, flat areola with no bud, slow ear recoil, a male genitalia that shows no scrotal r
26-28 weeks
What is done during the quiet examination?
I) Assess skin color
II) Assess patient movement
III) Overall visual inspection
Increased intracranial pressure is indicated when:
The fontanelles are bulging or tense
A pediatric patient presents with a history of a dry, nonproductive cough. What is the suspect?
Foreign body aspiration
When assessing a pediatric patient, you discover that the patient has a rapid bounding pulse, confusion, & muscular twitching. What is suspected?
Hypercarbia
the physical condition of having the presence of an abnormally high level of carbon dioxide in the circulating blood
What are indications to perform PFTs on a neonate or pediatric patient?
I)Diagnosing lung disorders,
II) Evaluate therapeutic response
III) Predict the risk of pulmonary dysfunction
What are indications for CPT?
I)Asthma,
II) Atelectasis,
III)Cystic Fibrosis
IV) Prolonged bed rest
V) Ventilator care
To ensure maximum effectiveness, PEP should be followed by what technique?
Forced Exhalation Technique (FET)
It is performed by having the patient inhale slowly and then "huffing" forcefully 2 to 3 times.
Traditional CPT includes
I) Postural drainage,
II) Percussion
III) Removal of secretion
What modality to administer aerosolized medication requires the least amount of patient coordination?
Small Volume Nebulizer (SVN)
What are indications for aerosolized medication therapy?
I) Wheezing,
II)Retractions,
III)Increased respiratory rate
IV)Increasing FiO2 requirements
One advantage to the mainstream nebulizer is that:
It can be used horizontally
Placement of a nebulizer in the ventilator circuit between the humidifier and the distal temperature probe may cause:
Overheating of the circuit when the nebulizer is removed
What would be considered hazards of aerosol drug therapy?
I) Infection,
II)Medication side effects,
III)Drug reconcentration
IV) over hydration
What is an advantage of MDI therapy?
Not indicated in patients younger than 12 years
The greatest hazard associated with the aerosolization of ribavirin into a ventilator circuit is:
Precipitation and accumulation of the drug on vent tubing and ETT
While suctioning the endotracheal tube following a CPT treatment, the patient becomes bradycardic, What should the respiratory care practitioner do?
Stop the procedure, hyperoxygenate the patient, and shorten the duration of suction with subsequent attempts.
The main indication for oxygen administration is:
Hypoxemia
The type of flowmeter often found on cylinder regulators is the:
Bourdon gage
A bubble humidifier is best used with what type of oxygen administration device?
Nasal Cannula
A physician orders a pediatric patient to be on an FiO2 of 0.35. What device would be best to deliver the ordered FiO2?
Venturi mask
Oxygen consumption is lowest in the neonate at which of the following skin temperature ranges (Degree C)?
36.0 - 36.5
What are involved in nonshivering thermogenesis?
I) Norepinephrine,
II) lipase,
III) nonesterified fatty acids
Premature newborns have a decreased ability to maintain body heat. What are reasons for that decreased ability?
I) Large body surface area,
II) Thin skin layer
III) Reduced ability to intake calories
A small preemie is placed on a warming mattress inside an incubator lined wih aluminum foli. The environmental temperature is maintained at 33C. Flow to the resuscitation bag is turned on inside the incubator with the flow of gas passing, over the infant'
convective
The initial response of a neonate to cold stress is?
Peripheral vasoconstriction
Radiant heat loss following delivery can be minimized by what?
I) Wrapping patient in a warm blanket
II) placing a cap on the patient's head
What is the advantage to using an open warmer?
Ease of patient access
A baby being overstimulated may show what sign?
Hiccoughs
What may cause abnormalities of fluid and electrolyte balance in neonates?
I) Asphyxia
II) Sepsis
III) Endocrine disorders
IV) maternal IV therapy
Sodium and water balance are primarily affected by:
Urine losses
What would indicate a fluid deficit in a neonate?
I) Decreased skin tugor
II) Sunken anterior fontanelle
III) Increase in suture overlap
A neonate appears clinically with jitters, irritability, apnea, and seizures. The probable cause is?
Hypocalcemia
Hypocalcemia is more likely to occur in newborns, especially in those who were born too early (preemies). Common causes of hypocalcemia in a newborn include:
Certain medications
Diabetes in the birth mother
Episodes of very low oxygen levels
The initial sign of Necrotizing enterocolitis (NEC) is:
Guaiac-positive stools
What is NOT an indication for obtaining a blood gas sample?
Departmental policy
What are common sites used to obtain arterial blood in neonates?
I) Umbilical artery
II) Radial artery
III) Capillary
In the presence of right-to-left shunting of blood through the ductus arteriosus, arterial blood from the UAC would show?
A low arterial PO2
What defines alveolar ventilation?
minute ventilation minus deadspace ventilation
As respiratory rate increases at a static tidal volume, what occurs?
I) PaCO2 decreases
II) alveolar ventilation increases
At pH of 7.40, what represents the correct balance of bicarbonate to dissolved carbon dioxide?
20:1
In the presence of respiratory acidosis, what is the amount of bicarbonate the body retains for each 1 mm Hg increase in PaCO2?
0.1 mEq/L
Carbonic acid is formed by a combination of:
HCO3 and H ions
NaHCO3, If given too rapidly, could lead to:
Intraventricular Hemorrage
The purpose of heating the skin at the attachment site of the TCM is to:
Increase the perfusion to the area
What factors would cause PtCO2 to measure lower than actual arterial PO2?
I) Shock
II) Severe Acidosis
III) Skin Edema
IV) Severe Anemia
The greatest hazard associated with transcutaneous monitors is:
Thermal injury
What would cause erroneous pulse oximetry readings?
Presence of carboxyhemoglobin
A major disadvantage of a mainstream end-tidal CO2 monitor is:
Accidental extubation
The greatest effect on the end-tidal CO2 monitor is exerted by:
Deadspace ventilation
The underlying etiology of RDS is:
Surfactant deficiency
What are complications of RDS?
Disseminated Intravascular Coagulation (DIC), Intraventricular hemorrhage, Infection & PDA
Oxygen toxicity, barotrauma, PDA and fluid overload are all linked to the development of:
Bronchopulmonary Dysplasia (BPD)
Bronchopulmonary dysplasia involves abnormal development of lung tissue. It is characterized by inflammation and scarring in the lungs. It develops most often in premature babies, who are born with underdeveloped lungs.
What is the LEAST likely to be used when treating BPD?
Extracorporeal Membrane Oxygenation (ECMO)
ECMO is used in infants who are extremely ill due to breathing or heart problems. The purpose of ECMO is to provide enough oxygen to the baby while allowing time for the lungs and heart to rest or heal.
The radiographic picture of Wilson-Mikity syndrome appears similar to:
Bronchopulmonary Dysplasia (BPD)
What best defines vaso-obliteration?
Necrosis of retinal vessels
Prevention of Retinopathy of prematurity (ROP) is based on:
Cautious use of oxygen
Intraventricular hemorrhage in premature neonates occurs most often in the:
Germinal matrix
Bleeding in the brain ventricles, without evidence of ventricular dilation, describes:
Grade 2 IVH
One of the initial signs of fetal asphyxia is:
Bradycardia
Meconium passage into the amniotic fluid is precipitated by:
Asphyxia
a condition in which insufficient or no oxygen and carbon dioxide are exchanged on a ventilatory basis
Intubation of the trachea, followed by suction applied to the endotracheal tube while it is being removed, is indicated when:
Any meconium is present in the amniotic fluid
A ventilator patient's status suddenly worsens with bradycardia, cyanosis, retractions, and apnea. The immediate reaction of the respiratory care practitioner would be:
Check for signs of extubation followed by tranillumination of the chest
Pulmonary Interstitial Emphysema (PIE) can best be treated by:
Low ventilatory pressures
A patient is suspected of having Persistent Pulmonary Hypertension of the Neonate (PPHN). What is the most accurate?
The hyperoxia-hyperventilation test
The infant is manually ventilated at a rate of
100-150 breaths per minute for 10 minutes.
This should result in a decrease in PaCO2 to
about 25 mmHg and a concomitant increase in
the arterial PH. In PPHN, an increase of
What isa risk of treating PPHN with NO?
Methemoglobinemia
Methemoglobinemia is a blood disorder in which an abnormal amount of methemoglobin -- a form of hemoglobin -- is produced. Hemoglobin is the molecule in red blood cells that distributes oxygen to the body. Methemoglobin cannot release ox
What are indicative of Transient Tachypnea of the Newborn (TTN)?
Tachypnea, Cyanosis & Normal PaO2 and PaCO2
What is NOT a cause of central apnea?
Vocal cord paralysis
What drug wold be used to treat central apnea?
Caffeine
Chorioamnionitis is caused by:
Bacterial infection
What are routes of HIV infections in the fetus and neonate?
Transplacentally, Breast milk & Contact with maternal secretions
Hepatitis, jaundice, hepatosplenomegaly, and neurologic abnormalities are symptoms of what fetal infection?
Disseminated herpes simplex
Under what circumstances should prophylactic broad-spectrum antibiotics be administered to a neonate?
amniotic sac rupture over 24 hours before delivery
A fetus receives immunity from the mother by which of the following antibodies?
IgG
What are the following clinical signs of an esophageal-tracheal anomaly?
Accumulation of oral secretions, Sporadiac respiratory distress & Regurgitation of feedings
The probable diagnosis of a neonate delivered with polyhydramnios, a flat abdomen, and respiratory distress is:
Diaphragmatic hernia
A higher systolic blood pressure in the right arm over either leg would indicate what?
Coarctation of the aorta
What heart defect is NOT compatible with life when an abnormal opening between the right and left heart does not exist?
Transposition of the great vessels
What cardiac anomalie would one expect an increased lung compliance?
Tricuspid atresia
What statement is true?
X-ray confirms the presence or absence of a disease process.
What densities are seen on a x-ray?
Gas, Fluid & bone
What may limit the interpretation of a chest x-ray?
Artifact, Patient movement & Improper technique
As you examine a chest x-ray, you note that the spaces between the vertebrae are visible and distinct. This film is:
Exposed correctly
Flattened diaphragms seen on a chest x-ray indicate?
Air trapping
The neonate cardiac silhouette is considered normal size if it is less than what percentage of the thoracic width?
60%
Undervascularization of the hilar region would indicate:
Right-to-left shunt
As you examine a patient's chest x=ray , you note the tip of the endotracheal tube to be near the carina. You would:
Pull the tube back slightly
Examine of a chest x-ray reveals a slightly elevated left diaphragm, with a slight mediastinal shift toward the left. The left lower lobe appears whiter than the upper lobes with a slight hyperinflation of the right lower lobe. What is the probable diagno
Atelectasis in the left lower lobe
A newborn infant presents from delivery with severe respiratory distress. On examination, the abdomen is scaphoid. The radiograph shows a severe mediastinal shift to the right. The likely diagnosis is:
Diaphragmatic hernia
Dense cystic patches arranged in generalized patterns that gradually increase in size and number describe which stage of BPD?
Stage 3
A decubitus film is best used to diagnose which of the following?
Foreign body aspiration
What are true regarding the chest radiograph of an asthma patient?
Hyperinflation is common during an acute attack, The chest x-ray may be normal & The lungs may appear hyperlucent during an attack.
Normally aerated lungs
Respiratory Distress Syndrome (RDS)
Is the most common lung disease found in premature infants. Characteristics: fine reticulogranular patterns, alveoli with increased tissue and water densities surrounding small areas of aerated alveoli. (ground glass)
Atelectasis
Is a consolidation of part or all of a lung due to a collapse of the alveoli.
Transient Tachypnea of the Newborn (TTN)
Seen within the first few hours of birth. Common to see small amounts of pleural fluid and symmetrical, stringy infiltrates in the hilar region, which may be due to engorged veins and lymphatic vessels. To distinguish TTN from other causes of respiratory
Pneumothorax
Is identified when the lung is displaced away from the chest wall by a dark band of air. The dark air space will have no lung markings, and frequently the border of the lung is seen as a sharp white line, medial to the air sack. Tension Pneumothorax: diap
Pneumomediastinum
Is identified by the presence of air in the mediastinum, outlining the thymus and the lateral aspects of the heart outlining of the thymus has been called "bat wing" and "angel wing." On a lateral view it looks like a sail.
Pulmonary Interstitial Emphysema (PIE)
Is caused by air leaking from a lung rupture and migrating throughout the lung parenchyma. The interstitial air compresses the alveoli and bronchioles, leading to atelectasis and collapse. Seen by dark streaks and cysts, surrounded by the white lung tissu
Wilson-Mikity syndrome
Bronchopulmonary Dysplasia (BPD)
Is recognized when infant lungs show the presence of hyperaeration in association with alternating areas of dark cystic areas and strand-like densities. Has 4 different stages (mild, moderate, severe & chronic, advanced BPD) Has a bubbly appearance caused
CROUP
Is diagnosed with an anteroposterior view of the neck. This area of the swelling in the subglottic region is seen as an "hourglass" or "steeple
Epiglottitis
Swelling of three to four times normal is seen at the base of the tongue and appears as if someone left a thumb print, thus the term "thumb sign".
Asthma
Is identified by hyperinflation with a slight depression of the diaphragm and an overall hyperlucency of both lung fields. Note: MAY SHOW LITTLE RADIOGRAPHIC CHANGE
Diaphragmatic Hernia
May occur at birth on in utero. Utero cause severe damage to the lung by hampering its growth and development. Roughly 80 to 85% occur on the left side.
Meconium Aspiration Syndrome (MAS)
Chest x-ray of MAS may look normal, in mild to very abnormal cases. In severe cases MAS shows bilateral infiltrates and air trapping. Air trapping predisposes the lungs to pulmonary interstitial emphysema, pneumomediastinum, & pneumothorax. With blockage
What is true regarding gaseous oxygen?
It supports and intensifies combustion.