If the tube does not have a vocal cord marking, a rule to estimate the depth of intubation is to add the number ____ to the body weight in kilograms (kg).
Which of the following has a suggested starting ventilation of 20 to 30 cm H2O under low compliance conditions?
- flow rate
- tidal volume
A neonate who is diagnosed with severe RDS has been deteriorating over the past 12 hours. The physician asks a therapist to evaluate this neonate for possible ECMO therapy. The therapist should recommend the neonate for ECMO therapy if she:
- has a gestational age of more than 34 weeks.
- has been mechanically ventilated for more than 2 weeks.
- has evidence of intracranial hemorrhage (ICH)
- weighs less than 2,000 g.
Other indications of ET intubation may include all of the following except:
- administration of oxygen.
- collection of tracheal specimens.
- mechanical ventilation.
- removal of secretions.
The most common cause of respiratory distress syndrome in newborns is:
- congenital heart disease
- low body weight
- oxygen toxicity
- surfactant deficiency
Intubation of the neonates following delivery is indicated under all of the following conditions except:
- Apgar score greater than 8.
- difficulty ventilating by bag and mask.
- meconium staining of amniotic fluid.
- presence of diaphragmatic hernia.
The ability of HFOV to oxygenate the blood is not as good as with other methods.
Which of the following is not a primary function of mechanical ventilation?
- Correction of metabolic acidosis
- Removal of carbon dioxide
- Support ventilation failure
Candidates for HFOV may exhibit all of the following clinical conditions with the exception of:
- chest radiograph consistent with diffuse, homogeneous lung disease,
- difficulty to wean from conventional ventilation.
- increasing ventilation requirement.
- rapidly increasing FiO2 requirement.
For neonates below 1,000 g body weight, the proper size laryngoscope blade should be size _______ and ETT size _____ (internal diameter, mm).
- 0; 2.5
- 0; 3.0
- 1; 2.5
- 1; 3.0
Because of the potential risks associated with ECMO, the clinical criteria used selects only those infants who are at an 80% or greater risk of mortality if conventional methods are used.
Patients with ____ are excluded from consideration of ECMO.
Ideally, the temperature of the gas at the ____ should be 37 °C with a water content of 44 mg/L.
- vocal cords
Which of the following is not a purpose of a conventional ventilator when used in tandem with HFJV?
- It provides a continuous gas flow for entrainment by HFJV.
- It provides pressure support ventilation.
- Its sigh breaths prevent microatelectasis.
- Its sigh breaths stimulate production of surfactant.
Neonatal ventilator circuits should have a high compression factor.
Early studies involving ____ showed that adequate ventilation occurred even when tidal volumes far below deadspace were used.
- dual-control ventilation
HFJV is used:
- after conventional ventilation has failed.
- for premies with RDS.
- in tandem with conventional mechanical ventilation.
- to provide intrapulmonary percussion.
During mechanical ventilation, some of the ventilator volume is “lost” within the circuit and humidifier and is not delivered to the patient. This wasted volume is called the ____.
- expansion volume
- compressible volume
- compression factor
- compliant factor
A(n) ____ of 35 to 50 mm Hg for 2 to 12 hours indicates a need for ECMO therapy.
Approximately 90% of surfactant is phospholipid, with ____ comprising 85% of the total amount.
- dipalmitoyl phosphatidylcholine
High frequency ventilation has the advantage of delivering ___________ and reducing the incidence of ______________.
- large mean airway pressure; necrotizing tracheobronchitis
- large tidal volume; barotrauma
- low peak inspiratory pressure; air trapping
- small tidal volume; barotrauma
Which of the following statements is true concerning the venovenous route in ECMO therapy?
- Blood is removed from the right atrium via the right carotid artery.
- Blood is removed from the right atrium via the femoral vein.
- Blood is returned to the aortic arch via the internal jugular vein.
- Blood is returned to the right atrium via the femoralvein.
During high frequency jet ventilation (HFJV) or high frquency oscillatory ventilation (HFOV), assessment of a patient’s cardiopulmonary status is difficult. Signs of deterioration may include all of the following except:
- respiratory distress.
Which of the following statements is true concerning the venoarterial route in ECMO therapy?
- Blood is removed from the brachial or femoral artery.
- Blood is removed from the right common carotid artery.
- Blood is returned to the aortic arch via the internal jugular vein.
- Blood is returned to the aortic arch via the right common carotid artery.
To prevent premature shutdown (power off) of the heated wire, the temperature probe should be placed:
- at the ETT adapter.
- inside the expiratory tubing.
- inside the incubator.
- outside the inlet to the incubator.
The indications for using HFJV include seveer pulmonary disease that is complicated by all of the following except:
- air leaks
- pulmonary hypoplasia.
- pulmonary hypotension.
- restrictive lung disease
In addition to an Apgar score of 3 or less obtained immediately after delivery, intubation of a neonate should be considered in all of the following conditions except:
- ETT administration of epinephrine or surfactant is indicated.
- ineffective bag/mask ventilation.
- premature rupture of amniotic membrane.
- presence of thick meconium on delivery.
Selection of an ETT for neonates is based on the ____ or gestational age of the neonate.
- birth length
- chest circumference
- neck circumference
- birth weight
Recent publications have reported that N-CPAP is both feasible and effective in most very-low-birth-weight infants and those with acute respiratory failure.
Since the tidal volume (VT) control is not available when using pressure-controlled ventilation, an estimated VT can be calculated by multiplying the inspiratory time (I time) and ____.
- I:E Ratio
- flow rate
During ____________ controlled ventilation, the ventilator delivers a variable _____________ depending on a patient’s lung compliance or airflow resistance.
- pressure-; flow
- pressure-; volume
- volume-; flow
- volume-; pressure
Therapeutic or rescue administration of surfactant is indicated in infants with all of the following signs except:
- ground glass appearance on chest x-ray.
- progressive hypoxemia.
- respiratory distress syndrome.
During pressure-controlled ventilation, a lower tidal volume would result when the patient’s compliance is __________ or airflow resistance is ______________.
- decreased; decreased
- decreased; increased
- increased; decreased
- increased; increased
A unique feature of the HFOV is that it produces extremely rapid ____________________ cycles.
- inspiratory and expiratory
- none of the answers are correct.
An infant has the following measurements: mean airway pressure = 25 cm H2O, PaO2 = 45 mm Hg at an FiO2 of 60%. What is the calculated oxygen index (OI)?
Based on the indications for prophylactic use of surfactant, the following condition must be met:
- birth weight less than 1250 g
- gestational age at or less than 26 weeks.
- PaO2/PAO2 less than 0.22.
- all of the answers are correct.
____ has potential applications for use in several diseases that traditionally have been difficult to treat such as RDS, aspiration syndromes, persistent pulmonary hypertension of the newborn, and pneumonia.
- Machine volume
- Liquid ventilation
- Volume guarantee
The blood gas values of a normal umbilical artery sample include all of the following except:
- PaCO2 from 35-45 mm Hg
- PaO2 greater than 50 mm Hg
- pH from 7.30-7.45
- SaO2 from 60%-90%
A randomized trial comparing two surfactants, those obtained from mammalian lungs and those that are synthetically produced, found an advantage in using synthetic surfactant.
A preterm infant has a diagnosis of respiratory distress syndrome. The therapist should expect to read in the chart that the neonate showed all of the following signs except:
- chest retraction.
- expiratory grunting.
- nasal flaring.
A neonate is being ventilated by HFOV. Her physician would like to lower the patient’s PaCO2. The therapist should increase the level of ventilation by ___________________ or ____________________.
- decreasing the power (amplitude); decreasing the frequency (Hz)
- decreasing the power (amplitude); increasing the frequency (Hz)
- increasing the power (amplitude); decreasing the frequency (Hz)
- increasing the power (amplitude); increasing the frequency (Hz)
The tidal volumes delivered by pressure-controlled ventilation are dependent on the:
- airflow resistance.
- patient’s lung compliance.
- pressure setting.
- all the answers are correct.
Which of the following common surfactants has a recommended dosage of 4 mL/kg every 6 hours up to 4 total doses in the first 48 hours?
In addition to the FiO2 control on a HFOV, a patient’s oxygenation status can be improved by increasing the:
- mean airway pressure
HFPPV is delivered at frequencies between ____ cycles per minute.
- 40 to 60
- 60 to 150
- 240 to 660
- 480 to 1800
CPAP reduces V/Q mismatch by improving ____ and reducing intrapulmonary shunting.
- minute ventilation
- respiratory frequency
- functional residual capacity
- gas exchange
The indications for using ____ include severe pulmonary disease that is complicated by air leaks, such as pulmonary interstitial emphysema (PIE), pulmonary hypoplasia, restrictive lung disease, and persistent pulmonary hypertension.
The power setting of HFOV determines all of the following parameters except:
- amplitude of oscillation.
- degree of ventilation
- inspiratory time.
- tidal volume
The general indications for mechanical ventilation include all of the following except:
- acute alveolar hyperventilation.
- acute hypoxemia (PaO2
- acute respiratory acidosis.
A blood gas report done on a neonate shows a PaCO2 of 58 mm Hg. The physician asks the therapist to increase the tidal volume via pressure-controlled ventilation. The therapist should increase the:
- expiratory time.
- peak inspiratory pressure.
- positive end-expiratory pressure.
- tidal volume.