Respiratory Neonatal & Pediatric Care Chapter 3 & 4 Study Guide:


1. There is no safe range to drink alcohol when pregnant.

2. Smoking mothers have babies that tend to be about 200g lighter than infants born of mothers who do not smoke.

3. Which condition a woman with a long history of smoking who is in the last part of the third trimester of her pregnancy is at high risk of developing?: premature rupture of membranes, placental abruption, placenta previa, SIDS.

4. What three conditions are associated with preeclampsia?: proteinuria, generalized edema, hypertension.

5. What risk factors delivery should the healthcare team be aware at the time of delivery of a newborn from a mother diagnosed with pregestational diabetes?: microcephaly

6. What metabolic disturbances should be considered from a baby that is very large for gestational age whose mother is diagnosed with gestational diabetes?: hypocalcemia, hyperkalemia, hypoglycemia

7. What microorganism often affects pregnancy outcome?: Group B sterptococcus

8. What is the main potential problem associated with the premature rupture of membranes?: fetal infection

9. What condition is responsible for up to 40% of the preterm births in the USA?: premature rupture of membranes

10. When does the maximal benefit of antenatal corticosteroid occur to reduce RDS?: after 48 hours

11. What condition is a significant problem in postterm pregnancy?: meconium aspiration

12. What medication will be the most appropriate to induce labor for a woman who is 41-weeks pregnant and at high risk for complication in the postpartum period?

13. What is the most common invasive procedure to assess the fetal condition?: amniocentesis

14. What is the best course of action for a pregnant woman whose non stress test reported two accelerations in fetal heart rate, each of at least 15 beats per minute and lasting at least 15 seconds, associated with maternal perception of fetal movement over a period of 20 minutes?: No action is required because this reactive non-stress test is associated with normal uteroplacental function

15. What condition would occur in a fetus that is undergoing a contraction stress test, the uterine contractions are stimulated by the intravenous infusion of oxytocin into the mother, the fetal PO2 drops below 12 mm Hg and causes the fetal heart rate to slow?: uteroplacental insufficiency

16. What other intrapartum assessment of the fetus can be done instead of obtaining a scalp blood gas sample?: fetal scalp stimulation

17. What FiO2 should be used to start positive pressure ventilation in the labor and delivery room to assist in the resuscitation of a term newborn according to the 2011 NRP guidelines?

18. What condition could cause a newborn to have hypoxemia due to hypothermia?: Hypoglycemia

19. What to do to prevent injury and atelectasis, and also avoid interfering with the infant’s ability to establish adequate ventilation, while stabilizing a preterm neonate before resuscitation?

20. What factors are taken into consideration when assessing the gestational age of a neonate?: previous maternal pregnancies, prenatal ultrasound evaluations, gestational duration based on the last menstrual cycle

21. The gestational age of a newborn has been evaluated to be 34 weeks. The newborn’s birth weight is greater than the 90th percentile. How should the therapist classify this infant?

A. Small for gestational age
B. Very large for gestational age
C. Large for gestational age
D. Average for gestational age

22. An infant arrives in the newborn nursery with an axillary body temperature of 95.6° F. Which of the following events may be responsible for this infant’s temperature?

A. The neonate was in an infant warmer in the delivery room.
B. The newborn has protracted diarrhea.
C. The delivery room temperature was low.
D. The infant was swaddled in numerous blankets.

23. A physical examination is being performed on a newborn, and the therapist notices that the infant’s arms do not move symmetrically. Which of the following situations could account for this problem?

A. An injury to the infant’s brachial plexus may have occurred during birth.
B. The infant experienced nuchal cords during birth.
C. The baby was born via cesarean section.
D. The infant may have been born breach.

24. The therapist notices that an infant presents with irregular areas of dusky skin alternating with areas of pale skin, On the basis of this observation, which of the following conditions should the therapist anticipate this patient having?

A. Polycythemia
B. Renal insufficiency
C. Situs inversus with dextrocardia
D. Hypotension

25. Which of the following neonatal skin presentations at birth is associated with a high hematocrit value or polycythemia and neonatal hyperviscosity syndrome?

A. Mottling
B. Vemix
C. Reddish blue appearance
D. Lanugo

26. Why are chest retractions more prominent among neonates than among older children and adults?

A. Because neonates generate a greater subatmospheric intrapleural pressure.
B. Because airway resistance through the smaller caliber airways is higher.
C. Because neonates have a much higher respiratory rate.
D. Because newborns have relatively thin and weak musculature, and a less rigid thorax.

27. Why is it difficult to localize auscultation findings of the thorax of a newborn?

A. Because the neonate’s chest is small and sounds are difficult to differentiate.
B. Because the newborn’s pulmonary compliance is low.
C. Because the neonate’s tidal volume is so small.
D. Because the newborn infant is frequently crying.

28. Which of the following statements refers to the diagnostic procedure called transillumination?

A. Place a light source between the surface of the bed and the patient’s back, and orient the patient in a supine position.
B. Insert a fiberoptic light sourne down a patient’s endotracheal tube and beyond the tube’s distal tip.
C. Position a beam of light against a patient’s chest wall in a well-lit room.
D. Direct a light source toward the ipsilateral surface of the patient’s thorax.

29. A neonate is found to have a bounding pulse. Which of the following conditions may contribute t this finding?
     I. Patent ductus arteriosus
     II. Hypoplastic left-sided heart syndrome
     Ill. Coarctation of the aorta
     IV. Left-to-right shunt

A. I and II only
B. I, Ill, and IV only
C. II and Ill only
D. I and IV only

30. What condition would be responsible for the therapist observing a pulse oximeter indicating decreased perfusion while central blood pressure remains normal?

A. Volume depletion with compensatory peripheral vasoconstriction
B. Hypoplastic right-sided heart syndrome
C. Hypervolemia with compensatory peripheral vasodilation
D. Hypoplastic left-sided heart syndrome

31. For the purpose of assessing right-to-left shunting, as in the case of persistent pulmonary hypertension, which of the following sites would render postductal blood?
     I. Right arm
     II. Left arm
     Ill. Right leg
     IV. Left leg

A. I only
B. II, III, and IV only
C. I, III, and IV only
D. II only

33. What would cause a preterm neonate to have a grunting cry?: Respiratory Distress

34. Which of the following information represent components of patient history for a new pediatric patient?
     I. Chief complaint
     II. History of present illness
     III. Past medical history
     IV. Occupational history

A. I and II only
B. III and IV only
C. I, II, and III only
D. I, II, III, and IV

35. Which of the following components comprise the history of present illness section of a patient’s medical history?
     I. Frequency and duration of symptoms
     II. Symptoms exhibited by parents
     III. Onset of symptoms
     IV. Symptoms resulting in hospitalizations

A. I and III only
B. II, III, and IV only
C. I, II, and IV only
D. I, II, and III only

36. Which of the following components comprise the past medical history section of the patient’s medical history?
     I. Birth weight
     II. Previous mechanical ventilation
     Ill. Recurrence of symptoms based on season
     IV. Emergency department visits

A. II only
B. I, II, Ill, and IV
C. I, II, and IV only
D. II and IV only

37. Which of the following components of a patient’s medical history is intended to determine the presence of symptoms not identified in the history of present illness and that may be related or contribute to the child’s underlying condition?

A. Chief complaint
B. History of present illness
C. Review of systems
D. Past medical history

38. A child who demonstrates head bobbing, nasal flaring, and grunting is exhibiting the signs of

A. Respiratory distress
B. Acidemia
C. Hypercapnia
D. Hypoxemia

39. Which of the following pulmonary diseases are not chest wall deformities, but are characterized by an increased anteroposterior diameter?
     I. Pectus excavatum
     II. Severe asthma
     III. Pneumonia
     IV. Cystic fibrosis

A I and III only
B. II and IV only
C. II, III, and IV only
D. I, II, Ill, and IV

40. During a physical examination of a child’s chest, the therapist perceives increased tactile fremitus over the patient’s right lower lobe. Which of the following conditions may cause this physical

A. Pulmonary consolidation
B. Aspirated foreign object
C. Mucous plug
D. Pneumothorax

41. While percussing the thorax of a child during a physical examination, the therapist hears a dull percussion note over the child’s right lung. Which of the following conditions may cause this physical finding?
     I. Atelectasis
     II. Pneumothorax
     III. Pleural effusion
     IV. Consolidation

A. I and II only
B. I, II, III, and IV
C. II, III, and IV only
D. I, II, and IV only

42. After placing a stethoscope over a small child’s trachea, the therapist hears expiratory stridor. Which of the following conditions is consistent this finding?

A. Laryngotracheobronchitis
B. Tracheomalacia
C. Asthma episode
D. Adenotonsillar hypertrophy

43. While auscultating a young child’s thorax, the therapist hears bilateral fine crackles. Which of the following conditions can produce these adventitious sounds?

A. Pulmonary edema
B. Asthma
C. Croup
D. Bronchitis

44. Which of the following white blood cell counts constitutes the condition leukopenia?

A. Less than or equal to 3500/mm
B. Greater than or equal to 25,000/mm
C. 10,000 to 20,000/mm
D. 5000 to 10,000/mm

45. Which of the following maternal complications are associated with cesarean section?
     I. Intraoperative bladder or bowel injuries
     II. Endomyometritis
     III. Failure to progress in labor
     IV. Placenta previa

A. I and II only
B. II and III only
C. III and IV only
D. I, II, and III only

46. How should the therapise interpret an amniotic fluid index of 25 cm?: Polyhydramnios

47. How should a therapist interpret a fetal biophysical profile score of 7?: Fetus appears to be normal

48. What medications are used as tocolytics?: magnesium sulfate

49. What are some methods to prevent heat loss & cold stress on a preterm neonate prior to resuscitation?: dry infants skin, wrap the infant in prewarmed blankets, remove wet linens from around the infant

50. Know what are the current recommendations for infants with meconium?:Therefore, current recommendationsfor infants with meconium are that: no intrapartum suctioning should occur; infants who are vigorous at birth (strong respiratory effort, a heart rate of greater than 100 beats/min, good muscle tone) should not receive tracheal suctioning; and infants who are not vigorous (no or poor respiratory effort, a heart rate of less than 100 beats/min, poor muscle tone) may receive direct laryngotracheal suctioning.

52. The therapist has been performing cardiopulmonary resuscitation on a neonate for about 90 seconds, applying ventilation with 100% oxygen and chest compressions. The infant has maintained a spontaneous heat rate of 40 beats/minute. What should the therapist recommend at this time?: Give Epinephrine

53. Examples to appropriately stimulate a newborn: flicking the bottoms of the feet and drying with a towel

54. What should the rate of ventilation be in a term newborn?: 40-60 breaths per minute