Question 1

In addition to the dorsalis pedis, which of the following arteries is involved when the modified Allen’s test is performed using a foot as the potential arterial puncture site?

  1. Axillary artery
  2. Femoral artery
  3. Posterior tibial artery
  4. Temporal artery

The modified Allen’s test can also be used to verify collateral circulation when using one of the arteries of the foot as a puncture site, by elevating the foot and compressing the dorsalis pedis and posterior tibial arteries. Collateral circulation is confirmed by releasing pressure from the artery that will not be punctured and assessing the nail beds and sole of the foot for return of blood flow.

 

Question 2

A therapist is viewing a chest X-ray of a pediatric patient who recently emerged from general anesthesia after upper abdominal surgery. The right hemidiaphragm is elevated, and atelectasis is seen as a long, thick horizontal line within the right lower lobe. Which of the following terms describes this type of atelectasis?

  1. Discoid
  2. Lobar atelectasis
  3. Silhouette sign
  4. Plate

When an X-ray beam passes through the chest, the densities of all the structures it encounters are summated. Thus a flat object such as platelike atelectasis (collapse of all or part of the lung) may add little to the opacity of the chest in one projection but may appear opaque when viewed on edge in another projection.

 

Question 3

Which of the following radiographic views would be the best suited for evaluating fractured ribs in a pediatric patient?

  1. Lateral decubitus at full inspiration
  2. Posteroanterior view at full expiration
  3. Anteroposterior view
  4. Oblique view

Oblique views are usually rotated 45 degrees from the frontal position. They are typically used in the evaluation for rib fractures and to better evaluate the entire heart borders.

 

Question 4

A therapist is viewing frontal and lateral neck X-rays of a 12-month-old child and notices what is described as the “steeple” or “church steeple” sign: subglottic narrowing below the vocal cords, and an overdistended hypopharynx. Which of the following conditions does this child likely have?

  1. Croup
  2. Tracheomalacia
  3. Adenoidal enlargement
  4. Epiglottitis

Croup (laryngotracheobronchitis) is the most common cause of upper airway obstruction in children, with a peak incidence in infants and children 6 months to 5 years of age. Most cases are virally induced (parainfluenza) and cause inspiratory stridor with a barking cough. Frontal and lateral neck radiographs may show the characteristic subglottic narrowing below the vocal cords with loss of the normal “shouldering” of the airway and resultant “church steeple” appearance. The hypopharynx usually appears overdistended.

 

Question 5

The respiratory therapist is evaluating a child with suspected foreign body aspiration. The radiographer gently adds pressure to the abdomen during expiration to take the chest radiograph. If an obstruction is confirmed, what changes should the RT expect to see?

  1. The size of the affected lung will decrease.
  2. The size of both lungs will decrease.
  3. The size of the affected lung will remain normal or the lung will be hyper-expanded.
  4. The size of the unaffected lung will increase.

Forced expiratory images are used in assessing the presence of a pneumothorax and to evaluate for foreign body aspiration in small children. When assessing foreign body aspiration in very young patients, the radiographer may gently add pressure to the abdomen during expiration. If an obstruction is present, the affected lung will not decrease in size but remain normal to hyper-expanded.

 

Question 6

Which of the following measurements requires a pulmonary (Swan-Ganz) artery catheter?

  1. Partial CO2 rebreathing, using the Fick method
  2. Pulmonary capillary wedge pressure
  3. Pulse contour analysis
  4. Pulse variability index

 

Question 7

Complications associated with indwelling vascular catheters include:

  1. Air embolism
  2. Infection
  3. Periventricular leukomalacia
  4. Both A and B

 

Question 8

While viewing a lateral view of a neck radiograph of an 18-month-old child, a therapist notices that the epiglottis is enlarged, the aryepiglottic folds are thickened, and the hypopharynx is overdistended. Which of the following conditions does this child likely have?

  1. Bronchopulmonary dysplasia
  2. Esophageal fistula
  3. Croup
  4. Epiglottitis

Whereas croup usually improves within a few days of supportive therapy, epiglottitis is a life-threatening disease causing acute inspiratory stridor, fever, and dysphasia (speech impairment). The usual pathogen is Haemophilus influenzae, type B with the risk of infection now greatly reduced by routine immunization programs. The diagnosis should be made by physical examination or by direct visualization through a scope. If a lateral radiograph of the neck is obtained, the epiglottis is enlarged (referred to as the thumb sign) and the aryepiglottic folds are thickened with overdistention of the hypopharynx. The radiograph is performed upright in the position most comfortable for the patient to breathe. Because safety of the child is of primary concern, the radiograph should be performed portably in the emergency department, where intubation can be performed quickly if necessary.

 

Question 9

The neonatal intensive care unit (NICU) respiratory therapy supervisor is observing a therapist obtain an arterial blood sample from an infant’s radial artery and notices that the therapist has the bevel of the needle pointed upward, entering the patient’s skin at a 45-degree angle and in a direction against the arterial flow. What should the supervisor do at this time?

  1. Continue to observe the procedure.
  2. Inform the therapist to turn the bevel downward.
  3. Tell the therapist to penetrate the infant’s skin at about a 60-degree angle.
  4. Advise the therapist to insert the needle in the same direction as the blood flows.

Insert the needle of the syringe or butterfly catheter into the artery at a 35- to 45-degree angle with the bevel up and advance it gently. Enter the artery from the direction opposite, or against, the blood flow. A flash in the hub of the syringe or butterfly catheter verifies that the needle penetrated the artery and is located in the lumen. In the small pediatric patient it is quite easy to pass through the artery with the needle. If a good pulse is palpated and no blood return occurs after the needle is inserted, pull the needle back incrementally and continue to watch for a flash of blood. If resistance is met when inserting the needle, slowly withdraw it immediately and change direction because it has most likely touched the bone.

 

Question 10

The most important advantage of continuous in-line blood gas sampling compared with umbilical blood gas sampling in neonates is:

  1. Decreased amount of blood wasted
  2. Lower incidence of clot formation
  3. Lower risk of infection
  4. The advantage of also being able to measure the cardiac index

 

Question 11

While viewing an anteroposterior view of a chest radiograph of a 24-month-old intubated child, a therapist notices that the endotracheal tube has now migrated right above the inferior clavicular border. What could explain this new location of the endotracheal tube?

  1. Flexion of the head
  2. Extension of the head
  3. Rotation of the head to the right
  4. Rotation of the head to the left

The position of the head, especially in a neonate, may result in a significant change in position of the endotracheal tube tip: the tip will advance toward the carina when the head is flexed.

 

Question 12

How will well-expanded, air-filled lungs appear on a chest radiograph?

  1. Light colored
  2. Gray
  3. Black
  4. White

The normal structures that are visualized on a chest radiograph are distinguishable because of differences in the absorption of the X-ray beam by the organs and tissues within the thoracic cavity. Bone and metallic orthopedic hardware appear bright white because of greater X-ray absorption and less exposure of the image receptor. In contrast, air has little beam absorption, and therefore well-expanded lungs appear relatively black. Soft tissue organs and fluid usually appear as shades of gray in between the white bones and black lungs.

 

Question 13

A therapist is viewing frontal chest X-ray of a 12-year-old child and notices mediastinal shift towards the right hemithorax along with elevated hemidiaphragm and vascular crowding. Which of the following conditions does this child likely have?

  1. Atelectasis
  2. Pneumonia
  3. Pleural effusion
  4. ARDS

Segments, lobes, and entire lungs may be collapsed, or atelectatic. This loss of volume may shift fissures toward the area of atelectasis, cause mediastinal shift toward the affected side, and elevate the ipsilateral diaphragm. Crowding of the pulmonary vascular and interstitial markings in the affected region will occur. The other lung or adjacent lobes may become more lucent secondary to hyperexpansion.

 

Question 14

Which of the following conditions can cause methemoglobinemia?

  1. Anemia
  2. Inhalation of nitric oxide (NO)
  3. Use of dobutamine
  4. High fraction of inspired oxygen

Methemoglobin forms when hemoglobin is oxidized to the ferric state. It causes the oxyhemoglobin dissociation curve to shift to the left, resulting in a decrease in hemoglobin’s ability to combine with oxygen. Nitrate-containing molecules in medications and therapeutic gases may cause methemoglobinemia.

 

Question 15

A mother has just given birth to a 42-week infant who is small for his gestational age. A chest radiograph of this neonate reveals coarse, patchy opacities secondary to atelectasis from bronchial obstruction alternating with areas of hyperinflation. Which of the following clinical disorders does this infant likely have?

  1. Acute respiratory distress syndrome
  2. Pulmonary interstitial emphysema
  3. Meconium aspiration syndrome
  4. Transient tachypnea of the newborn

Although meconium staining of amniotic fluid occurs in 12% of deliveries, only 2% of these newborns develop meconium aspiration syndrome. Predisposing factors are postmaturity, intrauterine stress, and small size for gestational age. The aspirated meconium is produced by the bowel plugs’ bronchi and causes a chemical pneumonitis. The chest radiograph is characterized by coarse, patchy opacities secondary to atelectasis from bronchial obstruction alternating with areas of hyperinflation.

 

Question 16

Which of the following factors would adversely affect the correlation between arterial puncture measurements and those from a capillary sample?

  1. Hypotension
  2. Hyperventilation
  3. Hypoxemia
  4. Hyperthermia

The accuracy of capillary blood gas value measurements is severely compromised by the presence of hypotension, hypothermia, hypovolemia, and lack of perfusion.

 

Question 17

Calculate a patient’s total arterial oxygen content given the following data:
•Arterial oxygen tension (PaO2), 100 mm Hg
•Arterial carbon dioxide tension (PacO2), 45 mm Hg
•Arterial oxygen saturation (SaO2), 97.5%
•Hemoglobin concentration ([Hb]), 15 g/dL
•Cardiac output, 4.5 L/minute
•Stroke volume, 55 mL/beat

  1. 19.9 vol%
  2. 18.7 vol%
  3. 16.6 vol%
  4. 14.9 vol%

The formula for calculating the total arterial oxygen content (CaO2) is as follows: O2 delivery = O2 content = (Hb X 1.34 X SaO2) + (PaO2 X 0.003)

 

Question 18

Which of the following is a hallmark of cystic fibrosis and is not also seen with asthma?

  1. Airway disease
  2. Atelectasis
  3. Bronchiectasis
  4. Hyperinflation

 

Question 19

On the basis of the position of the three-way stopcock shown here, identify which of the following activities related to arterial line blood sampling is occurring.

  1. The therapist is aspirating blood diluted with infusion fluid.
  2. The therapist is withdrawing blood from the arterial line.
  3. The therapist is keeping the stopcock in its normal operational position.
  4. The therapist is infusing fluid back into the system after having removed a blood sample.

What is depicted by the position of the three-way stopcock is the system’s normal operating position with the flush, or infusion, solution going to the patient while the sample port is closed.

 

Question 20

A patient has a systolic blood pressure of 100 mm Hg and a diastolic pressure of 75 mm Hg. What is this patient’s mean arterial pressure?

  1. 25 mm Hg
  2. 58 mm Hg
  3. 83 mm Hg
  4. 175 mm Hg

Monitoring arterial pressure waveforms helps to determine the patency of an arterial line and the quality of the pulse pressure and to calculate the mean arterial pressure (MAP). The arterial line monitor calculates MAP internally. However, the formula to obtain an indirect measurement of MAP with a sphygmomanometer is as follows: MAP = [(2 X diastolic) = systolic]/3



Question 21

A therapist is viewing a frontal chest radiograph of a neonate who has just been endotracheally intubated. The tip of the endotracheal tube is located between the inferior clavicular border and the carina. What should the therapist do at this time?

  1. Perform routine respiratory assessment in the morning and care for an intubated patient at this time.
  2. Withdraw the endotracheal tube a few millimeters.
  3. Advance the endotracheal tube a few millimeters.
  4. Remove the endotracheal tube and reinsert it because it is in the esophagus.

The frontal chest radiograph can readily be used to assess the proper placement of the ET tube, which should be positioned in the midtracheal region between the inferior clavicular border and the carina. If the tip is located above the clavicular border, the ET tube is too shallow.

 

Question 22

With an umbilical artery catheter (UAC) in the “low position,” which of the following blood vessels should be avoided?

  1. Celiac artery
  2. Superior mesenteric artery
  3. Renal artery
  4. Descending aorta

The low position is usually at the third to fourth lumbar (L3 to L4) space, between the renal artery and aortic intersection and above the takeoff of the inferior mesenteric artery. The UAC is placed to avoid the large tributaries supplied by these vessels in an effort to minimize trauma and hemodynamic disturbances of vital organs.

 

Question 23

Which of the following radiographic views provides the best perspective for ascertaining the position of an endotracheal tube in the patient’s esophagus?

  1. Anteroposterior view
  2. Left lateral decubitus
  3. Lateral view
  4. Oblique view

If a chest radiograph is obtained for suspected esophageal intubation, the stomach, small bowel, and esophagus will be distended with air while the lungs will be underinflated. Although usually not necessary, a lateral projection would demonstrate the endotracheal tube in the more posterior esophagus. The lateral projection may be more useful for showing adequate tracheal positioning and length in long-term placement of a tracheostomy tube.

 

Question 24

Which of the following arteries is considered the optimal puncture site for obtaining arterial blood samples from neonatal and pediatric patients?

  1. Radial artery
  2. Axillary artery
  3. Ulnar artery
  4. Popliteal artery

The preferred site in both neonatal and pediatric populations is the radial artery. The radial artery provides good access as well as collateral circulation to the hand by the ulnar artery. No nerves or veins are directly adjacent to the radial artery, and the patient’s wrist is easier to manipulate than other body parts. The bone and firm ligaments of the wrist make it easy to palpate, stabilize, and compress the radial artery.

 

Question 25

CT scans of the chest in a pediatric trauma patient are not routinely obtained because of

  1. A contraindication to the use of IV contrast agents
  2. The additional costs associated with CT imaging
  3. The high radiation dose
  4. The time necessary to complete the scan

 

Question 26

A therapist is examining an AP chest radiograph of a neonate and notices a structure projecting away from the mediastinum toward the right upper lung. This structure looks like a sail with a sharp inferior margin and lateral margins with wavy contours. Which of the following structures is the therapist observing?

  1. Thymus
  2. Right heart border
  3. Aortic notch
  4. Lymph node in the hilar region on the right

The mediastinum is composed of the heart, aorta, main pulmonary artery and proximal branches, origins of the great vessels from the aorta, the superior vena cava, and thymus. Thymic tissue is usually prominent in the neonate and becomes less apparent with age because of regression of the thymus and growth of surrounding structures. Because it is an anterior mediastinal structure, the thymus in the small child fills the anterior clear space normally seen on the lateral projection of a teenager or adult. On the AP or PA projection it may only cause widening of the superior mediastinum. When the thymus projects away from the mediastinum, typically into the right upper lung, it appears as a “sail” with a sharp inferior margin. The lateral margins often have a characteristic wavy contour (see Figure 6-4 in the textbook). Unlike a pathologic mass such as lymphoma, the normal thymus does not exert mass effect on the trachea.

 

Question 27

Which of the following is one of the most common arrhythmias observed as a complication from the insertion of a pulmonary artery catheter?

  1. Premature ventricular contraction
  2. S3 gallop
  3. Atrial fibrillation
  4. Paroxysmal atrial contraction

At insertion, complications include bleeding, pneumothorax, tricuspid or pulmonic valve damage, right atrium or right ventricle perforation, and arrhythmias resulting from the catheter traversing the right ventricle. The most frequently observed arrhythmias are premature ventricular contractions and ventricular tachycardia.

 

Question 28

While viewing the chest X-ray of an 18-month-old boy, a therapist notices that the trachea is truncated and that the right lung is collapsed. Which of the following situations or conditions may have caused this s

  1. An elevated right hemidiaphragm
  2. A mucous plug in the right mainstem bronchus
  3. A mass compressing the trachea
  4. A right-sided pneumothorax

Truncation of the right mainstem bronchus is often the sign of a mucous plug when the right lung is collapsed. Although the right hemidiaphragm is usually slightly higher than the left because of the underlying liver, the position of the diaphragm may indicate hemidiaphragm paralysis or abdominal pathology.

 

Question 29

A pediatric patient with pneumonia has an infiltrate in the lower half of the right lung. The right heart border is obliterated. In which lobe(s) of the right lung is the infiltrate located?

  1. Right upper lobe
  2. Right middle lobe
  3. Right lower lobe
  4. Right middle and lower lobes

Differences in tissue density allow the viewer to discriminate between different structures. The heart, which is composed of soft tissue of muscle density, is clearly demarcated by a distinct edge from the adjacent air-filled lung. However, if the lung becomes denser from loss of air, as in atelectasis, or if the alveoli become filled with pus, as in pneumonia, the sharp edge between the heart and the lung is no longer apparent. The sign caused when two normal structures lose their distinct edge and blend imperceptibly is widely known as the silhouette sign. If the right heart border is visible next to the infiltrate, the pneumonia is located in the right lower lobe. If the right heart border is obliterated, the infiltrate must be located in the right middle lobe, which resides immediately next to and in the same plane as the right side of the heart. Because the right lower lobe does not lie in the same plane as the right heart border, the two structures remain distinct on a chest radiograph.

 

Question 30

In addition to applying direct pressure to the puncture site immediately after the arterial puncture procedure, what can the therapist do to minimize the risk of hematoma formation in a patient who requires frequent radial arterial punctures?

  1. Have the patient maintain the arm in an elevated position for a couple of hours after the radial puncture.
  2. Have the patient shake the arm periodically throughout the day.
  3. Alternate arms used for arterial puncture and use other sites as well.
  4. Apply a bandage to the puncture site.

Scarring, laceration of the artery, and hematoma formation are more likely to occur with repeated puncture of an artery. Alternating puncture sites decreases this risk.

 

Question 31

A respiratory therapist has been ordered to obtain a blood gas sample from a nonintubated premature baby. After selecting the best site to obtain the sample, what should the RT suggest to ameliorate the pain associated with the procedure?

  1. Administer a small dose of fentanyl
  2. Inject lidocaine at the injection site
  3. Give a pacifier dipped in 24% sucrose
  4. Administer a lidocaine drip

For infants more than 4 months of age and for children, anesthetic cream or a lidocaine injection may be used to control the pain felt during a blood gas procedure. For nonintubated infants and premature newborns, a pacifier dipped in 24% sucrose is effective in helping to ameliorate the effects of pain.

 

Question 32

What method for obtaining blood gases should be initially tried in a neonate?

  1. Capillary blood gas determination
  2. Femoral artery puncture
  3. Pulmonary artery catheterization
  4. Umbilical artery catherterization

 

Question 33

If a blood gas sample is not obtained from an arterial stick in a premature baby without central access, which of the following sites should be considered because this blood vessel is larger than the radial artery at this age?

  1. Dorsalis pedis
  2. Temporal
  3. Posterior tibial
  4. Femoral

The dorsalis pedis or posterior tibial artery is considered if the radial artery shows signs of poor collateral circulation. In addition, the temporal artery provides an alternative site for the premature or newborn infant. Access is generally good because two branches are close to the scalp. In most premature and neonatal patients, the temporal artery branches are larger than the radial artery.

 

Question 34

What type of X-ray view is obtained when the radiographic plate is placed behind the patient’s back with the x, and the side up may better define ____________________.

  1. Anteroposterior view
  2. Posteroanterior view
  3. Lateral view
  4. Frontal view

Feedback: When the radiograph is performed at the patient bedside with mobile radiographic equipment, the image receptor is placed behind the patient’s back and the X-ray tube is placed in front of the patient’s chest. This obtains a frontal view in the anteroposterior (AP) projection, with the beam passing from anterior to posterior.

 

Question 35

Which of the following structures on a chest radiograph projects to the left, causes a prominent bulge of the superior mediastinum, and creates a mild indentation on the trachea?

  1. Left hemidiaphragm
  2. Apex of the heart
  3. Aortic arch
  4. Hilum

In normal anatomy the aortic arch is on the left and causes a prominent bulge of the superior mediastinum and a mild indentation on the trachea.

 

Question 36

A respiratory therapist is evaluating a chest radiograph of a patient taken 2 days after being admitted for significant respiratory distress right middle lobe pneumonia. Although the therapist notices a dramatic clinical improvement of the patient, the chest X-ray appears to be more radiopaque than the one on admission. What could explain this situation?

  1. The therapist is mistakenly looking at a different patient’s film.
  2. Incorrect exposure of the image receptor may have happened.
  3. Although the patient looks better, the pneumonia is probably worse.
  4. This is a normal phenomenon.

Incorrect exposure of the image receptor may alter the normal gray scale. Digital radiographic images are automatically rescaled to allow proper image contrast and brightness, and the image can be manipulated by the clinician after it is processed.

 

Question 37

Which of the following are criteria to order a chest radiograph in a pediatric patient who does not have chest symptoms?

  1. Fever
  2. Oxygen saturation < 95%
  3. White blood cell count > 20,000/mm3
  4. Creatinine > 2 mg/dL

Chest radiographs may also be appropriate for evaluation in a pediatric patient who does not have chest symptoms but does have a fever, oxygen saturation < 95%, and a white blood count >20,000/mm.

 

Question 38

The most accurate way to detetct changes in oxygenation in the blood is by obtaining the following:

  1. Arterial blood gas
  2. Capillary blood gas
  3. Mixed venous blood gas
  4. Pulse oximetry

 

Question 39

How would tricuspid stenosis be expected to influence a patient’s CVP value?

  1. Elevate it above normal
  2. Cause it to fall below normal
  3. Produce fluctuations in the CVP value
  4. Have no effect in the CVP value

Increased CVP values may result from:
• Hypervolemia, as with sudden fluid shifts or volume overload
• Interference with the ability of the right ventricle to pump blood, such as in tricuspid valve regurgitation or tricuspid stenosis, right ventricular failure or infarction, increased pulmonary vascular resistance, or cardiac tamponade
• Increased systemic vasoconstriction
• Left ventricular failure

 

Question 40

Which of the following factors influence the central venous pressure (CVP) measurement?

  1. Bicuspid valve function
  2. Right ventricular pressure
  3. Intravascular volume
  4. Systemic venous return

The placement of a central venous catheter provides for the measurement of the right atrial pressure, which represents the filling pressure of the right atrium. Systemic venous return, intravascular volume, tricuspid valve performance, myocardial function, and right ventricular pressure all affect the right atrial pressure.

 

Question 41

The lateral decubitus view is a frontal radiographic projection whereby the side down can be evaluated for presence of ____________________.

  1. A pleural effusion; a pneumothorax
  2. Consolidation; atelectasis
  3. A pleural effusion; consolidation

The lateral decubitus position is a frontal projection performed with the patient lying on either the right side (right lateral decubitus) or on the left side (left lateral decubitus). The down side can be evaluated for presence of fluid, such as a mobile pleural effusion, and the up side will demonstrate free air, such as in the case of a pneumothorax (air in the pleural cavity). Dech-ray tube in front of the patient’s chest?

 

Question 42

A 12-hour-old infant is experiencing respiratory distress, and the neonatologist orders a heel stick to assess the infant’s oxygenation status. What action should the therapist take at this time?

  1. Perform the heel stick as ordered.
  2. Instead of using the newborn’s heel, the therapist should use a finger as the site.
  3. Inform the physician that this procedure is inappropriate at this time.
  4. Explain to the doctor that an arterial puncture procedure is appropriate.

A capillary puncture is contraindicated in neonates less than 24 hours old. A newborn has a low systemic output, and vasoconstriction tends to be maximal during this stage secondary to a decrease in environmental temperature and an increase in circulating catecholamines. Capillary blood sampling is not recommended in a patient with decreased peripheral blood flow, especially in the case of hypotension.

 

Question Answer
Which of the following are potential sources of stress for the parents of sick neonates? Personal and family background,Situational conditions,Enviornmental stimuli
Ground transport is usually selected for neonatal transport if the referring hospital is less than _____ miles from the level III NICU. 100
If the barometric pressure at 7000 ft is 590 mm Hg, what is the partial pressure of oxygen in the atmosphere? 124 mm Hg
Sadness and its avoidance are found in which stage of grief? Stage IV
Which of the following is a common cause of problems with home apnea monitoring? Frequent false alarms.
Survivors of respiratory distress syndrome who have developed bronchopulmonary dysplasia probably constitute a majority of ventilator-dependent children. True
You have an “E” cylinder of oxygen with a gauge pressure of 1250 psi. You estimate that at current settings the transport ventilator will consume 8 liters per minute. How many minutes will this cylinder last if you are considering using it for transport? 43 minutes
Parents and family members may best be helped through grief by which of the following? Constant encouragement,Explanations of the care being given ,Allowing involvement in the care of the infant
Which of the following people coordinates home care services and acts as a liaison to the family? Case manager
When the death of a loved one appears likely, grief felt by the family is termed: anticipatory
Which of the following considerations is important when esophageal and/or tracheoesophageal fistula is suspected? Position baby in an upright position to minimize chances of aspiration.
The first stage of grief includes which of the following? Shock,Confusion ,Denial
Before transporting the neonate to the NICU, the transport team should: stabilize the infant,contact and advise the NICU,collect all patient chart data
Which of the following are possible hazards of home aerosol therapy? Fluid overload,Burns
Which of the following disorders present the greatest potential thermoregulation problem during transport? Gastroschisis
The human tendency to affix blame on someone or something generally produces: anger
Which of the following is the most common cause of home care failure Lack of community and family resources
The major goal of transport is to bring a high-risk mother or a distressed neonate to a tertiary care center in stable condition where advanced care can then be given. True
Which of the following aspects are disadvantages to air transport? Space limitations,Adverse weather can interfere,Vibrations and turbulence during transport
An infant with _____ should not be bag-and-mask ventilated. diaphragmatic hernia
How long will an E cylinder of oxygen last with a gauge pressure of 1900 psi running at 5 lpm? 1 hour 46 minutes
Sadness and its avoidance are found in which stage of grief? Stage IV
Which of the following is a common cause of problems with home apnea monitoring? Frequent false alarms.
Which of the following skills are needed by a transport team member? Placement of IVs ,Placement of UAC catheters,Chest tube placement ,Intubation ,Placement of UVC catheters
You have an “E” cylinder of oxygen with a gauge pressure of 1250 psi. You estimate that at current settings the transport ventilator will consume 8 liters per minute. How many minutes will this cylinder last if you are considering using it for transport? 43 minutes
Air transport by helicopter is indicated for distances of: 100 to 250 miles.
Which of the following considerations is important when esophageal and/or tracheoesophageal fistula is suspected? Position baby in an upright position to minimize chances of aspiration.
Which of the following is the most common cause of home care failure? Lack of community and family resources
. A visit to the NICU prior to delivery of a high-risk infant may reduce which of the following stages of grief? Shock
Of the following, which is the least likely to cause parental stress during home care? The visual appearance of the infant.
The major goal of transport is to bring a high-risk mother or a distressed neonate to a tertiary care center in stable condition where advanced care can then be given. True
Which of the following statements is true regarding assessment of oxygenation and ventilation of a newborn infant? If right-to-left shunting is present through a patient ductus arteriosus, blood obtained from a umbilical artery catheter (UAC) will have a lower PaO2 than blood obtained from a right radial artery.
Before departure on a helicopter transport, a neonate’s PaO{2} is 65 mmHg. During the flight, the PaO2 will most likely: decrease
Of the following, which can help thermoregulate the infant during transport? warmed IV bags wrapped in a blanket
Regarding tracheostomy tubes, which of the following is best suited for home care? uncuffed, slightly smaller than the trachea
Detecting clinical changes that may indicate infection or heart failure requires: establishing a baseline of normal patient status
The main advantage to liquid oxygen systems is: they hold a large quantity of gas
Parent-to-child bonding begins: with the anticipation of the child
Which of the following are advantages of home care? allows more normal family,interaction,patients get infections less frequently,cost savings
Which of the following is not true regarding the bureaucratic type of home care? may be more readily accepted by health care providers

 

Neonatal & Pediatric Care Chapter 6 & 8 Practice Questions:

 

1. Know what type of x-ray view is commonly performed portably & when patients are lying in bed: A frontal view in the AP projection with the beam passing from anterior to posterior the image receptor is placed behind the patient’s back and the x ray tube is placed in front of the patient’s chest.

2. Know what the lateral decubitus view is used to determine the presence of, specifically the lung that is up & the lung that is down: The down side is evaluated for fluid such as mobile pleural effusion the up side demonstrate fee air such as a pneumothorax ( air in Pleural cavity). This view can also be used for foreign body lodges in a bronchus that causes air trapping when this occurs the down side lung normally loses volume but may remain expanded when airflow is obstructed out of the bronchus.

3. Know what oblique views are used to evaluate or determine: They are used to evaluate rib fractures and to better evaluate the entire heart border.

4. Know what an x-ray would show for a child that has an obstruction due to a foreign body aspiration: Forced expiratory chest radiographs are most useful in demonstrating the air trapping, in some cases decubitus radiographs or fluoroscopy may be used but to find the object a lateral radiograph of the neck and frontal views of the chest and abdomen are obtained.

5. Know how air-filled lungs appear on a chest x-ray: It will appear black

6. Know what the term radiopaque refers to and what would it look like on a chest x-ray: Objects block radiation rather than allowing it to pass through they appear white.

7. Know what the term “plate” or “platelike” refers to on chest x-ray with atelectasis: It is the resultant triangular wedge extending from hilum to the anterior chest wall most diagnostic in lateral projection.

8. Know where a pneumonia would be if part of the heart border is obliterated on a chest x-ray, otherwise known as the silhouette sign: Left lower lobe pneumonia.

9. Know which structure on a chest x-ray is on the left and causes a prominent bulge of the superior mediastinum and a mild indentation on the trachea

10. Know which structure projects away from the mediastinum toward the right upper lung and looks like a sail with a sharp inferior margin and lateral margins with wavy contours: Thymus

11. Know what truncation of a mainstem bronchus and a collapsed lung are a sign of: Mucus plug

12. Know what two structures the tip of an ETT should be between: When looking at a chest x-ray
between the inferior clavicular border and the carina called the midtracheal region.

13. Know what would happen the ETT of a 24-month old child that is intubated and flexed his head, what would the x-ray show: The tip will be advanced toward the carina.

14. Know which view provides the best perspective for ascertaining the position of an ETT in the patient’s esophagus: A lateral projection would demonstrate the endotracheal tube in the posterior esophagus.

15. Know what condition causes a “church steeple” appearance: croup

16. Know what condition causes the epiglottis to be enlarged: The aryepiglottic folds to be thickened, & the hypopharynx to be overdistended both on a lateral neck radiograph
haemophilus influenzae

17. Know which condition would cause a chest radiograph of a neonate to reveal coarse, patchy opacities secondary to atelectasis from bronchial obstruction alternating with areas of hyperinflation: meconium aspiration syndrome.

18. Know what condition would cause a mediastinal shift towards the right hemithorax along with elevated hemidiaphragm and vascular crowding on the x-ray of a 12-year old child: Right sided atelectasis.

19. Know what symptoms a pediatric patient may have that would indicate the need for a chest xray but does not have any chest symptoms: fever with an unknown source, oxygen saturation of 95% or lower, white blood cell count of 20,000/mm or more.

20. Know what could be given to non-intubated infants and premature newborns to assist with the effects of pain: anesthetic cream, lidocaine injection, a pacifier dipped in 24% sucrose.

21. Know what sites can be used for ABG analysis of a neonate; which site is optimal for a neonate & pediatric patient; and which method/site should be tried initially on a neonate for a blood gas: femoral artery(emergency only), Radial (initially used on neonate), axillary artery, temporal artery, brachial artery, Dorsalis pedis artery, Posterior tibial artery.

22. Other than the radial artery, know what site is a good alternative site for obtaining a blood gas in premature and newborn infants: Capillary punture

23. Know which arterial sites on the foot should a modified Allen’s test be performed in neonates: Dorsalis pedis

24. Know the correct procedure & steps for obtaining an ABG; know what to do when a hematoma is present & you need to draw an ABG.

25. Know what affects the correlation between a capillary sample & an arterial puncture: Hypoxemia

26. Know the indications and contraindications of a capillary sample: When accurate assessment of oxygenation or ABG values is necessary. Should not be used for routine blood gas monitoring when less painful or noninvasive measurements provide results that are more accurate. Neonates less than 24 hours old. Not recommended in a patient with decreased peripheral blood flow, especially in a case of hypotension. Patient with polycythemia. Do not use areas that are edematous, inflamed, or infected. Avoid heel samples from ambulatory children with calluses on their feet.

27. Know which of the following blood vessels are avoided when a UAC is in the “low position”: Renal artery, Aortic intersection

28. Know how to calculate the mean arterial pressure (MAP) given the systolic and diastolic pressures: MAP=[(2= diastolic) + systolic

29. Know what factors affect CVPs which is used to measure right atrial pressure (RAP): Hypovolemia, Fluid imbalance, Hemorrhage, Extreme vasodilation, Shock

30. Know what is tricuspid stenosis and how would that affect a patient’s CVP value: Interference with the right ventricle’s ability to pump blood. It would increase the CVP value.

31. Know what are the complications associated with the insertion of a pulmonary artery catheter: Bleeding, Pneumothorax, Tricuspid or pulmonic valve damage, Right atrium or ventricle perforation, Cardiac arrhythmias.



32. Know how to calculate the total arterial O2 content (CaO2), given the data: O2 content= (Hb X 1.34 X Sao2) + (Pao2 X 0.003)

33. Know what is methemoglobinemia and what would cause it: Methemoglobin forms when hemoglobin is oxidized to the ferric state. It causes the oxyhemoglobin dissociation curve to shift to the left, resulting in a decrease in hemoglobin’s ability to combine with oxygen. Causes: Nitrate containing molecules in medications and therapeutic gases

34. Know what conditions/diseases are seen with cystic fibrosis patients that are not seen with asthmatic patients: Bronchiectasis, Enlarged pulmonary hila, Emphysema

35. Know what would be the initial method for obtaining a blood gas on a neonate: Radial puncture.

36. Know what are some complications associated with indwelling vascular catheters: Sepsis, Fungal sepsis, Pulmonary embolism, Difficulties with percutaneous approach in patients with poor peripheral perfusion and those with chronic disease, Cardiac arrhythmias.

37. Know what measurements are obtained when using a pulmonary (Swan-Ganz) artery catheter

38. Know why CT scans are not done routinely done on pediatric patients: Because of the high radiation dose.

39. Know what the advantage is of having a continuous in-line blood gas sampling versus an umbilical arterial line: Reliable results in a short amount of time, while substantially reducing the amount of blood loss and less exposure to health care providers.

40. Know what is the most accurate and reliable way to detect changes in oxygenation on a patient: ABG sampling