Question Answer
CF is a hereditary autosomal disease that controls movement of Cl ions through the cell membrane
Affects of CF on mucous glands is abnormal production of thick secretions
CF affects which exocrine glands sweat glands, pancreas, lungs
Exocrine pancreatic insufficiency causes what in CF patients sever decrease in digestive enzymes causing decreased digestive enzymes, malnutrition and diarrhea and sometimes diabetics
The standard test for CF is the sweat test, checks for increased sodium and chloride in perspiration
A positive sweat test is what greater than 60 mEg/L Cl
Does CF affect sterility? yes in males
What is an autosomal disease hereditary with both parents carriers, 50% chance of offspring being a carrier, 25% chance offspring having disease, 25% no disease no carrier
CF survival age is 29 years
Increased mortality in year 1 because of recurrent infections
CF children present with respiratory distress, hypoxemic and cyanotic, appear malnourished often admitted with failure to thrive
CF infections usually are what type staph and pseudomonas
Newborns with in 2 days present with what, are highly suggestive of CF meconium illeus (blocked poop)
The most common signs of CF are digital clubbing, chronic sinusitis, crackles in upper lobes
CF CXR will show hyperinflation due to always trying to take deep breaths
Why do CF patients have cor pulmonale chronic hypoxemia
The best way to treat and prevent respiratory tract infections in CF is bronchial hygiene
CPT in CF postural drainage, percussion, PEP and flutter
Percussion in CF 2-3 mins in 10 diff postural drainage positions for adequate clearance 45 minutes total 3-4 times per day
Bronchial hygiene in CF includes CPT, hydration of secretions, pt and family education, antibiotics, bronchodilators, pulmonzyme (dnase mucolytic), O2 therapy PRN, lung transplant
RX for pancreatic insufficiency includes pancreatic enzymes, vitamin supplements, both prior to meals or heavy snacks
Supraglottic involves not just epiglottis, but also aryepiglotic fold and arytenoids cartilages (folds around the hole)
Epiglottitis acute inflammation and selling of the supraglottic structures and partial or complete upper airway obstruction…a true airway emergency for 2-6 yr olds
Why is epiglottitis not as common as it once was development of the H-flu vaccine
How can we differentiate Epiglottitis from croup drooling, pt with Epiglottitis cannot swallow so they are big droolers
Symptoms of Epiglottitis high fever, sore throat, toxic appearance, apprehensive/irritated, drooling, muffled voice but not hoarse, inpir stridor, tachycardic, no cough, sterna retractions
Dx of Epiglottitis lateral neck xray with oblong swollen epiglottis with thumb print, ballooning of the hypopharynx
Tx of Epiglottitis first priority in all cases is establishing artificial airway, ETT 1 size smaller, o2 for hypozemia, monitor SaO2, freq spO2 & vitals, cyanotic O2 with blow by, sedation PRN, cultures, ICU 24-48 hrs, antibiotics, IV fluid, humidity, CPT if secretions
What is the most common cause of upper airway obstructions in children croup
What is the most common cause of croup acute laryngotracheobronchitis LTB
What population gets croup 6 months to 3 years
What causes LTB parainfluenza type I is most common at 75%, RSV, flue and mycoplasma pneumonia at 25%
Is the onset of Epiglottitis fast or slow very fast 4-5 hours
Is the onset of croup fast or slow slow 2-3 days
Symptoms of croup are swelling of subglottic area leading to partial obstruction, inspiratory stridor, hoarse, barking cough, low grad or no fever, suprasternal reatractions tachypnea, prefers to lie down
1mm of edema in subglottic area can lead to how much decrease in airflow 60%
Moderate stages of croup symptoms will be anxious, increased WOB, audible stridor, decreased breath sounds, dyspneic, decreased PaO2
Severe stages of croup symptoms will be increased anxiety, lethargic, dusky or cyanotic, pronounced stridor, barely audible, breath sounds way decreased, gasping totally exhausted leading to respiratory failure
DX of croup neck xray with hourglass or steeple sign, ballooning hypopharynx, lateral neck will have normal epiglottis
Tx of Croup cool mist, O2, racemic epi, hydration, primary caregiver present, steroids, avoid intubation if possible
Spasmodic croup accours with prodrome, child just wakes with barking cough, hoarseness and insp stridor
Prodrome is with out precursor symptoms
RX for spasmodic croup cool mist or cool nite air, usually gone after a nite or two
Bacterial tracheitis aka pseudomembranous croup
Bacterial tracheitis is a rare bacterial croup that looks like LTB, but have staph. 25% have sudden repiatory arrest
RX bachterial tracheitis IV antibiotics, humidity for crusty secretions, bronchoscopy to remove obstructive exudates, artificial airway for airway mgmt and pulm toilet, intub, long resolution, trach is often
ICU with bacterial tracheitis when stridor at test, suprasternal chest wall retractions, SaO3 less 95% on 50% fio2, vapo, heliox, Decadron, intubate
Bronchiolitis is highly contagious acute infection of the lower respiratory tract that causes inflammation, swelling and constriction of the bronchioles and small bronchi
What causes Bronchiolitis RSV
What precautions need to be taken with bronchiolitus gown, mask, gloves shower and change prior to picking up own kids
Bronchiolitis usually affects what age 6 months to 2 years
What kids are most susceptible to bronchiolitus cf bpd and asthma
Bronchiolitis usually starts with what URI or common cold, runny nose, cough and fever
Signs of Bronchiolitis are small airway obst and congestion, intercostals retraction, wheezes, fine crackles, tachypnea, tachycardia and poor feeding
Most severe symptoms of bronchiolitis lasts for how long 2 to 3 days
CXR in bronchiolitis looks like hyperinflation, peribronchiolar thickening, patchy consolidation
How is bronchiolitis diagnosed presents with rsv culture from nasopharynx positive with lower respiratory tract infection
Prevent rsv and bronchiolitis with immunoglobulin Synagis given monthy during winter
Hypoxemia in kids is SPO2 less than 92% and PaO2 less than 70 mmhg
Drugs for bronchiolitis are albuterol and racemic epi, hydration and antibiotics and cpt
Complications of bronchiolitis are apnea, residual decrease in pulm func, may dev asthma later
ARDS is adult resp distress syndrome, caused by lung injury, from sepsis, trauma, aspiration
Signs of are ARDS are sever dyspnea, hypoxemia, refractory to o2, rales or crackles, sterna retractions from decreased CL CXR
Treatment of ARDS includes intubation and ventilation with PEEP for decreased PaO2 and Increased PaCO2, diuretics, vasoactive agents for BP, inotropic cardiac, in haled b drugs and antibiotics
Near drowning is less than how long 24 hours
What age do most drowning happen 1 to 4 years and teen boys
Result of near drowning is what hypoxia and acidosis
What is dry drowning laryngospasm reflex
What is diving reflex face hits cold water and cns stimulated trigeminal nerv causes body to slow down, bradycardia, transient increase in arterial BP, peripheral vasoconstricion
CPR in children compress to breaths is 30 compressions 2 breaths or 15 to 2 with a partner
Infant cpr compressions per min is 80
What first cpr or 911 in kids cpr for 5 cyes then 911 in adults 911 then cpr
Treatment for hyperhydration in near drowning is continuous PEEP, 02 diuretics
Treatment for hyperventilation is intubate, vent and sedation
Treatment for Hyperpyrexia in near drowning is induce hypothermia with cooling blanket
Treatment Hyrexcitability in near drowning is barbiturate sededation
Treatment of hyperrigidity in near drowning is posturing
Close monitoring in near drowning includes ABG, CBC, electrolytes, CXR, hemodynamic status and ICP needs to be low 20’s
Febrile seizures are 6 months to 3 yrs, at 101.8, happen at temp rise
Pneumonia inflammation of gas exchange units, common in children, viral more common than bacterial, common with uri and rsv
Pneumonia presents with fever, malaise, rapid shallow breath, cough chest pain, chills
Pneumonia rx is abx, bedrest, oral fluid, antipyretics for fever
Muscular dystrophies are largest group of muscle diseases affecting children, progressive weakness wasting of muscles, degeneration of muscle fibers
What is most common Muscular dystrophy duchenne’s, age 3, waddling gate, wheelchair by 12, scoliosis causes resp probs, death by 20
What is milder form of muscular dystrophy becker’s, milder and presents older in life
AIDS risk factors for prenatal are parents esp mom are IV drug user, maternal promiscuity or prostitution, parental homosexuality
Other causes of pediatric aids exposure to infected blood products, infected breast milk, and small percentage of unkown
Kids who do not meet requirements of aids are said to have ARC aids related complex
Incubation of aid is 6 weeks to 10 years
Kids with aids present with failure to thrive, developmental delays, lymphadenopathy, chronic diarrhea, progressive neurologic dysfxn, hepatosplenomegaly, thrush, sepsis, hep b
Opportunistic infections in aids are pcp, Kaposi sarcoma, tb, cmv retinitis, MAC
Aids is diagnosed by ELISA, western blot, PRC, P24, HIV culture, ILISPOT, IVAP, IgA, IgM
What AIDs test does not check for antibodies PCR
What pulmonary symptoms do aids pt get severe dyspnea, fever, cough, toxic appearance, chest pain, variable sputum, thrush, lymphadenopathy
Aids meds are antiretrovirals, Abx, antifungals, antiparasitic, Zidovudine or ZDV when tcells below 500, ddl and ddC, IV TMP SMX, dapsone and aerosolized pentamidine and steroids for PCP
Precautions with aids is hand washing , eye shields, clothing covers, gloves, masks
SIDS happens at what age 40 percent at 1 to 12 months
Risk factors of sids are apnea, prematurity, sib with sids, low birth weight, maternal drug use, maternal smoking, more males, low apgar, history of alte’s prone position
What is ATLE apparent life threatening event, episode frightening enough to cause apnea, cyanosis or pallor, change in muscle tone (limp)
What do most ATLE result from GI reflux, upper airway obstruction, congenital anomalies of airway or heart, infection
SIDS monitors for what apnea of 10-15 seconds, low or high HR
 
Question Answer
Questions to ask when obtaining Hx of Pediatric Pt acute, chronic, congenital anomalies, Immunization Hx, Family illness, exposure/living environment
History: Long term vent= predisposed to disease
Immunization history to r/o what disease and to isolate potential exposures
What do you look for in the chart? previous x-rays and lab results
Always do a _____ _____ before stimulation of physical exam visual assessment
HR: newborn to 3 mo mean 140
HR: 3 mo to 2 yr mean 130
HR: 2yr to 10 yr mean 80
HR:>10 years mean 75
Respiratory Rate is higher when ___ awake
RR: age 1 to 5= 30s
RR: age 5 and older= 20s
What 2 things do you assess when taking HR and RR? pattern and rate
9 factors that influence HR and RR: fear, anxiety, stress, pain, activity, temp, fatigue, meds, acidosis
12 Additional things to assess General appearance, LOC, Emotional status, Cyanosis, Perfusion, dyspnea, Clubbing, accessory muscle use, retractions, flaring, grunting, BS
In regard to emotional status, when do you allow the child to remain with the parent? if they have a patent/uncompromised upper airway
Clubbing indicates what kind of disease? chronic
What 2 things could cause cough an irritant of an infection
A child is unable to cough up mucus < __ years of age 6
Things a CXR can diagnose upper airway obs, foreign body aspiration, lung fields, atelectasis, fluid (chronic or acute disease)
3 Non-invasive monitors used for trending End tidal CO2, Transcutaneous, Pulse Ox
4 labs usually drawn upon admission to PICU Blood gas, Glucose, Blood cultures, Electrolytes
PFT’s can be done on children age __ and older 6
7 Types of patients that might benefit from PFT Asthma, CF, Scoliosis, CP, Spina Bifida, Cardiac, BPD
5 General considerations for pediatric PFT change may be result of growth, technical factors, adjustable equipment, unique training, and lab environment-remove fears
4 indications for pediatric PFT to identify disease (diagnose/quantify severity), monitor course of disease, effectiveness of Tx (bronchodilator), Pre-op planning
4 causes for metabolic acidosis lactic acid, diarrhea, ketoacidosis, ingestion of toxins
What 3 things cause increased lactic acid in blood? tissue hypoxia, sepsis, cold stress
4 causes of metabolic alkalosis vomiting, gastric suctioning, certain drugs, electrolyte disorder
What 3 drugs/types of drugs cause metabolic alkalosis NAHCO3, Diuretics, Steroids
4 causes for respiratory acidosis lung disease, impaired lung motion, apnea, neurologic/neuromuscular
5 causes for Respiratory Alkalosis Anxiety/fear/pain, CNS, Ventilator induced
What is Tracheal Tug? Suprasternal retractions
Retractions of the SCM cause this sign of respiratory distress head bobbing
Why do you use SATs instead of PO2 when assessing oxygenation of an infant? bc fetal Hgb causes high saturation with low PO2
Roughly ow long does it take for an infant to replace all Fet Hgb with normal Hgb? 6-8 months
Normal range for a Newborns (birth-24hr) ABG values: pH:7.3-7.4, PaCO2: 30-40; PaO2: 60-90; HCO3:20-22
Normal range for an infant-toddler (up to 2 yrs) ABG values: pH 7.3-7.4; PaCO2: 30-40; PaO2: 80-100; HCO3: 20-22
>2yrs old ABG values are the same as ___ adults
4 things to remember when utilizing ABGs to treat children always consider age of pt, disease, always remember days or months of illness, and always remember that oxygen is toxic to pediatric pulmonary tissue
Premature infants have a PaO2 closer to __mmHg 60mmHg
If a patient has a PDA how would you treat? keep PaO2 high to keep pt from reverting back to fetal circulation
Pt’s with chronic disease states may never reach “normal” ABG values, a CO2 level of __-__ is often reached before intubation 50-60
A common cause of BPD is long term vent use
2 preductal sampling sites Right radial and cephalic
5 post ductal sampling sites umbilical, Right and left pedal, and Right and left posterior tibial
1 varaible sampling site left radial
Where is the safe area of the heel for capillary sampling of an infant-<2yrs? sides of the heels
A pt must be at least __ yrs old to perform a fingerstick capillary stick on 2 yrs old
2 indications for capillary blood gas unable to obtain ABG (smaller patient), Need only pH and PaCO2
4 factors affecting accuracy of sample pressure to puncture site, inadequate warming, excessive crying, poor perfusion
Accuracy of capillary blood gas pH is within .02-.04
Accuracy of capillary blood gas PaCO2 is within 2.2 mmHg
Capillary PaO2 will never read higher than ___ even though actual value may be much higher 60
Describe how you would obtain a capillary blood gas use safe area, warm site, wipe with alcohol swab, puncture, wipe off first drop, collect, wrap site, ice sample or run it
2 Complications of Capillary blood gas procedure cellulitis and scarring
2 common errors when running CBG’s air bubbles, delay causes metabolism(O2 decreases CO2 increases)
4 criteria for an arterial blood gas site accessible, easy to palpate, easy to stabilize, superficial vessel
3 procedural steps for ABG assess collateral flow, a butterfly needle may be used, usually drawing otehr labs too
2 complications of ABG draw hematoma, infection
Equipment for patency of Arterial catheterization infusion pump for children <15kg that is volume measured (1cc/hr heparinized saline drip) or a pressure bag and flush for children >15kg
4 complications of Arterial catheter bleeding at site, bleeding back into tubing, infection, embolus
3 indications for umbilical artery catheter freq blood sampling of newborn, Bp monitoring, and exchange transfusions
Where on an xray will you see the Umbilical artery catheter? Low: Lumbar vertebra 3-4; High: Thoracic vertebrae 6-9; left side
4 Complications of umbilical artery catheter embolus, hemorrhage, infection, perforation
2 indications for umbilical venous catheter resuscitation and exchange transfusion
Placement of umbilical venous catheter on xray inferior vena cava(5cm or less), right side
3 most common arterial puncture sites in children and infants radial, pedal, posterior tibial
5 things to ask yourself when assessing a chest x-ray quality of film?, Correct patient position?, Where is teh tip of ET tube?, What other lines are present?, What do the lung fields look like?
How many ribs should be seen on CXR? 8th – 9th during inspiration
What does radiopaque mean? underexposed, white out, consolidation
What is radiolucent? overexposed, black appearance, free air
Other than looking at lung fields what 4 other things would you look for/at? diaphragm, pleural space, bones and soft tissue
To identify chronic changes in a pediatric patient what kind of xray would you look at to see classic signs lateral neck xray
The carina is located at T_-T_ therefore tip of ET tube should not be past T_-T_ 3-4; 2-3
This gland blends with the cardiac silhouette and is visible until age 2 thymus
If pt has RDS you may see what? air bronchograms near hilum
Why is the right dome of diaphragm higher? elevation by the large liver
Diaphragmatic hernias are __% on the left, look for bowel higher than diaphragm 90%
1. 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? recommend non invasive monitors like a pulse ox or transcutaneous oxygen monitors.
2. An 18-month-old patient brought to the emergency department is exhibiting signs and symptoms consistent with an acute asthma episode, and is administered a -agonist to which the patient does not respond favorably. Which conditions could be responsible for this patient’s problem? Aspiration of a foreign object
3. After increasing the level of CPAP delivered to an infant, the therapist notices that the neonate’s PaCO2 rises and the PaO2 falls. What may have caused this situation? -periods of apnea – may need mechanical ventilation to regulate more.
4. As the therapist applies a pulse oximeter finger probe to a neonate who is receiving supplemental oxygen, she notices that the SpO2 reading is 100%. What should the therapist do in this situation? The therapist should obtain an arterial blood sample from this patient
5. By what percentage does breath holding increase particle deposition in the lungs? 10%
6. 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
20
7. During volume-controlled ventilation, which of the following factors influences the peak inspiratory pressure? Pulmonary Compliance
8. The following capnogram was obtained from a newborn infant receiving mechanical ventilation. How should the therapist evaluate this capnogram? Airway obstruction
9. The following pressure-volume loop was obtained from a patient receiving mechanical ventilation in the pressure support mode. What type of problem does this ventilator graphic represent? -Insufficient flow caused by insufficient driving pressure
10. For which types of patients would using a dry powder inhaler (DPI) for medication delivery likely be contraindicated? A 4 year old child, an 85 year old patient with COPD and a teenager with AMS
11. How can a patient avoid the problem of terminating inhalation when a plume from a pressurized metered-dose inhaler (pMDI) impacts the oropharynx? Use a valved holding chamber
12. How is the percentage of functional hemoglobin that is saturated with oxygen determined via pulse oximetry? The ratio of the red and infrared light that reaches the photodiode signifies the SpO2.
13. How is the positive pressure level established in a bubble CPAP system? submerging the distal end of expiratory limb straight into water at a measured depth (cmH20)
14. How would tricuspid stenosis be expected to influence a patient’s CVP value? INCREASED CVP
15. 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? alternating puncture sites decreases the risk of hematoma formation
16. An infant demonstrates the following capnogram while being mechanically ventilated. How should the therapist interpret this? The patient may have developed a pneumothorax
17. A Maquet Servo 300A ventilator has been set in such a manner that the resulting inspiratory flow exceeds the maximal flow for the selected patient range setting. What type of alarm will be activated?
18. The NICU RT supervisor is observing a therapist obtaining an ABG 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? allow the therapist to continue – this is correct technique
19. On the basis of clinical evidence, which medications appears to best relieve reversible airflow obstruction occurring in patients with chronic obstructive pulmonary disease (COPD)? Ipratropium Bromide
20. On the basis of the following flow-time scalar, which of the following conditions has developed? Auto PEEP
21. On the basis of the following pressure-volume loop, what ventilator setting change should the therapist make? -Increase the inspiratory flow
22. On the basis of the following waveform, in which anatomic locations is the distal tip of the pulmonary artery catheter located? Right Ventricle
23. On the basis of the following waveform, in which anatomic locations is the distal tip of the pulmonary artery catheter located? Pulmonary Capillary Wedge
24. On the basis of the following waveform, in which anatomic locations is the distal tip of the pulmonary artery catheter located? Pulmonary Artery
25. On the Maquet SERVO-i, what is the result of increasing the “inspiratory cycle off” settings? Enables expiration to occur at an earlier point in the peak flow requirements.
26. Over the last 90 minutes, the therapist has obtained three arterial blood samples from an arterial line inserted in a neonate receiving mechanical ventilation and being monitored by capnometry. The PaCO2 values were as follows: (1) 47 mm Hg, (2) 46 mm Hg, and (3) 47 mm Hg. How should the therapist evaluate the following capnogram? -Reduced pulmonary blood flow caused by overdistension of the lungs
27. 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? 83.3
28. A patient is about to be switched from a conventional mode of ventilation to inverse ratio ventilation. What should the therapist recommend for this patient before instituting this mode? That the patient be sedated and paralyzed
29. A pediatric patient with an inspiratory flow of 20 L/minute enters the emergency department wheezing and short of breath. Which devices would be most efficacious for delivering a bronchodilator? SVN
30. The physician asks the therapist to recommend a long-acting -agonist for a patient. Which of the following medications should the therapist recommend? Formoterol
31. The physician in the emergency department is attending to a 12-year-old child who has an exacerbation of asthma. The physician asks the therapist to recommend a medication that has a synergistic effect with -agonists during asthma exacerbations. Which medications should the therapist recommend? Ipratropium Bromide
32. Pirbuterol is known by which of the following brand names? MaxAir
33. Pneumatic nebulizers operate according to which of the following physical tenets? Bernoulli Principle
34. The therapist has applied a bandage-type pulse oximetry probe too tightly to an infant’s finger. What problem can be expected to occur in this situation? The monitor displays a message indicating inadequate pulse
35. The therapist is about to mechanically ventilate a neonate with a ventilator that delivers the volume guarantee mode. Which of the ventilator settings does the therapist need to set for this mode? Vt, I Time, Inspiratory Flow
36. The therapist is assessing a mechanically ventilated infant and observes that the transcutaneous electrode temperature is set between 43º C and 44º C. What action does the therapist need to take at this time? The temperature range set is appropriate; therefore, no action is necessary
37. The therapist is conducting a ventilator check for a neonate and makes the following notations on the ventilator flow sheet:
PEEP: 5
PIP: 25
Mand. Rate: 15
FiO2: 0.35On the basis of these observations, what should the therapist recommend for this neonate?
-Wean from mechanical ventilation
38. The therapist is initiating mechanical ventilation for a 12-year-old patient who has status asthmaticus. Which modes of ventilation is most appropriate for this patient at this time? Time or patient triggered pressure control ventilation
39. The therapist receives an order to administer a bronchodilator in-line to an infant receiving mechanical ventilation. The order also indicates that the nebulizer must not significantly increase the patient’s delivered tidal volume. Which aerosol delivery devices should the therapist select? Vibrating mesh neb, pMDI and Ultrasonic neb
40. The therapist would like to achieve an arterial oxygen tension (PaO2) of 85 mm Hg in an infant who has a PaO2 of 75 mm Hg with a stable arterial carbon dioxide tension (PaCO2) and stable lung conditions. This patient has the following ventilator settings:
RR 25
Vt 150ml
Insp Flow 60L/min
FiO2 0.60Determine FIO2 that needs to be set on the O2 blender required to achieve a PaO2 of 85mmHg
0.68
41. Twenty-four hours ago, a hospitalized pediatric patient was prescribed theophylline. The patient’s first dose at that time was 5.0 mg/kg. The patient has an oral dose of 2.5 mg/kg in hand and asks the therapist if the dose is correct. What should the therapist do at this time? Give patient medication – this is the correct dosage
42. What event or activity is represented by the wavy lines appearing on the following capnogram? Cardiac Oscillations
43. What FIO2 should a patient receive when CPAP is initiated? -same FiO2 pt was on before initiation of CPAP
44. What is the average range of normal circulating blood volume in a neonate? 85-90mL/kg
45. What is the potential problem associated with the use of methylprednisolone in neonates? Gasping Syndrome
46. What is the purpose of the optional open lung tool on the SERVO-i ventilator? To assist in determining the inflating and deflating pressure in the lungs.
47. What is the set flow in an Infant Flow CPAP system based on? -the flow of gas through the solenoid valve
48. What percentage of the nominal dose would remain in the nebulizer if the nebulizer had a residual volume of 1 ml and a fill volume of 2 ml? 50%
49. What settings require that the patient breath spontaneously? PS and CPAP
50. When airway pressure release ventilation is used, what physiologic process occurs as the higher pressure is released and the lower is achieved? Exhalation of Carbon Dioxide
51. Where can a therapist obtain an arterial blood sample from a neonate for acid-base and blood gas analysis? dorsalis pedis, posterior tibial, femoral, brachial, ulnar, radial ,axillary, temporal
52. Where in the CPAP delivery system should the pressure-relief/pop-off valve be situated? -as close to the patient’s airway as possible.
53. Where on the following normal capnogram is the end-tidal carbon dioxide (PetCO2) represented? D
54. Which adverse effects are likely to be experienced by patients who use nonselective -adrenergic agonists? Tremor, vasodilation, tachycardia, headache, nervousness, dizziness, palpitations, cough, nausea, vomiting, throat irritations.
55. Which anatomic structures has been shown to break down because of the use of nasal masks associated with IF-CPAP? nasal septum
56. Which arterial blood values reflects ventilatory failure? -decreasing pH below 7.25, CO2 greater than 60, FiO2 requirement exceeding 0.6 to 0.7 with PaO2 less than 50 to 60 mm Hg.
57. Which arteries are considered the optimal puncture site for obtaining arterial blood samples from neonatal and pediatric patients? radial artery
58. Which arteries are involved when the modified Allen’s test is performed, using a foot as the potential arterial puncture site? dorsalis pedis and posterior tibial arteries
59. Which characteristics of an aerosol influence(s) its ability to penetrate a mucous barrier? Solubility of the aerosol particles, change of the aerosol particles, size of the particles
60. Which complications are associated with the insertion of a pulmonary artery catheter? Bleeding, pneumothorax, tricuspid/pulmonic valve damage, RA or RV perforation, and arrythmias.
61. Which complications of CPAP can develop when an infant experiences inadvertent positive end-expiratory pressure (PEEP) from gas trapping resulting from tachypnea? Pneumothorax
62. Which conditional variables can most easily become the baseline variable? pressure is the easiest
63. Which conditions are contraindications for nasal CPAP? -upper airway abnormalities, untreated congenital diaphragmatic hernia, neuromuscular disorders, CNS depression meds, central or frequent apneas.
64. Which conditions can cause methemoglobinemia? Nitric containing molecules in medications and therapeutic gases
65. Which considerations is most important when using a large-volume nebulizer to provide oxygen and humidification to an infant in an incubator? Preventing a high noise level from developing
66. Which CPAP systems delivers a more consistent pressure, lowers work of breathing (WOB), is less sensitive to leaks, and is more effective at alveolar recruitment compared with other forms of CPAP? IF-CPAP
67. Which effects are related to activation of β-adrenergic receptor sites? Activation of adenyl cyclase, which increase the production of cAMP. This increase results in bronchial smooth muscle relaxation and skeletal muscle stimulation. Inhibits the release of inflammatory mediators through stabilization of the mast cell membrane.
68. Which effects constitute adverse reactions to recombinant human deoxyribonuclease I (rhDNase)? Voice alteration, pharyngitis, laryngitis, rash and chest pain.
69. Which factors increase the rate of inertial impaction of particles greater than 2 µm in diameter? Bifurcations and Obstructed Airways
70. Which factors influence the central venous pressure (CVP) measurement? mechanical ventilation and hypervolemia, interference of RV ability to pump blood = higher CVP, hypovolemia = lower CVP
71. Which factors influences the gas volume compressed in the ventilator circuit? -Water level in the humidifier
72. Which factors would adversely affect the correlation between arterial puncture measurements and those from a capillary sample? capillary PO2 is lower than the PO2 in arterial draws
73. Which features are often components of CPAP systems incorporated within infant ventilators? -apnea backup rate, leak compensation capabilities, highly responsive demand flow system.
74. Which features or characteristics apply to mainstream capnography? Mainstream capnography generally employs infrared spectrometers and the mainstream capnograph is placed at the proximal end of the ET tube.
75. Which form of CPAP is associated with a “thoracic wiggle”? -bubble nasal CPAP
76. Which functions are served by spacer and holding chambers in conjunction with pMDIs? Reduction in oropharyngeal deposition of drug, elimination of the cold Freon effect, and improvement in lower respiratory tract deposition
77. Which mechanism is the primary mechanism for deposition of particles with a diameter of 5 µm or greater? Inertial Impaction
78. Which medications is most suited for the treatment of postextubation edema? Racemic Epinephrine
79. Which medications is the only drug that inhibits 5-lipoxygenase? Zieleuton (Zyflo)
80. Which medications works to maintain the integrity of the mast cell? Cromolyn Sodium
81. Which methods is/are acceptable for delivering a drug via a pMDI to an intubated neonate receiving mechanical ventilation? Chose the best answer. In-line with the ventilator and through a resuscitation bag
82. Which modes of ventilation attempt to maintain a minimal target tidal volume with a constant pressure by manipulating the inspiratory flow? PRVC
83. Which motor and linkage mechanisms are used in ventilator compressors? -Pistons and cylinders, diaphrams, bellows and rotating vanes
84. Which of the following factors is the main physiologic factor responsible for deriving accurate transcutaneous data? Peripheral perfusion
85. Which outcomes are advantages of CPAP over mechanical ventilation in infants? -fewer nosocomial vent related infections, lower incidence of intraventricular hemmorhage, fewer incidents of retinopathy of the newborn.
86. Which physiologic effects are generally associated with the use of CPAP for the treatment of respiratory distress syndrome (RDS)? -stabilized chest wall, increased FRC
87. Which pulmonary artery catheter waveforms represents the catheter’s normal location? Pulmonary Artery Waveform
88. Which responses are considered adverse effects of inhaled corticosteroids? Oropharyngeal candidiasis, dysphonia, cough, dry throat, increased wheezing
89. Which statements accurately describe levalbuterol?
90. Which statements characterize a ventilator’s control scheme as closed loop? -Output variable is measured and compared with reference. Input is modified as needed.
91. Which statements describes the pressure-limited ventilation (PLV) mode available on the Dräger Medical Evita 4 ventilator? can be used to modify mandatory breaths in the CMV, SIMV, and MMV modes
92. Which statements refers to the Puritan Bennett 840 ventilator when it is set to deliver a flow-triggered breath? The ventilator deliver a base gas flow through the patient circuit during the expiratory phase of all breaths. The base flow is equal to the flow set as the trigger sensitivity plus 1.5L/min. As the patient breaths from the base flow, the vent detects a difference in the inspiratory and expiratory flow measurements. Flow triggering occurs when this flow differential equals the value set as the trigger sensitivity. (0.1-20L/min)
93. Which terms best describe(s) the activity of aerosol particles less than 3 µm in diameter throughout the distal airways? Brownian Movement
94. Which terms describes the rate of increase in airway pressure from baseline at the onset of inspiration? Pressure Rise Breath
95. Which terms is used to describe the variable responsible for initiating inspiration? Trigger (pressure, flow or volume)
96. Which terms is used to describe the variable that is responsible for terminating inspiration? Cycle (pressure, flow or volume)
97. Which terms is used to describe the variable that reaches a preset value before the end of inspiration? Limit (pressure, flow or volume)
98. Which therapeutic interventions would be appropriate for a neonate with a respiratory rate of 65 breaths/minute while displaying paradoxical chest wall movement with suprasternal and substernal retractions, grunting, nasal flaring, and cyanosis, along with the following blood gas data: pH 7.30; arterial partial pressure of carbon dioxide (PaCO2), 50 mm Hg; arterial partial pressure of oxygen (PaO2), 60 mm Hg? CPAP
99. Which valves function as output control valves? -Inspiratory flow valves and exhalation valves
100. Which variables is the control variable when both the volume and pressure waveforms vary considerably when the patient’s lung compliance and airway resistance change? Time
101. Which ventilator settings are preset during time-cycled, pressure-limited ventilation? I Time, RR, I:E Ratio
102. While attending to a neonatal patient in the neonatal intensive care unit (NICU), the therapist notices that a transcutaneous electrode is affixed to the upper chest of the neonate. What should the therapist do at this time? The therapist should do nothing because the transcutaneous electrode is properly placed.
103. While checking the ventilator of a pediatric patient, the therapist observes the following volume-time scalar: -Increase both inspiratory flow and pressure setting.
104. While nebulizing albuterol to a patient via a small-volume nebulizer, the therapist hears a sputtering sound originating from the nebulizer. How should the therapist respond to this situation? Terminate the treatment at this time
105. While working at the bedside of a small child who has myasthenia gravis, the therapist notices a new medication order prescribing glycopyrrolate (40 mc/kg four times a day) for the control of secretions. What should the therapist do at this time? Inform the nurse that this is contraindicated for patients with myasthenia gravis.
106. While working in the NICU with a mechanically ventilated newborn who is being monitored for PetCO2, the therapist observes the following capnogram. What interpretation should the therapist make? The patient is rebreathing his own exhaled gas
107. Why are pass-over humidifiers preferred over pneumatic nebulizer humidifiers? Pass overs transmit fewer pathogens than pneumatic nebs.
108. Why do transcutaneous oxygen tension (PO2) and carbon dioxide tension (PCO2) values differ from PaO2 and PaCO2 measurements? Because metabolism in the tissue consumes oxygen and produces carbon dioxide at the site of the electrode
109. Why should pMDIs containing steroids be used with a valved holding chamber? To reduce the risk of oral yeast infections
110. With an umbilical artery catheter (UAC) in the “low position,” which of the following blood vessels are avoided? UAC is placed between the renal artery and aortic intersection, and avoids the large tributaries supplied by those vessels to minimize trauma of the vital organs.