Question Answer
Normal PH in a child is 7.35 to 7.45, acceptable is 7.3 to 7.5
Normal PaCO2 is 35- 45 greater than 60 is chronic range
PaO2 normal range is 85- 100, 50 to 70 is safe in neonate
HCO3 normal is 22-26 (blank)
SPO2 must be at what above 92 percent
Signs of Hypoxemia in newborn are Pao2 less than 60 or SPO2 less than 90 on room air
Goal of O2 therapy in peds is adequate tissue oxygenation at lowest FIO2
Primary indication for O2 therapy is documented hypoxemia
Signs of respiratory distress are retractions, expiratory grunting, nasal flaring, cyanosis, tachycardia, tachypnea
A score of 2 on silver Anderson means what severe resp distress
Common clinical conditions with hypoxemia are post op pts, CO poisoning, cyanide poisoning, trauma, shock, acute MI
Hazards of o2 therapy are O2 toxicity, atelectasis, override hypoxic drive, ROP RLF, Fip Flp
What is flip flop potential complication with newborns on O2, drop in PaO2 when FIo2 is lowered, then no improvement when FIo2 back up, fix with smaller changes in FIO2
what is a blender mixes O2 and air from 50 PSI to manageable pressure, mixed on front dial to precise FIO2, uses flowmeter and LVN
oxyhood or headbox uses what fio2 50 or less
what gas source is used for an oxyhood blender and heated LVN
what is the liter flow for an oxyhood and why 7 lpm, to blow of co2
where and why do we always analyze co2 in an oxyhood or other equipment that covers a babies face? Close to babies face, as FIO2 can layer (blank)
what are the hazards of oxyhoods gas flow to low, temp to high or low, always monitor
what are the flow rates for a pediatric nasal canula .25 to 1.0
what is the fio2 for a pediatric nasal canulla 24 to 35 percent
hazards of O2 masks are aspiration of vomit, skin necrosis, decreased FIO2 if mask loose, CO2 retention if low low, minimum flow 5 liters
when do we use a tent for croup, cool mist in O2 rich environment, never with asthma
hazards of tents fog, fire, overhydration, bacteria
what is the fio2 of a self inflating resuscitator bag 80 to 100 percent
what is the fio2 of a flow inflating resuscitator bag 100 percent, needs manometer so not to over inflate lungs
SVN delivery for kids under 3 facemask or blowby
MDI spacers are best for what age over 3 years
MDI with space and face mask with what age under 3
Advantages of MDI are portable, efficient drug delivery, short prep and delivery, great inline, doesn’t stick
Disadvantages to MDI are coordination, fixed concentrations, limited drug choice, propellant allergies, aspiration of foreign body
DPI is only good for pt over what age 6 yrs
What is a SPAG small particle aerosol generator, special neb for Ribavarin, 2 gas sources, flow must be 7 no more than 15 for both. Caution to caregiver and clogged valves
The 6 rights to meds are TRAPDD, Time, Route, Approach, Person, Dose, Drug
CPT indications are retained secretions, excessive secretions, aspiration, prophylaxis ie postextubation (blank)
Signs to watch for in CPT rr and depth apnea in infants, hr and arrhythmias, aspiration, color, bs before and after, airway patency collapse in neonate, over mobilization of secretions, abg decreased spo2, ICP, mental status
Contraindications to CPT hypoxemia (all), vomiting and aspiration (PD)
How much can a child weigh before we do positions over 1500 g or 3 lbs
How do we remove secretions from older kids FET
How do we remove secretions from younger kids oral or nasal sxn
PEP for older kids is done how mask or mouth piece for 10 pep breaths then one 1 or 2 huff coughs for 10 to 15 mins, press is 10-20 cmh20
High frequency chest compressions is what jacket or vest
Flutter press is what 10-25
Clinically RT will see what and know suctioning is needed decreased chest excursion, rhonchi and or course crackles on auscultation, secretions in ETT
Increased secretions causes what increased Raw which decreases airflow and decreases ventilation
Suction Catheter equation 2 x ID of ETT then down one size so , a #4 ETT would be 2×4 is 8 so catheter size is 6 (blank)
Non intubated preemie catheter size is 5-6
Non intubated newborn catheter size is 5, 6 -8
Non intubated newborn to 6 months catheter size is 8-10
How far do we insert the catheter to the tip of the ett or ntt, add 4 cm to cm mark on tube
Steps to suctioning are 1. hyperoxygenate (1 min at 10 to 15 great fio2) 2. insert cath, 3. Press newborn 50 to 80 peds 80 to 100, 4. Rotate and withdraw less than 10 seconds
Suction pressure for newborns is 50 to 80
Suction pressure for peds is 80 to 100
Hazards of suctioning are primarily bradycardia caused by vagus nerve or hypoxemia, others are mucosal damage and atelectasis, airway contamination, extubation, mucosal plugging
When is CPAP used used in spontaneously breathing infants and children with rds or ards
What does CPAP do increases FRC to prevent atelectasis in ARDS increases CL decreases Raw decreases RR
How is CPAP administered in neonates and infants ETT and nasal prongs, ETT in children
What are the indications for CPAP decreased FRC due to pneumonia, atelectasis, pulmonary edema, or airway collapse or weaning from vent, abnormal abg pao2 below 50 on fio2 of 60 or resp distress like hypoxia, tachypnea, etc
What are normal pressures for cpap in peds 5 to 10 and same fio2
What are hazards of cpap misapplied level of cpap can cause hypoventilation resp acidosis decreased CO due to decreased venous return and air leak
Pediatric resuscitation ABC’s are airway, breath, check pulse (no pulse start compressions)
Pals resuscitation drugs are epi, adenosine, bicarb, glucose (aka D25), albumen
Defibrillation in children to calculate jules is 2 jules per kilo
Question Answer
PA pressure that exceeds aortic pressure PPHN
PDA is essential for survival in which congenital defect Transposition of the great vessels
Aorta and PA are reversed, 2 parallel circulations are created and tere is sever cyanosis. What disease is this Transposition of the great vessels
Ground glass on chest CXR in infants usually indicated what diesease RDS
This disease on CXR comes from ground glass into? BPD
What is true of epigolttitis? It is a life threatening disease
What do we look at for an APGAR Appearance (color), Pluse (HR), Grimace (reflex), Activity (muscle tone, Respirations (efficency)
Epiglottitis is inflamation of what superglotic structure
What surges at 35 weeks lecithin
in a fetus SVR ? PVR ? SVR-increases PVR-decreases
1 hz = 60 breaths
Normal RR for infant 30-60
What is the primary surfactant Lecithin
Bronchiolitis is most often casued from RSV
Delivery of NO will do what to afterload decrease
When would we use ECMO only for a reversible condition to buy more time
When would you expect to find a PDA PPHN
Symptom of epiglottitis Drooling (not stridor or barky cough)
How would you manage laryngotracheobronchitis? steroids, coolmist, rac.epi
what type of shunt is atrial septal defect L ot R shunt
L/S ratio of 5:1 indicates risk of RDS
Name 3 things present in TOF pulm stenosis, VSD, overriding aorta
Hyperoxia test shows PaO2 of 450, what does it indicate L ro R shunt – acyanotic
Pt with TGV on 100% O2 will have no effeect on cyanosis
Surfactant begins during what stage of lung development Term sac
Question Answer
At what stage of embryologic development does the ovum enter the uterus? morula
The respiratory system arises from what germ layer? endoderm
The earliest development of the lung begins at: 24 days
Dichotomy of the airways occurs during which phase of lung development? pseudoglandular
What best describes surface tension? the tendency of a liquid surface to contract inward. Like molecules attract each other and pull together
What is found in the amniotic fluid that is the best indicator of fetal lung maturity? PG
What does not appear to accelerate fetal lung maturation? Maternal preeclampsia
Lung fluid characteristics of a fetus… There is approximately 20 to 30 ml/kg present at birth, It has lower pH, protein, and bicarbonate levels than amniotic fluid, It maintains the patency of the developing airways.
What may occur following Cesarean section? TTN
The heart develops from which germ layer(s)? mesoderm
The embryologic truncus arteriosus develops into: The pulmonary artery, The aorta
Describe the path of blood that is shunted through the foramen ovale. From the right atrium to left atrium
The ductus arteriosus shunts blood from: The pulmonary artery to the aorta
“Baroreceptors are actually_______________” stretch receptors
In the placenta, the fetal vessels are contained in the: Chorionic villi
Identify the umbilical vein(s): the larger floppy vessels w/ thin walls are housed w/in the Wharton’s jelly along w/ the two smaller and thicker walled arteries.
Polyhydramnios is defined as: An excessive amount of amniotic fluid
What are some possible causes of polyhydramnios? Hydrocephalus. Esophageal atresia, Down syndrome, Cleft palate
Assessment of the fetus in the first trimester is facilitated by what technique? Transvaginal ultrasound
What cannot be detected by ultrasound? Presence of infection
What can be detected by an ultrasound? Position of the fetus, Position of the placenta, Volume of amniotic fluid
A high level of alpha-fetoprotein (AFP) found during amniocentesis indicates: Neural tube defect (Low AFP indicates Down syndrome)
What test done on amniotic fluid is used to help determine fetal kidney maturity? Creatinine levels
Monitoring of the fetal heart rate during labor and delivery is used to detect: Uterine contractions, Rupture of the amniotic sac, Compression of the umbilical cord, Bradycardia secondary to a vagal stimulus
The most accurate method of measuring fetal heart rate is: Fetal scalp electrode
A common cause of fetal bradycardia is: asphyxia
Type III decelerations are caused by what? Compression of the umbilical cord
What fetal scalp pH is the lower limit of normal? 7.25
A woman presents in her physician’s office for an examination. The first day of her last menstrual period was October 21. Fundal height is 25 cm. What would be the estimated date of delivery? July 28
What is the approximate gestational age of the fetus in question whose fundal height is 25 cm? 25 weeks
A fetus suffering prolonged hypoxia will demonstrate: A negative NST and positive CST
Give some true statements regarding fetal movements? Fetal movements show the greatest activity between 28 and 34 weeks, Fetal distress and stillbirth are common findings when the fetus is inactive, Movement has been detected as early as 7 weeks gestation.
What are part of the biophysical profile? Nonstress test, Fetal movement, Amniotic fluid volume
What involves removal of a fetal blood sample while still in utero? cordocentesis
When measuring maternal estriol levels, fetal distress is indicated when: Estriol levels decrease 50 to 60% in maternal urine
What are some factors of maternal history places the fetus at high risk? Previous miscarriage, Previous premature delivery, Maternal obesity
What are the five events that make up the birth process? Rupture of the membranes, Dilation of the cervix, Contraction of the uterus, Separation of the placenta, Shrinking of the uterus
At a dilatation of 5 cm, the cervix is: One-half dilated
The most common fetal presentation is: vertex
The head is said to be engaged in the birth canal when a station of___is reached. 0
Actual delivery of the fetus takes place during the second stage of labor and normally does not exceed: 2 hours
What drugs are used as a tocolytic? Magnesium,Terbutaline, Ritodrine, Nifedipine
Dystocia could result from? Breech presentation, Cephalopelvic disproportion, Uterine dysfunction
Vaginal delivery of the fetus is nearly impossible in _______ position? Transverse lie
A complete coverage of the cervical opening by the placenta is called: Total placenta previa
Substantial separation of the placenta from the uterus w/ no visible bleeding is called: Abruptio placentia
What are some indications for performing a cesarean delivery? Fetal distress, Cephalopelvic disproportion, Severe maternal preeclampsia
What factors explain why the mortality rate of multiple gestations is increased? An increased incidence of: Premature labor, Congenital abnormalities, Bacterial infections, Hypoglycemia
The most powerful influence on the initial breath is: asphyxia
Each breath subsequent to the first breath requires less negative pressure due to: Establishment of the FRC
Clamping of the umbilical cord results in: Raising the neonate’s arterial pressure
Blood flow through the foramen ovale normally ceases when: Left heart pressure exceeds right heart pressure
What are some anatomic and physiologic differences between adults and infants? Infants have a proportionally larger tongue, larger epiglottis, larger body surface area, it’s trachea is only a third the diameter of the adult’s and have a higher oxygen consumption.
What are some objectives signs that are included in the Ballard gestational age assessment? Ear recoil, sole creases, skin appearance, and presence of lanugo.
Upon examination of newborn, you find thick vernix covering the infant, gelatinous translucent skin, thick lanugo over the body, faint red lines on the soles of the feet, flat areola w/ no bud, slow ear recoil, a male genitalia that shows no scrotal ruga 26 – 28 weeks
What is done during the quiet examination? Assess skin color, Observe overall movement and muscle tone, Inspect the overall look of the pt., Observation of respiration
Increased ICP is indicated when: Fontanelles are bulging and tense
A pediatric pt presents w/ a history of a dry, nonproductive cough. You would suspect what? May be from an allergy, virus or foreign body aspiration
When assessing a pediatric pt, you discover that the pt has a rapid bounding pulse, confusion, and muscular twitching. What is suspected? hypercarbia
What are some indications to performing PFTs on a neonate or pediatric pt? Diagnosis of lung disorders, Follow the natural history of lung diseases and/or lung growth, Evaluation of therapeutic responses, Prediction of subsequent dysfunction.
Why are some results due to inaccurate pleural pressure readings when an esophageal balloon is used? Cardiac artifact, Paradoxical chest movement, REM sleep
Body plethysmography uses what gas law to measure gas volume? Boyle’s law: P x V – P1 x V1
An accurate PFT study done on a pediatric pt is mainly dependent on: Cooperation and maturity of the pt.
What are indications for CPT? Asthma, Atelectasis, Cystic fibrosis, Prolonged bed rest, Ventilator care
To ensure maximum effectiveness, PEP should be followed by what technique? FET
What is part of traditional CPT? Auscultation; postural drainage; percussion; vibration; and removal of secretions
What modality of aerosolized medication requires the least amount of pt coordination? SVN
What are indications for aerosolized medication therapy? Decreased breath sounds; decreased chest expansion; presence of wheezes and retractions; increased respiratory rate; nasal flaring; grunting; increasing ventilatory pressures; increasing FiO2 requirements and an increasing PaCO2.
One advantage to the mainstream nebulizer is that: Does not require additional tubing and is designed to be used in the horizontal position.
Placement of a medication nebulizer in the ventilator circuit between the humidifier and the distal temperature probe may cause: Overheating of the circuit when the nebulizer is removed
What could be considered hazards of aerosol drug therapy? Nosocomial infection, Medication side effects, Drug reconcentration, Ventilator malfunction, Excessive noise.
What is an advantage of MDI therapy? Fixed drug concentrations
The greatest hazard associated w/ the aerosolization of Ribavirin into a ventilator circuit is: Precipitation and accumulation of the drug on vent tubing and ETT
While suctioning the endotracheal tube following a CPT tx, the pt becomes bradycardic. What should the RCP do? Stop the procedure, hyperoxygenate the pt, and shorten the duration of suction w/ subsequent attempts.
The main indication for oxygen administration is: hypoxemia
Gaseous oxygen supports and intensifies combustion.
The type of flowmeter often found on cylinder regulators is the: Bourdon gauge
A bubble humidifier is best used w/ what type of oxygen administration device? cannula
A physician orders a pediatric pt to be on an FiO2 of 0.35. What device would best deliver the ordered FiO2? Simple mask at 6 L/min
Oxygen consumption is lowest in the neonate at what temperature range? 36-36.5 oC (Dottie says it is 36.5-37)
What is involved in nonshivering themogenesis? Norepinephrine, lipase, nonesterified fatty acids
Premature newborns have a decreased ability to maintain body heat. What are some reasons for that decreased ability? Large body surface area, Decreased amount of subcutaneous fat, Thin skin, Preemies have a lower thermoneutral environmental temperature ,And a reduced ability to intake calories.
A small preemie is placed on a warming mattress inside an incubator lined w/ aluminum foil. The environmental temp is maintained at 33oC. Flow to the resuscitation bag is turned on inside the incubator w/ the flow of gas passing over the infant’s head. Convection
Thin initial response of a neonate to cold stress is: Peripheral vasoconstriction
Radiant heat loss following delivery can be minimized by: Wrapping pt in a warm blanket, Placing a cap on the pts head
What is an advantage to using an open warmer? Ease of pt access
A baby who is being over-stimulated may show signs: Hiccoughs
An important part of environmental control is: “Quiet-time”
What are skin care recommendations for premature neonates? Use pectin-based adhesives between the skin and tape, Use Coban wraps to hold TCMs on the skin
What may cause abnormalities of fluid and electrolyte balance in neonates? Maternal IV therapy, Asphyxia, Sepsis, Endocrine disorders
The percentage of ICF that comprises TBW passes and exceeds the percentage of ECF at what approximate age? 3 months
Excessive intake of sodium in the postnatal period would lead to: Delayed contraction of the ECF
Sodium and water balance are primarily affected by: Urine losses
What would indicate a fluid deficit in a neonate? Decreased skin turgor, Sunken anterior fontanelle, Increase in suture overlap
What would most greatly increase insensible water loss? The presence of RDS
A pt w/ a diminished clotting mechanism would possibly have an imbalance in which electrolyte? calcium
A neonate appears clinically w/ jitters, irritability, apnea, and seizures. The probable cause is: hypocalcemia
A term neonate has an indirect bilirubin level of 5 mg/dl. The following day, the level has risen to 9 mg/dl. You would: Start phototherapy
The initial sign of NEC is: Guaiac-positive stools
Drug transfer across the placenta is affected by what? Concentration difference, lipid solubility of the drug, degree of ionization, molecular drug weight
Teratogenic drugs generally have their greatest effect during: The first trimester
A lipid-soluble drug has what characteristics? Readily cross cell membranes, high affinity for protein binding
What are types of biochemical reactions of drug metabolism in the liver? Excretion
Antibiotics, which is considered to be bateriostatic? Tetracycline
Drug for CHF? Digoxin
Drug for Supraventricular tachycardia? Adenosine
Drug for Severe hypotension? Dopamine
Acute bronchospasm would best be treated w/ what drug? Albuterol
Neonatal apnea is treated w/: Caffeine
What best describes the effects of Glucocorticoids? Stabilizes cell membranes, inhibits macrophage accumulation, and promotes gluconeogenesis
The drug that inhibits mast cell degranulation is: Cromolyn sodium
What would be the drug of choice in sedating a neonate following surgery? Morphine sulfate
Restlessness, irritability, tremors, high-pitched cry and vomiting are all signs of: Fetal drug w/drawal
What would be an indication for obtaining a blood gas sample? Significant blood loss
What are some common sites used to obtain ABG’s in neonates? Umbilical artery, radial artery, and capillary
In the presence of right-to-left shunting of blood through the ductus arteriosus, arterial blood from the UAC would show: A low arterial PO2
The complication of necrotizing enterocolitis is most prevalent in what blood gas access site? Umbilical artery
Reliable values obtained from capillary samples require what? Consistency in the technique
What best describes PaO2? The pressure of oxygen dissolved in plasma
Define alveolar ventilations? Minute ventilation minus deadspace ventilation
As respiratory rate increases at a static tidal volume, what can occur? PaCO2 decreases, Alveolar ventilation increases
At a pH of 7.40, what ratio represents the correct balance of bicarbonate to dissolved carbon dioxide? 20:1
In the presence of respiratory acidosis, what is the amount of bicarbonate the body retains for each 1 mm Hg increase in PaCO2? 0.1 mEq/L
Carbonic acid is formed by a combination of: HCO3- and H+ ions
NaHCO3-, if given too rapidly, could lead to: Diminished PaO2
The purpose of heating the skin at the attachment site of the TCM is to: Increase the perfusion to the area
What factors would cause PtCO2 to measure lower than actual arterial PO2? Shock, severe acidosis, skin edema, severe anemia
The greatest hazard associated w/ transcutaneous monitors is: Thermal injury
What would cause erroneous pulse oximetry readings? Presence of carboxyhemoglobin
A major disadvantage of mainstream end-tidal CO2 monitor is: Accidental extubation
The greatest effect on the end-tidal CO2 monitor is exerted by: Deadspace ventilation
An increasing PetCO2 may indicate: Worsening V/Q ratio, Improvement in alveolar deadspace disease
The underlying etiology of RDS is: Surfactant deficiency
What are complications of RDS? DIC, Intraventricular hemorrhage, Infection and PDA
Oxygen toxicity, barotrauma, PDA and fluid overload are all linked to the development of: BPD
What is likely to be used when treating complications of BPD? HFV, Theophylline, diuretic
The radiographic picture of Wilson-Mikity syndrome appears similar to: BPD
What best defines vaso-obliteration? Necrosis of retinal vessels
Prevention of ROP is based on: Cautious use of oxygen
Intraventricular hemorrhage in premature neonates occurs most often in the: Germinal matrix
Bleeding in the brain ventricles, w/o evidence of ventricular dilation, describes: Grade II IVH
One of the initial signs of fetal asphyxia is: bradycardia
Meconium passage into the amniotic fluid is precipitated by: asphyxia
Intubation of the trachea, followed by suction applied to the endotracheal tube while it is being removed, is indicated when: Thick meconium is present in the amniotic fluid
A ventilator pt’s status suddenly worsens w/ bradycardia, cyanosis, retractions, and apnea. The immediate reaction of the respiratory care practitioner would be: Check for signs of extubation followed by transillumination of the chest
PIE can best be treated by: Low ventilatory pressures
A pt is suspected of having PPHN. What is the most accurate test to make the diagnosis? The Hyperoxia-hyperventilation test
What is a risk of treating PPHN w/ NO? methemoglobinemia
What are indicative of TTN? Tachypnea, cyanosis, and normal PaO2 and PaCO2
What are some causes of central apnea? Blunted chemoreceptor sensitivity, stimulation of airway reflexes, and dysfunction of the respiratory centers
What drugs would be used to tx central apnea? caffeine
While performing an initial assessment on a newborn infant, the respiratory care practitioner notices that the entire body is blanched and pale w/ a rapid heart rate. This is most consistent w/: Hypovolemic anemia
A history given for her first prenatal examination reveals the following info: 23 years old, Unwed, Lives on low-income housing, Native American. What factors would be considered a high-risk factor? Marital Status, Living Conditions, Ethnicity
What are some indications for the administration of a bronchodilator? Decreased chest expansion, Wheezes, Increasing ventilator pressures
12 year old pt has been hospitalized for 4 weeks for tx of head injury. The pt received tracheostomy 24 hours previously. The following information is available: Retractions, Auscultation reveals Coarse rhonchi. What would be the most appropriate action? Suction the pt’s airway.
A transcutaneous PO2 monitor is being used on a 32-week neonate. The RCP notes that the TcPO2 is consistently lower than the actual PaO2 and the monitor does not trend w/ PaO2. What may be the cause(s) of this inconsistency? Inappropriate electrode temperature. Pt has a compromised hemodynamic status. There is excessive pressure on the electrode.
What is the minimal liter flow used w/ an oxyhood to reduce the possibility of CO2 retention? 7 L/min
What drug would produce anesthesia for performing a bronchoscopy? Fentanyl
While visually inspecting a 41-week neonate, the RCP notices that although the pt’s body is pink, the hands and feet are blue in appearance. This phenomenon is known as: Acrocyanosis
Palpation of the brachial pulses in a 2-day-old neonate show them to be strong and equal while the femoral pulses appear to be of a decreased force. The most likely cause of this is: Coarctation of the aorta
What would be considered a normal systolic blood pressure for a 1000 g neonate? 50 mmHg
A 35-week old neonate is brought from the delivery room to the NICU for resuscitation. The RCP notes that the pt is in extreme respiratory distress w/ unequal chest excursion and a scaphoid abdomen. The most likely diagnosis: Diaphragmatic hernia
A 3-week-old term infant is admitted to the pediatric unit for the tx of croup. The suction regulator is still in the room form the previous pediatric pt w/ the regulator set at -75 mmHg of pressure. The RCP should: Leave the regular at the present setting
The presence of _____ would indicate the least likelihood of a neonate developing RDS? PG
Ribavirin is indicated for what infection? RSV (respiratory syncytial virus)
What is used to evaluate the degree of respiratory distress in a newborn? Silverman-Anderson Index
The RCP would recommend chest physiotherapy for what specific reasons? Tx of atelectasis, Lung abscess, Mobilization of secretions
What are some hazards of oxygen use in a newborn? Retinopathy of prematurity, Oxygen toxicity, Cerebral vasoconstriction
While suctioning a 38-week mechanically ventilated infant, the pt’s HR drops to 85 beats/min. What is/are the most probable causes of this drop in HR? Hypoxia, Vagal stimulation
A RCP is administering oxygen to a 40-week neonate by attaching oxygen tubing from a flowmeter to the incubator. The practitioner is unable to achieve an FiO2 greater than 0.40. The most probable reason for not attaining the desired FiO2 is : The practitioner is using an older incubator and must lift the arm w/ the attached red flag.
The RCP is asked to recommend a parasympatholytic drug for inhalation. What is the BEST recommendation? Ipratropium bromide
A neonatal pt w/ Bronchopulmonary Dysplasia is receiving oxygen via a cannula. The pt has had 3 episodes of epistaxis in the last 24 hours. What is the most likely cause? The flow rate is excessive.
While using a sidestream type of end-tidal CO2 monitor on a 10yr-old near-drowning pt being mechanically vented, the RCP notes the analyzer fluctuates severely and oftentimes reads zero. What is the most probable cause of this problem? There is water in the sample tubing.
While performing CPT on a 31-week neonate, the RCP observes that the pt requires an increase in the FiO2 0.30 above the starting level. The most appropriate response would be to: Discontinue the tx
While working on a 28-week neonate in a radiant warmer, the RCP notes that the low temperature alarm activates. The radiant heater is on and the pt’s temperature is normal when measured rectally. What is the most likely cause of the alarm? The temperature probe has fallen off the pt.
The RCP is asked to obtain an arterial blood gas on a 4-day-old infant w/ a history of a patent ductus arteriosus. What would BEST reflect pre-ductal blood flow? Right radial artery
ABG is obtained after placing 39-week newborn in oxygen hood at FiO2 of 0.35, a flow of 5 L/min. Pt has history of TTN, w/ subnormal PaCO2 levels: pH 7.32, PaCO2 48 torr, PaCO2 68 torr, HCO3 24 mEq/L. What is most appropriate initial action? Increase the flow to 8-10 L/min
The “classic method” of measuring lung compliance and airway resistance on a neonate utilizes what, to estimate pleural pressure? Esophageal balloon
A 10-year-old pt is admitted to the ICU w/ a history of head injury following an automobile accident. The physician asks that the pt’s PaCO2 be maintained at a level of 25 torr and that it be closely monitored. What is the BEST recommendation? Capnography
A 4-day-old newborn being monitored w/ a pulse Oximeter and transcutaneous PCO2 monitor is noted to have a drop in SPO2 of 5-7% and a rise in the PaCO2 of 3-4 torr when asleep. What is the most appropriate recommendation? Perform a sleep study
While examining a 34-week neonate, the RCP moderate nasal flaring, intercostals retractions, and expiratory grunting. What is the most likely diagnosis? Respiratory Distress Syndrome
What are some of the symptoms of RDS? Subcutaneous emphysema
A 5-year-old pt w/ asthma is admitted to the hospital for tx. The pt is ordered on CPT QID. What is the goal of the therapy on this pt? Mobilization of secretions
Type 1, or early fetal heart decelerations, are the result of: Compression of the fetal head
3 yr old pt admitted to ED w/ SOB. RCP notes the pt has retractions, diffuse bilateral wheezing, and an increased respiratory rate. The physician orders a medication nebulizer w/ Cromolyn sodium and normal saline. What is the most appropriate action? Recommend a sympathomimetic drug be substituted for the Cromolyn sodium.
A 4-year-old pt is ordered on low flow oxygen w/ humidity to relieve nasal dryness. What combination would BEST fulfill the physician’s order? Oxygen cannula w/ a bubble humidifier
A RCP tx newborn, notes has worsening cyanosis despite > FiO2. Tachypneic w/ intercostals retractions. Audible sys. ejection click and loud second heart sound. X-ray shows prominent main pul. artery w/ mod. cardiomegaly. What test BEST deter. diag.? Hyperoxia-hyperventilation test
While using a venti-mask on a 10-year-old asthmatic pt, the RCP is unable to achieve the desired FiO2. What is the most likely cause? The oxygen flow is too low
A 4-year-old infant show signs of increasing respiratory distress. What would be BEST method of determining acid base balance? Capillary blood gas
The RCP assigned to the emergency room is asked to assess a 2yr-old female w/ a dry, nonproductive cough. The chart indicates that the pt has had no previous hospitalizations. What would be most helpful in assessing the cause of the cough? Interviewing the parents
A 3-week-old newborn being weaned from mechanical ventilation si receiving IV morphine 0.2 mg/kg q4 hours for agitation. The RCP should monitor the pt for: Bradycardia, Respiratory depression, Hypotension
At flows of 6 to 15 L/minute, a non-rebreathing mask can deliver an FiO2 of: 0.7 to 1.0
While observing a 39-week neonate, the RCP notices that the left arm does not move while the other extremities are actively moving. What is the most probable cause of this lack of movement? Possible fracture
A term newborn w/ TTN is being administered oxygen via an oxyhood. The following information is available: FiO2 0.23, PaO2 65 torr, PaCO2 41 torr. What would be the BEST recommendation? Initiate the pt on a nasal cannula.
Following intubation and the initiation of mechanical ventilation on a 30-week neonate, the RCP receives an order to initiate CPT. What would be appropriate methods of performing the therapy? Vibrator, Resuscitation mask, Percussor
6 yr-old male admitted to ED w/ HX of headache/nausea. Pulse ox shows SPO2 of 95% on a NC at 3 L/min. ABG results: pH 7.30, PaCO2 48 , PaO2 54 , HCO3 22 mEq/L, SPO2 86%. What is most probable cause of difference between pulse Ox and co-ox reading? Elevated level of carboxyhemoglobin
Before performing a radial puncture, the RCP should perform what test? Allen’s
RCP notes sudden change in clinical status of mech vented newborn. Auscultation reveals a shift of HRs to the left. A stat chest radiograph is obtained and show hyperlucency on the right w/ a left shift of trachea. These findings are consistent with: Right side pneumothorax
A 5-year-old pt is admitted to the emergency department w/ a history of upper respiratory infection for the past 2 days and a tight, inspiratory and expiratory stridor. The most appropriate aerosolized drug for this pt is: Racemic epinephrine
A 5-year-old pt is receiving a continuously analyzed FiO2 of 0.35 via a high flow wick humidifier attached to an air/oxygen blender. One hour later, the analyzed FiO2 show 0.27. What is the possible cause of the analyzer? The analyzer is being affected by the humidity.
An arterial blood gas analysis would be indicated for: A worsening of the clinical course, Increasing retractions, The appearance of cyanosis
What is used to administer the drug Ribavirin? SPAG
A 9-year-old pt admitted w/ Status Asthmaticus is being ventilated w/ a volume cycled ventilator. The RCP notices that the high pressure alarm triggers repeatedly, the pt is agitated and SPO2 is dropping to below 90%. What should the practitioner do FIR Auscultate breath sounds
What is the drug of choice for a neonate diagnosed w/ transposition of the great vessels? Prostaglandin E
Question Answer
Ovum Egg, Ova= More than one egg
Embryo Day4 (after fertilization) through week 8 of gestational development
Fetus Week 8 until birth
Neonate Newborn, generally up to 1 month of age
Infant 1 month- 1 year
Placenta Spongy structure that provides nutrients and O2 to fetus during pregnancy
Umbilical cord Lifeline between mother and fetus, Provides O2 and removes waste, Composed of 2 arteries and 1 vein
Uterus Place where fetus is held during development
Amniotic Fluid Clear liquid present in amniotic sac during pregnancy, Suspends and protects fetus, Shock absorber for fetus, Less acidic than fetal lung fluid, Forms around week 12, Highest levels at week 33
Whartons Jelly Gelatinous material inside umbilical cord, Protects cord from being pinched
Ductus Arteriousus Pathway (shunt) between aorta and pulmonary artery
Ductus Venosus Lies in abdominal cavity of developing fetus, Shunt between umbilical vein and inferior vena cava
Foramen Ovale Shunt between right and left atria
Para Number of children a woman has had, Includes live birth and stillborns (after 20 weeks)
Gravida Number of pregnancies
Primagravida First pregnancy
Doppler Sonic imagery of fetus
Lanugo Fine Hair covering fetal skin
Gestation Length of time baby is in the womb, Normal= 38-42 weeks
Meconium First feces of newborn infant, Composed of salts, amniotic fluid, mucus, bile, and epithelial cells, Sterile, Greenish black in color, Odorless, Very thick
Vernix White cheesy substance on fetal skin, Protects skin from water in amniotic sac
Braxton-Hicks Contractions False Labor
Effacement Cervix thinning, preparing for delivery
Surfactant Reduces surface tension in the alveoli, Decreased amounts in preemies is what causes RDS
Ectopic Pregnancy Fertilized egg that implants outside of the uterus
Amniocetesis Transabdominal puncture of amniotic sac to remove amniotic fluid, Used to check for genetic disorders and fetal lung maturity
APGAR Appearance Pulse Grimace Activity Respiration effort, Done at 1 min and 5 min after birth, Determines need for resuscitation
Acrocyanosis Bluish coloring of feet and hands, Common w/ newborns
Omphalocele Abdominal defect where intestines stick out of babies belly button
Necrotizing Enterocolitis Death of intestinal tissue
Peritonitis Inflammation of tissue that lines the inner wall of abdomen
Umbilical artery Catheter Catheter inserted into one of the umbilical arteries, Used for frequent blood draws of the newborn
Jaundice Yellowish tint of skin, Caused by too much bilirubin in the blood
Atresia Congenital absence or closure of a normal body opening or tubular structure
Hypoplasia Under-developed
Transposition Transfer of position from one spot to another
Anamoly Deviation from normal
Coarctation Compression, shriveling, or stricture of the walls of a vessel
Hypertrophy Increase in size or bulk of an organ or structure
Transillumination Passing light behind tissue to see structures between the light and the observer
Coarctation Compression, shriveling, or stricture of the walls of a vessel
Hypertrophy Increase in size or bulk of an organ or structure
Transillumination Passing light behind tissue to see structures between the light and the observer