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Pediatric/Perinatal
| Question | Answer |
|---|---|
| Full-term infants with RDS, surfactant nonresponders, and infants who cannot be extubated in the first weeks of life because of a respiratory condition should be evaluated for which of the following deficiencies? | I. -Antitrypsin deficiency, III. SP-B deficiency |
| Which of the following terms is used to describe the variable that is responsible for terminating inspiration? | Cycle variable |
| Which of the following cardiovascular conditions can cause surfactant inactivation? | II. Pulmonary hemorrhage, III. Hemorrhagic edema |
| Which of the following statements refer to the Bear Cub 750vs infant ventilator? | In A/C mode, mand. breaths are time or flow triggered., If mandatory breaths are pressure controlled, the resulting flow and volume waveforms are exponential,The low gas supply alarm activates if either the air or oxygen pressure falls below 24 2 psig. |
| Which of the following is the most common form of surfactant abnormality associated with acute lung injury? | Inactivation by proteins |
| What does the Laplace law postulate about the alveoli in the lung? | That alveoli would collapse as they got smaller |
| 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? | A technical alarm will be set off. |
| What are the physiologic benefits of surfactant? | II. Surfactant prevents capillary leakage of fluid into alveoli, III. Surfactant optimizes surface area for gas exchange, IV. Surfactant protects the epithelium of the lung. |
| About a century after Laplace described the relationship of transsurface pressure and surface tension at a gas-fluid interface in a sphere, what did von Neergaard discover about the retractile force of the lung? | That it was dependent on the surface tension in the alveoli |
| Which of the following relationships is correct regarding the composition of amniotic fluid as it relates to determining fetal lung maturity? | PG and lecithin increase while sphingomyelin decreases during gestation. |
| With the Dräger Medical Evita 4 ventilator, how will the inspiratory pressure waveform appear for a pressure-controlled mandatory breath when the pressure rise time is set at 0? | Rectangular |
| Which of the following terms is used to describe the variable that reaches a preset value before the end of inspiration? | Pressure rise time |
| Which of the following factors influence the ability to wean patients with congenital diaphragmatic hernia from extracorporeal membrane oxygenation (ECMO)? | II. Surfactant inactivation, III. Severe pulmonary hypoplasia |
| What is the role of SP-D in human pulmonary surfactant? | I. Suppresses proinflammatory responses II. Enhances phagocytosis III. Enhances killing of microbes |
| Which of the following components comprise pulmonary surfactant? | I. Dipalmitoyl phosphatidylcholine II. Phosphatidylcholine IV. Phospholipids |
| Which of the following terms is used to describe the variable responsible for initiating inspiration? | Trigger variable |
| Which of the following proteins are known to comprise human pulmonary surfactant? | I. SP-B II. SP-C III. SP-D |
| On the Maquet SERVO-i, what is the result of increasing the "inspiratory cycle off" settings? | It enables expiration to occur at an earlier point in the peak flow requirements. |
| Which of the following pathophysiologic conditions are components of meconium aspiration? | I. Surfactant inactivation II. Chemical pneumonitis |
| Which of the following physiologic consequences would develop if the liquid-gas interface were without surfactant? | III. Every breath would require a considerable amount of pressure to expand the lung with each inspiration.IV. All the alveoli would collapse during exhalation |
| Which of the following conditional variables can most easily become the baseline variable? | Pressure |
| Which of the following flow wave patterns is generated by the Puritan Bennett LP10 ventilator when the pressure limit control is inactivated? | Sinusoidal |
| A Newport HT50 ventilator experiences an AC power outage and switches to DC power. When will the low battery alarm activate? | When 30 minutes of battery life remains |
| Which of the following physiologic conditions result from the presence of normal amounts of pulmonary surfactant in the lung? | II. Uniform gas distribution during inspiration occurs. III. The functional residual capacity is maintained. |
| How is the minute ventilation decreased when a patient is being weaned from HFOV? | By reducing oscillatory amplitude |
| What is the primary therapeutic goal when a patient with lungs prone to atelectasis receives HFV? | To optimize lung inflation |
| How can the problem of conjunctival irritation associated with NPPV be overcome? | By using an appropriately sized interface |
| What type of monitoring should be used in the outpatient setting during NPPV for children with limited capacity to spontaneously increase minute ventilation because of an advanced neuromuscular disorder? | II. Cardiorespiratory impedance monitor III. Pulse oximeter |
| How is the radiographic assessment of neonatal lung volume assessed? | Counting the number of posterior ribs above the diaphragm |
| 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 |
| What are the consequences of failing to quickly wean a neonatal patient from HFV | I. Pulmonary over-distention IV. Impaired cardiac output |
| What is the primary goal of intermittent NPPV at night in children who have chronic disorders complicated by alveolar hypoventilation? | To improve the quality of sleep |
| What is the most common complication associated with NPPV among pediatric patients? | Skin irritation caused by the interface |
| Which of the following bilevel adjustments would the therapist need to make on the ventilator to reduce a patient's PaCO2? | Increase IPAP and maintain EPAP |
| Which of the following factors need to be considered for HFV ventilator circuits? | I. Time for gas egress during exhalation II. Circuit compliance IV. Intrinsic timing mechanisms |
| Which of the following bilevel ventilator settings influences upper airway stability? | EPAP |
| Which of the following modes of mechanical ventilation is generally absent on most portable volume-controlled ventilators used in the home? | Pressure support |
| Which of the following issues continue to confront the practice of surfactant replacement therapy? | II. Nature of surfactant to administer III. Timing of surfactant replacement IV. Method of delivery during HFV |
| How should a volume-controlled portable ventilator be adjusted to deliver the appropriate tidal volume (VT) to a pediatric patient during NPPV? | The delivered VT should be set at twice the child's physiologic VT. |
| According to the U.S. Food and Drug Administration, which of the following mechanical ventilatory rates constitutes high-frequency ventilation (HFV)? | More than 150 breaths/minute |
| What are the primary objectives of noninvasive positive-pressure ventilation (NPPV)? | II. To restore adequate carbon dioxide removal III. To decrease the patient's work of breathing |
| Enhanced diffusion is a function of which of the following factors | III. Tidal volume IV. Respiratory frequency |
| When NPPV is used to ventilate pediatric patients, which operating mode of ventilation is generally used? | Spontaneous/timed |
| What effect should the therapist expect to observe after initiating continuous positive airway pressure (CPAP) on a neonate who has a restrictive lung disorder? | Increased lung volume |
| 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 dioxid |
| What is the clinical significance of the IPAP-EPAP gradient in bilevel NPPV? | It determines the patient's tidal volume. |
| In which of the following types of pediatric patient has NPPV been used effectively to stabilize airway function? | Patients being weaned from mechanical ventilation after a laryngotracheoplasty |
| Which of the following steps might be involved when a therapist assesses a patient suspected of having a reduction of airway diameter while receiving HFV? | I. Observe the patient's chest wall for movement. II. Increase conventional ventilation. III. Apply ventilation via a manual resuscitation bag |
| What is a feared complication of long-term intermittent NPPV applied by means of a nasal mask to pediatric patients? | Impaired maxillary bone growth |
| Which of the following terms describes the rate of increase in airway pressure from baseline at the onset of inspiration? | Pressure breath |
| Which of the following 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 |
| Which of the following terms is used to describe the variable responsible for initiating inspiration? | Trigger variable |
| . On the Maquet SERVO-i, what is the result of increasing the "inspiratory cycle off" settings? | It enables expiration to occur at an earlier point in the peak flow requirements. |
| Which of the following relationships is correct regarding the composition of amniotic fluid as it relates to determining fetal lung maturity? | PG and lecithin increase while sphingomyelin decreases during gestation. |
| What does the Laplace law postulate about the alveoli in the lung? | That alveoli would collapse as they got smaller |
| Which of the following conditional variables can most easily become the baseline variable? | Pressure |
| Which of the following physiologic conditions result from the presence of normal amounts of pulmonary surfactant in the lung? | II. Uniform gas distribution during inspiration occurs. III. The functional residual capacity is maintained |
| Which of the following motor and linkage mechanisms are used in ventilator compressors? | I. Electric motor/rotating crank and piston III. Electric motor/rack and pinion IV. Direct-drive electric motor |
| Which of the following pathophysiologic conditions are components of meconium aspiration? | I. Surfactant inactivation II. Chemical pneumonitis |
| With the Dräger Medical Evita 4 ventilator, how will the inspiratory pressure waveform appear for a pressure-controlled mandatory breath when the pressure rise time is set at 0? | Rectangular |
| Which of the following settings requires that the patient breathe spontaneously? | Pressure support ventilation with CPAP |
| What is the purpose of the optional open lung tool on the SERVO-i ventilator? | To assist in determining the inflating and deflating pressures of the lung |
| What is the role of SP-D in human pulmonary surfactant | I. Suppresses proinflammatory responses II. Enhances phagocytosis III. Enhances killing of microbes |
| How do synthetic surfactants compare with bovine surfactants? | Bovine surfactants contain SP-B and SP-C, and synthetic surfactants contain SP-A and SP-D. |
| Which of the following statements characterize a ventilator's control scheme as closed loop? | I. An output variable is measured and compared with a reference. II. The input variable is modified as needed to more closely approximate the desired output. |
| Which of the following cardiovascular conditions can cause surfactant inactivation | II. Pulmonary hemorrhage III. Hemorrhagic edema |
| Which of the following terms is used to describe the variable that reaches a preset value before the end of inspiration? | Limit variable |
| How is pneumonia in a neonate believed to adversely affect surfactant? | I. By bacteria directly attacking type II pneumocytes III. By microbes releasing substances altering surfactant components |
| Which of the following terms is used to describe the variable that is responsible for terminating inspiration | Cycle varaible |
| Which of the following physiologic consequences would develop if the liquid-gas interface were without surfactant? | III. Every breath would require a considerable amount of pressure to expand the lung with each inspiration. IV. All the alveoli would collapse during exhalation. |
| Which of the following proteins are known to comprise human pulmonary surfactant? | I. SP-B II. SP-C III. SP-D |
| Which of the following proteins is found to be deficient in the sputum of patients with asthma? | SP-A |
| Which of the following statements refer to the Bear Cub 750vs infant ventilator? | I. In A/C mode, mandatory breaths r time or flow triggered. III. mandatory breaths are pressure controlled,the resulting flow and volume waveforms are exponential. IV.low gas supply alarm activates if either the air or o2 pressure falls below 24 2 psig |
| A Newport HT50 ventilator experiences an AC power outage and switches to DC power. When will the low battery alarm activate? | When approximately 2 hours of battery life remains |
| What is the primary therapeutic goal when a patient with lungs prone to atelectasis receives HFV? | To optimize lung inflation |
| In which of the following types of pediatric patient has NPPV been used effectively to stabilize airway function? | Patients unable to achieve adequate alveolar ventilation because of restrictive lung disorders |
| Which of the following steps might be involved when a therapist assesses a patient suspected of having a reduction of airway diameter while receiving HFV? | I. Observe the patient's chest wall for movement.. IV. Reduce the oscillatory amplitude. |
| During volume-controlled ventilation, which of the following factors influences the peak inspiratory pressure? | Pulmonary compliance |
| Which of the following statements best describes the relationship between tidal volume and frequency during HFJV of pediatric and neonatal patients? | Neonatal patients need higher frequencies and lower tidal volumes than pediatric patients. |
| During HFOV, manipulation of which of the following components establishes the continuous distending pressure? | III. Expiratory valve aperture IV. Bias flow |
| A patient receiving bilevel ventilation develops a leak at the interface. What action will likely take place at this time? | The ventilator will automatically compensate for this leak |
| What is the only absolute contraindication to a trial of NPPV in pediatric patients with acute respiratory distress? | Cardiovascular instability |
| When NPPV is used to ventilate pediatric patients, which operating mode of ventilation is generally used? | Spontaneous/timed |
| What is the clinical significance of the IPAP-EPAP gradient in bilevel NPPV? | It determines the patient's tidal volume. |
| During HFOV, which of the following factors has a direct influence on a neonate's delivered tidal volume? | II. Oscillatory amplitude |
| 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 |
| Which of the following ventilator settings are preset during time-cycled, pressure-limited ventilation | I. Inspiratory time III. Respiratory rate IV. Inspiratory-to-expiratory ratio |
| What are the consequences of failing to quickly wean a neonatal patient from HFV? | I. Pulmonary overdistention IV. Impaired cardiac output |
| How is the radiographic assessment of neonatal lung volume assessed | Counting the number of posterior ribs above the diaphragm |
| Which of the following bilevel adjustments would the therapist need to make on the ventilator to reduce a patient's PaCO2? | Increase IPAP and maintain EPAP |
| Which of the following bilevel ventilator settings influences upper airway stability | EPAP |
| Why may HFOV not be an optimal ventilation strategy for patients who have either fresh particulate meconium aspiration or bronchopulmonary dysplasia? | Gas trapping may develop. |
| Which of the following modes of ventilation attempt to maintain a minimal target tidal volume with a constant pressure by manipulating the inspiratory flow? | Pressure-regulated volume control (PRVC) |
| What is the most common complication associated with NPPV among pediatric patients? | Skin irritation caused by the interface |
| Which of the following forms of mechanical ventilation is the most efficacious method for acquired bronchopleural fistulas? | High-frequency jet ventilation (HFJV) |
| The therapist is conducting a ventilator check for a neonate and makes the following notations on the ventilator flow sheet: PEEP: 5 cm H2O,PIP: 25 cm H2O, RR 15 breaths/min, FIO2: 0.35 what should the therapist recommend for this neonate? | Weaning from mechanical ventilation |
| How is the minute ventilation decreased when a patient is being weaned from HFOV? | By reducing oscillatory amplitude |
| Which of the following features characterize neonatal HFOV circuits? | I. Larger diameter tubing for inspiratory gas flow II. Narrower diameter tubing for exhalation |
| According to the U.S. Food and Drug Administration, which of the following mechanical ventilatory rates constitutes high-frequency ventilation (HFV)? | More than 150 breaths/minute |
| A neonate demonstrates the following clinical signs 3 hours after birth: 1 Respiratory distress, breath sounds on the left side of the thorax, and chest radiograph revealing gastrointestinal. What is the neonate most likely? | Congenital diaphragmatic hernia |
| What are the major advantages of venovenous ECLS | Pulsatile flow in maintained, Potential emboli from the circuit are trapped in the pulmonary vasulature |
| What can be done to lower a patient's PaCO2 when it is elevated during ECLS | Increase the flow of the sweep gas |
Created by:
angelsfan
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