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Neonates Posttest

Neonates Posttest chapter 1-10 review

QuestionAnswer
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
Created by: dennison51801