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pediatrics > finalprep > Flashcards

finalprep Flashcards

1
Q

4 wks after ED visit for asthma a 2 yr old child presents for OP clinic follow up; the child was prescribed DPI pulmicort flexhaler 90 mcg 2x daily; child continues with nighttime cough what changes might you suggest?

a. begin administering 1 puff of salmeterol (serevent) 2 x daily
b. 4 mg montelukast (singulair) chewables 1 x daily at night
c. replace budesonide dpi with 2 puffs of flovent (fluticasone) 110 at 2x daily
d. replace pulmicort with 90 mcg at 1 puff advair (fluticasone/salmeterol) 100/50 at 2x daily

A

c. replace with flocent 110 at 2 x daily for 2 puffs

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2
Q

A hyperoxia test is ordered for a cyanotic neonate. An oxyhood is connected to wall O2 source. The FIO2 in oxyhood is analyzed at .80; what should be done first to increase the FIO2?

a. increase the flow rate
b. select a larger oxyhood
c. change to an air-oxygen blender
d. change to high flow nasal cannula

A

a. increase the flow rate

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3
Q 
A child with neuromuscular weakness has retention of secretions.  which is the most effective therapy:
a. IPV
B. mech insufflation-exsufflation
c. High frequency chest wall oscillation
d. positive expiratory pressure device
A

b. insufflation-exsufflation

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4
Q

A full term newborn with congenital diaphragmatic hernia is receiving HFJV at 10 ppm iNO; following a low range calibration, the NO concentration reads 14 ppm, which of the following should be done first:

a. perform a high range NO calibration
b. replace the sample line
c. calibrate the O2 sensor
d. change the injector module

A

a. perform a high rang NO calibration

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5
Q

A 9 yr old pt with CF has SOB and dizziness while in LLL drainage position. What should be done next:

a. stop all chest PT and discontinue further sessions
b. perform the therapy but for shorter time period
c. continue drainage, but not percussion or vibration
d. proceed with other drainage positions and note the patient’s discomfort

A

d. proceed with other positions and note patient’s discomfort

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6
Q

A 900 g infant is receiving mech ventilation and has bilateral chest tubes; chest xrays show flattened diaphragm & uniformly distributed small cystic radiolucencies; which type of mech ventilation should be used?

a. high frequency
b. differential lung
c. pressure controlled
d. pressure support

A

a. high frequency

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7
Q

During suctioning of infant with RSV at -80 of suctin pressure bright red blood from ETT is seen, what is cause of bronchial hemorrhage?
A. ETT perforated blood vessel
b. suction pressure too high
c. infant developed necrosis from pneumonia
d. catheter damaged the mucosa

A

d. the catheter damaged the mucosa

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8
Q

A chest xray is being reviewed of an infant with severe RDS; it shows tiny radiolucencies in the perhilar area of lung progressing outwards; these are most consistent with:

a. pneumothorax
b. pneumomediastinum
c. subcutaneous emphysema
d. PIE

A

D. PIE

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9
Q

A 3 yr old is admitted to ED with severe asthma; what is the best way to administer albuterol treatment:

a. breath actuated MDI with mask
b. SVN with mask
c. MDI with holding chamber
d. SVN with blow by technique

A

B. SVN with mask

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10
Q 
Following abdominal surgery a 16 y/o develops bibasilar atelectasis; the pulse ox reads .95 while receiving 50% O2 with AEM mask; what should be recommended?
A. Mask CPAP
B. IS
C. IPPB therapy
D. bronchodilator therapy
A

A. mask CPAP

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11
Q 
A neonate has PIE and is being converted to HFJV; when comparing the PIP to mechanical ventilation how should it be set on JFJV?
A. the same
B. 5-9% above
c. 10-19% below
D. 20-25% above
A

c. 10-19% below

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12
Q

An infant is receiving .25 oxygen via servo controlled incubator; low body temp alarm & high air temp alarms activated; what should be checked first

a. check teh O2 flow & FIO2
b. Increase the temp in the incubator
c. check the incubator’s air temp
d. confirm placement of the skin temp sensor

A

d. confirm placement of skin temp sensor

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13
Q

Which is the anitcipated result of iNO:

a. peripheral vasoconstriction
b. bronchodilation
c. pulmonary vasodilation
d. mast cell deactivation

A

c. pulmonary vasodilation

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14
Q 
Which of the following gases is used to perform high range calibration on NO2 sensor of iNO delivery system:
a. 45 ppm NO and 10 ppm NO2
b. 20 ppm NO and 5 ppm NO2
c. 10 ppm NO2
D. 45 ppm NO2
A

c. 10 ppm NO2

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15
Q

A 30 kg 8 yr old child with sepsis and ARDS is being mechanically ventilated on PC, A/C ventilation: the settings are FIO2 = .60, Mandatory rate = 20, Exhaled Vt = 180 mL, PIP = 35, PEEP = 10; ABG results are: pH 7.29, PaCO2= 60, PaO2= 65, HCO3 = 31, BE = -2; what should be recommended:

a. decreasing PIP to 30
b. increasing PEEP to 12
c. Increasing RR to 25
d. maintain current settings

A

d. maintain current settings

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16
Q

A specialist is called to nursery following recent delivery of 35 wk old neonate due to excessive secretions, coughing, respiratory distress, cyanosis, the SpO2 is 92%; a gastric tube advances to 8 cm. The specialist should:

a. initiate oxyhood at 50% & obtain chest xray
b. place a replogle tube and administer O2 as needed
c. intubate the right mainstem bronchus & obtain ABG
d. initiate nasal CPAP and administer albuterol

A

b. place a replogle tube and administer O2 as needed

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17
Q

A full term neonate with severe pneumonia is being ventilated with HFOV; Chest xray shows diffusely opaque lung fields expanded about 7th rib posteriorly; The PaO2 is 50% with FIO2 of .80; It is requested that ventilator settings be adjusted; what should be increased?

a. frequency
b. amplitude
c. I time %
d. mean airway pressure

A

d. mean airway pressure

18
Q

An 8 mos old infant is intubated with 4.0 ETT tube that is uncuffed; treatment for laryngeal web. The baby is being prepared for extubation when it is noticed that PIP during mandatory breath is 42 before air leak is heard; what should be done:

a. remove the ett
b. replace the ETT with smaller one
c. withdraw the ett 1 cm & resecure
d. evaluate for leak around the ETT in 4 hrs.

A

d. evaluate leak in 4 hrs

19
Q

A newborn with pulmonary htn is receiving dopamine; The infants PtcO2 = 5; the PAO2 from ABG = 40; what is likely true:

a. probe has fallen off
b. monitor should be recalibrated
c. infant has decreased peripheral perfusion
d. probe is overheating the sample

A

c. infant has decreased peripheral perfusion

20
Q

A 6 yr old with asthma has respiratory acidosis while receiving mech ventilation with an FIO2 of .30; with continuous albuterol, mg, and steroids. what should be added first to treatment:

a. nitric oxide
b. isoflurane
c. helium
d. xenon

A

c. helium

21
Q

An infant receiving mech ventilation has PIE on the right side; what position should be used to best improve oxygenation?

a. left side up
b. right side up
c. prone
d. supine

A

a. left side up

22
Q

A child is receiving bi level non invasive ventilation; ABG reveals elevated PaCO2 and SPO2 of .95; what should be increased:

a. expiratory positive airway pressure
b. inspiratory rise time
c. mandatory rate
d. oxygen concentration

A

c. mandatory rate

23
Q

A specialist is reviewing chart of 10 yr old who has recently had bone marrow transplant. The patient is receiving 300 mg of pentamadine; following treatment it was noted the patient had diffuse bilateral wheezing, dry cough, & SOB; what should be done

a. wait 1 week & then administer reduced dose of pentamadine (Nebupent)
b. wait 4 weeks and try again to administer pentamadine 300 mg
c. administer 2 puffs of albuterol before next treatment
d. undergo pre and post bronchodilator pft testing before next dose

A

c. administer 2 puffs of albuterol before next treatment

24
Q

A full term neonate receiving iNO for persistent pulmonary hypertension with HFOV; during vent check found that measured NO is 6 ppm higher than set nitric oxide concentration; the high and low calibration are successfully recalibrated & measured value continues to be high; what should be done:

a. increase the bias flow of the vent
b. place a one way valve after the injector module
c. decrease the fio2 on vent
d. replace the sample line

A

b. place a 1 way valve after the injector module

25
Q

After assembling a CPAP system no positive pressure reading is noted on the manometer; what could cause this problem

  1. there is a leak in the system
  2. flow control is off
  3. manometer is broken
  4. high pressure air and o2 lines are switched
    a. 1, 2, 3
    b. 1, 2, 4
    c. 1, 3, 4
    d. 2, 3, 4
A

a air leak, flow control is off, manometer is broke

26
Q

At 2 hrs of age a term newborn is cyanotic, RR 65, BP 57/32 & respiratory distress with grunting, nasal flaring, & retractions; Prenatal history shows oligohydraminos and baby has not voided since birth; this is consistent with

a. Congenital heart disease
b. pulmonary sequestration
c. potter syndrome
d. DiGeorge syndrome

A

c. potter syndrome

27
Q

A lateral neck xray of 3 yr old reveals ballooning of hypopharynx, thickening of aryepilottic folds, and obliteration of vallecula. the most likely diagnosis is

a. laryngotracheobronchitis
b. tonsillar abscess
c. epiglottitis
d. foreign body obstructin

A

c. epiglottitis

28
Q 
A 12 yr old with severe asthma to be placedd on continuous nebulization; prescribed 20 mg/hr of 0.5% albuterol; the LVN has output of 240 ml over 8 hrs with a set flow rate of 10 lpm; which of the following is correct:
a. 20 ml of albuterol & 220 ml of NS
b 32 ml of albuterol & 208 ml of NS
c. 48 ml albuterol & 220 ml of NS
d. 100 ml albuterol & 140 ml of NS
A

c. 32 ml of albuterol & 208 ml of NS

29
Q

A neonate is receiving 100% FIO2; two abg’s are obtained from right artery & umbilical aretery; the right radial PaO2 is 180; umbilical PaO2 is 68; what can be concluded;

a. diminished cardiac index
b. an intrapulmonary shunt
c. an aortic stenosis
d. patent ductus arteriosus

A

d. patent ductus arteriosus

30
Q 
a 37 week gestational age neonate is born in ED; 6 hrs later he develops respiratory distress what should be evaluated to determine the respiratory care plan:
a bilirubin
b. L/S ratio
c. CBC
d. BUN
A

c. CBC

31
Q

During bronchoscopy of 2 yr old child which monitors should be present:

  1. capnograph
  2. apnea monitor
  3. pulse oximeter
  4. cardiac monitor
    a. 1 & 2
    b. 1 and 3
    c. 2 and 4
    d. 3 and 4
A

d. 3 and 4

32
Q

A chest xray of 15 yr old shows complete homogenous opacification of left hemithorax; shift of mediastinum to right, presence of ETT and left subclavian catheter; what is the most likely reason for the mediastinal shift:

a. mucus plugging
b. pneumothorax
c. right mainstem intubation
d. misplaced subclavian catheter

A

d. misplaced subclavian catheter

33
Q 
a 26 hr old presents to ed in active labor at 32 weeks with no prenatal care; to prepare for delivery which tests should be reviewed;
1. hiv
2. hep b
3. group b strept
4. TB
A. 1 and 2
b. 1 and 4f
c. 2 and 3
d. 3 and 4
A

a. hiv & hep b

34
Q

Prior to use of INOvent, a low range calibration is performed using these gases:

  1. nitrogen
  2. nitric oxide
  3. nitrogen dioxide
  4. oxygen
    a. 1, 2, and 3
    b. 1, 2, and 4
    c. 1, 3, and 4
    d. 2, 3, and 4
A

d

35
Q

A full term neonate with PPHN has been receiving HFOV and iNO for 48 hrs;
FIO2 is .90; Paw 32, Frequ 12, Amplitude 65, iNO 40 ppm; abg is pH 7.38, PaCO2 52, PaO2 48; HCO3 31, BE -2; which should be recommended:
a. maintain current settings
b. initiate ECMO
c. Increase the iNO dose
d. place neonate prone

A

b. ECMO

36
Q

What is the optimal temp to deliver 100% RH via heated wire ckt & mech vent for 3mos old RSV baby?

a. 31
b. 34
c. 37
d. 40

A

c. 37 degrees C

37
Q

A 15 kg child receiving SIMV VC with following setting: FIO2 .45, Mand Rate 18, Eff Vt 135 ml; PEEP 4; to increase alveolar ventilation the most appropriate change is to increase:

a. mandatory rate
b. mean airway pressure
c. inspiratory time
d. PEEP

A

a mandatory rate

38
Q

When reviewing a chest xray of 3 yr old the right hemidiaphragm is obscured; the most likely cause is:

a. advanced hepatomegaly
b. pneumopericardium
c. lower lobe atelectasis
d. tension pneumothorax

A

c. lower lobe atelectasis

39
Q

An O2 flowmeter is used to administer 80/20 heliox for 10 yr old child; you should also recommend use of

a. nonrebreathing mask
b. simple o2 mask
c. .40 venturi mask
d. nasal cannula

A

a. non rebreathing mask

40
Q

A 2 yr old has received 2 aerosolized treatments of racemic epinephrine for mild stridor; following extubation for croup; what should be anticipate:

a. tracheostomy
b. reintunation
c. administering Supplemental O2
d. chest xray

A

b reintubation

41
Q

An xray of lateral neck shows steeple sign and subglottic narrowing, what is most likely cause:

a. retropharyngeal abscess
b. epiglottitis
c. FBA
d. Laryngotracheobronchitis

A

d. laryngotracheobronchitis

42
Q

a newborn is receiving PC, A/C ventilation with the following:
PIP = 20, PEEP 3, Itime .3 sec; Insp Flow 8 l/min; what is max Vt that can be delivered?
a. 24 ml
b. 40 ml
c. 80 ml
d. 133 ml

A

b. 40 ml

pediatrics (4 decks)

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