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Pediatrics: Smith > Homework Questions > Flashcards

Homework Questions Flashcards

1
Q

Signs of respiratory distress in a newborn include which of the following:

A

Grunting

Nasal flaring

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2
Q

Palpitation of a patient’s chest produces a vibration of the chest wall during quiet breathing. This suggests partial obstruction of the large airways by mucus. The name of this sign is:

A

Coarse crackles or tactile fremitus

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3
Q

If a patient has a normal capillary refill, the baseline of the nail bed will return in:

A

<3 seconds

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4
Q

The CABs of resuscitation mean:

A

Compressions, airway, breathing

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5
Q

Hazards of suctioning include all of the following except:

A

Improved airway clearance

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6
Q

The 6 year old has been intubated and is requiring suctioning. How far should you advance the suction catheter for removal of secretions?

A

Pass the suction catheter no more than 1 cm past the tip of the ETT

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7
Q

The pulse oximeter saturation (SpO2) reading of an active 3 year old could be difficult to detect because:

A

The child is very active

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8
Q

You are in a restaurant and the child at the table next to you starts to cough violently. He is 5 years old and was eating french fries when he suddenly turned red, started to cough and appears to be choking. His parents are nervously patting his back. What intervention needs to be done?

A

Perform the Heimlich maneuver

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9
Q

An 8 month old presents with head bobbing. The following is true about head bobbing:

A

It usually suggests respiratory distress, airway obstruction, or decreased lung compliance

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10
Q

When you are suctioning an infant or child, you should limit the suction time to haw many seconds?

A

15 seconds

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11
Q

Bedside evaluation of the degree of hypoxemia may best be accomplished by whcih of the following?

A

Pulse oximetry

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12
Q

A child with is 3 years old presents to the ED, with a respiratory rate of 60 breaths/min at rest. This is a normal respiratory rate for this age.

A

False

Normal RR for toddler: 22-37 breaths/min

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13
Q

Which of the following would most likely be found on a resuscitation code cart?

A
  1. resuscitation bag and appropriate size masks
  2. oxygen flowmeter with nipple adapter
  3. appropriate sizes of ET tubes
  4. suction catheters, tubing, canister and suction regulator

1, 2, 3, 4

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14
Q

You are asked to assess an infant who has just been admitted to the pediatric unit to determine the need for respiratory therapy treatments. Upon your assessment, you determined that the child needs a bronchodilator treatment. Where would you assess the heart rate of the infant prior to the treatment?

A

The brachial artery

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15
Q

You notice paradoxical breathing. Which of the following conclusions is most consistent with this observation?

A

Work of breathing is increased

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16
Q

An infant produces an audible noise that appears to be stridor. The following is true about stridor:

a. it is a high-pitched, monophonic, audible noise
b. it may occur during inspiration
c. patients with laryngomalacia or subglottic stenosis may have inspiratory stridor
d. all of the above

A

a. it is a high-pitched, monophonic, audible noise
b. it may occur during inspiration
c. patients with laryngomalacia or subglottic stenosis may have inspiratory stridor
Correct answer: d. all of the above

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17
Q

The correct pressure to use during ventilation of a pediatric patient with a resuscitation bag and mask is:

A

The pressure causing the chest to rise

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18
Q

A recently home-delivered baby is brought in to the Emergency Department by the paramedics. The physician asks you to help evaluate her condition. Normal vital signs for a term newborn include all of the following except:

a. heart rate 130/min
b. blood pressure of 64/40
c. respiratory rate of 20/min
d. rectal temperature of 36.5º C

A

a. heart rate 130/min
b. blood pressure of 64/40
c. respiratory rate of 20/min
d. rectal temperature of 36.5º C

Answer: C

A normal term newborn should have a RR of 30-60. All of the other listed vital signs are normal for a newborn.

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19
Q

Which of the following clinical signs would the therapist notice initially in an infant or child who is experiencing respiratory distress?

A
  1. retractions
  2. grunting
  3. nasal flaring

1, 2, 3

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20
Q

While evaluating a patient’s cardiopulmonary status, the RCP determines that he patient has a capillary refill of 7 sec. This reflects which of the following?

A

Decreased peripheral perfusion

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21
Q

If you are alone, 5 CABs (2 mins of CPR) are to be performed on a child or infant before calling 911.

A

True

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22
Q

The pulse of an 11 year old male (not a code situation) would be palpated at the:

A

Radial artery

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23
Q

Where do you find the narrowest portion of the pediatric airway that may compromise endotracheal intubation?

A

cricoid cartilage

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24
Q

For an infant who is choking and is able to cough, you must always perform 5 back blows and 5 chest thrusts to attempt to remove the object.

A

True

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25
Q

What is the appropriate pressure range for routine suctioning of a child who is 4 years old?

A

Infants: -80 - -100 mmHg
Child: -100 - -120 mmHg

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26
Q

Digital clubbing is indicative of:

A

Chronic hypoxia

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27
Q

When assessing the work of breathing, which of the following need to be assessed?

I. Intercostal and substernal retractions
II. Patient’s body position
III. Use of accessory muscles
IV. Movement of the diaphragm

A

I. Intercostal and substernal retractions
II. Patient’s body position
III. Use of accessory muscles
IV. Movement of the diaphragm

I, II, III, IV

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28
Q

Which size suction catheter would be most appropriate if a child had a 6.0 mm endotracheal tube in place?

A

10 french

Rationale: Size ETT x 2. Use next size down ex: 2 x 6 = 12, answer 10 french

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29
Q

A self-inflating bag always requires an oxygen source for the bag to function.

A

False

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30
Q

What are the types of retractions noted on a child in respiratory distress?

A

Suprasternal, subcostal, substernal

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31
Q

Which spinal deformity presents with a hunchback appearance and a lateral curvature of the spine?

A

Kyphoscoliosis

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32
Q

A pulse check during the resuscitation effort of a 5 year old child would be palpated at the ________ artery.

A

Carotid or femoral

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33
Q

A pulse check on an infant during cardiopulmonary resuscitation should be palpated at the:

A

Brachial

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34
Q

Children are less prone to a cardiac arrest than a respiratory arrest.

A

True

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35
Q

Why are chest retractions more prominent among neonates than among older children and adults?

A

Because newborns have relatively thin and weak musculature and a less rigid thorax

36
Q

A respiratory rate greater than _____ in a child above 5 years of age would indicate that the child is in respiratory distress and needs further investigating as to why they are having difficulty breathing.

A

35 bpm

Normal RR for school-age child: 18-25 breaths/min

37
Q

You are performing CPR to help resuscitate a child who is 5 years old who is now in cardiac arrest. What compression method should you use?

A

Heel of one hand or heel of one hand over the other (ex: bigger child)

38
Q

A 2 year old toddler is en route via ambulance to the pediatric intensive care unit following a motor vehicle collision (MVC). The patient is showing signs of having a head injury and the pediatric physician has asked you to prepare the endotracheal tube for immediate intubation of their airway. What size ETT would you prepare?

A

4.5 mm uncuffed ETT

39
Q

The compression to ventilation ratio for a child during CPR with a single rescuer is 30:2.

A

True

40
Q

Inspiratory stridor is the major clinical sign of:

A

Glottic edema

41
Q

When auscultating the chest of a 3 year old child, you notice a hi-pitched monophonic inspiratory sounds coming from the upper airway. You would describe this as:

A

Stridor

42
Q

The term that means an abnormally fast respiratory rate is:

A

Tachypnea

43
Q

What is not a sign of respiratory distress in an infant?

A

Crying

44
Q

The first sign of hypoxia is:

A

Tachycardia

45
Q

Which of the following risk factors are associated with SIDS?

A

I. Maternal cigarette smoking
III. Loose bedding
IV. Bed sharing

I, III, IV

46
Q

What is the minimum level of oxygen tension in a child that requires oxygen administration?

A

PaO2 of 80 mm Hg

47
Q

The physician orders 32% oxygen for a 12 year old patient with cystic fibrosis. Which of the following oxygen delivery devices would best ensure this oxygen concentration?

A

air-entrainment mask

48
Q

While making oxygen rounds, the respiratory therapist notices that the reservoir bag on the patient’s non-rebreathing mask completely deflates as the patient inspires. Which of the following should the therapist recommend at this time?

A

Increase the flow to the mask

Rationale: The reservoir bag of a partial or non-rebreathing mask should remain one-half to one-third full at all times during the breathing cycle. If it collapses at any time, it is an indication of inadequate flow to the mask. (Recall)

49
Q

In which of the following conditions is the oxygen-carrying capacity reduced despite the presence of a normal arterial oxygen tension?

A

Carbon monoxide poisoning

50
Q

Which of the following disorders can develop in neonates as a result of receiving concentrations of oxygen that produce a high PaO2?

A

Retinopathy of prematurity

51
Q

What plausible ways does HHFNC improve oxygenation?

A

a. nasal pharyngeal CO2 washout at flows that exceed expiratory gas flow
b. filling the nasal cavity with oxygen-enriched gas
c. positive pressure

Correct answer:
d. all of the above

52
Q

Which of the following oxygen-delivery devices would be most suitable for an infant being treated for choanal atresia?

A

Oxygen hood

53
Q

Which of the following oxygen modalities would you recommend for a toddler needing a low FIO2?

A

cannula

54
Q

What is the leading cause of death in infants?

A

SIDS

55
Q

Which of the following statements best describes the condition sudden infant death syndrome (SIDS)?

A

SIDS is uncommon after infants are 6 months old.

56
Q

Which of the following is considered a limitation of the high-flow nasal cannula?

A

The amount of airway positive pressure cannot be measured.

57
Q

When weaning an infant receiving oxygen from a nasal cannula attached to a low-flow flow meter set at 100%, what range represents the recommended oxygen flow reduction from the flow meter?

A

0.1 to 0.2 L/minute

58
Q

A physician has ordered 40% oxygen to be administered to an active 3 year old. Which of the following delivery devices would you recommend for this patient?

A

Oxygen tent

59
Q

A 5 year old patient with a history of asthma is admitted to the emergency department after complaining of chest tightness and wheezing. The pulse oximeter reading drops from 95% to 88%. Which of the following devices should be selected to deliver oxygen to this patient?

A

Nasal Cannula

60
Q

What is the minimal flow rate that should be used to deliver oxygen through a hood to an infant?

A

10 lpm

61
Q

What is a concern(s) when using a HHFNC?

A

a. a lack of understanding of the actual FiO2 delivered
c. a lack of knowledge concerning the actual amount of positive pressure applied to the patient’s airway

Correct answer: A and C

62
Q

The respiratory therapist is asked to deliver a medication to a patient with cystic fibrosis via nonpressurized aerosol that will improve the mobilization of sputum. Which of the following should be recommended?

A

Dornase alfa

63
Q

The purpose of supplying an adequate flow to masks / hoods is to prevent

A

rebreathing of CO2

64
Q

An anxious 10 year old asthma patient is being given a breathing treatment with levalbuterol (Xopenex). His initial heart rate of 110 beats per minute has now increased to 120 beats per minute. What do you recommend be done?

A

Continue the treatment

65
Q

ACT is required in only a limited number of conditions, all of which are characterized by which of the following?

A

chronic, excessive sputum production

66
Q

Which of the following oxygen-delivery devices would be most suitable for an infant who is unable to breathe through their nose?

A

Oxygen hood

67
Q

Digital clubbing can be most easily assessed by

A

inspecting the angulation of the nail bed

68
Q

Which of the following allows immediate determination of the lowest FiO2 needed for satisfactory oxygenation?

A

Pulse oximetry

69
Q

The therapeutic use of O2 may aid in accomplishing which of the following?

A

I. decrease work of breathing
II. decrease myocardial work

Answer: I, II only

70
Q

Which of these drug classes would be used to reduce airway inflammation?

A

Corticosteroids

71
Q

Which of the following would indicate a need for O2 therapy for a child?

A
  1. SaO2 less than 90%
  2. PaO2 less than 80 mm Hg

Answer: 1 and 3

72
Q

Positioning a patient to enlist gravity to help move secretions from the preipheral airways to the central or large airways is termed:

A

Postural drainage

73
Q

The four components of traditional ACT are:

A

Postural drainage, percussion, vibration and coughing

74
Q

Administration of high O2 concentrations to a neonate for a prolonged period of time may result in which of the following?

A

I. atelectasis
II. retinopathy of prematurity

Answer: I, II only

75
Q

All of the following are considered airway clearance therapies except:

A

Incentive spirometry

76
Q

A respiratory therapist has been assigned to administer ACT to a number of patients on the ward. In which of the following conditions may ACT be contraindicated?

A

I. Foreign body aspiration
II. Frank hemoptysis
III. Empyema
IV. Untreated pneumothorax

Answer: I, II, II, and IV

77
Q

Which of the following is the best aerosolized bronchodilator for a patient with an asthma attack?

A

Albuterol (Proventil)

78
Q

An infant who sleeps in the supine position is at decreased risk of SIDS.

A

True

79
Q

A cooperative and alert post-op patient who is able to eat requires a continuous but low FIO2. Precise FIO2 concentrations are not needed. Which of the following devices would best achieve this end?

A

Nasal cannula

Key phrase: “Precise FiO2 concentrations are NOT needed”

80
Q

A 2 year old patient has been diagnosed as having laryngotracheobronchitis (LTB). Her pulse oximetry reading remains below 90% while awake. Which of the following is the best method to provide cool, oxygen enriched environment for this patient?

A

Oxygen mist tent

81
Q

The minimum flow rate for a simple mask is:

A

6 L/min

82
Q

Retinopathy of prematurity (ROP) is a potentially serious management problem mainly in the care of whom?

A

Premature or low-birth-weight infants

83
Q

Which of the following is a high-flow oxygen delivery system in which the gas delivery apparatus is sufficient to meet all inspiratory flow requirements of a patient?

A

24% air-entrainment mask

84
Q

The act of clapping with your hand on the chest wall to facilitate removal of secretions is termed:

A

Percussion

85
Q

Which of the following signs and symptoms are associated with the presence of hypoxemia?

A
  1. Tachypnea
  2. Tachycardia
  3. Cyanosis

1, 2, and 3

86
Q

The indications or need for chest physical therapy include all of the following except:

A

Patient has a strong productive cough

87
Q

A fever is associated with patients who have LTB. True or False?

A

False

Pediatrics: Smith (3 decks)

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