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Respiratory 2024 > Neonatal and Pediatric Chapter 1-4 > Flashcards

Neonatal and Pediatric Chapter 1-4 Flashcards

Study Guide

1
Q

Which of the following phases of human lung development is characterized by the formation
of a capillary network around airway passages?
a. Pseudoglandular
b. Saccular
c. Alveolar
d. Canalicular

A

d. Canalicular

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2
Q

Regarding postnatal lung growth, by approximately what age do most of the alveoli that will
be present in the lungs for life develop?
a. 6 months
b. 1 year
c. 1.5 years
d. 2 years

A

c. 1.5 years

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3
Q

The respiratory therapist is evaluating a newborn with mild respiratory distress due to tracheal
stenosis. During which period of lung development did this problem develop?
a. Embryonal
b. Saccular
c. Canalicular
d. Alveolar

A

a. Embryonal

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4
Q

Which of the following mechanisms are responsible for the possible association between
oligohydramnios and lung hypoplasia?
I. Abnormal carbohydrate metabolism
II. Mechanical restriction of the chest wall
III. Interference with fetal breathing
IV. Failure to produce fetal lung liquid
a. I and III only
b. II and III only
c. I, II, and IV only
d. II, III, and IV only

A

d. II, III, and IV only

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5
Q

What is the purpose of the substance secreted by the type II pneumocyte?
a. To increase the gas exchange surface area
b. To reduce surface tension
c. To maintain lung elasticity
d. To preserve the volume of the amniotic fluid

A

b. To reduce surface tension

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6
Q

Which of the following tests of the amniotic fluid have been shown to be sensitive indicators
of lung maturity?
a. Levels of prednisone
b. Levels of epidermal growth factor
c. Levels of prostaglandins
d. Levels of phosphatidylglycerol and phosphatidylcholine

A

d. Levels of phosphatidylglycerol and phosphatidylcholine

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7
Q

Approximately how much fetal lung fluid is secreted daily?
a. About 150 to 200 ml
b. About 250 to 300 ml
c. About 350 to 400 ml
d. About 450 to 500 ml

A

b. About 250 to 300 ml

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8
Q

The lung bud emerges from which of the following structures?
a. The pharynx
b. The foregut
c. The mesenchyme
d. The tubular epithelium

A

a. The pharynx

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9
Q

Which of the following embryonic germ layers gives formation to the respiratory system?
a. Endoderm
b. Mesoderm
c. Ectoderm
d. Periderm

A

a. Endoderm

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10
Q

What is the function of Wharton’s jelly inside the umbilical cord?
a. To help provide nutrition to the fetus
b. To prevent the vessels inside the cord from kinking
c. To help protect the fetus
d. To regulate the temperature between the fetus and the mother

A

b. To prevent the vessels inside the cord from kinking

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11
Q

Which of the following organs is considered to be the first complete form?
a. Heart
b. Brain
c. Lungs
d. Kidneys

A

a. Heart

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12
Q

A pregnant woman is coming for an early prenatal evaluation and wants to know if she can
listen to the baby’s heartbeat. How early can the fetal heartbeat be detected?
a. Day 8
b. Day 22
c. Day 45
d. Day 60

A

b. Day 22

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13
Q

Which of the following anatomic structures are fetal shunts?
I. Foramen ovale
II. Sinus venosus
III. Ductus venosus
IV. Ductus arteriosus
a. I and III only
b. I, III, and IV only
c. I, II, and IV only
d. II, III, and IV only

A

b. I, III, and IV only

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14
Q

Which of the following events causes cessation of right-to-left shunt through the foramen
ovale?
a. Increased levels of PO2 in the blood of the neonate
b. Decreased levels of PCO2 in the blood of the newborn
c. Increased systemic vascular resistance
d. Removal of the placenta, causing lowered blood volume returning to the right side
of the fetal heart

A

c. Increased systemic vascular resistance

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15
Q

How long after birth should it take for the ductus arteriosus to close completely?
a. 24 hours
b. 48 hours
c. 96 hours
d. 1 week

A

c. 96 hours

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16
Q

During early embryonic development, which of the following structures supply nutrition to
the growing embryo?
a. Angiogenic clusters
b. Chorionic membrane
c. Bulbus cordis
d. Wharton’s jelly

A

a. Angiogenic clusters

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17
Q

Which of the following paths accurately traces oxygenated blood from the placenta to the
fetus?
a. Umbilical arteries, ductus venosus, right atrium, left atrium, foramen ovale, aorta,
umbilical vein
b. Umbilical vein, ductus arteriosus, right atrium, umbilical arteries, foramen ovale,
left atrium, aorta
c. Aorta, umbilical arteries, umbilical vein, ductus venosus, right atrium, foramen
ovale, left atrium
d. Umbilical vein, ductus venosus, right atrium, foramen ovale, left atrium, aorta,
umbilical arteries

A

d. Umbilical vein, ductus venosus, right atrium, foramen ovale, left atrium, aorta,
umbilical arteries

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18
Q

A pregnant woman has been diagnosed with pregestational diabetes. Of which of the
following adverse fetal outcomes should the therapist be aware at the time of delivery?
a. Unexplained abruption placenta
b. Oligohydramnios
c. Malformations of the cardiovascular system
d. Fetal limb malformations

A

c. Malformations of the cardiovascular system

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19
Q

The respiratory therapist is attending a term labor of a woman diagnosed with gestational
diabetes. The baby is very large for gestational age. What metabolic disturbances should be
considered?
I. Hyperglycemia
II. Hypocalcemia
III. Hyperkalemia
IV. Hypoglycemia
a. II and IV only
b. I, II, and III only
c. I and III only
d. II, III, and IV only

A

d. II, III, and IV only

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20
Q

Which of the following microorganisms most commonly affect pregnancy outcome?
a. Group B Streptococcus
b. Haemophilus influenzae
c. Mycobacterium tuberculosis
d. Hepatitis C virus

A

a. Group B Streptococcus

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21
Q

What is generally accepted as a safe limit for alcohol consumption during pregnancy to avoid
the development of fetal alcohol syndrome?
a. One to two 8-ounce drinks per day are considered acceptable.
b. Four to five 8-ounce drinks per week are considered safe.
c. Three to four 12-ounce drinks per week are considered reasonable.
d. No safe range of alcohol consumption is deemed safe during pregnancy.

A

d. No safe range of alcohol consumption is deemed safe during pregnancy

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22
Q

What is the average birth weight difference between infants born of mothers who smoke and
those born of nonsmoking mothers?
a. Infants born of mothers who smoke tend to be about 200 g lighter than infants born
of mothers who do not smoke.
b. Infants born of mothers who smoke are generally about 400 g lighter than infants
born of nonsmoking mothers.
c. Infants born of mothers who smoke are predisposed to weigh approximately 600 g
less than infants born of mothers who do not smoke.
d. Infants of mothers who smoke are likely to be born about 800 g lighter than those
born of mothers who do not smoke.

A

a. Infants born of mothers who smoke tend to be about 200 g lighter than infants born
of mothers who do not smoke.

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23
Q

A woman with a long history of smoking is now in the last part of the third trimester of her
pregnancy. She is at high risk for which of the following conditions?
I. Premature rupture of membranes
II. Placental abruption
III. Placenta previa
IV. Asthma
a. II and IV only
b. I, II, and III only
c. I and III only
d. I, II, III, and IV

A

b. I, II, and III only

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24
Q
  1. What is the main potential problem associated with the premature rupture of membranes?
    a. Fetal dehydration
    b. Fetal infection
    c. Maternal hypotension
    d. Maternal renal failure
A

b. Fetal infection

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25
Q

Which of the following conditions is responsible for up to 40% of the preterm births in the
United States?
a. Cervical insufficiency
b. Premature rupture of the fetal membranes
c. Obstetrical intervention mandated by fetal jeopardy
d. Hormonal treatment during pregnancy

A

b. Premature rupture of the fetal membranes

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26
Q

How should the therapist interpret an amniotic fluid index of 5 cm?
a. Polyhydramnios
b. Multihydramnios
c. Oligohydramnios
d. Anhydramnios

A

c. Oligohydramnios

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27
Q

Once preterm labor is diagnosed, which of the following medications should be considered as
tocolytic?
a. Magnesium sulfate
b. Sodium bicarbonate
c. Calcium carbonate
d. Epinephrine

A

a. Magnesium sulfate

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28
Q

A pregnant woman at 30 weeks of gestation with premature rupture of membranes has been
admitted to the hospital with preterm labor. The physician has ordered betamethasone. When
does the maximal benefit of antenatal corticosteroid occur to reduce RDS?
a. After 12 hours
b. After 24 hours
c. After 48 hours
d. After 1 week

A

c. After 48 hours

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29
Q

Which of the following conditions is a significant problem in postterm pregnancy?
a. Infection
b. Fetal anencephaly
c. Meconium aspiration
d. Obesity

A

c. Meconium aspiration

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30
Q

A woman 41 weeks pregnant is at high risk for complication in the postpartum period. Which
of the following agents will be more appropriate to induce labor?
a. Magnesium sulfate
b. Aspirin
c. Terbutaline
d. Oxytocin

A

d. Oxytocin

31
Q

Which of the following procedures is performed after the 16th week of pregnancy and can be
used to assess for chromosomal abnormalities?
a. Amniocentesis
b. Scalp fetal pH
c. Stress test
d. Needle ultrasound

A

a. Amniocentesis

32
Q

The respiratory therapist is called to assist in the labor of a pregnant woman whose NST
reported two accelerations in fetal heart rate, each of at least 15 beats per minute and lasting at
least 15 seconds, associated with maternal perception of fetal movement over a period of 20
minutes. What is the best course of action?
a. A C-section should be scheduled as soon as possible.
b. No action is required because this reactive NST is associated with normal
uteroplacental function.
c. A CST should be performed before fetal stress is confirmed.
d. Oxytocin should be administered to prevent more fetal stress.

A

b. No action is required because this reactive NST is associated with normal
uteroplacental function.

33
Q

A fetus is undergoing a contraction stress test. Uterine contractions are stimulated by the
intravenous infusion of oxytocin into the mother. The fetal PO2 drops below 12 mm Hg and
causes the fetal heart rate to slow. Which of the following conditions is likely indicated by this
occurrence?
a. Placenta abruption
b. Oligohydramnios
c. Uteroplacental insufficiency
d. Nuchal cords

A

c. Uteroplacental insufficiency

34
Q

How should the therapist interpret a fetal biophysical profile score of 8?
a. The fetus requires careful evaluation and possibly immediate delivery.
b. The fetus requires another biophysical profile in 24 hours.
c. The fetus appears to be normal.
d. The data are inconclusive and the profile needs to be redone immediately.

A

c. The fetus appears to be normal.

35
Q

Which of the following maternal complications is associated with cesarean section?
a. Significant blood loss
b. Endomyometriosis
c. Failure to progress in labor
d. Placenta previa

A

a. Significant blood loss

36
Q

A therapist is resuscitating a term newborn. The heart rate falls to 55 beats per minute. What
is the best course of action?
a. Intubate and provide positive airway pressure
b. Administer IV or ET epinephrine
c. Apply bag-mask ventilation
d. Continue compressions until heart rate is greater than 60

A

b. Administer IV or ET epinephrine

37
Q

A therapist is called to the labor and delivery room to assist in the resuscitation of a term
newborn. If necessary, what FiO2 should be used to start positive pressure ventilation?
a. 100% and wean as needed
b. 21% and make changes utilizing preductal oximetry
c. 50% and wean for SpO2 >88%
d. Any FiO2 as long as peak pressures do not exceed 20 cm H2O

A

b. 21% and make changes utilizing preductal oximetry

38
Q

A therapist treating a newborn with hypoxemia due to hypothermia should also be aware of
which of the following conditions?
a. Hypercarbia
b. Hypoglycemia
c. Hypocalcemia
d. Left-to-right shunt

A

b. Hypoglycemia

39
Q

A therapist is resuscitating a term newborn. What should be the rate of ventilation?
a. 20 to 30 breaths per minute
b. 30 to 40 breaths per minute
c. 40 to 60 breaths per minute
d. 60 to 100 breaths per minute

A

c. 40 to 60 breaths per minute

40
Q

A therapist is called to the labor and delivery room to assist in the resuscitation of a 32-week
newborn. What FiO2 should be used to start positive pressure ventilation?
a. 100% and then adjusted using clinical assessment and preductal pulse oximetry
b. 50% and then adjusted using clinical assessment and preductal pulse oximetry
c. 30% and then adjusted using clinical assessment and preductal pulse oximetry
d. Any FiO2 as long as peak pressures do not exceed 20 cm H2O

A

c. 30% and then adjusted using clinical assessment and preductal pulse oximetry

41
Q

What measures can the therapist take to prevent heat loss and cold stress before performing
resuscitation on a preterm neonate?
I. Dry the infant’s skin.
II. Wrap the infant in pre-warmed blankets.
III. Remove wet linens from around the infant.
IV. Measure the neonate’s body temperature.
a. IV only
b. I and II only
c. I, II, and III only
d. I, II, and IV only

A

c. I, II, and III only

42
Q

While stabilizing a preterm neonate before resuscitation, what should the therapist do to avert
injury and atelectasis, and to avoid interfering with the infant’s ability to establish adequate
ventilation?
I. Use a bulb syringe.
II. Avoid excessive suctioning of clear fluid from the nasopharynx.
III. Use a suction catheter clearing the mouth first and then the nose.
IV. Suction using direct laryngoscopy.
a. IV only
b. I and II only
c. I, II, and III only
d. I, II, and IV only

A

c. I, II, and III only

43
Q

As the head of a neonate contaminated with meconium emerges at birth, the heart rate monitor
indicates 120 beats per minute, and the physician notices that the infant has good muscle tone
and a strong respiratory effort. What should the physician do at this time to provide airway
care?
a. Intubate the infant immediately.
b. Perform pharyngeal and tracheal suctioning immediately.
c. Perform tracheal suctioning only at this time.
d. Only routine monitoring of respiratory vital signs is needed at this time.

A

d. Only routine monitoring of respiratory vital signs is needed at this time.

44
Q

A newborn does not appear to respond to the extrauterine environment. Both the cry and
respiratory effort are weak. Which of the following methods should the therapist use to
stimulate the newborn?
a. Hold the newborn upside down.
b. Rub over the sternal area.
c. Suction the nasopharynx.
d. Gently rub the back.

A

d. Gently rub the back.

45
Q

The therapist has completed a 1-minute Apgar score. The following evaluations were
obtained.
(1) The infant is pale.
(2) The heart rate is 90 beats per minute.
(3) The respiratory effort is irregular.
(4) Some muscle tone is noted.
(5) No response to nasal suctioning is found.
On the basis of these findings, what Apgar score should be assigned to this neonate?
a. 1
b. 2
c. 3
d. 5

A

c. 3

46
Q

Which of the following parameters of the Apgar score provides the most important prognostic
value?
a. Heart rate
b. Respiratory rate
c. Skin color
d. Muscle tone

A

a. Heart rate

47
Q

Which of the following factors are taken into consideration when assessing the gestational age
of a neonate?
I. Previous maternal pregnancies
II. Prenatal ultrasound evaluations
III. Postnatal findings based on physical and neurologic examinations
IV. Gestational duration based on the last menstrual cycle
a. I and III only
b. I, II, and III only
c. I, II, and IV only
d. II, III, and IV only

A

d. II, III, and IV only

48
Q

The gestational age of a newborn has been evaluated to be 34 weeks. The newborn’s birth
weight is greater than the 90th percentile. How should the therapist classify this infant?
a. Small for gestational age
b. Average for gestational age
c. Large for gestational age
d. Very large for gestational age

A

c. Large for gestational age

49
Q

An infant arrives in the newborn nursery with an axillary body temperature of 95.6°F. Which
of the following events may be responsible for this infant’s temperature?
a. The neonate was in an infant warmer in the delivery room.
b. The infant was swaddled in numerous blankets.
c. The delivery room temperature was low.
d. The newborn has protracted diarrhea.

A

c. The delivery room temperature was low.

50
Q

A physical examination is being performed on a newborn, and the therapist notices that the
infant’s arms do not move symmetrically. Which of the following situations could account for
this problem?
a. An injury to the infant’s brachial plexus may have occurred during birth.
b. The infant may have been born breach.
c. The baby was born via cesarean section.
d. The infant experienced nuchal cords during birth.

A

a. An injury to the infant’s brachial plexus may have occurred during birth.

51
Q

The therapist notices that an infant presents with irregular areas of dusky skin alternating with
areas of pale skin. On the basis of this observation, which of the following conditions should
the therapist anticipate this patient having?
a. Polycythemia
b. Hypotension
c. Situs inversus with dextrocardia
d. Renal insufficiency

A

b. Hypotension

52
Q

Which of the following neonatal skin presentations at birth is associated with a high
hematocrit value or polycythemia and neonatal hyperviscosity syndrome?
a. Mottling
b. Lanugo
c. Reddish blue appearance
d. Vernix

A

c. Reddish blue appearance

53
Q

Why are chest retractions more prominent among neonates than among older children and
adults?
a. Because neonates generate a greater subatmospheric intrapleural pressure
b. Because newborns have relatively thin and weak musculature and a less rigid
thorax
c. Because neonates have a much higher respiratory rate
d. Because airway resistance through the smaller caliber airways is higher

A

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

54
Q

Why is it difficult to localize auscultation findings of the thorax of a newborn?
a. Because the neonate’s chest is small and sounds are difficult to differentiate
b. Because the newborn infant is frequently crying
c. Because the neonate’s tidal volume is so small
d. Because the newborn’s pulmonary compliance is low

A

a. Because the neonate’s chest is small and sounds are difficult to differentiate

55
Q

While performing a physical examination on a newborn infant, the therapist notices that the
point of maximal cardiac impulse is to the left of the sternal border. Which of the following
conditions can cause this situation?
a. Atelectasis of the right lung
b. Bilateral pulmonary consolidation
c. Right-sided pneumothorax
d. Left main stem bronchus intubation

A

c. Right-sided pneumothorax

56
Q

Which of the following statements refers to the diagnostic procedure called transillumination?
a. Place a light source between the surface of the bed and the patient’s back and
orient the patient in a supine position.
b. Direct a light source toward the ipsilateral surface of the patient’s thorax.
c. Position a beam of light against a patient’s chest wall in a well-lit room.
d. Insert a fiberoptic light source down a patient’s endotracheal tube and beyond the
tube’s distal tip.

A

b. Direct a light source toward the ipsilateral surface of the patient’s thorax

57
Q

A neonate is found to have a bounding pulse. Which of the following conditions may
contribute to this finding?
a. Right-to-left shunt
b. Coarctation of the aorta
c. Left-to-right shunt
d. Patent foramen ovale

A

c. Left-to-right shunt

58
Q

What condition would be responsible for the therapist observing a pulse oximeter indicating
decreased perfusion while central blood pressure remains normal?
a. Volume depletion with compensatory peripheral vasoconstriction
b. Hypoplastic left-sided heart syndrome
c. Hypervolemia with compensatory peripheral vasodilation
d. Hypoplastic right-sided heart syndrome

A

a. Volume depletion with compensatory peripheral vasoconstriction

59
Q

For the purpose of assessing right-to-left shunting, as in the case of persistent pulmonary
hypertension, which of the following sites would render post ductal blood?
I. Right arm
II. Left arm
III. Right leg
IV. Left leg
a. I and II only
b. II only
c. III and IV only
d. II, III, and IV only

A

d. II, III, and IV only

60
Q

The therapist is evaluating a newborn with an abdominal defect consisting of protrusion of the
membranous sac that encloses abdominal contents through an opening in the abdominal wall
into the umbilical cord. Which of the following conditions is consistent with this description?
a. Enterocolitis
b. Ascites
c. Congenital diaphragmatic hernia
d. Omphalocele

A

d. Omphalocele

61
Q

After the umbilical cord has been cut in the delivery room during the delivery of an infant
who is large for gestational age, the therapist notices that the umbilical cord is large and fat.
Which of the following maternal conditions is likely present?
a. Congestive heart failure
b. Renal insufficiency
c. Diabetes mellitus
d. Hypertension

A

c. Diabetes mellitus

62
Q

The therapist notices that a preterm newborn has a grunting cry. Which of the following
conditions is most consistent with this description?
a. Hypothyroidism
b. Neurologic injury
c. Respiratory distress syndrome
d. Laryngeal edema

A

a. Hypothyroidism

63
Q

Which of the following pieces of information represent components of patient history for a
new pediatric patient?
I. Chief complaint
II. History of present illness
III. Past medical history
IV. Occupational history
a. I and II only
b. III and IV only
c. I, II, and III only
d. I, II, III, and IV

A

c. I, II, and III only

64
Q

Which of the following components compose the history of present illness section of a
patient’s medical history?
a. Immunizations
b. Symptoms exhibited by parents
c. Aggravating or alleviating factors
d. Symptoms resulting in hospitalizations

A

c. Aggravating or alleviating factors

65
Q

Which of the following components compose the past medical history section of the patient’s
medical history?
I. Birth weight
II. Previous mechanical ventilation
III. Recurrence of symptoms based on season
IV. Emergency department visits
a. II only
b. II and IV only
c. I, II, and IV only
d. I, II, III, and IV

A

c. I, II, and IV only

66
Q

Which of the following components of a patient’s medical history is intended to determine the
presence of symptoms not identified in the history of present illness and may be related or
contribute to the child’s underlying condition?
a. Chief complaint
b. Past medical history
c. Review of systems
d. History of present illness

A

c. Review of systems

67
Q

Head bobbing, nasal flaring, and grunting are exhibiting signs of which of the following?
a. Respiratory distress
b. Hypoxemia
c. Hypercapnia
d. Acidemia

A

a. Respiratory distress

68
Q

Which of the following are recommendations for infants with meconium staining?
I. No intrapartum suctioning should occur.
II. Infants who are vigorous at birth should not receive tracheal suctioning.
III. Infants who are not vigorous may receive direct laryngotracheal suctioning.
IV. Intrapartum suctioning should not occur.
a. I and II only
b. III and IV only
c. II, III, and IV only
d. I, II, and III only

A

d. I, II, and III only

69
Q

During a physical examination of a child’s chest, the therapist perceives increased tactile
fremitus over the patient’s right lower lobe. Which of the following conditions may cause this
physical sign?
a. Pulmonary consolidation
b. Pneumothorax
c. Mucous plug
d. Aspirated foreign object

A

a. Pulmonary consolidation

70
Q

While percussing the thorax of a child during a physical examination, the therapist hears a
dull percussion note over the child’s right lung. Which of the following conditions may cause
this physical finding?
I. Atelectasis
II. Pneumothorax
III. Pleural effusion
IV. Consolidation
a. I and II only
b. I, III, and IV only
c. II, III, and IV only
d. I, II, III, and IV

A

b. I, III, and IV only

71
Q

After placing a stethoscope over a small child’s trachea, the therapist hears expiratory stridor.
Which of the following conditions is consistent with this finding?
a. Laryngotracheobronchitis
b. Adenotonsillar hypertrophy
c. Asthma episode
d. Tracheomalacia

A

d. Tracheomalacia

72
Q

While auscultating a young child’s thorax, the therapist hears bilateral fine crackles. Which of
the following conditions can produce these adventitious sounds?
a. Pulmonary edema
b. Bronchitis
c. Croup
d. Asthma

A

a. Pulmonary edema

73
Q

Which of the following white blood cell counts constitutes the condition leukopenia?
a. Less than or equal to 3500/mm3
b. 5000 to 10,000/mm3
c. 10,000 to 20,000/mm3
d. Greater than or equal to 25,000/mm3

A

a. Less than or equal to 3500/mm3

Respiratory 2024 (3 decks)

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