Practice Tests Flashcards
How long should it take to complete on circuit of the NRP algorithm? (from birth to administration of first dose of epinephrine?
30 sec
60 sec
90 sec
120 sec
150 sec
90 sec
How often should you be evaluating the patient according to the NRP algorithm?
Ever minutes
Every 2 minutes
Every 15 sec
Every 30 sec
Whenever there is a change in the patient’s status
Every 30 sec
Restoration of adequate ventilation usually will result in _______ improvement in heart rate?
Rapid
Gradual
Slow
Rapid
a term newborn is apneic with a HR of 55 bpm you should?
Give supplemental oxygen
Provide positive pressure ventilation
Administer chest compressions
Both b and c
All of the above
All of the above
If a newborn has meconium stained amniotic fluid and has been vigorous since delivery you should?
Suction mouth and trachea
Clear mouth and nose of secretions
Dry, stimulate and reposition
Both b and c
All of the above
Both b and c
A newborn that is born at term, has no meconium in the amniotic fluid or on the skin, is breathing well, and has good muscle tone________________ need resuscitation.
Does
Does Not
Does Not
If a newborn is still not breathing after a few seconds of stimulation. The next action should be to administer__________
Additional stimulation
Positive Pressure ventilation
Compressions
Only b and c
All of the above
Positive Pressure ventilation
Which of these would be your first actions if the HR remains below 60 bpm, despite administration of ventilation and chest compressions?
Ensure ventilation is being given properly
Ensure chest compressions are being given optimally
Ensure that you are using 100% oxygen
Give the patient epinephrine.
Only a,b, and c.
Only a,b, and c.
What concentration of epinephrine should you use during resuscitation?
1: 10
1: 100
1: 1,000
1: 10,000
None of the above.
1:10,000
What dose of epinephrine should you instill through the ETT during resuscitation?
- 1 ml/kg
- 01 mg/kg
10 ml/kg
1.0 ml/kg
Both a and b
Both a and b
If you have a 4.1 kg newborn patient requiring epinephrine how much should you instill through the ETT? (type in the amount to one decimal place no need to state ml)
0.3
How often can you repeat the dose of epinephrine if the patient does not respond with an increased HR?
Every 30 seconds
Every minute
Every 3 minutes
Every 5 minutes
Both c and d
Both c and d
How soon should you check the HR after administration of epinephrine?
Every 30 seconds
Every minute
Every 3 minutes
Every 5 minutes
Both c and d
Every 30 seconds
What should you do if you suspect a patient’s airway is blocked due to Robin Syndrome?
Intubate the trachea
Prone position the baby
Provide PPV with increased pressures
Both b and c
Prone position the baby
Which of these is a contraindication for giving Naloxone?
Mother is addicted to narcotics
Mother has been given narcotics within the last 4 hours
Baby has normal HR and color with PPV
Baby presents with recurrent respiratory depression
Mother is addicted to narcotics
A 38 week gestation neonate (2750 g) is ventilated on the Hamilton G5. Settings:
Mode: P-CMV
PCset: 18 cmH2O
PEEP: 7 cmH2O
VtE: 14 mL
Ti: 0.40 sec
RRset: 40 bpm
RRtotal: 47 bpm
FiO2: 0.55
ABG: 7.34 / 40 / 68 / 21 / -4.2 / 94%
Based on this information, the best change to the vent settings would be:
Increase RR
Increase PC level
Decrease PC level and decrease FiO2
Decrease PC level and decrease PEEP
Decrease RR and decrease FiO2
Decrease PC level and decrease FiO2
ABG goals for term babies → pH 7.25, CO2 45-55
Decrease PCset → 18+7 = 25, would want to decrease to a total of 18 to reach into the weaning parameters
You are ventilating an adult patient (IBW 75 kg) who had H1N1 pneumonia. Normal ABGs and SpO2 >/= 90% are currently targeted
Mode: APRV
PHigh: 28 cmH2O
Plow: 0 cmH2O
Thigh: 5.5 s
Tlow: 0.5s
FiO2: 0.60
VTE: 610 ml
ABG: 7.28/52/61/24/0/91%
Based on the information the best change to the ventilator settings would be:
Increase Thigh
Decrease Thigh
Increase Phigh
Decrease Phigh
Decrease Thigh
You are ventilating an adult patient (IBW 70 kg) in APRV. The patient had developed ARDS secondary to sepesis and is now resolving. Normal ABGs and SpO2 >/= 90% are being targeted.
Mode: APRV
Phigh: 26 cmH2O
Plow: 0 cmH2O
Thigh: 5.0 s
Tlow: 0.5 s
FiO2: 0.40
VTE: 575 ml
ABG: 7.46/33/97/24/0/98%
Based on the information, when weaning this patient within APRV the strategy would include:
Decreasing Thigh, decreasing Phigh
Increasing Thigh, decreasing Phigh
Increasing TLow, decreasing Phigh
Increasing Thigh, increasing Tlow
Increasing Thigh, increasing Tlow
A neonatal patient is ventilated on the sensorimedics 3100A. If the patient’s ETT were to become kincked you would expect:
The SpO2 to decrease
The adjustable high MAP alarm to be activated\
The adjustable low MAP alarm to be activated
The dump valve to open
B and d
The SpO2 to decrease
No alarms for obstructed tubes on oscillators.
A 27 week neonate is ventilated on the Sensormedics 3100A
Frequency: 13 Hz
MAP: 11 cmH2O
Amplitude (change in P): 18 cmH2O
I time %: 33%
FiO2: 0.60
ABG: 7.22/58/46/23/82%
Which of the following changes to the oscillating settings would help to return the blood gas values to goal ranges?
Increased amplitude, decreased MAP
Decreased amplitude, decreased MAP
Increased amplitude, increased MAP
Decreased amplitude, increased MAP
Increased amplitude, increased MAP
You are ventilating a patient on the 3100 oscillator and increase frequency control how will that change PaO2
No Change
You are ventilating a patient on the 3100 oscillator and increase frequency control how will that change PaCO2
Increase
You are ventilating a patient on the 3100 oscillator and increase frequency control how will that change Minute volume
Decrease
You are ventilating a patient on the 3100 oscillator and increase frequency control how will that change tidal volume
Decrease
Prone positioning may be part of a ventilation strategy for which of the following patient conditions:
ARDS
Pneumonia
Severe asthma exacerbation
All of the above
a and b only
a and b only
You are ventilating a 70 kg patient with the following settings:
Mode: MMV
RRset: 12
RRtotal: 26
Vtset: 560 mL
Vtspont: 280 mL
PEEP: 10 cmH2O
FiO2: 0.45
PS: 10 cmH2O
Current orders: ventilate to pH 7.35 - 7.45, PaCO2 35 - 45, keep SpO2 > 90%
Current ABG: 7.29 / 56 / 64 / 26 / -1 / 91%
What changes could be made to correct this ABG?
Increase RRset to 15
Increase Vtset to 690 mL
Increase PEEP to 12 cmH2O
Increase PS to 17 cmH2O
Increase PS to 17 cmH2O
For a healthy individual, the expected difference between points C & D (on the above diagram is 3-5mmHg of CO2, what does point D represent?
The partial pressure of CO2 dissolved in arterial blood
What Does the Shaded Area Represent
CO2 from alveoli experiencing decreased capillary blood flow
Not all cells of the lung participate in gas exchange, but still need O2 for metabolism, so CO2 from these cells add to the CO2 level. Shunt and alveolar deadspace contribute to the PaCO2. Everything below dotted line is due to alveolar deadspace, above the line is shunt
Vd/Vt = (PaCO2 - PECO2)/ PaCO2 → enghoff (all the shaded area)
Vd/Vt = (PACO2 - PECO2) / PACO2 –>bohr (true alv. Deadspace -assumes gas exchange did occur)
Your patient is currently on an SBT. Approx 15 minutes into the trial you observe that his RR has increased from 18 to 25 and he seems to be working using more accessory muscles to breathe. In that same amount of time your volumetric capnograph has shown an increase in VtCO2. What should you do for patient?
This is a normal response to the imposed WOB of the SBT. Continue SBT
This is an abnormal response to the imposed WOB of the SBT. Discontinue the SBT
The increase in VtCO2 correlates with an increase in PaCO2 and the patient is failing. Discontinue the SBT
The VtCO2 is an indication of how much CO2 is present in exhaled gas at any given time and normally increases from the start of exhalation to the end of exhalation. Continue the SBT
This is a normal response to the imposed WOB of the SBT. Continue SBT
Workload goes up, CO2 goes up → appropriate change (if CO2 decreased, patient is tiring out → stop)
D. doesn’t explain the changes we saw. It’s true for every breath.
Increase the % support
Calculating deadspace volume
Use Vd/Vt = (PaCO2 - PECO2)/ PaCO2
PECO2 = (Pbaro - 47) * FECO2
→ FECO2 from etCO2
Vd/Vt * Vt = Vd
You have a pt that is complaining of chest pain and on 4 LPM O2 and nitroglycerin. He has been stable and comfortable for the last hour when you assess him he is responsive alert RR 16 and BP 138/87 with the following rhythm what should you do
Should request cardiology consult
A patient is symptomatic with the following rhythm what should you do
Cardiovert
You have stabilized a bradycardic patient in third degree heart block using TCP at a rate of 60 bpm. Mechanical capture has been confirmed. The patient remains hypotensive. Your next action would be to:
Increase the mA setting
Increasing the rate of pacing
Start an infusion of epinephrine
Cardiovert the patient at 50 J
Increasing the rate of pacing
A neonate is being managed immediately post-delivery. They are receiving ventilaion by mask with a good technique and are not improving after 2 min. The mask seal is verified yet the heart rate remains 85 bpm and there is poor chest movement. The next action should be:
Perform endotracheal intubation
Perform chest compressions
Give epinephrine
All the above
Perform endotracheal intubation
A baby is born and placed on the radiant warmer. You immediately note no crying, limp tone, and gasping respirations. Your first action should be to:
Dry and stimulate the baby
Provide PPV
Perform intubation
Provide O2 therapy
Dry and stimulate the baby
A 28 year old female is delivering a 39 week infant, pre-natal care was followed. The membranes ruptured 5 hours ago and the fluid is clear, she has received fentanyl 30 minutes prior to delivery. Baby is placed under the warmer, positioned, airway cleared, dried and stimulated. HR is 110, no tone, no respiratory effort. Which of the following is the next action?
Give narcan
Intubate
Provide tactile stimulation
PPV
Initiate chest compressions
PPV
A 2 year old child is seen in the ER of a local hospital and diagnosed with croup. The physician orders a dose of aerosolized epinephrine via small volume nebulizer. What size aerosol particle is most likely to provide the greatest therapeutic benefit to the patient?
Particles > 10 um
Particles 5 - 10 um
Particles 2 - 5 um
Particles 0.8 - 3 um
Particles 5 - 10 um
You are delivering a mixture of 30:70 heliox continuously to a patient with a non-rebreather. The O2 flowmeter reads 12 lpm. What flow is being delivered to the patient?
12 lpm
22 lpm
19 lpm
8 lpm
19 lpm
A 10 kg child requires salbutamol; the order is for 0.03 mL/kg. How many mL of solution will you need?
- 3 mL
- 03 mL
3 mL
30 mL
0.3 mL
Common uses for inhaled nitric oxide include all of the following except:
ARDS
PPHN
Primary pulmonary hypertension
Status asthmaticus
Status asthmaticus
An asthmatic girl has been using a SVN for Ventolin treatment for the past few years. Her prescription was to use 2.5 mg. How many puffs with an MDI and spacer should she use?
2
5
8
10
5
Nebulized epinephrine has been ordered for a child with croup in the ED. You draw up 5 mL from a multidose vial that reads 1:1000 epinephrine. How many mg of epi is in the solution that is drawn up?
10 mg
5 mg
- 5 mg
- 5 mg
5 mg
One of these statements about methemoglobinemia is NOT correct
Causes blood to appear rusty brown
Causes SpO2 to be erroneously high
Is defined as metHg of over 10%
Can be treated with methylene blue
Is defined as metHg of over 10%
