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Interventions 3 > Practice Tests > Flashcards

Practice Tests Flashcards

1
Q

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

A

90 sec

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2
Q

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

A

Every 30 sec

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3
Q

Restoration of adequate ventilation usually will result in _______ improvement in heart rate?

Rapid

Gradual

Slow

A

Rapid

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4
Q

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

A

All of the above

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5
Q

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

A

Both b and c

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6
Q

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

A

Does Not

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7
Q

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

A

Positive Pressure ventilation

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8
Q

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.

A

Only a,b, and c.

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9
Q

What concentration of epinephrine should you use during resuscitation?

1: 10
1: 100
1: 1,000
1: 10,000

None of the above.

A

1:10,000

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10
Q

What dose of epinephrine should you instill through the ETT during resuscitation?

  1. 1 ml/kg
  2. 01 mg/kg

10 ml/kg

1.0 ml/kg

Both a and b

A

Both a and b

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11
Q

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)

A

0.3

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12
Q

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

A

Both c and d

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13
Q

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

A

Every 30 seconds

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14
Q

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

A

Prone position the baby

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15
Q

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

A

Mother is addicted to narcotics

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16
Q

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

A

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

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17
Q

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

A

Decrease Thigh

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18
Q

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

A

Increasing Thigh, increasing Tlow

19
Q

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

A

The SpO2 to decrease

No alarms for obstructed tubes on oscillators.

20
Q

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

A

Increased amplitude, increased MAP

21
Q

You are ventilating a patient on the 3100 oscillator and increase frequency control how will that change PaO2

A

No Change

22
Q

You are ventilating a patient on the 3100 oscillator and increase frequency control how will that change PaCO2

A

Increase

23
Q

You are ventilating a patient on the 3100 oscillator and increase frequency control how will that change Minute volume

A

Decrease

24
Q

You are ventilating a patient on the 3100 oscillator and increase frequency control how will that change tidal volume

A

Decrease

25
Q

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

a and b only

26
Q

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

A

Increase PS to 17 cmH2O

27
Q

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?

A

The partial pressure of CO2 dissolved in arterial blood

28
Q

What Does the Shaded Area Represent

A

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)

29
Q

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

A

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.

30
Q
A

Increase the % support

31
Q

Calculating deadspace volume

A

Use Vd/Vt = (PaCO2 - PECO2)/ PaCO2

PECO2 = (Pbaro - 47) * FECO2

→ FECO2 from etCO2

Vd/Vt * Vt = Vd

32
Q

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

A

Should request cardiology consult

33
Q

A patient is symptomatic with the following rhythm what should you do

A

Cardiovert

34
Q

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

A

Increasing the rate of pacing

35
Q

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

A

Perform endotracheal intubation

36
Q

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

A

Dry and stimulate the baby

37
Q

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

A

PPV

38
Q

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

A

Particles 5 - 10 um

39
Q

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

A

19 lpm

40
Q

A 10 kg child requires salbutamol; the order is for 0.03 mL/kg. How many mL of solution will you need?

  1. 3 mL
  2. 03 mL

3 mL

30 mL

A

0.3 mL

41
Q

Common uses for inhaled nitric oxide include all of the following except:

ARDS

PPHN

Primary pulmonary hypertension

Status asthmaticus

A

Status asthmaticus

42
Q

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

A

5

43
Q

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

  1. 5 mg
  2. 5 mg
A

5 mg

44
Q

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

A

Is defined as metHg of over 10%

Interventions 3 (34 decks)

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