Chapter 22; Neonatal and Pediatric Ventilation

Chapter 22; Neonatal and Pediatric Ventilation

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. Respiratory failure is imminent in infants who demonstrate which of the following?

a.	Substernal retractions
b.	Tachypnea
c.	Grunting
d.	Nasal flaring

 

 

ANS:   C

Infants attempt to maintain a back pressure in the lungs to preserve the functional residual capacity by narrowing the glottis and maintaining respiratory muscle activity (active exhalation). This results in vocalization during exhalation, or “grunting,” which often is mistaken for crying. Grunting, which usually can be heard without auscultation, is a useful clinical sign of impending respiratory failure.

 

DIF:    1                      REF:    pg. 461

 

2. The primary goals of mechanical ventilatory support in newborns and pediatric patients include all of the following except ____________________.

a.	improving lung compliance
b.	eliminating airway resistance
c.	achieving adequate lung volume
d.	limiting lung injury

 

 

ANS:   B

The goals of mechanical ventilatory support in newborns and pediatric patients are to (1) provide adequate ventilation and oxygenation, (2) achieve adequate lung volume, (3) improve lung compliance, (4) reduce WOB, and (5) limit lung injury. If airway resistance is a problem, it needs to be addressed; however, eliminating it is not a goal of mechanical ventilatory support.

 

DIF:    1                      REF:    pg. 462

 

3. A newborn with which of the following clinical manifestations should receive nasal CPAP?

a.	Substernal retractions, PaCO2 = 65 mm Hg, PaO2 = 48 mm Hg, FIO2 = 0.4.
b.	Tachypnea, nasal flaring, PaCO2 = 50 mm Hg, PaO2 = 50 mm Hg, FIO2 = 0.6.
c.	Grunting, substernal retractions, pH = 7.20, PaCO2 = 70 mm Hg, PaO2 = 40 mm Hg, FIO2 = 0.7.
d.	Tachypnea, pale skin, pH = 7.32, PaCO2 = 45 mm Hg, PaO2 = 75 mm Hg, FIO2 = 0.21.

 

 

ANS:   B

A newborn with tachypnea, nasal flaring, a PaCO₂ of 50 mm Hg, a PaO₂ of 50 mm Hg, and an F_IO₂ of 0.6 meets the criteria for nasal CPAP. A newborn with these findings has adequate minute ventilation, as evidenced by the PaCO₂ of 50 mm Hg, but also has hypoxemia that is not being corrected by an F_IO₂ of 0.6. The newborn in option A (substernal retractions, PaCO₂ = 65 mm Hg, PaO₂ = 48 mm Hg, F_IO₂ = 0.4) does not have an adequate minute ventilation and requires some ventilatory assistance. Mechanical ventilation is indicated for the newborn in option C (grunting, substernal retractions, pH = 7.20, PaCO₂ = 70 mm Hg, PaO₂ = 40 mm Hg, F_IO₂ = 0.7), because this patient has respiratory acidosis and uncorrected hypoxemia. The newborn in option D (tachypnea, pale skin, pH = 7.32, PaCO₂ = 45 mm Hg, PaO₂ = 75 mm Hg, F_IO₂ = 0.21) has two of the physical indications for CPAP, but the ABG findings demonstrate adequate oxygenation.

 

DIF:    2                      REF:    pg. 463; Box 22-1

 

4. Infants with which of the following problems would benefit from nasal CPAP?

a.	Cleft palate
b.	Choanal atresia
c.	Patent ductus arteriosus
d.	Tracheoesophageal fistula

 

 

ANS:   C

A newborn with a patent ductus arteriosus has increased pulmonary blood flow and reduced lung compliance and FRC and therefore would benefit from the positive intrathoracic pressure produced by CPAP. The use of CPAP can be dangerous in newborns with choanal atresia, a tracheoesophageal fistula, or a cleft palate.

 

DIF:    1                      REF:    pg. 464

 

5. The most common interface for infants receiving CPAP is which of the following?

a.	Nasopharyngeal tube
b.	Binasal prongs
c.	Nasal mask
d.	Endotracheal tube

 

 

ANS:   B

The short binasal prongs are the most commonly used interface for infants receiving nasal CPAP. Nasal masks are slowly becoming more popular. The least popular method of administering CPAP is through nasopharyngeal or endotracheal tubes, because they are invasive.

 

DIF:    1                      REF:    pg. 464