Neonatal and Pediatric Respiratory Care: A Patient Case Method, 1st Edition Test Bank

Name: Neonatal and Pediatric Respiratory Care: A Patient Case Method, 1st Edition Test Bank
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Master difficult topics with Neonatal and Pediatric Respiratory Care: A Patient Case Method, 1st Edition Test Bank, featuring easy explanations and exam-ready questions.

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Chapter 1 Making Sense of Caring for Kids: A Different Approach to Respiratory Care
Multiple Choice
1. When utilizing bag-mask ventilation on an unconscious child, what airway should initially be
considered the first choice to use?
A. Nasal pharyngeal airway
B. Oral airway
C. Endotracheal tube
D. Nasal trumpet
ANS: B
2. What is the smallest portion of a child’s airway?
A. Epiglottis
B. Laryngeal opening
C. Cricoid ring
D. Glottis
ANS: C
3. What may lead to the collapse of the extrathoracic trachea?
A. Increased work of breathing
B. Increased inflammation
C. Increased inspiratory pressure
D. Increased negative pressure
ANS: D
4. Which is the best position for keeping the airway open in both children and adults?
A. Sniffing
B. Jaw-thrust maneuver
C. Head lift–chin tilt maneuver
D. Combination of jaw-thrust and head-tilt maneuvers
ANS: A
5. In newborns, what interalveolar connections are responsible for the lack of collateral air circulation?

A. Septum
B. Pores of Kohn
C. Lung parenchyma
D. Functional residual capacity
ANS: B
6. Which of the following options explain why infants and children have a lower pulmonary reserve than
adults do?
A. Smaller hearts, more elastic recoil in the lung, chest wall noncompliant
B. Larger hearts, less elastic recoil in the lung, chest wall noncompliant
C. Smaller hearts, more elastic recoil in the lung, chest wall more compliant
D. Larger hearts, less elastic recoil in the lung, chest wall more compliant
ANS: D
7. Why would cricoid pressure (Sellick maneuver) be applied to a patient?
A. To aid in intubation for visualization
B. To decrease gastric insufflation and aspiration
C. To increase ability to swallow
D. It is never helpful and should not be performed.
ANS: B
8. What data are imperative to obtain to make a patient assessment?
A. Chief complaint, vital signs, and blood gases
B. Subjective and objective information
C. Patient history and chief complaint
D. Vital signs and subjective and objective information
ANS: C
9. The preverbal scale for preterm infants, known as FLACC, is used to quantify pain. What does this
acronym stand for?
A. Fear, Listless, Anxious, Conscious, Crying
B. Fever, Limb movement, Anxiety, Crying, Conscious
C. Facial expression, Leg movement, Activity, Cry, Consolability
D. Flaccid, Listless, Awake, Conscious, Crying
ANS: C

10. What is the purpose of transcutaneous monitoring?
A. Industry standard for assessment of pH, PaO2, PaCO2, and HCO3
B. Accurate, simple, and noninvasive method of measuring SaO2
C. Electrochemically measures the skin-surface PO2 and PCO2 by heating localized area of the skin to
induce hyperperfusion
D. Is of no clinical use and used in lieu of arterial blood gases
ANS: C
11. What does BPCA stand for?
A. Best Practice Children’s Act
B. Best Pharmacological Children’s Act
C. Best Practice Child Act
D. Best Pharmaceuticals for Children Act
ANS: D
12. What laryngoscope blade is recommended for children younger than 3 years old?
A. Macintosh blade
B. Fiberoptic blade
C. Miller blade
D. Stylet blade
ANS: C
13. What laryngoscope blade should be used on an infant who weighs 10 kg?
A. Size 0 straight
B. Size 2 Miller
C. Size 2 Macintosh
D. Size 1 Miller
ANS: D
14. What is evidence-based medicine?
A. The ability to care for your patient from set protocols determined 10 years ago
B. Delivering care from unscientific data and set procedures set forth by the hospital
C. Conscientious, explicit, and judicious use of current best evidence in making decisions about the care
of the individual patient
D. Integrating many clinical experts who review best practices within a number of hospitals and
determining the best mode of action to take care of your patients
ANS: C

True/False
15. To avoid increased work of breathing, infants automatically compensate by decreasing their
respiratory rate to decrease their minute ventilation.
ANS: FALSE
16. Infants are more susceptible than are adults to right mainstem intubation of the right lung.
ANS: TRUE
17. Because of their basal oxygen consumption, children will desaturate more rapidly than adults will.
ANS: TRUE
18. Regardless of whether an injury occurred or the potential for injury was present, a medication error is
an unpreventable event that occurs in the process of ordering or delivering a medication.
ANS: FALSE
19. Few respiratory medications are FDA approved for use in neonates.
ANS: TRUE
20. Aerosol-dose medication is calculated based on body size.
ANS: FALSE
21. When receiving an aerosol treatment, infants usually inhale through their nose regardless of whether
their mouths are open.
ANS: TRUE

22. All published data are considered equal, to help clinicians and scientists develop and classify the
quality and validity of research evidence.
ANS: FALSE
23. Children do not need to meet vigorous international and federal guidelines prior to being initiated into
a research study approved by the internal review board.
ANS: FALSE
Short Answer
24. List five errors that can occur in arterial blood gas sampling.
ANS: Heparin dilution, air in sample, venous admixture, temperature, metabolism
25. Define off-label use.
ANS: Off-label use is when medication is prescribed and delivered for an intended use, such as age,
group, or condition, other than what is documented in the proposed labeling.

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Chapter 2 Fetal Cardiopulmonary Development
Multiple Choice
1. What percentage of live births occurs before the 37-week gestation period?
A. 10%
B. 15%
C. 12%
D. 18%
ANS: C
2. What measuring tool for due date estimation is effective at young gestational age as a result of size
variability being minimal?
A. Biparietal diameter
B. Crown-rump
C. Transverse diameter of the head
D. Head circumference
ANS: B
3. During which lung development stage do the right and left lung buds arise from the esophagus?
A. Canalicular phase
B. Pseudoglandular phase
C. Saccular phase
D. Embryonic phase
ANS: D
4. Starting at which week during the gestational period can the presence of mucus be found in the fetal
lung?
A. 13 weeks
B. 12 weeks
C. 14 weeks
D. 11 weeks
ANS: A

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5. During which gestational phase have the airways begun to branch to approximately four generations?
A. Embryonic phase
B. Saccular phase
C. Pseudoglandular phase
D. Canalicular phase
ANS: C
6. Fetal lung fluid composition consists of which of the following?
A. Very high pH, low bicarbonate and protein levels, lower sodium and high chloride concentrations
B. Very low pH, low bicarbonate and protein levels, higher sodium and high chloride concentrations
C. Very low pH, low bicarbonate and protein levels, lower sodium and low chloride concentrations
D. Very high pH, low bicarbonate and protein levels, high sodium and low chloride concentrations
ANS: B
7. During which lung development phase does phosphatidylglycerol (PG) first appear?
A. Saccular phase
B. Pseudoglandular phase
C. Canalicular phase
D. Alveolar phase
ANS: A
8. At the end of which phase does mature surfactant begin to appear, so that the neonate is at minimal risk
of pulmonary complications?
A. Alveolar phase
B. Saccular phase
C. Canalicular phase
D. Pseudoglandular phase
ANS: B
9. At which week of development is the one-chambered heart efficiently pumping blood to the embryo?
A. 3 weeks
B. 5 weeks
C. 4 weeks
D. 2 weeks
ANS: C

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10. Which of the following statements is not true about the germinal matrix?
A. The germinal matrix is a weakly supported and highly vascularized area at the surface of the lateral
ventricles that is prone to hypoxic-ischemic injury.
B. The germinal matrix is irregular and prone to rupture.
C. The germinal matrix leads to a low incidence of intraventricular hemorrhage in premature neonates.
D. An increase in systemic blood pressure in a premature infant will increase cerebral blood flow.
ANS: C
11. The cerebrum controls all of the following except:
A. Consciousness and higher mental thinking
B. Reasoning and judgment
C. Involuntary muscular activities and learning
D. Emotions and intelligence
ANS: C
12. Blood returns to the fetus through which of the following pathways?
A. Umbilical vein, ductus venosus, foreman ovale, umbilical artery
B. Umbilical artery, ductus arteriosus, foreman ovale, umbilical artery
C. Umbilical artery, foramen ovale, ductus arteriosus, umbilical artery
D. Umbilical vein, ductus arteriosus, foramen ovale, ductus venosus, umbilical artery
ANS: A
13. In fetal circulation, the ______atrium is at higher pressure than the ______ atrium.
A. left/right
B. right/left
ANS: B
14. During fetal development, what structure allows circulation to bypass the lungs?
A. Septum primum
B. Ductus venosus
C. Ductus arteriosus
D. Foramen ovale
ANS: C
15. The foramen ovale connects the:

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A. Right ventricle to the left ventricle
B. Right atrium to the left ventricle
C. Right atrium to the left atrium
D. Right atrium to the left ventricle
ANS: C
16. What structure vasoconstricts after the umbilical cord is clamped?
A. Ductus arteriosus
B. Ligamentum venosum
C. Foramen ovale
D. Ductus venosus
ANS: D
17. Despite increased knowledge and preventative care, what percent of all preterm births are unexplained
and spontaneous?
A. 20%
B. 25%
C. 30%
D. 35%
ANS: C
18. Which lecithin-sphingomyelin (L/S) ratio designates lung maturity?
A. 2:1; 5% chance to develop respiratory distress syndrome if delivered
B. 1:1; 1% chance to develop respiratory distress syndrome if delivered
C. 2:1; 2% chance to develop respiratory distress syndrome if delivered
D. 1.5:1.5; 1% chance to develop respiratory distress syndrome if delivered
ANS: C
19. What simple test utilizes a sample of amniotic fluid combined with ethanol to determine lung
maturity?
A. Surfactant-albumin ratio (S/A)
B. Lecithin-sphingomyelin ratio (L/S)
C. TDx Fetal Lung Maturity test
D. Foam test
ANS: D

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20. What substance speeds up lung growth and reduces the incidence of respiratory distress syndrome?
A. Indomethacin
B. Terbutaline
C. Tocolytic drugs
D. Glucocorticoids
ANS: D
21. Which lung profile test is considered a simple, rapid test that is widely used and requires a low level
of expertise and a small volume (1 mL) of amniotic fluid?
A. Lecithin-sphingomyelin (L/S) ratio
B. Shake test
C. Phosphatidylcholine (PG) presence
D. Surfactant-albumin (S/A) ratio
ANS: D
22. What lung profile test is considered less reliable and is ordered only 27% of the time in clinical
practice?
A. Lecithin-sphingomyelin (L/S) ratio
B. Lamellar body count
C. Phosphatidylcholine (PG) presence
D. Surfactant-albumin (S/A) ratio
ANS: B
True/False
23. During the first appearance of pulmonary surfactant, type 1 cells also appear.
ANS: FALSE
24. Higher surface tension improves lung compliance.
ANS: FALSE
25. The alveolar phase is considered to end at about the first or second year of life.
ANS: TRUE

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Chapter 3 Resuscitation of the Newborn During Transition to Extrauterine Life
Multiple Choice
1. What stage of labor does the cervix reach complete dilatation?
A. Active phase
B. Latent phase
C. Deceleration phase
D. Transition phase
ANS: C
2. All of the following statements about fetal heart rate monitoring are true except:
A. It is used to estimate a fetus’s tolerance of labor process.
B. It is used to make decisions on the method and speed of the delivery.
C. It improves neonatal outcomes.
D. It has become the standard method of care in the United States.
ANS: C
3. A sinusoidal heart rate is indicative of:
A. Uteroplacental insufficiency
B. umbilical cord compression
C. A change in vagal tone after brief hypoxia episodes
D. Severe fetal hypoxia, acidosis, or anemia
ANS: D
4. Transition to the extrauterine world consists of all of the following rapid, physiological events except:
A. Establishment of respirations
B. Vasoconstriction of the pulmonary vasculature and increase in pulmonary vascular resistance
C. Transition of fetal circulation to adult circulation
D. Expansion of the lungs

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ANS: B
5. A newborn presents at delivery with meconium-stained amniotic fluid and is handed to the
resuscitation team. She is crying, has central cyanosis, and is moving spontaneously. Which of the
following is the most appropriate first action for the team to take to resuscitate?
A. Dry, stimulate, and suction the mouth and nose.
B. Auscultate the lungs to evaluate aspiration of meconium.
C. Intubate and suction the trachea to remove meconium.
D. Place the baby on the mother’s chest.
ANS: A
6. Randomized controlled trials have suggested all of the following statements regarding induced
hypothermia are true except:
A. Infants with moderate-to-severe hypoxic encephalopathy may be protected against brain injury.
B. Strict guidelines must be implemented within 12 to 24 hours following birth.
C. Infants with moderate-to-severe ischemic encephalopathy should be offered therapeutic hypothermia in
a timely manner.
D. Registered respiratory therapists must be aware of their institutional policies to provide appropriate
follow-up care.
ANS: B
7. What actions are usually enough to stimulate a newborn to breathe?
A. Positioning, drying, and suctioning
B. Positioning, drying, and slapping the newborn’s buttocks
C. Positioning, drying, and vigorously rubbing the newborn’s back
D. Positioning, drying, and flicking the newborn’s arm
ANS: A
8. What is the course of action when a newborn presents with secondary apnea?
A. Place in sniffing position.
B. Place on apnea monitor.
C. Initiate positive pressure ventilation.
D. Administer medications to increase heart rate.

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ANS: C
9. Baby Carter presents with gasping, his heart rate is greater than 100 bpm, and the presence of
secondary apnea is seen. Initially, what is the best approach when managing this newborn?
A. Biphasic positive airway pressure therapy
B. Positive pressure ventilation via resuscitation bag and mask
C. Oxygen therapy
D. Positioning, drying, and vigorously rubbing the newborn’s back
ANS: B
10. If a newborn weighs 2.5 kg, where should the endotracheal tube be taped?
A. 7.5 cm at the upper lip
B. 8.5 cm at the upper lip
C. 7.0 cm at the upper lip
D. 8.0 cm at the upper lip
ANS: B
11. What chest compression method is recommended by the Neonatal Resuscitation Program, and gives a
greater peak systolic pressure when performing CPR on newborns?
A. Two-finger technique (compressing the chest with two fingers as the second hand supports the back)
B. One finger technique (compressing the chest with one finger as the second hand supports the back)
C. Two-thumb encircling-hand technique (two thumbs with fingers encircling the chest and supporting
the back)
D. Two-thumb encircling-hold technique (two thumbs with fingers encircling the chest and supporting the
back)
ANS: C
12. What is the compressions-to-ventilation ratio that a registered respiratory therapist should use during
neonatal resuscitation?
A. 2:1
B. 3:1
C. 20:2

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D. 15:2
ANS: B
13. What route may be used to administer epinephrine 1:10,000 (0.1 mg/mL) to increase heart rate?
A. Subcutaneously
B. Intravenously only
C. Endotracheally only
D. Intravenously and endotracheally
ANS: D
14. What does the acronym APGAR stand for?
A. Assessment, pulse, grimace, appearance, resonance
B. Appearance, pulse, grimace, activity, respirations
C. Assessment, pulse, ground-glass appearance, asthma, respirations
D. Assessment, projection, grimace, auditory, respirations
ANS: B
15. Withholding and discontinuing resuscitation efforts may be appropriate in all of the following
circumstances except:
A. When the birth weight is less than 400 grams
B. When gestational age is less than 28 weeks
C. When parental agreement is obtained
D. When there is an undetectable heart rate after 10 minutes of CPR
ANS: B
16. Which of the following statements are true regarding disadvantages of self-inflating bags?
I. Inability to know if a good seal is being obtained
II. A reservoir attachment needed to achieve 100% FiO₂
III. Ability to provide 100% FiO₂ free- flowing dependably
IV. Inability to provide 100% FiO₂ free-flowing dependably
A. I, III, IV
B. II, III, IV

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C. I, II, IV
D. I and II
ANS: C
True/False
17. During cardiopulmonary resuscitation, a newborn’s heart rate should be assessed every 5 seconds to
determine effectiveness of compressions.
ANS: False
18. In the presence of meconium, it is suggested to use a bulb syringe aspirator vigorously to reduce the
risk of aspiration.
ANS: False
19. It is best to intubate and not to bag-mask ventilate a newborn when multiple unsuccessful attempts to
establish an airway have occurred because hypoxia and permanent damage will occur after 4 minutes.
ANS: False

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