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NEONATAL & PEDIATRIC RESPIRATORY CARE Latest Edition, Walsh
NEONATAL & PEDIATRIC RESPIRATORY CARE Latest Edition, Walsh
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TEST BANK MULTIPLE CHOICE1. Which of the following major forces opposes inspiration?
NEONATAL & PEDIATRIC
a. Inspiratory flow
b. Surface tension
c. Airway resistance
RESPIRATORY CARE
d. Respiratory rate
ANS: C
The combination of lung compliance (C) and airway resistance (Raw) is the major force
Latest
Edition, Walsh opposing inspiration, whereas elastic recoil is the force responsible for passive normal
exhalation.
REF: p. 66
2. Pulmonary function testing has been ordered in an infant. Which of the following represents a
real risk to this infant?
a. The infant may require sedation for up to 3 hours.
b. If the infant cries, it will make the test invalid or open to misinterpretation.
c. The gases used for the PFT may be toxic for the infant.
d. The inability to feed the child 24 hours prior to the test
ANS: B
In infant testing, the subject may need to be lightly sedated in the laboratory for 2 to 3 hours
to complete a full set of studies. Sedation carries some risk, and testing should not be viewed
as routine. The NPO guidelines from the hospital sedation policy may allow infants who are
younger than 6 months to receive formula and solids for up to 6 hours, breast milk for up to 4
hours, and clear liquids for up to 2 hours before sedation. Children who are 6 months or older
may receive solids and liquids for up to 6 hours and clear liquids for up to 2 hours before
sedation.
REF: p. 66
3. Why must caution be exercised when using a face mask while performing pulmonary function
testing on neonates?
a. To prevent trigeminal nerve stimulation
b. To avoid necrosis of the facial skin
c. To prevent vagal reflexes
d. To prevent gastric insufflations
ANS: A
A face mask is required when testing neonates and infants. Caution must be exercised because
using a face mask can cause trigeminal nerve stimulation and induce vagal reflexes that may
TEST BANK
alter the pattern of heart or respiratory rhythm.
REF: pp. 66-67
4. The respiratory therapist places a face mask on an infant to measure FRC. What should the
therapist do to minimize the presence of air leaks and improve accuracy of the test?
a. Place a nose clip on the infant.
b. Minimize the amount of helium used during the test.
: Pulmonary Function Testing and Bedside Pulmonary Mechanics c. Minimize oxygen concentration and increase nitrogen concentration.
, d. Apply petroleum jelly on the edges of the mask before applying the mask to the
face. a. A
b. B
ANS: D
c. C
Applying petroleum jelly to the edges of a disposable mask is helpful for ensuring an airtight
d. D
seal with no leaks on the infant's face.
ANS: C
REF: p. 68 A relatively noninvasive technique to generate a partial expiratory flow volume (PEFV) curve
in infants allows the measurement of expiratory flows during a forced maneuver in infants and
5. How is airway resistance calculated? small children. A rapid thoracic compression or "hug" is delivered to the sleeping infant's
a. By dividing the airway occlusion pressure by the expiratory flow chest and abdomen with an inflatable jacket to produce a forced expiration. A
b. By dividing the transpulmonary pressure by the expiratory flow pneumotachometer with a sealed face mask measures exhaled gas flow. The flow at the end-
c. By multiplying the expiratory flow by the pressure gradient responsible for expiratory point of a normal resting tidal breath (FRC) is measured on the PEFV curve. This
initiating inspiration flow value, the maximal expiratory flow at FRC, is reported as liters per second.
d. By multiplying the expiratory occlusion pressure by the transpulmonary pressure
gradient REF: p. 68
ANS: A
8. A pre- and postbronchodilator, partial expiratory pressure–volume maneuver was performed
Airway resistance (Raw) reflects the nonelastic airway and tissue influences resisting gas
on a 9-month-old boy. The child’s prebronchodilator maxFRC was 67 mL/second and the
flow. Raw is calculated from the ratio of airway occlusion pressure to expiratory flow. Raw is
postbronchodilator maxFRC was 94 mL/second. How should the therapist interpret these data?
described in centimeters of water per liter per second (cm H2O/L/s). a. The data are erroneous.
b. The data are inconclusive.
REF: p. 68
c. The patient will not clinically improve with bronchodilator administration.
6. Which of the following factors is the most important determinant of high airway resistance d. The patient has demonstrated clinically significant improvement with
and air trapping in small infants? bronchodilator administration.
a. The small tidal volume ANS: D
b. Small diameter of the airways PEFV studies are frequently performed before and after aerosolized bronchodilator therapy.
c. Excessive amount of mucus production An increase in maximal expiratory flow at FRC by at least 20% demonstrates a positive
d. The length of the airways response to bronchodilator therapy. The maxFRC values presented in the question (pre-maxFRC,
ANS: B 67 mL/s; and post-maxFRC, 94 mL/s) indicate a 40% improvement.
Raw is dependent on the radius, length, and number of airways and varies with volume, flow,
REF: p. 68
and respiratory frequency. The small diameters of an infant's tracheobronchial tree result in
high resistance to gas flow.
9. According to the ATS-ERS acceptability criteria for an FVC maneuver performed on a 9-year-
old child, what is considered a satisfactory exhalation time?
REF: p. 68
a. 1 second
7. On the partial expiratory flow–volume loop shown here, identify the point depicting the b. 2 seconds
“maximal expiratory flow at FRC.” c. 3 seconds
d. 6 seconds
ANS: C
Satisfactory exhalation duration is 6 seconds (3 second for children <10 years old) or a plateau
in the volume–time curve.
REF: p. 70
10. A child has been diagnosed with vocal cord dysfunction. Which of the following flow–volume
loops demonstrates this condition?
a. Figure 5-9C
b. Figure 5-9A
c. Figure 5-9B
d. Figure 5-8B
, ANS: A
Flow limitation on the inspiratory portion of the loop is characteristic of an extrathoracic I. The forced vital capacity (FVC) may remain normal.
obstruction (Figure 5-9B). This is common in children with vocal cord dysfunction (VCD). II. The forced expiratory volume in 1 second (FEV1) is decreased.
III. The ratio of residual volume to total lung capacity (RV/TLC) may be normal.
REF: p. 70 IV. The FEV1 is decreased.
a. II and IV only
11. The respiratory therapist is looking at a flow–volume curve that displays a concave shape on b. I, II, and III only
the expiratory tracing. What is this change most consistent with? c. I, III, and IV only
a. Neuromuscular disease d. II, III, and IV only
b. Abnormal chest wall configuration
c. Interstitial fibrosis ANS: C
d. Asthma On the basis of spirometry, an obstructive lung disorder is characterized as follows:
• FVC normal or decreased
ANS: D • FEV1 decreased
The most common chronic diseases in children—asthma, cystic fibrosis, and • FEV1/FVC decreased
bronchopulmonary dysplasia—are obstructive. Obstructive diseases produce a concave shape • TLC normal or increased
or scoop to the flow–volume curve. • RV increased
• RV/TLC increased
REF: p. 74
Table 5-2 in the textbook compares obstructive and restrictive lung diseases in terms of these
spirometric measurements.
12. A reduction in the DLCO may indicate the presence of which of the following conditions?
REF: p. 74
I. Pulmonary fibrosis
II. Pulmonary edema 15. On the basis of the bronchial provocation data presented in the following table, identify the
III. Hematologic disorders PD20 (provocative dose that produces a 20% fall in FEV1).
IV. Bronchiolitis obliterans
a. I and II only
b. I and III only
c. I, II, and III only
d. I, II, III, and IV
ANS: D
Indications for testing in the pediatric population that may produce a reduced DLCO include
pulmonary fibrosis (primary disease or secondary to radiation treatment or chemotherapy),
immunologic disorders (scleroderma, systemic lupus erythematosus), bronchiolitis obliterans,
pulmonary edema, and hematologic disorders.
REF: p. 74
a. 0.025 mg/mL
13. The therapist is reviewing a flow–volume loop obtained from a pediatric patient and observes b. 0.25 mg/mL
decreased volume and normal flows. On the basis of this observation, how should the c. 2.5 mg/mL
therapist interpret this finding? d. 10 mg/mL
a. Obstructive pattern
b. Restrictive pattern ANS: D
c. Fixed airway obstruction Methacholine and mannitol are two very common inhalation challenge agents that have well-
d. Variable extrathoracic obstruction
described protocols. In methacholine testing, a test is considered positive if the FEV1 falls
more than 20% from baseline. The concentration of the challenge drug is used as a marker of
ANS: B the degree of bronchial reactivity and is called the PD20, the provocative dose that produces a
The restrictive pattern is typically characterized by preserved flows with a reduction in the 20% fall in FEV1. For example, a patient with highly reactive asthma may have a fall in FEV1
volume. of 20% with a methacholine concentration of 0.25 mg/mL. A patient with mild asthma may
experience a 20% fall in the FEV1 at 10 mg/mL. In mannitol testing a 15% decline in FEV1 is
REF: p. 74 considered a positive response. The patient presented in this question experienced clinically
significant bronchial provocation at a methacholine dose of 10 mg/mL because the FEV1
14. Which of the following pulmonary function values characterize an obstructive lung defect? dropped 24% from baseline at that point.
, b. To help patients with asthma management at home
REF: p. 78 c. To evaluate the strength of respiratory muscles
d. To assist in performing bronchial hygiene techniques
16. On the basis of the data presented below, calculate the time constant.
• Tidal volume (VT), 600 mL ANS: C
• Respiratory rate (RR), 12 breaths/minute MIP is an important measure to help differentiate weakness from other causes of restrictive
• Lung compliance (C), 0.2 L/cm H2O lung disease. It can be an important differentiating point for children and young adults with
• Airway resistance (Raw), 2.5 cm H2O/L/second various neuromuscular diseases. These patients usually have a combination of scoliosis and
• Peak inspiratory pressure (PIP), 30 cm H2O muscle weakness, both of which might contribute to reduced lung volumes. Measuring MIP
• Inspiratory time (TI), 2 seconds helps in determining how much reduction might be caused by weakness. Because many
• Expiratory time (TE), 1 second neuromuscular diseases are progressive, MIP helps to document this progression. MIP may
a. 4.5 seconds also indicate the patient's physical ability to take a deep breath and is often measured when
b. 3.0 seconds weaning a patient from mechanical ventilation is being considered.
c. 0.5 second REF: p. 84
d. 0.1 second : Radiographic Assessment
ANS: C Test Bank
Respiratory time constants, tau ( ), are the mathematical product of compliance and resistance
expressed as seconds because all the units of pressure and volume measurement cancel out MULTIPLE CHOICE
except time. A time constant is an interval over which a given change occurs, as a percentage
of total change. Three time constants are required to reach 95% of inflation or exhalation. T I, 1. What type of X-ray view is obtained when the radiographic plate is placed behind the patient’s
or inflation time, and TE should be at least three times the respiratory time constants for back with the x, and the side up may better define .
optimal inspiration or expiration to occur. a. Anteroposterior view
b. Posteroanterior view
REF: p. 82 c. Lateral view
17. How should the therapist interpret the following pressure–volume loop obtained from a d. Frontal view
mechanically ventilated infant?
ANS: A
Feedback: When the radiograph is performed at the patient bedside with mobile radiographic
equipment, the image receptor is placed behind the patient's back and the X-ray tube is placed
in front of the patient's chest. This obtains a frontal view in the anteroposterior (AP)
projection, with the beam passing from anterior to posterior.
REF: p. 89
2. The lateral decubitus view is a frontal radiographic projection whereby the side down can be
evaluated for presence of .
a. Atelectasis; a pneumothorax
b. A pleural effusion; a pneumothorax
a. A leak has developed in the ventilator–patient system. c. Consolidation; atelectasis
b. The patient’s lungs are being overinflated. d. A pleural effusion; consolidation
c. The patient is displaying trigger dyssynchrony.
ANS: B
d. The patient’s lungs are exhibiting increased compliance.
The lateral decubitus position is a frontal projection performed with the patient lying on either
ANS: B the right side (right lateral decubitus) or on the left side (left lateral decubitus). The down side
The pressure–volume loop demonstrates overdistention. Note the "penguin" or "bird's beak" can be evaluated for presence of fluid, such as a mobile pleural effusion, and the up side will
appearance in the shape of the loops. These loops demonstrate idealized slopes (dashed lines) demonstrate free air, such as in the case of a pneumothorax (air in the pleural cavity). Dech-
for change in compliance for the entire breath (C) and change in compliance in the last 20% of ray tube in front of the patient’s chest?
inspiratory pressure (C20). The C20/C ratio identifies lung overdistention.
REF: p. 89
REF: p. 83
18. What is the clinical purpose for measuring the maximal inspiratory pressure (MIP)? 3. The respiratory therapist is evaluating a child with suspected foreign body aspiration. The
a. To assess lung function before and after bronchodilator administration radiographer gently adds pressure to the abdomen during expiration to take the chest
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