Question 1

Which of the following substances prevents the release of Ca2+ from the sarcoplasmic reticulum?

Accepted Answer

A)  Intracellular cGMP 
B)  EDRF 
C)  cGMP-dependent kinase 
D)  Calmodulin 
A)  Intracellular cGMP 
B)  EDRF 
C)  cGMP-dependent kinase 
D)  Calmodulin C

Question 2

Vascular smooth muscle is largely dependent on which of the following intracellular ions?

Accepted Answer

A)  Na+ 
B)  K+ 
C)  Ca2+ 
D)  Mg2+ 
A)  Na+ 
B)  K+ 
C)  Ca2+ 
D)  Mg2+ C

Question 3

Which of the following medications contributes to an increased right-to-left intrapulmonary shunting?

Accepted Answer

A)  Dobutamine 
B)  Dopamine 
C)  Prostacyclin 
D)  Prostaglandin A 
A)  Dobutamine 
B)  Dopamine 
C)  Prostacyclin 
D)  Prostaglandin A C

Question 4

An infant has been receiving iNO for the last 3 days. Which important level should be monitored when ordering a co-oximetry?

Accepted Answer

A)  Methemoglobin 
B)  Carboxyhemoglobin 
C)  Reduced hemoglobin 
D)  Oxyhemoglobin 
A)  Methemoglobin 
B)  Carboxyhemoglobin 
C)  Reduced hemoglobin 
D)  Oxyhemoglobin

Question 5

The respiratory therapist has initiated iNO at 20 ppm for an infant with pulmonary hypertension. After 2 hours a blood gas test reveals a 10% improvement in SaO2. What should the therapist do?

Accepted Answer

A)  Keep iNO at 20 ppm and wait at least 2 hours before considering any change. 
B)  Increase iNO to 30 ppm and keep the same FiO2. 
C)  Keep iNO at 20 ppm and wean the FiO2 by 10%. 
D)  Increase iNO to 30 ppm with no changes in FiO2. 
A)  Keep iNO at 20 ppm and wait at least 2 hours before considering any change. 
B)  Increase iNO to 30 ppm and keep the same FiO2. 
C)  Keep iNO at 20 ppm and wean the FiO2 by 10%. 
D)  Increase iNO to 30 ppm with no changes in FiO2.

Question 6

The therapist is treating a very irritable young child with upper airway obstruction. Which oxygen device will be the most appropriate to administer the greatest concentration of helium?

Accepted Answer

A)  Close-fitting nonrebreathing mask 
B)  Close-fitting partial rebreathing mask 
C)  Nasal cannula 
D)  High-flow nasal cannula 
A)  Close-fitting nonrebreathing mask 
B)  Close-fitting partial rebreathing mask 
C)  Nasal cannula 
D)  High-flow nasal cannula

Question 7

What is the product of the reaction between oxygen and nitric oxide?

Accepted Answer

A)  Oxygen radicals. 
B)  N2O. 
C)  NO2. 
D)  The two molecules do not react with each other. 
A)  Oxygen radicals. 
B)  N2O. 
C)  NO2. 
D)  The two molecules do not react with each other.

Question 8

Which of the following inhaled anesthetics should the therapist recommend to administer via a face mask to a conscious, spontaneously breathing pediatric patient who has status asthmaticus?

Accepted Answer

A)  Isoflurane 
B)  Enflurane 
C)  Sevoflurane 
D)  Halothane 
A)  Isoflurane 
B)  Enflurane 
C)  Sevoflurane 
D)  Halothane

Question 9

How should the NO2 alarm be set on the delivery system?

Accepted Answer

A)  At 2 ppm 
B)  At 4 ppm 
C)  At 6 ppm 
D)  At 8 ppm 
A)  At 2 ppm 
B)  At 4 ppm 
C)  At 6 ppm 
D)  At 8 ppm

Question 10

The therapist is using an oxygen flowmeter to deliver an 80:20 heliox mixture to a patient. The reading on the flowmeter is 10 L/minute. What is the actual flow received by the patient?

Accepted Answer

A)  5.5 L/minute 
B)  10 L/minute 
C)  12.5 L/minute 
D)  18 L/minute 
A)  5.5 L/minute 
B)  10 L/minute 
C)  12.5 L/minute 
D)  18 L/minute

Question 11

The therapist is evaluating a small tachypneic infant receiving heliox mixture 70:30 through an infant hood. Although the SpO2 has improved, the child shows signs of worsening work of breathing. What is the most probable mechanism to explain this situation?

Accepted Answer

A)  The FiHe is too low in a 70:30 mixture to change work of breathing in this infant. 
B)  The flow going through the infant hood is inadequate. 
C)  A greater concentration of helium is present at the top of the hood and away from the infant's nose and mouth. 
D)  The infant is breathing too fast; thus heliox is not reaching the airways. 
A)  The FiHe is too low in a 70:30 mixture to change work of breathing in this infant. 
B)  The flow going through the infant hood is inadequate. 
C)  A greater concentration of helium is present at the top of the hood and away from the infant's nose and mouth. 
D)  The infant is breathing too fast; thus heliox is not reaching the airways.

Question 12

What is the potential benefit of adding heliox to patients who have status asthmaticus while undergoing mechanical ventilation?

Accepted Answer

A)  To improve pulmonary compliance 
B)  To reverse bronchospasm 
C)  To minimize air trapping 
D)  To facilitate the removal of tracheobronchial secretions 
A)  To improve pulmonary compliance 
B)  To reverse bronchospasm 
C)  To minimize air trapping 
D)  To facilitate the removal of tracheobronchial secretions

Question 13

The therapist is performing a routine assessment and ventilator check on a patient who is receiving heliox near the wye adapter of the ventilator circuit. He notices a serious discrepancy between the set tidal and the exhaled volume. What should the therapist do to correct this situation?

Accepted Answer

A)  Administer heliox through the heliox-approved inlet of the mechanical ventilator. 
B)  Add a 16-inch piece of corrugated tubing between the wye adapter and the place on the inspiratory limb where heliox is administered. 
C)  Reduce the liter flow on the heliox. 
D)  Adjust ventilator settings to compensate for the lower viscosity of heliox. 
A)  Administer heliox through the heliox-approved inlet of the mechanical ventilator. 
B)  Add a 16-inch piece of corrugated tubing between the wye adapter and the place on the inspiratory limb where heliox is administered. 
C)  Reduce the liter flow on the heliox. 
D)  Adjust ventilator settings to compensate for the lower viscosity of heliox.

Question 14

A patient who has been admitted with status asthmaticus is receiving beta adrenergics every 2 hours and heliox with very limited response. What should the therapist suggest at this time?

Accepted Answer

A)  Change heliox to 100% helium. 
B)  Administer nitrogen. 
C)  Administer inhaled anesthetics. 
D)  Add iNO. 
A)  Change heliox to 100% helium. 
B)  Administer nitrogen. 
C)  Administer inhaled anesthetics. 
D)  Add iNO.

Question 15

Which of the following parameters of mechanical ventilation is affected negatively by the use of heliox?

Accepted Answer

A)  PEEP 
B)  Plateau pressure 
C)  Peak pressure 
D)  Volume 
A)  PEEP 
B)  Plateau pressure 
C)  Peak pressure 
D)  Volume

Question 16

The respiratory therapist has initiated nitric oxide for an infant with severe refractory hypoxemia. The initial dose was 20 ppm and titrated up to 30 ppm for the last 1 hour due to lack of response. However, there still is no response. What should the therapist do?

Accepted Answer

A)  Increase iNO to 40 ppm 
B)  Increase iNO to 60 ppm 
C)  Increase iNO to 80 ppm 
D)  Discontinue iNO and consider a different therapeutic intervention 
A)  Increase iNO to 40 ppm 
B)  Increase iNO to 60 ppm 
C)  Increase iNO to 80 ppm 
D)  Discontinue iNO and consider a different therapeutic intervention

Question 17

The therapist taking care of an infant on iNO observes that the NO2 levels have been increasing. In order to correct the situation, he increases the inspiratory flow of the ventilator. What will be some of the limitations associated with this change?
I. It reduces time of contact between NO and O2.
II. It affects the mean airway pressure because it changes the inspiratory time.
III. It may increase the delivered tidal volume.
IV. It reduces the mean airway pressure and increases the inspiratory time.

Accepted Answer

A)  I only 
B)  II and IV only 
C)  I, II, and III only 
D)  II, III, and IV only 
A)  I only 
B)  II and IV only 
C)  I, II, and III only 
D)  II, III, and IV only

Question 18

After increasing the inspiratory flow of the ventilator to decrease the generation of NO2, the therapist notices many changes in the ventilator parameters. The therapist adds the NO into the inspiratory limb of the ventilator circuit close to the patient. What will be a limitation of the procedure?

Accepted Answer

A)  A larger number of oxygen radicals are produced at this position. 
B)  Adding NO too close to the patient reduces proper mixing, which is necessary to ensure accurate NO measurement. 
C)  Adding NO in this position of the circuit is contraindicated. 
D)  The contact time between NO and O2 is too long to be clinically useful. 
A)  A larger number of oxygen radicals are produced at this position. 
B)  Adding NO too close to the patient reduces proper mixing, which is necessary to ensure accurate NO measurement. 
C)  Adding NO in this position of the circuit is contraindicated. 
D)  The contact time between NO and O2 is too long to be clinically useful.

Question 19

Which of the following inhaled anesthetic gases has/have demonstrated the possibility to treat status asthmaticus?
I. Halothane
II. Thromboxane
III. Isoflurane
IV. Sevoflurane

Accepted Answer

A)  II only 
B)  I, II, and III only 
C)  I, III, and IV only 
D)  II, III, and IV only 
A)  II only 
B)  I, II, and III only 
C)  I, III, and IV only 
D)  II, III, and IV only

Question 20

Inhaled NO has been administered to an infant for nearly 2 hours. The respiratory therapist notices suboptimal response and suggests HFOV. What is the principle behind the potential benefit of adding this ventilatory modality to this infant?

Accepted Answer

A)  HFOV improves ventilation and reduces the formation of NO2. 
B)  Lung volumes are optimized with HFOV and further enhance the effects of iNO. 
C)  The high frequency accelerates the diffusion of NO through the alveolar surface. 
D)  HFOV reduces the need for higher doses of iNO. 
A)  HFOV improves ventilation and reduces the formation of NO2. 
B)  Lung volumes are optimized with HFOV and further enhance the effects of iNO. 
C)  The high frequency accelerates the diffusion of NO through the alveolar surface. 
D)  HFOV reduces the need for higher doses of iNO.

Exam 18: Administration of Gas Mixtures

Which of the following substances prevents the release of Ca2+ from the sarcoplasmic reticulum?

Vascular smooth muscle is largely dependent on which of the following intracellular ions?

Which of the following medications contributes to an increased right-to-left intrapulmonary shunting?

An infant has been receiving iNO for the last 3 days. Which important level should be monitored when ordering a co-oximetry?

The respiratory therapist has initiated iNO at 20 ppm for an infant with pulmonary hypertension. After 2 hours a blood gas test reveals a 10% improvement in SaO2. What should the therapist do?

The therapist is treating a very irritable young child with upper airway obstruction. Which oxygen device will be the most appropriate to administer the greatest concentration of helium?

What is the product of the reaction between oxygen and nitric oxide?

Which of the following inhaled anesthetics should the therapist recommend to administer via a face mask to a conscious, spontaneously breathing pediatric patient who has status asthmaticus?

How should the NO2 alarm be set on the delivery system?

The therapist is using an oxygen flowmeter to deliver an 80:20 heliox mixture to a patient. The reading on the flowmeter is 10 L/minute. What is the actual flow received by the patient?

The therapist is evaluating a small tachypneic infant receiving heliox mixture 70:30 through an infant hood. Although the SpO2 has improved, the child shows signs of worsening work of breathing. What is the most probable mechanism to explain this situation?

What is the potential benefit of adding heliox to patients who have status asthmaticus while undergoing mechanical ventilation?

The therapist is performing a routine assessment and ventilator check on a patient who is receiving heliox near the wye adapter of the ventilator circuit. He notices a serious discrepancy between the set tidal and the exhaled volume. What should the therapist do to correct this situation?

A patient who has been admitted with status asthmaticus is receiving beta adrenergics every 2 hours and heliox with very limited response. What should the therapist suggest at this time?

Which of the following parameters of mechanical ventilation is affected negatively by the use of heliox?

The respiratory therapist has initiated nitric oxide for an infant with severe refractory hypoxemia. The initial dose was 20 ppm and titrated up to 30 ppm for the last 1 hour due to lack of response. However, there still is no response. What should the therapist do?

After increasing the inspiratory flow of the ventilator to decrease the generation of NO2, the therapist notices many changes in the ventilator parameters. The therapist adds the NO into the inspiratory limb of the ventilator circuit close to the patient. What will be a limitation of the procedure?

Which of the following inhaled anesthetic gases has/have demonstrated the possibility to treat status asthmaticus? I. Halothane II. Thromboxane III. Isoflurane IV. Sevoflurane

Inhaled NO has been administered to an infant for nearly 2 hours. The respiratory therapist notices suboptimal response and suggests HFOV. What is the principle behind the potential benefit of adding this ventilatory modality to this infant?

Fetal Lung Development

Fetal Gas Exchange and Circulation

Antenatal Assessment and High-Risk Delivery

Examination and Assessment of the Neonatal and Pediatric Patient

Pulmonary Function Testing and Bedside Pulmonary Mechanics

Radiographic Assessment

Pediatric Flexible Bronchoscopy

Invasive Blood Gas Analysis and Cardiovascular Monitoring

Noninvasive Monitoring in Neonatal and Pediatric Care

Oxygen Administration

Aerosols and Administration of Inhaled Medications

Airway Clearance Techniques and Hyperinflation Therapy

Airway Management

Surfactant Replacement Therapy

Noninvasive Mechanical Ventilation and Continuous Positive Pressure of the Neonate

Noninvasive Mechanical Ventilation of the Infant and Child

Invasive Mechanical Ventilation of the Neonate and Pediatric Patient

Extracorporeal Membrane Oxygenation

Pharmacology

Thoracic Organ Transplantation

Neonatal Pulmonary Disorders

Surgical Disorders in Childhood That Affect Respiratory Care

Congenital Cardiac Defects

Pediatric Sleep-Disordered Breathing

Pediatric Airway Disorders and Parenchymal Lung Diseases

Asthma

Cystic Fibrosis

Acute Respiratory Distress Syndrome

Shock

Pediatric Trauma

Disorders of the Pleura

Neurological and Neuromuscular Disorders

Transport of Infants and Children

Home Care

Quality and Safety

Filters

Which of the following substances prevents the release of Ca²⁺ from the sarcoplasmic reticulum?

The respiratory therapist has initiated iNO at 20 ppm for an infant with pulmonary hypertension. After 2 hours a blood gas test reveals a 10% improvement in SaO₂. What should the therapist do?

How should the NO₂ alarm be set on the delivery system?

The therapist is evaluating a small tachypneic infant receiving heliox mixture 70:30 through an infant hood. Although the SpO₂ has improved, the child shows signs of worsening work of breathing. What is the most probable mechanism to explain this situation?