Question 1

What is the most common complication associated with NIV among pediatric patients?

Accepted Answer

A)  Ventilator-associated pneumonia 
B)  Gastric insufflation 
C)  Claustrophobia 
D)  Skin irritation caused by the interface 
A)  Ventilator-associated pneumonia 
B)  Gastric insufflation 
C)  Claustrophobia 
D)  Skin irritation caused by the interface D

Question 2

When a bilevel ventilator is used in the spontaneous/timed mode, at what point does the ventilator employ the timed feature?

Accepted Answer

A)  During exhalation 
B)  To terminate inspiration 
C)  Throughout the ventilatory cycle 
D)  Only in the event of prolonged apnea 
A)  During exhalation 
B)  To terminate inspiration 
C)  Throughout the ventilatory cycle 
D)  Only in the event of prolonged apnea D

Question 3

How should a volume-regulated ventilator for NIV be adjusted to deliver the appropriate tidal volume (VT) to a pediatric patient?

Accepted Answer

A)  The preset VT should be equal to the patient's estimated anatomic dead space volume. 
B)  The delivered VT should be equal to the estimated anatomic dead space divided by the patient's respiratory rate. 
C)  The VT should be set by dividing the patient's PaCO2 by two. 
D)  The delivered VT should be set at twice the child's physiologic VT. 
A)  The preset VT should be equal to the patient's estimated anatomic dead space volume. 
B)  The delivered VT should be equal to the estimated anatomic dead space divided by the patient's respiratory rate. 
C)  The VT should be set by dividing the patient's PaCO2 by two. 
D)  The delivered VT should be set at twice the child's physiologic VT. D

Question 4

Which of the following restrictive disorders are likely to respond to both to NIV and CPAP in children?
I. Atelectasis
II. ARDS
III. Pneumonia
IV. Morbid obesity

Accepted Answer

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

Question 5

What level of IPAP is typically sufficient to achieve the goals of NIV in pediatric patients?

Accepted Answer

A)  20 to 25 cm H2O 
B)  15 to 20 cm H2O 
C)  8 to 12 cm H2O 
D)  5 to 10 cm H2O 
A)  20 to 25 cm H2O 
B)  15 to 20 cm H2O 
C)  8 to 12 cm H2O 
D)  5 to 10 cm H2O

Question 6

What effect should the therapist expect to observe after successful initiation of continuous positive airway pressure (CPAP) on a neonate who has a restrictive lung disorder?

Accepted Answer

A)  Decreased arterial partial pressure of carbon dioxide (PaCO2) 
B)  A lower mean airway pressure 
C)  A normal alveolar-arterial oxygen tension difference [P(A-a)O2] gradient 
D)  Increased lung volume 
A)  Decreased arterial partial pressure of carbon dioxide (PaCO2) 
B)  A lower mean airway pressure 
C)  A normal alveolar-arterial oxygen tension difference [P(A-a)O2] gradient 
D)  Increased lung volume

Question 7

What is the most effective way for the therapist to promote effective triggering and prevent asynchrony with NIV?

Accepted Answer

A)  Optimize inspiratory flow. 
B)  Titrate inspiratory pressure to achieve a tidal volume of 5 mL/kg. 
C)  Set the device on spontaneous-timed mode. 
D)  Minimize leaks around the interface. 
A)  Optimize inspiratory flow. 
B)  Titrate inspiratory pressure to achieve a tidal volume of 5 mL/kg. 
C)  Set the device on spontaneous-timed mode. 
D)  Minimize leaks around the interface.

Question 8

When should NIV be selected over CPAP in children with OSA?

Accepted Answer

A)  For every patient who is hypoxemic 
B)  When OSA is complicated by alveolar hypoventilation and hypercarbia 
C)  When OSA is complicated by hypoxemia 
D)  For every patient who is hypoxemic and hypercapnic 
A)  For every patient who is hypoxemic 
B)  When OSA is complicated by alveolar hypoventilation and hypercarbia 
C)  When OSA is complicated by hypoxemia 
D)  For every patient who is hypoxemic and hypercapnic

Question 9

When considering NPAV devices, what is considered the most beneficial effect over NIV?

Accepted Answer

A)  Its effect on CO2 clearance 
B)  Its faster restoration of oxygenation 
C)  Its effect on cardiac filling pressures and volumes 
D)  Its effect on spontaneous tidal volume 
A)  Its effect on CO2 clearance 
B)  Its faster restoration of oxygenation 
C)  Its effect on cardiac filling pressures and volumes 
D)  Its effect on spontaneous tidal volume

Question 10

A child with a chronic disorder complicated by alveolar hypoventilation is placed on intermittent NIV at night. What is the primary goal of this therapy?

Accepted Answer

A)  To decrease the work of breathing 
B)  To decrease the need for inserting an endotracheal tube 
C)  To improve the quality of sleep and reduce daytime symptoms 
D)  To improve arterial oxygenation 
A)  To decrease the work of breathing 
B)  To decrease the need for inserting an endotracheal tube 
C)  To improve the quality of sleep and reduce daytime symptoms 
D)  To improve arterial oxygenation

Question 11

What are the primary objectives of noninvasive ventilation (NIV)?
I. To increase the likelihood of successful weaning from mechanical ventilation
II. To improve respiratory gas exchange
III. To decrease the patient's work of breathing
IV. To reduce the risk of ventilator-associated pneumonia

Accepted Answer

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

Question 12

What is considered the most successful therapeutic condition where NIV can be used in children?

Accepted Answer

A)  Treatment of hypoxemic exacerbation of children with chronic neuromuscular disorders 
B)  Treatment of hypercapnic exacerbation of children with chronic neuromuscular disorders 
C)  Treatment of exacerbation of children with acute asthma attacks 
D)  Treatment of exacerbation of children with pulmonary edema due to congenital heart defects 
A)  Treatment of hypoxemic exacerbation of children with chronic neuromuscular disorders 
B)  Treatment of hypercapnic exacerbation of children with chronic neuromuscular disorders 
C)  Treatment of exacerbation of children with acute asthma attacks 
D)  Treatment of exacerbation of children with pulmonary edema due to congenital heart defects

Question 13

A patient receiving bilevel ventilation develops a small leak at the interface. What action should the therapist take at this time?

Accepted Answer

A)  The therapist should increase the pressure limit. 
B)  The therapist should increase the inspiratory flow. 
C)  The therapist should increase the length of the inspiratory time. 
D)  The therapist should verify that the ventilator automatically compensates for this leak. 
A)  The therapist should increase the pressure limit. 
B)  The therapist should increase the inspiratory flow. 
C)  The therapist should increase the length of the inspiratory time. 
D)  The therapist should verify that the ventilator automatically compensates for this leak.

Question 14

A patient receiving PAV is noticed to increase breathing effort. Which parameters will the ventilator modify to respond to this patient's increased respiratory demand?
I. Increase flow
II. Increase tidal volume
III. Increase pressure
IV. Increase CPAP

Accepted Answer

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

Question 15

HFNC has been ordered for a newborn at a rate of 2 L/minutes. What is the approximate nasopharyngeal pressure at this setting?

Accepted Answer

A)  3 cm H2O 
B)  2 cm H2O 
C)  1 cm H2O 
D)  1.5 cm H2O 
A)  3 cm H2O 
B)  2 cm H2O 
C)  1 cm H2O 
D)  1.5 cm H2O

Question 16

What is the clinical significance of the IPAP-EPAP gradient in bilevel NIV?

Accepted Answer

A)  It represents the mean airway pressure to which the patient's lungs are exposed. 
B)  It determines the patient's tidal volume. 
C)  The IPAP-EPAP gradient determines the inspiratory time. 
D)  This gradient determines the level of pressure support the patient will receive. 
A)  It represents the mean airway pressure to which the patient's lungs are exposed. 
B)  It determines the patient's tidal volume. 
C)  The IPAP-EPAP gradient determines the inspiratory time. 
D)  This gradient determines the level of pressure support the patient will receive.

Question 17

What is the only absolute contraindication to a trial of NIV in pediatric patients with acute respiratory distress?

Accepted Answer

A)  Cardiovascular instability 
B)  Nasopharyngeal obstruction 
C)  Inability to handle oral secretions 
D)  Extreme agitation or anxiety 
A)  Cardiovascular instability 
B)  Nasopharyngeal obstruction 
C)  Inability to handle oral secretions 
D)  Extreme agitation or anxiety

Question 18

In what particular setting has long-term use of NIV on children with cystic fibrosis been successful?

Accepted Answer

A)  As a bridge to transplantation 
B)  As the routine treatment for bronchopulmonary hygiene 
C)  As the primary indication for reduction of exacerbations 
D)  As the primary treatment of hypoventilation 
A)  As a bridge to transplantation 
B)  As the routine treatment for bronchopulmonary hygiene 
C)  As the primary indication for reduction of exacerbations 
D)  As the primary treatment of hypoventilation

Question 19

Which of the following NIV interfaces should the therapist consider when a child complains of discomfort with a nasal mask?
I. Oronasal mask
II. Nasal plugs
III. Helmet
IV. Nasal pillows

Accepted Answer

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

Question 20

Which of the following bilevel ventilator settings influences upper airway stability?

Accepted Answer

A)  IPAP 
B)  Mode 
C)  Respiratory rate 
D)  EPAP 
A)  IPAP 
B)  Mode 
C)  Respiratory rate 
D)  EPAP

Exam 16: Noninvasive Mechanical Ventilation of the Infant and Child

What is the most common complication associated with NIV among pediatric patients?

When a bilevel ventilator is used in the spontaneous/timed mode, at what point does the ventilator employ the timed feature?

How should a volume-regulated ventilator for NIV be adjusted to deliver the appropriate tidal volume (VT) to a pediatric patient?

Which of the following restrictive disorders are likely to respond to both to NIV and CPAP in children? I. Atelectasis II. ARDS III. Pneumonia IV. Morbid obesity

What level of IPAP is typically sufficient to achieve the goals of NIV in pediatric patients?

What effect should the therapist expect to observe after successful initiation of continuous positive airway pressure (CPAP) on a neonate who has a restrictive lung disorder?

What is the most effective way for the therapist to promote effective triggering and prevent asynchrony with NIV?

When should NIV be selected over CPAP in children with OSA?

When considering NPAV devices, what is considered the most beneficial effect over NIV?

A child with a chronic disorder complicated by alveolar hypoventilation is placed on intermittent NIV at night. What is the primary goal of this therapy?

What are the primary objectives of noninvasive ventilation (NIV)? I. To increase the likelihood of successful weaning from mechanical ventilation II. To improve respiratory gas exchange III. To decrease the patient's work of breathing IV. To reduce the risk of ventilator-associated pneumonia

What is considered the most successful therapeutic condition where NIV can be used in children?

A patient receiving bilevel ventilation develops a small leak at the interface. What action should the therapist take at this time?

A patient receiving PAV is noticed to increase breathing effort. Which parameters will the ventilator modify to respond to this patient's increased respiratory demand? I. Increase flow II. Increase tidal volume III. Increase pressure IV. Increase CPAP

HFNC has been ordered for a newborn at a rate of 2 L/minutes. What is the approximate nasopharyngeal pressure at this setting?

What is the clinical significance of the IPAP-EPAP gradient in bilevel NIV?

What is the only absolute contraindication to a trial of NIV in pediatric patients with acute respiratory distress?

In what particular setting has long-term use of NIV on children with cystic fibrosis been successful?

Which of the following NIV interfaces should the therapist consider when a child complains of discomfort with a nasal mask? I. Oronasal mask II. Nasal plugs III. Helmet IV. Nasal pillows

Which of the following bilevel ventilator settings influences upper airway stability?

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Examination and Assessment of the Neonatal and Pediatric Patient

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