Question 1

How should a therapist determine the size of the nasal prongs to effectively administer CPAP to infants?

Accepted Answer

A)  The prongs should occlude only 50% of the external nares diameter. 
B)  The prongs should occlude at least 75% of the external nares diameter. 
C)  The prongs should occlude 100% of the external nares diameter with minimal blanching. 
D)  The prongs should occlude 100% of the external nares diameter without blanching. 
A)  The prongs should occlude only 50% of the external nares diameter. 
B)  The prongs should occlude at least 75% of the external nares diameter. 
C)  The prongs should occlude 100% of the external nares diameter with minimal blanching. 
D)  The prongs should occlude 100% of the external nares diameter without blanching. D

Question 2

Which of the following conditions are contraindications for nasal CPAP?
I. Pneumonia
II. Tracheoesophageal fistula
III. Choanal atresia
IV. Atelectasis

Accepted Answer

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

Question 3

Which of the following therapeutic interventions would be appropriate for a neonate with a respiratory rate of 65 breaths/minute while displaying paradoxical chest wall movement with suprasternal and substernal retractions, grunting, nasal flaring, and cyanosis, along with the following blood gas data: pH 7.30; PaCO2 50 mm Hg; PaO2 60 mm Hg?

Accepted Answer

A)  Intubation and mechanical ventilation 
B)  High flow nasal cannula 
C)  Extracorporeal membrane oxygenation 
D)  Continuous positive airway pressure (CPAP) 
A)  Intubation and mechanical ventilation 
B)  High flow nasal cannula 
C)  Extracorporeal membrane oxygenation 
D)  Continuous positive airway pressure (CPAP) D

Question 4

A preterm infant in respiratory distress is a candidate for CPAP. To minimize the work of breathing, which device should be used?

Accepted Answer

A)  B-CPAP 
B)  IF-CPAP 
C)  Single probe CPAP 
D)  V-CPAP 
A)  B-CPAP 
B)  IF-CPAP 
C)  Single probe CPAP 
D)  V-CPAP

Question 5

How is the positive pressure level established in a bubble CPAP system?

Accepted Answer

A)  The therapist dials the desired CPAP level directly on the ventilator. 
B)  The therapist immerses the distal end of the expiratory limb a certain distance below the water surface. 
C)  The CPAP level is established by stacking adaptors with weighted balls to the distal opening of the expiratory limb. 
D)  The positive pressure is achieved by tightening a screw clamp attached to the expiratory limb until the desired pressure is achieved. 
A)  The therapist dials the desired CPAP level directly on the ventilator. 
B)  The therapist immerses the distal end of the expiratory limb a certain distance below the water surface. 
C)  The CPAP level is established by stacking adaptors with weighted balls to the distal opening of the expiratory limb. 
D)  The positive pressure is achieved by tightening a screw clamp attached to the expiratory limb until the desired pressure is achieved.

Question 6

Weaning strategies from CPAP include which of the following?
I. Decreasing CPAP to a predefined level of airway pressure and then stopping CPAP completely
II. Removing CPAP for a predetermined number of hours each day and gradually increasing the amount of time off CPAP each day until it can be stopped completely
III. Complete removal if vital signs stable
IV. Stopping CPAP and starting high-flow heated humidified air/oxygen via nasal cannula

Accepted Answer

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

Question 7

Which form of CPAP has been associated with a "thoracic wiggle"?

Accepted Answer

A)  IF-CPAP (infant flow CPAP) 
B)  MV-CPAP (mechanical ventilator CPAP) 
C)  B-CPAP (bubble CPAP) 
D)  V-CPAP (ventilator-derived CPAP) 
A)  IF-CPAP (infant flow CPAP) 
B)  MV-CPAP (mechanical ventilator CPAP) 
C)  B-CPAP (bubble CPAP) 
D)  V-CPAP (ventilator-derived CPAP)

Question 8

What is considered the most effective interface option for delivering CPAP to infants?

Accepted Answer

A)  Binasal prongs 
B)  Nasal mask 
C)  Nasal pillows 
D)  Oronasal mask 
A)  Binasal prongs 
B)  Nasal mask 
C)  Nasal pillows 
D)  Oronasal mask

Question 9

After initiating IF-CPAP in an infant at 8 cm H2O, the therapist notices a low-pressure alarm. What should be done to correct this situation?

Accepted Answer

A)  Correct the leak by placing a chin trap. 
B)  Change to a smaller cannula. 
C)  Increase the flow through the CPAP system. 
D)  Change the flow generator. 
A)  Correct the leak by placing a chin trap. 
B)  Change to a smaller cannula. 
C)  Increase the flow through the CPAP system. 
D)  Change the flow generator.

Question 10

After increasing the level of CPAP delivered to an infant, the therapist notices that the neonate's PaCO2 rises and the PaO2 falls. What may have caused this situation?

Accepted Answer

A)  The FiO2 was not increased sufficiently. 
B)  The CPAP level was not raised enough. 
C)  The CPAP level was raised too high. 
D)  A problem with the interface has likely developed. 
A)  The FiO2 was not increased sufficiently. 
B)  The CPAP level was not raised enough. 
C)  The CPAP level was raised too high. 
D)  A problem with the interface has likely developed.

Question 11

Which of the following outcomes are advantages of CPAP over mechanical ventilation in infants?
I. Lower risk of sepsis
II. Lower incidence of lung injury
III. Fewer cases of chronic lung disease
IV. Lower incidence of renal failure

Accepted Answer

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

Question 12

In order to rinse the system of exhaled CO2 and meet the inspiratory flow rate requirements of infants placed on B-CPAP, the flow rate of humidified gas should be set at:

Accepted Answer

A)  6 to 10 L/minute 
B)  11 to 15 L/minute 
C)  16 to 20 L/minute 
D)  at least 15 L/minute 
A)  6 to 10 L/minute 
B)  11 to 15 L/minute 
C)  16 to 20 L/minute 
D)  at least 15 L/minute

Question 13

Which of the following features are often components of CPAP systems incorporated within infant ventilators?
I. Highly responsive demand flow systems
II. Apnea backup breaths
III. FiO2 compensation mechanisms
IV. Leak compensation capabilities

Accepted Answer

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

Question 14

Which of the following CPAP systems delivers a more consistent pressure, lowers work of breathing (WOB), is less sensitive to leaks, and is more effective at alveolar recruitment compared with other forms of CPAP?

Accepted Answer

A)  B-CPAP 
B)  MV-CPAP 
C)  V-CPAP 
D)  IF-CPAP 
A)  B-CPAP 
B)  MV-CPAP 
C)  V-CPAP 
D)  IF-CPAP

Question 15

Where in the CPAP delivery system should the pressure-relief/pop-off valve be placed to detect circuit occlusion?

Accepted Answer

A)  Anywhere along the exhalation limb 
B)  Anywhere along the inspiratory limb 
C)  Inside the ventilator 
D)  As close to the patient's airway as possible 
A)  Anywhere along the exhalation limb 
B)  Anywhere along the inspiratory limb 
C)  Inside the ventilator 
D)  As close to the patient's airway as possible

Question 16

Which of the following complications of CPAP can develop when an infant experiences inadvertent positive end-expiratory pressure (PEEP) from gas trapping resulting from tachypnea?

Accepted Answer

A)  Pulmonary hypertension 
B)  Pneumothorax 
C)  Atelectasis 
D)  Diaphragmatic hernia 
A)  Pulmonary hypertension 
B)  Pneumothorax 
C)  Atelectasis 
D)  Diaphragmatic hernia

Question 17

Which of the following anatomic structures should be closely evaluated when using nasal masks in the administration of IF-CPAP?

Accepted Answer

A)  Tragus 
B)  Philtrum 
C)  Sphenoid axis 
D)  Lower lip 
A)  Tragus 
B)  Philtrum 
C)  Sphenoid axis 
D)  Lower lip

Question 18

After initiating B-CPAP in an infant at 6 cm H2O, the therapist notices that, although "bubbling" is present, the pressure in the manometer fluctuates between 2 and 5 cm H2O. What may have caused this situation?

Accepted Answer

A)  The FiO2 was not increased sufficiently. 
B)  The CPAP level was not raised enough. 
C)  The flow through the CPAP system is too low. 
D)  A problem with the interface has likely developed. 
A)  The FiO2 was not increased sufficiently. 
B)  The CPAP level was not raised enough. 
C)  The flow through the CPAP system is too low. 
D)  A problem with the interface has likely developed.

Question 19

When nasal cannulas are used in infants at high flows, which factors determine the amount of pressure to the airways?
I. Flow rate
II. Size of the leak around the cannula
III. Degree of the mouth opening
IV. FiO2

Accepted Answer

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

Question 20

A bubble CPAP has been set up on an infant at 12 L/minute and the water column is reading 4 cm H2O. A chest X-ray reveals mild lung overdistention. What is the most feasible explanation for this finding?

Accepted Answer

A)  The amount of CPAP is excessive for this age group. 
B)  The flow rate is very high and the CPAP measured at the nasal prongs is probably >4 cm H2O. 
C)  The cannula is probably too large for the infant and causes inadvertent CPAP. 
D)  The chest X-ray finding is consistent with the amount of CPAP set at the water chamber. 
A)  The amount of CPAP is excessive for this age group. 
B)  The flow rate is very high and the CPAP measured at the nasal prongs is probably >4 cm H2O. 
C)  The cannula is probably too large for the infant and causes inadvertent CPAP. 
D)  The chest X-ray finding is consistent with the amount of CPAP set at the water chamber.

Exam 15: Noninvasive Mechanical Ventilation and Continuous Positive Pressure of the Neonate

How should a therapist determine the size of the nasal prongs to effectively administer CPAP to infants?

Which of the following conditions are contraindications for nasal CPAP? I. Pneumonia II. Tracheoesophageal fistula III. Choanal atresia IV. Atelectasis

A preterm infant in respiratory distress is a candidate for CPAP. To minimize the work of breathing, which device should be used?

How is the positive pressure level established in a bubble CPAP system?

Which form of CPAP has been associated with a "thoracic wiggle"?

What is considered the most effective interface option for delivering CPAP to infants?

After initiating IF-CPAP in an infant at 8 cm H2O, the therapist notices a low-pressure alarm. What should be done to correct this situation?

After increasing the level of CPAP delivered to an infant, the therapist notices that the neonate's PaCO2 rises and the PaO2 falls. What may have caused this situation?

Which of the following outcomes are advantages of CPAP over mechanical ventilation in infants? I. Lower risk of sepsis II. Lower incidence of lung injury III. Fewer cases of chronic lung disease IV. Lower incidence of renal failure

In order to rinse the system of exhaled CO2 and meet the inspiratory flow rate requirements of infants placed on B-CPAP, the flow rate of humidified gas should be set at:

Which of the following features are often components of CPAP systems incorporated within infant ventilators? I. Highly responsive demand flow systems II. Apnea backup breaths III. FiO2 compensation mechanisms IV. Leak compensation capabilities

Which of the following CPAP systems delivers a more consistent pressure, lowers work of breathing (WOB), is less sensitive to leaks, and is more effective at alveolar recruitment compared with other forms of CPAP?

Where in the CPAP delivery system should the pressure-relief/pop-off valve be placed to detect circuit occlusion?

Which of the following complications of CPAP can develop when an infant experiences inadvertent positive end-expiratory pressure (PEEP) from gas trapping resulting from tachypnea?

Which of the following anatomic structures should be closely evaluated when using nasal masks in the administration of IF-CPAP?

After initiating B-CPAP in an infant at 6 cm H2O, the therapist notices that, although "bubbling" is present, the pressure in the manometer fluctuates between 2 and 5 cm H2O. What may have caused this situation?

When nasal cannulas are used in infants at high flows, which factors determine the amount of pressure to the airways? I. Flow rate II. Size of the leak around the cannula III. Degree of the mouth opening IV. FiO2

A bubble CPAP has been set up on an infant at 12 L/minute and the water column is reading 4 cm H2O. A chest X-ray reveals mild lung overdistention. What is the most feasible explanation for this finding?

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 of the Infant and Child

Invasive Mechanical Ventilation of the Neonate and Pediatric Patient

Administration of Gas Mixtures

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

After initiating IF-CPAP in an infant at 8 cm H₂O, the therapist notices a low-pressure alarm. What should be done to correct this situation?

After increasing the level of CPAP delivered to an infant, the therapist notices that the neonate's PaCO₂ rises and the PaO₂ falls. What may have caused this situation?

In order to rinse the system of exhaled CO₂ and meet the inspiratory flow rate requirements of infants placed on B-CPAP, the flow rate of humidified gas should be set at:

Which of the following features are often components of CPAP systems incorporated within infant ventilators? I. Highly responsive demand flow systems II. Apnea backup breaths III. FiO₂ compensation mechanisms IV. Leak compensation capabilities

After initiating B-CPAP in an infant at 6 cm H₂O, the therapist notices that, although "bubbling" is present, the pressure in the manometer fluctuates between 2 and 5 cm H₂O. What may have caused this situation?

When nasal cannulas are used in infants at high flows, which factors determine the amount of pressure to the airways? I. Flow rate II. Size of the leak around the cannula III. Degree of the mouth opening IV. FiO₂

A bubble CPAP has been set up on an infant at 12 L/minute and the water column is reading 4 cm H₂O. A chest X-ray reveals mild lung overdistention. What is the most feasible explanation for this finding?