Question 1

A common finding in a neonate with MAS is a respiratory rate that is:

Accepted Answer

A)  under 40/min. 
B)  between 40 and 60/min. 
C)  well over 60/min. 
D)  cyclical with faster and then slower breaths. 
A)  under 40/min. 
B)  between 40 and 60/min. 
C)  well over 60/min. 
D)  cyclical with faster and then slower breaths. C

Question 2

The major pathologic or structural changes associated with the physical presence of meconium in MAS include:
1) partially obstructed airways, air trapping, and alveolar hyperinflation.
2) pulmonary air leak syndromes (pneumomediastinum or pneumothorax).
3) totally obstructed airways and absorption atelectasis.
4) pulmonary edema and alveolar flooding.

Accepted Answer

A) 1, 3 
B) 1, 2, 4 
C) 2, 3, 4 
D) 1, 2, 3 
A) 1, 3 
B) 1, 2, 4 
C) 2, 3, 4 
D) 1, 2, 3 D

Question 3

Hyperinflation is noted on the chest radiograph of a patient with MAS. What sudden developments must be watched for?
1) PPHN
2) Pneumothorax
3) Cardiomegaly
4) Pneumomediastinum

Accepted Answer

A) 2, 3 
B) 2, 4 
C) 1, 2, 3 
D) 1, 3, 4 
A) 2, 3 
B) 2, 4 
C) 1, 2, 3 
D) 1, 3, 4 B

Question 4

Infants who are older than 42 weeks' gestation are at greater risk for MAS because they have:
1) a full bowel.
2) strong peristalsis.
3) amniotic fluid in their stomach.
4) sphincter tone.

Accepted Answer

A) 1, 3 
B) 2, 4 
C) 2, 3, 4 
D) 1, 2, 4 
A) 1, 3 
B) 2, 4 
C) 2, 3, 4 
D) 1, 2, 4

Question 5

A patient with MAS has had a chest radiograph taken. What findings can be expected?

Accepted Answer

A)  Elevated diaphragms 
B)  Mediastinal shift 
C)  Irregular densities throughout the lungs 
D)  Air bronchograms 
A)  Elevated diaphragms 
B)  Mediastinal shift 
C)  Irregular densities throughout the lungs 
D)  Air bronchograms

Question 6

A neonate with MAS has hypoxemia. Which of the following can be a pulmonary effect of this?

Accepted Answer

A)  Status asthmaticus 
B)  Persistent pulmonary hypertension of the newborn (PPHN) 
C)  Bronchopulmonary dysplasia (BP
D)  
D)  Pulmonary fibrosis 
A)  Status asthmaticus 
B)  Persistent pulmonary hypertension of the newborn (PPHN) 
C)  Bronchopulmonary dysplasia (BP
D)  
D)  Pulmonary fibrosis

Question 7

A patient has meconium aspiration syndrome (MAS) and a chemical pneumonitis as a result. What effects can this have?
1) Increased surfactant production
2) Increased bacterial growth
3) Edema of bronchial mucosa
4) Excessive bronchial secretions

Accepted Answer

A) 2, 3 
B) 1, 4 
C) 1, 2, 4 
D) 2, 3, 4 
A) 2, 3 
B) 1, 4 
C) 1, 2, 4 
D) 2, 3, 4

Question 8

Indications that a newborn has aspirated meconium include:
1) a high Apgar score.
2) meconium in amniotic fluid.
3) newborn is not actively breathing.
4) meconium staining on skin.

Accepted Answer

A) 1, 3 
B) 2, 4 
C) 2, 3, 4 
D) 1, 2, 3 
A) 1, 3 
B) 2, 4 
C) 2, 3, 4 
D) 1, 2, 3

Question 9

Risk factors for the development of MAS include:
1) being postterm.
2) a mother who is hypertensive.
3) a mother who is toxemic.
4) being the first twin born.

Accepted Answer

A) 1, 4 
B) 2, 3 
C) 2, 3, 4 
D) 1, 2, 3 
A) 1, 4 
B) 2, 3 
C) 2, 3, 4 
D) 1, 2, 3

Question 10

How may a fetus respond when he/she becomes hypoxemic?

Accepted Answer

A)  The fetus stops making breathing efforts. 
B)  The fetus makes rapid, shallow chest movements. 
C)  The fetus makes very deep, gasping inspiratory movements. 
D)  The fetus shows Kussmaul respirations. 
A)  The fetus stops making breathing efforts. 
B)  The fetus makes rapid, shallow chest movements. 
C)  The fetus makes very deep, gasping inspiratory movements. 
D)  The fetus shows Kussmaul respirations.

Question 11

What is the consequence of meconium aspiration if there is a "ball-valve" effect in the small airways?

Accepted Answer

A)  Air trapping on exhalation 
B)  Apnea of prematurity 
C)  Air trapping on inhalation 
D)  Bronchiectasis 
A)  Air trapping on exhalation 
B)  Apnea of prematurity 
C)  Air trapping on inhalation 
D)  Bronchiectasis

Question 12

It is highly suspected that a newborn has aspirated meconium. What actions should be immediately undertaken?
1) Instill exogenous surfactant
2) PRN suctioning of the airways
3) Gentle oral suctioning
4) Elective intubation for the clearance of meconium stained fluid

Accepted Answer

A) 2, 3 
B) 1, 4 
C) 2, 3, 4 
D) 1, 2, 3 
A) 2, 3 
B) 1, 4 
C) 2, 3, 4 
D) 1, 2, 3

Question 13

If mechanical ventilation is needed to support a neonate with MAS, which of the following settings is especially important?

Accepted Answer

A)  High positive end-expiratory pressure (PEEP) level. 
B)  Long exhalation time. 
C)  High humidity level. 
D)  Give no more than 50% oxygen. 
A)  High positive end-expiratory pressure (PEEP) level. 
B)  Long exhalation time. 
C)  High humidity level. 
D)  Give no more than 50% oxygen.

Question 14

About how many neonatal patients with MAS will require mechanical ventilation or CPAP?

Accepted Answer

A)  50% to 70% 
B)  30% to 50% 
C)  10% to 15% 
D)  Less than 10% 
A)  50% to 70% 
B)  30% to 50% 
C)  10% to 15% 
D)  Less than 10%

Question 15

What risks are there in positive-pressure ventilation before all meconium has been removed from the airways?
1) Forcing meconium into the lower airways
2) Pneumothorax
3) Triggering persistent pulmonary hypertension of the neonate (PPHN)
4) Triggering an asthma attack

Accepted Answer

A) 1, 4 
B) 3, 4 
C) 1, 2 
D) 2, 3, 4 
A) 1, 4 
B) 3, 4 
C) 1, 2 
D) 2, 3, 4

Question 16

An infant with MAS will show what clinical manifestations associated with the more negative intrapleural pressures needed during inspiration?
1) Seesaw breathing movement.
2) Breath sounds reveal rhonchi and crackles.
3) Expiratory grunting.
4) Cyanosis of the dependent thoracic areas.

Accepted Answer

A) 1, 4 
B) 2, 3 
C) 2, 3, 4 
D) 1, 2, 3 
A) 1, 4 
B) 2, 3 
C) 2, 3, 4 
D) 1, 2, 3

Exam 35: Meconium Aspiration Syndrome

A common finding in a neonate with MAS is a respiratory rate that is:

Hyperinflation is noted on the chest radiograph of a patient with MAS. What sudden developments must be watched for? 1) PPHN 2) Pneumothorax 3) Cardiomegaly 4) Pneumomediastinum

Infants who are older than 42 weeks' gestation are at greater risk for MAS because they have: 1) a full bowel. 2) strong peristalsis. 3) amniotic fluid in their stomach. 4) sphincter tone.

A patient with MAS has had a chest radiograph taken. What findings can be expected?

A neonate with MAS has hypoxemia. Which of the following can be a pulmonary effect of this?

A patient has meconium aspiration syndrome (MAS) and a chemical pneumonitis as a result. What effects can this have? 1) Increased surfactant production 2) Increased bacterial growth 3) Edema of bronchial mucosa 4) Excessive bronchial secretions

Indications that a newborn has aspirated meconium include: 1) a high Apgar score. 2) meconium in amniotic fluid. 3) newborn is not actively breathing. 4) meconium staining on skin.

Risk factors for the development of MAS include: 1) being postterm. 2) a mother who is hypertensive. 3) a mother who is toxemic. 4) being the first twin born.

How may a fetus respond when he/she becomes hypoxemic?

What is the consequence of meconium aspiration if there is a "ball-valve" effect in the small airways?

It is highly suspected that a newborn has aspirated meconium. What actions should be immediately undertaken? 1) Instill exogenous surfactant 2) PRN suctioning of the airways 3) Gentle oral suctioning 4) Elective intubation for the clearance of meconium stained fluid

If mechanical ventilation is needed to support a neonate with MAS, which of the following settings is especially important?

About how many neonatal patients with MAS will require mechanical ventilation or CPAP?

What risks are there in positive-pressure ventilation before all meconium has been removed from the airways? 1) Forcing meconium into the lower airways 2) Pneumothorax 3) Triggering persistent pulmonary hypertension of the neonate (PPHN) 4) Triggering an asthma attack

An infant with MAS will show what clinical manifestations associated with the more negative intrapleural pressures needed during inspiration? 1) Seesaw breathing movement. 2) Breath sounds reveal rhonchi and crackles. 3) Expiratory grunting. 4) Cyanosis of the dependent thoracic areas.

The Patient Interview

The Physical Examination

The Pathophysiologic Basis for Common Clinical Manifestations

Pulmonary Function Testing

Blood Gas Assessment

Assessment of Oxygenation

Assessment of the Cardiovascular System

Radiologic Examination of the Chest

Other Important Tests and Procedures

The Therapist-Driven Protocol Program

Respiratory Insufficiency, Respiratory Failure and Ventilatory Management Protocols

Recording Skills and Intra-Professional Communication

Chronic Obstructive Pulmonary Disease, Chronic Bronchitis and Emphysema

Asthma

Cystic Fibrosis

Bronchiectasis

Atelectasis

Pneumonia, Lung Abscess Formation, and Important Fungal Diseases

Tuberculosis

Pulmonary Edema

Pulmonary Vascular Disease: Pulmonary Embolism and Pulmonary Hypertension

Flail Chest

Pneumothorax

Pleural Effusion and Empyema

Kyphoscoliosis

Cancer of the Lung, Prevention and Palliation

Interstitial Lung Diseases

Acute Respiratory Distress Syndrome

Guillain-Barré Syndrome

Myasthenia Gravis

Cardiopulmonary Assessment and Care of Patients With Neuromuscular Disease

Sleep Apnea

Newborn Assessment and Management

Pediatric Assessment, Protocols, and Pals Management

Transient Tachypnea of the Newborn

Respiratory Distress Syndrome

Pulmonary Air Leak Syndrome

Respiratory Syncytial Virus Infection Bronchiolitis

Chronic Lung Disease of Infancy

Congenital Diaphragmatic Hernia

Congenital Heart Disease

Croup and Croup-Like Syndromes: Laryngotracheobronchitis, Bacterial Tracheitis, and Acute Epiglottitis

Near Drowningwet Drowning

Smoke Inhalation, Thermal Injuries, and Carbon Monoxide Intoxication

Filters