Question 1

Which of the following is the term used to describe the exchange of gas between lung units with different time constants?

Accepted Answer

A)  Streaming 
B)  Pendelluft 
C)  Taylor-type dispersion 
D)  Diffusion 
A)  Streaming 
B)  Pendelluft 
C)  Taylor-type dispersion 
D)  Diffusion

Question 2

Newer ventilators allow neonates to use what type of trigger for better synchronization with the ventilator?

Accepted Answer

A)  Time 
B)  Flow 
C)  Pressure 
D)  Volume 
A)  Time 
B)  Flow 
C)  Pressure 
D)  Volume

Question 3

Both inspiration and expiration are active in which type of high-frequency ventilation?

Accepted Answer

A)  High-frequency positive pressure ventilation 
B)  High-frequency oscillatory ventilation 
C)  High-frequency jet ventilation 
D)  High-frequency percussive ventilation 
A)  High-frequency positive pressure ventilation 
B)  High-frequency oscillatory ventilation 
C)  High-frequency jet ventilation 
D)  High-frequency percussive ventilation

Question 4

A pediatric patient with air leak syndrome is being ventilated with PC-CMV.The settings are: rate = 20 breaths/min,TI = 0.8 sec,PIP = 30 cm H₂O,PEEP = 8 cm H₂O,FɪO₂ = 0.8,MAP = 14 cm H₂O.The patient is to be switched to HFOV.What MAP range is appropriate for this patient?

Accepted Answer

A)  8-10 cm H₂O 
B)  10-12 cm H₂O 
C)  12-14 cm H₂O 
D)  14-16 cm H₂O 
A)  8-10 cm H₂O 
B)  10-12 cm H₂O 
C)  12-14 cm H₂O 
D)  14-16 cm H₂O

Question 5

A 3-month-old,6.4-kg infant with ARDS is receiving ventilatory support.The initial settings are: PC-CMV,PIP = 22 cm H₂O,PEEP = 5 cm H₂O,rate = 30 breaths/min,FɪO₂ = 0.6.The ABG results show a PₐO₂ of 48 mm Hg.The respiratory therapist increases the PEEP to 8 cm H₂O.The pressure-volume loops below show the change that occurs after this increase.(Loop A [solid line] was generated from the initial settings.Loop B [dashed line] was generated from the increase in PEEP.)The respiratory therapist's most appropriate action is which of the following?

Accepted Answer

A)  Decrease the PEEP to 5 cm H₂O. 
B)  Keep the PEEP at 8 cm H₂O. 
C)  Decrease the PIP to 20 cm H₂O. 
D)  Increase the PIP to 24 cm H₂O. 
A)  Decrease the PEEP to 5 cm H₂O. 
B)  Keep the PEEP at 8 cm H₂O. 
C)  Decrease the PIP to 20 cm H₂O. 
D)  Increase the PIP to 24 cm H₂O.

Question 6

A neonate of 30 weeks' gestation shows signs of respiratory distress after delivery,including grunting,nasal flaring,and cyanosis.The baby is placed on nasal CPAP at 6 cm H₂O with an FɪO₂ of 0.6.The grunting and nasal flaring are alleviated,and the ABG results on these settings are: pH = 7.20,PₐCO₂ = 64 mm Hg,PₐO₂ = 48 mm Hg,SₐO₂ = 70%,HCO₃⁻ = 21 mEq/L.The respiratory therapist should recommend which of the following?

Accepted Answer

A)  Increase the CPAP to 8 cm H₂O and the FɪO₂ to 0.7. 
B)  Switch to nasal IMV, an inspiratory pressure of 18 cm H₂O, PEEP of 4 cm H₂O, and an FɪO₂ of 0.8. 
C)  Continue with the current settings and monitor the patient closely. 
D)  Intubate and use PC-IMV, an inspiratory pressure of 16 cm H₂O, PEEP of 5 cm H₂O, and an FɪO₂ of 0.8. 
A)  Increase the CPAP to 8 cm H₂O and the FɪO₂ to 0.7. 
B)  Switch to nasal IMV, an inspiratory pressure of 18 cm H₂O, PEEP of 4 cm H₂O, and an FɪO₂ of 0.8. 
C)  Continue with the current settings and monitor the patient closely. 
D)  Intubate and use PC-IMV, an inspiratory pressure of 16 cm H₂O, PEEP of 5 cm H₂O, and an FɪO₂ of 0.8.

Question 7

During HFOV,oxygenation can be improved by making which of the following changes?
1)Increasing the FɪO₂
2)Decreasing the amplitude
3)Increasing the MAP
4)Increasing the frequency

Accepted Answer

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

Question 8

The gas flow rate for a noncommercial bubble CPAP device should be set at _______ L/min.

Accepted Answer

A)  3 
B)  5 
C)  8 
D)  10 
A)  3 
B)  5 
C)  8 
D)  10

Question 9

Which of the following are contraindications for the use of pressure support in neonates receiving nasal IMV?
1)Large airway leaks
2)Ineffectiveness of triggering
3)Increased risk of volutrauma
4)Hypocapnia from excessive triggering

Accepted Answer

A)  1 and 2 only 
B)  1 and 3 only 
C)  2 and 3 only 
D)  2 and 4 only 
A)  1 and 2 only 
B)  1 and 3 only 
C)  2 and 3 only 
D)  2 and 4 only

Question 10

A mechanically ventilated pediatric patient in the process of being weaned is switched to PC-IMV with PS.The respiratory therapist notes that every PS breath is being time cycled.The most likely cause of this is which of the following?

Accepted Answer

A)  The PS setting is too high. 
B)  The flow cycle setting is too low. 
C)  This is the normal cycle for PS. 
D)  A large leak is present around the cuffless ET tube. 
A)  The PS setting is too high. 
B)  The flow cycle setting is too low. 
C)  This is the normal cycle for PS. 
D)  A large leak is present around the cuffless ET tube.

Question 11

A pediatric patient intubated with a 3.5-mm endotracheal tube is receiving pressure support ventilation.The respiratory therapist notes patient-ventilator asynchrony and a rapid deceleration of flow that prematurely ends inspiration.The most appropriate action to alleviate this is which of the following?

Accepted Answer

A)  Increase the PS level. 
B)  Increase the rise time. 
C)  Decrease the PS level. 
D)  Increase the flow cycle. 
A)  Increase the PS level. 
B)  Increase the rise time. 
C)  Decrease the PS level. 
D)  Increase the flow cycle.

Question 12

The pressure manometer in-line with a bubble CPAP setup is reading higher than the depth of the expiratory limb in the liquid-filled bottle.This is most likely caused by which of the following?

Accepted Answer

A)  Set flow rate above 5 L/min 
B)  Set flow rate below 5 L/min 
C)  Fluid in the inspiratory line 
D)  Improperly placed manometer 
A)  Set flow rate above 5 L/min 
B)  Set flow rate below 5 L/min 
C)  Fluid in the inspiratory line 
D)  Improperly placed manometer

Question 13

The most common interface for infants receiving CPAP is which of the following?

Accepted Answer

A)  Nasopharyngeal tube 
B)  Binasal prongs 
C)  Nasal mask 
D)  Endotracheal tube 
A)  Nasopharyngeal tube 
B)  Binasal prongs 
C)  Nasal mask 
D)  Endotracheal tube

Question 14

The number of time constants for almost complete equilibration of alveolar pressure in a normal infant's lungs is___________.

Accepted Answer

A)  1-3 
B)  2-4 
C)  3-5 
D)  4-7 
A)  1-3 
B)  2-4 
C)  3-5 
D)  4-7

Question 15

The minimum acceptable pH for a premature or term newborn is which of the following?

Accepted Answer

A)  7.20 
B)  7.25 
C)  7.30 
D)  7.35 
A)  7.20 
B)  7.25 
C)  7.30 
D)  7.35

Question 16

The maximum percent leak that may be allowed around a cuffless endotracheal tube is which of the following?

Accepted Answer

A)  6% 
B)  12% 
C)  19% 
D)  25% 
A)  6% 
B)  12% 
C)  19% 
D)  25%

Question 17

An 835-g newborn is receiving HFOV with the following settings: MAP = 10 cm H₂O; FɪO₂ = 0.6; frequency = 10 Hz; amplitude (P)= 20 cm H₂O.The ABG values are: pH = 7.35,PaCO2 = 40 mm Hg,PaO2 = 40 mm Hg.Based on these data,which of the following is the most appropriate action?

Accepted Answer

A)  Increase the frequency. 
B)  Increase the MAP. 
C)  Decrease the amplitude. 
D)  Decrease the bias flow. 
A)  Increase the frequency. 
B)  Increase the MAP. 
C)  Decrease the amplitude. 
D)  Decrease the bias flow.

Question 18

Neurally adjusted ventilator assist (NAVA)is particularly useful with newborns because it ___________________.

Accepted Answer

A)  reduces gas trapping 
B)  is not affected by leaks 
C)  decreases the development of VILA 
D)  is sensitive to changes in respiratory drive 
A)  reduces gas trapping 
B)  is not affected by leaks 
C)  decreases the development of VILA 
D)  is sensitive to changes in respiratory drive

Question 19

A preterm neonate is being supported with nasal SiPAP.The baseline CPAP level is set at 6 cm H₂O,the high CPAP level at 10 cm H₂O,the rate is 20 "sigh" breaths,and the FɪO₂ is 0.8.The baby's PₐO₂ on these settings has been steadily declining and is now 48 mm Hg.The physician and respiratory therapist decided to use nasal HFV before intubating and using mechanical ventilation.The initial settings for NHFV for this patient should include which of the following?

Accepted Answer

A)  MAP = 10 cm H₂O; frequency = 8 Hz; FɪO₂ = 1.0 
B)  MAP = 10 cm H₂O; frequency = 10 Hz; FɪO₂ = 0.8 
C)  MAP = 6 cm H₂O; frequency = 8 Hz; FɪO₂ = 0.8 
D)  MAP = 6 cm H₂O; frequency = 10 Hz; FɪO₂ = 1.0 
A)  MAP = 10 cm H₂O; frequency = 8 Hz; FɪO₂ = 1.0 
B)  MAP = 10 cm H₂O; frequency = 10 Hz; FɪO₂ = 0.8 
C)  MAP = 6 cm H₂O; frequency = 8 Hz; FɪO₂ = 0.8 
D)  MAP = 6 cm H₂O; frequency = 10 Hz; FɪO₂ = 1.0

Question 20

The primary goals of mechanical ventilatory support in newborns and pediatric patients include all of the following except ____________________.

Accepted Answer

A)  improving lung compliance 
B)  eliminating airway resistance 
C)  achieving adequate lung volume 
D)  limiting lung injury 
A)  improving lung compliance 
B)  eliminating airway resistance 
C)  achieving adequate lung volume 
D)  limiting lung injury

Which of the following is the term used to describe the exchange of gas between lung units with different time constants?

Newer ventilators allow neonates to use what type of trigger for better synchronization with the ventilator?

Both inspiration and expiration are active in which type of high-frequency ventilation?

A pediatric patient with air leak syndrome is being ventilated with PC-CMV.The settings are: rate = 20 breaths/min,TI = 0.8 sec,PIP = 30 cm H₂O,PEEP = 8 cm H₂O,FɪO₂ = 0.8,MAP = 14 cm H₂O.The patient is to be switched to HFOV.What MAP range is appropriate for this patient?

During HFOV,oxygenation can be improved by making which of the following changes? 1)Increasing the FɪO₂ 2)Decreasing the amplitude 3)Increasing the MAP 4)Increasing the frequency

The gas flow rate for a noncommercial bubble CPAP device should be set at _______ L/min.

Which of the following are contraindications for the use of pressure support in neonates receiving nasal IMV? 1)Large airway leaks 2)Ineffectiveness of triggering 3)Increased risk of volutrauma 4)Hypocapnia from excessive triggering

A mechanically ventilated pediatric patient in the process of being weaned is switched to PC-IMV with PS.The respiratory therapist notes that every PS breath is being time cycled.The most likely cause of this is which of the following?

The pressure manometer in-line with a bubble CPAP setup is reading higher than the depth of the expiratory limb in the liquid-filled bottle.This is most likely caused by which of the following?

The most common interface for infants receiving CPAP is which of the following?

The number of time constants for almost complete equilibration of alveolar pressure in a normal infant's lungs is___________.

The minimum acceptable pH for a premature or term newborn is which of the following?

The maximum percent leak that may be allowed around a cuffless endotracheal tube is which of the following?

An 835-g newborn is receiving HFOV with the following settings: MAP = 10 cm H₂O; FɪO₂ = 0.6; frequency = 10 Hz; amplitude (P)= 20 cm H₂O.The ABG values are: pH = 7.35,P_aCO₂ = 40 mm Hg,P_aO₂ = 40 mm Hg.Based on these data,which of the following is the most appropriate action?

Neurally adjusted ventilator assist (NAVA)is particularly useful with newborns because it ___________________.

The primary goals of mechanical ventilatory support in newborns and pediatric patients include all of the following except ____________________.

Basic Terms and Concepts of Mechanical Ventilation

How Ventilators Work

How a Breath Is Delivered

Establishing the Need for Mechanical Ventilation

Selecting the Ventilator and the Mode

Initial Ventilator Settings

Final Considerations in Ventilator Setup

Initial Patient Assessment

Ventilator Graphics

Assessment of Respiratory Function

Hemodynamic Monitoring

Methods to Improve Ventilation in Patient-Ventilator Management

Improving Oxygenation and Management of ARDS

Ventilator-Associated Pneumonia

Sedatives, Analgesics, and Paralytics

Extrapulmonary Effects of Mechanical Ventilation

Effects of Positive Pressure Ventilation on the Pulmonary System

Troubleshooting and Problem Solving

Basic Concepts of Noninvasive Positive-Pressure Ventilation

Weaning and Discontinuation from Mechanical Ventilation

Long-Term Ventilation

Special Techniques in Ventilatory Support

Filters

Exam 22: Neonatal and Pediatric Ventilation

Which of the following is the term used to describe the exchange of gas between lung units with different time constants?

Newer ventilators allow neonates to use what type of trigger for better synchronization with the ventilator?

Both inspiration and expiration are active in which type of high-frequency ventilation?

A pediatric patient with air leak syndrome is being ventilated with PC-CMV.The settings are: rate = 20 breaths/min,TI = 0.8 sec,PIP = 30 cm H₂O,PEEP = 8 cm H₂O,FɪO₂ = 0.8,MAP = 14 cm H₂O.The patient is to be switched to HFOV.What MAP range is appropriate for this patient?

During HFOV,oxygenation can be improved by making which of the following changes? 1)Increasing the FɪO₂ 2)Decreasing the amplitude 3)Increasing the MAP 4)Increasing the frequency

The gas flow rate for a noncommercial bubble CPAP device should be set at _______ L/min.

Which of the following are contraindications for the use of pressure support in neonates receiving nasal IMV? 1)Large airway leaks 2)Ineffectiveness of triggering 3)Increased risk of volutrauma 4)Hypocapnia from excessive triggering

A mechanically ventilated pediatric patient in the process of being weaned is switched to PC-IMV with PS.The respiratory therapist notes that every PS breath is being time cycled.The most likely cause of this is which of the following?

The pressure manometer in-line with a bubble CPAP setup is reading higher than the depth of the expiratory limb in the liquid-filled bottle.This is most likely caused by which of the following?

The most common interface for infants receiving CPAP is which of the following?

The number of time constants for almost complete equilibration of alveolar pressure in a normal infant's lungs is___________.

The minimum acceptable pH for a premature or term newborn is which of the following?

The maximum percent leak that may be allowed around a cuffless endotracheal tube is which of the following?

An 835-g newborn is receiving HFOV with the following settings: MAP = 10 cm H₂O; FɪO₂ = 0.6; frequency = 10 Hz; amplitude (P)= 20 cm H₂O.The ABG values are: pH = 7.35,PaCO2 = 40 mm Hg,PaO2 = 40 mm Hg.Based on these data,which of the following is the most appropriate action?

Neurally adjusted ventilator assist (NAVA)is particularly useful with newborns because it ___________________.

The primary goals of mechanical ventilatory support in newborns and pediatric patients include all of the following except ____________________.

Basic Terms and Concepts of Mechanical Ventilation

How Ventilators Work

How a Breath Is Delivered

Establishing the Need for Mechanical Ventilation

Selecting the Ventilator and the Mode

Initial Ventilator Settings

Final Considerations in Ventilator Setup

Initial Patient Assessment

Ventilator Graphics

Assessment of Respiratory Function

Hemodynamic Monitoring

Methods to Improve Ventilation in Patient-Ventilator Management

Improving Oxygenation and Management of ARDS

Ventilator-Associated Pneumonia

Sedatives, Analgesics, and Paralytics

Extrapulmonary Effects of Mechanical Ventilation

Effects of Positive Pressure Ventilation on the Pulmonary System

Troubleshooting and Problem Solving

Basic Concepts of Noninvasive Positive-Pressure Ventilation

Weaning and Discontinuation from Mechanical Ventilation

Long-Term Ventilation

Special Techniques in Ventilatory Support

Filters

An 835-g newborn is receiving HFOV with the following settings: MAP = 10 cm H₂O; FɪO₂ = 0.6; frequency = 10 Hz; amplitude (P)= 20 cm H₂O.The ABG values are: pH = 7.35,P_aCO₂ = 40 mm Hg,P_aO₂ = 40 mm Hg.Based on these data,which of the following is the most appropriate action?