Peds Exam #3 review

Peds Exam #3 review

by Lorraine Nichols

Multiple Choice

Where is the tracheostomy tube usually placed in children?

• Between the second and fourth tracheal rings

• Between the fourth and fifth tracheal rings

• Between the cricoid and the thyroid cartilage

• Between the first and second tracheal rings

Multiple Choice

A conventional jet nebulizer with a dead volume of 1 mL is filled with a 3-mL solution of albuterol. What percent of the medication is available for nebulization?

• 33%

• 50%

• 75%

• 100%

Multiple Choice

Which of the following is the best explanation of why the therapist should routinely avoid advancing the catheter tip beyond the distal end of the endotracheal tube when performing endotracheal suctioning on a neonate?

• To reduce the risk of inadvertent extubation with the suction catheter

• To prevent the development of bronchial stenosis and granulomas

• To decrease the chance of removing too much lung volume

• To minimize the risk of oxygen desaturation

Multiple Choice

Which of the following tracheostomy sizes would produce the lowest amount of aerosol deposition in a spontaneously breathing pediatric patient?

• 3.5 mm ID

• 4.5 mm ID

• 5.5 mm ID

• All have similar deposition

Multiple Choice

By which of the following mechanisms are high-frequency chest compressions purported to mobilize tracheobronchial secretions?

• By dislodging mucus directly from bronchial walls

• By advancing the mucociliary escalator at a faster than normal rate

• By mechanically lysing long molecules of mucus into smaller, more mobile segments

• By generating brief periods of high expiratory airflow

Multiple Choice

A respiratory therapist has been assigned to administer CPT to a patient with cystic fibrosis. What areas of the body should the RT avoid when percussing the patient?

• Intercostal spaces

• Areas of subcutaneous emphysema

• Precordium

• Areas between the scapulas

Multiple Choice

Which of the following considerations is most important when using a large-volume nebulizer to provide oxygen and humidification to an infant in an incubator?

• Meeting the inspiratory flow demands of the infant

• Supplying the infant with adequate humidification

• Delivering sufficient oxygen to meet the infant’s needs

• Preventing a high noise level from developing

Multiple Choice

Prior to 2005, why were endotracheal tubes (ETTs) without cuffs routinely recommended for children less than 8 years of age?

• Because some lung volumes are so small cuffs are unnecessary

• Because in some infants the ETT creates a seal against the cricoid cartilage

• Because less airway resistance develops without a cuff, promoting lower ventilation pressures

• Because ETTs without cuffs enable pressure venting when an infant cries

   

Multiple Choice

Where should the therapist secure a 4.0-mm endotracheal tube after the intubation procedure?

• 8 cm at the lip

• 9 cm at the lip

• 10 cm at the lip

• 12 cm at the lip

Multiple Choice

Which of the following anatomic differences between the larynx of an infant and that of an adult makes blind nasal intubation of the infant more difficult?

• The larynx of an infant is more cephalad and anterior.

• The upper airway in the laryngeal area is smaller in an infant.

• The cricoid cartilage in an infant acts as a partial airway obstruction.

• The upper airway structures in an infant are more pliable and compliant.

Multiple Choice

Which of the following conditions is considered a disadvantage of nasotracheal intubation in neonates?

• Postextubation atelectasis among very low–birth weight infants

• Pressure necrosis of the nares

• Deformation of the nasal turbinates

• Olfactory nerve damage

Multiple Choice

A 5-year-old child is brought to the emergency department in severe respiratory distress with a diagnosis of epiglottitis. What measures must be performed to secure the child’s airway?

• The child should be immediately intubated orally in the emergency department.

• A tracheotomy needs to be performed in the emergency department.

• The child is in urgent need of transport to the operating room to be intubated.

• Nebulized 2.2% racemic epinephrine needs to be given via face mask every 10 minutes.

Multiple Choice

Ideally, how many hours after last feeding should a therapist consider before changing a tracheostomy tube to minimize the risk of vomiting and aspiration?

• At least 2 hours

• At least 4 hours

• At least 6 hours

• At least 12 hours

Multiple Choice

Which of the following physiologic consequences would develop if the liquid–gas interface were without surfactant?

• Large alveoli would empty into smaller ones at the end of exhalation.

• Every exhalation would demand ventilatory muscle activity.

• Every breath would require a considerable amount of pressure to expand the lung with each inspiration.

• Some alveoli would collapse during exhalation.

Multiple Choice

Which of the following physiologic conditions results from the presence of normal amounts of pulmonary surfactant in the lung?

• Pulmonary compliance decreases.

• Uniform gas distribution during expiration occurs.

• The functional residual capacity is maintained.

• Pulmonary perfusion matches alveolar ventilation.

Multiple Choice

What appears to be the benefit of administering prophylactic surfactant replacement therapy to preterm infants?

I. Decreased risk of mortality

II. Reduced threat of pneumothorax

III. Decreased incidence of diaphragmatic hernia

IV. Reduced risk of developing pulmonary interstitial emphysema

• I and II only

• II and IV only

• I, II, and IV only

• II, III, and IV only

Multiple Choice

The physician in the emergency department is attending to a 12-year-old child who has an exacerbation of asthma. The physician asks the therapist to recommend a medication that has a synergistic effect with beta-2 agonists during asthma exacerbations. Which of the following medications should the therapist recommend?

• Montelukast

• Ipratropium bromide

• Fluticasone

• Triamcinolone

Multiple Choice

What is the most important variable used to assess the efficacy of CPT?

• Quality of the chest radiograph

• Degree and persistence of coughing

• Changes in the color and consistency of mucus

• Amount of mucus obtained during and after treatment

Multiple Choice

The therapist is about to perform endotracheal intubation on a 2-year-old infant. What size endotracheal tube needs to be used?

• 3.5 mm ID

• 4.0 mm ID

• 4.5 mm ID

• 5.0 mm ID

Multiple Choice

Which of the following considerations is most important when using a large-volume nebulizer to provide oxygen and humidification to an infant in an incubator?

• Meeting the inspiratory flow demands of the infant

• Supplying the infant with adequate humidification

• Delivering sufficient oxygen to meet the infant’s needs

• Preventing a high noise level from developing

Multiple Choice

On the basis of the following diagram, which of the following lung segments is being drained?

• Right middle lobe

• Left lingular segment of the lower lobe

• Lateral basal segment of the right lower lobe

• Apical–posterior segment of the left upper lobe

Multiple Choice

Which of the following are considered common mixtures of Heliox?

I. 80% helium–20% oxygen

II. 70% helium–30% oxygen

III. 80% oxygen–20% helium

IV. 70% oxygen–30% helium

• I and II only

• I and III only

• II and IV only

• III and IV only

Multiple Choice

While working at the bedside of a small child who has myasthenia gravis, the therapist notices a new medication order prescribing glycopyrrolate for the control of secretions. The ordered dosage route is intramuscular and intravenous dosage is 5 mcg/kg every 3 to 4 hours. What should the therapist do at this time?

• Inform the nurse that this medication is contraindicated for patients with myasthenia gravis.

• Inform the nurse that the dose is incorrect.

• Inform the nurse that this medication is contraindicated in children.

• Mention nothing because the prescription is correct.

Multiple Choice

Which of the following medications is a recombinant humanized monoclonal anti-IgE antibody use for the treatment of severe persistent asthma?

• rhDNase

• RespiGam

• Omalizumab

• Palivizumab

Multiple Choice

How can a patient avoid the problem of terminating inhalation when a plume from a pressurized metered-dose inhaler (pMDI) impacts the oropharynx?

• Hold the pMDI closer the mouth.

• Use a valved holding chamber.

• Depress the nozzle only half the full distance.

• Instruct the patient to inspire a short, rapid breath

Multiple Choice

Which of the following methods is acceptable for delivering a drug via a pMDI to an intubated neonate receiving mechanical ventilation?

• In-line with the ventilator

• Through a resuscitation bag

• Through a T-piece

• In-line with a spacer

Multiple Choice

Which of the following benefits have been associated with the use of inhaled tobramycin?

I. Improvement of FEV₁

II. Treats Pseudomona aeruginosa infection

III. Treats Burkholderia cepacia infection

IV. Reduction in parenteral use of antibiotics

• I and IV only

• I, II, and III only

• I, III, and IV only

• I, II, III, and IV