finalprep Flashcards
(42 cards)
4 wks after ED visit for asthma a 2 yr old child presents for OP clinic follow up; the child was prescribed DPI pulmicort flexhaler 90 mcg 2x daily; child continues with nighttime cough what changes might you suggest?
a. begin administering 1 puff of salmeterol (serevent) 2 x daily
b. 4 mg montelukast (singulair) chewables 1 x daily at night
c. replace budesonide dpi with 2 puffs of flovent (fluticasone) 110 at 2x daily
d. replace pulmicort with 90 mcg at 1 puff advair (fluticasone/salmeterol) 100/50 at 2x daily
c. replace with flocent 110 at 2 x daily for 2 puffs
A hyperoxia test is ordered for a cyanotic neonate. An oxyhood is connected to wall O2 source. The FIO2 in oxyhood is analyzed at .80; what should be done first to increase the FIO2?
a. increase the flow rate
b. select a larger oxyhood
c. change to an air-oxygen blender
d. change to high flow nasal cannula
a. increase the flow rate
A child with neuromuscular weakness has retention of secretions. which is the most effective therapy: a. IPV B. mech insufflation-exsufflation c. High frequency chest wall oscillation d. positive expiratory pressure device
b. insufflation-exsufflation
A full term newborn with congenital diaphragmatic hernia is receiving HFJV at 10 ppm iNO; following a low range calibration, the NO concentration reads 14 ppm, which of the following should be done first:
a. perform a high range NO calibration
b. replace the sample line
c. calibrate the O2 sensor
d. change the injector module
a. perform a high rang NO calibration
A 9 yr old pt with CF has SOB and dizziness while in LLL drainage position. What should be done next:
a. stop all chest PT and discontinue further sessions
b. perform the therapy but for shorter time period
c. continue drainage, but not percussion or vibration
d. proceed with other drainage positions and note the patient’s discomfort
d. proceed with other positions and note patient’s discomfort
A 900 g infant is receiving mech ventilation and has bilateral chest tubes; chest xrays show flattened diaphragm & uniformly distributed small cystic radiolucencies; which type of mech ventilation should be used?
a. high frequency
b. differential lung
c. pressure controlled
d. pressure support
a. high frequency
During suctioning of infant with RSV at -80 of suctin pressure bright red blood from ETT is seen, what is cause of bronchial hemorrhage?
A. ETT perforated blood vessel
b. suction pressure too high
c. infant developed necrosis from pneumonia
d. catheter damaged the mucosa
d. the catheter damaged the mucosa
A chest xray is being reviewed of an infant with severe RDS; it shows tiny radiolucencies in the perhilar area of lung progressing outwards; these are most consistent with:
a. pneumothorax
b. pneumomediastinum
c. subcutaneous emphysema
d. PIE
D. PIE
A 3 yr old is admitted to ED with severe asthma; what is the best way to administer albuterol treatment:
a. breath actuated MDI with mask
b. SVN with mask
c. MDI with holding chamber
d. SVN with blow by technique
B. SVN with mask
Following abdominal surgery a 16 y/o develops bibasilar atelectasis; the pulse ox reads .95 while receiving 50% O2 with AEM mask; what should be recommended? A. Mask CPAP B. IS C. IPPB therapy D. bronchodilator therapy
A. mask CPAP
A neonate has PIE and is being converted to HFJV; when comparing the PIP to mechanical ventilation how should it be set on JFJV? A. the same B. 5-9% above c. 10-19% below D. 20-25% above
c. 10-19% below
An infant is receiving .25 oxygen via servo controlled incubator; low body temp alarm & high air temp alarms activated; what should be checked first
a. check teh O2 flow & FIO2
b. Increase the temp in the incubator
c. check the incubator’s air temp
d. confirm placement of the skin temp sensor
d. confirm placement of skin temp sensor
Which is the anitcipated result of iNO:
a. peripheral vasoconstriction
b. bronchodilation
c. pulmonary vasodilation
d. mast cell deactivation
c. pulmonary vasodilation
Which of the following gases is used to perform high range calibration on NO2 sensor of iNO delivery system: a. 45 ppm NO and 10 ppm NO2 b. 20 ppm NO and 5 ppm NO2 c. 10 ppm NO2 D. 45 ppm NO2
c. 10 ppm NO2
A 30 kg 8 yr old child with sepsis and ARDS is being mechanically ventilated on PC, A/C ventilation: the settings are FIO2 = .60, Mandatory rate = 20, Exhaled Vt = 180 mL, PIP = 35, PEEP = 10; ABG results are: pH 7.29, PaCO2= 60, PaO2= 65, HCO3 = 31, BE = -2; what should be recommended:
a. decreasing PIP to 30
b. increasing PEEP to 12
c. Increasing RR to 25
d. maintain current settings
d. maintain current settings
A specialist is called to nursery following recent delivery of 35 wk old neonate due to excessive secretions, coughing, respiratory distress, cyanosis, the SpO2 is 92%; a gastric tube advances to 8 cm. The specialist should:
a. initiate oxyhood at 50% & obtain chest xray
b. place a replogle tube and administer O2 as needed
c. intubate the right mainstem bronchus & obtain ABG
d. initiate nasal CPAP and administer albuterol
b. place a replogle tube and administer O2 as needed
A full term neonate with severe pneumonia is being ventilated with HFOV; Chest xray shows diffusely opaque lung fields expanded about 7th rib posteriorly; The PaO2 is 50% with FIO2 of .80; It is requested that ventilator settings be adjusted; what should be increased?
a. frequency
b. amplitude
c. I time %
d. mean airway pressure
d. mean airway pressure
An 8 mos old infant is intubated with 4.0 ETT tube that is uncuffed; treatment for laryngeal web. The baby is being prepared for extubation when it is noticed that PIP during mandatory breath is 42 before air leak is heard; what should be done:
a. remove the ett
b. replace the ETT with smaller one
c. withdraw the ett 1 cm & resecure
d. evaluate for leak around the ETT in 4 hrs.
d. evaluate leak in 4 hrs
A newborn with pulmonary htn is receiving dopamine; The infants PtcO2 = 5; the PAO2 from ABG = 40; what is likely true:
a. probe has fallen off
b. monitor should be recalibrated
c. infant has decreased peripheral perfusion
d. probe is overheating the sample
c. infant has decreased peripheral perfusion
A 6 yr old with asthma has respiratory acidosis while receiving mech ventilation with an FIO2 of .30; with continuous albuterol, mg, and steroids. what should be added first to treatment:
a. nitric oxide
b. isoflurane
c. helium
d. xenon
c. helium
An infant receiving mech ventilation has PIE on the right side; what position should be used to best improve oxygenation?
a. left side up
b. right side up
c. prone
d. supine
a. left side up
A child is receiving bi level non invasive ventilation; ABG reveals elevated PaCO2 and SPO2 of .95; what should be increased:
a. expiratory positive airway pressure
b. inspiratory rise time
c. mandatory rate
d. oxygen concentration
c. mandatory rate
A specialist is reviewing chart of 10 yr old who has recently had bone marrow transplant. The patient is receiving 300 mg of pentamadine; following treatment it was noted the patient had diffuse bilateral wheezing, dry cough, & SOB; what should be done
a. wait 1 week & then administer reduced dose of pentamadine (Nebupent)
b. wait 4 weeks and try again to administer pentamadine 300 mg
c. administer 2 puffs of albuterol before next treatment
d. undergo pre and post bronchodilator pft testing before next dose
c. administer 2 puffs of albuterol before next treatment
A full term neonate receiving iNO for persistent pulmonary hypertension with HFOV; during vent check found that measured NO is 6 ppm higher than set nitric oxide concentration; the high and low calibration are successfully recalibrated & measured value continues to be high; what should be done:
a. increase the bias flow of the vent
b. place a one way valve after the injector module
c. decrease the fio2 on vent
d. replace the sample line
b. place a 1 way valve after the injector module
