Question 1

What is the significance of a shorter tracheal length in infants and children?

Accepted Answer

A shorter tracheal length in infants and children makes it easier for an endotracheal tube to be advanced too far, leading to right mainstem intubation.

Question 2

What is the location of the larynx in infants as compared to adults?

Accepted Answer

In infants, the larynx is positioned higher in the neck, around the level of C1-C3, while in adults, it is located lower, around the level of C4-C5.

Question 3

Why must infants increase their respiratory rate and not their tidal volume when work of breathing increases?

Accepted Answer

Infants have a more compliant thorax, which is less stable, making it difficult to increase tidal volume effectively. Therefore, they increase their respiratory rate to meet increased demands.

Question 4

The growth process at puberty is driven by what two hormones?

Accepted Answer

Growth hormone and sex hormones (such as estrogen and testosterone) are primarily responsible for the growth spurt and physical changes during puberty.

Question 5

Which of the following is characteristic of volume ventilation?

Accepted Answer

Volume ventilation is used when precise control of minute ventilation is desired, as it delivers a set tidal volume regardless of changes in lung compliance or resistance.

Question 6

A neonate is being ventilated via pressure-control mode. To assess changes in compliance or resistance, the therapist should monitor the:

Accepted Answer

The answer of A neonate is being ventilated via pressure-control...

Question 7

A therapist receiving a verbal order to initiate CPAP on a neonate must first assess the neonate for adequate:

Accepted Answer

The therapist must first assess the neonate for adequate spontaneous breathing to ensure that CPAP can be effectively used, as CPAP requires the patient to be breathing spontaneously.

Question 8

Which of the following is a hazard of CPAP?

Accepted Answer

Barotrauma is a potential hazard of CPAP (Continuous Positive Airway Pressure) as it involves the risk of overdistending the lungs due to excessive pressure, which can lead to lung injury.

Question 9

If volume ventilation is used in the neonate, what tidal volume range is recommended?

Accepted Answer

The recommended tidal volume range for neonates during volume ventilation is typically 4 to 5 mL/kg to ensure adequate ventilation while minimizing the risk of lung injury.

Question 10

When ventilating a pediatric patient with a cuffed endotracheal tube, what size is appropriate for a 5 year old using Cole's formula?

Accepted Answer

Cole's formula for estimating the appropriate endotracheal tube size for children is (age/4) + 4. For a 5-year-old, this would be (5/4) + 4 = 5.25, so a size 5.0 tube is appropriate.

Question 11

A neonatal patient on pressure ventilation with a PIP of 18 has a PaCO₂ of 57. What pressure setting will normalize the PaCO₂?

Accepted Answer

Increasing the Peak Inspiratory Pressure (PIP) from 18 to 26 will increase the tidal volume and improve ventilation, thereby reducing the elevated PaCO2 of 57 to a more normal level.

Question 12

The physician orders a pediatric patient to have a PaO₂ of 90 mm Hg. The patient is currently on an F_IO₂ of 0.45 with a PaO₂ of 72. What F_IO₂ will achieve the physician's order?

Accepted Answer

To increase the PaO2 from 72 mm Hg to 90 mm Hg, the FIO2 needs to be increased proportionally. Using the formula: (Desired PaO2 / Current PaO2) x Current FIO2 = New FIO2, we get (90/72) x 0.45 = 0.5625. The closest option is 0.5.

Question 13

What is the most prevalent phospholipid in surfactant?

Accepted Answer

Phosphatidylcholine is the most prevalent phospholipid in pulmonary surfactant, which reduces surface tension in the lungs and is crucial for proper respiratory function.

Question 14

What is the expected change in lung mechanics after the administration of surfactant?

Accepted Answer

Surfactant reduces surface tension in the alveoli, leading to increased lung compliance, which makes it easier for the lungs to expand during inhalation.

Question 15

What is the recommended cuff pressure when using a cuffed tube to ventilate a pediatric patient?

Accepted Answer

The recommended cuff pressure for a cuffed endotracheal tube in pediatric patients is typically between 20-25 cm H₂O to ensure adequate ventilation while minimizing the risk of tracheal injury.

Question 16

Which of the following should be used to guide the minute ventilation setting when ventilating a child?

Accepted Answer

PaCO₂ is used to guide minute ventilation settings as it reflects the adequacy of ventilation and helps in maintaining proper carbon dioxide levels in the blood.

Question 17

Which of the following changes will reduce the PaCO₂ in an infant on high-frequency oscillatory ventilation?

Accepted Answer

Decreasing the frequency (Hz) in high-frequency oscillatory ventilation increases the tidal volume, which can help reduce PaCO2 by enhancing CO2 elimination.

Question 18

When evaluating NAVA catheter placement, the screen shows blue on the first ECG line only. What is the appropriate action to take?

Accepted Answer

Pulling the catheter out a bit will correct the placement and allow for the blue line to appear on all ECG lines.

Question 19

What oxygenation index qualifies an infant for ECMO?

Accepted Answer

An oxygenation index (OI) of 40 or greater is typically used as a threshold for considering ECMO (Extracorporeal Membrane Oxygenation) in infants, as it indicates severe respiratory failure.

Question 20

A patient on ECMO has fluid retention with reduced urine output. The patient is receiving platelets and is on inotropic medications to maintain the cardiac output. Which of the following would indicate recovery?

Accepted Answer

Diuresis, or increased urine output, would indicate recovery as it suggests improved kidney function and fluid balance, which are often compromised in patients on ECMO.

Quiz 12: Neonatal and Pediatric Mechanical Ventilation