Chapter 22; Neonatal and Pediatric Ventilation Test Bank MULTIPLE CHOICE 1. Respiratory failure is imminent in infants who demonstrate which of the following? a. Substernal retractions b. Tachypnea c. Grunting d. Nasal flaring ANS: C Infants attempt to maintain a back pressure in the lungs to preserve the functional residual capacity by narrowing the glottis and maintaining respiratory muscle activity (active exhalation). This results in vocalization during exhalation, or “grunting,” which often is mistaken for crying. Grunting, which usually can be heard without auscultation, is a useful clinical sign of impending respiratory failure. DIF:
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2. The primary goals of mechanical ventilatory support in newborns and pediatric patients include all of the following except . a. improving lung compliance b. eliminating airway resistance c. achieving adequate lung volume d. limiting lung injury ANS: B The goals of mechanical ventilatory support in newborns and pediatric patients are to (1) provide adequate ventilation and oxygenation, (2) achieve adequate lung volume, (3) improve lung compliance, (4) reduce WOB, and (5) limit lung injury. If airway resistance is a problem, it needs to be addressed; however, eliminating it is not a goal of mechanical ventilatory support. DIF:
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3. A newborn with which of the following clinical manifestations should receive nasal CPAP? a. Substernal retractions, PaCO2 = 65 mm Hg, PaO2 = 48 mm Hg, FIO2 = 0.4. b. Tachypnea, nasal flaring, PaCO2 = 50 mm Hg, PaO2 = 50 mm Hg, FIO2 = 0.6. c. Grunting, substernal retractions, pH = 7.20, PaCO2 = 70 mm Hg, PaO2 = 40 mm Hg, FIO2 = 0.7. d. Tachypnea, pale skin, pH = 7.32, PaCO2 = 45 mm Hg, PaO2 = 75 mm Hg, FIO2 = 0.21. ANS: B
