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C-NPT practice questions

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Question 1Patient Assessment and Stabilization for Transport

Which three components make up the Pediatric Assessment Triangle?

  1. Heart rate, blood pressure, and respiratory rate
  2. Temperature, blood glucose, and oxygen saturation
  3. Pupillary response, motor tone, and reflex activity
  4. Appearance, work of breathing, and circulation to skin Correct answer.

Explanation

The Pediatric Assessment Triangle is a rapid, from-the-doorway visual and auditory assessment built on appearance, work of breathing, and circulation to skin. It is completed before any equipment is applied or vital signs are measured.

Question 2Patient Assessment and Stabilization for Transport

Which set of findings is scored on the Apgar score?

  1. Heart rate, respiratory effort, muscle tone, reflex irritability, and color Correct answer.
  2. Muscle tone, blood glucose, heart rate, reflex, and saturation
  3. Heart rate, blood pressure, respiratory rate, temperature, and color
  4. Color, capillary refill, tone, heart rate, and blood pressure

Explanation

The Apgar score assigns 0 to 2 points in each of five categories: heart rate, respiratory effort, muscle tone, reflex irritability, and color. The score is reported at 1 and 5 minutes and reflects response to resuscitation rather than a diagnosis of asphyxia.

Question 3Patient Assessment and Stabilization for Transport

Using the standard formula, which uncuffed endotracheal tube internal diameter is appropriate for a 4-year-old child?

  1. 4.0 mm
  2. 5.0 mm Correct answer.
  3. 5.5 mm
  4. 6.0 mm

Explanation

The formula for uncuffed tubes is internal diameter (mm) = (age in years / 4) + 4, which gives 5.0 mm for a 4-year-old. Tube size should always be confirmed by an audible leak and clinical assessment.

Question 4Patient Assessment and Stabilization for Transport

Which items correctly expand the SBAR handoff format?

  1. Situation, Baseline, Action, Response
  2. Situation, Breathing, Assessment, Referral
  3. Situation, Background, Assessment, Recommendation Correct answer.
  4. Status, Background, Airway, Recommendation

Explanation

SBAR stands for Situation, Background, Assessment, and Recommendation. It gives the receiving team a concise, structured report during transfer of care at the referring facility, en route, and at the accepting facility.

Question 5Patient Assessment and Stabilization for Transport

A term newborn at 2 hours of life is jittery with a point-of-care glucose of 32 mg/dL. Which action is most appropriate?

  1. Give 2 mL/kg of 10% dextrose IV, then start an infusion Correct answer.
  2. Feed 20 mL of formula and recheck in 2 hours
  3. No treatment; recheck glucose in 4 hours
  4. Give 2 mL/kg of 25% dextrose IV push

Explanation

A symptomatic newborn with glucose below 45 mg/dL needs intravenous dextrose, typically 2 mL/kg of D10 followed by a continuous infusion with repeat monitoring. Concentrated dextrose such as D25 is hyperosmolar and can injure peripheral veins and tissues.

Question 6Patient Assessment and Stabilization for Transport

In neonatal resuscitation with effective positive-pressure ventilation, chest compressions should begin when the heart rate remains below which value?

  1. 60 beats/min Correct answer.
  2. 40 beats/min
  3. 100 beats/min
  4. 80 beats/min

Explanation

Compressions are started when the heart rate stays below 60 beats/min despite at least 30 seconds of effective ventilation with 100% oxygen. A rate below 100 beats/min is the trigger to begin or correct positive-pressure ventilation.

Question 7Patient Assessment and Stabilization for Transport

Which measure best prevents heat loss in a 30-week preterm infant during ground transport?

  1. Apply a chemical warming pad directly against the infant's skin
  2. Swaddle the infant in several warm blankets and check axillary temperature hourly
  3. Prewarmed servo-controlled incubator plus hat and plastic wrap Correct answer.
  4. Set the ambulance heater to maximum and keep the infant uncovered

Explanation

A prewarmed, servo-controlled transport incubator combined with a hat and a polyethylene wrap limits evaporative, conductive, and convective losses in very preterm infants. Servo control also prevents overheating during a long transport.

Question 8Patient Assessment and Stabilization for Transport

Which heart rate range is expected for a healthy, awake 2-year-old?

  1. 90 to 150 beats/min Correct answer.
  2. 120 to 200 beats/min
  3. 160 to 220 beats/min
  4. 50 to 80 beats/min

Explanation

An awake toddler typically has a heart rate of roughly 90 to 150 beats/min. Rates outside this range warrant evaluation for fever, pain, hypovolemia, hypoxia, or arrhythmia.

Question 9Patient Assessment and Stabilization for Transport

A 3-year-old with gastroenteritis has a heart rate of 160 beats/min, capillary refill of 4 seconds, cool mottled extremities, and a blood pressure of 95/70 mm Hg. Which finding best indicates the shock has progressed from compensated to decompensated?

  1. Capillary refill of 4 seconds
  2. Hypotension for age Correct answer.
  3. Cool, mottled extremities
  4. Heart rate of 160 beats/min

Explanation

Compensated shock maintains blood pressure through tachycardia and vasoconstriction, so hypotension is a late and ominous sign in children. Tachycardia, delayed capillary refill, and mottling reflect compensatory mechanisms rather than decompensation.

Question 10Patient Assessment and Stabilization for Transport

A 4-year-old has been seizing continuously for 8 minutes and has no intravenous access. Which medication is the first-line treatment?

  1. Phenytoin 20 mg/kg IV
  2. Phenobarbital 20 mg/kg IV
  3. Midazolam 0.2 mg/kg intranasal or IM Correct answer.
  4. Levetiracetam 60 mg/kg IV

Explanation

A benzodiazepine is first-line for convulsive status epilepticus, and midazolam can be given intranasally or intramuscularly when no IV is available. Phenytoin, levetiracetam, and phenobarbital are second-line agents used after benzodiazepines fail.

Question 11Patient Assessment and Stabilization for Transport

A 10-year-old with new-onset diabetes has a glucose of 620 mg/dL, a pH of 7.12, and deep respirations. Which is the most appropriate initial fluid order?

  1. 5% dextrose in 0.45% sodium chloride at maintenance rate only
  2. Sodium bicarbonate 1 mEq/kg IV to correct the acidosis
  3. Regular insulin 0.1 units/kg IV bolus followed by an infusion
  4. 0.9% sodium chloride 10 to 20 mL/kg over 1 hour, then reassess Correct answer.

Explanation

Initial management of pediatric diabetic ketoacidosis is an isotonic saline bolus of 10 to 20 mL/kg with reassessment, followed by an insulin infusion started after fluid resuscitation. Insulin boluses and routine bicarbonate are avoided because of the risk of cerebral injury and hypokalemia.

Question 12Patient Assessment and Stabilization for Transport

Intraosseous access is indicated in a child when which condition is present?

  1. A central venous line has been placed but its tip position has not yet been confirmed by radiograph
  2. One peripheral IV attempt has failed and the child is hemodynamically stable with no urgent medication need
  3. Urgent access is needed and IV cannulation has failed after two attempts or 90 seconds Correct answer.
  4. The child is younger than 5 years and requires any medication regardless of IV status

Explanation

Intraosseous access is a rescue route used when urgent vascular access is needed and peripheral IV cannulation cannot be achieved quickly, generally after about two attempts or 90 seconds. It is not limited by patient age and can be used for fluids, blood, and most resuscitation medications.

Question 13Patient Assessment and Stabilization for Transport

An umbilical venous catheter is placed emergently in a 1-hour-old hypotensive newborn to administer fluids. Until tip position is confirmed radiographically, the catheter should be inserted no deeper than which distance?

  1. 8 to 10 cm
  2. 1 to 2 cm
  3. 6 to 8 cm
  4. 2 to 4 cm Correct answer.

Explanation

For emergency use, a low umbilical venous catheter is inserted only 2 to 4 cm so it remains in the umbilical vein rather than entering the hepatic sinusoids. Deeper insertion without radiographic confirmation risks hepatic injury and extravasation.

Question 14Patient Assessment and Stabilization for Transport

A 28-week infant at 30 minutes of life has grunting, retractions, and an SpO2 of 86% in room air. Which is the best next step?

  1. Start CPAP at 5 to 6 cmH2O and titrate FiO2 to an SpO2 of 90% to 95% Correct answer.
  2. Give racemic epinephrine by nebulizer and recheck in 1 hour
  3. Intubate immediately and administer surfactant before any other respiratory support is provided
  4. Give 100% oxygen by face mask and reassess in 30 minutes

Explanation

Early nasal CPAP is standard support for a preterm infant with respiratory distress syndrome, with oxygen titrated to a target saturation of 90% to 95%. Intubation and surfactant are reserved for infants who fail CPAP or require significant oxygen.

Question 15Patient Assessment and Stabilization for Transport

A 6-year-old develops hives, wheezing, and hypotension minutes after receiving a cephalosporin. Which is the first-line medication?

  1. Methylprednisolone 2 mg/kg IV
  2. Albuterol 2.5 mg by nebulizer
  3. Diphenhydramine 1 mg/kg IV
  4. Epinephrine 0.01 mg/kg IM (1:1000) in the thigh Correct answer.

Explanation

Intramuscular epinephrine into the lateral thigh is the first-line treatment for anaphylaxis because it reverses bronchospasm and vasodilation rapidly. Antihistamines, steroids, and bronchodilators are adjuncts and do not treat the shock.

Question 16Patient Assessment and Stabilization for Transport

Immediately after intubation, a colorimetric carbon dioxide detector shows no color change. What is the most appropriate next step?

  1. Secure the tube and obtain a chest radiograph
  2. Advance the tube 1 cm and reassess the detector
  3. Increase the oxygen flow and continue ventilating
  4. Remove the tube, ventilate by bag-mask, and reintubate Correct answer.

Explanation

Absence of a color change after intubation indicates the tube is not in the trachea, most often esophageal placement. The tube must be removed promptly, the child ventilated by bag-mask, and intubation reattempted. Persistent carbon dioxide detection is used to confirm tracheal placement.

Question 17Patient Assessment and Stabilization for Transport

A 7-year-old is brought in after a high-speed motor vehicle collision. Which action should be performed first during the primary survey?

  1. Obtain IV access and draw blood samples
  2. Insert a urinary catheter to monitor output
  3. Obtain a full set of limb radiographs
  4. Immobilize the cervical spine while securing the airway Correct answer.

Explanation

The primary survey follows an ABCDE sequence, beginning with airway and cervical spine protection in a trauma patient. Procedures, laboratory studies, and imaging follow once airway, breathing, and circulation have been addressed.

Question 18Patient Assessment and Stabilization for Transport

A 3-month-old has a heart rate of 260 beats/min with a narrow QRS complex and is alert and feeding. Vagal maneuvers have failed. Which is the next treatment?

  1. Synchronized cardioversion at 0.5 J/kg immediately
  2. Amiodarone 5 mg/kg IV over 20 minutes
  3. Adenosine 0.1 mg/kg rapid IV push with a saline flush Correct answer.
  4. Digoxin 20 mcg/kg IV push

Explanation

For a stable infant with supraventricular tachycardia who fails vagal maneuvers, adenosine is the first-line drug given as a rapid IV push with an immediate flush. Synchronized cardioversion is reserved for infants who are unstable or unresponsive to medication.

Question 19Patient Assessment and Stabilization for Transport

A newborn with an antenatal diagnosis of left congenital diaphragmatic hernia is in respiratory distress. Which set of initial actions is most appropriate?

  1. Intubate early, decompress the stomach with a nasogastric tube, and ventilate gently Correct answer.
  2. Place the infant in Trendelenburg position and give 100% oxygen by hood
  3. Delay intubation until an arterial blood gas confirms hypercapnia
  4. Bag-mask ventilate with high peak pressures and then obtain a chest radiograph to confirm the diagnosis

Explanation

Infants with congenital diaphragmatic hernia should be intubated early, have the stomach decompressed, and be ventilated with low pressures to limit barotrauma to the hypoplastic lung. Bag-mask ventilation should be avoided because it distends intrathoracic bowel and worsens respiratory compromise.

Question 20Patient Assessment and Stabilization for Transport

Which consideration is most important when transporting a hypoxic infant by fixed-wing aircraft at cruising altitude?

  1. Lower cabin humidity improves clearance of airway secretions
  2. Vibration has no effect on intravenous lines or monitors
  3. Cabin noise reduces the need for continuous monitoring
  4. Cabin altitude lowers inspired oxygen pressure, so oxygen needs may rise Correct answer.

Explanation

A pressurized cabin at cruising altitude is equivalent to an altitude of roughly 1500 to 2400 meters, which lowers the partial pressure of inspired oxygen and can worsen hypoxemia. Oxygen delivery often must be increased and oxygenation monitored continuously.

Question 21Patient Assessment and Stabilization for Transport

A 3-day-old has central cyanosis with an SpO2 of 72% despite 100% oxygen and a normal chest radiograph. Which intervention is most likely to improve oxygenation?

  1. Start a prostaglandin E1 infusion Correct answer.
  2. Give 20 mL/kg of 0.9% saline as a bolus
  3. Give albuterol by nebulizer
  4. Start inhaled nitric oxide

Explanation

Cyanosis unresponsive to supplemental oxygen with a normal chest radiograph suggests a ductal-dependent cyanotic congenital heart lesion. Prostaglandin E1 maintains ductal patency and improves pulmonary blood flow or mixing until definitive management.

Question 22Patient Assessment and Stabilization for Transport

A ventilated 5-year-old suddenly develops absent breath sounds on one side, tracheal deviation, and hypotension. Which is the immediate intervention?

  1. Start a dopamine infusion
  2. Perform needle decompression of the affected side Correct answer.
  3. Obtain a chest radiograph before any procedure
  4. Perform endotracheal suctioning and increase PEEP

Explanation

Tension pneumothorax is a clinical diagnosis, and immediate needle decompression precedes any imaging. Tube thoracostomy follows once the immediate threat is relieved.

Question 23Patient Assessment and Stabilization for Transport

A 2-year-old in septic shock with a systolic blood pressure of 55 mm Hg requires intubation. Which induction agent is preferred?

  1. Ketamine 1 to 2 mg/kg IV Correct answer.
  2. Morphine 0.1 mg/kg IV
  3. Sodium thiopental 4 mg/kg IV
  4. Propofol 2 mg/kg IV

Explanation

Ketamine preserves sympathetic tone and typically maintains blood pressure, making it the preferred induction agent in a hypotensive child. Propofol and thiopental cause vasodilation and myocardial depression and can precipitate cardiovascular collapse.

Question 24Patient Assessment and Stabilization for Transport

A 6-year-old opens the eyes only to painful stimulation, makes incomprehensible sounds, and withdraws the limb from pain. What is the Glasgow Coma Scale score?

  1. 7
  2. 8 Correct answer.
  3. 5
  4. 6

Explanation

Eye opening to pain scores 2, incomprehensible sounds score 2, and withdrawal from pain scores 4, for a total of 8. The score should be reported with its components because the total can mask a severe deficit in one domain.

Question 25Patient Assessment and Stabilization for Transport

Using the PALS definition, hypotension in a 5-year-old is defined as a systolic blood pressure below which value?

  1. 90 mm Hg
  2. 80 mm Hg Correct answer.
  3. 100 mm Hg
  4. 70 mm Hg

Explanation

The PALS threshold for hypotension in children aged 1 to 10 years is a systolic pressure below 70 + (2 × age) mm Hg, which equals 80 mm Hg at age 5. Pressures below this threshold indicate decompensated shock and should prompt immediate intervention.

Question 26Patient Assessment and Stabilization for Transport

During the rapid visual assessment performed before touching a child who is about to be transported, which three elements make up the pediatric assessment triangle?

  1. Glasgow Coma Scale score, pupil size, and blood glucose
  2. Airway, breathing, and circulation
  3. Heart rate, blood pressure, and respiratory rate
  4. Appearance, breathing effort, and perfusion Correct answer.

Explanation

The pediatric assessment triangle is a hands-off, seconds-long impression built from appearance, work of breathing, and circulation to the skin. It is used first because it immediately signals how sick the child is and how urgently stabilization must occur before and during transport. The structured ABCDE survey and measured vital signs come afterward.

Question 27Patient Assessment and Stabilization for Transport

A 3-year-old is unresponsive after a witnessed collapse, and no weight is available from the family or records. Which method is most appropriate for rapidly estimating weight to guide medication dosing and equipment sizing during stabilization for transport?

  1. Divide the child's age in months by 10 to estimate kilograms
  2. Ask the parent to estimate the weight in pounds and convert it
  3. Assume a weight of 10 kg for any child younger than 5 years
  4. Use a length-based (Broselow-type) resuscitation tape Correct answer.

Explanation

A length-based tape converts measured length into a weight range and links that range to precalculated drug doses and correctly sized equipment. It is fast, reproducible, and more accurate than guessing when the actual weight is unknown. Parental estimates and age-based formulas are useful only as rough cross-checks.

Question 28Patient Assessment and Stabilization for Transport

A 2-year-old has just been intubated for respiratory failure and is being prepared for transport. The abdomen is becoming distended and the peak inspiratory pressures are rising. Which action is most appropriate?

  1. Delay gastric tube placement until arrival at the receiving facility
  2. Accept lower tidal volumes and continue the transport
  3. Decompress the stomach with a nasogastric or orogastric tube Correct answer.
  4. Increase delivered tidal volume to compensate for the distention

Explanation

Positive-pressure ventilation forces gas into the stomach, and gastric distention elevates the diaphragm, reduces thoracic compliance, and raises peak pressures while impairing effective ventilation. Gastric decompression restores compliance and also lowers the risk of vomiting and aspiration during movement. It should be done before or early in transport rather than deferred.

Question 29Patient Assessment and Stabilization for Transport

A 4-year-old is supine on a rigid backboard after a motor vehicle collision with suspected cervical spine injury. Because of a prominent occiput, the neck is pushed into hyperextension and the ear-to-shoulder alignment is lost. Which action best corrects this?

  1. Pad under the torso and shoulders to lift them Correct answer.
  2. Place a folded towel under the head to raise the occiput further
  3. Tilt the backboard head-down by 15 degrees
  4. Remove the cervical collar to relieve pressure on the neck

Explanation

Young children have a proportionally large occiput, so lying flat on a rigid surface pushes the head forward and extends the neck. Raising the torso and shoulders with padding restores neutral alignment of the ear over the shoulder while the head is held manually. Neutral alignment, not traction or collar removal, is the goal during movement and transport.

Question 30Patient Assessment and Stabilization for Transport

A 5-year-old with a ventriculoperitoneal shunt has vomited and been lethargic for two days. He is now drowsy with a heart rate of 58 beats/min and irregular respirations, but his airway is patent and bag-mask ventilation is effective. A community hospital is 10 minutes away and a pediatric center with neurosurgical capability is 45 minutes away. Which transport decision is most appropriate?

  1. Transport directly to the pediatric neurosurgical center Correct answer.
  2. Transport to the community hospital to stabilize before any further movement
  3. Transport to the community hospital because the child is too unstable for a longer trip
  4. Remain at the scene until a second advanced life support unit arrives

Explanation

Bradycardia with irregular respirations and a declining level of consciousness in a child with a shunt suggests raised intracranial pressure from shunt malfunction, a time-critical neurosurgical emergency. When airway and breathing can be supported en route, going directly to a facility able to provide definitive neurosurgical care avoids a harmful second delay. Severity of illness alone does not justify a destination that cannot deliver the needed intervention.

Question 31Respiratory Care and Mechanical Ventilation

A preterm newborn receiving supplemental oxygen has a reliable preductal pulse oximeter reading. Which SpO2 range should the team target?

  1. 96% to 100%
  2. 90% to 95% Correct answer.
  3. 80% to 85%
  4. 85% to 89%

Explanation

Neonatal resuscitation guidance targets a preductal SpO2 of 90% to 95% once oximetry is dependable, with the FiO2 adjusted to stay within that band. The range balances adequate oxygen delivery against the hazards of hyperoxia in immature tissues.

Question 32Respiratory Care and Mechanical Ventilation

Using the standard uncuffed endotracheal tube formula, which internal diameter is appropriate for a 4-year-old child?

  1. 5.0 mm Correct answer.
  2. 4.5 mm
  3. 5.5 mm
  4. 4.0 mm

Explanation

For uncuffed tubes the formula is (age in years ÷ 4) + 4, which gives 5.0 mm for a 4-year-old. A cuffed tube is usually selected half a size smaller.

Question 33Respiratory Care and Mechanical Ventilation

By which route is exogenous surfactant given to a newborn with respiratory distress syndrome?

  1. Given by intramuscular injection
  2. Instilled into the trachea Correct answer.
  3. Given by intravenous infusion
  4. Nebulized through a face mask

Explanation

Surfactant is instilled directly into the trachea, usually through the endotracheal tube or a thin catheter, and is then distributed by subsequent ventilation. Systemic routes do not deliver drug to the alveolar surface.

Question 34Respiratory Care and Mechanical Ventilation

What is the primary physiologic goal of nasal CPAP in a preterm infant with respiratory distress syndrome?

  1. Maintain functional residual capacity Correct answer.
  2. Increase the respiratory rate
  3. Reduce oxygen consumption
  4. Stimulate surfactant production

Explanation

CPAP splints the compliant airways and opposes end-expiratory alveolar collapse, which preserves functional residual capacity and improves oxygenation. Surfactant production is not stimulated by distending pressure.

Question 35Respiratory Care and Mechanical Ventilation

Which condition is most strongly associated with unrestricted oxygen administration to a very preterm infant?

  1. Retinopathy of prematurity Correct answer.
  2. Intraventricular hemorrhage
  3. Necrotizing enterocolitis
  4. Meconium aspiration syndrome

Explanation

Hyperoxia causes vasoconstriction followed by abnormal neovascularization in the immature retina, producing retinopathy of prematurity. This is why oxygen is titrated to a defined saturation target in preterm infants.

Question 36Respiratory Care and Mechanical Ventilation

What initial FiO2 should be used when positive pressure ventilation is started in a term newborn?

  1. 40%
  2. 100%
  3. 21% Correct answer.
  4. 30%

Explanation

Term newborns are started at 21% oxygen with the FiO2 titrated upward to reach the target SpO2. Preterm infants under about 35 weeks begin at 21% to 30%.

Question 37Respiratory Care and Mechanical Ventilation

What ventilation rate is recommended during positive pressure ventilation of a newborn in the delivery room?

  1. 10 to 20 breaths/min
  2. 20 to 30 breaths/min
  3. 70 to 90 breaths/min
  4. 40 to 60 breaths/min Correct answer.

Explanation

Delivery room positive pressure ventilation is delivered at 40 to 60 breaths/min, roughly once per second. Rates outside this range impair CO2 removal or shorten expiratory time excessively.

Question 38Respiratory Care and Mechanical Ventilation

Why is heated humidification used in a mechanically ventilated infant?

  1. To lower the inspired oxygen concentration
  2. To prevent gastric distension
  3. To reduce the work of breathing
  4. To condition inspired gas and protect the airway Correct answer.

Explanation

Heated humidification replaces the heat and moisture the upper airway normally provides, keeping secretions thin and preserving mucociliary clearance. Without it, dried secretions cause tube obstruction and heat loss.

Question 39Respiratory Care and Mechanical Ventilation

Which ventilator mode delivers a set number of mandatory breaths while allowing unsupported spontaneous breaths between them?

  1. SIMV Correct answer.
  2. CPAP
  3. Assist-control
  4. HFOV

Explanation

SIMV delivers a fixed number of mandatory breaths and permits spontaneous breathing between them; those spontaneous breaths are unsupported unless pressure support is added. Assist-control instead supports every breath the patient initiates.

Question 40Respiratory Care and Mechanical Ventilation

On a pressure-limited, time-cycled neonatal ventilator, which setting most directly determines the tidal volume delivered?

  1. Fraction of inspired oxygen
  2. Inspiratory time
  3. Peak inspiratory pressure Correct answer.
  4. Positive end-expiratory pressure

Explanation

In pressure-limited ventilation the tidal volume is set by the driving pressure (PIP minus PEEP) acting on lung compliance. Raising PIP increases tidal volume until overdistension limits further gain.

Question 41Respiratory Care and Mechanical Ventilation

A neonate with respiratory distress syndrome on lung-protective ventilation has pH 7.28, PaCO2 58 mmHg, and PaO2 65 mmHg. What is the most appropriate action?

  1. Increase PIP to normalize the PaCO2
  2. Increase the set rate substantially
  3. Give intravenous sodium bicarbonate
  4. Continue the current settings Correct answer.

Explanation

This gas reflects tolerated permissive hypercapnia: a PaCO2 in the high 50s is acceptable when pH remains at or above roughly 7.25 and oxygenation is adequate. Escalating ventilator support to normalize CO2 would increase the risk of lung injury.

Question 42Respiratory Care and Mechanical Ventilation

Using the 7-8-9 rule, at what depth should an oral endotracheal tube be secured in a 2 kg newborn?

  1. 6 cm
  2. 7 cm
  3. 9 cm
  4. 8 cm Correct answer.

Explanation

The 7-8-9 rule assigns oral insertion depth of 7 cm for 1 kg, 8 cm for 2 kg, and 9 cm for 3 kg. Depth is confirmed with auscultation and a chest radiograph.

Question 43Respiratory Care and Mechanical Ventilation

In a neonate on conventional mechanical ventilation, which parameter is most closely linked to oxygenation?

  1. Mean airway pressure Correct answer.
  2. Ventilator rate
  3. Inspiratory flow rate
  4. Tidal volume

Explanation

Oxygenation depends mainly on alveolar recruitment, which is reflected by mean airway pressure; raising MAP improves recruitment up to the point of overdistension. Carbon dioxide removal is more closely tied to rate and tidal volume.

Question 44Respiratory Care and Mechanical Ventilation

During transport, a ventilated child's capnography waveform abruptly disappears and breath sounds are absent bilaterally. What is the most likely cause?

  1. Patient hyperventilation
  2. Mucus plugging of the airway
  3. A small pneumothorax
  4. Endotracheal tube displacement Correct answer.

Explanation

An abrupt loss of the capnography waveform together with absent bilateral breath sounds indicates that the tube is no longer in the trachea. Immediate laryngoscopy and reintubation are required.

Question 45Respiratory Care and Mechanical Ventilation

Which action is most appropriate during endotracheal suctioning of a 1.5 kg infant?

  1. Instill saline before every pass
  2. Suction continuously for 30 seconds
  3. Limit each pass to 10 seconds or less Correct answer.
  4. Suction routinely every 30 minutes

Explanation

Brief passes with preoxygenation limit hypoxemia and vagally mediated bradycardia in small infants. Suctioning should be performed only when secretions are present, not on a fixed schedule.

Question 46Respiratory Care and Mechanical Ventilation

A term infant with meconium aspiration syndrome is hyperinflated on the chest radiograph. Which ventilator strategy is most appropriate?

  1. Apply PEEP of 10 cmH2O
  2. Lengthen expiratory time and limit PIP Correct answer.
  3. Shorten the expiratory time
  4. Raise the set rate to 60 breaths/min

Explanation

Partial airway obstruction in meconium aspiration causes air trapping, so expiratory time must be long enough for complete exhalation and PIP should be limited to reduce air leak. Sedation and high-frequency ventilation may be added if gas exchange remains poor.

Question 47Respiratory Care and Mechanical Ventilation

A 20 kg child with acute respiratory distress syndrome is started on lung-protective ventilation. What tidal volume should be targeted?

  1. 120 mL Correct answer.
  2. 60 mL
  3. 160 mL
  4. 200 mL

Explanation

Lung-protective ventilation targets about 6 mL/kg of predicted body weight, so 6 × 20 kg gives 120 mL. This limit reduces volutrauma while accepting higher CO2 levels.

Question 48Respiratory Care and Mechanical Ventilation

Which set of findings best indicates readiness for extubation in a ventilated infant?

  1. FiO2 0.30 with spontaneous effort and adequate gas exchange Correct answer.
  2. Ventilator rate of 40 with no spontaneous effort
  3. Copious secretions requiring frequent suctioning
  4. FiO2 0.60 with a PaCO2 of 65 mmHg and no spontaneous effort

Explanation

Extubation readiness requires a low oxygen requirement, adequate spontaneous respiratory effort, acceptable blood gases, and manageable secretions. A high FiO2, absent drive, or heavy secretion burden predicts failure.

Question 49Respiratory Care and Mechanical Ventilation

A ventilated child has pH 7.20, PaCO2 68 mmHg, and bicarbonate 26 mEq/L. Which change addresses the primary abnormality?

  1. Increase the ventilator rate Correct answer.
  2. Give a fluid bolus
  3. Increase the PEEP
  4. Decrease the FiO2

Explanation

A low pH with an elevated PaCO2 and a normal bicarbonate indicates acute respiratory acidosis, so minute ventilation must be increased. Raising the rate lowers PaCO2, provided expiratory time remains adequate.

Question 50Respiratory Care and Mechanical Ventilation

A 10 kg child is started on high-flow nasal cannula at 2 L/kg/min. What flow rate should be set?

  1. 5 L/min
  2. 20 L/min Correct answer.
  3. 40 L/min
  4. 10 L/min

Explanation

The prescribed dose is 2 L/kg/min, so 2 × 10 kg equals 20 L/min. Flow is titrated to work of breathing and oxygenation within the device's limits.