1. Which of the following phases of human lung development occurs from 17 to 26 weeks of gestation, and is characterized by the formation of a capillary network around airway passages?

    D. Canalicular
  2. Regarding postnatal lung growth, by approximately what age do most of the alveoli that will be present in the lungs for life develop?

    C. 1.5 years
  3. Which of the following mechanisms appear to explain why oligohydramnios is associated with lung hypoplasia?
    I. Abnormal carbohydrate metabolism
    II. Mechanical restriction of the chest wall
    III. Interference with fetal breathing
    IV. Failure to produce fetal lung liquid

    B. II, III, and IV only
  4. What is the purpose of the material secreted by the type II pneumocyte?

    D. To reduce surface tension
  5. Which the following vascular networks is the major source of fetal lung liquid?

    C. Pulmonary circulation
  6. What is the function of Wharton’s jelly inside the umbilical cord?

    D. To prevent the vessels inside the cord from kinking
  7. During the third gestational week, which of the following organs is the first to form?

    C. Heart
  8. What is the approximate fetal heart rate by the sixth week of gestation?

    C. 95 beats/minute
  9. Which of the following anatomic structures constitute fetal shunts?
    I. Foramen ovale
    II. Sinus venosus
    III. Ductus venosus
    IV. Ductus arteriosus

    D. III and IV only
  10. Which of the following events causes cessation of right-to-left shunt through the foramen ovale?

    C. Increased systemic vascular resistance
  11. Which of the following events or conditions is the most important risk factor for preterm birth?

    C. Prior preterm delivery
  12. What is generally accepted as a safe limit for alcohol consumption during pregnancy to avoid the development of fetal alcohol syndrome?
    A. One to two 8-ounce drinks per day are considered acceptable.
    B. Four to five 8-ounce drinks per week are considered safe.
    C Three to four 12-ounce drinks per week are considered reasonable.
    D. No safe range of alcohol consumption is deemed safe during pregnancy.
    D. No safe range of alcohol consumption is deemed safe during pregnancy.
  13. What is the average birth weight difference between infants born of mothers who smoke and those of nonsmoking mothers?

    D. Infants born of mothers who smoke tend to be about 200 g lighter than infants born of mothers who do not smoke.
  14. Which of the following conditions are associated with preeclampsia?
    I. Multiparity
    II. Proteinuria
    III. Generalized edema
    IV. Hypertension

    B. II, III, and IV only
  15. Which of the following maternal and/or fetal conditions are associated with pregestational diabetes?
    I. Hydrops fetalis
    II. Ketoacidosis
    III. Preeclampsia
    IV. Fetal death

    D. II, III, and IV only
  16. Which of the following drugs is recommended to treat a group B Streptococcus infection for a patient who is allergic to penicillin?
    A Vancomycin
    B. Clindamycin
    C. Ampicillin
    D. Ketoconazole
    B. Clindamycin
  17. What is the main potential problem associated with the premature rupture of membranes?

    A. Fetal infection
  18. Which of the following maternal or fetal conditions can be determined or assessed via
    I. Maternal Rh isoimmunization
    II. Trisomy 21
    III. Placenta previa
    IV. Placental abruption

    B. I and II only
  19. Which of the following maternal complications are associated with cesarean section?
    I. lntraoperative bladder or bowel injuries
    II. Endomyometritis
    III. Failure to progress in labor
    IV. Placenta previa

    B. I and II only
  20. How should the therapist interpret an amniotic fluid index of 5 cm?

    A. Oligohydramnios
  21. A fetus is undergoing a contraction stress test. Uterine contractions are stimulated by the intravenous infusion of oxytocin into the mother. The fetal P0 drops below 12 mm Hg and causes the fetal heart rate to slow. Which of the following conditions is likely indicated by this occurrence?

    B. Uteroplacental insufficiency
  22. How should the therapist interpret a fetal biophysical profile score of 7?

    B. The fetus appears to be normal.
  23. In lieu of obtaining a scalp blood gas sample, what can the therapist do to conduct intrapartum sessment of the fetus?
    A Fetal scalp stimulation
    B. Umbilical cord blood sampling
    C. Placental blood sampling
    D. Biophysical profile
    A Fetal scalp stimulation
  24. Which of the following medications are used as tocolytics?
    I. Magnesium sulfate
    II. Sodium bicarbonate
    III. Calcium carbonate
    IV. Indomethacin LA.

    B. I and IV only
  25. Which of the following outcomes is associated with intrapartum amnioinfusion of postterm infants demonstrating meconium-stained amniotic fluid?

    C. This procedure reduces the rate of cesarean deliveries.
  26. A team has been summoned to the delivery room to perform neonatal resuscitation. Because no perinatal history is available, which of the following information would be useful for the resuscitation team to know in preparation for this event?
    I. Number of babies expected
    II. Age of the mother
    III Gestational age of the infant
    IV. Presence or absence of meconium
    A. I and IV only
    B. II and III only
    C I, III, and IV only
    D. I, II, III, and IV
    C I, III, and IV only
  27. What measures can the therapist take to prevent heat loss and cold stress before performing resuscitation on a preterm neonate?
    I. Dry the infant’s skin.
    II. Wrap the infant in prewarmed blankets.
    III. Remove wet linens from around the infant.
    IV. Measure the neonate’s body temperature.

    D. I, II, and III only
  28. While stabilizing a preterm neonate before resuscitation, the therapist notices the infant display laryngeal spasm, bradycardia, and a delayed onset of spontaneous breathing. What could have caused these events to occur?

    C. Performing aggressive pharyngeal suctioning
  29. As the head of a neonate contaminated with meconium emerges at birth, the heart rate monitor indicates 120 beats/minute, and the physician notices that the infant has good muscle tone and a strong respiratory effort. What should the physician do at this time to provide airway care?
    A. Intubate the infant immediately.
    B. Perform pharyngeal and tracheal suctioning immediately. C. Perform tracheal suctioning only at this time.
    D. Do not perform tracheal suctioning on this infant at this time.
    D. Do not perform tracheal suctioning on this infant at this time.
  30. A preterm neonate with a heart rate of 55 beats/minute is receiving positive-pressure ventilation immediately after delivery. What should the therapist do at this time?

    B. Apply cardiac compressions and maintain positive-pressure ventilation.
  31. A term infant is born displaying acrocyanosis. What should the therapist do at this time?

    C. Do nothing, as this condition is often transient.
  32. The therapist has completed a 1-minute Apgar score. The following evaluations were obtained: the infant is pale.
    The heart rate is 90 beats/minute.
    The respiratory effort is irregular.
    Some muscle tone is noted.
    No response to nasal suctioning is found.
    On the basis of these findings, what Apgar score should be assigned to this neonate?

    B. 3
  33. The therapist, working with a neonate, observes that the newborn has adequate ventilatory efforts and a heart rate of 120 beats/minute. However, at the same time, the infant demonstrates cyanosis of the lips and mucous membranes. What should the therapist do at this time?

    A. Direct 100% oxygen at a flow of 8 L/minute about one-half inch above the infant’s nose and mouth.
  34. A respiratory therapy supervisor is observing a staff member perform bag—mask ventilation on an infant who is being resuscitated. The supervisor notices that the therapist places his fingers on the anterior margin of the infant’s mandible, and lifts the infant’s face into the mask. What should the supervisor do at this time?

    D. Take no action because the therapist is correctly performing valve—mask ventilation.
  35. While performing positive-pressure mechanical ventilation on a neonate, the therapist notices that the infant’s thorax is not displaying bilateral expansion during each inspiration. Auscultation of the chest reveals diminished bilateral breath sounds. The infant’s heart rate is 85 beats/minute and observation demonstrates central cyanosis. Which of the following events may have caused this clinical situation?
    I. Pneumothorax
    II. Poorly positioned or leaking mask
    III. Inappropriately sized endotracheal tube
    IV. Airway obstruction

    D. I, II and IV only
  36. What appears to be the reason for the infrequent need to administer chest compressions and cardiopulmonary resuscitative drugs to neonates in the delivery rooms?

    B. The delivery of adequate ventilation is the primary factor in effective resuscitation of a neonate.
  37. What ratio of chest compressions and positive-pressure breaths must the therapist administer to a newborn during cardiopulmonary resuscitation?

    A. Three compressions for every one breath
  38. The therapist has been performing cardiopulmonary resuscitation on a neonate for about 90 seconds, applying ventilation with 100% oxygen and chest compressions. The infant has maintained a spontaneous heat rate of 40 beats/minute. What should the therapist recommend at this time?

    D. Administering epinephrine
  39. Which of the following medications is used to reverse respiratory depression induced by opioid overdose?

    A. Naloxone
  40. Which of the following actions constitutes appropriate stimulation of a neonate?
    I. Gently slapping the infant’s buttocks
    II. Gently shaking the infant’s upper torso
    III. Flicking the bottoms of the infant’s feet
    IV. Drying with a towel

    B. III and IV only
  41. Which of the following factors are taken into consideration when assessing the gestational age of a neonate?
    I. Previous maternal pregnancies
    II. Prenatal ultrasound evaluations
    Ill. Postnatal findings based on physical and neurologic examinations
    IV. Gestational duration based on the last menstrual cycle

    A. III, and IV only
  42. The gestational age of a newborn has been evaluated to be 34 weeks. The newborn’s birth weight is greater than the 90th percentile. How should the therapist classify this infant?

    D. Large for gestational age
  43. An infant arrives in the newborn nursery with an axillary body temperature of 95.6° F. Which of the following events may be responsible for this infant’s temperature?

    A. The delivery room temperature was low.
  44. A physical examination is being performed on a newborn, and the therapist notices that the infant’s arms do not move symmetrically. Which of the following situations could account for this problem?

    C. An injury to the infant’s brachial plexus may have occurred during birth.
  45. The therapist notices that an infant presents with irregular areas of dusky skin alternating with areas of pale skin, On the basis of this observation, which of the following conditions should the therapist anticipate this patient having?

    D. Hypotension
  46. Which of the following neonatal skin presentations at birth is associated with a high hematocrit value or polycythemia and neonatal hyperviscosity syndrome?

    A. Reddish blue appearance
  47. Why are chest retractions more prominent among neonates than among older children and adults?

    C. Because newborns have relatively thin and weak musculature, and a less rigid thorax.
  48. Why is it difficult to localize auscultation findings of the thorax of a newborn?

    A. Because the neonate’s chest is small and sounds are difficult to differentiate.
  49. While performing a physical examination on a newborn infant, the therapist notices that the point of maximal cardiac impulse is to the left of the sternal border. Which of the following conditions can cause this situation?

    B. Right-sided pneumothorax
  50. Which of the following statements refers to the diagnostic procedure called transillumination?

    C. Direct a light source toward the ipsilateral surface of the patient’s thorax.
  51. A neonate is found to have a bounding pulse. Which of the following conditions may contribute t this finding?
    I. Patent ductus arteriosus
    II. Hypoplastic left-sided heart syndrome
    Ill. Coarctation of the aorta
    IV. Left-to-right shunt

    B. I and IV only
  52. What condition would be responsible for the therapist observing a pulse oximeter indicating decreased perfusion while central blood pressure remains normal?

    C. Volume depletion with compensatory peripheral vasoconstriction
  53. For the purpose of assessing right-to-left shunting, as in the case of persistent pulmonary hypertension, which of the following sites would render postductal blood?
    I. Right arm
    II. Left arm
    Ill. Right leg
    IV. Left leg

    A. II, III, and IV only
  54. Which of the following conditions can cause abdominal distention?
    I. Enterocolitis
    II. Ascites
    III. Congenital diaphragmatic hernia
    IV. Omphalocele

    D. I and II only
  55. Which of the following conditions are associated with scaphoid abdomen?
    I. Necrotizing enterocolitis
    II. Gastroschisis
    III. Prune-belly syndrome
    IV. Sepsis

    C. II and III only
  56. While performing an examination of the abdomen of a neonate, the therapist is able to palpate the infant’s liver 1 to 2 cm below the right costal margin. Which of the following conditions can account for this development?

    D. Normal liver position
  57. After the umbilical cord has been cut in the delivery room during the delivery of a large for gestational age infant, the therapist notices that the umbilical cord is large and fat. Which of thE following maternal conditions is likely present?

    C. Diabetes mellitus
  58. A newborn who presents as pale, mottled, floppy, with little interest in feeding, and slightly irritabl ost likely has which of the following conditions?
    A Sepsis
    B. Respiratory distress syndrome
    C. Retinopathy of prematurity
    D. Cri du chat
    A Sepsis
  59. The therapist has placed a pulse oximeter probe on a finger of the right hand of a newborn and another pulse oximeter probe on a toe of the infant’s left foot. The pulse oximeter on the right hand reads 80% and the one on the left foot indicates 65%. Which of the following disease conditions does this neonate possibly have?

    D. Persistent pulmonary hypertension of the newborn
  60. Which of the following white blood cell counts constitutes the condition leukopenia?

    D. Less than or equal to 3500/mm
  61. Which of the following information represent components of patient history for a new pediatric patient?
    I. Chief complaint
    II. History of present illness
    III. Past medical history
    IV. Occupational history
    A. I and II only
    B. III and IV only
    C. I, II, and III only
    D. I, II, III, and IV
    C I, II, and III only
  62. The presentation in the emergency department of a 7-year-old child with a productive cough, diaphoresis, and fever while on vacation with her parents represents which of the following chief complaints?
    A. Cystic fibrosis
    B Pneumonia
    C. Asthma exacerbation
    D. Respiratory distress
    D. Respiratory distress
  63. Which of the following components comprise the history of present illness section of a patient’s medical history?
    I. Frequency and duration of symptoms
    II. Symptoms exhibited by parents
    III. Onset of symptoms
    IV. Symptoms resulting in hospitalizations

    A. I and III only
  64. Which of the following components comprise the past medical history section of the patient’s medical history?
    I. Birth weight
    II. Previous mechanical ventilation
    Ill. Recurrence of symptoms based on season
    IV. Emergency department visits

    A. I, II, and IV only
  65. Which of the following components of a patient’s medical history is intended to determine the presence of symptoms not identified in the history of present illness and that may be related or contribute to the child’s underlying condition?

    C. Review of systems
  66. A child who demonstrates head bobbing, nasal flaring, and grunting is exhibiting the signs of

    C. Respiratory distress
  67. Which of the following pulmonary diseases are not chest wall deformities, but are characterized by an increased anteroposterior diameter?
    I. Pectus excavatum
    II. Severe asthma
    III. Pneumonia
    IV. Cystic fibrosis
    A I and III only
    B. II and IV only
    C. II, III, and IV only
    D. I, II, Ill, and IV
    B. II and IV only
  68. During a physical examination of a child’s chest, the therapist perceives increased tactile fremitus over the patient’s right lower lobe. Which of the following conditions may cause this physical

    B. Pulmonary consolidation
  69. While percussing the thorax of a child during a physical examination, the therapist hears a dull percussion note over the child’s right lung. Which of the following conditions may cause this physical finding?
    I. Atelectasis
    II. Pneumothorax
    III. Pleural effusion
    IV. Consolidation

    B. I, II, and IV only
  70. After placing a stethoscope over a small child’s trachea, the therapist hears expiratory stridor. Which of the following conditions is consistent this finding?

    D. Tracheomalacia
  71. While auscultating a young child’s thorax, the therapist hears bilateral fine crackles. Which of the following conditions can produce these adventitious sounds?

    D. Pulmonary edema
  72. Examination of the ears, eyes, nose, and throat may reveal findings associated with which of the following conditions?

    D. Allergies
  73. What is the cause of hepatosplenomegaly associated with advanced cystic fibrosis?

    B. Right ventricular failure
  74. Which of the following terms is used to describe a low-pitched, wet sound similar to snoring, which suggests nasopharyngeal, oropharyngeal, and/or hypopharyngeal airway obstruction?

    C. Stertor
  75. When performing a physical examination of the thorax, in what order should the therapist proceed the assessment?

    D. Inspection, palpation, percussion, and auscultation
  76. Which of the following clinical presentations signify respiratory distress?
    I. Head bobbing
    II. Digital clubbing
    III. Central cyanosis
    IV. Retractions

    C. I, III, and IV only
  77. Which of the following conditions are components of respiratory failure?
    I. Pulmonary hypertension
    II. Impaired oxygenation
    III. Insufficient cardiac output
    IV. Inadequate ventilation

    B. II and IV only
  78. Why do infants and children have higher oxygen demands than adults?

    A. Because they have higher metabolic rates
  79. Within the context of respiratory failure, what is the role of arterial blood gas analysis?

    C. It may be used to confirm the clinical impression.
  80. How should the therapist intervene on noticing the presence of agonal respirations displayed by pediatric patient?

    D. As if the patient had respiratory arrest
  81. How will an infant physiologically attempt to maintain blood pressure?
    I. Increase heart rate
    II. Improve cardiac contractility
    III. Increase peripheral vascular tone
    IV. Decrease pulmonary vascular resistance

    C. I, II, and III only
  82. Someone who loses a significant volume of blood because of hemorrhage is likely to develop

    D. Decompensated shock
  83. What is the next pathophysiologic development that is likely to occur in a patient experiencing respiratory failure and shock?

    A. Cardiac arrest
  84. Which of the following clinical aspects of the patient can the therapist observe from a relatively short distance, for example, on entering the patient’s room?
    I. Adequacy of renal function
    II. Adequacy of oxygenation
    III. Sufficiency of ventilation
    IV. Level of cerebral perfusion

    C. II, III, and IV only
  85. Which of the following conditions produce metabolic acidosis?
    I. Diabetic ketoacidosis
    II. Hypokalemia
    III. Salicylate poisoning
    IV. Chronic renal insufficiency

    C. I, III, and IV only
  86. A therapist walks into the room of a pediatric patient and notices the child sitting upright, and leaning forward by the bedside table; what position has the patient assumed?

    A. The tripod position
  87. The therapist notices that the hands and feet of an infant are cool, pale or dusky. How should this finding be interpreted?

    B. Peripheral perfusion is deteriorating
  88. As the therapist enters a patient’s room, he notices decreased thoracic expansion while a child breathes spontaneously. Which of the following conditions can cause this finding?
    I. Pleural effusion
    II. Decreased cardiac output
    III. Atelectasis
    IV. Foreign body aspiration

    B. I, III, and IV only
  89. A mother states that her 4-month-old son fails to make eye contact with her. Which of the following conditions can cause this problem?

    C. Cerebral hypoperfusion
  90. Which of the following conditions can cause delayed capillary refill in a child?

    A. Decreased cardiac output
  91. Which of the following cardiovascular effects may compensate for decreased systemic blood pressure caused by decreased left ventricular output?

    C. Systemic vasoconstriction
  92. How should the therapist interpret a situation in which a child displays mottling, pallor, and peripheral cyanosis?

    C. Poor peripheral perfusion
  93. Urine output is a good indicator of which of the following functions?

    B. Renal function
  94. What should be the initial step taken by the therapist when confronted with a seriously injured child?

    A. Rapid cardiopulmonary assessment
  95. For the purpose of airway support, how should the therapist position an infant who is in respiratory distress?

    A. With the infant’s head and neck in a neutral position
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