NPS NPS Respiratory Management 2 — Questions and Answers
Question 1: What is the primary advantage of nasal CPAP (nCPAP) over mechanical ventilation for preterm neonates with mild-moderate RDS?
- Higher oxygen delivery
- Avoidance of intubation and reduced BPD risk (Correct answer)
- More precise tidal volume control
- Easier nursing care
Correct answer: Avoidance of intubation and reduced BPD risk
nCPAP avoids the trauma of intubation and reduces the incidence of bronchopulmonary dysplasia by recruiting alveoli non-invasively.
Question 2: During neonatal resuscitation, the initial FiO2 for a term newborn should be:
- 21% (room air) (Correct answer)
- 40%
- 60%
- 100%
Correct answer: 21% (room air)
Current NRP guidelines recommend starting resuscitation of term newborns with room air (21% O2), titrating upward based on pulse oximetry.
Question 3: A neonate develops a sudden deterioration on mechanical ventilation. The NPS performs a DOPE assessment. What does 'D' stand for?
- Decreased breath sounds
- Displacement of the ETT (Correct answer)
- Drug effect
- Diaphragm weakness
Correct answer: Displacement of the ETT
The DOPE mnemonic for sudden deterioration on a ventilator stands for Displacement, Obstruction, Pneumothorax, and Equipment failure.
Question 4: What is the minimum recommended positive end-expiratory pressure (PEEP) for mechanically ventilated neonates with RDS?
- 1–2 cmH2O
- 3–4 cmH2O
- 4–6 cmH2O (Correct answer)
- 8–10 cmH2O
Correct answer: 4–6 cmH2O
A PEEP of 4–6 cmH2O is recommended for neonates with RDS to maintain functional residual capacity and prevent alveolar collapse between breaths.
Question 5: Meconium aspiration syndrome (MAS) is characterized by which pathophysiological mechanism?
- Surfactant excess with alveolar overdistension
- Airway obstruction, surfactant inactivation, and chemical pneumonitis (Correct answer)
- Pulmonary hypoplasia from oligohydramnios
- Bacterial pneumonia from GBS
Correct answer: Airway obstruction, surfactant inactivation, and chemical pneumonitis
MAS causes a ball-valve airway obstruction, inactivates surfactant, triggers chemical pneumonitis, and often leads to pulmonary hypertension.
Question 6: A 32-week neonate is being weaned from mechanical ventilation. Which post-extubation support is most likely to prevent re-intubation?
- Low-flow nasal cannula at 0.5 LPM
- Heated humidified high-flow nasal cannula (HHHFNC)
- Nasal CPAP at 5–7 cmH2O (Correct answer)
- Supplemental O2 via hood
Correct answer: Nasal CPAP at 5–7 cmH2O
Post-extubation nasal CPAP at 5–7 cmH2O is the most effective respiratory support for preterm neonates to maintain lung recruitment and prevent apnea.
NPS NPS Respiratory Management 2
What is the primary advantage of nasal CPAP (nCPAP) over mechanical ventilation for preterm neonates with mild-moderate RDS?