RNC-NIC Respiratory Care 2 — Questions and Answers
Question 1: A 28-week neonate on CPAP has increasing oxygen requirements and work of breathing. Chest X-ray shows a diffuse 'ground-glass' appearance with air bronchograms. What is the most likely diagnosis?
- Meconium aspiration syndrome
- Respiratory distress syndrome (RDS) (Correct answer)
- Transient tachypnea of the newborn
- Pneumonia
Correct answer: Respiratory distress syndrome (RDS)
Ground-glass opacification with air bronchograms on CXR is the classic radiographic finding of RDS due to surfactant deficiency in premature infants.
Question 2: When administering surfactant therapy via the INSURE technique, what does the acronym stand for?
- Intubate, Suction, Use surfactant, Remove tube and Extubate
- Intubate, Surfactant, Use CPAP, Recover, Extubate
- Intubate, give SURfactant, Extubate (Correct answer)
- Inflate lungs, Suction, Use CPAP, Remove tube, Extubate
Correct answer: Intubate, give SURfactant, Extubate
INSURE stands for INtubate, give SURfactant, and Extubate, minimizing ventilator exposure in preterm infants.
Question 3: A term neonate born through thick meconium-stained fluid is vigorous at birth. What is the current recommended initial management?
- Immediate endotracheal intubation and suctioning
- Routine care without immediate tracheal suctioning (Correct answer)
- Gastric suctioning before initiating respirations
- Laryngoscopy and direct visualization of cords before PPV
Correct answer: Routine care without immediate tracheal suctioning
Current NRP guidelines recommend routine care for vigorous meconium-stained neonates; immediate tracheal suctioning is no longer recommended for vigorous infants.
Question 4: A 32-week neonate receiving conventional mechanical ventilation has a PaCO2 of 28 mmHg on ABG. What ventilator adjustment is most appropriate?
- Increase respiratory rate
- Decrease tidal volume or respiratory rate (Correct answer)
- Increase FiO2
- Increase PEEP
Correct answer: Decrease tidal volume or respiratory rate
Hypocarbia (PaCO2 < 35 mmHg) in neonates risks cerebral vasoconstriction and periventricular leukomalacia; decreasing minute ventilation is indicated.
Question 5: Which finding on a neonatal blood gas indicates a mixed respiratory and metabolic acidosis?
- pH 7.25, PaCO2 55 mmHg, HCO3 24 mEq/L
- pH 7.20, PaCO2 55 mmHg, HCO3 16 mEq/L (Correct answer)
- pH 7.30, PaCO2 35 mmHg, HCO3 18 mEq/L
- pH 7.28, PaCO2 30 mmHg, HCO3 14 mEq/L
Correct answer: pH 7.20, PaCO2 55 mmHg, HCO3 16 mEq/L
A mixed acidosis shows both elevated PaCO2 (respiratory component) and reduced bicarbonate (metabolic component) with a low pH.
Question 6: A neonate on high-frequency oscillatory ventilation (HFOV) has bilateral hyperinflation on CXR. Which parameter should be decreased?
- Frequency (Hz)
- Mean airway pressure (MAP) (Correct answer)
- Amplitude (ΔP)
- FiO2
Correct answer: Mean airway pressure (MAP)
Mean airway pressure controls lung volume and oxygenation in HFOV; hyperinflation indicates MAP is too high and should be reduced.
Question 7: A nurse notices the endotracheal tube markings have shifted and the neonate's breath sounds are absent on the left. What has most likely occurred?
- Left-sided pneumothorax
- Right mainstem bronchus intubation (Correct answer)
- Accidental extubation
- Mucus plug in left bronchus
Correct answer: Right mainstem bronchus intubation
Right mainstem intubation is common in neonates due to the straighter angle of the right bronchus, causing absent breath sounds on the left.
RNC-NIC Respiratory Care 2
A 28-week neonate on CPAP has increasing oxygen requirements and work of breathing.
Chest X-ray shows a diffuse 'ground-glass' appearance with air bronchograms.
What is the most likely diagnosis?