RNC-NIC Respiratory Care 3 — Questions and Answers
Question 1: A premature neonate develops a sudden deterioration with decreased breath sounds on the right, hypotension, and bradycardia. Transillumination of the chest is positive on the right. What is the immediate intervention?
- Increase ventilator pressures
- Emergency needle decompression at the second intercostal space, midclavicular line (Correct answer)
- Chest X-ray before any intervention
- Increase FiO2 to 100%
Correct answer: Emergency needle decompression at the second intercostal space, midclavicular line
Tension pneumothorax is a life-threatening emergency requiring immediate needle decompression at the 2nd intercostal space, midclavicular line, without waiting for imaging.
Question 2: Which of the following is the correct target SpO2 range for a premature neonate less than 32 weeks gestational age receiving supplemental oxygen?
- 85-89%
- 90-95% (Correct answer)
- 96-99%
- 88-92%
Correct answer: 90-95%
Current evidence supports targeting SpO2 of 90-95% in extremely preterm neonates to balance the risks of retinopathy of prematurity and mortality.
Question 3: A neonate with congenital diaphragmatic hernia (CDH) is intubated at birth. Which ventilation strategy is most appropriate?
- High PIP with high PEEP to fully inflate the lungs
- Gentle ventilation with permissive hypercapnia and low pressures (Correct answer)
- High-frequency jet ventilation immediately
- Aggressive hyperventilation to reduce pulmonary hypertension
Correct answer: Gentle ventilation with permissive hypercapnia and low pressures
Gentle ventilation with permissive hypercapnia avoids barotrauma to the hypoplastic lungs in CDH; aggressive ventilation worsens outcomes.
Question 4: When setting up a neonatal ventilator, which tidal volume range is considered lung-protective for a preterm neonate?
- 2-3 mL/kg
- 4-6 mL/kg (Correct answer)
- 7-9 mL/kg
- 10-12 mL/kg
Correct answer: 4-6 mL/kg
Tidal volumes of 4-6 mL/kg are recommended for lung-protective ventilation in preterm neonates to minimize volutrauma.
Question 5: A 26-week neonate receiving CPAP has FiO2 requirements of 0.45. Which clinical criteria would support transition to mechanical ventilation?
- SpO2 of 92% on FiO2 0.45
- Apnea requiring stimulation twice in one hour
- PaCO2 of 50 mmHg with pH 7.30
- FiO2 greater than 0.40 with increased work of breathing and apnea (Correct answer)
Correct answer: FiO2 greater than 0.40 with increased work of breathing and apnea
Failure criteria for CPAP include increasing FiO2 needs (>0.40-0.50), recurrent apnea, and signs of respiratory failure, indicating need for intubation.
Question 6: A neonate is being weaned from mechanical ventilation. Which parameter is typically weaned last before extubation?
- FiO2
- Peak inspiratory pressure (PIP)
- Positive end-expiratory pressure (PEEP)
- Respiratory rate (Correct answer)
Correct answer: Respiratory rate
Respiratory rate is typically weaned last as it supports the neonate's minute ventilation; once the rate is low enough, extubation is considered.
Question 7: Which lung condition is characterized by air trapping in neonates who develop chronic lung disease often associated with prolonged mechanical ventilation and oxygen exposure?
- Respiratory distress syndrome
- Bronchopulmonary dysplasia (BPD) (Correct answer)
- Pulmonary interstitial emphysema (PIE)
- Pneumonia
Correct answer: Bronchopulmonary dysplasia (BPD)
Bronchopulmonary dysplasia (BPD) is a chronic lung disease resulting from lung injury related to prematurity, oxygen toxicity, and mechanical ventilation.
RNC-NIC Respiratory Care 3
A premature neonate develops a sudden deterioration with decreased breath sounds on the right, hypotension, and bradycardia.
Transillumination of the chest is positive on the right.
What is the immediate intervention?