RNC-NIC Respiratory Care 4 — Questions and Answers
Question 1: A neonate with persistent pulmonary hypertension (PPHN) is not responding adequately to conventional therapy. Which inhaled medication is commonly used to reduce pulmonary vascular resistance?
- Inhaled epinephrine
- Inhaled nitric oxide (iNO) (Correct answer)
- Inhaled albuterol
- Inhaled budesonide
Correct answer: Inhaled nitric oxide (iNO)
Inhaled nitric oxide selectively dilates pulmonary vasculature, reducing pulmonary vascular resistance in PPHN without causing systemic hypotension.
Question 2: A neonate with BPD is being treated with diuretics. Which electrolyte imbalance is most commonly associated with chronic furosemide use in neonates?
- Hypernatremia and hyperkalemia
- Hyponatremia and hypokalemia (Correct answer)
- Hyperkalemia and metabolic acidosis
- Hyperchloremia and hypernatremia
Correct answer: Hyponatremia and hypokalemia
Furosemide causes urinary losses of sodium, potassium, and chloride, leading to hyponatremia, hypokalemia, and hypochloremic metabolic alkalosis.
Question 3: What is the primary physiologic purpose of PEEP in neonatal mechanical ventilation?
- To increase tidal volume delivery
- To prevent alveolar collapse at end-expiration (Correct answer)
- To improve CO2 elimination
- To reduce airway resistance
Correct answer: To prevent alveolar collapse at end-expiration
PEEP maintains functional residual capacity by preventing alveolar collapse between breaths, improving oxygenation and reducing atelectasis.
Question 4: A nurse is caring for a neonate with pulmonary interstitial emphysema (PIE) on the right side. Which positioning intervention may help?
- Supine with head elevated
- Right lateral decubitus positioning (Correct answer)
- Left lateral decubitus positioning
- Prone positioning
Correct answer: Right lateral decubitus positioning
Right lateral decubitus positioning compresses the affected lung, reducing air entry and promoting resolution of PIE on the right side.
Question 5: Which of the following correctly describes the difference between High-Frequency Oscillatory Ventilation (HFOV) and High-Frequency Jet Ventilation (HFJV)?
- HFOV uses active expiration while HFJV relies on passive recoil (Correct answer)
- HFJV uses active expiration while HFOV relies on passive recoil
- Both use the same exhalation mechanism
- HFOV delivers higher tidal volumes than HFJV
Correct answer: HFOV uses active expiration while HFJV relies on passive recoil
HFOV uses active inspiration and expiration via oscillation, while HFJV delivers high-velocity gas pulses with passive exhalation relying on chest recoil.
Question 6: A neonate born at 35 weeks gestation develops tachypnea, grunting, and retractions within 2 hours of birth that resolve by 24-48 hours. What is the most likely diagnosis?
- Respiratory distress syndrome
- Pneumonia
- Transient tachypnea of the newborn (TTN) (Correct answer)
- Meconium aspiration syndrome
Correct answer: Transient tachypnea of the newborn (TTN)
Transient tachypnea of the newborn results from delayed resorption of fetal lung fluid and typically resolves within 24-72 hours in late-preterm or term neonates.
Question 7: During resuscitation of a term newborn who is not breathing, PPV is initiated but chest rise is not seen. What is the FIRST corrective step according to NRP guidelines?
- Increase PIP immediately
- Reposition the airway and ensure a proper mask seal (MR. SOPA) (Correct answer)
- Insert an orogastric tube
- Intubate immediately
Correct answer: Reposition the airway and ensure a proper mask seal (MR. SOPA)
NRP MR. SOPA steps begin with Mask adjustment and Reposition before escalating to Suction, Open mouth, Pressure increase, and Airway (intubation).
RNC-NIC Respiratory Care 4
A neonate with persistent pulmonary hypertension (PPHN) is not responding adequately to conventional therapy.
Which inhaled medication is commonly used to reduce pulmonary vascular resistance?