RNC-NIC Respiratory Care 5 — Questions and Answers
Question 1: A neonate on synchronized intermittent mandatory ventilation (SIMV) begins to actively fight the ventilator. Which condition should the nurse first assess for?
- Need for sedation only
- Pneumothorax, tube malposition, obstruction, or other acute deterioration (Correct answer)
- Hunger or need for feeding
- Hyperthermia
Correct answer: Pneumothorax, tube malposition, obstruction, or other acute deterioration
Neonate-ventilator asynchrony and agitation should prompt immediate assessment for acute complications such as pneumothorax, tube displacement, or obstruction before sedation.
Question 2: A blood gas from a ventilated preterm neonate shows pH 7.18, PaCO2 62 mmHg, HCO3 22 mEq/L. How should this be classified?
- Metabolic acidosis
- Respiratory acidosis (Correct answer)
- Mixed acidosis
- Compensated respiratory alkalosis
Correct answer: Respiratory acidosis
The low pH with elevated PaCO2 and normal bicarbonate indicates uncompensated respiratory acidosis, likely due to hypoventilation.
Question 3: Which clinical sign is most indicative of adequate chest rise during bag-mask ventilation in a neonate?
- Audible breath sounds with a stethoscope over the abdomen
- Visible symmetric chest wall movement similar to normal breathing (Correct answer)
- Oxygen saturation rising above 99%
- Gastric distension resolving
Correct answer: Visible symmetric chest wall movement similar to normal breathing
Adequate bag-mask ventilation produces visible, symmetric chest rise that mimics normal tidal breathing, indicating appropriate tidal volume delivery.
Question 4: A nurse notes that a 30-week neonate's endotracheal tube has copious thick secretions. Which suctioning practice is correct for an intubated neonate?
- Suction every hour routinely to maintain airway patency
- Suction only when clinically indicated with catheter no larger than half the ETT internal diameter (Correct answer)
- Instill normal saline before every suction pass to loosen secretions
- Use the largest suction catheter available to ensure complete clearance
Correct answer: Suction only when clinically indicated with catheter no larger than half the ETT internal diameter
ETT suctioning should be performed only when clinically indicated and with a catheter no more than half the ETT internal diameter to avoid airway trauma.
Question 5: Which parameter in HFOV primarily controls CO2 elimination?
- Mean airway pressure (MAP)
- FiO2
- Amplitude (ΔP) (Correct answer)
- Inspiratory time
Correct answer: Amplitude (ΔP)
In HFOV, amplitude (ΔP) determines the oscillatory volume (DCO2) and is the primary control for CO2 elimination.
Question 6: A 27-week neonate has just received intratracheal surfactant. What should the nurse closely monitor for in the first 30 minutes post-administration?
- Hyperglycemia and metabolic alkalosis
- Rapid improvement in oxygenation requiring prompt FiO2 and pressure reduction (Correct answer)
- Hyperthermia and tachycardia
- Metabolic acidosis and hyponatremia
Correct answer: Rapid improvement in oxygenation requiring prompt FiO2 and pressure reduction
Surfactant rapidly improves lung compliance and oxygenation, requiring prompt reduction of FiO2 and ventilator pressures to prevent hyperoxia and barotrauma.
Question 7: A 34-week neonate with respiratory distress has a chest X-ray showing streaky perihilar markings and fluid in the fissures bilaterally. What does this suggest?
- Meconium aspiration syndrome
- Respiratory distress syndrome
- Transient tachypnea of the newborn (TTN) (Correct answer)
- Pulmonary hemorrhage
Correct answer: Transient tachypnea of the newborn (TTN)
Streaky perihilar infiltrates and fluid in the fissures are classic radiographic features of TTN, reflecting retained fetal lung fluid.
RNC-NIC Respiratory Care 5
A neonate on synchronized intermittent mandatory ventilation (SIMV) begins to actively fight the ventilator.
Which condition should the nurse first assess for?