Kacmarek: Egan's Fundamentals of Respiratory Care, 10th 

Edition ​Chapter 31: Neonatal and Pediatric Respiratory Disorders  

Test Bank  

MULTIPLE CHOICE  

1. Another name for respiratory distress syndrome (RDS) is:  

a. hyaline membrane disease  
b. transient tachypnea of the newborn  
c. type II RDS  
d. persistent pulmonary hypertension  
 
2. What are the major factors in the pathophysiology of RDS?  
1. qualitative surfactant deficiency  
2. increased alveolar surface area  
3. increased small airways compliance  
4. presence of the ductus arteriosus  
a. 1 and 2  
b. 1 and 3  
c. 1, 3, and 4  
d. 1, 2, 3, and 4  

3. Which of the following factors is associated with an increase in the incidence of RDS? 
a. maternal heart disease  
b. maternal diabetes  
c. maternal asthma  
d. long labor  

4. In preterm infants, adequate amounts of surfactant are present; however, it is trapped inside 
type II cells.  
a. True  
b. False  

5. What is the first clinical sign of RDS in the newborn infant?  

a. cyanosis  
b. wheezing  
c. hypertension  
d. tachypnea  

6. Which of the following clinical signs is not consistent with the onset of RDS? 
a. grunting  
b. retractions  
c. nasal flaring  
d. cyanosis  

 
7. What diagnostic parameter is most often used to confirm the diagnosis of RDS? 
a. arterial blood gases  
b. chest radiograph  
c. pulmonary function test  
d. serum enzymes  

8. Which of the following findings on the chest radiograph is not typical for RDS? 
a. hyperinflation  
b. air bronchograms  
c. diffuse hazy infiltrates  
d. bilateral reticulogranular densities  

9. Which of the following treatments is the least useful for the treatment of RDS? 
a. CPAP  
b. surfactant replacement therapy  
c. high-frequency ventilation  
d. bronchial hygiene techniques  

10.  You  are  caring  for  an  infant  with  RDS.  Nasal  CPAP has been used; however, the infant 
suddenly  deteriorates  and  is  demonstrating severe hypoxemia on an FIO​2 of
​  0.60. What 
should be done next?  
a. Increase the CPAP.  
b. Intubate the infant and begin mechanical ventilation.  
c. Switch to nasal CPAP.  
d. Increase the FIO​2​.  

11. What is the maximum PIP that should be used with mechanical ventilation of larger premature 
infants to prevent volutrauma?  
a. 25 cm H​2​O  
b. 30 cm H​2​O  
c. 40 cm H​2​O  
d. 50 cm H​2​O 

12. The current standard of care is delivery surfactant replacement to all infants with RDS. 
a. True  
b. False  
13. In which infants is the surfactant administered as rescue?  
a. infants delivered prematurely  
b. infants with failure on CPAP trial  
c. infants with diagnosis of RDS  
d. infants with congenital heart disease  

14. What is believed to be the cause of transient tachypnea of the newborn (TTN)? 
a. persistent hypoxemia  
b. immature surfactant  
c. delayed clearance of fetal lung fluid  
d. persistent fetal circulation  
15. Most infants with transient tachypnea are born premature.  
a. True  
b. False  

16. Mothers of infants with transient tachypnea tend to have longer labor intervals and a higher 
incidence of failure to progress in labor.  
a. True  
b. False  

17. What radiographic finding is common in infants with transient tachypnea? 

a. low lung volumes  
b. bilateral perihilar lymphadenopathy  
c. hyperinflation  
d. mucus plugging  

18. What treatment usually causes improvement in the initial treatment of transient tachypnea of 
the newborn?  
a. mechanical ventilation with PEEP  
b. oxygen with low FIO​2  
c. bronchodilators  
d. mucolytics  

19. What treatment is indicated for infants with transient tachypnea requiring higher FIO​2​? 
a. frequent turning of the infant  
b. oxygen  
c. mechanical ventilation  
d. CPAP  

20. What treatment may improve lung fluid clearance in the infant with transient tachypnea? 
a. CPAP  
b. oxygen  
c. mechanical ventilation  
d. frequent turning of the infant  

21. Which statements about TTN are true?  

1. TTN and neonatal pneumonia have similar clinical signs.  
2. The need for mechanical ventilation in TTN is rare.  
3. A small number of infants with TTN eventually have persistent pulmonary 
hypertension. 4. Intravenous administration of antibiotics should be considered.  
a. 1 and 2  
b. 1 and 3  
c. 1, 2, and 3  
d. 1, 2, 3, and 4  

22. Meconium-stained amniotic fluid is common among infants of less than 37 weeks’ gestational 
age.  
a. True  
b. False  
23. Normally, meconium is not passed by the infant until after birth. 
a. True  
b. False  

24. What percentage of births will present with meconium-stained amniotic fluid? 
a. 2%  
b. 12%  
c. 25%  
d. 50%  
25. Which of the following is not a problem with the typical case of meconium aspiration 
syndrome?  
a. lung tissue damage  
b. pulmonary obstruction  
c. hypovolemia  
d. pulmonary hypertension  

26. What is associated with ball-valve obstruction in meconium aspiration syndrome? 

a. volutrauma  
b. atelectrauma  
c. hypertension  
d. hypotension  

27. Which of the following clinical findings is NOT usually seen in meconium aspiration 
syndrome?  
a. tachypnea and grunting  
b. irregular pulmonary densities on the chest film 
c. metabolic acidosis  
d. respiratory alkalosis  

28. Which of the following blood gas alteration is usually seen in meconium aspiration 
syndrome?  
a. hypoxemia and respiratory acidosis  
b. hypoxemia and mixed respiratory and metabolic alkalosis  
c. hypoxemia and normal acid-base balance  
d. hypoxemia and mixed respiratory and metabolic acidosis  
29. Which of the following should be done early in the treatment of the non-vigorous infant with 
meconium aspiration syndrome?  
a. suctioning  
b. mask CPAP  
c. antibiotics  
d. vasopressors  

30. Which of the following ventilatory modalities has been associated with a lesser rate of air leak 
in MAS?  
1. IMV  
2. SIMV  
3. HFV  
4. CPAP  
a. 1  
 b. 1 and 2  
c. 2 and 3  
d. 1, 2, and 3 

31. Which of the following have been implicated in the origin of bronchopulmonary dysplasia 
(BPD)?  
1. oxygen toxicity  
2. malnutrition  
3. mechanical ventilation  
a. 1  
b. 1 and 2  
c. 1 and 3  
d. 1, 2, and 3  

32. What factor is not associated with the new description of BPD?  
a. improvements in ventilator management  
b. use of surfactant  
c. use of HFV  
d. postnatal steroid therapy  

33. What clinical finding is typically seen with BPD infants?  

a. areas of air-trapping on the chest film  
b. areas of consolidation on the chest film  
c. hypoxemia and hypercapnia  
d. hypocapnia  

34. What is the best strategy in the management of BPD?  

a. adequate fluid management  
b. prevention  
c. aggressive mechanical ventilation  
d. PEEP  
35. Which of the following therapies has little effect on long-term outcome such as mortality and 
duration of oxygen therapy in infants with BPD?  
a. diuretics  
b. steroids  
c. antibiotics  
d. bronchodilators  

36. Which of the following is not associated with apnea episodes in premature infants? 
a. Apnea lasts longer than 15 seconds.  
b. Apnea is associated with cyanosis.  
c. Apnea is associated with bradycardia.  
d. Apnea lasts longer than 1 minute.  

37. Which of the following is NOT associated with causing apnea in premature infants? 
a. gender  
b. intracranial lesion  
c. gastroesophageal reflux  
d. impaired oxygenation  
38. Treatment of the premature infant with apnea includes all the following except: 
a. tactile stimulation  
b. theophylline  
c. transfusion  
d. bronchial hygiene  

39. Infants who have apnea of prematurity are at greater risk of SIDS than other infants. 
a. True  
b. False  
40. What physiologic abnormality is believed to be the cause of persistent pulmonary 
hypertension in the newborn (PPHN)?  
a. right-to-left shunting  
b. high cardiac output  
c. high pulmonary vascular resistance  
d. metabolic acidosis  

41. Normally the PVR/SVR ratio is greater than 1 in the fetus.  

a. True  
b. False  
42. What are the three fundamental pathophysiologic events that explain PPHN? 
1. vascular spasm 
2. hypoxemia  
3. increased muscle wall thickness  
4. decreased cross-sectional area  
a. 1  
b. 1 and 2  
c. 1 and 3  
d. 1, 2, 3, and 4  

43. Which of the following factors may stimulate pulmonary vascular spasm and cause persistent 
pulmonary hypertension in the newborn?  
1. hypoxemia  
2. hypoglycemia  
3. hypotension  
4. pain  
a. 1  
b. 1 and 2  
c. 1, 2, 3, and 4  
d. 4  

44. Infants with persistent pulmonary hypertension usually have hypoxemia out of proportion to 
the lung disease detected by radiography.  
a. True  
b. False  

 
45. Treatment of the infant with persistent pulmonary hypertension may include all the following 
except:  
a. ECMO  
b. high-frequency ventilation  
c. nitric oxide 
d. theophylline  

46. Which of the following is an example of an internal obstruction to the infant’s airway? 
a. hemangiomas  
b. neck mass  
c. tracheoesophageal fistula  
d. laryngomalacia  

47. Which of the following is the most common type of esophageal atresia? 
a. esophageal atresia with a proximal fistula  
b. esophageal atresia with a distal fistula  
c. intact esophagus with an H fistula  
d. esophageal atresia without either fistula  

48. The pathophysiologic abnormalities associated with congenital diaphragmatic hernia include 
all the following except:  
a. malformation of the left ventricle  
b. lung hypoplasia  
c. pulmonary hypertension  
d. unusual anatomy of the inferior vena cava  

49. Clinical findings associated with congenital diaphragmatic hernia include all the following 
except:  
a. severe cyanosis  
b. decreased breath sounds  
c. displaced heart sounds  
d. hepatomegaly  

50. Which of the following diagnostic tools serves to confirm the diagnosis of CDH? 
a. sweat test  
b. fluoroscopy  
c. chest radiography  
d. ultrasound  

51. The mortality rate for infants with congenital diaphragmatic hernia is usually low. 
a. True  
b. False  

52. Which of the following is the most common defect of the abdominal wall? 
a. inguinal hernia  
b. omphalocele  
c. gastroschisis  
d. agenesis of abdominal muscles 
53. Which of the following are common neuromuscular defect that affect infants? 
1. spinal muscular atrophy  
2. congenital myasthenia gravis  
3. myotonic dystrophy  
4. poliomyelitis  
a. 1  
b. 1, 2, and 3  
c. 1 and 3  
d. 1, 2, and 4  

54. Which of the following defects is not associated with tetralogy of Fallot? 
a. ventricular septal defect  
b. right ventricular hypoplasia  
c. pulmonary stenosis  
d. dextroposition of the aorta  

55. Children with tetralogy of Fallot are at risk for sudden death from arrhythmia later in life. 
a. True  
b. False  
56. Which of the following is the most likely diagnosis in the newborn with severe cyanosis at 
birth?  
a. persistent pulmonary hypertension 
b. tetralogy of Fallot  
c. transposition of the great vessels  
d. ventricular septal defect  

57. Which of the following is NOT true regarding ventricular septal defects in infants? 
a. are quite common  
b. usually cause right-to-left shunting  
c. may cause congestive heart failure  
d. usually do not appear immediately after birth  

58. How soon after birth does the ductus typically close?  
a. 1 to 2 days  
b. 3 to 4 days  
c. 5 to 7 days  
d. 10 days  
59. In left ventricular outflow obstructions, systemic blood flow depends on patency of the ductus 
arteriosus.  
a. True  
b. False  

60. Most infants with hypoplastic left heart syndrome do not need to be supported with 
mechanical ventilation.  
a. True  
b. False 

 
61. In which of the following defects is heart transplantation an accepted option for treatment? 
a. interrupted aortic arch  
b. coarctation of the aorta  
c. hypoplastic left heart syndrome  
d. none of the above  

62. Sudden infant death syndrome (SIDS) is the most common cause of death in infants under the 
age of 1 year.  
a. True  
b. False  

63. Which of the following maternal characteristics is NOT associated with an increased 
frequency of SIDS?  
a. younger than 20 years  
b. low socioeconomic status  
c. cigarette smoking  
d. history of asthma  
 
64. Which of the following infant characteristics is associated with an increased risk of SIDS? 
a. female gender  
b. preterm birth  
c. high APGAR score  
d. full-term birth 

65. It is not difficult to differentiate death from SIDS from death by intentional suffocation. 
a. True  
b. False  
66. The American Academy of Pediatrics recommends that infants be placed in either the supine 
or the side-lying position for the first 6 months of life to reduce the risk of SIDS. a. True  
b. False  

67. Which of the following findings is not associated with gastroesophageal reflux (GER) 
disease?  
a. stridor  
b. apnea  
c. reactive airways disease  
d. syncope  

68. Which of the following are used to diagnose GER?  

1. esophageal pH testing  
2. chest radiograph  
3. upper GI contrast studies  
4. gastric scintiscanning  
a. 1  
b. 1, 2, and 3 
c. 1 and 3  
d. 1, 3, and 4  
69. Bronchiolitis is an acute infection of the lower respiratory tract usually caused by bacterial 
organisms.  
a. True  
b. False  

70. The following diseases are commonly associated with bronchiolitis most likely to result in 
respiratory failure except:  
a. infant with congenital heart failure  
b. infant with BPD  
c. child with cystic fibrosis  
d. pneumonia  

71. Which of the following findings is not typical for infants with bronchiolitis? 
a. stridor  
b. wheezing  
c. dyspnea  
d. tachypnea  

72. Which of the following groups of infants should receive passive immunization for RSV? 
1. chronic lung disease  
2. infants born less than 32 weeks’ gestational age  
3. infants with congenital heart disease  
4. infants with retinopathy of prematurity  
a. 1  
b. 1, 2, and 3  
c. 1 and 3  
d. 1, 3, and 4  

73. Which of the following therapies is considered controversial in the management of the infant 
with severe bronchiolitis?  
a. hydration  
b. oxygen  
c. bronchodilator therapy  
d. CPAP  

74. Which of the following statements is TRUE about croup?  

1. caused by viral organism  
2. most common form of airway obstruction in children aged 6 months to 6 
years 3. causes subglottic swelling and obstruction  
4. most often caused by parainfluenza virus  
a. 1 and 3  
b. 2, 3, and 4  
c. 3 and 4  
d. 1, 2, 3, and 4  

 
75. Which of the following clinical signs is NOT common with croup?  
a. stridor  
b. murmur  
c. coughing  
d. cyanosis  

76. Which of the following is the most common radiographic finding that suggests the presence of 
croup?  
a. thumb sign  
b. flail chest  
c. sail sign  
d. steeple sign  

77. Which of the following clinical findings suggests the child with croup should be hospitalized? 
1. stridor at rest  
2. suprasternal retractions  
3. cyanosis on room air  
4. harsh breath sounds  
a. 1  
b. 1 and 2  
c. 1, 3, and 4  
d. 1, 2, 3, and 4  
 
78. Which of the following treatments is least likely to be needed in the treatment of the child 
with croup?  
a. oxygen  
b. mechanical ventilation  
c. aerosolized racemic epinephrine  
d. budesonide  

79. What modality is believed to be the cause of a decrease in the reported incidence of 
epiglottitis over the past decade?  
a. vaccine  
b. better diet  
c. improved epidemiology reporting  
d. better quality of air  
80. Which of the following clinical findings is NOT typically seen in patients with epiglottitis? 
a. high fever  
b. stridor  
c. croupy barking cough  
d. drooling  

81. Which of the following is the most common radiographic finding that suggests the presence of 
epiglottitis?  
a. thumb sign  
b. flail chest  
c. sail sign  
d. steeple sign  
82. Which of the following therapies is LEAST likely to be needed in the child with epiglottitis? 
a. tracheostomy  
b. pressure support with low-level CPAP  
c. high FIO​2  
d. humidity therapy  

83. A 2 year old boy is in severe respiratory distress. The child is drooling and has labored 
breathing. Stridor is heard. RR is 42 and HR is 140. What should be done next? a. 
Intubate.  
b. Provide 100% oxygen on non-rebreather mask.  
c. Administer racemic epinephrine.  
d. Place on CPAP with low PSV.  

84.  What  is  the  likely  diagnosis  of  a  18-month  old  patient  in  moderate respiratory distress with a 
one-week  history  of  a low-grade fever and chills, barking cough, and an AP chest radiograph 
which shows a steeple sign?  
a. pulmonary interstitial emphysema  
b. bronchopulmonary dysplasia  
c. epiglottis  
d. croup  

85. Patients with cystic fibrosis often have trouble with the digestion of fats and have deficiency 
of the fat-soluble vitamins.  
a. True  
b. False  

86. What is the leading cause of death among patients with cystic fibrosis? 
a. pancreatic disease  
b. lung disease  
c. gastrointestinal disease  
d. diabetes  

87. Which test is commonly used to confirm the diagnosis of cystic fibrosis? 
a. sweat chloride  
b. chest radiograph  
c. lung diffusion capacity  
d. serum enzyme levels  

88. What therapy has been shown to reduce the incidence of bronchiectatic exacerbations in the 
patient with cystic fibrosis?  
a. autogenic lung drainage  
b. inhaled tobramycin  
c. chest physical therapy  
d. bronchodilator therapy  
 
 
89. What therapy has been shown to reduce the rate of loss of lung function in patients with cystic 
fibrosis?  
a. high doses of ibuprofen  
b. continuous oxygen therapy  
c. corticosteroids  
d. inhaled DNase