KETTERING NPS PRACTICE EXAM Q&A NEWLY MODIFIED TESTED AND APPROVED!!!

KETTERING NPS

PRACTICE EXAM Q&A NEWLY MODIFIED
TESTED AND APPROVED!!!
A 10-year old girl was involved in a personal watercraft accident and suffered a C-3 fracture
requiring mechanical ventilation. Nine days following intubation, the pediatric intensivist
asks the neonatal/ pediatric specialist for a recommendation regarding an artificial airway for
this patient. the specialist should recommend a/an

A. uncuffed ETT

B. Tracheostomy tube

C. LMA

D. Carlen's tube -- ANSWER--B. Tracheostomy tube




A 28-week gestation-age neonate requires endotracheal intubation. the inflant weighs 1kg.

the appropriate length of insertion for the ETT is

A. 5.5 cm

B. 6.5 cm

C. 7.5 cm

D. 8.5 cm -- ANSWER--B. 6.5 cm (27-29 wks, 900-1000 grams)




5.5 cm for 23-24 wks or 500-600 grams

6.0 cm for 25-26 wks or 700-800 grams



1

,The neonatal/pediatric specialist is preparing for the intubation of a 4-year old near drowning
victim. the appropriate endotracheal tube size for this child is

A. 3mm

B. 4mm

C. 5mm

D. 6mm -- ANSWER--C. 5mm




Tube size= age in years +16, divided by 4




Which of the following should the neonatal/pediatric specialist anticipate when using an
endotracheal tube that was too large for an 8-year old child?

1. Decreased perfusion of airway wall

2. Tracheal necrosis

3. Vocal cord damage

4. increased airway resistance




A. 1 and 4 only

B. 2 and 3 only

C. 1,2, and 3 only

D, 1,2,3, and 4 -- ANSWER--C. 1,2,and 3 only



2

,A neonatal/pediatric specialist is re-taping an ETT on a 4-year old child in the PICU.
Following the procedure the specialist notes that the PETCO2 monitor reads zero. Which of
the following should the specialist recommend?

A. chest x-ray

B. suction the ETT

C. advance the ETT

D. remove the ETT -- ANSWER--D. remove the ETT (an ETCO2 of zero means the tube is
not in the trachea)




The pediatric pulmonologist is preparing to intubate a child with laryngotracheal stenosis.
Which of the following devices would be most appropriate for this potentially difficult

intubation?

A. Laryngeal mask airway

B. Laryngoscope with miller blade

C. Laryngoscope with Macintosh blade

D. Flexible fiberoptic bronchoscope -- ANSWER--D. flexible fiberoptic bronchoscope




A 5-year old patient with epiglottitis was intubated for airway management. Following
extubation, the neonatal/ pediatric specialist notes the presence of marked inspiratory stridor.
The specialist should

A. provide cool mist aerosol B.
Reintubate the patient
C. administer heliox therapy


3

, D. administer racemic epinephrine -- ANSWER--B. reintubate the patient (airway
emergency!)




An 11- year old patient on mechanical ventilation has a size 6 mm ID cuffed ETT in place.
The neonatal/pediatric specialist uses a cufflator to measure the cuff pressure and notes that
the cuff pressure is 24 cm H2O. The specialist should

A. Maintain the current cuff pressure

B. reinflate the cuff with minimal leak technique

C. Change to a larger tube

D. Change to a smaller tube -- ANSWER--C. Change to a larger tube. (cuff pressure should
not exceed 20 cm H2O, if it is higher then the tube needs to be changed to a larger tube
size)




A 2-year old patient with a severe case of laryngotracheobronchitis was extubated earlier in
the morning. The patient received aerosolized racemic epinephrine Q6HR throughout the day.
During her initial assessment, the night shift neonatal/ pediatric specialist notes that the
patient has mild to moderated inspiratory stridor. Vital signs: BP 80/40 mmHg, HR 100/min,
RR 28/min, temp 37 degrees C, and SpO2 is 93% on 30% oxygen by cool aerosol. Which of
the following should the specialist recommend?

A. levalbuterol (Xopenex)

B. prostacyclin (flolan)

C. Helium- Oxygen gas mixture

D. Reintubate the patient -- ANSWER--C. Helium- Oxygen gas mixture




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