Test Bank for Perinatal and Pediatric Respiratory Care, 3rd Edition: Walsh

Test Bank for Perinatal and Pediatric Respiratory

Care, 3rd Edition: Walsh

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 Walsh: Perinatal and Pediatric Respiratory Care, 3rd Edition
Chapter 10: Invasive blood Gas Analysis and Cardiovascular Monitoring

Test Bank

MULTIPLE CHOICE

1. From which of the following sites can a therapist obtain an arterial blood sample from
a neonate for acid–base and blood gas analysis?
I. Dorsalis pedis
II. Temporal artery
III. Subclavian artery
IV. Posterior tibial artery
A. I and IV only
B. II and IV only
C. I, II, and III only
D. I, II, and IV only
ANS: D

Feedback
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: The following arteries are arterial puncture sites suitable for
obtaining arterial blood samples from infants and children:
• Temporal artery
• Axillary artery
• Radial artery
• Ulnar artery
• Brachial artery
• Femoral artery
• Dorsalis pedis artery
• Posterior tibial artery
Figure 10-1 in the textbook illustrates where these arteries are located on the
patient’s body.

OBJ: Recall

2. Which of the following arteries is considered the optimal puncture site for obtaining
arterial blood samples from neonatal and pediatric patients?
A. Radial artery
B. Axillary artery
C. Ulnar artery
D. Popliteal artery

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 Test Bank 10-2

ANS: A

Feedback
A. Correct response: The preferred site in both neonatal and pediatric populations is
the radial artery. The radial artery provides good access as well as collateral
circulation to the hand by the ulnar artery. No nerves or veins are directly
adjacent to the radial artery, and the patient’s wrist is easier to manipulate than
other body parts. The bone and firm ligaments of the wrist make it easy to
palpate, stabilize, and compress the radial artery.
B. Incorrect response: See explanation A.
C. Incorrect response: See explanation A.
D. Incorrect response: See explanation A.

OBJ: Recall

3. Which of the following arteries are involved when the modified Allen’s test is
performed, using a foot as the potential arterial puncture site?
I. Axillary artery
II. Femoral artery
III. Posterior tibial artery
IV. Dorsalis pedis
A. I and II only
B. II and III only
C. II and IV only
D. III and IV only
ANS: D

Feedback
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: The modified Allen’s test can also be used to verify collateral
circulation when using one of the arteries of the foot as a puncture site, by
elevating the foot and compressing the dorsalis pedis and posterior tibial arteries.
Collateral circulation is confirmed by releasing pressure from the artery that will
not be punctured, and assessing the nailbeds and sole of the foot for return of
blood flow.

OBJ: Recall

4. The neonatal intensive care unit (NICU) respiratory therapy supervisor is observing a
therapist obtain an arterial blood sample from an infant’s radial artery, and notices
that the therapist has the bevel of the needle pointed upward, entering the patient’s
skin at a 45-degree angle, and in a direction against the arterial flow. What should the
supervisor do at this time?

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 Test Bank 10-3

A. Continue to observe the procedure.

B. Inform the therapist to turn the bevel downward.
C. Tell the therapist to penetrate the infant’s skin at about a 60-degree angle.
D. Advise the therapist to insert the needle in the same direction as the blood flows.
ANS: A

Feedback
A. Correct response: The therapist is performing this component of the arterial
puncture procedure correctly; therefore, the NICU supervisor need not prompt
the therapist to alter the procedure. This aspect of the procedure requires that the
therapist insert the needle of the syringe, or butterfly catheter, into the artery at a
35- to 45-degree angle to the surface of the skin with the bevel up, while
advancing the needle gently. The direction of entry of the needle into the artery
must be opposite, or against, the blood flow.
B. Incorrect response: See explanation A.
C. Incorrect response: See explanation A.
D. Incorrect response: See explanation A.

OBJ: Application

5. In addition to applying direct pressure to the puncture site immediately after the
arterial puncture procedure, what can the therapist do to minimize the risk of
hematoma formation in a patient who requires frequent radial arterial punctures?
A. Have the patient maintain the arm in an elevated position for a couple of hours
after the radial puncture.
B. Have the patient shake the arm periodically throughout the day.
C. Alternate arms used for arterial puncture, and use other sites as well.
D. Apply a bandage to the puncture site.
ANS: C

Feedback
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: Alternating puncture sites decreases this risk. Other
complications associated with arterial punctures in infants and children include
nerve damage, bleeding, obstruction of the artery by clots or spasms, trauma to
the artery, and pain.
D. Incorrect response: See explanation C.

OBJ: Application

6. Which of the following factors would adversely affect the correlation between arterial
puncture measurements and those from a capillary sample?
I. Hypotension

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 Test Bank 10-4

II. Hypoventilation
III. Hypovolemia
IV. Hypothermia
A. II only
B. I and III only
C. II and IV only
D. I, III, and IV only
ANS: D

Feedback
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: Accuracy of capillary samples is severely reduced by the
presence of hypotension, hypothermia, hypovolemia, and lack of perfusion.
Hypoventilation and hyperventilation do not negatively impact the correlation
among data from arterial blood samples and measurements from capillary blood
samples.

OBJ: Recall

7. A 12-hour-old infant is experiencing respiratory distress, and the neonatologist orders

a heel stick to assess the infant’s oxygenation status. What action should the therapist
take at this time?
A. Perform the heel stick as ordered.
B. Instead of using the newborn’s heel, the therapist should use a finger as the site.
C. Inform the physician that this procedure is inappropriate at this time.
D. Explain to the doctor that an arterial puncture procedure is appropriate.
ANS: C

Feedback
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: A capillary puncture is contraindicated in neonates less than 24
hours old. A newborn has a low systemic output, and vasoconstriction tends to
be maximal during this stage secondary to a decrease in environmental
temperature and an increase in circulating catecholamines. Capillary blood
sampling is not recommended in a patient with decreased peripheral blood flow,
especially in the case of hypotension.
D. Incorrect response: See explanation C.

OBJ: Application

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 Test Bank 10-5

8. With an umbilical artery catheter (UAC) in the “low position,” which of the following
blood vessels are avoided?
I. Celiac artery
II. Inferior mesenteric artery
III. Renal artery
IV. Aortic intersection
A. III only
B. II and III only
C. I, II, and III only
D. II, III, and IV only
ANS: D

Feedback
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: The low position is usually at the third to fourth lumbar (L3 to
L4) space, between the renal artery and aortic intersection and above the takeoff
of the inferior mesenteric artery. The UAC is placed to avoid the large tributaries
supplied by these vessels in an effort to minimize trauma and hemodynamic
disturbances of vital organs.

OBJ: Recall

9. On the basis of the position of the three-way stopcock shown here, identify which of
the following activities related to arterial line blood sampling is occurring.

A. The therapist is aspirating blood diluted with infusion fluid.

B. The therapist is withdrawing blood from the arterial line.

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 Test Bank 10-6

C. The therapist is not manipulating the stopcock, which is in its normal operational
position.
D. The therapist is infusing fluid back into the system after having removed a blood
sample.
ANS: C

Feedback
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response:

What is depicted by the position of the three-way stopcock is the system’s

normal operating position with the flush, or infusion, solution going to the
patient while the sample port is closed.
D. Incorrect response: See explanation C.

OBJ: Analysis

10. What is the average range of normal circulating blood volume in a neonate?
A. 75 to 80 ml/kg
B. 80 to 85 ml/kg
C. 85 to 90 ml/kg
D. 90 to 95 ml/kg
ANS: C

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 Test Bank 10-7

Feedback
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: The circulating blood volume in neonates and children is
approximately 85 to 90 ml/kg and 70 to 75 ml/kg, respectively. Because the
circulating blood volume in neonates and children is small, recording and
limiting the volume of blood withdrawn from these patients and/or infused is
important.
D. Incorrect response: See explanation C.

OBJ: Recall

11. A patient has a systolic blood pressure of 100 mm Hg and a diastolic pressure of 75
mm Hg. What is this patient’s mean arterial pressure?
A. 25 mm Hg
B. 58 mm Hg
C. 83 mm Hg
D. 175 mm Hg
ANS: C

Feedback
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: The placement of an arterial catheter enables the direct
measurement of arterial blood pressure values, that is, the systolic and diastolic
pressures. Arterial waveforms are also provided. Monitoring arterial pressure
waveforms helps to determine the patency of an arterial line and the quality of
the pulse pressure, and to calculate the mean arterial pressure (MAP). The
arterial line monitor calculates MAP internally. However, the formula to obtain
an indirect measurement of MAP with a sphygmomanometer is as follows:

D. Incorrect response: See explanation C.

OBJ: Application

12. Which of the following factors influence the central venous pressure (CVP)
measurement?
I. Bicuspid valve function
II. Right ventricular pressure
III. Intravascular volume

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 Test Bank 10-8

IV. Systemic venous return

A. I and III only
B. II and III only
C. II and IV only
D. II, III, and IV only
ANS: D

Feedback
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: The placement of a central venous catheter provides for the
measurement of the right atrial pressure, which represents the filling pressure of
the right atrium. Systemic venous return, intravascular volume, tricuspid valve
performance, myocardial function, and right ventricular pressure all affect the
right atrial pressure.

OBJ: Recall

13. How would tricuspid stenosis be expected to influence a patient’s CVP value?
A. Elevate it above normal
B. Cause it to fall below normal
C. Produce fluctuations in the CVP value
D. Have no effect in the CVP value
ANS: A

Feedback
A. Correct response: Increased CVP values may result from:
• Hypervolemia, as with sudden fluid shifts or volume overload
• Interference with the ability of the right ventricle to pump blood, such as in
tricuspid valve regurgitation or tricuspid stenosis, right ventricular failure or
infarction, increased pulmonary vascular resistance, or cardiac tamponade
• Increased systemic vasoconstriction
• Left ventricular failure
B. Incorrect response: See explanation A.
C. Incorrect response: See explanation A.
D. Incorrect response: See explanation A.

OBJ: Application

14. On the basis of the following waveform, in which of the following anatomic locations
is the distal tip of the pulmonary artery catheter located?

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 Test Bank 10-9

A. Right atrium
B. Right ventricle
C. Pulmonary artery
D. Wedged position
ANS: D

Feedback
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: The pressure waveform presented represents the characteristic
tracing obtained when the balloon on the pulmonary artery catheter is inflated,
and the catheter is allowed to float into the wedged position.

OBJ: Analysis

15. On the basis of the following waveform, in which of the following anatomic locations
is the distal tip of the pulmonary artery catheter located?

A. Right atrium
B. Right ventricle
C. Pulmonary artery
D. Wedged position
ANS: C

Feedback
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: The pressure waveform presented represents the characteristic

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 Test Bank 10-10

tracing obtained when the distal tip of the pulmonary artery catheter is residing
in the pulmonary artery.
D. Incorrect response: See explanation C.

OBJ: Analysis

16. On the basis of the following waveform, in which of the following anatomic locations
is the distal tip of the pulmonary artery catheter located?

A. Right atrium
B. Right ventricle
C. Pulmonary artery
D. Wedged position
ANS: B

Feedback
A. Incorrect response: See explanation B.
B. Correct response: The pressure waveform presented illustrates the characteristic
tracing obtained when the pulmonary artery catheter is located in the right
ventricle. Notice the high right ventricular systolic pressure (30 mm Hg) and the
low right ventricular diastolic pressure (below 5 mm Hg).
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B.

OBJ: Analysis

17. Which of the following pulmonary artery catheter waveforms represents the catheter’s
normal location?
A.

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 Test Bank 10-11

B.

C.

D.

ANS: D

Feedback
A. Incorrect response: This pressure waveform illustrates a pulmonary capillary
wedge pressure from a pulmonary artery catheter.
B. Incorrect response: This pressure waveform depicts a central venous pressure
tracing obtained from a central venous pressure catheter, or from the proximal
lumen of a pulmonary artery catheter.
C. Incorrect response: This pressure waveform demonstrates a right ventricular
pressure tracing.
D. Correct response: This pressure waveform reflects the presence of the distal tip
of the pulmonary artery catheter in the pulmonary artery, where this catheter
should normally reside. After the pulmonary artery catheter has been placed in
the proper position, the catheter’s monitor should show the catheter positioned to
produce a pulmonary artery pressure waveform, except for times when
pulmonary capillary wedge pressure readings are obtained.

OBJ: Analysis

18. Which of the following complications are associated with the insertion of a
pulmonary artery catheter?
I. Pneumothorax
II. Bicuspid valve damage
III. Cardiac dysrhythmias
IV. Perforation of the left atrium
A. I and II only
B. II and III only

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 Test Bank 10-12

C. I, II, and III only

D. I, II, III, and IV
ANS: D

Feedback
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: At insertion, complications include bleeding, pneumothorax,
tricuspid or pulmonic valve damage, right atrium or right ventricle perforation,
and arrhythmias resulting from the catheter traversing the right ventricle. The
most frequently observed arrhythmias are premature ventricular contractions and
ventricular tachycardia.

OBJ: Recall

19. Calculate a patient’s total arterial oxygen content given the following data:
• Arterial oxygen tension (PaO2), 100 mm Hg
• Arterial carbon dioxide tension (PaCO2), 45 mm Hg
• Arterial oxygen saturation (SaO2), 97.5%
• Hemoglobin concentration ([Hb]), 15 g/dl
• Cardiac output, 4.5 L/minute
• Stroke volume, 55 ml/beat
A. 19.9 vol%
B. 18.7 vol%
C. 16.6 vol%
D. 14.9 vol%
ANS: A

Feedback
A. Correct response: The formula for calculating the total arterial oxygen content
(CaO2) is as follows:

B. Incorrect response: See explanation A.

C. Incorrect response: See explanation A.
D. Incorrect response: See explanation A.

OBJ: Application

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Test Bank for Perinatal and Pediatric Respiratory Care, 3rd Edition: Walsh

Test Bank 10-13

20. Which of the following conditions can cause methemoglobinemia?

I. Anemia
II. Inhalation of nitric oxide (NO)
III. Use of digoxin
IV. High fraction of inspired oxygen
A. I and II only
B. II and III only
C. III and IV only
D. I, II, and III only
ANS: B

Feedback
A. Incorrect response: See explanation B.
B. Correct response: Methemoglobin forms when hemoglobin is oxidized to the
ferric (Fe3+) state from the ferrous (Fe2+) state. It causes the oxyhemoglobin
dissociation curve to shift to the left, resulting in a decrease in the ability of
hemoglobin to combine with oxygen. Methemoglobin is incapable of
transporting oxygen because it cannot combine reversibly with oxygen. Nitrate-
and nitrite-containing medications, for example, digoxin and inhaled NO gas,
may cause methemoglobinemia.
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B.
Figure credits
Unn Fig. 10-1: From Wilkins RL, Stoller JK, Kacmarek RM: Egan’s fundamentals of
respiratory care, ed 9, St. Louis: Mosby; 2009.

OBJ: Recall

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