Principles Of Pediatric Anesthesia And care! Trivia Quiz

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Infant Quizzes & Trivia

Review of material for Principles II quiz 2 on pediatric anesthesia.


Questions and Answers
  • 1. 

    What should be your first action when preparing to do a pre-op assessment on a 3 yr old child?

    • A.

      Review the chart

    • B.

      Introduce yourself to the child’s parents and obtain a thorough history

    • C.

      Introduce yourself to child, and attempt to play a game or comfort them

    • D.

      Get your blow gun ready, and load it with a ketamine dart.

    Correct Answer
    A. Review the chart
    Explanation
    When preparing to do a pre-op assessment on a 3-year-old child, the first action should be to review the chart. This is important because it allows the healthcare provider to familiarize themselves with the child's medical history, any previous surgeries, allergies, and other relevant information. Reviewing the chart helps in planning and tailoring the assessment according to the child's specific needs and medical condition, ensuring a safe and effective pre-op assessment process.

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  • 2. 

    Which of the following is the most common reason for cancellation of pediatric procedures?

    • A.

      Asthma Exacerbation

    • B.

      Upper Respiratory Infections

    • C.

      Non-compliance with NPO requirements

    • D.

      Instability due to illness

    Correct Answer
    B. Upper Respiratory Infections
    Explanation
    Upper respiratory infections are the most common reason for cancellation of pediatric procedures. This is because these infections can cause symptoms such as coughing, sneezing, and congestion, which can make it difficult for the child to breathe and cooperate during the procedure. Additionally, there is an increased risk of complications and infection spread during the procedure if the child has an active respiratory infection. Therefore, it is common practice to cancel pediatric procedures when a child has an upper respiratory infection to ensure their safety and minimize the risk of complications.

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  • 3. 

    You are assessing 4 yr old Madelyn prior to her going in for enucleation of her left eye. When you see her in pre-op she appears to be a little under the weather. She is sneezing and has yellow mucus coming her nose. You listen to her lungs and hear a slight wheeze while her mom says she began to run a temperature late last night. She appears fine and is watching and giggling at a children’s show on a portable DVD player her mother brought to calm her.  What do you do for this patient?

    • A.

      Give a dose of Tylenol and a respiratory treatement pre-op before continuing with procedure.

    • B.

      It is only an eye surgery, not thoracic so she will be fine.

    • C.

      Talk to the surgeon regarding possibly cancelling the surgery

    • D.

      That depends entirely upon whether Madelyn was a premature baby or has any other coexisting diseases.

    Correct Answer
    C. Talk to the surgeon regarding possibly cancelling the surgery
    Explanation
    Based on the given information, the patient, Madelyn, is showing symptoms of being sick, such as sneezing, yellow mucus, and a slight wheeze. Additionally, her mother mentions that she had a fever the previous night. These symptoms indicate that Madelyn may have an underlying respiratory infection, which can increase the risk of complications during surgery. Therefore, the appropriate action would be to talk to the surgeon about the possibility of cancelling the surgery to ensure Madelyn's safety and well-being.

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  • 4. 

    You are going to do a pre-op on 5 yr old Trevor who is going in today for a repair of an inguinal hernia. When you go to assess him pre-op you see he is sniffly. His mother says he has seasonal allergies and has a constant runny nose. You go to look at Trevor and indeed his little nose is red and he has clear mucus coming from his nose, but no fever or wheezes. He does not appear to be otherwise ill and in fact is playing with his stuffed dinosaur. Is it safe to proceed with the procedure?

    • A.

      Not enough information to decide at this time.

    • B.

      No, he is displaying signs of an upper respiratory infection.

    • C.

      Only safe to proceed if pt is given a respiratory treatment and an arterial line inserted to closely monitor hemodynamic stability.

    • D.

      Yeah, he’s fine. We can proceed!

    Correct Answer
    D. Yeah, he’s fine. We can proceed!
    Explanation
    Based on the given information, Trevor is only displaying symptoms of seasonal allergies such as a runny nose with clear mucus, but he does not have a fever or wheezes. He appears to be otherwise healthy and is even playing with his stuffed dinosaur. Therefore, it is safe to proceed with the procedure as his symptoms do not indicate an upper respiratory infection or any other serious illness.

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  • 5. 

    A 2 yr old child may drink milk up to how many hours prior to procedure?

    • A.

      6 hours

    • B.

      4 hours

    • C.

      3 hours

    • D.

      8 hours

    Correct Answer
    A. 6 hours
    Explanation
    A 2-year-old child should not drink milk up to 6 hours prior to a medical procedure. This is because milk can take longer to digest compared to other fluids and may increase the risk of complications during the procedure, such as vomiting or aspiration. It is important to follow these guidelines to ensure the child's safety and to obtain accurate test results.

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  • 6. 

    A 7 yr old child must not eat solid food for how many hours prior to procedure?

    • A.

      6 hours

    • B.

      8 hours

    • C.

      3 hours

    • D.

      4 hours

    Correct Answer
    B. 8 hours
    Explanation
    Prior to a medical procedure, it is generally recommended that a 7-year-old child refrains from consuming solid food for a period of 8 hours. This is important to ensure that the child's stomach is empty, reducing the risk of complications during the procedure such as aspiration or vomiting. By abstaining from solid food for 8 hours, the child's digestive system has sufficient time to process and empty any previously consumed food, resulting in a safer and more successful procedure.

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  • 7. 

    Which of the following would not be an appropriate way to reduce intra-op heat loss in the pediatric patient?

    • A.

      Use of an overhead radiant heating unit

    • B.

      Use of a water mattress, with circulating warm water

    • C.

      Use cloths dipped in 40o C water and place onto child’s head during procedure

    • D.

      Use a Bair hugger placed on the child’s body

    Correct Answer
    C. Use cloths dipped in 40o C water and place onto child’s head during procedure
    Explanation
    Using cloths dipped in 40o C water and placing them onto a child's head during a procedure would not be an appropriate way to reduce intra-op heat loss in a pediatric patient. This method could potentially cause hypothermia and increase the risk of complications. The other options mentioned, such as using an overhead radiant heating unit, a water mattress with circulating warm water, or a Bair hugger placed on the child's body, are all effective ways to reduce heat loss and maintain the patient's body temperature during surgery.

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  • 8. 

    What type of breathing circuit would you choose for a child weighing less than 10 kg?

    • A.

      Small semi-closed Circuit

    • B.

      Mapleson A

    • C.

      Standard adult semi closed system

    • D.

      Jackson-Rees Circuit

    Correct Answer
    D. Jackson-Rees Circuit
    Explanation
    The Jackson-Rees Circuit would be the most suitable choice for a child weighing less than 10 kg. This circuit is specifically designed for pediatric patients and provides controlled ventilation. It is a modification of the Mapleson A circuit, which is not as suitable for small children. The Standard adult semi-closed system is designed for adult patients and may not provide the appropriate ventilation for a child of this size. Therefore, the Jackson-Rees Circuit is the best option for ensuring safe and effective ventilation in a child weighing less than 10 kg.

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  • 9. 

    What type of circuit would you choose for a pediatric patient weighing more than 10 kg?

    • A.

      Small semi-closed Circuit

    • B.

      Mapleson A

    • C.

      Standard adult semi closed system

    • D.

      Jackson-Rees Circuit

    Correct Answer
    A. Small semi-closed Circuit
    Explanation
    A small semi-closed circuit would be the most suitable choice for a pediatric patient weighing more than 10 kg. This type of circuit is specifically designed for smaller patients and provides a more controlled and precise delivery of anesthesia gases. It allows for efficient removal of carbon dioxide and minimizes the risk of rebreathing. Additionally, the smaller circuit size ensures that the patient receives the appropriate amount of anesthesia gases based on their weight and size.

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  • 10. 

    When setting an adult vent for pediatric use in pressure controlled mode, which of the following would be inappropriate?

    • A.

      Set I:E ratio 1:2

    • B.

      Pop off limit to vent to 30 cm H2O

    • C.

      VT to minimum of 200 ml/kg/min

    • D.

      All the above are correct

    Correct Answer
    B. Pop off limit to vent to 30 cm H2O
    Explanation
    Setting the pop off limit to vent to 30 cm H2O would be inappropriate when setting an adult vent for pediatric use in pressure controlled mode. This is because the pop off limit should be set to a lower value in order to prevent excessive pressure buildup in the pediatric patient's lungs. A higher pop off limit could lead to barotrauma or lung injury. Therefore, the correct answer is to set the pop off limit to a lower value, not 30 cm H2O.

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  • 11. 

    What would be an appropriate size LMA for an infant weighing 9 kg?

    • A.

      0.5

    • B.

      1

    • C.

      1.5

    • D.

      2.5

    Correct Answer
    C. 1.5
    Explanation
    An appropriate size LMA for an infant weighing 9 kg would be 1.5. This is because the size of the LMA is typically chosen based on the weight of the patient. In this case, the infant weighs 9 kg, and the appropriate size LMA for this weight range is 1.5.

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  • 12. 

    What would be an appropriate size LMA for a child weighing 27 kg?

    • A.

      3

    • B.

      1.5

    • C.

      4

    • D.

      2.5

    Correct Answer
    D. 2.5
    Explanation
    An appropriate size LMA for a child weighing 27 kg would be 2.5. The size of the LMA is chosen based on the weight of the child, and in this case, a child weighing 27 kg would require a size 2.5 LMA.

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  • 13. 

    What would be an appropriate sized ETT for a 3 yr old child weighing 18 kg?

    • A.

      4.5

    • B.

      4

    • C.

      3.5

    • D.

      3

    Correct Answer
    A. 4.5
    Explanation
    An appropriate sized ETT for a 3-year-old child weighing 18 kg would be 4.5. The size of the endotracheal tube (ETT) is determined based on the weight and age of the child. In this case, a 4.5 ETT would be suitable for a 3-year-old child weighing 18 kg.

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  • 14. 

    What would be an appropriate size ETT for a 9 yr old child weighing  33 kg?

    • A.

      5

    • B.

      6

    • C.

      4.5

    • D.

      7

    Correct Answer
    B. 6
    Explanation
    An appropriate size endotracheal tube (ETT) for a 9-year-old child weighing 33 kg would be 6. This size is determined based on the weight and age of the child, as well as other factors such as the size of the child's airway and the intended use of the ETT. It is important to select the correct size ETT to ensure proper ventilation and oxygenation during medical procedures.

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  • 15. 

    What size laryngoscope blade would you choose to intubate an 8  yr old child?

    • A.

      1.5 mil

    • B.

      3 mac

    • C.

      2.5 mil

    • D.

      2 mac

    Correct Answer
    D. 2 mac
    Explanation
    The correct answer is 2 mac. The size of the laryngoscope blade for intubating an 8-year-old child would typically be chosen based on the child's age and size. The "mac" measurement refers to the size of the blade, with larger numbers indicating larger blades. In this case, 2 mac would be the appropriate size for intubating the child.

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  • 16. 

    In order to work well EMLA cream must be applied at least how many minutes prior to IV start?

    • A.

      45 minutes

    • B.

      2 hours

    • C.

      30 minutes

    • D.

      15 minutes

    Correct Answer
    A. 45 minutes
    Explanation
    EMLA cream is a topical anesthetic that needs time to take effect before it can numb the skin for an IV start. Applying it at least 45 minutes prior allows the cream to penetrate the skin and desensitize the area, ensuring that the patient feels minimal pain during the procedure. Applying it for a shorter duration may not provide sufficient numbing effect, while applying it for longer than 45 minutes may not provide any additional benefit and may unnecessarily prolong the waiting time for the patient.

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  • 17. 

    What is an appropriate hourly maintenance fluid rate for a child weighing 15 kg?

    • A.

      60 ml

    • B.

      50 ml

    • C.

      25 ml

    • D.

      15 ml

    Correct Answer
    B. 50 ml
    Explanation
    An appropriate hourly maintenance fluid rate for a child weighing 15 kg is 50 ml. This is because the maintenance fluid rate is typically calculated based on the child's weight, and a common formula used is 4-2-1. According to this formula, the first 10 kg of body weight requires 4 ml of fluid per kg per hour, the next 10 kg requires 2 ml per kg per hour, and any additional weight requires 1 ml per kg per hour. In this case, the child weighs 15 kg, so the calculation would be: (10 kg x 4 ml) + (5 kg x 2 ml) = 40 ml + 10 ml = 50 ml.

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  • 18. 

    When doing a pedi drug set up, it is recommended to draw up your drugs in ‘unit dose’ syringes.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Drawing up drugs in 'unit dose' syringes during a pedi drug set up is recommended because it ensures accurate dosing and reduces the risk of medication errors. Unit dose syringes contain a pre-measured amount of medication, which eliminates the need for manual calculations and reduces the chances of administering the wrong dose. This practice is particularly important when dealing with pediatric patients who require precise and individualized medication doses based on their weight and age. By using unit dose syringes, healthcare professionals can enhance patient safety and minimize the potential for dosing errors.

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  • 19. 

    What would be an appropriate dose of pre-op versed for a 6 yr old child weighing 24 kg?

    • A.

      24 mg IV

    • B.

      6 mg PO

    • C.

      12 mg PO

    • D.

      48 mg PO

    Correct Answer
    C. 12 mg PO
    Explanation
    An appropriate dose of pre-op versed for a 6-year-old child weighing 24 kg would be 12 mg PO (by mouth). This dosage is determined based on the weight of the child and the route of administration, which in this case is oral. It is important to consider the weight of the child when determining the appropriate dosage to ensure safety and effectiveness of the medication.

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  • 20. 

    How much Ketamine (in dart form) should be given for pre-op sedation of a child weighing 15 kg?

    • A.

      10 mg

    • B.

      5 mg

    • C.

      60 mg

    • D.

      30 mg

    Correct Answer
    D. 30 mg
    Explanation
    The correct answer is 30 mg. Ketamine is a medication used for pre-op sedation in children. The dosage is typically based on the child's weight, with a recommended dose of 1-2 mg/kg. Since the child in this question weighs 15 kg, the appropriate dose would be 15-30 mg. Therefore, the correct answer is 30 mg.

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  • 21. 

    The majority of pediatric cardiac arrests occur when?

    • A.

      Induction

    • B.

      Maintenance

    • C.

      Emergence

    • D.

      Rates are equal during all 3 phases

    Correct Answer
    A. Induction
    Explanation
    Pediatric cardiac arrests mainly occur during the induction phase. This is the initial stage of anesthesia where the patient is being prepared for surgery and anesthesia is administered. During this phase, there are various factors that can contribute to cardiac arrest, such as the administration of medications, airway manipulation, and the stress response to surgery. The maintenance and emergence phases are relatively stable and less likely to result in cardiac arrest. Therefore, the majority of pediatric cardiac arrests occur during the induction phase.

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  • 22. 

    Most pediatric arrests are due to ________ causes in children.

    • A.

      Cardiac

    • B.

      Respiratory

    • C.

      Congenital defects

    • D.

      Circulatory collapse

    Correct Answer
    B. Respiratory
    Explanation
    Most pediatric arrests are due to respiratory causes in children. This is because children have smaller airways compared to adults, making them more susceptible to respiratory issues such as asthma, bronchiolitis, and pneumonia. Additionally, children may not have fully developed respiratory muscles, making it harder for them to breathe during respiratory distress. Respiratory causes can lead to inadequate oxygenation and ventilation, resulting in cardiac arrest if not promptly addressed. Therefore, respiratory causes are the most common reason for pediatric arrests.

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  • 23. 

    What is the most common cause of respiratory arrest in pediatric patients?

    • A.

      Airway Obstruction

    • B.

      Difficult intubation

    • C.

      Laryngospasm

    • D.

      Bronchospasm

    Correct Answer
    C. Laryngospasm
    Explanation
    Laryngospasm is the most common cause of respiratory arrest in pediatric patients. Laryngospasm refers to the sudden closure of the vocal cords, which can obstruct the airway and lead to respiratory distress or arrest. It can be triggered by various factors such as irritation, infection, or aspiration. Prompt recognition and intervention are crucial in managing laryngospasm to prevent further complications and ensure adequate oxygenation.

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  • 24. 

    Which of the following is not a risk factor associated with cardiac arrests in the pediatric patient?

    • A.

      Emergency Surgery

    • B.

      ASA 3-5

    • C.

      Congenital Airway Deformities

    • D.

      Children 1-4 yrs old

    Correct Answer
    D. Children 1-4 yrs old
    Explanation
    Children 1-4 years old are not a risk factor associated with cardiac arrests in pediatric patients. While emergency surgery, ASA 3-5 (American Society of Anesthesiologists physical status classification), and congenital airway deformities are all known risk factors, being in the age range of 1-4 years old does not increase the risk of cardiac arrests in pediatric patients.

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  • 25. 

    You are going to do a pre-op on a 6 yr old patient about to undergo a Left nephrectomy to remove a tumor.You walk into the room and find a very nervous little boy clutching a bear and hiding under the covers, the father also looks very upset and nervous. What should your approach be to do this pre-op?

    • A.

      Approach the parent and attempt to calm him first

    • B.

      Come back later when both are feeling a bit better

    • C.

      Approach the child, and attempt to calm him first.

    • D.

      Give the child some versed.

    Correct Answer
    A. Approach the parent and attempt to calm him first
    Explanation
    In this scenario, the best approach would be to first address the parent's concerns and attempt to calm them down. By doing so, it will create a more relaxed environment for both the child and the parent, which will ultimately help in calming the child as well. It is important to prioritize the emotional well-being of both the child and the parent before proceeding with the pre-op preparations.

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  • 26. 

    A child with a recent URI would be at an increased risk for all of the following except:

    • A.

      Laryngospasm

    • B.

      Pneumonia

    • C.

      Atelectasis

    • D.

      Wheezing

    Correct Answer
    B. Pneumonia
    Explanation
    A child with a recent URI (upper respiratory infection) is at an increased risk for complications such as laryngospasm, atelectasis, and wheezing. This is because the inflammation and mucus production in the upper airways can lead to narrowing or blockage of the air passages, causing these symptoms. However, pneumonia is a lower respiratory tract infection that affects the lungs, and while a URI can sometimes progress to pneumonia, it is not directly associated with a recent URI. Therefore, pneumonia would not be considered an increased risk for a child with a recent URI.

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  • 27. 

    A healthy pediatric patient with no pre-existing congenital anomalies does not need any preop lab tests if the procedure is expected to have minimal blood loss.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    In a healthy pediatric patient with no pre-existing congenital anomalies, preoperative lab tests are not necessary if the procedure is expected to have minimal blood loss. This is because the risk of complications or abnormalities is low in such cases, and the benefits of conducting lab tests may not outweigh the potential harm or discomfort to the patient. However, it is important to note that this answer assumes the patient is otherwise healthy and has no underlying medical conditions that may warrant further evaluation.

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  • 28. 

    You are auscultating heart sounds on a 7 yr old child and hear a short, soft, systolic murmur.  How would you classify this murmur?

    • A.

      Pathologic

    • B.

      Detrimental

    • C.

      Innocent

    • D.

      None of above

    Correct Answer
    C. Innocent
    Explanation
    The given correct answer is "Innocent." In this scenario, the short, soft, systolic murmur heard in a 7-year-old child is likely to be innocent or benign. Innocent murmurs are common in children and are usually harmless. They are often soft, brief, and heard during systole. They are not associated with any structural heart abnormalities or symptoms. It is important to differentiate innocent murmurs from pathologic murmurs that may indicate underlying heart conditions. However, based on the given information, the murmur is most likely innocent.

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  • 29. 

    What pre-op medication would you choose for a 3 week old child, who weighs 4 kg, undergoing  surgery to  correct a pyloric stenosis?

    • A.

      Ketamine 8 mg IM

    • B.

      Versed 0.4 mg IM

    • C.

      Fentanyl lollipop 40 mcg PO

    • D.

      Atropine 0.08 mg IM

    Correct Answer
    D. Atropine 0.08 mg IM
    Explanation
    Atropine is the correct pre-op medication choice for a 3 week old child undergoing surgery to correct pyloric stenosis. Atropine is commonly used to reduce secretions and prevent bradycardia during anesthesia induction. It is administered intramuscularly (IM) and the dosage of 0.08 mg is appropriate for a child of this age and weight. Ketamine and Versed are not typically used in infants of this age, and Fentanyl lollipop is not the preferred route of administration for pre-op medication in this case.

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  • 30. 

    When monitoring the pediatric patient, where should the precordial stethoscope be placed?

    • A.

      Left sternal border 2nd or 3rd intercostals space

    • B.

      Right sterna border 2nd or 3rd intercostals space

    • C.

      Left midclavicular line 5th intercostals space

    • D.

      Depends upon what you are trying to monitor

    Correct Answer
    A. Left sternal border 2nd or 3rd intercostals space
    Explanation
    The correct answer is left sternal border 2nd or 3rd intercostals space. This is the ideal placement for the precordial stethoscope when monitoring a pediatric patient. This location allows for optimal auscultation of the heart sounds and allows the healthcare provider to assess any abnormalities or irregularities in the heart rhythm. Placing the stethoscope in this position ensures accurate and reliable monitoring of the pediatric patient's cardiac status.

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  • 31. 

    You are the SRNA for a 2 week old child undergoing repair of a patent PDA. Which of the following is not true regarding proper monitor placement?

    • A.

      A precordial stethoscope should be used to evaluate heart tone, rate, and murmurs.

    • B.

      O2 sat probe should be placed on the left hand for the procedure

    • C.

      Twitch monitor should be placed along ulnar nerve at the wrist

    • D.

      The only change to ECG monitoring is the use of pediatric ECG leads and changing alarm limits.

    Correct Answer
    B. O2 sat probe should be placed on the left hand for the procedure
    Explanation
    The O2 sat probe should be placed on the right hand for the procedure, not the left hand. This is because the right hand is the standard site for pulse oximetry monitoring in pediatric patients.

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  • 32. 

    The best way to administer an IV fluid bolus to an infant is through use of a pressure bag to administer fluid quickly.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Administering an IV fluid bolus to an infant through the use of a pressure bag is not the best way to do so. Infants have delicate veins that can easily be damaged by the high pressure from a pressure bag. The best way to administer an IV fluid bolus to an infant is by using a syringe pump or a gravity drip system, which allows for a slower and more controlled infusion of fluids.

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  • 33. 

    Which of the following children would likely experience the greatest amount of separation anxiety?

    • A.

      A 4 month old child

    • B.

      An 11 month old child

    • C.

      A 5 yr old child

    • D.

      A 13 yr old child

    Correct Answer
    B. An 11 month old child
    Explanation
    An 11-month-old child would likely experience the greatest amount of separation anxiety because this stage is known as the "stranger anxiety" phase. During this time, infants become more aware of their primary caregivers and may become distressed when separated from them. This is a normal part of their development as they begin to form attachments and understand the concept of object permanence. The other age groups mentioned (4 months, 5 years, and 13 years) are less likely to experience significant separation anxiety compared to an 11-month-old child.

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  • 34. 

    What would be the ideal position for induction of a 4 yr old child who is frightened and refuses to lie flat on the OR table?

    • A.

      Use a couple nurses to make the child lie down and then induce

    • B.

      Stand next to the child, as they sit on the side of the OR table and then apply the mask to induce.

    • C.

      Have the child sit in center of OR table while you sit nearby and wrap your arm around child to induce via mask inhalation.

    • D.

      Use reason, tell the child if they do not lie down you will have to give them a shot instead.

    Correct Answer
    C. Have the child sit in center of OR table while you sit nearby and wrap your arm around child to induce via mask inhalation.
    Explanation
    The ideal position for induction of a frightened 4-year-old child who refuses to lie flat on the OR table would be to have the child sit in the center of the OR table while the healthcare provider sits nearby and wraps their arm around the child. This position allows for close proximity and physical contact, which can provide comfort and reassurance to the child. Inducing via mask inhalation also allows for a non-invasive method of administration, which may be less intimidating for the child compared to other options such as receiving a shot.

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  • 35. 

    For a normal inhalational induction your N2O should be at ______ and your O2 should be at ________ to start out with.

    • A.

      70%, 30%

    • B.

      50%, 50%

    • C.

      40%, 60%

    • D.

      0 %, 100 %

    Correct Answer
    A. 70%, 30%
    Explanation
    For a normal inhalational induction, the correct ratio of N2O to O2 should be 70% N2O and 30% O2. This is because N2O acts as a potent analgesic and anxiolytic, helping to reduce pain and anxiety during the induction process. On the other hand, O2 is necessary to maintain adequate oxygenation and prevent hypoxia. Therefore, a higher concentration of N2O is required compared to O2 for a successful inhalational induction.

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  • 36. 

    What size IV catheter would be best to use on a 3 yr old child?

    • A.

      24

    • B.

      22

    • C.

      20

    • D.

      18

    Correct Answer
    B. 22
    Explanation
    A 22-gauge IV catheter would be best to use on a 3-year-old child. IV catheters are measured by their gauge size, with a smaller gauge indicating a larger diameter. A 22-gauge catheter is smaller in diameter compared to a 24-gauge catheter, making it more suitable for a young child. It allows for a more comfortable insertion and reduces the risk of complications such as infiltration or phlebitis. A larger gauge catheter, such as 20 or 18, may cause unnecessary discomfort and potential complications for a child of this age.

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  • 37. 

    During an inhalational induction, once your pediatric patient is tubed your first priority should be…

    • A.

      Inserting the precordial stethoscope

    • B.

      Applying nerve monitor to assess paralysis

    • C.

      Starting an IV

    • D.

      Turning up the sevo higher

    Correct Answer
    C. Starting an IV
    Explanation
    Starting an IV is the first priority during an inhalational induction in a pediatric patient after intubation. This is because an IV provides access to administer medications, fluids, and emergency drugs if needed. It also allows for the administration of anesthesia and other necessary interventions during the procedure. Starting an IV early ensures that the patient has a secure and reliable route for medication administration and fluid management throughout the induction process.

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  • 38. 

    Which of the following is incorrect regarding maintenance of survival position?

    • A.

      The jaw and chin should be rotated downward to further open the airway

    • B.

      Using tips of your fingers, jaw thrust should be applied bilaterally

    • C.

      Fingers should be placed on bony prominence of face

    • D.

      Downward pressure should not be applies to mask, instead lift jaw up to form tight seal

    Correct Answer
    D. Downward pressure should not be applies to mask, instead lift jaw up to form tight seal
    Explanation
    The correct answer is "Downward pressure should not be applied to the mask, instead lift the jaw up to form a tight seal." This is incorrect because when performing maintenance of the survival position, downward pressure should be applied to the mask to ensure a tight seal. This helps in maintaining an open airway and ensuring effective respiration.

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  • 39. 

    You are the SRNA for a 6 yr old child coming in from the ER for an emergent appendectomy. Which of the following is the best choice for induction?  

    • A.

      Inhalational induction as patient Is not likely to cooperate with IV placement

    • B.

      IV must be placed prior to procedure for safe induction.

    • C.

      IM induction with ketamine

    • D.

      None of above are appropriate

    Correct Answer
    B. IV must be placed prior to procedure for safe induction.
    Explanation
    The best choice for induction in this scenario is to place an IV prior to the procedure for safe induction. This is because an emergent appendectomy requires a reliable and immediate access to administer medications and fluids during the surgery. Inhalational induction may not be feasible as the patient is not likely to cooperate with IV placement, and IM induction with ketamine may not provide the necessary level of control and safety during the procedure. Therefore, the safest option is to ensure IV access before induction.

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  • 40. 

    The first step in the pediatric RSI sequence is….

    • A.

      Preoxygenation with spontaneous ventilation

    • B.

      Application of cricoids pressure

    • C.

      Pretreatment with atropine

    • D.

      Delivery of induction agent

    Correct Answer
    C. Pretreatment with atropine
    Explanation
    Pretreatment with atropine is the first step in the pediatric RSI sequence. Atropine is administered to children to prevent bradycardia, which can occur during intubation due to stimulation of the vagus nerve. By administering atropine before the induction agent, the risk of bradycardia is minimized, ensuring a safer intubation procedure. Preoxygenation with spontaneous ventilation, application of cricoids pressure, and delivery of the induction agent are important steps in the RSI sequence, but they occur after pretreatment with atropine.

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  • 41. 

    What would be an appropriate IM stun dose ketamine for a 14 yr old boy weighing 40 kg?

    • A.

      320 mg

    • B.

      200 mg

    • C.

      160 mg

    • D.

      80 mg

    Correct Answer
    D. 80 mg
    Explanation
    An appropriate IM stun dose of ketamine for a 14-year-old boy weighing 40 kg would be 80 mg. This dose is determined based on the weight of the individual and is considered suitable for achieving the desired effect.

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  • 42. 

    The MAC for all anesthetic agents are highest at what age?

    • A.

      6-12 months

    • B.

      4-6 yrs

    • C.

      1-4 yrs

    • D.

      0-6 months

    Correct Answer
    A. 6-12 months
    Explanation
    The correct answer is 6-12 months. During this age range, the MAC (minimum alveolar concentration) for anesthetic agents is highest. MAC refers to the concentration of anesthetic required to prevent movement in response to a painful stimulus in 50% of patients. This suggests that infants between 6-12 months require a higher concentration of anesthetic agents to achieve the desired effect compared to other age groups.

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  • 43. 

    Which of the following inhalational anesthetic agents may cause bradycardia, vasodilation and myocardial depression in infants?

    • A.

      Desflurane

    • B.

      Isoflurane

    • C.

      Sevoflurane

    • D.

      Opioids

    Correct Answer
    B. Isoflurane
    Explanation
    Isoflurane is known to cause bradycardia, vasodilation, and myocardial depression in infants. This is because it has a direct negative inotropic effect on the heart, causing a decrease in cardiac contractility. Additionally, it can cause vasodilation, leading to a decrease in systemic vascular resistance and blood pressure. These effects are more pronounced in infants compared to adults, making isoflurane a potential risk for cardiovascular depression in this population.

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  • 44. 

    Which of the inhalational agents had the highest incidence of  emergence delirum?

    • A.

      Sevoflurane

    • B.

      Isoflurane

    • C.

      Desflurane

    • D.

      Halothane

    Correct Answer
    C. Desflurane
    Explanation
    Desflurane has the highest incidence of emergence delirium among the given inhalational agents. Emergence delirium is a common side effect of anesthesia, characterized by confusion, agitation, and disorientation upon awakening from anesthesia. Desflurane is known to have a faster onset and offset of action compared to other inhalational agents, which may contribute to a higher incidence of emergence delirium. Additionally, Desflurane has a pungent odor and irritates the airway, which can further increase the risk of delirium.

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  • 45. 

    You are the nurse for a premature child who was born at full term. The child is now 10 weeks old and doing very well. The child is having a minor procedure and was maintained with fentanyl 2mcg/kg and 0.5 MAC  Isoflurane. The childs mother wants to know when the child can come home. What do you tell her?

    • A.

      As soon as I wheel her out of the OR you can take her!

    • B.

      We will watch her in the PACU for 2-3 hours after the procedure and then she may go home.

    • C.

      We will keep her for 48-72 hours just to monitor her for safety.

    • D.

      We will most likely keep her overnight on a pulse oximeter just to watch her.

    Correct Answer
    D. We will most likely keep her overnight on a pulse oximeter just to watch her.
    Explanation
    The correct answer is "We will most likely keep her overnight on a pulse oximeter just to watch her." This answer is the most appropriate because it ensures the safety and well-being of the premature child after the minor procedure. Monitoring the child overnight on a pulse oximeter allows for continuous monitoring of oxygen levels, which is important for premature infants who may be more susceptible to respiratory issues. This precautionary measure helps to ensure that any potential complications can be identified and addressed promptly before allowing the child to go home.

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  • 46. 

    High dose opioid therapy during maintenance of anesthesia may be appropriate for which of the following?

    • A.

      Child with cardiac instability who requires surgical intervention

    • B.

      Pt who will be extubated after surgery and requires pain control

    • C.

      A healthy 2 yr old who is no longer at risk for post-op apnea

    • D.

      A child with respiratory insufficiency who may not have sufficient gas exchange for inhalational agents.

    Correct Answer
    A. Child with cardiac instability who requires surgical intervention
    Explanation
    High dose opioid therapy during maintenance of anesthesia may be appropriate for a child with cardiac instability who requires surgical intervention. Opioids can provide effective analgesia and help stabilize hemodynamics in this patient population. The high dose may be necessary to adequately control pain and prevent further cardiovascular instability during the procedure. However, it is important to carefully monitor the patient's respiratory status and titrate the dose to avoid respiratory depression.

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  • 47. 

    Which of the following children is the best candidate for a deep extubation?

    • A.

      An 18 month old child who just had a minor procedure, no past HX and spontaneous ventilation for whole case.

    • B.

      A 9 yr old healthy child with asthma (no attacks in one year and no wheezes) having a minor elective procedure, spontaneous ventilation maintained throughout procedure

    • C.

      An 5 yr old healthy child with no medical history, needed paralysis during procedure but has now been fully reversed.

    • D.

      A 7 yr old child who came for emergent appendectomy

    Correct Answer
    B. A 9 yr old healthy child with asthma (no attacks in one year and no wheezes) having a minor elective procedure, spontaneous ventilation maintained throughout procedure
    Explanation
    The 9-year-old healthy child with asthma is the best candidate for a deep extubation because they have not had any asthma attacks in one year and do not currently have wheezes. This indicates that their asthma is well-controlled and stable. Additionally, the child is undergoing a minor elective procedure and has maintained spontaneous ventilation throughout the procedure, suggesting that they have good respiratory function. These factors make them a suitable candidate for a deep extubation, where the endotracheal tube is removed while the patient is still anesthetized.

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  • 48. 

    Which of the following properly describes the Sundown Sign?

    • A.

      When toddlers become confused at night and start climbing out of bed.

    • B.

      A sign commonly seen in pts with a PPFO where the pt will turn blue (sundown) while coughing or bucking and creating a temporary shunt.

    • C.

      Contraction of the inferior rectus muscle of the eye causing the eyeball to look downward toward the toes.

    • D.

      Just before waking up when the child begins to move and both feet point down as their back arches upward due to stimulation from ETT.

    Correct Answer
    C. Contraction of the inferior rectus muscle of the eye causing the eyeball to look downward toward the toes.
    Explanation
    The Sundown Sign refers to the contraction of the inferior rectus muscle of the eye, which causes the eyeball to look downward toward the toes. This term is used to describe this specific eye movement.

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  • 49. 

    You are the SRNA for 22 month old Collin who is about to be extubated. During emergence he starts to vigorously cough and then becomes cyanotic. You have 100% O2, and make sure he is not hypoventilating. You suction his airway to check form any obstruction and find there is no obstruction, yet little Collin still remains blue. What is wrong?

    • A.

      Laryngospasm

    • B.

      Bronchospasm

    • C.

      Pulmonary Hypertension

    • D.

      PPFO

    Correct Answer
    D. PPFO
  • 50. 

    Which of the following is not helpful in preventing laryngospasm?

    • A.

      Suction secretions immediately after extubation

    • B.

      Extubate deep

    • C.

      Extubate totally awake

    • D.

      Immediately after extubation, stretch the larynx

    Correct Answer
    A. Suction secretions immediately after extubation
    Explanation
    Suctioning secretions immediately after extubation is not helpful in preventing laryngospasm. Laryngospasm is a condition where the vocal cords spasm and close off the airway, leading to difficulty in breathing. Suctioning secretions may irritate the larynx and trigger laryngospasm. The other options, such as extubating deep, extubating totally awake, and stretching the larynx immediately after extubation, are helpful in preventing laryngospasm as they promote a smooth and safe extubation process.

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