Neonatal Nurse Practitioner Practice Exam

In the case of a 30-week gestational age neonate with diminished air entry after intubation, what should the nurse consider?

1. The tube is plugged

2. The tube is too high

3. The tube is too low

4. The airway is obstructed

The correct answer is: The tube is too high

In the scenario of a 30-week gestational age neonate experiencing diminished air entry after intubation, considering that the tube may be positioned too high is crucial for determining potential causes of inadequate ventilation. When the endotracheal tube is inserted too high, it may not adequately enter the trachea, leading to improper ventilation of the lungs. This can occur if the tube is accidentally placed in the upper airway structures, such as the esophagus or the hypopharynx, rather than the trachea. In neonates, particularly those born preterm, the anatomical structures can be quite small and pliable, making it easier for misplacement to happen. In this context, diminished air entry suggests that not enough air is reaching the lower lungs, potentially due to the tube being positioned above the area where effective gas exchange occurs. Moreover, if the tube were actually obstructed or placed too low, one would expect different signs: obstruction typically presents with stridor or increased work of breathing, and a tube that is too low might still allow air entry but could lead to complications such as right mainstem intubation. This understanding underscores the importance of proper tube placement confirmed through clinical assessment and monitoring of breath sounds and chest