Chapter 42 - Neonatal Care

35. If hypovolemia is suspected or confirmed, you should administer ____ mL of normal saline to a 6-pound newborn over a period of ____. A) 18, 10 to 20 minutes B) 27, 5 to 10 minutes C) 33, 10 to 20 minutes D) 55, 5 to 10 minutes

B) 27, 5 to 10 minutes

70. Your assessment of a depressed 7-pound newborn reveals tachypnea, pallor, weak peripheral pulses, a heart rate of 120 beats/min, and a blood glucose level of 58 mg/dL. Which of the following interventions will MOST likely cause improvement in this newborn's condition? A) 0.3 mg of naloxone B) 32 mL of normal saline C) 6.5 mL of 10% dextrose D) 0.06 mg of epinephrine

B) 32 mL of normal saline

5. A newborn born between ___ and ___ weeks of gestation is described as term. A) 36, 38 B) 38, 42 C) 40, 42 D) 42, 44

B) 38, 42

29. Chest compressions are indicated in the newborn if its heart rate remains less than ____ beats/min despite effective positive-pressure ventilations for ____ seconds. A) 80, 30 B) 60, 30 C) 60, 60 D) 80, 60

B) 60, 30

53. Which of the following factors is associated with the HIGHEST risk of newborn hypoglycemia? A) Neonatal polycythemia B) Morbid obesity in the mother C) The larger of discordant twins D) 5-minute Apgar score of less than 7

B) Morbid obesity in the mother

17. An oropharyngeal airway would MOST likely be indicated for a newborn with: A) gasping respirations. B) Pierre Robin sequence. C) a diaphragmatic hernia. D) prolonged periods of apnea.

B) Pierre Robin sequence.

1. Which of the following is NOT an antepartum risk factor that increases the potential that a newborn may require resuscitation? A) Preeclampsia B) Prolapsed cord C) Polyhydramnios D) Multiple gestations

B) Prolapsed cord

27. Signs of a diaphragmatic hernia include all of the following, EXCEPT: A) a scaphoid or concave abdomen. B) bilaterally absent breath sounds. C) noted increased work of breathing. D) audible bowel sounds in the chest.

B) bilaterally absent breath sounds

12. The initial steps of newborn resuscitation include: A) free-flow oxygen. B) proper positioning. C) assessment of pulse rate. D) positive-pressure ventilation.

B) proper positioning.

42. Respiratory distress in a premature infant is MOST often the result of: A) a pneumothorax. B) surfactant deficiency. C) pneumonia at birth. D) intracranial hemorrhage

B) surfactant deficiency

7. While preparing equipment for newborn resuscitation, which of the following items is/are NOT considered optional? A) Pulse oximeter B) Cardiac monitor C) Endotracheal tubes D) Laryngeal mask airway

C) Endotracheal tubes

55. Which of the following disorders or conditions is related to decreased glycogen stores in the newborn? A) Large for gestational age B) Hypoxia or hypothermia C) Small for gestational age D) Maternal diabetes mellitus

C) Small for gestational age

4. Causes of delayed fetal transition include all of the following, EXCEPT: A) acidosis. B) hypothermia. C) birth at 41 weeks. D) meconium aspiration.

C) birth at 41 weeks.

16. Choanal atresia is defined as a: A) small chin that causes a posteriorly positioned tongue. B) condition in which high-flow oxygen causes blindness. C) bony or membranous obstruction of the back of the nose. D) condition in which the occipital skull is abnormally large.

C) bony or membranous obstruction of the nose

15. A newborn with central cyanosis, adequate respirations, and a heart rate of 120 beats/min should initially be treated with: A) continued observation only. B) high-flow oxygen via mask. C) free-flow oxygen at 5 L/min. D) positive-pressure ventilation.

C) free-flow oxygen at 5 L/min.

34. Signs of hypovolemia in the newborn include all of the following, EXCEPT: A) persistent pallor. B) weak central pulses. C) persistent acrocyanosis. D) persistent bradycardia.

C) persistent acrocyanosis

33. The recommended IV dose and concentration of epinephrine for the newborn is: A) 0.01 mg/kg, 1:1,000. B) 0.3 to 1 mL/kg, 1:10,000. C) 0.01 to 0.03 mg/kg, 1:1,000. D) 0.1 to 0.3 mL/kg, 1:10,000.

D) 0.1 to 0.3 mL/kg, 1:10,000

13. If you feel 13 pulsations in a 6-second time frame, the newborn's heart rate is approximately: A) 30 beats/min. B) 60 beats/min. C) 90 beats/min. D) 130 beats/min.

D) 130 beats/min.

43. In which of the following situations would a newborn MOST likely experience a seizure? A) Hyperglycemia B) Post-term gestation C) Maternal aspirin use D) 33 weeks' gestation

D) 33 weeks' gestation

22. The correct positive-pressure ventilation rate for an apneic newborn is: A) 12 to 20 breaths/min. B) 20 to 30 breaths/min. C) 30 to 40 breaths/min. D) 40 to 60 breaths/min.

D) 40 to 60 breaths/min

10. An infant born with a pink body and blue extremities, a pulse rate of 90 beats/min, a strong cry, and active movement should be assigned an initial Apgar score of: A) 5. B) 6. C) 7. D) 8.

D) 8.

68. You and your partner are caring for a 5-pound distressed newborn. After providing 30 seconds of effective bag-mask ventilations, the newborn's heart rate remains below 60 beats/min. You should: A) cannulate the umbilical vein and give 0.5 mL of epinephrine. B) try tactile stimulation as you continue bag-mask ventilations. C) start a peripheral IV line and give 4 mEq of sodium bicarbonate. D) continue bag-mask ventilations and initiate chest compressions.

D) continue bag-mask ventilations and initiate chest compressions

69. During the delivery of a post-term baby, you note the presence of particulate meconium in the amniotic fluid. Your post-delivery assessment of the newborn reveals that it is active, has a strong cry, and has a heart rate of 110 beats/min. You should: A) deliver free-flow oxygen at 5 L/min while performing deep oropharyngeal suctioning with a bulb syringe aspirator. B) avoid any form of tactile stimulation, perform laryngoscopy, and suction meconium from the trachea with an ET tube. C) preoxygenate the newborn with bag-mask ventilations for 30 seconds and then perform endotracheal intubation. D) ensure that the infant is warm and dry, administer free-flow oxygen if needed, and provide continuous monitoring.

D) ensure that the infant is warm and dry, administer free-flow oxygen if needed, and provide continuous monitoring.

51. Severely hypothermic newborns may present with sclerema, which is defined as: A) a yellow or orange tint to the white portion of the eyes. B) spontaneous bleeding due to blood-clotting abnormalities. C) an inability to shiver due to an immature immune system. D) hardening of the skin associated with reddening and edema.

D) hardening of the skin associated with reddening and edema.

39. A newborn is at GREATEST risk for meconium aspiration if he or she: A) is large for his or her gestational age. B) requires positive-pressure ventilations. C) has respiratory depression at the time of birth. D) is born at more than 42 weeks' gestation.

D) is born at more than 42 weeks' gestation.

28. After inserting an orogastric tube in a newborn, you should: A) leave the 20-mL syringe attached. B) perform intubation within 2 minutes. C) connect the tube to continuous suction. D) leave the tube open to allow air to vent.

D) leave the tube open to allow air to vent.

48. The primary source of heat production in the newborn is: A) shivering. B) hyperventilation. C) peripheral vasoconstriction. D) nonshivering thermogenesis.

D) nonshivering thermogenesis

60. During transport of a newborn, timely intervention of acute deterioration is MOST effectively achieved by: A) ensuring placement of at least one IV line. B) reassessing vital signs every 5 to 10 minutes. C) cardiac monitoring and the use of capnography. D) ongoing observation and frequent reassessment

D) ongoing observation and frequent reassessment

64. During your rapid assessment of a newborn's cardiopulmonary status, you note that its respirations are adequate, you feel 8 pulsations in a 6-second time frame, and the newborn is centrally pink but peripherally cyanotic. The MOST appropriate next action should be to: A) provide 30 seconds of tactile stimulation. B) administer positive-pressure ventilations. C) assess the newborn's blood glucose level. D) give free-flow oxygen by mask at 5 L/min.

B) administer positive-pressure ventilations.

58. Nearly half of all birth-related injuries: A) result in varying degrees of central nervous system dysfunction. B) are potentially avoidable with anticipation of obstetric risk factors. C) cause death of the newborn secondary to prolonged cerebral anoxia. D) are associated with negligence on the part of the health care provider.

B) are potentially avoidable with anticipation of obstetric risk factors

3. Which of the following events is a critical part of fetal transition? A) Diversion of blood flow to the fetus's lungs B) An acute increase in intrapulmonary pressure C) Fetal lung expansion within 5 minutes after birth D) Blood flow diversion across the ductus arteriosis

A) Diversion of blood flow to the fetus's lungs

8. Which of the following statements regarding the Apgar score is correct? A) If resuscitation is necessary, the Apgar score is completed to determine the result of the resuscitation. B) The Apgar score is determined on the basis of the newborn's condition at 2 and 10 minutes after birth. C) If resuscitation is needed, it should commence immediately after you obtain the 1-minute Apgar score. D) A newborn with a heart rate of greater than 80 beats/min would be assigned a score of 2 on the Apgar score.

A) If resuscitation is necessary, the Apgar score is completed to determine the result of the resuscitation.

14. The MOST common etiology for bradycardia in a newborn is: A) severe hypoxia. B) untreated acidosis. C) occult hypovolemia. D) increased vagal tone

A) severe hypoxia.

46. The single MOST common cause of seizures in both term and preterm infants is: A) intracranial hemorrhaging. B) hypoxic ischemic encephalopathy. C) congenital or developmental defects. D) a severe derangement in electrolytes

B) hypoxic ischemic encephalopathy.

40. In contrast to primary apnea, secondary apnea: A) is characterized by profound tachycardia. B) commonly follows a brief period of hypoxia. C) is usually unresponsive to stimulation alone. D) necessitates immediate endotracheal intubation.

C) is usually unresponsive to stimulation alone.

21. Compared to subsequent breaths, the first few positive-pressure breaths delivered to a distressed newborn: A) should provide a volume equal to 40 to 45 mm Hg. B) should make the chest rise significantly. C) may necessitate manual disabling of the pop-off valve. D) generally require a significantly lower volume of air.

C) may necessitate manual disabling of the pop-off valve.

9. According to the Apgar score, a newborn with a heart rate of 80 beats/min and slow, irregular breathing should receive a combined score of: A) 2. B) 3. C) 4. D) 5.

A) 2.

54. Newborn hypoglycemia is defined as a blood glucose level lower than: A) 45 mg/dL. B) 50 mg/dL. C) 55 mg/dL. D) 60 mg/dL.

A) 45 mg/dL

56. What dose and concentration of glucose would be MOST appropriate for a 6-pound hypoglycemic newborn? A) 5.5 mL of 10% dextrose (D10) B) 6 mL of 25% dextrose (D25) C) 6.5 mL of 10% dextrose (D10) D) 7.5 mL of 25% dextrose (D25)

A) 5.5 mL of 10% dextrose (D10)

25. What size and type of laryngoscope blade is recommended for use in a full-term newborn? A) No. 1, straight B) No. 2, straight C) No. 1, curved D) No. 2, curved

A) No. 1, straight

45. What type of seizure is MOST common in premature infants? A) Tonic seizure B) Subtle seizure C) Myoclonic seizure D) Focal clonic seizure

A) Tonic seizure

74. Which of the following congenital defects results in an undersized or absent right ventricle? A) Tricuspid atresia B) Pulmonary stenosis C) Tetralogy of Fallot D) Atrial septal defect

A) Tricuspid atresia

38. A shift of heart tones and severe respiratory distress despite positive-pressure ventilations is indicative of: A) a pneumothorax. B) a diaphragmatic hernia. C) Pierre Robin sequence. D) a pericardial tamponade.

A) a pneumothorax

20. Common causes of respiratory distress in the newborn include: A) mucous obstruction of the nose. B) unrecognized metabolic alkalosis. C) persistent pulmonary hypotension. D) maternal use of a narcotic analgesic

A) mucous obstruction of the nose

50. When fever is suspected in the newborn, you should: A) observe for the presence of a rash. B) assist ventilations with a bag-mask device. C) administer acetaminophen or ibuprofen. D) quickly lower the newborn's body temperature.

A) observe for the presence of a rash

36. How much naloxone should you give to a 6.5-pound newborn with respiratory depression secondary to maternal narcotic administration? A) 0.3 mg B) 0.4 mg C) 0.5 mg D) 0.6 mg

A) 0.3 mg

66. You are transporting a newborn who requires ongoing ventilatory support and chest compressions for severe bradycardia. Your estimated time of arrival at the hospital is 45 minutes. Air medical transport was unavailable due to severe weather in the vicinity. A peripheral IV line has been established in the antecubital vein and you are in the process of attempting intubation. Approximately 10 seconds into your intubation attempt, the newborn's heart rate suddenly drops more. You should: A) abort the intubation attempt and continue ventilations. B) continue the intubation attempt and administer atropine. C) administer 0.1 to 0.3 mL/kg of epinephrine rapid IV push. D) ensure that chest compressions are of adequate rate and depth.

A) abort the intubation attempt and continue ventilations.

31. If a newborn requires epinephrine and peripheral venous access is unsuccessful, you should: A) cannulate the umbilical vein. B) insert an IO catheter. C) perform intubation immediately. D) inject the drug directly into a vein.

A) cannulate the umbilical vein

30. When performing chest compressions on a newborn, you should: A) compress the chest one third the anteroposterior depth of the chest. B) use the two-finger compression technique if two rescuers are present. C) reassess the newborn's heart rate after every 60 seconds of compressions. D) deliver 120 compressions and 40 ventilations during any 60-second period.

A) compress the chest one third the anteroposterior depth of the chest.

71. An untreated patent ductus arteriosus may cause subsequent development of: A) congestive heart failure. B) ventricular septal defect. C) pulmonary stenosis. D) a patent foramen ovale.

A) congestive heart failure

44. A subtle seizure in the newborn is characterized by: A) eye deviation. B) repetitive jerking. C) flexion of the arms. D) tonic limb extension.

A) eye deviation

62. During your assessment of a 30-year-old woman in active labor, she admits to being a chronic heroin abuser and states that she last "shot up" about 6 hours ago. After the baby delivers, you will MOST likely need to: A) give positive-pressure ventilations. B) administer 0.1 mg/kg of naloxone. C) suction meconium from its airway. D) administer free-flow oxygen by mask.

A) give positive-pressure ventilations

52. The quickest way to prevent newborn hypothermia involves: A) administering warmed IV fluids. B) thoroughly drying the newborn after birth. C) applying a hot water bottle to the groin area. D) administering warmed, humidified oxygen.

B) thoroughly drying the newborn after birth

65. After performing the initial steps of resuscitation, you assess a newborn and note that its respirations are poor and its pulse rate is 50 beats/min. You should: A) immediately begin positive-pressure ventilations and chest compressions and then reassess the newborn's pulse rate in 30 seconds. B) begin chest compressions if the heart rate remains below 60 beats/min after 30 seconds of effective positive-pressure ventilation. C) begin chest compressions, insert an endotracheal tube, and administer 0.1 to 0.3 mL/kg of epinephrine 1:10,000 down the endotracheal tube. D) perform tactile stimulation for 30 seconds, reassess the infant's respirations and pulse rate, and begin positive-pressure ventilations if there is no improvement.

B) begin chest compressions if the heart rate remains below 60 beats/min after 30 seconds of effective positive-pressure ventilation.

23. The MOST common reasons for ineffective bag-mask ventilations in the newborn are: A) equipment malfunction and a ventilation rate that is too rapid. B) inadequate mask-to-face seal and incorrect head position. C) hyperflexion of the newborn's head and thick mucous plugs. D) pneumothorax and a face mask that is too large for the infant.

B) inadequate mask-to-face seal and incorrect head position.

24. Endotracheal intubation is clearly indicated in the newborn if: A) its heart rate is improving, but only because of adequate ventilations and chest compressions. B) meconium is present in the amniotic fluid and the newborn is limp and has a heart rate of 70 beats/min. C) central cyanosis is persistent despite the administration of free-flow oxygen for 30 to 45 seconds. D) a small, 27-gauge IV line is present and epinephrine is required to treat refractory bradycardia.

B) meconium is present in the amniotic fluid and the newborn is limp and has a heart rate of 70 beats/min

11. If a newborn does not respond to the initial steps of resuscitation, the need for further intervention is based upon: A) pulse rate, activity, and appearance. B) respiratory effort, pulse rate, and color. C) appearance, skin color, and muscle tone. D) respirations, appearance, and muscle tone.

B) respiratory effort, pulse rate, and color.

19. The MOST common device used to provide positive-pressure ventilation to a newborn in the prehospital setting is a: A) T-piece resuscitator. B) self-inflating bag-mask device. C) flow-inflating bag-mask device. D) manually triggered ventilator.

B) self-inflating bag-mask device

59. Caput succedaneum is defined as: A) bilateral temporal bone fractures caused by a delivery that includes the use of forceps. B) temporary swelling of the soft tissue of the baby's scalp secondary to pressure from the dilating cervix. C) an area of bleeding between the parietal bone and its covering periosteum that resolves in 1 to 2 months. D) permanent cranial disfigurement caused by vaginal delivery in a woman with cephalopelvic disproportion.

B) temporary swelling of the soft tissue of the baby's scalp secondary to pressure from the dilating cervix.

75. Total anomalous pulmonary venous return is a rare congenital defect in which: A) pressure in the lungs causes pulmonary hypertension. B) the four pulmonary veins connect to the right atrium. C) venous blood mixes with arterial blood in the heart. D) blood returns to the lungs after being reoxygenated.

B) the four pulmonary veins connect to the right atrium.

37. Naloxone is NOT recommended for use in newborns: A) who weigh less than 5.5 lbs. B) who are born to narcotic-addicted mothers. C) unless the umbilical vein has been cannulated. D) with shallow breathing and persistent bradycardia.

B) who are born to narcotic-addicted mothers.

32. Epinephrine is indicated during newborn resuscitation if: A) the heart rate does not increase above 80 beats/min after 30 to 60 seconds of effective positive-pressure ventilation. B) the newborn is bradycardic and thick secretions are hindering your ability to provide effective positive-pressure ventilations. C) the heart rate remains below 60 beats/min after 30 seconds of effective ventilation and an additional 30 seconds of chest compressions. D) profound central cyanosis persists despite 30 seconds of effective positive-pressure ventilation with 100% supplemental oxygen.

C) the heart rate remains below 60 beats/min after 30 seconds of effective ventilation and an additional 30 seconds of chest compressions.

49. Which of the following statements regarding fever in the newborn is correct? A) Fever in newborns is defined as a rectal temperature greater than 99.0°F. B) The ability of the newborn to dissipate heat through sweating is prominent. C) Fever may not always be a presenting feature in newborns with an infection. D) Because of their active immune systems, newborns commonly experience fever.

C) Fever may not always be a presenting feature in newborns with an infection

47. Which of the following anticonvulsant medications would MOST likely be administered to a newborn with seizures in the prehospital setting? A) Dilantin B) Depakote C) Lorazepam D) Phenobarbital

C) Lorazepam

72. When an atrial septal defect is present: A) blood flow to the lungs is significantly decreased, which leads to severe hypoxemia. B) the heart must push harder to force blood flow past a narrowed aorta, resulting in increased afterload. C) deoxygenated blood is able to shift from one atrium to the other and mix with oxygen-rich blood. D) blood is allowed to bypass the right ventricle and lungs due to the fetus's lungs being filled with fluid.

C) deoxygenated blood is able to shift from one atrium to the other and mix with oxygen-rich blood

67. You have been providing bag-mask ventilation to a newborn with a sustained heart rate of 75 beats/min for approximately 5 minutes. The infant's abdomen is markedly distended. Although you are properly trained, your protocols do not allow you to intubate newborns. The MOST appropriate intervention involves: A) intubating immediately. B) suctioning the oropharynx. C) inserting an orogastric tube. D) manual gastric decompression.

C) inserting an orogastric tube.

26. When suctioning the newborn's oropharynx to clear secretions prior to intubation, it is MOST important to: A) limit suctioning to 15 seconds. B) use a flexible suction catheter. C) monitor the newborn's heart rate. D) assess pulse oximetry and capnography.

C) monitor the newborn's heart rate.

41. Mortality and morbidity are high among infants who are delivered at 24 weeks' gestation, usually because of: A) congenital heart defects. B) infection and hypothermia. C) respiratory and neurologic problems. D) metabolic and immune deficiencies.

C) respiratory and neurologic problems

61. You are assisting in the delivery of a baby. After the baby's head emerges from the vagina, you should quickly assess for the presence of a nuchal cord and then: A) assess for facial cyanosis. B) administer free-flow oxygen. C) suction its mouth and nose. D) dry its face to stimulate breathing.

C) suction its mouth and nose.

63. You have just delivered a little girl who was born 4 weeks premature. There is no evidence of meconium in the amniotic fluid. After drying, warming, suctioning, positioning, and stimulating the infant, she remains acrocyanotic and is not crying. You should: A) determine the newborn's Apgar score. B) begin assisting her ventilations at once. C) resuction her mouth for up to 10 seconds. D) open her airway and assess respirations.

D) open her airway and assess respirations

6. A delay in clamping the umbilical cord and keeping the baby below the level of the placenta can result in fetal: A) anemia. B) hypovolemia. C) exsanguination. D) polycythemia.

D) polycythemia.

57. In addition to an IV dextrose bolus, the MOST important treatment for newborn hypoglycemia is: A) IV fluid boluses. B) assisted ventilation. C) a 25% dextrose infusion. D) proper thermal management.

D) proper thermal management

18. A newborn with a pulse rate of 80 beats/min: A) requires ventilations and chest compressions. B) should be treated with 0.02 mg/kg of atropine. C) is likely under the influence of maternal opiates. D) requires immediate positive-pressure ventilation.

D) requires immediate positive-pressure ventilation

73. Tetralogy of Fallot is a combination of four heart defects, including: A) atrial septal defect. B) coarctation of the aorta. C) tricuspid atresia. D) right ventricular hypertrophy.

D) right ventricular hypertrophy

2. The risk of newborn complications is HIGHEST if the amniotic sac: A) encases the baby's face at birth. B) is still intact at the time of birth. C) contains thin, brown amniotic fluid. D) ruptured more than 18 hours before birth.

D) ruptured more than 18 hours before birth.