14-15

An infant born at an estimated 25 weeks' gestation who is now 56 weeks corrected postconceptual age remains mechanically ventilated in synchronous intermittent mechanically ventilation mode. The chest radiograph is consistent with severe bronchopulmonary dysplasia. The ventilator settings most appropriate for this infant would include a(n): A:inspiratory time of 0.3 seconds. B:respiratory rate of 50 breaths/minute. C:inspired oxygen fraction (FiO2) of 0.21 with a corresponding Pao2 of 30. D:peak end-expiratory pressure of 4 cm H2O.

Correct:A Short inspiratory times allow for longer expiratory times. In bronchopulmonary dysplasia (BPD), expiration is prolonged.

The most common cyanotic heart lesion at birth is: A:tetralogy of Fallot. B:aortic stenosis. C:atrial septal defect. D:pulmonary atresia.

Correct:A Tetralogy of Fallot is a cyanotic lesion and occurs 1 per 5000 births and accounts for 10% of all defects.

What is the targeted preductal SpO2 at 1 minute after birth for uncomplicated infants born at term? A:60% to 65% B:65% to 70% C:75% to 80% D:85% to 95%

Correct:A The 1-minute targeted preductal Sp O2 is 60% to 65%.

An infant is diagnosed with transposition of the great arteries. The nurse should expect chest radiograph findings to reveal which type of cardiac silhouette? A:Egg on a string B:Wall to wall heart C:Boot shaped D:Egg in a basket

Correct:A The aorta is anterior to the main pulmonary artery in transposition of the great arteries, producing a narrow mediastinum or the appearance of an "egg on a string."

A characteristic radiographic finding of a pneumomediastinum is: A:the "sail sign." B:a mediastinal shift toward the unaffected side. C:decreased heart size. D:the liver is clearly defined from the anterior abdominal wall on a right lateral view.

Correct:A The classic radiographic sign of a pneumomediastinum is the "sail sign," which results from free air lifting the thymus.

The nurse should utilize which of the following parameters to select the appropriate sized blood pressure cuff? A:25% greater than the width of the extremity B:50% greater than the width of the extremity C:The same width as the extremity D:75% greater than the width of the extremity

Correct:A The cuff width should be 25% greater than the width of the extremity. The blood pressure reading will be falsely elevated if the cuff is too narrow and falsely low if the cuff is too large.

In which phase of fetal lung development would the nurse expect distal pulmonary vasculature and capillary networks to develop? A:Canalicular B:Embryonic C:Pseudoglandular D:Alveolar expansion

Correct:A The development of vascular structures to supply air spaces occurs during the canalicular phase.

An experienced nurse is orienting a new NICU bedside nurse whose assignment includes a 40-day-old, former 25-week-gestation infant diagnosed with bronchopulmonary dysplasia (BPD). Which of the following explanations about BPD is most accurate? A:BPD is characterized by altered lung development with decreased numbers of alveoli and abnormal blood vessel development. B:The cause of BPD is oxygen toxicity. C:BPD occurs only in preterm infants with severe respiratory distress syndrome. D:BPD results from lung damage cause by mechanical ventilation.

Correct:A The newer description of bronchopulmonary dysplasia (BPD) is that BPD is characterized by altered lung development with decreased numbers of alveoli and abnormal blood vessel development as opposed to lung damage.

Which of the following statements regarding extracorporeal membrane oxygenation (ECMO) is true? A:An oxygenation index of 40 for 4 hours is an inclusion criterion. B:A Pao2 of 100 that is responsive to inhaled nitric oxide (iNO) is an inclusion criterion. C:A pH of 7.35 that is responsive to pharmacologic and ventilator management is an inclusion criterion. D:ECMO is rapidly replacing iNO for the therapeutic management of persistent pulmonary hypertension of the newborn.

Correct:A The oxygen index (OI) is a measure used to assess refractory hypoxemia. One of the criteria for initiating extracorporeal membrane oxygenation (ECMO) treatment is an OI of 35 to 60 for 0.5 to 6 hours.

The nurse should recognize which of the following as characteristics of fetal circulation? A:The ventricles function in parallel in utero. B:There are two shunts. C:The atria pumps blood directly into the pulmonary circulation. D:The placenta is a high-resistance circuit.

Correct:A The ventricles of the fetal heart work in parallel, not in series, as in postnatal circulation after transition. This parallel circulation results in well-oxygenated blood entering the left ventricle, which supplies the heart and brain, and less oxygenated blood entering the right ventricle, which supplies the rest of the body.

When caring for an infant requiring cardiorespiratory support and continuous monitoring, including pulse oximetry, the nurse realizes: A:the accuracy of pulse oximetry may be affected by vasoconstricting drugs. B:pulse oximetry eliminates the need for blood gas analysis. C:pulse oximetry is not accurate when a large alveolar-arterial gradient is present. D:pulse oximetry has a slow response time for determining oxygen saturation and therefore readings may not accurately reflect the patient's current status.

Correct:A Vasoconstricting medications, such as dopamine, may affect saturation readouts.

A nurse is caring for an infant who has undergone surgical repair of a ventricular septal defect. The nursing plan of care should include recognition of which of the following complications? A:Cardiac arrhythmias B:Pulmonary hypotension C:Pulmonary hypertension D:Right ventricular failure

Correct:A Ventral septal defect closure complications may include right bundle branch block, third-degree heart block, aortic insufficiency, tricuspid insufficiency, and other common surgical complications such as infection or bleeding

The most effective strategy to prevent retinopathy of prematurity is to: A:reduce ambient light. B:implement oxygen targeting guidelines. C:frequently monitor arterial blood gases. D:raise oxygen saturation alarm limits.

Correct:B Evidence-based research demonstrates that implementing oxygen-targeting guidelines reduces the incidence of severe retinopathy of prematurity (ROP).

An infant who has a ventral septal defect is ready for discharge and is ordered to receive furosemide (Lasix) at home. Which of the following statements should the nurse provide to the mother for discharge teaching? A:If the infant looks puffy, an extra dose may be needed. B:Give the Lasix the same time each day as ordered. C:Please weigh the diapers with every diaper change. D:Take the infant's blood pressure twice a week.

Correct:B Furosemide (Lasix) is a potent diuretic and should be given as prescribed.

The most common cystic malformation of the lung resulting in obstructive air trapping is: A:bronchopulmonary dysplasia. B:congenital lobar emphysema. C:congenital diaphragmatic hernia. D:cystic adenomatoid malformation.

Correct:B In congenital lobar emphysema (CLE), air is trapped in one or more lung lobes at birth due to a defect in bronchial cartilage; obstructive emphysema occurs because air enters but cannot leave the lobe due to collapse of the poorly structured airway. CLE is generally limited to the upper lobes and is the most common cystic lung defect.

An infant is receiving digoxin. The nurse should be aware that the presence of concurrent hypokalemia may result in which of the following? A:Decrease the effectiveness of digoxin B:Precipitate digoxin toxicity at lower serum levels C:Lead to hypertensive episodes D:Precipitate bleeding events

Correct:B In infants with hypokalemia, toxicity may occur despite serum digoxin concentrations below 2.0 ng/ml, because potassium depletion sensitizes the myocardium to digoxin. Thus it is desirable to maintain normal serum potassium concentrations in patients being treated with digoxin.

Infants with micrognathia and glossoptosis require careful monitoring by the nurse for which of the following complications? A:Cor pulmonale B:Obstructive apnea C:Subglottic stenosis D:Reactive airway disease

Correct:B Infants with Pierre Robin sequence, which is characterized by micrognathia and glossoptosis, are at increased risk of posterior airway obstruction resulting in obstructive apnea.

The most common cause of stridor in the infant is: A:choanal atresia. B:laryngomalacia. C:vocal cord paralysis. D:congenital subglottic stenosis.

Correct:B Laryngomalacia is the leading cause of stridor in the infant.

When assessing an infant diagnosed with coarctation of the aorta, the nurse should expect which of the following symptoms? A:Lower extremities warm to touch B:Blood pressure gradient >15 mm Hg between upper and lower extremities C:4+ pulses in lower extremities D:Upper extremities cool to touch

Correct:B The narrowing of the aorta at the transverse aortic arch causes the blood pressure (BP) and perfusion to be lower in the legs than in the arms. The BP (>15 mm Hg) is the most consistent factor in critical coarctation of the aorta and is present in 97% of cases.

Which of the following factors is predictive of a low risk for respiratory distress syndrome? A:A lecithin-sphingomyelin (L/S) ratio of 3:2 B:The presence of phosphatidylglycerol (PG) in the presence of blood-contaminated amniotic fluid C:An L/S ratio of greater than 2:1 in the presence of blood-contaminated amniotic fluid D:The absence of PG in amniotic fluid

Correct:B The presence of phosphatidylglycerol (PG) in amniotic fluid is associated with a very low risk for the development of respiratory distress syndrome (RDS), whereas the absence of PG is associated with RDS. PG determination is valid even in the presence of blood-contaminated amniotic fluid.

Which of the following would be the appropriate management for ventilator-induced respiratory alkalosis? A:Increase the ventilator rate. B:Decrease minute ventilation. C:Increase peak inspiratory pressure. D:Decrease positive end-expiratory pressure.

Correct:B The ventilatory rate and tidal volume directly affect PaCO2 values. When the ventilatory rate, and thus the minute ventilation, is decreased, PaCO2 levels will rise to help correct respiratory alkalosis.

A term infant has Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. At 12 hours of life, a nurse auscultates a physiologic murmur. The nurse should: A:monitor for any increase in quality or intensity. B:notify the neonatologist of the finding. C:suspect a congenital heart lesion. D:anticipate an order for an electrocardiogram.

Correct:A Fifty percent of infants may have physiologic murmurs within the first 48 hours of delivery. These murmurs can be related to the incomplete transition to postnatal circulation reflecting left-to-right flow through a patent ductus arteriosus, increased flow over the pulmonary valve associated with a fall in pulmonary vascular resistance, or mild bilateral peripheral pulmonary artery stenosis related to the size and pressure differential between the main pulmonary trunk and the pulmonary branches. Physician notification is not necessary given this is integral to normal transitional process. It would be appropriate to monitor for any increase in quality or intensity.

A nurse is caring for an infant diagnosed with a small ventricular septal defect. Which of the following is an accurate statement regarding the defect? A:It often will close spontaneously. B:It is likely to require surgical intervention within first month of life. C:It requires prompt medical management soon after delivery. D:Repair can be done during a cardiac catheterization.

Correct:A Fifty percent to seventy-five percent of all small ventral septal defects (VSDs) will close spontaneously without treatment. About 20% of large defects will become smaller spontaneously.

An infant is receiving furosemide (Lasix) for management of congestive heart failure. The nurse should anticipate which of the following results from the arterial blood gas and electrolyte panel? A:Hypochloremic metabolic alkalosis B:Metabolic acidosis from hyperkalemia C:Respiratory acidosis from chronic heart failure D:Hyperchloremic metabolic alkalosis

Correct:A Furosemide (Lasix) is a loop diuretic commonly used to treat or prevent congestive heart failure. It removes large amounts of potassium and chloride from the body, thus possibly causing hypochloremic metabolic alkalosis when used chronically. Electrolytes and fluid balance should be monitored during long-term therapy.

Diuretic therapy with furosemide (Lasix) has been shown to improve lung compliance in infants with bronchopulmonary dysplasia. Complications associated with its use include: A:ototoxicity. B:hyperkalemia. C:hyperchloremia. D:metabolic acidosis.

Correct:A Furosemide can damage the stria vascularis, part of the cochlear duct. Hearing impairment may be temporary or permanent.

Active inspiration and expiration occur in which of the following situations? A:High-frequency oscillatory ventilation B:Spontaneous respirations C:Conventional mechanical ventilation D:High-frequency jet ventilation

Correct:A High-frequency oscillatory ventilation (HFOV) utilizes active inspiration and expiration; the electromagnetically driven diaphragm used in HFOV moves gas into the lung and pulls air from the lung.

A nurse is caring for an infant with pulmonary hypertension per echocardiogram. The plan of care should include avoidance of which of the following conditions? A:Hypoxia and acidosis B:Hyperoxia and alkalosis C:Hypoxia and alkalosis D:Hyperoxia and acidosis

Correct:A Hypoxia increases the pulmonary vascular restriction, which leads to further acidosis. Alkalosis and oxygen both are effective pulmonary vasodilators.

An infant has received a cardiac transplant. The parents must be taught how to give the immunosuppressive medications. The nurse would interpret which of the following statements as indicative of their understanding? A:"My baby will take rejection drugs daily for the rest of her life." B:"My baby will take this medication until she starts school." C:"I can cut the reject medication in half if I am running short." D:"I can get my sister to give the rejection medication when she visits once a week."

Correct:A Immunosuppressive medications are required daily to prevent rejection of the transplanted heart for the life of the patient. The doses cannot be reduced by half at the parent's discretion.

During her assessment of an infant on high-frequency ventilation (HFV), the nurse notices increased chest wall motion. This could be due to: A:improved compliance. B:inadequate amplitude. C:gas trapping. D:a large pneumothorax.

Correct:A Improved lung compliance, excessive peak inspiratory pressure or amplitude, and machine failure may result in increased chest wall motion.

Extrapulmonary causes of lower airway obstruction in the newborn include which of the following? A:Vascular ring B:Choanal atresia C:Bronchomalacia D:Pierre Robin sequence

Correct:A In vascular ring, the aortic arch and anomalous vessels form a partial or complete ring around either the trachea, the esophagus, or both, resulting in compression of those structures. They occur outside the pulmonary system.

Mechanical ventilation is indicated for which of the following conditions? A:Congenital diaphragmatic hernia B:PCO2 of 50 mm Hg on blood gas C:Mild-moderate respiratory distress D:Pulmonary edema

Correct:A Indications for mechanical ventilation include respiratory failure, pulmonary insufficiency, need for surfactant administration, severe apnea and bradycardia episodes, cardiovascular support, central nervous system disease, and surgery. Pulmonary insufficiency is common with a large congenital diaphragmatic hernia defect.

A 500-gram infant with a patent ductus arteriosus is being treated with indomethacin. When formulating a plan of care, the nurse should monitor which of the following parameters? A:Urinary output B:Blood pressure and pulses C:Liver enzymes and bilirubin levels D:Activity level and state of arousal

Correct:A Indomethacin is an inhibitor of prostaglandin synthesis. Most notably, it decreases blood flow to the renal system, thus decreasing renal perfusion and urinary output. If oliguria occurs, electrolytes should be monitored and renally excreted drugs should be adjusted appropriately. Gastrointestinal perfusion may also be decreased, but generally not to the extent of renal function.

An infant with tetralogy of Fallot exhibits persistent crying, which evolves into a "Tet spell." The nurse should place the infant in which of the following positions? A:Supine, legs extended B:Knee-to-chest C:Abdomen D:Side-lying

Correct:A Infants who have tetralogy of Fallot and are eating, crying, or doing anything that requires more oxygen may exhibit trouble breathing with severe cyanosis. The knee-to-chest or squatting position is the best position to increase blood flow to the lungs.

An infant is 24 hours postoperative from corrective congenital heart disease surgery requiring cardiopulmonary bypass with urinary output since surgery of less than 0.5ml/kg/day. This finding is most likely to be indicative of: A:customary urinary output. B:failure of surgical repair. C:potential infection. D:chronic renal failure.

Correct:A It is normal to have oliguria for up to 48 hours after cardiopulmonary bypass.

A large ventricular septal defect (VSD) may not be immediately evident at birth due to: A:elevated pulmonary vascular resistance. B:patency of the ductus venosus. C:patent ductus arteriosus that prevents flow through the VSD. D:decreased pulmonary vascular resistance.

Correct:A Large ventral septal defects are not symptomatic at birth because the pulmonary vascular resistance is normally elevated at this time.

Factors that predispose infants with bronchopulmonary dysplasia to pulmonary edema include which of the following? A:Impaired lymphatic drainage B:Decreased capillary permeability C:Increased plasma oncotic pressure D:Decreased pulmonary vascular resistance

Correct:A Lymphatic drainage is impaired in infants with bronchopulmonary dysplasia (BPD), which predisposes them to pulmonary edema.

An infant with congenital heart disease is requiring afterload reduction. The nurse should anticipate an order for which of the following medications? A:Milrinone B:Dopamine C:Hydralazine D:Dexamethasone

Correct:A Milrinone is a phosphodiesterase-3 inhibitor that increases cyclic adenosine monophosphate, thereby improving the inotropic state of the heart. Milrinone also provides dose-dependent increase in cardiac contractility and is a systemic and pulmonary vasodilator and thus an effective agent in both right and left ventricular systolic dysfunction.

Which of the following factors affect control of ventilation in the spontaneously breathing infant? A:Sleep state, hypoxemia, hypercapnia B:Central nervous system maturity, hyperoxia, hypoglycemia C:Functional residual capacity, hypoxemia, hyperoxemia D:Hypercapnia, functional residual capacity, certain reflex responses

Correct:A Neurologic factors affecting control of ventilation in the spontaneously breathing infant include central nervous system maturity (degree of myelination and arborization), sleep state (rapid eye movement versus quiet sleep), and reflex responses (Hering-Breuer reflex, head reflex, intercostal-phrenic reflex, trigeminal-cutaneous reflex, and the glottis closure reflex).

Which of the following statements is true regarding inhaled nitrogen oxide (iNO)? A:iNO is inactivated after it combines with hemoglobin. B:iNO is an effective pulmonary vasodilator with a half-life of 3 to 5 minutes. C:iNO is initiated and maintained at 20 ppm until pulmonary vascular relaxation has occurred. D:Once pulmonary vascular relaxation has been accomplished, it is safe to halt administration of iNO because the half-life is so short.

Correct:A Nitric oxide in the circulation reacts with the iron-containing molecules in hemoglobin. Nitric oxide reduces oxyhemoglobin, producing methemoglobin.

The nurse should anticipate which of the following as the most common sequela to an infant after cardiac surgery? A:Feeding difficulties B:Sepsis C:Brain injury D:Chronic renal failure

Correct:A One half of infants who require cardiac surgery will have feeding problems.

An infant has an arterial blood gas drawn while receiving 80% FiO2. The pH is 7.2, the PaCO2 is 69 mm Hg, and the PaO2 is 175 mm Hg. The nurse should interpret these results as originating from which body system or process? A:Pulmonary B:Cardiac C:Metabolic D:Infectious

Correct:A PaCO2 is commonly elevated with pulmonary disease, especially in the face of a normal Pa O2.

A maternal history of chorioamnionitis, fever, premature rupture of membranes longer than 24 hours, prolonged labor with intact membranes, and excessive obstetric manipulations predisposes the infant to which of the following conditions? A:Congenital pneumonia B:Respiratory distress syndrome C:Meconium aspiration syndrome D:Transient tachypnea of the newborn

Correct:A Pathogens responsible for early-onset pneumonia are acquired transplacentally and from the birth canal before or during delivery. Maternal fever indicates infection; premature rupture of membranes, prolonged labor, and excessive obstetric manipulations predispose to ascending infection.

Which of the following would be included in the differential diagnosis of transient tachypnea of the newborn? A:Pneumonia B:Pneumothorax C:Pleural effusion D:Pulmonary interstitial emphysema

Correct:A Pneumonia can be congenital or acquired. Clinical signs are similar to those of transient tachypnea of the newborn, including tachypnea, oxygen desaturation, and decreased lung compliance.

Which of the following is considered a precursor or risk factor for sudden infant death syndrome? A:Prenatal and postnatal exposure to cigarette smoke B:Apnea C:Low environmental temperature D:Short QT interval

Correct:A Prenatal and postnatal cigarette smoke exposure is a risk factor for sudden infant death syndrome (SIDS).

An infant is maintained on prostaglandin E1 at 0.1 mcg/kg/min for a diagnosis of transposition of the great vessels. The nurse should consider which of the following side effects when formulating the plan of care? A:Hyperthermia B:Hypertension C:Hyperglycemia D:Hypercalcemia

Correct:A Prostaglandin E1 is a potent vasodilator.

An infant presents at birth with cyanosis and is started on prostaglandin E1 at 0.05 mcg/kg/min for suspected congenital heart disease. The nurse should monitor for which of the following initial side effects? A:Apnea B:Hypertension C:Hyperglycemia D:Hypercalcemia

Correct:A Prostaglandin E1 is a potent vasodilator. Apnea is common at the higher doses and especially when the infusion is initiated.

The nursing plan of care should include which of the following actions to lessen the likelihood of clinical decompensation during pulmonary hypertensive crisis after congenital heart disease surgery? A:Providing a minimal-stimulation environment B:Avoiding excess narcotic administration C:Ensuring that the bladder remains emptied D:Positioning the infant in the knee-chest position

Correct:A Pulmonary hypertensive crisis can be treated/prevented with minimal stimulation, narcotic administration, sedative administration, paralysis, oxygen administration, inhaled nitric oxide administration, phosphodiesterase inhibitor administration, and prostacyclin administration.

Early signs of respiratory disease in a neonate include: A:retractions. B:hypotension. C:acrocyanosis. D:respiratory rate of 30 to 40 breaths/minute.

Correct:A Retractions are the result of increased chest wall compliance, immature intercostal muscles, and increased inspiratory pressure. Retractions worsen with increasing disease.

A term infant requires intubation for respiratory distress at birth. The pulse oximeter probe reads as follows: right hand 75% saturation, left foot 92% saturation. The nurse should anticipate which of the following conditions? A:Sepsis B:Respiratory distress syndrome C:Transposition of the great arteries D:Truncus arteriosus

Correct: C The infant has reversed differential cyanosis. This can be seen with transposition of the great arteries when the preductal saturations are lower than the postductal saturations. The transposition of the arteries leads to two separate circulations. The deoxygenated blood goes out the right atrium to the aorta to the body (right hand); therefore the pulse oximeter reading is lower.

A hyperoxia test is ordered for an infant presenting with tachypnea and mild cyanosis. An arterial blood gas is drawn from the right radial artery with a PaO2 of 200 mm Hg. The nurse should anticipate that this result is indicative of: A:respiratory distress syndrome. B:persistent pulmonary hypertension. C:cyanotic cardiac defect. D:complex congenital heart defect.

Correct:A A hyperoxia test is performed by administering 100% oxygen for 10 minutes and then measuring the arterial preductal PaO2 (right radial artery). A significant increase in PaO2 levels, particularly a Pa O2 level >150 mm Hg, makes the likely cause respiratory distress rather than cardiac in origin.

What should the nursing plan of care for an infant who is exhibiting signs of septic shock include? A:Provide a neutral thermal environment B:Deferring parental notification until further information is available C:Administration of 5 ml/kg normal saline boluses D:Increase frequency of neuroassessments to every hour

Correct:A A neutral thermal environment decreases oxygen consumption.

A full-term infant has apnea at 10 hours of life. The most likely cause is: A:sepsis. B:placement on the back to sleep. C:hyperglycemia. D:apnea of prematurity.

Correct:A A pathologic condition in the mother or infant should be highly suspected when an infant has apnea in the first 24 hours of life. Sepsis is an example of a pathologic state.

A nurse is assessing a 24-week infant who underwent a recent patent ductus arteriosus ligation and has a blood pressure of 25/13 mm Hg with oxygen saturation at 70%. The nurse should immediately assess the infant for which of the following? A:Tension pneumothorax B:Low end-expiratory pressure C:Inadequate tidal volume D:Decreased cardiac afterload

Correct:A A tension pneumothorax will compress the heart and lungs, leading to inadequate venous return to the heart. The compression causes cyanosis and hypotension. Once the air is removed, the lung will reexpand and better oxygenation will occur with improvement in blood pressure.

What nursing measure would be a priority in the long-term care plan for an infant with congestive heart failure? A:Adequate caloric intake B:Fluid restriction C:Physical therapy D:Sedation

Correct:A Adequate calorie intake will ensure the infant stays appropriate on the growth curve. Most cardiac infants will self-regulate their intake.

Which factor will cause a shift to the left in the oxygen-hemoglobin dissociation curve? A:Increase in pH B:Increase in PaCO2 C:Increase in temperature D:Increase in diphosphoglycerate level

Correct:A An increase in pH causes a shift to the left in the oxygen dissociation curve.

The nurse is admitting a term infant who has just undergone stage 1 Norwood repair. Vitals signs are heart rate 200, blood pressure mean 38, and temperature 98.6° F. The nurse should assess the infant for: A:hypovolemia. B:hypocalcemia. C:acidosis. D:hypoglycemia.

Correct:A Blood, fluid loss, and third spacing can cause hypovolemia after surgery. Hypovolemia is a common cause of tachycardia.

Which of the following is a pathologic condition characterized by right ventricular hypertrophy and right axis deviation on electrocardiogram, respiratory wheezing, hepatomegaly, and radiographic findings of cystic lesions with lung hyperinflation? A:Bronchopulmonary dysplasia B:Respiratory distress syndrome C:Meconium aspiration syndrome D:Pulmonary interstitial emphysema

Correct:A Bronchopulmonary dysplasia is characterized by right ventricular hypertrophy and right axis deviation on electrocardiogram, respiratory wheezing, hepatomegaly from heart failure, and cystic lesions on chest radiograph.

Central apnea is defined as: A:absence of airflow and respiratory effort. B:absence of airflow with continued respiratory effort. C:a condition with both neurologic and obstructive components. D:cyclic respirations of breathing for 10 to 15 seconds, followed by apnea for 5 to 10 seconds, that occur at least three times in succession.

Correct:A Central apnea is the absence of breathing effort. Without respiratory effort, airflow is zero.

Which of the following factors is thought to decrease the severity of respiratory distress syndrome in the at-risk population? A:Chronic intrauterine stress B:Second-born twin C:Male sex D:Cesarean section without labor

Correct:A Chronic fetal stress increases endogenous corticosteroids, resulting in accelerated lung maturity and a decrease in the severity of respiratory distress syndrome (RDS).

Dexamethasone has been ordered by the nurse practitioner for an infant. The bedside nurse would expect which of the following for this infant? A:Urine output of 5 ml/kg/hour B:Increased ventilator support C:Mean arterial blood pressure of 40 mm Hg D:Biventricular atrophy on echocardiography

Correct:A Corticosteroids have been shown to decrease the permeability of the pulmonary vasculature, which minimizes pulmonary edema. Dexamethasone has also been shown to increase diuresis. A urine output of 5 ml/kg/hr is indicative of increased diuresis.

An infant is receiving digoxin. The nurse should hold the dose if the heart rate is: A:50. B:150. C:200. D:220.

Correct:A Digoxin can have toxic side effects of PR prolongation, sinus bradycardia, or sinoatrial block. It should be discontinued if the heart rate is less than 100. Bradycardia, not tachycardia, is a side effect of digoxin.

An infant with congestive heart failure is receiving digoxin. The nurse should expect which of the following effects from the medication? A:Increased cardiac output B:Increased urine output C:Decreased blood pressure D:Increased heart rate

Correct:A Digoxin is an inotrope and increases cardiac output and is used to lower the heart rate in infants with tachycardia.

A nurse should expect the primary action of dobutamine is to improve cardiac output by predominantly increasing: A:contractility. B:vascular resistance. C:heart rate. D:pulmonary vascular resistance.

Correct:A Dobutamine is an inotropic vasopressor and increases myocardial contractility. It decreases systemic and pulmonary vascular resistance. It only slightly increases heart rate.

An infant is receiving a dopamine infusion via peripheral intravenous (IV) at 6 mcg/kg/min. The nurse should anticipate the presence of which of the following at the IV site? A:Blanching B:Redness C:Coldness D:Oozing skin

Correct:A Dopamine causes peripheral vasoconstriction. Some blanching is noted along the line of the vein it is infusing.

A 600-gram infant is exhibiting hypotension related to bacterial sepsis. The nurse should expect which of the following medications to optimally treat the hypotension? A:Dopamine B:Dobutamine (Dobutrex) C:Volume expander D:Hydrocortisone

Correct:A Dopamine increases the blood pressure (BP) in 90% of extremely low-birth-weight infants, and volume expansion only improves BP in 40% of these infants.

The underlying clinical pathology of transient tachypnea of the newborn is respiratory distress resulting from which of the following conditions? A:Aspiration B:Retained lung fluids C:Pulmonary hypoplasia D:Progressive atelectasis

Correct:B Transient tachypnea of the newborn generally occurs in term or late-preterm infants with a history of cesarean section or precipitous delivery. Lack of compression of the fetal chest results in retained fetal interstitial lung fluid, which leads to collapse of the bronchioli. Chest radiographic findings include pro¬minent perihilar streaking, hyperaeration, and mild to moderate cardiomegaly. The perihilar streaking represents engorgement of the periarterial lymphatics that participate in the clearance of alveolar fluid.

Which of the following statements about high-frequency ventilation (HFV) is true? A:HFV does not cause gas trapping. B.Gas exchange occurs even when tidal volume is less than anatomic dead space. C:The mean airway pressure used to support lung volume using HFV is lower than that required with conventional mechanical ventilation. D:HFV is not as effective as conventional mechanical ventilation for eliminating carbon dioxide.

Correct:B Using the mechanisms of convection and molecular diffusion, gas exchange using high- frequency ventilation (HFV) occurs even when tidal volume approaches or is less than anatomical dead space due to the increase in turbulence of the gas molecules during HFV.

Which of the following nursing interventions may exacerbate apnea in preterm infants? A:Limiting loud noises B:Weighing on a cold scale C:Controlling environmental temperature D:Positioning with small rolls under the neck and shoulder

Correct:B Weighing on a cold scale is one example of environmental stress, which has been shown to precipitate apneic episodes.

An infant is diagnosed with transposition of the great arteries and is scheduled for a balloon atrial septostomy. The nurse should expect which of the following outcomes? A:Decreased cardiac afterload B:Increased cardiac output C:Adequate mixing of the deoxygenated and oxygenated blood D:Increased dilatation of the coronary arteries

Correct:C A cardiac catheter is placed across the atrial septum at the foramen ovale. A balloon is inflated and then pulled across to open the septum to provide a way for the two parallel circuits to mix the deoxygenated blood from the body with the oxygenated blood from the lungs at the atrial level. There is no dilatation of the coronary arteries as a result of this procedure.

Nursing management of a preterm infant with acute respiratory distress syndrome should be directed toward: A:liberalizing administration of fluids. B:handling frequently to provide developmental stimulation. C:maintaining the infant in a neutral thermal environment. D:decreasing inspired oxygen fraction (FiO2) for oxygen saturation values of less than 88%.

Correct:C A neutral thermal environment maintains normal body temperature, the temperature at which an individual's oxygen consumption is minimized.

An infant with profound acidosis has vasopressor-resistant hypotension. The nurse should understand which of the following as a contributing factor? A:The heart is being overburdened by vasopressor administration. B:The acidosis has no relation to the hypotension. C:The heart does not respond well to catecholamines in the presence of acidosis. D:Acidosis is a direct side effect of vasopressor administration.

Correct:C Acidosis can impair the myocardial response to catecholamines, thus further reducing contractility.

Surfactant secretion would most likely be stimulated by which of the following? A:Hypoventilation B:Lung hypoinflation C:Adenosine triphosphate D:β-Adrenergic receptor blocker

Correct:C Adenosine triphosphate is a purine receptor agonist that is a potent stimulator of surfactant secretion. Surfactant secretion is stimulated by hyperventilation.

On physical examination of an infant, inspiratory and expiratory wheezing, intercostal retractions, and an oxygen saturation of 68% are noted. These signs would alert the nurse to the possibility of bronchospasm. The most appropriate intervention would be administration of which of the following medications? A:Caffeine (Cafcit) B:Furosemide (Lasix) C:Albuterol (Ventolin, Proventil) D:Theophylline (Theo-Dur, Slo-Bid)

Correct:C Albuterol is a bronchodilator—specifically, a β2-adrenergic agent—that within minutes effectively increases compliance and decreases airway resistance.

The obstetric provider requests that the high-risk neonatal team attend the emergency C-section delivery of a term infant with nonreassuring fetal status. Which of the following factors does the team consider to be the best indication for the need to resuscitate? A:Maternal general anesthesia B:A 1-minute Apgar score of 4 C:Infant's clinical presentation and response D:Maternal administration of magnesium sulfate

Correct:C Although the need for resuscitation is based in part on anticipation of likely problems, the best indication for resuscitation need is the infant's clinical presentation and response.

Dexamethasone administration for the treatment of bronchopulmonary dysplasia has been associated with an increased incidence of which of the following? A:Pulmonary air leak B:Necrotizing enterocolitis C:Neurodevelopmental dysfunction D:Severe retinopathy of prematurity

Correct:C An increased incidence of neurodevelopmental dysfunction, including cerebral palsy, has been widely associated with dexamethasone use.

A radiology report corresponding to a chest x-ray states that lung fields are overaerated and clear, which is consistent with: A:pulmonary air leak. B:congenital lobar emphysema. C:hyperinflation. D:hydrothorax.

Correct:C An x-ray showing overaerated but clear lung fields is indicative of hyperinflation.

Advantages of bubble continuous positive airway pressure (CPAP) include which o f the following? A:It is not necessary to heat the gas. B:Pressure is generated by changing the flow rate of gases during inspiration and expiration to maintain a constant airway pressure in the gas flow leaving the nasal prongs. C:The system can be inexpensive, simple, and readily available. D:The system delivers continuous positive pressure at two separate CPAP levels.

Correct:C As long as heaters and a gas source are available, the bubble continuous positive airway pressure (CPAP) system can be inexpensive, readily available, and easily maintained. The system utilizes a one-liter bottle of sterile water and CPAP tubing. The level of water in which the expiratory end of the CPAP tubing is submerged determines the amount of pressure generated.

Which of the following is an advantage of the venovenous bypass route over the venoarterial route for extracorporeal membrane oxygenation? A:Cardiac preload is decreased B:Faster weaning of ventilator support C:Decreased risk of arterial embolization D:Decreased time to stabilize the patient

Correct:C Because oxygenated blood returns to the right side of the heart and lungs, the danger of arterial embolization is minimized compared with the venoarterial (VA) route, where oxygenated blood returns directly into the arterial circulation.

Factors that predispose an infant to bronchopulmonary dysplasia include which of the following? A:Full-term birth B:Fluid restriction C:Mechanical ventilation D:Inspired oxygen concentration of 0.21

Correct:C Bronchopulmonary dysplasia (BPD) is more common in infants who have undergone mechanical ventilation. This is due to the associated barotrauma and oxygen toxicity.

A chest radiograph is ordered for an infant with a suspected patent ductus arteriosus. The nurse should anticipate which of the following findings? A:Boot-shaped heart B:Decreased pulmonary vascular markings C:Increased pulmonary vasculature with cardiomegaly D:An "egg on a string"-appearing heart

Correct:C Common clinical manifestations of a patent ductus arteriosus include increased pulmonary vasculature and cardiomegaly on chest radiograph, bounding peripheral pulses, and an active precordium. A widening pulse pressure with a low diastolic blood pressure may be present. Unexplained acidosis may be present.

A term infant is delivered vaginally after an uncomplicated labor and delivery. Immediately after birth, the infant becomes cyanotic with severe grunting, retracting, and nasal flaring. The infant is intubated, and positive pressure ventilation is started. On physical examination, breath sounds are diminished on the left side with displacement of cardiac sounds toward the right. The abdomen is scaphoid in appearance. A chest radiograph reveals dilated loops of bowel in the thoracic space with right mediastinal shift. The nurse should prepare to assist with management of which of the following conditions? A:Pneumothorax B:Pneumomediastinum C:Congenital diaphragmatic hernia D:Cystic adenomatoid malformation

Correct:C Congenital diaphragmatic hernia (CDH) is a herniation of abdominal organs into the thoracic cavity through a diaphragmatic defect. Clinical signs include respiratory distress and cyanosis at birth or shortly thereafter. The infant deteriorates, rather than improves, with bag-and-mask ventilation because the intestines distend with air and further compromise lung function. Breath sounds are diminished, point of maximal impulse may be shifted, the chest is barrel shaped, and the abdomen is scaphoid. A radiograph taken immediately after birth may not demonstrate intestine in the thorax, but later images will clearly demonstrate air-filled bowel. Survival rate is 50%.

Continuous positive airway pressure ventilation would be indicated in an infant with which of following diagnoses? A:Cleft palate B:Choanal atresia C:Laryngomalacia D:Tracheoesophageal fistula

Correct:C Continuous positive airway pressure (CPAP) ventilation is therapeutic in the treatment of an infant with laryngomalacia because it prevents collapse of poorly formed cartilage structures.

An infant is receiving dopamine at an infusion rate of 3 mcg/kg/min for which of the following purposes? A:Increase of blood pressure B:Constriction of pulmonary vasculature C:Vasodilatation of renal vascular bed D:Vasoconstriction of peripheral veins

Correct:C Dopamine at a low dose is selective to the renal, mesenteric, cerebral, and coronary vasculature with little effect on the heart rate or blood pressure or pulmonary vasculature.

An infant with hypotension is being treated with dopamine at a dosage of 15 mcg/kg/min through a peripheral intravenous catheter. Which of the following should be assessed hourly by the nurse? A:Femoral pulses B:Heart sounds C:Infusion site D:Urinary output

Correct:C Dopamine can cause blanching and severe skin ischemia/necrosis with infiltration.

An infant with a ventricular septal defect presents with a loud, pansystolic murmur at birth but is otherwise asymptomatic. The nurse would anticipate the subsequent development of symptoms at 1 to 2 months of age due to which of the following? A:Pulmonary hypertension B:Closure of a patent ductus arteriosus C:Development of congestive heart failure D:Increased cardiac load due to nutritional weight gain

Correct:C Infants with a small isolated defect are often asymptomatic. The murmur of a small defect may be detected within the first 24 to 36 hours of life, because the very restrictive opening permits the normal rapid fall in pulmonary arterial resistance and pressures. In term infants born at sea level with a large ventral septal defect, clinical deterioration may occur at any time from approximately 3 to 12 weeks after birth.

Which of the following is a long-term complication associated with congenital diaphragmatic hernia repair? A:Chylothorax B:Potter syndrome C:Gastroesophageal reflux D:Necrotizing enterocolitis

Correct:C Long-term complications associated with congenital diaphragmatic hernia (CDH) repair include chronic lung disease, recurrent diaphragmatic hernia, gastroesophageal reflux, growth restriction, and neurodevelopmental delay.

A nursing intervention that helps alleviate apnea in preterm infants is: A:performing endotracheal suction. B:weighing on a cold scale. C:controlling environmental temperature. D:tapping on the outside of the isolette.

Correct:C Maintaining the environmental temperature in a neutral thermal range can help to alleviate temperature stress, which can lead to iatrogenic apnea. Apnea can be induced by a multitude of causes, including iatrogenic factors.

A 35 5/7 weeks' gestation infant has a maternal medication history of prenatal vitamins, occasional aspirin, and recent ibuprofen use. The infant at birth exhibits a heart rate of 200, respiratory rate of 80, rales, central cyanosis, and poor perfusion. The nurse should recognize these symptoms as indicative of which of the following? A:Neonatal abstinence syndrome B:Ibuprofen withdrawal C:Premature closure of the patent ductus arteriosus (PDA) D:PDA

Correct:C Maternal use of aspirin and ibuprofen (prostaglandin inhibitors) can cause the ductus to close. This may occur in utero.

Which of the following practices has reduced the rate of bronchopulmonary dysplasia? A:Multiple courses of antenatal steroids B:Long-term use of postnatal steroid therapy C:Use of vitamin A D:Routine intubation and early/prophylactic use of surfactant in very-low-birth-weight preterm infants

Correct:C Oxygen toxicity is associated with the development of bronchopulmonary dysplasia (BPD). Vitamin A, an antioxidant, is effective against oxygen radicals.

When choosing the appropriate nasal prongs for administering continuous positive airway pressure, the nurse knows that: A:prongs should loosely fit in the nares to avoid injury to the nasal septum. B:using moderate force, prongs should fill the nostrils completely. C:part of the prongs should remain outside the nose. D:the larger the prongs, the higher the airway resistance.

Correct:C Part of the prongs should remain outside the nose to keep the prong bridge from pressing into the septum.

A newborn infant with respiratory difficulty is diagnosed with a congenital chylothorax. A thoracentesis followed by placement of a tube thoracotomy for continuous drainage is performed. The nurse must monitor this patient closely for: A:apnea. B:air leak. C:infection. D:subcutaneous emphysema.

Correct:C Pleural fluid draining from a chylothorax contains a high number of lymphocytes. Removal of these cells, which play a significant role in the immune system, places the infant at risk for infection due to lymphopenia.

Hyponatremia associated with respiratory distress syndrome in a preterm infant with no documented weight loss within the first few days of life is indicative of: A:total body sodium depletion. B:excessive evaporative loss. C:excessive total body water. D:high-volume urinary output.

Correct:C Preterm infants are expected to lose 10% of their birth weight. This weight loss is the result of excretion of extracellular fluid.

The administration of surfactant at the time of delivery is termed: A:rescue therapy. B:assisted ventilation. C:prophylactic therapy. D:chemical resuscitation.

Correct:C Prophylactic administration of surfactant occurs soon after birth, after the initial resuscitation and endotracheal intubation.

Pulmonary interstitial emphysema results from extraneous air in the: A:subcutaneous tissue. B:pleural space. C.connective tissue of the peribronchovascular sheaths. D:alveoli trabeculae-visceral pleura.

Correct:C Pulmonary interstitial emphysema occurs when gases collect in the connective tissue of the peribronchovascular sheaths and is a complication of mechanical ventilation.

The neonate's unique response to hypoxemia and carbon dioxide retention is characterized by: A:an initial decrease in respiratory effort. B:prolonged sustained increase in alveolar ventilation. C:a brief period of increased respiration followed by respiratory depression. D:an increase in minute ventilation above baseline until blood levels of oxygen and carbon dioxide normalize.

Correct:C Responses to hypoxemia and changes in PaCO2 are different in the adult and in the neonate. The adult responds with sustained increased ventilation. The neonate, however, demonstrates a brief period of increased ventilation as chemoreceptors in the medulla and carotid and aortic vessels sense an abnormal PaCO2 level, followed by respiratory depression as the sensitivity of peripheral and central chemoreceptors diminishes. Disturbances in rate and rhythm develop.

Upon auscultation of a recently extubated infant, the nurse hears continuous low-pitched breath sounds during inspiration and expiration. What adventitious breath sound is described here? A:Crackles B:Wheezes C:Rhonchi D:Stridor

Correct:C Rhonci are characterized by continuous, low-pitched breath sounds occurring on inspiration and expiration. Rhonchi are associated with secretions or stricture in the larger airways and improve or resolve with cough or suctioning.

An infant has a history of profound in utero anemia. The nurse should assess for which of the following potential conditions after birth? A:Complex congenital heart disease B:Supraventricular tachycardia C:Congestive heart failure D:Persistent patent ductus arteriosus

Correct:C Severe anemia in the prenatal period can cause congestive heart failure because the fetal heart is trying to compensate for the lack of red blood cells.

An infant is receiving chlorothiazide (Diuril) with laboratory results as follows: sodium 137 mEq/L, potassium 2.5 mEq/L, and chloride 105 mEq/L. Which of the following medications should the nurse expect to be ordered? A:Furosemide (Lasix) B:Sodium chloride (NaCl) C:Spironolactone (Aldactone) D:Digoxin

Correct:C Spironolactone is a potassium-sparing diuretic.

A chest x-ray showing multiple small cyst formation, opaque lung fields, and visible cardiac borders occurring in the first 10 to 20 days of life is consistent with what stage of chronic lung disease? A:Stage I B:Stage II C:Stage III D:Stage IV

Correct:C Stage III chronic lung disease (CLD) develops in the first 10 to 20 days of life and is characterized by multiple small cyst formation within opaque lungs and visible cardiac borders.

Surfactant is produced in the lungs by: A:acini. B:type I pneumocytes. C:type II pneumocytes. D:surfactant protein A.

Correct:C Surfactant is produced and secreted by the lamellar bodies of the type II cells of the lungs.

As the nurse prepares to administer a dose of caffeine to a preterm infant, the nurse determines that the infant is tachycardic, with a heart rate of 190 beats/minute. The infant is resting quietly in the incubator. The nurse should: A:administer the dose of caffeine. B:wait 5 minutes before administering the dose. C:withhold the dose and notify the physician or neonatal nurse practitioner. D:remeasure the heart rate and administer the dose if heart rate is less than 180 beats/minute.

Correct:C Tachycardia is an adverse effect of caffeine. Therefore the dose should not be administered, and the physician or neonatal nurse practitioner should be notified immediately. Serum drug level will be measured to check for caffeine toxicity. The nurse should monitor the infant for additional adverse effects, including ventricular ectopy; gastrointestinal upset; and central nervous system manifestations of restlessness, irritability, and agitation.

An infant exhibits intermittent periods of cyanosis after birth. The nurse should anticipate that the infant may be afflicted with which of the following conditions? A:Ventricular septal defect B:Pulmonary stenosis C:Truncus arteriosus D:Atrial septal defect

Correct:C The anatomy of truncus arteriosus involves a single great artery originating from both the left and right ventricles. The blood flow to the lungs is directly dependent on the pulmonary vascular resistance. As the pulmonary vascularity changes, the pulmonary blood flow will also change, causing changes in the amount of blood flowing into the lungs.

The nurse is caring for an infant whose heart rate has increased to 260. The blood pressure remained within normal limits, and perfusion was 2 seconds for the first 30 minutes. After 30 minutes the capillary refill increased to 5 seconds. The nurse should anticipate which of the following actions as the highest priority? A:Transesophageal probe placement B:Defibrillation C:Cardioversion D:Initiation of chest compressions

Correct:C The first line of therapy is synchronized cardioversion in a hemodynamically unstable patient with supraventricular tachycardia. The drug of choice has become adenosine for acute management. If available, esophageal pacing is effective, but not the first line of treatment.

A newborn infant requires supplemental oxygen, and oxygen administration is initiated via oxygen hood. An appropriate nursing intervention would be to: A:switch the infant to a nasal cannula. B:do nothing, because no intervention is required. C:ensure sufficient gas flow to prevent carbon dioxide retention. D:obtain an order and change the patient to nasal continuous positive airway pressure ventilation.

Correct:C The flow rate through an oxygen hood must be sufficient to prevent the retention of carbon dioxide. This requires a flow meter and oxygen blender so that adequate flow is provided and the prescribed oxygen concentration is delivered.

Tetralogy of Fallot is a combination of which of the following cardiac defects? A:Ventral septal defect (VSD), atrial septal defect (ASD), coarctation of the aorta, and patent ductus arteriosus (PDA) B:VSD, pulmonary valve stenosis, right ventricular (RV) hypertrophy, and aortic stenosis C:VSD, pulmonary valve stenosis, RV hypertrophy, and overriding aorta D:ASD, PDA, coarctation of the aorta, and overriding aorta

Correct:C The four defects of tetralogy of Fallot are ventricular septal defect (VSD), pulmonary valve stenosis, right ventricular hypertrophy, and overriding Aorta.

Aspiration pneumonitis acquired at delivery manifests within the first hours to days of life. Which of the following pathogens is most commonly associated with aspiration pneumonitis? A:Chlamydia trachomatis B:Respiratory syncytial virus C:Group β-hemolytic streptococci D:Fungi, especially Candida species

Correct:C The most common bacterial organisms causing pneumonia in the newborn period are group B streptococci and gram-negative organisms.

Which of the following x-ray findings is consistent with a pneumothorax? A:Increased pulmonary vascular markings B:Narrow intercostal spaces C:Enlarged cardiac silhouette D:Sharp contrast between the cardiac border and the diaphragm

Correct:D A sharp edge sign, in which the cardiac border and the diaphragm are seen in sharp contrast, is a radiographic finding of a pneumothorax.

Which of the following would cause an infant to exhibit signs and symptoms of decreased respiratory effort, lethargy, and bradycardia? A:Hyperglycemia B:Caffeine (Cafcit) administration C:Isoproterenol (Isuprel) administration D:Adenosine (Adenocard) administration

Correct:D Adenosine inhibits heart rate by blocking electrical conduction at the atrioventricular node and inhibits respirations.

Adenosine is the drug of choice for which of the following cardiac arrhythmias? A:Premature atrial contractions B:Sinus tachycardia C:Premature ventricular contractions D:Supraventricular tachycardia

Correct:D Adenosine is the drug of choice for prompt conversion of paroxysmal supraventricular tachycardia to sinus rhythm because of its success rate and its very short duration of action. It acts by directly inhibiting the atrioventricular (AV) nodal conduction and increases the AV nodal refractory period, but has lesser effects on the sinoatrial node.

A radiographic picture of grainy lungs and prominent air bronchograms is characteristic of which of the following conditions? A:Pneumonia B:Pulmonary edema C:Pulmonary air leaks D:Respiratory distress syndrome

Correct:D Air bronchograms are air in the bronchial tree visualized against a background of generalized alveolar atelectasis and are characteristic of respiratory distress syndrome.

Which of the following statements about the care of an infant with a chest tube is accurate? A:Repositioning of the patient should be minimized. B:Milking and stripping of the chest tube are routine interventions to ensure tube patency. C:Continuous bubbling in the water seal chamber is an indication that the chest tube is functioning effectively. D:Tube patency, fluctuation, and bubbling in the drainage system should be monitored and documented hourly.

Correct:D An important aspect of chest tube care is the frequent monitoring and documentation of tube patency, oscillation of fluid within the drainage system, and presence or absence of bubbling in the water seal chamber. Continuous bubbling in the water seal chamber indicates an air leak; the source may be either the patient or the system.

When assessing an infant with respiratory distress syndrome, the nurse calculates the infant's urine output to be more than 5 ml/kg/hour for an 8-hour period. The nurse suspects that the increase in urine output is indicative of which of the following conditions? A:Renal failure B:Worsening pulmonary status C:Development of chronic lung disease D:Recovery phase of respiratory distress syndrome

Correct:D An infant with respiratory distress syndrome may exhibit oliguria, especially if the infant is hypoxic or renal perfusion is diminished. A natural diuresis occurs at 48 to 72 hours of age and precedes the onset of the recovery phase.

The clinical presentation of tachypnea, hypercarbia, tissue mottling, diminished capillary refill, and oliguria associated with patent ductus arteriosus in the preterm infant is the result of which of the following conditions? A:Systemic hypertension B:Pulmonary hypoperfusion C:Right-to-left shunting of blood D:Left-to-right shunting of blood

Correct:D Blood flow through a patent ductus arteriosus (PDA) is pressure dependent. In a preterm infant, as pulmonary vascular resistance decreases, blood leaves the aorta and enters the pulmonary artery, which results in a left-to-right shunt, pulmonary edema, and diminished gas exchange at the alveolar level.

Which of the following is an advantage of caffeine (Cafcit) over theophylline (Theo-Dur, Slo-Bid) in the management of apnea of prematurity? A:Caffeine can be given only by mouth. B:Caffeine requires twice-a-day dosing. C:Caffeine is excreted more rapidly by the kidneys. D:Caffeine has a longer half-life, which results in smaller changes in its plasma concentration.

Correct:D Caffeine has a longer half-life than theophylline, which results in smaller changes in plasma concentration.

Early signs of respiratory distress within the first 24 hours of life in a full-term neonate include: A:hypotension. B:acrocyanosis. C:periodic breathing. D:grunting, flaring, and retractions.

Correct:D Clinical signs and symptoms of respiratory distress in the newborn include grunting (to keep alveoli open), flaring (to increase air intake), and retractions (reflecting increased work of breathing).

Continuous positive airway pressure is most likely to be used with which of the following conditions? A:Congenital diaphragmatic hernia B:Central apnea C:Pneumothorax D:Obstructive apnea

Correct:D Continuous positive airway pressure (CPAP) is effective with obstructive apnea because it stabilizes the chest wall and splints the airways and diaphragm.

Which of the following is key to the diagnosis of transient tachypnea of the newborn? A:Need for supplemental oxygen B:Blood gas showing mild respiratory acidosis C:Physical signs of respiratory distress D:Chest x-ray findings

Correct:D Transient tachypnea of the newborn (TTN) is diagnosed by excluding other causes of respiratory distress, labor and delivery history, and radiographic findings.

The initial chest radiograph for a large-for-gestational-age term infant delivered by cesarean section reveals diffuse haziness with prominent perihilar streaking bilaterally and fluid in the fissures. This radiographic picture is consistent with which diagnosis? A:Respiratory distress syndrome B:Meconium aspiration syndrome C:Pulmonary interstitial emphysema D:Transient tachypnea of the newborn

Correct:D Transient tachypnea of the newborn manifests on chest radiograph as bilateral, symmetric, perihilar streakiness caused by increased interstitial and alveolar fluid.

An arterial blood gas analysis was obtained with the following results: pH 7.32, PaCO2 67, Pao2 46, and base excess +2. What is the best interpretation of these results? A:Respiratory acidosis B:Hypoxemia and respiratory alkalosis C:Partially compensated metabolic acidosis D:Partially compensated respiratory acidosis and hypoxemia

Correct:D When acid-base status is being assessed, the pH and the two acid-base determinants (PaCO2 and HCO3) are examined. In this case the blood gas values reflect partial compensation in which both acid-base components remain abnormal in opposite directions as the pH approaches a normal value.

Why is inhaled nitric oxide useful in the treatment of persistent pulmonary hypertension? A:Inhaled nitric oxide supports cardiac function. B:Inhaled nitric oxide promotes bronchodilation. C:Inhaled nitric oxide decreases systemic arterial pressure. D:Inhaled nitric oxide is a potent selective pulmonary vasodilator.

Correct:D Rationale: Inhaled nitric oxide (iNO) has been proven to be a selective and potent pulmonary vasodilator.

A balloon septostomy is done for an infant with transposition of the great vessels to achieve which of the following? A:Increase pulmonary and systemic mixing at the atrial level B:Increase cardiac output by creating a ventricular septal defect C:Decrease pulmonary and systemic mixing at the ventricular level D:Create a parallel circulation between the venous and arterial circuits

Correct:A When an infant has a restrictive atrial septal defect (ASD), a balloon atrial septostomy, a technique developed by William Rashkind in 1966, may be performed. The procedure involves inserting a balloon-tipped catheter across the foramen ovale into the left atrium. The balloon is then inflated and forcibly withdrawn so that the catheter tears the septum primum and enlarges the ASD. Mixing should increase immediately, with a corresponding increase in arterial oxygen saturation.

Which of the following modes of mechanical ventilation describes the delivery of a synchronized breath, with each spontaneous breath meeting the threshold criteria, or the delivery of mechanical breaths at a preset regular rate if there is no spontaneous respiratory effort? A:Assist/control B:Pressure support ventilation C:Neurally adjusted ventilation D:Synchronized intermittent mandatory ventilation

Correct:A With the assist/control mode of ventilation, either a synchronized breath is delivered with each spontaneous breath that meets threshold criteria or in the absence of spontaneous respirations, mechanical breaths are delivered at a preset regular rate.

While performing a pulse oximetry screening on an infant nearing discharge a nurse notes a differential of 2% between preductal and postductal readings. The nurse should do which of the following? A:Notify the neonatologist immediately B:Consider this a negative screen C:Retest in 1 hour D:Instruct the family to schedule a repeat test after discharge

Correct:B A screen result would be considered positive if any oxygen saturation measures less than 90%, oxygen saturation is less than 95% in both extremities on three measures—each separated by 1 hour, or there is a 3% absolute difference in oxygen saturation between the right hand and foot on three measures, each separated by 1 hour. Any screening that is >95% in either extremity with no more than a 3% absolute difference in oxygen saturation between the upper and lower extremity would be considered a "pass" result, and screening would end.

Arterial blood gas results of pH 7.24, PCO2 51, PO2 40, and HCO3- 17 represents: A:compensated metabolic acidosis and hypoxia. B:mixed respiratory and metabolic acidosis and hypoxia. C:partially compensated metabolic acidosis and hypoxia. D:respiratory acidosis and hypoxia.

Correct:B Abnormalities in both the metabolic (HCO3 <22 mEq/L) and the respiratory (PCO2 >45 mm Hg) components in combination with acidosis (pH <7.35) represent mixed acidosis.

The family of a 4-hour-old term infant is concerned about bluish coloring of the hands and feet. The mucous membranes are pink, and the infant is in no distress. The nurse should explain to the family that: A:this condition warrants notifying the physician. B:the infant is exhibiting acrocyanosis, a transitional finding. C:the infant is bruised from delivery, which will resolve with time. D:the infant is exhibiting central cyanosis.

Correct:B Acrocyanosis involves the hands and feet, but does not involve the mucous membranes. It can persist from birth up to several hours of life and thus is considered a transitional finding in the absence of distress. It is thought to be caused by vasomotor instability and does not require physician notification.

An infant is ordered to receive adenosine. Which method of medication administration should the nurse utilize? A:Retrograde infusion B:Rapid intravenous (IV) push C:Slow IV push D:Intramuscular

Correct:B Adenosine transiently blocks the conduction of the atrioventricular node. It is only given rapidly by IV due its half-life of only 10 seconds or less.

An infant has a history of episodic supraventricular tachycardia that resolves spontaneously. An echocardiogram is performed, and there is slurred upstroke of the QRS and the presence of a delta wave. The nurse should suspect which of the following conditions? A:Coarctation of the aorta B:Wolff-Parkinson-White syndrome C:DiGeorge syndrome D:Atrioventricular canal defect

Correct:B Coarctation of the aorta, DiGeorge syndrome, and AV canal do not present with SVT.

Which one of the following statements about continuous positive airway pressure (CPAP) is true? A:CPAP and positive end-expiratory pressure are synonymous. B:CPAP can be delivered using either continuous or variable flow. C:The specified amount of pressure is delivered continuously only during the inspiratory phase of respiration. D:The specified amount of pressure is delivered continuously only during the expiratory phase of respiration.

Correct:B Continuous flow devices include neonatal ventilators and bubble continuous positive airway pressure (CPAP). Ventilators provide gas while limiting the outflow of gases based on the pressure setting. With bubble CPAP, the expiratory tubing is submerged in a chamber of water, and the level of water determines the amount of pressure generated. The flow of gases in continuous with both the ventilator and the bubble mode of delivering CPAP. Some devices use specialized prongs or masks and flow generators to deliver variable flow in which the flow rate of gases changes during inspiration and expiration to maintain a constant airway pressure.

While being mechanically ventilated, an infant becomes agitated and cyanotic. The infant's respirations are vigorous but asynchronous from those of the ventilator. The best initial response is to: A:obtain a chest radiograph. B:suction the endotracheal tube. C:administer vecuronium. D:change the mode of ventilation from synchronized intermittent mandatory ventilation to assist-control ventilation.

Correct:B Cyanosis with vigorous respirations is indicative of an obstructed endotracheal tube.

Which of the following medications is used to treat apnea that is refractory to methylxanthine therapy? A:Caffeine (Cafcit) B:Doxapram (Dopram) C:Theophylline (Theo-Dur, Slo-Bid) D:Aminophylline (Phyllocontin, Truphylline)

Correct:B Doxapram is a respiratory stimulant used to treat apnea that is refractory to methylxanthine therapy.

While caring for a preterm infant on ventilator support and end-tidal CO2 monitoring, the nurse should be aware that: A:end-tidal CO2 monitoring is more accurate than transcutaneous CO2 monitoring in infants with severe lung disease. B:end-tidal CO2 monitoring is less accurate in infants with severe lung disease. C:end-tidal CO2 monitoring is unaffected by lung function. D:end-tidal CO2 monitoring is not recommended for use in preterm infants. 40. Which of the following ventilator parameters is favorable for extubation?

Correct:B End-tidal CO2 monitoring cannot be relied on for accuracy in infants with severe lung disease (large alveolar-arterial gradient).

A newborn term infant with meconium aspiration syndrome is intubated and conventional ventilation is started. When the infant is 3 hours of age, the cardiorespiratory monitor sounds alarms for bradycardia and hypotension. The infant is extremely restless and cyanotic, with diminished breath sounds on the left side, poor peripheral pulses, asymmetric chest rise, and a mediastinal shift toward the right. The nurse should suspect the development of which of the following conditions? A:Pleural effusion B:Tension pneumothorax C:Pulmonary hemorrhage D:Pulmonary interstitial emphysema

Correct:B Meconium aspiration syndrome (MAS) places the infant at risk for air leak due to the ball-valve phenomenon: Air enters the alveoli but cannot escape. Distended alveoli rupture, which results in air leak. Air leak is a major risk factor associated with assisted ventilation in infants with MAS. A tension pneumothorax occurs as air builds up under pressure in the pleural space. The affected lung collapses and forces the mediastinum toward the contralateral side. Signs and symptoms of tension pneumothorax are acute respiratory decompensation with cyanosis, apnea, and bradycardia. On examination, the affected lung will exhibit diminished breath sounds. Increased anteroposterior diameter of the chest will be noted on visualization. Serous fluid is produced from the parietal pleural capillaries and enters the pleural space. It is reabsorbed into the parietal pleural lymphatics. Production and absorption of serous fluid are constant.

Subglottic stenosis may result from: A:multiple doses of surfactant. B:prolonged intubation. C:endotracheal tube placed in the right mainstem bronchus. D:traumatic intubation.

Correct:B Narrowing of the subglottic diameter is usually associated with prolonged intubation.

The chest radiograph for an infant who is being mechanically ventilated, taken 1 day after surfactant administration, reveals grossly hyperinflated lungs with coarse radiolucencies extending from the pleura to the hilum. This radiographic picture is most consistent with which of the following diagnoses? A:Respiratory distress syndrome B:Pulmonary interstitial emphysema C:Transient tachypnea of the newborn D:Persistent pulmonary hypertension of the newborn

Correct:B On the chest radiograph, pulmonary interstitial emphysema is characterized by hyperinflated lungs with coarse radiolucencies extending from the pleura to the hilum.

A preterm infant being treated with mechanical ventilation for severe respiratory distress syndrome suddenly has hypotension, muffled heart sounds, and bradycardia. The chest radiograph reveals a "halo" surrounding the heart. The nurse should prepare to assist with management of which of the following conditions? A:Pneumothorax B:Pneumopericardium C:Pneumomediastinum D:Pulmonary interstitial emphysema

Correct:B Pneumopericardium is characterized by cyanosis, muffled heart sounds, hypotension, and bradycardia. The chest radiograph reveals a "halo" around the heart.

Which of the following symptoms would be most important for the nurse to assess for an infant with suspected pulmonary edema? A:Tachycardia B:Tachypnea C:Hypothermia D:Hypotension

Correct:B Respirations >60 at rest is the first sign noted in congestive heart failure and pulmonary edema.

In the delivery room a 1200-g infant at 30 weeks' gestation shows grunting, nasal flaring, and chest wall retractions. Which of the following pulmonary pathophysiologic conditions is most likely occurring? A:Pulmonary air leak syndrome B:Respiratory distress syndrome C:Meconium aspiration syndrome D:Transient tachypnea of the newborn

Correct:B Respiratory distress syndrome (RDS) is the result of surfactant deficiency. The incidence of RDS is inversely proportional to the gestational age of the infant, and RDS is the most common pulmonary problem in the preterm infant. At 30 weeks' gestational age, surfactant production is minimal, which leads to atelectasis, hypoxia, and acidosis. The infant's attempt to increase ventilation is characterized by grunting, nasal flaring, and retractions.

The nurse should anticipate the placement of endocardial pacing wires after which of the following procedures? A:Patent ductus arteriosus ligation B:Endocardial cushion defect repair C:Pericardial needle decompression D:Coarctation of the aorta repair

Correct:B Surgeries near the conduction system may predispose the infant to arrhythmias that may require temporary pacing, which is the case with endocardial cushion defect.

The American Academy of Pediatrics recommendations for preventions of sudden infant death syndrome (SIDS) include: A:home cardiorespiratory monitoring. B:proper sleep position. C:limiting bedding to no more than 2 loose blankets in the crib. D:using positioning devices to keep the infant on his or her side.

Correct:B The American Academy of Pediatrics (AAP) recommends placing infants on their back for sleep time to decrease the risk of sudden infant death syndrome (SIDS).

To rule out group B streptococcal infection as an underlying cause of respiratory distress, which of the following studies would be most appropriate? A:Eye culture B:Blood cultures C:Cultures of nasopharyngeal secretions D:Cultures of axillary and rectal specimens

Correct:B The diagnosis of sepsis is hard to make based on clinical findings alone. A positive finding on cultures of the blood, cerebrospinal fluid, or urine is the gold standard.

The nurse should educate parents that the electrical conducting system of the heart becomes functional at approximately how many weeks gestation? A:32 B:10 C:21 D:28

Correct:B The fetal electrical conducting system becomes functional around 10 weeks, with a normal sinus rhythm seen by 16 weeks.

An infant is admitted to the NICU from the delivery room exhibiting tachypnea, nasal flaring, cyanosis, and increased anteroposterior diameter of the chest. The amniotic fluid was characterized as thick "pea-stained" fluid. An initial arterial blood gas analysis determines that endotracheal intubation is warranted. Which of the following is most appropriate as an initial setting for this infant when synchronized intermittent mandatory ventilation is started? A:Low rate B:Low inspiratory time C:Low peak inspiratory pressure D:High positive end-expiratory pressure

Correct:B The history and clinical findings suggest that this infant has meconium aspiration syndrome (MAS). Hyperinflation occurs due to ball-valve air trapping. Lower inspiratory time will allow adequate exhalation time to prevent air trapping.

Medical management of an infant with respiratory distress complicated by patent ductus arteriosus would include which of the following? A:Volume expansion B:Indomethacin (Indocin) C:Acetaminophen (Tylenol) D:Prostaglandin E1 (Alprostadil)

Correct:B The inhibition of cyclooxygenase by the nonsteroidal antiinflammatory agent indomethacin (Indocin) results in decreased prostaglandin synthesis and contributes to ductus arteriosus closure.

The parents of an infant with complex congenital heart disease (CHD) ask the nurse why the heart defect was not found on fetal echocardiogram. The nurse should explain to the parents that: A:it would be best to ask the obstetrician. B:the heart is not fully examined during a fetal echocardiogram. C:a fetal echocardiogram detects approximately 30% to 50% of severe CHD. D:10% of infants with an abnormal fetal echocardiogram are diagnosed with CHD after birth.

Correct:C Fetal echocardiograms are commonly done on mothers who have a history suspect for congenital heart disease (CHD). A family history of CHD, fetal malformations on routine obstetric ultrasound, abnormal fetal heart rhythm, maternal insulin-dependent diabetes, or exposure to known teratogens are also possible indications for a fetal echocardiogram. Fetal echocardiogram detects between 30% and 50% of severe CHD before birth.

A 3.5-kg, postdate infant was born via cesarean section because of prolonged fetal bradycardia and thick meconium-stained fluid. At delivery the infant was limp, apneic, cyanotic, and bradycardic and required intubation. Suctioning of the trachea produced thick green material. On admission, the admitting nurse recognizes that this infant is at high risk for which of the following conditions? A:Pulmonary edema B:Nonspecific respiratory distress C:Meconium aspiration syndrome D:Transient tachypnea of the newborn

Correct:C Fetuses with in utero hypoxemia and acidosis often pass meconium and initiate respiratory efforts. Respiratory efforts increase the risk of meconium aspiration. If meconium is retrieved from the trachea during neonatal resuscitation after birth, vigilance is required for the development of meconium aspiration syndrome (MAS), frequently with persistent pulmonary hypertension. Mild MAS can show a normal lung pattern on chest radiograph.

Which of the following statements about pulmonary physiology is accurate? A:Tidal volume is defined as the volume of air maximally inspired and maximally expired in one breath. B:Vital capacity is defined as the amount of air that moves into or out of the lungs with each normal respiration. C:Functional residual capacity is defined as the volume of gas that remains in the lungs after normal expiration. D:Physiologic dead space is defined as the volume of gas within the area of the pulmonary conducting airways that cannot engage in gas exchange.

Correct:C Gas remaining in the lungs after a normal expiration is known as functional residual capacity (FRC). FRC is approximately 30 ml/kg.

When obtaining a blood sample for capillary blood gas analysis, the nurse knows to: A:avoid the posterolateral aspect of the heel. B:hold the puncture site above the rest of the extremity to facilitate collection. C:avoid the calcaneus. D:squeeze the extremity to increase blood flow.

Correct:C Heel sticks made to the curvature of the heel (calcaneus) place the infant at risk for calcaneal osteomyelitis.

Which of the following populations of infants at 36 weeks of gestation would be at increased risk for developing respiratory distress syndrome? A:Infants of heroin-addicted mothers B:Infants of mothers with hypertension C:Infants of class A/B/C diabetic mothers D:Infants with intrauterine growth restriction

Correct:C Hyperglycemia and hyperinsulinemia present in diabetes inhibit surfactant C (phosphatidylcholine) protein synthesis.

Mechanically ventilated infants must be monitored for acid-base status. Prolonged, severe hypocapnia resulting in respiratory alkalosis places the infant at risk for: A:apnea. B:renal failure. C:periventricular leukomalacia. D:gastroesophageal reflux disease.

Correct:C Hypocapnia induces cerebral ischemia, leading to neuronal cell injury and death.

Factors that predispose an infant to broncho¬pulmonary dysplasia include which of the following? A:Hypovolemia B:Full-term birth C:Oxygen administration and mechanical ventilation D:Transient tachypnea of the newborn

Correct:C In bronchopulmonary dysplasia (BPD), the lung is injured in the canalicular period by an inflammatory reaction. Causes include immaturity, infection, volutrauma or barotrauma, and oxidative stress.

An infant fails a congenital heart screen with oxygen saturations in the low 90s while in room air. An echocardiogram shows normal structure of heart with inability to rule out coarctation of the aorta. Which vessel prevents coarctation of the aorta from being ruled out? A:Overriding pulmonary artery B:Pulmonary vein C:Patent ductus arteriosus D:Ductus venosus

Correct:C In the presence of a large patent ductus arteriosus (PDA), the narrowing of the aorta may be hidden. The normal site of narrowing is at the left subclavian artery. Stenosis of the arch evolves as the PDA closes.

Initial blood gas analysis for an infant with respiratory distress syndrome reveals the following: pH 7.28, PaCO2 65, Pao2 85, HCO3 22. The most appropriate management for this infant, who is being mechanically ventilated, is to: A:decrease the ventilator rate. B:decrease the inspiratory time. C:increase the peak inspiratory pressure. D:increase the positive end-expiratory pressure.

Correct:C Increasing peak inspiratory pressure will increase tidal volume, thereby decreasing PaCO2. PaCO2 is inversely proportional to respiratory rate.

The care provider has ordered indomethacin (Indocin) for an infant diagnosed with a patent ductus arteriosus. Which of the following would indicate to the nurse that it is safe to administer the medication? A:Serum creatinine level of 2.0 mg/dl B:Urine output of 0.5 ml/kg/hour C:Platelet count of 110,000/mm3 D:Radiographic evidence of necrotizing enterocolitis

Correct:C Indomethacin inhibits platelet aggregation. Platelet count must be normal before administration of indomethacin to prevent unintended blood loss. The minimum acceptable platelet count is 60,000/mm3.

An infant of a diabetic mother presents with pallor, poor feeding, tachypnea, a large heart on chest radiographs, and systolic ejection murmur. These factors are most likely related to which of the following? A:Patent ductus arteriosus B:Peripheral pulmonic stenosis C:Cardiomyopathy D:Coarctation of the aorta

Correct:C Infants born to mothers with uncontrolled diabetes are at risk for transposition of the great vessels, ventricular septal defects, cardiomyopathy, and complex congenital heart disease.

An infant is born with low-set ears, excess nuchal skin, a broad chest, widely spaced nipples, peripheral lymphedema, and absent pulses in the lower extremities. The nurse suspects the infant has coarctation of the aorta. Which chromosomal defect can cause this constellation of findings? A:Trisomy 21 B:Trisomy 18 C:Turner syndrome D:Klinefelter syndrome

Correct:C Infants with Turner syndrome can present with cardiovascular anomalies, short stature, low-set ears, excess nuchal skin, a broad chest with widely spaced nipples, peripheral lymphedema, and ovarian dysgenesis. Common defects are coarctation of the aorta and bicuspid aortic valve. About 30% of infants with Turner syndrome will have a coarctation of the aorta.

An infant requires frequent arterial blood gas (ABG) monitoring, but obtaining ABG specimens is difficult in the infant. A transcutaneous oxygen and carbon dioxide monitor is ordered for this infant. The nurse knows that: A:no more ABG specimens will be needed. B:the umbilical arterial catheter can now be removed. C:use of this monitor will reduce the number of ABG specimens needed. D:there is a direct correlation between the transcutaneous oxygen and carbon dioxide values and the ABG values.

Correct:C The need for subsequent arterial blood gas (ABG) measurements is reduced but not eliminated. The monitor must be calibrated before use and then correlated with ABG results. The placement site must be changed frequently based on the probe temperature and the condition of the infant's skin to prevent skin burns. When the site is changed, the monitor must be recalibrated and another ABG analysis performed to determine the correlation between the monitor values and the ABG results.

Which of the following statements about the oxygen-hemoglobin dissociation curve is accurate? A:The absence of cyanosis indicates a well-oxygenated infant. B:A right-shifted curve indicates increased affinity of hemoglobin for oxygen. C:The hemoglobin-oxygen dissociation curve reflects the affinity of hemoglobin for oxygen. D:Hemoglobin's affinity for oxygen is primarily influenced by serum glucose and electrolyte values.

Correct:C The oxygen-hemoglobin dissociation curve reflects oxygen tension—the partial pressure of oxygen bound to hemoglobin.

Results of an infant's arterial blood gas analysis are pH 7.25, PaCO2 70, HCO3 21, base deficit -4, Pao2 50, and oxygen saturation 88%. These blood gas results are indicative of which acid-base condition? A:Metabolic acidosis B:Metabolic alkalosis C:Respiratory acidosis D:Respiratory alkalosis

Correct:C The pH of 7.25 indicates acidosis. The PaCO2 is indicative of a respiratory component. The HCO3 of 21 is normal. Therefore the cause of the acidosis is respiratory, not metabolic. The hallmark of metabolic acidosis is a low HCO3. Metabolic alkalosis demonstrates an elevated pH due to a high HCO3. The pH would be elevated (alkalotic) if PaCO2 were low.

In an infant with tetralogy of Fallot, the severity of symptoms will be most affected by which of the following? A:Degree of pulmonary edema B:Size of the ventricular septal defect C:Degree of right ventricular outflow obstruction D:Size of the patent ductus arteriosus

Correct:C The presence of an obstruction to right ventricular (RV) outflow with a large ventral septal defect causes a right-to-left shunt at the ventricular level with arterial desaturation. The greater the obstruction and the lower the systemic vascular resistance, the greater is the right-to-left shunt. Thus the clinical findings vary with the degree of RV outflow obstruction. Patients with mild obstruction are minimally cyanotic or acyanotic. Those with severe obstruction are most likely to be deeply cyanotic from birth. Few children are asymptomatic. In those with significant RV outflow obstruction, many have cyanosis at birth, and nearly all have cyanosis by age 4 months.

Which of the following statements about endotracheal tube continuous positive airway pressure (CPAP) is true? A:There is no need to use sterile technique when suctioning. B:There is a decreased risk for air leaks compared with nasal CPAP. C:Work of breathing could increase, leading to fatigue. D:This method is the preferred method for delivering noninvasive ventilation.

Correct:C The resistance in the endotracheal tube is increased due to the small diameter and longer length than the trachea; therefore work of breathing is increased, and apnea or respiratory distress may result.

A hypotensive infant is diagnosed with a ductal-dependent lesion. The nurse should include which of the following treatments as the most crucial in the plan of care? A:Administration of antibiotics B:Initiation of supplemental oxygen C:Initiation of intravenous prostaglandin E1 infusion D:Administration of 5 ml/kg normal saline bolus

Correct:C The single most important intervention for a ductal-dependent lesion is the infusion of IV prostaglandin E1 (PGE1) to ensure ductal patency and improve left-to-right shunting and systemic blood flow. The initial dose of PGE1 is usually 0.1 mcg/kg/min. PGE1 should then be titrated to the lowest effective dose and can be administered through an umbilical venous catheter, central line, IO line, or peripheral IV line with equal efficacy, although central access is preferred.

A 3-hour-old infant requires transfer to a higher level of neonatal care related to suspected congenital heart disease. The nurse should include which of the following in formulating the plan of care? A:Designate the obtainment of transfer consent to accepting institution B:Arrange for mother to accompany infant during transport C:Assure nursing report is communicated between sending and receiving facilities D:Request sending neonatologist outline plan for surgical repair to parents

Correct:C There should be communication from the sending nurse to the receiving nurse at the tertiary center.

An infant is 24 hours postprocedure for the placement of a tunneled central catheter and suddenly exhibits a period of tachycardia followed by profound bradycardia. The nurse verifies endotracheal tube placement and determines heart sounds inaudible with no palpable pulses. There is display of an electrical rhythm on electrocardiogram. The nurse should anticipate: A:escalation of positive pressure ventilation. B:administration of antibiotics. C:pericardial tap. D:pharmacologic closure of the patent ductus arteriosus

Correct:C Rationale: Pericardial tamponade has multiple known causes, but a new onset after a central line procedure may indicate an iatrogenic perforation of the vessel near the pericardial space. The result is a filling of the pericardial sac with blood and possibly fluid, thus causing a decline in cardiac function. Symptoms may include a period of initial tachycardia followed by bradycardia, pulse paradoxus, PR depression, ST elevation, electrical alternans, declining or absent pulses, and quiet or absent heart sounds. When infants have a rapid decompensation and death is an immediate concern, rapid needle decompression of the pericardial space is necessary.

Which of the following cardiac lesions can be palliated with a transcatheter balloon valvuloplasty? A:Patent ductus arteriosus B:Hypoplastic left heart syndrome C:Peripheral pulmonary artery stenosis D:Aortic stenosis

Correct:D A balloon valvuloplasty can be performed in the catheterization laboratory immediately after the infant has been stabilized with medical and pharmacologic treatment, including prostaglandin E1. It is the procedure of choice for reduction of transvalvular gradients in symptomatic infants. This procedure is an ideal palliative treatment option because mortality from surgical valvuloplasty early after diagnosis can be high due to the critical illness severity. Balloon valvuloplasty thus provides relief of the valvular gradient and allows for future surgical intervention to be performed on an unscarred chest.

An infant is being mechanically ventilated because of respiratory failure secondary to respiratory distress syndrome. Arterial blood gas results indicate a rising PaCO2. Breath sounds are coarse bilaterally, with bubbling of secretions observed in the endotracheal tube. The infant is extremely restless, with "seesaw" respirations. The ventilator is consistently sounding an alarm for high inspiratory pressure. The nurse's first action should be to: A:reposition the infant. B:administer an analgesic. C:silence the ventilator alarm. D:assess breath sounds, suction, and reassess breath sounds.

Correct:D Criteria for endotracheal suctioning include visible secretions in the tube, coarse breath sounds, increased agitation, and changes in arterial blood gas values. After suctioning, the infant is reassessed to determine the effectiveness of the procedure.

While caring for an intubated infant, the nurse recognizes that the infant requires endotracheal suctioning. Which of the following actions is appropriate? A:Use sterile normal saline before suctioning to mobilize and thin secretions. B:Turn the infant's head from side to side with suction passes to advance the catheter down the contralateral bronchus. C:Insert and remove the catheter several times to ensure removal of secretions. D:Provide nonnutritive sucking and/or body containment during suction procedure.

Correct:D Developmental care techniques, such as providing nonnutritive sucking and body containment, are effective strategies to decrease the infant's stress response to suctioning.

A disadvantage of using pulse oximetry to monitor blood oxygenations is: A:a slow response to changes in blood oxygen. B:low correlation of SpO2 and PaO2 at lower saturations. C:there is no way to verify the reliability of the sensor. D:phototherapy can interfere with SpO2 accuracy.

Correct:D Direct sunlight, phototherapy lights, and procedure lights can interfere with sensor function and SpO2 accuracy and give falsely reassuring readings. Shielding the probe from external light by use of an opaque wrap is recommended.

The nurse should expect an infant to have which of the following heart defects when a chest radiograph reveals a heart that fills the entire chest? A:Pulmonary atresia B:Tricuspid atresia C:Hypoplastic left heart syndrome D:Ebstein malformation

Correct:D Ebstein malformation on x-ray reveals extreme cardiomegaly with severity depending on the degree of tricuspid valve insufficiency and size of the atrial shunt.

Surfactant improves lung function by: A:increasing opening pressure. B:inhibiting alveolar fluid clearance. C:promoting structural maturation of the lung. D:reducing surface tension at the air-liquid interface in the alveolus.

Correct:D Establishing an air-liquid interface in the alveolus is one of two transitional events required for extrauterine functioning. The other is a rhythmic respiration pattern.

Which of the following ventilator parameters is favorable for extubation? A:Intermittent mandatory ventilation of 22 to 30/minute B:Peak inspiratory pressure of 20 to 24 cm H2O C:Tidal volume of 6 to 8.5 ml/kg D:FiO2 of 26%

Correct:D Evaluation for extubation should be considered when ventilator parameters are low: supplemental oxygen ranging between 21% and 30%; peak inspiratory pressure 14 to 18 cm H2O; VT 3.5 to 5 ml/kg; and intermittent mandatory ventilation 10 to 20/minute.

Expiratory grunting represents the infant's attempt to: A:conserve energy. B:decrease upper airway resistance. C:overcome large airway obstruction. D:maintain a normal functional residual capacity.

Correct:D Expiratory grunting is an attempt to slow expiratory flow rates, prevent alveolar atelectasis, and maintain functional residual capacity.

Inclusion criteria for the use of extracorporeal membrane oxygenation for the treatment of cardiorespiratory failure include: A:severe lung hypoplasia. B:gestational age of 32 weeks. C:bilateral grade IV intracranial hemorrhage. D:left congenital diaphragmatic hernia without liver herniation in a full-term infant.

Correct:D Full-term infants with a small congenital diaphragmatic hernia without liver herniation have a good prognosis and therefore meet the criteria for management using extracorporeal membrane oxygenation (ECMO).

An infant with a ventricular septal defect has been receiving furosemide (Lasix) for 2 weeks. The nurse should anticipate that the electrolyte panel may exhibit which of the following? A:Hyperchloremia B:Hyperkalemia C:Hyperglycemia D:Hypokalemia

Correct:D Furosemide (Lasix) is a loop diuretic and is used to eliminate excess water.

The nurse should monitor an infant who has experienced pulmonary and intracranial hemorrhage for which of the following types of shock? A:Cardiogenic B:Septic C:Neurologic D:Hypovolemic

Correct:D Hypovolemic shock is a state of inadequate blood volume and can be seen with any condition that causes blood or fluid losses such as intraventricular hemorrhage, pulmonary hemorrhage, vomiting and diarrhea, severe third spacing, or large fluid loss from defects such a gastroschisis.

Severe asphyxia of the full-term infant in the early neonatal period may result in which of the following conditions? A:Pneumonia B:Transient tachypnea of the newborn C:Left-to-right shunting through the foramen ovale D:Persistent pulmonary hypertension of the newborn

Correct:D Hypoxia and acidosis are endogenous mediators that increase pulmonary vascular resistance and lead to persistent pulmonary hypertension and hypoperfusion of the lungs.

Radiographic findings characteristic of severe bronchopulmonary dysplasia include which of the following? A:Pleural effusion B:Alveolar infiltrates C:Dark areas without parenchymal markings D:Cystic lung fields with hyperinflation and atelectasis

Correct:D In bronchopulmonary dysplasia, by the end of the first or second week of life, the chest radiograph shows haziness of vessel margins progressing to linear densities representing alveolar collapse. This is followed by a bubbly appearance with hyperaeration, especially at the lung bases. Serous fluid is produced from the parietal pleural capillaries and enters the pleural space. It is reabsorbed into the parietal pleural lymphatics. Production and absorption of serous fluid are constant. In disease states, production may increase, which results in a pleural effusion.

A nurse is caring for a 4-kg infant who has undergone cardiac surgery and is now 72 hours post-op. The plan of care includes monitoring for an adequate amount of urine output postoperatively. The nurse should expect how many ml/hour of urinary output? A:1 ml/hour B:2 ml/hour C:3 ml/hour D:4 ml/hour

Correct:D This infant should have 4 to 8ml/h or 1 to 2ml/kg/hour urinary output postoperatively to ensure adequate renal perfusion 48 hours post surgery.

An infant has a prenatal history of polyhydramnios. On physical examination, the infant appears normal. At first feeding, he becomes dusky with respiratory distress, and suctioning of the nasopharynx/oropharynx is required. Further attempts to nipple-feed are met with the same results. The nurse expects the cause of this infant's respiratory distress to be: A:choanal atresia. B:pulmonary hypoplasia. C:congenital heart disease. D:esophageal atresia with tracheoesophageal fistula.

Correct:D In esophageal atresia with tracheoesophageal fistula, the esophagus ends in a blind pouch in 85% of cases. Attempts to feed and the accumulation of oropharyngeal secretions result in respiratory distress and the need for suctioning. Polyhydramnios suggests a condition in which the fetus does not swallow amniotic fluid normally, as with an upper gastrointestinal obstruction.

An infant presents with cyanosis at birth and is later diagnosed with transposition of the great vessels per echocardiography. The nurse recognizes that the degree of cyanosis depends on which of the following factors? A:Volume of cardiac output B:Amount of obstruction to the pulmonary circuit C:Quantity of pulmonary edema D:Volume of mixing between pulmonary and systemic circulations

Correct:D In transposition of the great vessels, the degree of cyanosis depends on the amount of mixing between the pulmonary and systemic circulations. Oxygenated pulmonary venous blood is returned to the lungs, and desaturated systemic blood is returned to the body. Thus the two circulations exist in parallel. Some mixing between them must occur to allow oxygenated blood to reach the systemic circulation and the desaturated blood to reach the lungs.

What are the caloric requirements for an infant with severe bronchopulmonary dysplasia? A:80 to 100 kcal/kg/day B:100 to 120 kcal/kg/day C:120 to 140 kcal/kg/day D:150 to 180 kcal/kg/day

Correct:D Infants with bronchopulmonary dysplasia have a caloric requirement of 150 to 180 kcal/kg/day to compensate for the increased metabolic demands of respiratory effort and the fluid restriction that is required. Growth failure is common if fewer calories are provided.

Which of the following is a synthetic type of surfactant that contains a peptide and sinapultide and mimics surfactant protein B? A:Beractant (Survanta) B:Poractant alfa (Curosurf) C:Calfactant (Infasurf) D:Lucinactant (Surfaxin

Correct:D Lucinactant (Surfaxin) is a synthetic surfactant that contains the peptide sinapultide, which mimics surfactant protein B. Initial dosage is 5.8 ml/kg every 6 hours based on clinical response.

Lung development is completed by what age? A:38 to 40 weeks of gestation B:12 to 15 months of age C:6 to 8 years of age D:16 to 18 years of age

Correct:D Maturation occurs around 19 years of age with final vascular growth, decreased number of mucus glands, and adult shape of the thorax.

Which pathophysiology is associated with meconium aspiration syndrome? A:Atelectasis-prone lungs susceptible to volutrauma B:Hemodynamic impairment and restricted chest and/or diaphragmatic movement C:Gas interstitium compressing alveoli, airways, and pulmonary venules D:Uneven aeration and risk of gas trapping and surfactant inactivation

Correct:D Meconium aspiration syndrome is characterized by uneven aeration with areas of atelectasis and gas trapping. Surfactant function is disrupted by meconium.

The nurse initiates a milrinone infusion for an infant who recently underwent open heart surgery. Which vital sign should the nurse monitor closely related to this infusion? A:Respirations B:Pain C:Temperature D:Blood pressure

Correct:D Milrinone is phosphodiesterase inhibitor that increases heart rate and contractility and is a vasodilator. Some patients may need volume infusion after a load of milrinone. The other vital signs are not affected.

Congenital heart disease is most commonly associated with which of the following? A:Tobacco use B:Genetic syndrome C:Alcohol use in the third trimester D:Multifactorial influence

Correct:D Most cases of congenital heart disease are multifactorial.

A chest x-ray was obtained after oxygen requirements increased from 25% to 35% for an infant on nasal cannula at 1 liter per minute (LPM) NC 1 LPM. The physical examination is unchanged from baseline. The x-ray shows a small pneumothorax on the left side. Which of the following actions would be considered inappropriate? A:Monitoring the infant for additional changes in respiratory status B:Positioning the infant with the affected side down C:Ensuring that supplies needed for needle thoracentesis are at the bedside D:Placing the infant on nasal continuous positive airway pressure

Correct:D Nasal continuous positive airway pressure may increase end expiratory pressure and worsen a pneumothorax and therefore should be avoided.

Necrotizing tracheobronchitis is characterized by which of the following? A:Stridor B:Softening of the cartilaginous airway rings and a failure to support the round shape of the trachea C:Dilation of the trachea and bronchi D:Inflammation and granulation of the distal trachea

Correct:D Necrotizing tracheobronchitis is a necrotic inflammatory process that involves the distal trachea and mainstem bronchi. With this complication, normal tracheal mucosa is replaced with acute inflammatory cells, leading to mucosal sloughing and occlusion of the distal trachea, granulation, atelectasis, and impaired gas exchange.

A 26-week-gestation infant has a blood pressure of 33 mm Hg systolic, 18 mm Hg diastolic, and a mean arterial pressure of 23 mm Hg. The nurse should interpret this as: A:normotensive. B:hypovolemic. C:hypertensive. D:hypotensive.

Correct:D Normal blood pressure for the first week of life is considered to be a mean arterial blood pressure at least equal to the gestational age of the infant. This infant is hypotensive given the gestational age of 24 weeks and the mean arterial pressure of 23 mm Hg.

Which of the following can cause a pulse oximeter to display inaccurate oxygen saturation values? A:Prematurity B:Use of vasodilating drugs C:Cyanotic heart disease D:Decreased peripheral perfusion

Correct:D Obtaining accurate pulse oximetry readings depends on adequate perfusion of the monitoring site, probe position, and the ability of the equipment to detect arterial pulsations.

An infant is diagnosed with persistent pulmonary hypertension. The nurse should give priority to which of the following treatment measures? A:Paralysis B:Furosemide C:Sildenafil D:Oxygen

Correct:D Oxygen is a proven pulmonary vasodilator and the first line of treatment in pulmonary hypertension.

By 72 hours of life, a small preterm infant who has been treated with surfactant for respiratory distress syndrome develops a grade II-VI continuous murmur at the left upper sternal border. Bilateral rales are heard on auscultation of breath sounds. Bounding peripheral pulses with a widened pulse pressure are present. Urine output is less than 2 ml/kg/hour. Blood gas analyses reveal increasing hypoxemia, hypercarbia, and metabolic acidosis with subsequent need for increased ventilatory support. These findings are most consistent with which condition? A:Sepsis B:Air leak C:Pneumonia D:Patent ductus arteriosus

Correct:D Patent ductus arteriosus is an outcome of surfactant usage. Clinical findings include bounding peripheral pulses, widening pulse pressure, diminished left ventricular output with decreased renal and mesenteric blood flow, and metabolic acidosis. A murmur is typically, although not always, present.

Extracorporeal membrane oxygenation is indicated for which of the following conditions? A:Bilateral pulmonary hypoplasia B:Bronchopulmonary dysplasia C:Transient tachypnea of the newborn D:Persistent pulmonary hypertension of the newborn

Correct:D Patient selection criteria for extracorporeal membrane oxygenation (ECMO) include gestational age of more than 34 weeks, birth weight of more than 2 kg, presence of grade II or less intracranial hemorrhage, absence of complex congenital heart disease or lethal malformations, and reversible lung disease. Persistent pulmonary hypertension of the newborn (PPHN) is an acute and reversible cardiorespiratory disease. ECMO is warranted if standard therapies fail to reverse PPHN.

An intubated infant's pulse oximeter sounds an alarm because oxygen saturation is 75%. The nurse suctions the infant's airway, and pink-tinged secretions are obtained. The most appropriate action would be to: A:perform aggressive endotracheal suctioning. B:transfuse platelets to reach a platelet count of 200,000/mm3. C:transfuse red blood cells to reach a hemoglobin level of 15 mg/dl. D:increase the peak end-expiratory pressure from 4 to 6 cm H2O.

Correct:D Pink-tinged secretions are indicative of a pulmonary hemorrhage with minimal bleeding. Treatment of a pulmonary hemorrhage in an intubated patient is to increase the peak end-expiratory pressure to tamponade the bleeding at the site.

Which of the following nursing activities will optimize patient outcomes in the intubated extremely preterm infant with respiratory distress syndrome? A:Multiple laboratory specimen draws via heel stick B:Infusion of intravenous fluids at 150 ml/kg/day C:Frequent and scheduled endotracheal suctioning D:Placement of a transparent plastic covering over an infant who is on an open warmer bed

Correct:D Placing a transparent plastic covering over an infant on an open warmer will help to maintain a neutral thermal environment and thereby decrease oxygen consumption.

Which of the following factors interferes with transillumination of a pneumothorax? A:Dim room lighting B:Bright light from the transilluminator C:Large-for-gestation infant D:Darkly pigmented skin

Correct:D Preliminary diagnosis of a pneumothorax by transillumination may be difficult in infants with darkly pigmented skin.

A nurse is caring for an infant with Wolf-Parkinson-White (WPW) syndrome. The plan of care should include which of the following for the prevention of supraventricular tachycardia associated with WPW? A:Adenosine B:Hydralazine C:Digoxin D:Propranolol

Correct:D Propranolol is the medication of choice for the prevention of supraventricular tachycardia (SVT) in infants with SVT caused by Wolff-Parkinson-White (WPW) syndrome.

Which of the following is considered a contraindication for chest physiotherapy? A:Atelectasis B:Neuromuscular compromise C:Chest tube or gastrostomy tube in place D:Pulmonary hemorrhage

Correct:D Pulmonary hemorrhage is an absolute contraindication for chest physiotherapy (CPT) due to the risk of exacerbation of bleeding.

An infant has bounding pulses in the brachial and femoral arteries per nursing assessment. The nurse should document these pulse palpations as: A:1+. B:2+. C:3+. D:4+.

Correct:D Pulse volume is graded from 0 to 4: Absent: 0, Weak: 1+, Weak to average: 2+, Strong: 3+, Bounding: 4+

Heliox, a mixture of helium and oxygen at a 4:1 ratio, has been demonstrated to have beneficial ventilatory effects in infants with: A:pneumothorax. C:necrotizing enterocolitis. D:obstructive pulmonary disease.

Correct:D Research has demonstrated that the use of heliox reduces the length of time mechanical ventilation is required in infants with obstructive pulmonary diseases such as reactive airway, bronchiolitis secondary to respiratory syncytial virus infection, and pulmonary interstitial emphysema.

Which of the following is a possible cause of respiratory acidosis? A:Acetazolamide administration B:Maternal heroin addiction C:Diuretic therapy D:Apnea

Correct:D Respiratory acidosis is secondary to insufficient alveolar ventilation and may result from apnea due to hypoventilation.

A 38-week-gestation infant had apnea, hypotonia, cyanosis, and a heart rate of less than 100 beats/minute at delivery. When tactile stimulation and blow-by oxygen fail to induce spontaneous respiration, the nurse initiates positive pressure bag-and-mask ventilation, suspecting that the infant has which of the following conditions? A:Idiopathic apnea B.Obstructive apnea C:Primary apnea associated with asphyxia D:Secondary apnea associated with asphyxia

Correct:D Secondary apnea is a result of prolonged asphyxia. It is marked by gasping respirations and a decrease in blood pressure and heart rate that is not responsive to stimulation and/or oxygen supplementation.

Compared with dexamethasone, low-dose hydrocortisone is associated with: A:an equivalent safety profile. B:an increase in adverse neurodevelopmental outcomes. C:a lower incidence of bronchopulmonary dysplasia /chronic lung disease. D:a lower risk of reduced brain growth.

Correct:D Studies suggest that low-dose hydrocortisone is safer for the immature brain in that there is less effect on cerebral tissue volume and fewer adverse neurodevelopmental outcomes compared with dexamethasone.

Which of the following statements is the most accurate about what occurs during the terminal sac stage of fetal lung development? A:The adult component of alveoli is obtained. B:A decrease in pulmonary vascularization occurs. C:Surface-active phospholipid (lecithin) is first detected. D:A progressive increase in alveolar capillary surface area occurs that is necessary for gas exchange.

Correct:D The terminal sac stage of fetal lung development is characterized by the refinement of the acini. Primary saccules continue to divide. The development of the surfactant system occurs. An increase in the alveolar-blood barrier surface area increases secondary to capillary invasion. The respiratory system continues to mature through childhood, with the greatest growth in the first 1 to 2 years.

A 39-week, large-for-gestational-age infant was delivered by cesarean section. The Apgar scores were 8 and 9 at 1 and 5 minutes, respectively, and initial vital signs were stable. At 2 hours of age, the infant exhibits increased work of breathing and a pulse oximetry reading of 88% on room air. Blow-by oxygen raises the oxygen saturation to 96%. An arterial blood gas analysis reveals the following: pH 7.36, PaCO2 37, HCO3 24, and Pao2 65. Appropriate management for this infant would include which of the following interventions? A:Administration of surfactant B:Administration of inhaled nitric oxide C:Intubation and mechanical ventilation D:Provision of supplemental oxygen to maintain Pao2 at 70 to 80

Correct:D Supplemental oxygen administration has relieved this infant's hypoxemia and is readily available as therapy. Supplemental oxygen will treat the diagnosed problem of hypoxemia. An infant who is large for gestational age as a result of maternal diabetes is at increased risk for surfactant deficiency, because the hyperglycemia and hyperinsulinemia present in diabetes inhibit surfactant C (phosphatidylcholine) protein synthesis.

The nurse anticipates that an infant will be scheduled for surgical reduction of a congenital diaphragmatic hernia: A:immediately after delivery. B:after surfactant therapy. C:after a trial period of treatment with inhaled nitric oxide. D:once pulmonary stabilization has been achieved.

Correct:D Surgical repair of a congenital diaphragmatic hernia is performed once pulmonary and cardiovascular stabilization has been achieved. Early management includes mechanical ventilation, sedation and chemical paralysis, frequent monitoring of arterial blood gas values, inotropic support for systemic hypotension, and correction of metabolic acidosis. Extracorporeal membrane oxygenation (ECMO) and inhaled nitric oxide (iNO) may be indicated in severe cases.

An infant is diagnosed with hypoplastic left heart syndrome. The nurse should be aware that historically the treatment approach was: A:multistaged surgical repair. B:heart transplant. C:single-stage surgical repair. D:palliative care.

Correct:D Survival of infants with hypoplastic left heart syndrome in the twentieth century was not >25%. Current overall 1-year survival rates of complete staged procedures are 75% and transplant 80% to 85%. However, 25% will die while awaiting transplant.

Which of the following statements about ventilation-perfusion matching (Va/Qc) is true? A.Alveolar underventilation results in a high Va/Qc ratio. B:A Va/Qc ratio of 1 indicates a shunt. C:The ideal ventilation-perfusion ratio is zero. D:Ventilation-perfusion mismatching is the most common reason for hypoxia.

Correct:D The Va/Qc ratio expresses the interaction between pulmonary ventilation and perfusion. Matching ventilation and perfusion is required for efficient gas exchange. Mismatching is the most common cause of hypoxia.

The formation of respiratory bronchioles (ie, acini) during the canalicular stage of fetal lung development is significant because it heralds: A:initiation of surfactant synthesis. B:creation of alveolar ducts and alveoli. C:rapid proliferation of pulmonary vasculature. D:primitive development of the gas exchange section of the lung.

Correct:D The canalicular phase of fetal lung development (16-26 weeks' gestation) is characterized by the formation of gas-exchanging acini. The development of respiratory bronchioles and pulmonary capillaries occurs. The degree of acinus-capillary coupling has a direct effect on the gas exchange that occurs.

A male infant is born with probable congenital heart disease (CHD). The parents ask if male gender increases the risk of having CHD. Which of the following is the best response by the nurse? A:Ask the pediatric cardiologist for that information. B:The chances are 50 to 50. C:The incidence of CHD is dependent on length of gestation. D:Gender-related differences are noted in some types of CHD.

Correct:D The highest sex ratios are for aortic stenosis, coarctation of the aorta, and d-transposition of the great arteries; the lowest are multiple ventricular septal defects, truncus arteriosus, and heterotaxia with congenital heart defect.

When an apnea monitor sounds an alarm 20 seconds after the cessation of breathing, the most appropriate immediate response is to: A:assess breath sounds. B:provide blow-by oxygen. C:administer positive pressure ventilation with bag and mask. D:provide gentle tactile stimulation of the chest and/or extremities.

Correct:D The immediate initial step after determining the absence of respirations (as has been done in this scenario) is to provide gentle tactile stimulation. This is all the infant may require to resume spontaneous respirations.

Which of the following modes of mechanical ventilation is not a mode of patient-triggered ventilation? A:Synchronized intermittent mandatory ventilation B:Assist control ventilation C:Volume-targeted ventilation D:Intermittent mandatory ventilation

Correct:D The intermittent mandatory ventilation mode of ventilator support delivers breaths at a predetermined rate, irrespective of where the patient's spontaneous breath is in the respiratory cycle.

When the nurse is planning the care of the infant receiving continuous positive airway pressure ventilation at 8 cm H2O, which of the following interventions should receive the least consideration? A:Monitoring PaCO2 B:Monitoring and documenting urine output C:Monitoring vital signs and oxygen saturation via pulse oximetry D:Maintaining the nasogastric tube to gravity drainage

Correct:D The nasogastric tube should receive the least consideration. Infants are obligate nose breathers, and maximum continuous positive airway pressure (CPAP) needs to be maintained. Gastric overdistention can be managed by using a larger-bore orogastric tube.

An infant has a Blalock-Taussig shunt placed. Upon transfer from the operating room, the nurse notes a cerebral near-infrared spectroscopy attached to the forehead. The nurse should expect this device to provide data on which of the following? A:Central venous pressure B:Brain activity C:Seizure activity D:Cerebral oxygenation

Correct:D The near-infrared spectroscopy monitor assesses trends in renal, abdominal, or cerebral (if on forehead) oxygenation.

Which of the following is a complication associated with patent ductus arteriosus? A:Metabolic alkalosis B:Pulmonary air leak C:Pulmonary hypoplasia D:Pulmonary hemorrhage

Correct:D The preterm infant has less pulmonary arterial muscle and immature pulmonary parenchyma. The left-to-right shunting in patent ductus arteriosus results in increased pulmonary blood flow and increases the chance of pulmonary hemorrhage.