Neonatal Resuscitation Review questions

The recommended intravenous dose of epinephrine is

0.1 to 0.3 mL/kg

List the 3 rapid evaluation questions that determine which newborns should be brought to the radiant warmer for the initial steps.

1. Is the baby term? 2. Does the baby have good tone? 3. Is the baby breathing or crying?

List the 5 steps of newborn care

1. Provide warmth 2. Position the head and neck 3. Clear secretions from the airway 4. Dry 5. Stimulate

What are the 4 pre-birth questions to ask the provider before every delivery?

1. what is the expected gestational age? 2. is the amniotic fluid clear? 3. how many babies are expected? 4. are there any additional risk factors?

For positive-pressure ventilation, adjust the flowmeter to (5 L/min)/ (10 L/min).

10 L/min

Oxygen saturation should be 85% to 95% by (2 minutes of age)/(10 minutes of age).

10 minutes of age

A flow rate of (2L/min)/(10L/min) is used for free-flow oxygen administration.

10L/min

The recommended concentration of epinephrine for newborns is

1:10,000

If positive-pressure ventilation is given, at least (1)/(2) qualified providers will be needed at the radiant warmer to perform the necessary steps efficiently.

2 qualified providers will be needed

For babies weighing less than 1,000 g, the endotracheal tube size should be (2.5 mm)/(3.5 mm).

2.5 mm

Begin positive-pressure ventilation with an inspiratory pressure of (20 to 25 cm H2O)/(40 to 60 cm H2O).

20 to 25 cm H2O

Ventilation of the term newborn begins with (21% oxygen)/(40% oxygen)

21% oxygen

The ratio of chest compression's to ventilation is

3 compression's to 1 ventilation

If a baby's heart rate remains below 60 beats per minute, you can repeat the dose of epinephrine every:

3 to 5 minutes

You should try to take no longer than (30)/(60) seconds to complete the endotracheal intubation procedure.

30

Administer positive-pressure ventilation at a rate of (20 to 25 breaths per minute)/(40 to 60 breaths per minute).

40 to 60 breaths per minute

If you are using a device that administers positive end-expiratory pressure (PEEP), the recommended initial pressure is (5 cm H2O)/(10 cm H2O).

5 cm H2O

You count a newborn's heartbeat for 6 seconds and count 6 beats. You report the heart rate as (36 beats per minute)/(60 beats per minute).

60 beats per minute

If a baby is breathing, the heart rate is above 100 beats per minute, the airway is clear and correctly positioned, but the respiration's are labored, you may consider (deep pharyngeal suction)/(CPAP)

CPAP

Babies at risk of pulmonary hypetension should routinely receive sufficient supplemental oxygen to achieve a target oxygen saturation of 100% (True)/(False)

False

The preferred laryngoscope blade size for use in a term newborn is (No. 1)/(No. 0).

No. 1

What phrase is used to achieve the correct rhythm for coordinating chest compression's and ventilation.

One-and-Two-and-Three-and-Breath-and...

A newborn is apneic. She does not improve with initial steps, and PPV is started. The first assessment of the heart rate is 40 beats per minute. After 30 seconds of PPV that moves the chest, her heart rate is 80 beats per minute. Chest compression's (should)/(should not) continue.

Should

You have provided warmth, position the head and neck, cleared the airway, dried, and stimulated a newborn. It is now 60 seconds after birth and she is still apneic and limp. Your next action is to?

Start positive-pressure ventilation

A (self-inflating bag)/(T-piece resuscitator) can provide CPAP for a spontaneously breathing baby.

T-piece resuscitator

You have started positive-pressure ventilation for an apneic newborn. The heart rate has remained 40 beats per minute despite performing all of the ventilation corrective steps and ventilation through and endotracheal tube for 30 seconds. Your assistant sees chest movement with positive-pressure ventilation. You should (increase the ventilation rate to 100 breaths/minute)/(proceed to chest compression's).

You should proceed to chest compression's

You have started positive-pressure ventilation for an apneic newborn. The heart rate is 40 beats per minute and is not improving with positive-pressure ventilation. Your assistant does not see chest movement. You should (start the ventilation corrective steps)/(proceed to chest compression's).

You should start the ventilation corrective steps

You attend the birth of a baby that received PPV during the first minutes of life. He improved and has been monitored in the nursery. A short time later, you are called because he has developed acute respiratory distress. You should suspect (a pneumothorax)/(a congenital heart defect) and should rapidly prepare (a needle aspiration device)/(epinephrine).

a pneumothorax, rapidly prepare a needle aspiration device

If a high-risk birth is anticipated, (1 qualified person)/(a qualified team) should be present at the birth.

a qualified team

List 3 additional steps that will help maintain this baby's temperature

a. increase the room temperature b. prepare a thermal mattress c. prepare a polyethylene plastic bag or wrap, and pre-warm a transport incubator if the baby will be moved after birth.

You may decrease the risk of neurologic injury in a premature newborn during and after resuscitation by (tilting the bed so the baby's legs are higher than the head)/(adjusting the bed so that the baby's legs are even or lower than the head).

adjusting the bed so that the baby's legs are even or lower than the head

You should briefly stop compression's to check the baby's heart rate response after (30 seconds)/(60 seconds) of chest compression's with coordinated ventilation's.

after 60 seconds

During the pre-resuscitation team briefing, (prepare for a routine delivery because you do not know what will be needed)/(anticipate potential complications and discuss how responsibilities will be delegated).

anticipate potential complications and discuss how responsibilities will be delegated

Positive-pressure ventilation is indicated if the baby is ___________ or ___________, or the heart rate is less than __________ beats per minute after the initial steps.

apneic, gasping, and 100 bpm

In a full-term baby, insert an emergency umbilical venous catheter

approximately 2 to 4 cm or until blood can be aspirated

A baby is born limp and apneic. You place her under a radiant warmer, position her airway, remove secretions, and dry and stimulate her. She does not improve. The next step is to (stimulate her more)/(begin positive-pressure ventilation).

begin positive-pressure ventilation

A qualified nurse or respiratory care practitioner who has been trained in neonatal resuscitation and has strong leadership skills (can)/(cannot) be the team leader.

can

A baby delivered at 30 weeks gestation. At 5 minutes of age, she is breathing, has a heart rate of 140 beats per minute, and is receiving CPAP with 30% oxygen. An oximeter on her right hand is reading 95% and is increasing. You should (decrease the oxygen concentration)/(begin PPV)

decrease the oxygen concentration

A baby born at 36 week's gestation received PPV and oxygen supplementation in the delivery room. This baby (does)/(dose not) need frequent evaluation of her respiratory effort and oxygenation during the immediate neonatal period.

does

Every newborn (does)/(does not) need an initial rapid evaluation of gestational age, muscle tone, and respiratory effort.

does

The vocal cord guide on an endotracheal tube (does)/(does not) reliably predict the correct insertion depth.

does not

You have inserted an endotracheal tube and are giving positive-pressure ventilation through it. The CO2 detector does not change color and the baby's heart rate is decreasing. The tube is most lickly placed in the (esophagus)/(trachea).

esophagus

Before birth, the alveoli in the fetal lungs are (collapsed)/(expanded)/ and filled with (fluid)/(air).

expanded, and filled with fluid

You have administered positive-pressure ventilation for an apneic newborn. The baby's heart rate increased rapidly after the first few breaths. The heart rate is now 120 beats per minute, the oxygen saturation is 90% and the baby is beginning to breathe spontaneously. You should (gradually discontinue positive-pressure ventilation)/(discontinue pulse oximetry).

gradually discontinue positive-pressure ventilation

When giving free-flow oxygen with a T-piece resuscitator or flow-inflating bag, you should (hold the mask above the baby's face, allowing some gas to escape around the edges of the mask)/(create a seal by holding the mask tightly to the baby's face).

hold the mask above the baby's face, allowing some gas to escape around the edges of the mask

The preferred route for epinephrine is (intravenous)/(endotracheal).

intravenous

You attend the birth of a baby with antenatally diagnosed congenital diaphragmatic hernia. Promptly after birth, you should (begin face-mask ventilation and insert and orogastric tube in the stomach)/(intubate the trachea and insert an orogastric tube in the stomach).

intubate the trachea and insert an orogastric tube in the stomach

A baby is born at term with a bilateral cleft lip and palate and a very small mandible. She requires positive-pressure ventilation. You are unable to achieve a seal with bag and mask. You have tried to intubate twice but have not been successful. Insertion of a laryngeal mask (is)/(is not) indicated.

is

Both right and left-handed people should hold the laryngoscope in their (right)/(left) hand.

left

When using suction to clear secretions, first suction the newborn's (mouth)/(nose)

mouth

If using a stylet, the tip of the stylet (must)/(must not) extend beyond the endotracheal tube's side and end holes.

must not

The correct depth of chest compression's is approximately

one-third of the anterior-posterior diameter of the chest

Before birth Oxygen is supplied to the fetus by (placenta)/(the fetal lungs).

placenta

An anatomically shaped mask should be positioned with the (pointed)/(rounded) end over the newborn's nose.

pointed end

A newborn has respiratory distress after birth. He has a small lower jaw and a cleft palate. The baby's respiratory distress may improve if you place a small endotracheal tube in the nose, advance it into the pharynx, and position him (supine [on his back])/(prone [on his stomach]).

prone (on his stomach)

The oxygen concentration used during resuscitation is guided by the use of a (manometer)/(pulse-oximeter) that measures the baby's oxygen saturation.

pulse-oximeter

When resuscitating newborns, chest compression's and medications are (rarely)/(frequently) needed.

rarely needed

After birth, air in the alveoli causes vessels in the baby's lungs to (constrict)/(relax).

relax

A baby is found limp, blue, and cyanotic in his mother's room 12 hours after an uncomplicated vaginal birth. He does not improve after stimulation and suctioning his mouth/nose with a bulb syringe. Your first priority is to (restore adequate ventilation by beginning PPV)/(restore adequate circulation by administering epinephrine).

restore adequate ventilation by beginning PPV

Members of an effective resuscitation team (share information)/(work quietly and independently).

share information

If a newborn requires admission to a neonatal intensive care unit, the parents (should)/(should not) be encouraged to see and touch the baby.

should

When a high-risk newborn is anticipated because of the presence of risk factors, resuscitation supplies and equipment (should)/(should not) be unpacked and ready for use.

should

You have the glottis in view, but the voice cords are closed. You (should)/(should not) wait until they are open to insert the tube.

should

A newborn has been receiving face-mask ventilation, but is not improving. Despite performing the first 5 ventilation corrective steps, the heart rate is not rising and there is poor chest movement. An alternative airway, such as an endotracheal tube or a laryngeal mask, (should)/(should not) be inserted immediately.

should be

A full-term newborn had significant birth depression and required a complex resuscitation. He has continued respiratory failure with CO2 retention and a metabolic acidosis. Sodium bicarbonate (should)/(should not) be infused immediately after resuscitation.

should not

A baby has received chest compression's and coordinated ventilation. You briefly stop compression's and the ECG monitor shows the baby's heart rate is 80 beats per minute. You should (continue)/(stop) chest compression's. You should (continue)/(stop) PPV.

should stop chest compression's, and you should continue PPV

A mother received a narcotic medication for pain relief 1 hour before delivery. After birth, the baby does not have spontaneous respirations and does not improve with stimulation. Your first priority is to (start PPV)/(administer the narcotic antagonist naloxone).

start PPV

If you have not completed endotracheal intubation within the recommended time limit, you should (continue the intubation attempt for 30 seconds using free-flow oxygen to support the baby)/(stop, resume positive-pressure ventilation with a mask, then try again or insert a laryngeal mask).

stop, resume positive-pressure ventilation with a mask, then try again or insert a laryngeal mask

A newborn heart rate is 50 beats per minute. He has not improved with ventilation through a face mask or a properly placed 3.5 mm endotracheal tube. His chest is not moving with PPV. You should (suction the trachea using an 8F suction catheter or meconium aspirator)/(proceed immediately to chest compression).

suction the trachea using an 8F suction catheter or meconium aspirator

To insert an orogastric tube, measure the distance from the bridge of the nose to the earlobe and from the earlobe (to the nipples)/(to a point halfway between the xiphoid process and the umbilicus).

to a point halfway between the xiphoid process and the umbilicus

The single most important and most effective step in neonatal resuscitation is (aggressive stimulation)/(ventilation of the lungs).

ventilation of the lungs

Every delivery should be attended by at least 1 skilled person (whose only responsibility is the management of the newborn)/( who shares responsibility for the mother and newborn's care).

whose only responsibility is the management of the newborn

You inserted an endotracheal tube and the CO2 detector changed color when you gave positive-pressure breaths. You hear breath sounds with your stethoscope only on the right side of the chest. You should (withdraw)/(advance) the tube slightly and listen with the stethoscope again.

withdraw

Among babies with moderate to severe hypoxic-ischemic encephalopathy, aggressive warming and hyperthermia (improves)/(worsens) the baby's outcome and should be (encouraged)/(avoided).

worsens, avoided

A baby is born at 26 weeks gestation. The initial steps of care, including gentle stimulation, have been completed and he is nearly 1-minute old. He is not breathing and his heart rate is 80 beats per minute. You should (start CPAP with a face mask)/(Start PPV)

you should start PPV