CCRN Neonatal
Most respiratory disorders result in a ventilation-perfusion mismatch. Ideally, the ventilation-perfusion ratio should be
1 to 1
At approximately _____ weeks of gestation the heart has developed a fully functioning electrical conduction system.
10
Umbilical venous catheters (UVC) provide central venous access for glucose infusions that exceed what concentration?
12.5%
Which of the following substances appears darkest on x-ray?
Air
Which of the following is NOT one of the seven core measures of neuroprotective family-centered developmental care?
Artificial schedules
Which of the following is a common abnormality associated with a hypospadias?
Chordee
Which of the following opioids causes less histamine release and may be more appropriate for newborns with hypovolemia or hemodynamic instability?
Fentanyl
Fetal alcohol syndrome is the most serious form of fetal alcohol spectrum disorder. Which is NOT TRUE about fetal alcohol syndrome?
Fetal alcohol syndrome only happens if the mother is an alcoholic.
What is the most important measure in relieving engorgement?
Frequent and effective milk removal via pumping or direct feeding
Which of the following is a prerenal cause of acute renal failure?
Hemorrhage failure of autoregulation to maintain renal blood flow and GFR; hypoperfusion; result of hypovolemia; hypotension
A GI series may reveal a "transition zone" in which of the following clinical conditions?
Hirschprung's disease
Routine postoperative care of an infant with a repair of a tracheoesophageal fistula includes which of the following?
If the orogastric tube is dislodged, call the surgical staff to replace it.
Which of the following immunoglobulins cross the placenta?
IgG
All late preterm infants are at risk for hypoglycemia due to which of the following?
Impaired ability to generate glucose from glycogen stores and increased glucose utilization
Which laboratory results are indicative of disseminated intravascular coagulopathy?
Increased PT and PTT times also decreased platelet count, decreased coag factors, and increased fibrin split products
In which of the following conditions is the neonate MOST at risk for hypokalemia?
Increased gastrointestinal losses
Appropriate nutritional management of the neonate with congestive heart failure is best achieved by which of the following?
Individualizing to minimize energy consumption
Which type of phototherapy unit provides higher than with traditional fluorescent bulbs?
LED banks and pads
Which of the following statements about the subsystems of the Synactive Theory of Development are TRUE?
Organization is critical for energy consumption, caloric requirements, and growth.
Which of the following is the MOST significant risk factor for opioid withdrawal?
Overall dose administered higher total dose and longer infusion duration
Symptoms of Anemia
Pallor tachycardia tachypnea
The neonate with a complicated meconium ileus will MOST often present with which of the following signs?
Respiratory distress and sepsis
How can the nurse ensure that a family makes an informed feeding decision?
Share the science of human milk and how human milk affects infant health.
Which of the following statements about hemangiomas is TRUE?
Some hemangiomas are permanent, and others will resolve. nodules, solid, elevated lesions; arise from deeper layers of the skin > 1 cm; more common in preterm infants, females, caucasian, multiples; referred to as stork bite; blanches w pressure; darkens when crying; includes port wine stains
Which of the following are signs of hydrocephalus?
Vomiting, lethargy, irritability
One of the advantages human milk has over formula is that it
contains very long-chain fatty acids.
The bundle of fibers which connects the cerebral hemispheres is the
corpus callosum.
Management of the patient with bladder exstrophy includes
covering the defect with plastic wrap.
Complex/multifactorial anomalies
have a recurrence risk dependent upon how closely related the affected person is to the neonate.
A sign that parents are experiencing acute stress disorder includes
having flashbacks of the trauma.
The MOST common cause of hyperbilirubinemia in the newborn is
hemolytic disease.
Function of thrombocyte
hemostasis
The clinical presentation of esophageal atresia and tracheoesophageal fistula includes all of the following EXCEPT
history of oligohydramnios.
Symptoms of mild perinatal asphyxia include
hyperalert state and jitteriness.
One of the medications given to cause constriction and closure of the ductus arteriosus in the neonate is
indomethacin.
Polycythemia in the immediate newborn period is often associated with
infant of a diabetic mother.
The most significant role of surfactant in neonatal lung development is to
maintain alveolar stability by decreasing surface tension.
All of the following may predispose an infant to a subdural hemorrhage EXCEPT
prematurity. shoulder dystocia, vaginal breech, instrument assisted
The following arterial blood gas results: pH 7.28, PaO2 74, PaCO2 55, HCO3- 21 and base deficit -4 indicate
respiratory acidosis.
Insensible water losses occur primarily through
respiratory and cutaneous routes.
An underpenetrated x-ray may result in over diagnosis of
respiratory distress syndrome.
Function of immunoglobulin
specific antibody-mediated response
sign/symptom of pneumomediastinum
spinnaker or sail sign
All of the following interventions promote positive maturation of the auditory system EXCEPT
sterile hospital workspace or environment.
An infant born at 40 5/7 weeks gestation and weighed 5 lbs 2oz (2,360 grams). In completing a gestational age assessment on this infant, you would identify her as
term, small for gestational age.
Nondisjunction is defined as
the failure of paired chromosomes to separate equally during cell division.
Venipuncture is indicated when
the heels are too edematous or damaged.
complication of gastric tube insertion
the tip can perforate the esophagus during insertion
Function of erythrocyte
transports oxygen and carbon dioxide
The new classification for acute kidney injury (AKI) is based on
urine output and change in serum creatinine level.
Hydrogel dressings such as Vigilon may be
used after irrigation of an infected wound.
A fluid accumulation in the dermal layer of the skin would be described as a
wheal.
Autoregulation is a process that
maintains steady-state cerebral blood flow despite changes in cerebral perfusion pressure. the ability to maintain steady-state cerebral blood flow despite changes in cerebral perfusion pressure; allows body to divert blood to where it is most needed;
The cause of bleeding in a newborn with early stage vitamin K deficiency bleeding is typically related to
maternal medications that impact synthesis and storage. usually occurs in the first 24 hours and is related to maternal medications that may interfere with stores or funtion of vitamin K; anticonvulsants, tuberculostatic agents, vitamin K antagonists.
The MOST common screening tests for Down Syndrome offered to parents in the first trimester
maternal serum alpha fetoprotein.
The birth of a infant with congenital anomalies is a situational crisis that may be used to
maximize a family's adaptation and reorganization.
The single, teenage father may have additional difficulties when he attempts to be a parent because he
may not be recognized as having any parental rights.
The valve located between the left atrium and left ventricle is called the
mitral.
Nastassia is a one-hour-old neonate, born at 39 weeks gestation by primary cesarean birth for fetal bradycardia. She was hypotonic at birth with gasping respirations and a heart rate of 80. She was provided bulb suctioning and bag mask ventilation and recovered by five minutes of life. On admission to the NICU, her temperature was 36° C. After admission to the NICU, her arterial blood gas is pH: 7.19, PCO2: 63, HCO3: 14. The correct interpretation of this blood gas is
mixed respiratory and metabolic acidosis.
Patient care management for the neonate with hypernatremia often includes
monitoring for hyperglycemia and hypocalcemia.
Compared to full term formulas, preterm formulas contain
more calories and increased protein.
Which of the following statements is MOST accurate when describing the availability of albumin binding sites to bilirubin?
Availability of bilirubin binding sites may be affected by poor nutrition, medications, or intralipids.
Which of the following statements about the late preterm infant is TRUE?
Body mass and fat stores are low and may impact the infant's ability to maintain normal temperatures.
Which of the following is NOT a neural tube defect?
Brachial plexus palsy
Which of the following neonatal behaviors is MOST indicative of pain?
Brow bulge and eye squeeze Facial activity is the most specific indicator of pain; Immediate behavioral responses include changes in facial and body movements
Which of the following skin lesions may be associated with neurofibromatosis?
Café-au-lait spots
During which phase of fetal pulmonary development do the type II pneumocytes become numerous and begin to produce and store surfactant?
Canalicular phase
Which of the following microorganisms is a causative agent for late onset sepsis?
Candida albicans
The appropriate depth for an endotracheal tube can be calculated by measuring the distance from the nasal septum to the tragus of the ear and adding ___ cm?
1 cm
The tip of an appropriately positioned endotracheal tube should be how far above the carina?
1 cm
What is the timeframe for early hyponatremia in the neonate?
1-2 days
Chlorhexidine should be used with caution in infants less than what age?
2 months
The dose for oral glucose gel for asymptomatic neonatal hypoglycemia is _____mg/kg body weight.
200
What is the smallest gauge of needle recommended for transfusion of red blood cells for the neonate?
24 gauge
Circadian rhythms
24 hour cycles that are produced by an internal biological clock; regulates the sleep wake cycle and changes in hormone levels
The late preterm infant should meet the following discharge criteria: Successful feedings for
24 hours and vital signs within normal limits for 12 hours prior to discharge.
Pulse oximetry screening for critical congenital heart disease (CCHD) is most accurate when performed when the infant is how many hours of age?
24 hours or more
Both cortical and brainstem auditory-evoked responses can be elicited at which of the following postmenstrual ages?
25-28 weeks
By which gestational age does the fetus develop the esophageal sphincter and limited motility in the gut?
28 weeks
The functional residual capacity in a newborn infant should be approximately
30 ml/kg.
According to the AAP, intubation attempts should be limited to ______seconds.
30 seconds
The late preterm infant population is currently defined as infants who are born between
34 to 36 6/7 weeks of gestation.
At how many weeks gestation is suck-swallow-breathe coordination present?
34-36
Which of the following newborns meets the criteria for neuroprotective cooling?
36 weeks, Apgar score of 3 at 10 minutes, cord arterial blood pH 7.05 35-36 wks gestation, >1800g, pH<7 with base defecit of >12-16, apgar score<3 at 5 or 10 minutes, and lack of respiratory effort at 10 min
Topical anesthetics are approved for use in newborns greater than
37 weeks postmenstrual age.
How much folic acid is recommended in the preconception period and in the first three months of pregnancy for women who have had a prior infant with a neural tube defect?
4,000 mcg 4 mg (4000 mcg) starting at least one month before conception and through at least 3 months of pregnancy
Late preterm infants may need additional time to meet the criteria recommended for discharge. Therefore, late preterm infants should NOT be discharged prior to
48 hours of life.
Patient care management for the recently delivered NICU infant's mother should include all of the following EXCEPT?
Delaying breast pumping to allow for maternal rest
Which of the following promotes positive feeding experiences in the high risk newborn?
Familiarizing the newborn with the odor of breastmilk or formula
Which statement about cerebral metabolism is FALSE?
The brain uses lactic acid for fuel during anaerobic metabolism.
The birth or death of a sick or preterm neonate may place families in a state of crisis, defined as
a temporary disequilibrium caused by events so stressful that customary coping skills are ineffective.
The optimal item to use when securing a PIV is
a transparent dressing.
Diagnostic test results that indicate thrombocytopenia include
decreased platelet count.
The neonate has difficulty responding to large fluid loads due to a(n)
decreased tubular sensitivity to aldosterone.
When performing a venipuncture, why would it be best to enter the skin at a 15-20 degree angle?
decreases the likelihood of going through the vessel.
Clinical manifestations of hypothyroidism include
decreasing body growth and enlarged tongue.
All of the following have had an impact on the rising late preterm birth rate EXCEPT
decreasing maternal age.
Gastroesophageal reflux is associated with
delayed gastric emptying.
Effects of excessive handling include all of the following
disturbance of sleep inhibits healing, decreased secretion of growth hormone, increased secretion of cortisol and adrenaline; fluctuations in BP/cerebral boodflow (IVH); oxygen desats
During fetal life, the ductus arteriosus
diverts blood flow from the pulmonary artery to the descending aorta.
Duodenal atresia is strongly suggested when the abdominal x-ray shows
double-bubble sign.
Blood specimens placed on filter paper for newborn screening should be
dried in air at room temperature for three hours before being placed in the envelope.
The dermis layer of the skin does not contain
fatty connective tissue. Lies directly beneath the epidermis; made up of collagen/elastin fibers, nerves, blood vessels, sebaceous glands, sweat glands, hair follicles, subcutaneous layer, sensors (nerves)
Facilitated tucking is a strategy to decrease the pain sensation experienced by preterm infants is to
flex the extremities and hold them close to the trunk.
sign/symptom of TTN
fluid in the interlobar fissure
With a complete endocardial cushion defect, blood will flow
freely among all four chambers of the heart.
Hemoglobin values at birth are dependent upon
gestational age and volume of placental transfer.
Eye prophylaxis with a single-use dose of sterile ophthalmic ointment containing 1% tetracycline or 0.5% erythromycin is usually administered within the first few hours of birth to prevent an eye infection caused by
gonorrhea.
Preeclampsia may result in all of the following fetal conditions
growth restriction, hypoxia/neurological injury, prematurity.
The condition in which the newborn's immature hypothalamus does not regulate peripheral blood vessels, resulting in a vasoconstriction on one side of the body with a vasodilation on the opposite side of the body is called
harlequin phenomena.
Neonates receiving surfactant are at increased risk of developing
pulmonary hemorrhage.
A full term neonate who presents at six hours of age with increasingly labile oxygenation that appears disproportionate to the pulmonary disease should be evaluated for
pulmonary hypertension of the newborn.
A right-to-left shunt will be seen with
pulmonary stenosis.
The renin-angiotensin-aldosterone system is responsible for
regulating sodium, potassium, and regional blood flow.
The decision to intubate an infant born through thick meconium should be based on the infant's
response to stimulation and bag and mask ventilation.
When collecting free-flowing blood for a serum ammonia test, applying pressure will
result in red blood cell lysis.
Within hours of birth, the neonate signals to the mother that they are hearing her voice by
sucking faster on a pacifier. turn eyes and head toward the mothers voice and sucking faster on a pacifier
Parallel circulations in which there are separate pulmonary and systemic circulatory systems occur in
transposition of the great vessels.
A priority of management for the neonate diagnosed with polycystic kidney disease is
treatment of systemic hypertension. monitoring and treatment of hypertension, nephrectomy sometimes indicated, peritoneal dialysis
Periventricular leukomalacia may be caused by all of the following physiologic conditions EXCEPT
treatment with extracorporeal membrane oxygenation.
A mother is concerned regarding the safety of her medications and breastfeeding. What is the best nursing intervention to reassure and support the woman's breastfeeding goals?
Find information on the safety of the medications while breastfeeding to share with her.
Many infants with the diagnosis of persistent pulmonary hypertension (PPHN) will have pharmacologic support. Identify the medication that is a direct-acting vasodilator and acts by relaxing pulmonary vessel musculature.
Nitric oxide
A non-pharmacologic intervention that modulates the transmission or processing of nociception through mediation by the endogenous nonopioid system is
Non nutritive sucking; sweet tasting solutions
Which of the following is NOT TRUE about fresh milk compared to frozen, thawed milk?
Frozen, thawed milk should be used before fresh milk
Which of the following is an etiology for postrenal kidney failure?
Fungal infection Urinary tract abnormalities, extrinsic obstruction of the urinary tract, fungal infections
Which of the following is an isolated defect and is NOT associated with other anomalies, associations, or syndromes?
Gastroschesis
Which neonatal condition is contraindicated for placement of an umbilical catheter?
Gastroschisis
Which of the following protocols is used to treat a dobutamine extravasation? Administer
5 subcutaneous injections of phentolamine (Regitine) around the periphery of the site within one hour of infiltration. phentolamine s/b used to reverse vasoconstricting effects of dopamine; administer hyaluronudase in 4-5 0.2 ml sc injections around ther periphery of the injury; tx most effective when done w/in one hour, but may still be beneficial if done in 12 hours.
In contrast to term newborns, bilirubin levels in late preterm newborns typically peak at
5-7 days of life
Which substrate is the major source of fuel to the brain?
Glucose
The purpose of a silo for abdominal defects is to
Gradually reduce the bowel over several days.
Baby Beatrice is a preterm infant who is now 14 days old. The infant's mother was discharged home at 72 hours. How much milk should the mother be producing per 24 hours by day 14?
500-600 ml
Depending on the amount of weight loss, electrolyte values, and markers of renal function, fluid is usually administered at which rate in the first 48 hours of life?
60-100 ml/kg/day
When viewing an x-ray of an infant with normal lung volume, the diaphragm is normally seen at which rib on the right side of the chest?
8th
An infant whose birth weight is at what percentile on the growth chart is at increased risk for hypoglycemia due hyperinsulinism?
97th
Blood products administered to neonates are irradiated to prevent which of the following conditions?
Graft-versus-host disease leukodepleted to prevent against graft v. host disease; irradiated to protect against CMV
Signs of renal compromise or severe fluid deficit will often include a urine output of less than
0.5 ml/kg/hour.
Baby Eduardo was born with anencephaly, a serious type of neural tube defect (NTD), and he died in the NICU two days after birth. His grieving parents ask the nurse if the risk of this birth defect can be reduced in a future pregnancy. Which is the BEST reply?
"By taking a prescription dose of 4.0 milligrams of folic acid before a future pregnancy, you can reduce the risk of NTDs."
At the 14-day-old pediatric visit for a preterm Baby, her mother states she is pumping four times a day, and her 24-hour milk volume is 300 milliliters. What would be the best response?
"Let's talk about how to increase the number of pumping sessions to 8 or more in a 24-hour period."
Predictors of positive parenting outcomes include which of the following?
Asking meaningful questions about the infant
Skin excoriations should be treated in the following way:
Apply a semi-occlusive layer to increase moisture. dressing should be changed every 8-12 hours; cleanse with warm sterile water, keep skin moist,
A discrepancy greater than 10 mm Hg between the blood pressure in the upper and lower extremities is indicative of which defect?
Coarctation of the aorta
A newborn's maternal history includes oligohydramnios sequence. What might be an expected finding on physical exam?
Compressed facial features potter's sequence;bilateral renal agenesis, atresia of the ureter or urethra, polycystic or multicystic kidney disease, renal hypoplasia, amniotic rupture, maternal hypertension/pre-e
When performing the initial physical assessment of a newborn, the nurse notices the genitalia are atypical. Which condition might be responsible for this disorder?
Congenital adrenal hyperplasia
The neonate displaying a marbling or mottling effect of the skin would be exhibiting which of the following skin conditions?
Cutis marmorata
Benefits of human milk for the NICU infant include which of the following?
Decreased number of days of IV nutrition
Disadvantages associated with continuous gavage feedings include all of the following EXCEPT?
Decreases in the amount of gastric acid in the stomach
Which of the following increases cerebral blood flow?
Decreasing pH and hypoglycemia decreased pH, increased K+, hypoxemia, increased osmolarity, hypoglycemia (below 30)
Potential etiologies of Prerenal AKI
Dehydration, Hemorrhage, Capillary leak
Which of the following is the most controversial management strategy for treatment of congestive heart failure in the preterm neonate?
Digoxin therapy
Which of the following are associated with neonatal anemia?
Discordant twins, placenta previa, elevated Kleihauer-Betke test
Which types of shock are commonly seen in the infant who is septic?
Distributive and hypovolemic
Of the following veins, which would be the best choice for inserting a peripheral IV?
Dorsum of the hand
A common organism responsible for early onset sepsis is
E. coli. MOST common is GBS
If a NICU infant is unable to sustain a latch to the breast, what would be an appropriate intervention?
Educate the mother on the use of a nipple shield.
An infant born at 36 weeks gestation is small for gestational age and hypotonic. Her physical exam yields low set, "fawn-like" ears and micrognathia. A renal ultrasound shows horseshoe shaped kidneys. She also has a loud, audible murmur and an echocardiogram yields a large VSD. Which congenital anomaly do you suspect?
Edwards syndrome
Damage to the calcaneus is more likely when a heel stick is performed using what part of the foot?
End of the heel
Which white blood cell is MOST effective in the destruction of parasites in neonates with a parasitic infection?
Eosinophil
Following a birth complicated by shoulder dystocia, the neonate should be assessed for
Erb's palsy.
Which of the following is the MOST commonly observed newborn rash?
Erythema toxicum
When caring for a newborn on an insulin infusion, the glucose levels should be monitored how often during the initial titration of the drip?
Every 15 minutes
The best option for volume replacement in an infant with disseminated intravascular coagulopathy is
FFP (fresh, frozen plasma).
Which of the following organs forms first in the embryo?
Heart
Interventions for the family in crisis include which of the following?
Holding discussions when the mother and father are together
Prior to examining an infant for ROP, mydriatic agents may be instilled into the eye. It is important to monitor the infant for which of the following side effects of these agents?
Hypertension, reflex bradycardia, apnea
Pulmonary venous congestion is most commonly identified with which of the following defects?
Hypoplastic left heart
When compared to full term human milk, preterm human milk has which of the following?
Increased fat, protein, and caloric density
Which of the following is an accurate statement about human milk oral care for the NICU infant?
Infants can absorb immune components of human milk through their buccal mucosa.
Predictors of negative parenting outcomes include which of the following?
Infrequent visits that are for short periods of time
Ebony is a 28 week gestation infant in the NICU on ventilatory support. During a routine shift assessment, you find that the IV has infiltrated. After application of hyaluronidase, you might consider which of the following interventions?
Instilling multiple puncture holes with a 23 gauge needle.
Which of the following does NOT cross the placenta from the mother to the fetus?
Insulin
Which of the following treatments may be used to decrease the need for exchange transfusion in the newborn with extreme or critical hyperbilirubinemia?
Intravenous immunoglobulin
A neonate at 12 hours of life with meconium aspiration syndrome who has been intubated since birth suddenly develops severe respiratory distress, tachycardia, and hypotension. Which diagnosis would be least likely to be in the differential?
Intraventricular hemorrhage
You have initiated phototherapy for a two day old preterm newborn with hyperbilirubinemia. After six hours of phototherapy, the total serum bilirubin level is unchanged. What are your thoughts?
Irradiance level should be checked and skin exposure maximized.
Which statement is most accurate when identifying the pathophysiology of transient tachypnea of the newborn (TTN)?
Labor enhances the process of fetal lung fluid absorption
In order to pass a pulse oximetry screening for critical congenital heart disease (CCHD), which oxygenation and percentage of variance is required in the right hand and foot?
Less than 95% O2 saturation and greater than 3% variance
What is the preferred type of nutrition for vulnerable and premature infants?
Mother's own milk
Which is the most prevalent theory of the etiology of congenital heart disease?
Multifactorial etiology
Which of the following is NOT a risk factor for a delay in lactogenesis II and/or low milk supply
Multiparity is not a risk factor for a delay in lactogenesis II and/or low milk supply
The Arnold-Chiari II malformation is associated with which of the following neural tube defects?
Myelomeningocele disruption of an already closed neural tube, malformation of the pons and medulla; accounts for 90% of lumbar myelomeningoceles
Who should dictate the feeding experience in the NICU?
NICU infant
Which pain scoring tool was researched in preterm and full-term infants who required capillary, venous, or arterial punctures and is useful for newborns who are NOT on cardiorespiratory monitoring?
NIPS (Neonatal Infant Pain Scales)
Which of the following is the greatest fear of parents whose newborn is in a high risk care setting?
Newborn experiencing painful procedures
An absence of air flow despite respiratory effort is an example of which apnea classification?
Obstructive apnea
Bilirubin levels rise in an infant with severe gram-negative sepsis for which of the following reasons?
Overproduction and decreased excretion of bilirubin
All of the following neonatal pain scoring tools have been tested on newborns EXCEPT
PIPP (Premature Infant Pain Profile), NIPS (Neonatal Infant Pain Scales), CRIES (Crying, Required Oxygen, Increased Vital Signs, Expression, Sleeplessness) have been used
Which of the following parties is MOST essential to the feeding experience of the NICU infant?
Parent/family member
Which of the following defects increases blood flow to the lungs?
Patent ductus arteriosus
What is the best treatment option for severe intractable hyperkalemia?
Peritoneal dialysis
Symptoms of Thrombocytopenia
Petechiae, bleeding from IV site, bruising
The initial pharmacologic management of an infant with a seizure disorder is which of these medications?
Phenobarbital loading dose 20 mg/kg IV over 10-15 minutes
Which of the following conditions is not an air leak?
Pneumatosis intestinalis
Potential etiologies of Intrarenal AKI
Polycystic kidneys, Asphyxia, Nephrotoxic medications
Potential etiologies of Postrenal AKI
Posterior urethral valves, Fungal infections, neurogenic bladder
Which term describes the combination of the pressure on the ventricular walls caused by the volume of blood inside those walls and follows the principles of the Frank-Starling law?
Preload
What is the MOST common type of acute renal failure in the neonatal period?
Prerenal
Which of the following risk factors predispose an infant to intraventricular hemorrhage?
Preterm infant <28 weeks gestation with respiratory distress syndrome
Which of the following is true about the physiology of lactation?
Prolactin is responsible for milk synthesis
Which statement best supports organizational recommendations for prevention of kernicterus or extreme hyperbilirubinemia?
Provide follow up care based on the risk assessment at the time of discharge. promote and support bf, measure tcb w in 24 hours, measure all bili levels according to age in hours...
Preterm neonates have fewer glomeruli and tubular immaturity, which contribute to which of the following physiologic processes?
Retention of sodium and bicarbonate, free water excretion, and decreased renal concentrating capacity
Which statement lists the four defects that make up the tetralogy of Fallot?
Pulmonary stenosis, ventricular septal defect, right ventricular hypertrophy, ascending aorta overriding the ventricular septal defect
According to the Synactive Theory of Development, the autonomic subsystem is responsible for which of the following?
Regulating cardiopulmonary activity regulates cardiopulmonary activity, GI peristalsis, peripheral skin blood flow
A post-op infant is exhibiting tachycardia, oxygen desaturations, and elevated blood pressure. She received a dose of Fentanyl 1.5 hours ago. Which of the following is the MOST appropriate action?
Reposition the infant with arms and legs flexed.
Positioning interventions used for the high risk preterm neonate includes which of the following?
Side-lying with trunk flexed and extremities midline encourage flexion; not hip abduction, not shoulder retraction, not arching, not neck extension
An infant exhibiting apnea, bradycardia, decreased reflexes, hypotonia, and unequal pupillary reaction would be diagnosed with which stage of hypoxic ischemic encephalopathy?
Stage III
How does the neonate respond to increase cardiac output?
Tachycardia is the main neonatal cardiac response to increase cardiac output.
Symptoms of Polycthemia
Tachypnea, plethora, prolonged cap refill time
What are the symptoms of congestive heart failure?
Tachypnea, tachycardia, central or prolonged peripheral cyanosis, BP higher in R arm than either leg, arrhythmias, poor feeding, cardiomegaly on CXR, hepatomegaly, pulmonary fine or coarse rales.
A newborn with polycythemia may exhibit which of the following?
Tachypnea, thrombocytopenia, hypoglycemia
Maturation of the sensory systems occurs in the following order
Tactile, vestibular, gustatory-olfactory, auditory, and visual.
Which of the following explains why a preterm infant is at greater risk for negative sodium balance?
There is an increased proportion of water in the extracellular fluid compartment.
Which of the following statements accurately describes the ability of infants to transition to breastfeeding?
There is no research to support that infants need to be a certain gestational age to transition to the breast.
During pregnancy, maternal ingestion of goitrogenic substances such as iodide or lithium may lead to which of the following endocrine conditions?
Transient congenital hypothyroidism
A neonate at 10 hours of age is found to be cyanotic and without respiratory distress symptoms. The EKG and chest x-ray are normal. The administration of oxygen is not relieving the cyanosis. The healthcare provider should have a high index of suspicion for which of the following defects?
Transposition of the great vessels
A meconium plug is associated with of the following conditions?
Uncontrolled maternal diabetes
The development of pneumonia in chronically ventilated infants is most commonly associated with which of the following organisms?
Ureaplasma urealyticum
What is the primary cause of skin breakdown in infants within a newborn intensive care setting?
Use of adhesives to secure tubing
The standard for diagnosing necrotizing enterocolitis is which of the following?
abdominal xray
A deformation is a(n)
abnormality caused by unusual mechanical forces on normal tissue.
A preterm birth may delay the following steps of attachment from occurring EXCEPT
accepting the pregnancy.
Using test weights to evaluate milk transfer during direct breastfeeding has been found to
accurately measure breastfeeding adequacy.
sign/symptom of RDS
air bronchograms
Skin pH at birth in the preterm neonate is
alkaline and very slowly becomes acidic. alkaline; mean pH of 6.34; pH falls to 4.95 in first four days of life; creates "acid mantle"; adult pH is 5.7; acid mantel is created by chemical and biologic properties at skin surface.
The initial antibiotic choice for infants with suspected meningitis includes
ampicillin and a third generation cephalosporin amp and third gen cephalosporin (cefotax and ceftaz)
In the immediate newborn transition period, the ability to maintain functional residual lung capacity is most dependent upon
an adequate amount of alveolar surfactant.
If the neonate is symptomatic with a plasma glucose value of less than 40mg/dl (2.2 mmol/L) and is refusing or NOT tolerating feedings, the nurse should request orders for the following interventions:
an intravenous bolus of 2 ml/kg D10W and an intravenous D10W infusion initiated at 80 ml/kg/day.
A communicating hydrocephalus results from damage to the
arachnoid granulations. arachnoid granulations over the surface of the brain
Positioning the tip of an umbilical catheter in the heart increases the risk of
arrhythmia.
In order to create a developmentally-friendly healing environment, the nurse should not
assessing vital signs when infant is sleeping.
Parents should be taught to assess their infant's _________ temperature.
axillary
All of the following are guidelines for basic skin care of the neonate except
bathe with mild soap and warm water once per day.
When providing interventions for families experiencing perinatal loss, the nurse should
be an active listener and provide information regarding support groups.
In the nine steps of attachment, "confirming the pregnancy" refers to the
beginning of the mother's psychological acceptance that she is pregnant.
Hyperpigmented or blue-gray macules are
benign.
Neonates at risk of hypoglycemia should have their glucose levels evaluated within 2 hours of life because
blood glucose levels reach their lowest point within one to two hours after delivery.
Prior to intubation, an anticholinergic drug may be given to reduce the incidence of
bradycardia.
The etiology of necrotizing enterocolitis includes all of the following EXCEPT
breast milk feedings.
Extravasation injury is more common when IV solutions containing _________ are infused.
calcium
Complications of percutaneous central venous lines
catheter migration.
Function of T cell
cellular immunity
Thyroid hormones are required for maturation of which of these systems?
central nervous system.
A hemorrhage associated with birth trauma that does NOT cross suture lines is called a
cephalohematoma.
An edematous, bruised lesion on the right anterior scalp where the vacuum was applied. This lesion has clearly demarcated edges, is firm to touch, and does not cross the suture line. This is best described as a
cephalohematoma.
A low birth weight infant's temperature increases during skin-to-skin care. This is an example of heat transfer by
conduction.
The neonate born to a mother with uncontrolled diabetes mellitus should be evaluated for
congenital malformations.
Signs of polycythemia include
congestive heart failure and pulmonary edema. also poor feeding and hypoglycemia;
Jeremiah was born via emergent cesarean birth at 38 weeks gestation after a complete abruption. He required a full resuscitation, and his Apgar scores were 1 at 5 minutes, 3 at 7 minutes, and 5 at 10 minutes. He is currently on ventilatory support with a diagnosis of hypoxic ischemic encephalopathy. Jeremiah is MOST at risk for hypoglycemia because
damage to the liver may impair synthesis of enzymes that facilitate glucose homeostasis.
The definition of ischemia is a(n)
decrease in the flow of blood available to perfuse the brain. a decrease in the flow of blood available to perfuse the brain; the ischemic process damages the cerebral blood vesseks as wekk as their surrounding support structures.
The late preterm newborn is at risk of developing hypothermia because of
decreased ability to flex extremities
The compromised neonate has difficulty regulating acid-base homeostasis due to
decreased ability to handle acid load.
Symptoms of hyperkalemia include
electrocardiographic changes and dysrhythmias.
Hyperthermia is defined as an axillary temperature greater than 99.5ºF (37.5ºC). The MOST common cause of hyperthermia in the newborn is
environmental.
Symptoms of zinc deficiency include
excoriations of skin folds.
The nurse finds small white or yellow papules with erythematous margins located on the neonate's face and trunk. Management should include
explaining to the parents the rash is a normal newborn finding.
Clinical presentation of renal vein thrombosis includes
hematuria and anemia. hematuria, flank mass, thrombocytopenia, transient hypertenion, urine output of <1 ml/kg/hr, anemia
A clinical feature commonly found in a neonate with Down syndrome is
hypotonia.
Expected findings in a neonate born to a mother who received magnesium sulfate in labor include
hypotonia.
complication of ET intubation
hypoxia, especially if the attempt is prolonged
complication of umbilical line insertion
if the tip of the catheter enters the heart, it can erode through the heart muscle, allowing fluid to accumulate in the pericardial space.
For an infant who is displaying signs of neonatal abstinence syndrome, an accurate score assessment is best completed when?
immediately after a feeding.
Benefits of skin-to-skin (kangaroo) care include
improved thermoregulation and cardio function, decreased incidence/severity of infections, increased weight gain, non pharmacologic intervention, enhanced physiologic organization, improved breastfeeding outcomes, increased alertness and exploration of the environment
Continuous positive airway pressure (CPAP) improves oxygenation by
improving the ventilation-perfusion ratio.
Immediate responses to unmanaged pain include the following
increased HR, increased BP, decreased sats, increased ICP, increased cortisol release
Clinical presentation of subdural hemorrhage
increased ICP, instrumented delivery, coma
At the onset of labor the release of catecholamines stimulates
increased absorption of lung fluid.
The glomerular filtration rate doubles by the end of the second week of postnatal life because of
increased glomerular surface area.
You are the nurse caring for a 38 weeks gestation, female infant, who was born one hour ago in the parking lot of the emergency room. On admission to the nursery, the neonate's rectal temperature was 95ºF (35ºC). You recognize that cold stress may predispose the infant to
increased oxygen consumption and hypoxia.
Clinical presentation of subarachnoid hemorrhage
increasing OFC, shock, vacuum-assisted delivery
Antenatal steroids enhance lung maturation by
increasing the number of type II pneumocytes in the lung.
The goals of neuroprotective cooling in infants with hypoxic ischemic encephalopathy include all of the following EXCEPT
increasing the uptake of glutamate. Goal to inhibit brain cell necrosis by decreasing brain's metabolic rate, awakening excitatory amino acids, slowing the uptake of glutamate, decreasing the production of nitric oxide and free radicals
Function of granulocyte
infection response
Routine nursing interventions to prevent hypoglycemia in the late preterm infant should include
initiation of breastfeeding of all late preterm infants within the first hour of life.
Maturation of the gastrointestinal tract is MOST influenced by
initiation of feeding.
The most common finding when a neonate presents with gastroschisis is a(n)
intestinal malrotation.
The nurse should recognize that the mother is experiencing signs of grief when she
is preoccupied with the image of her lost baby.
Which of the following statements does not accurately describe the stratum corneum? The stratum corneum
is the outermost layer of cells that form the dermal layer.
Anemia due to decreased red blood cell survival should be anticipated in the neonate with a history of
isoimmune-mediated hemolysis.
Drying and separation of the umbilical cord is best facilitated by
keeping the cord open to the air by folding the diaper down below the cord.
Symptoms of olfactory and taste disturbances may be manifested by
lack of coordination of swallow and suck.
A subgaleal hemorrhage is treated as a medical emergency because
large blood loss may lead to hypovolemic shock.
The following conditions may all lead to metabolic acidosis
loss of HCO3/excess acid load d/t prematurity, renal tubular necrosis, severe diarrhea, hypoxia, hypoperfusion, inborn errors of metabolism, caloric deprivation, intolerance of cow's milk protein.
The MOST accurate predictor of infection when analyzing white blood count is
neutropenia.
The MOST common signs of pyloric stenosis include
non-bilious emesis that becomes frequent and projectile.
Gluconeogenesis is the process of converting
non-glucose precursors to glucose.
Evidence that the psychological task of acknowledging guilt about the birth of a 26-week gestational age neonate has become pathologic includes
not responding to the neonate's progress because the infant represents failure.
Nursing care for the infant with surgical repair of an abdominal wall defect would include
observing for signs of increased intra-abdominal pressure.
All of the following increase parental confidence in caring for the late preterm infant EXCEPT
open visitation so others can help with newborn care.
Complement works with the immune system to
opsonize bacteria to facilitate phagocytosis.
Function of hemoglobin
oxygen carrying protein
The standard for diagnosing gastroesophageal reflux disorder includes which of the following?
pH probe test
The psychological task of anticipatory grieving involves
parental acknowledgement that the infant is at risk for death while hoping for survival.
NICU nurses who experience secondary traumatic stress may benefit from
participating in a case review or debriefing.
sign/symptom of MAS
patchy infiltrates
A 29 week gestation infant who displays symptoms of a pulmonary hemorrhage should be evaluated for
patent ductus arteriosus.
A 38-week gestation neonate presents to the NICU with respiratory distress symptoms and anuria. On physical examination, she is found to have hypertension, bilateral flank masses, and hypoplastic lungs. The best diagnosis for this presentation is
polycystic kidney disease.
Risk factors for hyperbilirubinemia
prematurity, exclusive breastfeeding, infection, hemoglobinopathies, isoimmunization, polycythemia, delayed meconium passage, cephalohematoma
The type of patient-triggered ventilator that applies a constant pressure during inspiration and terminates with a decrease in air flow, thereby decreasing the work of breathing, is a(n)
pressure support ventilation.
Mean airway pressure is defined as the
pressure transmitted to the lung throughout the respiratory cycle.
The purpose of minimal enteral feedings is to
prevent the intestinal mucosa from atrophying.
Management of the neonate with an intraventricular hemorrhage includes
preventing wide swings in systemic blood pressure.
The nurse should utilize the following interventions to promote successful breastfeeding in the late preterm infant EXCEPT
providing supplementation after every feeding.
Symptoms of subtle seizures include
rowing, stepping, or pedaling movements. motor automatisms, buccolingual movements; most common and account for 1/2 of all seizures; found in preterm and term infants; rowing, stepping, pedaling movements, eye blinking/fluttering, staring, smacking of lips, drooling, sucking on ET tube
Barriers to normal development include all of the following
separation from parents,numerous care providers, medically necessary equipment, medications and adverse effects, artificial schedules, continuous sensory stimulation
Clinical presentation of acute renal failure includes all of the following EXCEPT
serum creatinine <1.5 mg/dl (132.6 μmol/L). oliguria, normal urine output, elevated creat, polyuria, hematuria, proteinuria, fluid overloead, dehydration, vomiting, poor eating, elevated medication levels
Clinical presentation of subgaleal hemorrhage
sever asphyxia, birth trauma, often asympotomatic, seizures on 2nd or 3rd day of life
The components of safe sleep include the following EXCEPT
sharing a sleep surface with parents.
A papule is defined as a
solid, elevated lesion with distinct borders less than 0.5 cm in size. solid or fluid filled lesions that are elevated with distinct borders; less than 1 cm in diameter
The purpose of trophic feeds is to
stimulate functional development of the GI tract.
It is important to evaluate the neonate with critical pulmonary stenosis for
symptoms of right-sided congestive heart failure.
complication of chest tube insertion
the tip of the tube (or introducer if used) can cause damage to the lung tissue
The full newborn cardiovascular assessment includes auscultation, inspection, and palpation. The point of maximum impulse is usually palpable and can be auscultated in the
third to fourth intercostal space and left of the midclavicular line.
During the process of hematopoiesis, the megakaryoblast matures to which of the following cells?
thrombocytes (platelets)
Development of the visual system requires
use and visual experience for eye function to mature. ensure opportunities for quiet sleep and dark periods, cycle light to mimic day/night periods, limit intense noiseconsider patterned visual stimulation, eliminate direct light exposure
The best treatment for irritant (contact) diaper dermatitis with skin breakdown is
using generous applications of skin barriers containing zinc oxide. barrier ointments; cavilon is the only alcohol-free skin protectant that is FDA approved for use on infants over 30 days of age as a treatment
The major structural anomaly associated with total anomalous pulmonary venous return (TAPVR) includes pulmonary
veins failing to be incorporated in the left atrium.
How soon after birth should a mother ideally initiate pumping and with what type of pump?
within 1 hour
The depth of insertion for an orogastric tube is determined by measuring the distance from the mouth to ear and then to the bottom of the
xiphoid process.
Education for the parents of a neonate diagnosed with phenylketonuria (PKU) includes which of the following?
✓ A low protein formula (diet) is necessary to avoid/ameliorate developmental delay.
A 7-day-old neonate with an unremarkable hospital course who now presents with increasing episodes of hypoglycemia, severe metabolic acidosis, recurrent vomiting, and high ammonia levels should be evaluated for what disorder?
✓ An inborn error of metabolism
Which of the following is TRUE about neonates with achondroplasia?
✓ The disorder can be inherited as an autosomal dominant condition.
Education for parents of a male neonate diagnosed with an X-linked recessive single gene disorder would include
✓ all of his daughters will be obligate carriers.
The predominant difference between single-gene disorders and multifactorial disorders is that in multifactorial disorders
✓ they are caused by a combination of genetic and environmental influences.
