NRP 7TH EDITION

What size laryngoscope blade should be used to intubate a newborn with an estimated gestational age of 30 weeks (estimated birth weight of 1,200 g)? 2 00 0 1

0

For a newborn weighing 1 kg, what dose of 1:10,000 (0.1 mg/mL) concentration of intravenous epinephrine is indicated? 0.5 mL 1 mL 5 mL 0.1 mL

0.1 mL

How soon after administration of intravenous epinephrine should you pause compressions and reassess the baby's heart rate? 30 seconds 10 to 16 seconds 5 minutes 1 minute

1 minute

During the resuscitation of a newborn, you auscultate the apical pulse and count 10 beats over a 6 second period. What heart rate do you report to your team? 60 beats per minute 30 beats per minute 100 beats per minute 120 beats per minute

100 beats per minute

A newborn of 34 weeks' gestation is not breathing (apneic) at birth, does not respond to initial steps and requires positive-pressure ventilation. What concentration of oxygen should be used as you begin positive-pressure ventilation? 50 - 70% oxygen 100% oxygen 30 - 50% oxygen 21 - 30% oxygen

21 - 30% oxygen

You are in the delivery room caring for a preterm newborn at 27 weeks' gestation. The baby is 5 minutes old and breathing spontaneously. The baby's heart rate is 120 beats per minute and the oxygen saturation is 90% in room air. The baby's respirations are labored. Which of the following is an appropriate action? _____ Administer positive-pressure ventilation with an initial inflation pressure of 30 to 35 cm H20 Provide vigorous stimulation on the back, trunk, and extremities Provide supplemental oxygen to rapidly increase the baby's oxygen saturation above 95% Administer CPAP at 5 cm H20 pressure

Administer CPAP at 5 cm H20 pressure

Which statement best describes normal transitional physiology at the time of birth? Babies may take as long as 10 minutes after birth to increase their oxygen saturation to greater than 90%. Visual assessment of cyanosis is a reliable indicator of the baby's oxygen saturation. The oxygen saturation normally rises to at least 90% by 2 minutes of age. Oxygen saturation by pulse oximetry is unreliable in the newborn, and 100% oxygen is recommended immediately after birth.

Babies may take as long as 10 minutes after birth to increase their oxygen saturation to greater than 90%.

Which of the following may be associated with delayed cord clamping in vigorous preterm newborns? Decreased need for blood transfusions Increased intraventricular hemorrhage Increased incidence of necrotizing enterocolitis Decreased blood pressure

Decreased need for blood transfusions

What is the preferred method for assessing heart rate during chest compressions? Auscultate with a stethoscope Pulse oximeter reading on the right hand or wrist Palpate the umbilical cord Electronic cardiac (ECG) monitoring

Electronic cardiac (ECG) monitoring

A baby's heart rate does not increase after intubation and the breath sounds are louder on the right side than the left side of the chest. Which of the following is a common cause of asymmetric breath sounds in an intubated baby? Neck mass Robin sequence Oral mass Endotracheal tube inserted too deep

Endotracheal tube inserted too deep

A baby born at 36 weeks' gestation was apneic after birth and required positive-pressure ventilation and oxygen supplementation in the delivery room. He continues to require supplemental oxygen after birth. Which of the following statements is true? If he has continuing respiratory distress, sodium bicarbonate should be infused immediately. His parents should be discouraged from seeing or touching him after birth because it may agitate him and cause additional complications. His blood pressure does not need to be monitored because hypotension (low blood pressure) does not occur after resuscitation. His blood glucose level should be checked soon after resuscitation and then at regular intervals until stable and normal.

His blood glucose level should be checked soon after resuscitation and then at regular intervals until stable and normal.

A full-term baby is born in the hospital lobby. He is not breathing (apneic), despite positioning his head in sniffing position, clearing his airway, drying, and providing tactile stimulation. You have emergency equipment including a self-inflating bag. You should start positive-pressure ventilation Only after placement of a pulse oximeter sensor Only after transport to a neonatal care area Only after arrival of an oxygen tank Immediately

Immediately

A full-term baby is born by emergency cesarean delivery because of fetal bradycardia (Category III fetal heart rate tracing). The baby is limp and not breathing after initial steps. What is the next step in the resuscitation process? Initiate positive-pressure ventilation and check for increasing heart rate Provide free-flow oxygen, and begin chest compressions Initiate chest compressions using the 2-thumb technique Continue stimulating the baby for an additional 30 seconds

Initiate positive-pressure ventilation and check for increasing heart rate

During resuscitation, a baby is responding to positive-pressure ventilation with a rapidly increasing heart rate. Her heart rate and oxygen saturation suddenly worsen.She has decreased breath sounds on the left side and transillumination also reveals a bright glow on the left side.What is the most likely cause of this distress? Choanal atresia Displacement of endotracheal tube from the trachea into the esophagus Obstruction of the endotracheal tube with thick secretions Left-sided pneumothorax

Left-sided pneumothorax

Which of the following is true about a pneumothorax in the newborn? Using transillumination, light appears to spread less on the side of the chest with a pneumothorax. Positive-pressure ventilation increases the risk of pneumothorax If a baby is in severe distress and suddenly worsening, a chest radiograph (x-ray) must be obtained before evacuating a suspected pneumothorax. Every pneumothorax requires immediate evacuation.

Positive-pressure ventilation increases the risk of pneumothorax

You are at the resuscitation of a newborn who is gasping and has a heart rate of 60 beats per minute. What is the most important action you can take? Provide positive-pressure ventilation Provide free-flow oxygen Provide chest compressions Apply CPAP

Provide positive-pressure ventilation

Your hospital is planning Neonatal Resuscitation Program® training and trying to decide who should be included. For every delivery, what is the minimum requirement for care of the newborn at birth? Someone capable of initiating resuscitation should be available on call from home to respond if there is a problem with the newborn. Someone capable of initiating neonatal resuscitation should be available in the hospital to be called after birth. Someone capable of initiating neonatal resuscitation should be present at every delivery whose only responsibility is management of the newborn. Someone capable of initiating neonatal resuscitation should be present only if risk factors are identified.

Someone capable of initiating neonatal resuscitation should be present at every delivery whose only responsibility is management of the newborn.

Your team attends an emergency cesarean delivery of a term baby because of chorioamnionitis, meconium-stained amniotic fluid, and fetal heart rate decelerations. At delivery, the newborn is term as expected, with very poor tone and he is not breathing (apneic). You quickly perform initial steps, but the newborn is still not breathing. What is the most appropriate next step of resuscitation? Immediately intubate and suction the trachea Start positive-pressure ventilation and check heart rate response after 15 seconds Start cardiac compressions coordinated 3:1 with ventilation, and prepare to insert an umbilical venous catheter Intubate and administer 0.05 mg/kg of endotracheal epinephrine

Start positive-pressure ventilation and check heart rate response after 15 seconds

A baby required ventilation and chest compressions. After 60 seconds of chest compressions, the electronic cardiac monitor indicates a heart rate of 70 beats per minute. What is your next action? Stop chest compressions and stop positive-pressure ventilation. Continue chest compressions and continue positive-pressure ventilation. Stop chest compressions; continue positive-pressure ventilation. Administer epinephrine while continuing chest compressions and positive-pressure ventilation with 100% oxygen.

Stop chest compressions; continue positive-pressure ventilation.

What is the preferred technique for removing secretions from the mouth and nose of a newborn who requires resuscitation? Suction the mouth before the nose. Suction deeply to clear secretions. Suction vigorously to clear secretions. Suction the nose before the mouth.

Suction the nose before the mouth.

What do you expect to happen after administration of a dose of intravenous epinephrine during a resuscitation? The heart rate will increase within 5 to 10 seconds. The heart rate will increase about 1 minute after administration. You will be able to stop chest compressions almost immediately. If heart rate does not improve, all subsequent doses should be given through the endotracheal tube.

The heart rate will increase about 1 minute after administration.

Four pre-birth questions should be asked to assess perinatal risk and determine who should be present at the birth. Which is one of the questions? Is this her first baby? Are membranes ruptured? What is the estimated fetal weight? What is the gestational age?

What is the gestational age?

When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute? 60 breaths, 60 compressions 40 breaths, 80 compressions 30 breaths, 90 compressions 60 breaths, 120 compressions

30 breaths, 90 compressions

The steps of intubation should ideally be completed within which duration? 30 seconds 60 seconds 40 seconds 90 seconds

30 seconds

What is the target axillary temperature range for the preterm newborn? 34.5ºC to 36ºC 37ºC to 38.5ºC 36.5ºC to 37.5ºC 35.5ºC to 37ºC

36.5ºC to 37.5ºC

You have started positive-pressure ventilation for a newborn because her heart rate is low (bradycardia). What is the most important indicator of successful positive-pressure ventilation? Audible and bilateral breath sounds Improvement in tone and movement A rising heart rate Chest movement with each breath

A rising heart rate

What is the most effective maneuver to establish spontaneous breathing in a baby that is apneic after initial steps? Continued rubbing of the back Administration of positive-pressure ventilation that inflates the lungs Administration of free-flow oxygen Application of CPAP

Administration of positive-pressure ventilation that inflates the lungs

After chest compressions with coordinated ventilations are started, the heart rate should be assessed: When spontaneous respirations return After 90 seconds After 30 seconds After 60 seconds

After 60 seconds

You have been called to attend a birth and are the only healthcare provider responsible for the management of the newborn in the room. When should you first call for additional help? Before birth, when you have identified the presence of a perinatal risk factor that increases the likelihood of requiring neonatal resuscitation. After birth, when you determine the baby requires positive-pressure ventilation. After birth, when the obstetrician or labor nurse suggests you need additional help. After birth, when you determine the baby requires intubation.

Before birth, when you have identified the presence of a perinatal risk factor that increases the likelihood of requiring neonatal resuscitation.

What is the appropriate technique to stimulate a baby to breathe? Gently rub the baby's back or extremities Hold the baby upside down and gently pat the buttocks Apply free-flow oxygen to the baby's face Vigorously suction the oropharynx with a bulb syringe

Gently rub the baby's back or extremities

A baby is born at 34 weeks' gestation. After the initial steps of resuscitation, the baby is not breathing (apneic). What are the next steps? Administer free-flow oxygen, place a pulse oximeter sensor on the right hand or wrist, evaluate heart rate. Initiative positive-pressure ventilation, place a pulse oximeter sensor on the right hand or wrist, evaluate heart rate. Administer CPAP, place a pulse oximeter sensor on the right hand or wrist, evaluate color and tone. Provide additional tactile stimulation, evaluate color and tone, evaluate heart rate.

Initiative positive-pressure ventilation, place a pulse oximeter sensor on the right hand or wrist, evaluate heart rate.

A baby is born at term with a bilateral cleft lip and palate and a very small mandible. She requires positive-pressure ventilation because she is not breathing. You are unable to achieve a seal with bag and mask. Which intervention is indicated? Attempt endotracheal intubation multiple times Insert a laryngeal mask Administer CPAP Place an orogastic tube

Insert a laryngeal mask

Which of the following statements is true? Intravenous administration of epinephrine results in reliable and effective absorption. The same dose is used for endotracheal and intravenous administration of epinephrine. Endotracheal administration of epinephrine results in reliable and effective absorption. Intravenous administration of epinephrine should not be repeated more than once.

Intravenous administration of epinephrine results in reliable and effective absorption.

You attend the birth of a baby with prenatally diagnosed congenital diaphragmatic hernia. After birth, you should Begin face-mask ventilation and insert an orogastric tube into the stomach Intubate the trachea and insert an orogastric tube into the stomach Administer epinephrine Start CPAP

Intubate the trachea and insert an orogastric tube into the stomach

You are called to attend to a newborn at birth. At the time the baby is delivered, which 3 questions should you ask to evaluate whether the baby can stay with his mother or be moved to the radiant warmer for further assessment? Is the baby pink? Is the baby breathing or crying? Is the amniotic fluid clear? Is the amniotic fluid clear? Is the baby breathing or crying? Is the baby of low birth weight? Is the baby warm? Does the baby have good tone? Is the baby full-term? Is the baby term? Does the baby have good muscle tone? Is the baby breathing or crying?

Is the baby term? Does the baby have good muscle tone? Is the baby breathing or crying?

You are in the delivery room caring for a preterm newborn at 27 weeks' gestation. Resuscitation has been completed and the baby is ready to be transported to the neonatal intensive care unit. Which of the following is a true statement about the baby's subsequent care? Maintain the baby's body temperature above 38 ºC (100.4 ºF). Monitor blood glucose levels because of the risk of hypoglycemia after birth. Apnea and bradycardia are uncommon, self-limited and no monitoring is required. Position the baby's legs higher than the baby's head (Trendelenburg position) to decrease the chance of neurologic injury.

Monitor blood glucose levels because of the risk of hypoglycemia after birth.

What is the recommended way to determine if a baby requires supplemental oxygen in the delivery room? Place an oximeter sensor on the baby's right hand or wrist and assess oxygen saturation. Send an arterial blood gas, and evaluate the partial pressure of oxygen. Assess the color of the baby's hands and feet. Assess the color of the baby's chest and abdomen, and monitor for central cyanosis.

Place an oximeter sensor on the baby's right hand or wrist and assess oxygen saturation.

Which statement describes recommended practice when using a pulse oximeter in the delivery room? Place the pulse oximeter sensor on the right hand and adjust the oxygen concentration to achieve 100% oxygen saturation. Place the pulse oximeter sensor on the right foot and use the minute specific oxygen saturation target to guide oxygen supplementation. Place the pulse oximeter sensor on the right foot and adjust the oxygen concentration to achieve 100% oxygen saturation. Place the pulse oximeter sensor on the right hand and use the minute specific oxygen saturation target to guide oxygen supplementation.

Place the pulse oximeter sensor on the right hand and use the minute specific oxygen saturation target to guide oxygen supplementation.

hich of the following is true about the preparation and resources needed for a very preterm birth? A size-1 laryngoscope and size 3.5-mm endotracheal tube should be prepared for the initial intubation attempt. Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, and a hat. The delivery room temperature should be decreased to approximately 65ºF to 66ºF (18.3ºC to 18.8ºC). Personnel skilled in intubation and umbilical catheter placement may be on call at home.

Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, and a hat.

You are part of a team preparing for the birth of a baby who has meconium-stained fluid and a category III fetal heart rate tracing. A person skilled in endotracheal intubation should be Available from a remote location in the hospital. Not necessary if a team member knows how to place a laryngeal mask. Called in from home when the baby is born and then requires intubation. Present at the birth.

Present at the birth.

You have determined a baby needs resuscitation at birth. What are the initial steps of newborn care? Provide warmth, position head to open airway, evaluate the baby's color Provide warmth, clear secretions with a suction catheter, evaluate the baby's color, and evaluate heart rate Position head to open the airway, dry, stimulate, evaluate the baby's color Provide warmth, position head and neck to open the airway, clear secretions from the airway if needed, dry, stimulate

Provide warmth, position head and neck to open the airway, clear secretions from the airway if needed, dry, stimulate

What time frame should be used to administer intravenous epinephrine? Over 3 to 5 minutes Rapid push, as quickly as possible Over 1 to 2 minutes Over 5 to 10 minutes

Rapid push, as quickly as possible

A newborn requires complex resuscitation. You have intubated and are administering positive-pressure ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions, and the need to continue one or both of these measures? Blood pressure, oxygen saturation, heart rate Respirations, blood pressure, heart rate Respirations, blood pressure, oxygen saturation Respirations, heart rate, oxygen saturation

Respirations, heart rate, oxygen saturation

Which statement best describes the ethical principle(s) that guide the resuscitation of a newborn? All decisions regarding resuscitation are made by the health care providers, and parents do not participate in decision making. The ethical principles of beneficence, nonmaleficence, autonomy, and justice are used for adults and older children, but they do not apply to newborns. The approach to decisions in the newborn should be guided by the same principles used for adults and older children. The baby is a minor and all decisions regarding resuscitation should be made during an emergency meeting of the hospital ethics committee.

The approach to decisions in the newborn should be guided by the same principles used for adults and older children.

A full-term newborn has a heart rate less than 60 beats per minute despite 30 seconds of positive-pressure ventilation that moves the chest. Your team plans to intubate. Which of the following is a true statement regarding the procedure? The baby should be positioned on a flat surface with the neck slightly extended. The assistant should ensure that the stylet, if used, extends beyond the end of the endotracheal tube. The endotracheal tube should be slowly pushed through closed vocal cords. The intubation procedure should ideally by completed in 60 seconds.

The baby should be positioned on a flat surface with the neck slightly extended.

Which of the following is the best indication for volume expansion after resuscitative efforts that included intubation, chest compressions, and IV epinephrine? The baby's heart rate is 120 beats per minute after resuscitative efforts, but she is very pale. The baby's heart rate rapidly increased to 120 beats per minute with epinephrine, but her pulses seem weak. The baby's heart rate is 120 beats per minute after resuscitative efforts and there is a history of extensive vaginal bleeding during labor. The baby's heart rate remains 50 beats per minute after resuscitative efforts and pulses are weak.

The baby's heart rate remains 50 beats per minute after resuscitative efforts and pulses are weak.

In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn? The newborn's parents The hospital ethics committee The members of the health care team The hospital chaplain

The newborn's parents

When a newborn has a high risk of mortality and there is a significant burden of morbidity among survivors, what should be included in your discussion with the parents concerning options for resuscitation? The option of providing comfort care can be considered. No resuscitation will be started under any circumstances. The hospital ethics committee must be consulted to make a decision. The resuscitation team alone will make the appropriate decision after birth.

The option of providing comfort care can be considered.

Effective team functioning is critical in ensuring the best performance. Which of these characteristics is critical in team leaders? They should be able to maintain situational awareness. They should be solely responsible for assessment and planning. They must take on several jobs at the same time to ease the team's work. They should never allow team members to participate in decision-making.

They should be able to maintain situational awareness.

When are chest compressions indicated? When the heart rate remains less than 100 beats per minute after 30 seconds of positive-pressure ventilation that moves the chest, preferably through an alternative airway. When the heart rate remains less than 60 beats per minute after 30 seconds of positive-pressure ventilation that moves the chest, preferably through an alternative airway. When the heart rate is less than 80 beats per minute. When the heart rate remains less than 100 beats per minute despite positive-pressure ventilation with 100% oxygen.

When the heart rate remains less than 60 beats per minute after 30 seconds of positive-pressure ventilation that moves the chest, preferably through an alternative airway.