Medic OB FINAL 1

You are resuscitating a 15-day-old infant who was found pulseless and apneic in her crib. Which of the following questions would be most helpful when obtaining a history from the parents?

"Does your daughter have any congenital heart abnormalities?"

Which of the following is the appropriate way to document a premature infant's gestational age?

"Infant was born at 33 weeks and 4 days gestation."

Which of the following is the correct dosage of epinephrine in neonatal resuscitation?

0.01 to 0.03 mg/kg, 1:1,000

You are assessing a 1-minute APGAR score on a patient who has peripheral cyanosis and a heart rate of 98, who cried spontaneously after delivery, is actively moving his extremities, and has a strong cry. What is the APGAR score of this patient?

8

At 90 seconds after birth, based on the following findings, which newborn does NOT require resuscitative efforts beyond routine care?

HR = 100, RR = 30, peripheral cyanosis, APGAR = 8

Which of the following is NOT a recommended method for assessing the heart rate of a newborn?

Palpating the carotid pulse

You suspect that a newborn has choanal atresia. Which of the following signs would lead you to this diagnosis?

The baby cannot nurse and breathe at the same time.

Which of the following is TRUE regarding vaginal delivery?

The compression of the infant's chest during vaginal delivery aids in the removal of fluid from the fetal lungs.

Immediately after delivery, a neonate is crying and moving his arms and legs, but is centrally cyanotic. You recognize:

signs of a normal, healthy infant

Which of the following best describes Pierre Robin syndrome?

A congenital condition characterized by a small jaw and large tongue in conjunction with a cleft palate

You are called to the home of a 72-hour-old infant whose mother is concerned because the infant has been "vomiting after she eats." Based on this information, which of the following should you include in your history and physical assessment? A) End-tidal CO2 monitoring B) Auscultation of gastric sounds C) Asking if the baby could have ingested any toxins D) Assessing the fontanels

Assessing the fontanels

You have just assisted in the delivery of a 34-week-gestation infant in the office of a methadone clinic. After 30 seconds of drying and stimulation, the infant remains limp and cyanotic, with a pulse of 50. Which of the following is the most appropriate action to take at this point? A) Begin CPR at a rate of 3 compressions to 1 ventilation. B) Intubate the trachea, ventilate, reassess, and prepare to transport to a NICU. C) Begin bag-valve-mask ventilations and establish intravenous access. D) Continue to warm and dry the infant for an additional 30 seconds, while preparing to intubate.

Begin CPR at a rate of 3 compressions to 1 ventilation.

Which of the following is NOT an option for prehospital vascular access in the newborn?

Femoral vein cannulation

You have just assisted in the delivery of an approximately 4 kg newborn whose mother is a rather petite primapara. On assessment, you note that there is no spontaneous movement of the infant's right arm at the shoulder, but he moves the elbow and wrist. He otherwise exhibits vigorous movement and has a 1-minute APGAR score of 9. Which of the following should you suspect? A) Neonatal abstinence syndrome B) Spinal cord damage C) Fractured clavicle D) Caput succedaneum

Fractured clavicle

Which of the following is NOT a consequence of respiratory insufficiency in the newborn?

Hyperglycemia

A 4-hour-old infant is inconsolable with a weak cry. His hands and feet are trembling. The mother reports a history of gestational diabetes and hypertension, and states she delivered at home without complication. Which of the following is the most likely cause of this infant's signs and symptoms? A) Type 1 diabetes mellitus B) Meconium aspiration C) Hypoglycemia D) Febrile seizures

Hypoglycemia

Which of the following conditions may result in persistent fetal circulation?

Hypoxia

Which of the following are likely to occur when suctioning a newborn's airway?

Hypoxia, bradycardia

Which of the following statements is TRUE of prehospital newborn care? A) It is impossible to anticipate which deliveries may result in the need for newborn resuscitation. B) Newborns weighing over 2,500 grams are at higher risk of respiratory compromise. C) Sixty percent of newborns delivered outside a hospital require some form of resuscitation. D) Low-birth-weight babies are much more likely to require immediate assistance after delivery

Low-birth-weight babies are much more likely to require immediate assistance after delivery

You are called to a residence to care for a 3-hour-old infant in respiratory distress. Your physical exam reveals retractions, grunting, and tachypnea, along with rhonchi and crackles in the lungs. The midwife reports that the amniotic fluid had "thin meconium." Which of the following is the most likely cause of this infant's signs and symptoms? A) Tetralogy of Fallot B) Cardiac compromise C) Persistent fetal circulation D) Meconium aspiration

Meconium aspiration

Which of the following statements is TRUE regarding the cardiac output of a neonate? A) Cardiac output doubles within the first few hours of life. B) The cardiac output of a neonate is strongly influenced by body temperature. C) Neonates do not readily alter their pulse rate; cardiac output depends mainly on stroke volume. D) Newborns have a fixed stroke volume; cardiac output depends mostly on heart rate.

Newborns have a fixed stroke volume; cardiac output depends mostly on heart rate.

Which of the following describes the appropriate administration of intravenous fluids in a newborn?

Normal saline, 10 mL/kg, slow IV push

You have been called to the residence of a five-day-old infant. His parents are concerned because he sleeps about 18 hours a day. They took a rectal temperature and got a reading of 100°F. Which of the following is the best course of action? A) Administer a 10 mL/kg fluid bolus. B) Undress the infant to his diaper and sponge him with tepid water. C) Reassure the parents that the infant's sleep patterns and temperature are normal. D) Contact medical control to order acetaminophen.

Reassure the parents that the infant's sleep patterns and temperature are normal.

A newborn has just been delivered. You notice a greenish-brown substance on the infant, and observe a vigorous cry and active movement. What is the appropriate way to manage this patient? A) Prepare to suction the trachea with an endotracheal tube and meconium aspirator. B) Using a bulb syringe, suction the nose and then the mouth. C) Rub the infant with a dry towel and place on the mother's chest. D) Lay the infant supine and place padding behind the shoulders.

Rub the infant with a dry towel and place on the mother's chest.

Which of the following statements BEST describes the relationship between primary and secondary apnea in newborns? A) Primary apnea is due to respiratory failure, whereas secondary apnea is due to cardiac arrhythmia. B) Primary apnea occurs only at birth, whereas secondary apnea occurs anytime during the first month of life. C) Secondary apnea results from primary apnea. D) Secondary apnea is a less serious condition and responds well to tactile stimulation and an oxygen-enriched atmosphere.

Secondary apnea results from primary apnea.

Which of the following BEST describes why hypoglycemia after delivery is common in infants born to mothers with gestational diabetes? A) The fetus develops compensatory insulin production in utero due to maternal hyperglycemia, which causes hypoglycemia after delivery. B) The genetic nature of diabetes mellitus makes infants born to mothers with gestational diabetes more likely to have diabetes themselves. C) The fetus is no longer receiving insulin via the umbilical cord, and therefore becomes hypoglycemic after birth. D) Gestational diabetes may cause fetal pancreatic abnormalities that cause hypoglycemia after birth.

The fetus develops compensatory insulin production in utero due to maternal hyperglycemia, which causes hypoglycemia after delivery.

In which of the congenital anomalies of the heart is there a narrowing in the arch of the aorta, obstructing blood flow?

coarctation of the aorta

The appearance of your newborn patient leads you to suspect that he has Pierre Robin syndrome. Which of the following should be your most immediate concern?

Upper airway obstruction

A newborn was found pulseless and apneic in his crib. After lengthy attempts at resuscitation, medical control has advised you to stop resuscitation. When you inform the parents, they become hysterical and the mother cries, "Give me my baby! I don't want you touching him!" You should: A) gently tell the mother that, unfortunately, she cannot hold the baby until the coroner arrives. B) hand the child to the mother and allow the parents time alone with the child. C) request that a law enforcement officer remain with the mother. D) move the infant to the ambulance and transport.

hand the child to the mother and allow the parents time alone with the child.

Factors that stimulate the newborn to take the first breath include all of the following EXCEPT:

hyperglycemia.

A first-time mother has called 911 because her 5-day-old son is "acting sick." Your assessment reveals a lethargic infant with a patent airway, adequate respirations, and a pulse rate of 100 beats per minute. His skin is cold to the touch and mottled. The mother reports she was giving the child a bath just prior to calling EMS. You suspect: A) hypoxia. B) hyperglycemia. C) hypothermia. D) hypercarbia.

hypothermia.

In some cases, the spinal cord and associated structures of a newborn may be exposed. This abnormality is called a:

meningomyelocele.

All of the following are accurate methods for obtaining the heart rate of a newborn EXCEPT:

palpating a brachial pulse.

In which of the congenital anomalies of the heart does the ductus arteriosus fail to close?

patent ductus arteriosus

You are caring for a newborn who had prolonged respiratory distress and hypoxia following birth. You recognize that continued hypoxia and subsequent severe acidosis can cause:

persistent fetal circulation

You have just assisted in the delivery of a full-term infant in the back of the ambulance. Ten minutes after delivery, you obtain vital signs on the newborn and find the following: heart rate 120, respirations 54, and SpO2 of 90%. You recognize: A) the need for immediate supplemental oxygen. B) appropriate vital signs for this infant. C) tachycardia and the possibility of shock. D) tachypnea and possible respiratory distress.

tachycardia and the possibility of shock.

You respond to an apartment for a "sick child." You arrive to find a 2-week-old infant in her mother's arms, wrapped in a thick blanket. The mother reports that the baby has been coughing, and suddenly "went stiff" 10 minutes ago. The infant is listless and not rousable. You should FIRST: A) unwrap the child and assess skin temperature. B) apply oxygen and assess blood glucose. C) obtain a blood pressure and medical history. D) package the infant in a car seat and transport emergently.

unwrap the child and assess skin temperature.