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CCRN Neonatal Questions and Answers
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A deformation is a(n) ✔✔abnormality caused by unusual mechanical forces on normal tissue.
A low birth weight infant's temperature increases during skin-to-skin care. This is an example of heat transfer by ✔✔conduction.
At the onset of labor the release of catecholamines stimulates ✔✔increased absorption of lung fluid.
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.
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.
During fetal life, the ductus arteriosus ✔✔diverts blood flow from the pulmonary artery to the descending aorta.
Expected findings in a neonate born to a mother who received magnesium sulfate in labor include ✔✔hypotonia.
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.
Following a birth complicated by shoulder dystocia, the neonate should be assessed for ✔✔Erb's palsy.
Preeclampsia may result in all of the following fetal conditions ✔✔growth restriction, hypoxia/neurological injury, prematurity.
Hyperthermia is defined as an axillary temperature greater than 99.5ºF (37.5ºC). The MOST common cause of hyperthermia in the newborn is ✔✔environmental.
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.
The neonate born to a mother with uncontrolled diabetes mellitus should be evaluated for ✔✔congenital malformations.
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.
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.
The development of pneumonia in chronically ventilated infants is most commonly associated with which of the following organisms? ✔✔Ureaplasma urealyticum
Antenatal steroids enhance lung maturation by ✔✔increasing the number of type II pneumocytes in the lung.
Mean airway pressure is defined as the ✔✔pressure transmitted to the lung throughout the respiratory cycle.
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
The following arterial blood gas results: pH 7.28, PaO2 74, PaCO2 55, HCO3- 21 and base deficit -4 indicate ✔✔respiratory acidosis.
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.
Most respiratory disorders result in a ventilation-perfusion mismatch. Ideally, the ventilation- perfusion ratio should be ✔✔1 to 1
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
Which of the following conditions is not an air leak? ✔✔Pneumatosis intestinalis
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.
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.
Neonates receiving surfactant are at increased risk of developing ✔✔pulmonary hemorrhage.
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
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
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 right-to-left shunt will be seen with ✔✔pulmonary stenosis.
Appropriate nutritional management of the neonate with congestive heart failure is best achieved by which of the following? ✔✔Individualizing to minimize energy consumption
At approximately _____ weeks of gestation the heart has developed a fully functioning electrical conduction system. ✔✔ 10
The major structural anomaly associated with total anomalous pulmonary venous return (TAPVR) includes pulmonary ✔✔veins failing to be incorporated in the left atrium.
The valve located between the left atrium and left ventricle is called the ✔✔mitral.
Which is the most prevalent theory of the etiology of congenital heart disease? ✔✔Multifactorial etiology
How does the neonate respond to increase cardiac output? ✔✔Tachycardia is the main neonatal cardiac response to increase cardiac output.
Which of the following defects increases blood flow to the lungs? ✔✔Patent ductus arteriosus
Which of the following is the most controversial management strategy for treatment of congestive heart failure in the preterm neonate? ✔✔Digoxin therapy
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.
Which of the following organs forms first in the embryo? ✔✔Heart
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
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
Which types of shock are commonly seen in the infant who is septic? ✔✔Distributive and hypovolemic
With a complete endocardial cushion defect, blood will flow ✔✔freely among all four chambers of the heart.
An infant whose birth weight is at what percentile on the growth chart is at increased risk for hypoglycemia due hyperinsulinism? ✔✔97th
Insensible water losses occur primarily through ✔✔respiratory and cutaneous routes.
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.
One of the advantages human milk has over formula is that it ✔✔contains very long-chain fatty acids.
Patient care management for the neonate with hypernatremia often includes ✔✔monitoring for hyperglycemia and hypocalcemia.
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
Signs of renal compromise or severe fluid deficit will often include a urine output of less than ✔✔0.5 ml/kg/hour.
Symptoms of hyperkalemia include ✔✔electrocardiographic changes and dysrhythmias.
The purpose of trophic feeds is to ✔✔stimulate functional development of the GI tract.
What is the best treatment option for severe intractable hyperkalemia? ✔✔Peritoneal dialysis
What is the timeframe for early hyponatremia in the neonate? ✔✔1-2 days
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
Which of the following does NOT cross the placenta from the mother to the fetus? ✔✔Insulin
Which of the following parties is MOST essential to the feeding experience of the NICU infant? ✔✔Parent/family member
Clinical manifestations of hypothyroidism include ✔✔decreasing body growth and enlarged tongue.
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 renal vein thrombosis includes ✔✔hematuria and anemia. hematuria, flank mass, thrombocytopenia, transient hypertenion, urine output of <1 ml/kg/hr, anemia
During pregnancy, maternal ingestion of goitrogenic substances such as iodide or lithium may lead to which of the following endocrine conditions? ✔✔Transient congenital hypothyroidism
Management of the patient with bladder exstrophy includes ✔✔covering the defect with plastic wrap.
Potential etiologies of Intrarenal AKI ✔✔Polycystic kidneys, Asphyxia, Nephrotoxic medications
Potential etiologies of Postrenal AKI ✔✔Posterior urethral valves, Fungal infections, neurogenic bladder
Potential etiologies of Prerenal AKI ✔✔Dehydration, Hemorrhage, Capillary leak
The compromised neonate has difficulty regulating acid-base homeostasis due to ✔✔decreased ability to handle acid load.
The glomerular filtration rate doubles by the end of the second week of postnatal life because of ✔✔increased glomerular surface area.
The neonate has difficulty responding to large fluid loads due to a(n) ✔✔decreased tubular sensitivity to aldosterone.
The new classification for acute kidney injury (AKI) is based on ✔✔urine output and change in serum creatinine level.
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
Which of the following is an etiology for postrenal kidney failure? ✔✔Fungal infection Urinary tract abnormalities, extrinsic obstruction of the urinary tract, fungal infections
A common organism responsible for early onset sepsis is ✔✔E. coli. MOST common is GBS
A newborn with polycythemia may exhibit which of the following? ✔✔Tachypnea, thrombocytopenia, hypoglycemia
Anemia due to decreased red blood cell survival should be anticipated in the neonate with a history of ✔✔isoimmune-mediated hemolysis.
Bilirubin levels rise in an infant with severe gram-negative sepsis for which of the following reasons? ✔✔Overproduction and decreased excretion of bilirubin
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
Complement works with the immune system to ✔✔opsonize bacteria to facilitate phagocytosis.
Diagnostic test results that indicate thrombocytopenia include ✔✔decreased platelet count.
During the process of hematopoiesis, the megakaryoblast matures to which of the following cells? ✔✔thrombocytes (platelets)
Hemoglobin values at birth are dependent upon ✔✔gestational age and volume of placental transfer.
Signs of polycythemia include ✔✔congestive heart failure and pulmonary edema. also poor feeding and hypoglycemia;
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
