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CCRN Neonatal
Which types of shock are commonly seen in the infant who is septic? - ✔ ✔ Distributive and hypovolemic
The late preterm newborn is at risk of developing hypothermia because of - ✔ ✔ decreased ability to flex extremities
The major structural anomaly associated with total anomalous pulmonary venous return (TAPVR) includes pulmonary - ✔ ✔ veins failing to be incorporated in the left atrium.
The MOST accurate predictor of infection when analyzing white blood count is - ✔ ✔ neutropenia.
The MOST common cause of hyperbilirubinemia in the newborn is - ✔ ✔ hemolytic disease.
The most common finding when a neonate presents with gastroschisis is a(n) - ✔ ✔ intestinal malrotation.
The MOST common screening tests for Down Syndrome offered to parents in the first trimester - ✔ ✔ maternal serum alpha fetoprotein.
The MOST common signs of pyloric stenosis include - ✔ ✔ non-bilious emesis that becomes frequent and projectile.
The most significant role of surfactant in neonatal lung development is to - ✔ ✔ maintain alveolar stability by decreasing surface tension.
The neonate born to a mother with uncontrolled diabetes mellitus should be evaluated for - ✔ ✔ congenital malformations.
The neonate displaying a marbling or mottling effect of the skin would be exhibiting which of the following skin conditions? - ✔ ✔ Cutis marmorata
The neonate has difficulty responding to large fluid loads due to a(n) - ✔ ✔ decreased tubular sensitivity to aldosterone.
The neonate with a complicated meconium ileus will MOST often present with which of the following signs? - ✔ ✔ Respiratory distress and sepsis
The new classification for acute kidney injury (AKI) is based on - ✔ ✔ urine output and change in serum creatinine level.
Which white blood cell is MOST effective in the destruction of parasites in neonates with a parasitic infection? - ✔ ✔ Eosinophil
Who should dictate the feeding experience in the NICU? - ✔
✔ NICU infant
With a complete endocardial cushion defect, blood will flow
- ✔ ✔ freely among all four chambers of the heart.
A low birth weight infant's temperature increases during skin-to-skin care. This is an example of heat transfer by - ✔
✔ conduction.
A meconium plug is associated with of the following conditions? - ✔ ✔ Uncontrolled maternal diabetes
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.
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 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
A newborn with polycythemia may exhibit which of the following? - ✔ ✔ Tachypnea, thrombocytopenia, hypoglycemia
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
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
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
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.
A preterm birth may delay the following steps of attachment from occurring EXCEPT - ✔ ✔ accepting the pregnancy.
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
A right-to-left shunt will be seen with - ✔ ✔ pulmonary stenosis.
All of the following interventions promote positive maturation of the auditory system EXCEPT - ✔ ✔ sterile hospital workspace or environment.
All of the following may predispose an infant to a subdural hemorrhage EXCEPT - ✔ ✔ prematurity. shoulder dystocia, vaginal breech, instrument assisted
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
An absence of air flow despite respiratory effort is an example of which apnea classification? - ✔ ✔ Obstructive apnea
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 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
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.
An infant exhibiting apnea, bradycardia, decreased reflexes, hypotonia, and unequal pupillary reaction would be diagnosed with which stage of hypoxic ischemic encephalopathy? - ✔ ✔ Stage III
An infant whose birth weight is at what percentile on the growth chart is at increased risk for hypoglycemia due hyperinsulinism? - ✔ ✔ 97th
At the onset of labor the release of catecholamines stimulates - ✔ ✔ increased absorption of lung fluid.
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;
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
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.
temperature for three hours before being placed in the envelope.
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
Chlorhexidine should be used with caution in infants less than what age? - ✔ ✔ 2 months
Circadian rhythms - ✔ ✔ 24 hour cycles that are produced by an internal biological clock; regulates the sleep wake cycle and changes in hormone levels
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 < ml/kg/hr, anemia
Clinical presentation of subarachnoid hemorrhage - ✔ ✔ increasing OFC, shock, vacuum-assisted delivery
Clinical presentation of subdural hemorrhage - ✔ ✔ increased ICP, instrumented delivery, coma
Clinical presentation of subgaleal hemorrhage - ✔ ✔ sever asphyxia, birth trauma, often asympotomatic, seizures on 2nd or 3rd day of life
Compared to full term formulas, preterm formulas contain - ✔ ✔ more calories and increased protein.
Complement works with the immune system to - ✔ ✔ opsonize bacteria to facilitate phagocytosis.
Complex/multifactorial anomalies - ✔ ✔ have a recurrence risk dependent upon how closely related the affected person is to the neonate.
complication of chest tube insertion - ✔ ✔ the tip of the tube (or introducer if used) can cause damage to the lung tissue
complication of ET intubation - ✔ ✔ hypoxia, especially if the attempt is prolonged
complication of gastric tube insertion - ✔ ✔ the tip can
perforate the esophagus during insertion
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.
Duodenal atresia is strongly suggested when the abdominal x-ray shows - ✔ ✔ double-bubble sign.
During fetal life, the ductus arteriosus - ✔ ✔ diverts blood flow from the pulmonary artery to the descending aorta.
During pregnancy, maternal ingestion of goitrogenic substances such as iodide or lithium may lead to which of the following endocrine conditions? - ✔ ✔ Transient congenital hypothyroidism
During the process of hematopoiesis, the megakaryoblast matures to which of the following cells? - ✔ ✔ thrombocytes (platelets)
During which phase of fetal pulmonary development do the type II pneumocytes become numerous and begin to produce and store surfactant? - ✔ ✔ Canalicular phase
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.
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.
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.
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
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.
Expected findings in a neonate born to a mother who received magnesium sulfate in labor include - ✔ ✔ hypotonia.
Extravasation injury is more common when IV solutions containing _________ are infused. - ✔ ✔ calcium
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.
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.
Fetal alcohol syndrome is the most serious form of fetal alcohol spectrum disorder. Which is NOT TRUE about fetal
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.
How does the neonate respond to increase cardiac output?
- ✔ ✔ Tachycardia is the main neonatal cardiac response to increase cardiac output.
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
How soon after birth should a mother ideally initiate pumping and with what type of pump? - ✔ ✔ within 1 hour
Hydrogel dressings such as Vigilon may be - ✔ ✔ used after irrigation of an infected wound.
Hyperpigmented or blue-gray macules are - ✔ ✔ benign.
Hyperthermia is defined as an axillary temperature greater than 99.5ºF (37.5ºC). The MOST common cause of hyperthermia in the newborn is - ✔ ✔ environmental.
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.
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.
Immediate responses to unmanaged pain include the following - ✔ ✔ increased HR, increased BP, decreased sats, increased ICP, increased cortisol release
In contrast to term newborns, bilirubin levels in late preterm newborns typically peak at - ✔ ✔ 5-7 days of life
In order to create a developmentally-friendly healing environment, the nurse should not - ✔ ✔ assessing vital signs when infant is sleeping.
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
In the immediate newborn transition period, the ability to maintain functional residual lung capacity is most dependent upon - ✔ ✔ an adequate amount of alveolar surfactant.
In the nine steps of attachment, "confirming the pregnancy" refers to the - ✔ ✔ beginning of the mother's psychological acceptance that she is pregnant.
Management of the patient with bladder exstrophy includes - ✔ ✔ covering the defect with plastic wrap.
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
Maturation of the gastrointestinal tract is MOST influenced by - ✔ ✔ initiation of feeding.
Maturation of the sensory systems occurs in the following order - ✔ ✔ Tactile, vestibular, gustatory-olfactory, auditory, and visual.
Mean airway pressure is defined as the - ✔ ✔ pressure transmitted to the lung throughout the respiratory cycle.
Most respiratory disorders result in a ventilation-perfusion mismatch. Ideally, the ventilation-perfusion ratio should be - ✔ ✔ 1 to 1
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.
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
A clinical feature commonly found in a neonate with Down syndrome is - ✔ ✔ hypotonia.
A common organism responsible for early onset sepsis is - ✔ ✔ E. coli. MOST common is GBS
A communicating hydrocephalus results from damage to the
- ✔ ✔ arachnoid granulations. arachnoid granulations over the surface of the brain
A deformation is a(n) - ✔ ✔ abnormality caused by unusual mechanical forces on normal tissue.
A deformation is a(n) - ✔ ✔ abnormality caused by unusual mechanical forces on normal tissue.
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 fluid accumulation in the dermal layer of the skin would be described as a - ✔ ✔ wheal.
Positioning the tip of an umbilical catheter in the heart increases the risk of - ✔ ✔ arrhythmia.
Potential etiologies of Intrarenal AKI - ✔ ✔ Polycystic kidneys, Asphyxia, Nephrotoxic medications
Potential etiologies of Postrenal AKI - ✔ ✔ Posterior urethral valves, Fungal infections, neurogenic bladder
