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NNP Practice Exam (CCPR 2015)

Terms in this set (175)

Indication of a plugged endotracheal tube is
a. condensation in the endotracheal tube
b. sudden decrease in chest wall movement
c. tachycardia
b. sudden decrease in chest wall movement
A neonate has a low T4 and elevated TSH. The appropriate next step would be
a. begin thyroid hormone replacement therapy
b. monitor the infant for lethargy, hypotonia and feeding difficulties
c. recheck T4 and TSH levels at two months of age
a. begin thyroid hormone replacement therapy
A 32 week gestational age male neonate has a 4 cm nontender mass in the right testicle. Differential diagnosis can be faciliated by
a. palpation
b. transillumination
c. ultrasound evaluation
b. transillumination
A neonate who has been in the NICU for two weeks is demonstrating habituation in response to environmental stimuli. Habituation is best defined as
a. decreasing responsivity to external stimuli
b. increasing attention to a new stimulus
c. reacting vigorously to repeated stimuli
a. decreasing responsivity to external stimuli
Which sense becomes the neurodevelopmental interface between the infant and the world at birth?
a. Auditory
b. Tactile
c. Visual
b. Tactile
A newborn with respiratory distress has a chest x-ray that reveals unilateral or bilateral streaky densities and confluent mottled, opacified areas. The nurse should anticipate that initial intervention should be
a. initiation of antibiotics
b. sepsis workup
c. surfactant administration
b. sepsis workup
A neonate born to a mother given Demerol three hours prior to delivery is apneic and cyanotic with heart rate of 74 at one hour after birth. The initial intervention should be
a. administration of naloxone 0.1mg/kg
b. bag and mask ventilation
c. placement of endotracheal tube
b. bag and mask ventilation
The best recommendation for treatment of intraventricular hemorrhage is
a. management of ensuing problems
b. fluid restriction
c. Dopamine for blood pressure support
a. management of ensuing problems
Which congenital heart defect is suspected when a systolic murmur is heard at the location noted on the diagram?
a. Atrial septal defect
b. Pulmonary valve stenosis
c. Ventricular septal defect
c. Ventricular septal defect
A two day old neonate has an abdominal mass. The most likely cause is
a. adrenal hemorrhage
b. polycystic kidney
c. volvulur
b. polycystic kidney
Nasal septum dislocation can be differentiated from normal variant of a misshapened nose by performing
a. a compression test
b. sinus transillumination
c. x-ray
a. a compression test
Orotracheal intubation is preferable to nasotracheal intubation during acute neonatal resuscitation because
a. a smaller size endotracheal tube can be utilized
b. it can be performed without additional equipment
c. the endotracheal tube is easier to stabilize
b. it can be performed without additional equipment
Following a traumatic delivery, a neonate's arm falls motionless along the side of the body and is rotated inwards. Extension of the forearm is present but there is no limitation on the movement of the hand. Once localized edema and pain diminished, the neonate should be referred for
a. casting of the affected limb
b. physical therapy
c. surgical repair
b. physical therapy
On physical examination of a 4100 gm male neonate, a firm scrotal mass is palpated. The next step in the evaluation is
a. transillumination
b. ultrasound
c. x-ray
a. transillumination
The absence of which reflex distinguishes total brachial plexus palsy from Erb's palsy?
a. Grasp
b. Moro
c. Radical
a. Grasp
A Neuromuscular development characteristic of prematurity includes increased
a. heel to ear resistance
b. hip flexion and adduction
c. popliteal angle
c. popliteal angle
An infant is noted to have vertebral anomalies, a single umbilical artery, and a tracheoesophageal fistula. What studies should you consider obtaining?
a. echocardiogram
b. eye exam
c. renal ultrasound
c. renal ultrasound
The decreased ability of the preterm neonate to produce heat to maintain normal body temperature is most related to
a. decreased thermal receptors in the skin
b. large surface skin area relative to body mass
c. limited subcutaneous tissue and brown fat stores
c. limited subcutaneous tissue and brown fat stores
The nurse should recognize that the auditory sounds of the NICU can compromise a neonate's neurobehavioral development and that most noise is produced by
a. equipment
b. exogenous sources
c. staff
c. staff
Pro-coagulation factors II, VII, IX and X are activated by
a. fibrinogen maturation
b. prothrombin
c. vitamin K
c. vitamin K
The skin barrier function in the 25 week gestation neonate may take up to how many weeks to mature?
a. 2 weeks
b. 4 weeks
c. 8 weeks
c. 8 weeks
Which of the following is a true statement regarding neonatal hyperbilirubinemia?
a. Conjugated bilirubin is reabsorbed in the intestine
b. Newborn infants produce more bilirubin per day than adults
c. In VLBW infants, albumin has an increased affinity for bilirubin
b. Newborn infants produce more bilirubin per day than adults
Neonates born to mothers with uncontrolled phenylketonuria (PKU) are at increased risk for
a. cardiac defects
b. microcephaly
c. prematurity
b. microcephaly
The grief response associated with (permanent, progressive, recurring and cyclic) loss is
a. anticipatory
b. chronic grief
c. chronic sorrow
c. chronic sorrow
A neonate born at 36 weeks gestation weighing 3000 gm is at increased risk for
a. jaundice
b. patent ductus arteriosus
c. polycythemia
a. jaundice
The foundation for nursing education, practice and documentation is the
a. nursing process
b. nurse practice act
c. standard of care
a. nursing process
Definitive diagnosis of HIV infection in a neonate born to an HIV-positive mother requires
a. detection of HIV-specific nucleic acid
b. enzyme linked immunosorbent assay (ELISA)
c. viral load assays
a. detection of HIV-specific nucleic acid
The potent stimulant of smooth muscle contraction that is essential for ductus arteriosus closure is increased
a. circulating prostaglandins
b. oxygen tension
c. pulmonary vascular resistance
b. oxygen tension
The primary therapy for disseminated intravascular coagulation consists of
a. heparin administration
b. infusion of fresh frozen plasma
c. treatment of the underlying disorder
c. treatment of the underlying disorder
Intrauterine growth restricted infants are at risk for decreased glycogen stores because of
a. altered regulation of insulin secretion in pancreatic beta cells
b. hypoxia-induced increased catecholamine secretions
c. inhibition of gluconeogenesis secondary to high insulin concentrations
b. hypoxia-induced increased catecholamine secretions
The immunoglobulin that is secreted in breastmilk is
a. IgA
b. IgG
c. IgM
a. IgA
Language development delays are most likely noted in neonates exposed to maternal use of
a. alcohol
b. cocaine
c. nicotine
> a. alcohol
The Pierre Robin sequence may be a part of a syndrome such as
a. Smith-Lemli-Opitz Syndrome
b. Stickler Syndrome
c. VACTERL
b. Stickler Syndrome
The majority of hypertension in infants can be accounted for as a result of
a. endocrine disorders
b. intrinsic renal disease
c. umbilical artery catheter complications
b. intrinsic renal disease
An increase in cerebral blood flow can be expected in association with
a. decreased PCO₂
b. decreased PaO₂
c. decreased Kt level
b. decreased PaO₂
Physiologic jaundice is due to a combination of increased bilirubin load to the liver and
a. decreased excretion of bilirubin
b. defective conjugation due to increased glucuronyl transferase
c. increased hepatic uptake
a. decreased excretion of bilirubin
When placing a neonate on an oxygen saturation monitor, the nurse should recognize that a primary factor in obtaining an accurate reading is
a. adequate warming of the electrode
b. calibration of the monitor
c. perfusion status of the infant
c. perfusion status of the infant
Anemia of prematurity is characterized by a low reticulocyte count and
a. abnormal erythroid maturation
b. compromised bone marrow production
c. inadequate response to erythropoietin
inadequate response to erythropoietin
Limiting factors when deciding whether a LBW infant should be immunized per the CDC immunization schedule include
a. birthweight
b. clinical condition
c. gestational age
b. clinical condition
The efficacy of phototherapy depends on
a. adequate hydration of the infant
b. amount of time the infant is exposed to phototherapy
c. irradiance of the lights
c. irradiance of the lights
Cardiac enlargement in neonates with congestive heart failure occurs due to volume overload or
a. hypoxia
b. increased blood flow diverted from extremities
c. pressure overload
pressure overload
Infants with bronchopulmonary dysplasia have increased energy needs. These increased needs may be as much as
a. 10%-20%
b. 20%-40%
c. 40%-60%
b. 20%-40%
Markers of impaired fatty acid oxidation in neonates include
a. cardiomyopathy
b. hyperketonuria
c. lactic acidosis
cardiomyopathy
Inborn errors of metabolism should be considered when the infant presents with
a. alkalosis
b. hyperglycemia
c. seizures
c. seizures
The best predictor of bilirubin toxicity is
a. bilirubin-albumin ratio
b. hearing impairment
c. total serum bilirubin concentration
hearing impairment
An infant who refers twice on an Auditory Brainstem Response test (ABR) should have a full scale auditory diagnostic evaluation by
a. 2 months of age
b. 3 months of age
c. 4 months of age
b. 3 months of age
The optimal time to perform a gestational age assessment for the neonate born at 26 weeks gestation is
a. 48-72 hours of age
b. after 72 hours of age
c. within 12 hours of age
c. within 12 hours of age
Lower fluid administration rates are associated with lower incidence of morbidity in neonates with
a. enterostomies
b. necrotizing enterocolitis
c. omphalocele
necrotizing enterocolitis
A preterm neonate who required resuscitation at birth is admitted to the neonatal intensive care nursery in stable condition. Care of this infant should include
a. a chest x-ray to rule out pneumothorax
b. insertion of urinary catheter to monitor output
c. oral feeding to prevent hypoglycemia
a. a chest x-ray to rule out pneumothorax
A preterm infant of a diabetic mother has experienced several seizures. The initial action that needs to be taken with this neonate is to
a. assess for metabolic imbalances
b. obtain ultrasound
c. perform lumbar puncture
a. assess for metabolic imbalances
Diagnosis of hypertelorism or hypotelorism is primarily based on the measurement represented by point
a. A
b. B
c. C
A
Preterm infants should receive the influenza vaccine at
a. 3 months of age
b. 6 months of age
c. 12 months of age
b. 6 months of age
Phototherapy is contraindicated with the following condition
a. breast milk jaundice
b. congenital erythropoietic porphyria
c. hemophilla
congenital erythropoietic porphyria
A woman on methadone wants to breastfeed. She should be advised that
a. supervised methadone use is considered safe
b. the baby should be weaned gradually to avoid withdrawal
c. transfer of methadone via breast milk precludes breastfeeding
a. supervised methadone use is considered safe
What are the protein requirements for term infants?
a. 1-2 g/kg/d
b. 2-2.5 g/kg/d
c. 3-4 g/kg/d
2-2.5 g/kg/d
Criteria for successful weaning from an incubator to an open crib include that the infant
a. has at least three days of consistent weight gain
b. is medically stable
c. weighs at least 1200 gm
b. is medically stable
A chest x-ray of a neonate shows low lung volumes and a fine reticulogranular pattern of air density. This is consistent with
a. immature lungs
b. meconium aspiration
c. neonatal pneumonitis
a. immature lungs
A preterm neonate who has been in the neonatal intensive care unit for several months has just been weaned from a ventilator. The parents live several hundred miles away and have not been able to visit the unit on a regular basis. The mother picks up the infant, and the infant starts squirming and recoils from the mother's touch. The nurse should counsel the mother that these behaviors reflect
a. a lack of bonding between mother and child
b. detachment due to multiple care givers
c. the infant's association of touch with pain
the infant's association of touch with pain
A neonate is oliguric. A 10-20 mL/kg body weight test dose of isotonic solution is given IV over 1 hour. If the problem is prerenal, the urine output should
a. decrease
b. increase
c. remain unchanged
b. increase
Validity as applied to a research instrument demonstrates
a. ability of the instrument to measure in a consistent manner
b. degree to which the instrument measures what it was purported to measure
c. how the instrument was able to correlate data it to the hypotheses
degree to which the instrument measures what it was purported to measure
T lymphocytes develop and differentiate in the
a. bone marrow
b. lymph nodes
c. thymus
thymus
In the newborn a tense fontalle is a/an
a. early sign of meninigitis
b. late sign of meningitis
c. sign of a subgaleal hemmorage
b. late sign of meningitis
The mandatory diagnostic test for infants suspected of having congenital syphilis is
a. CSF VDRL
b. fluorescent treponemal antibody absorption
c. serum VDRL
a. CSF VDRL
There is an increased risk of hypochloremia in neonates who
a. are asphyxiated at birth
b. had prolonged diarrhea
c. have been over-treated with diuretics
c. have been over-treated with diuretics
Compared to indomethacin, ibuprofen reduces the incidence of side effects in which system?
a. Gastrointestinal
b. Hepatic
c. Renal
c. Renal
The American Academy of Pediatrics recommends discharge of the late preterm infant after
a. 24 hours
b. 48 hours
c. 72 hours
b. 48 hours
When meconium aspiration syndrome is suspected, x-ray findings that would be confirmatory for the condition are
a. hyperexpansion
b. peripherial air bronchograms
c. reticulogranular pattern
hyperexpansion
Prior to administration of sodium bicarbonate for resuscitation, the following should be established
a. adequate ventilation
b. correction of hypovolemic shock
c. documentation of respiratory acidosis
a. adequate ventilation
Which of the following statement describes high-frequency ventilation (HFV)?
a. Assessment of chest wall vibration indicates lung compliance and effectiveness of ventilation
b. HFV is most effective for disorders in which oxygenation is the major problem
c. Provides adequate gas exchange using small tidal volume
Assessment of chest wall vibration indicates lung compliance and effectiveness of ventilation
To decrease the chance that a PICC will advance into the jugular vein, the inserter should
a. prevent the head from turning side to side
b. turn the head away from the insertion site
c. turn the head toward the insertion site
turn the head toward the insertion site
A neonate is receiving hydrochlorothiazide PO 1 mg/kg every 12 hours. The nurse should understand that the pharmacologic action is
a. affects chloride transport in the loop of Henle
b. decreases calcium excretian
c. inhibits sodium reabsorption in the distal nephron
inhibits sodium reabsorption in the distal nephron
A newborn presents with phenotypic findings of down syndrome, ventricular hypertrophy, increased pulmonary markings and variable murmurs. These findings are suggestive of
a. atrioventricular canal
b. cor pulmonale
c. total anomalus venous connection
a. atrioventricular canal
A six day old neonate develops eyelid swelling with a purulent discharge. Gram negative intracellular diplococci are identified on gram stain. This conjunctivitis is caused by
a. chlamydia
b. gonorrhea
c. herpes
gonorrhea
Absence of the ileocecal valve in the neonate with short bowel syndrome can lead to
a. bacterial overgrowth in the small bowel
b. nutritional deficiencies and cholestasis
c. watery or fatty diarrhea
bacterial overgrowth in the small bowel
Hirschsprung's disease occurs due to
a. abnormal gut motility
b. enzyme deficiency
c. ganglion cell deficiency
ganglion cell deficiency
Neonatal hypocalcemia is most likely to occur with
a. perinatal asphyxia
b. placental insufficiency
c. postmaturity
a. perinatal asphyxia
A provider asks a nurse to obtain a signature on informed consent for surgery. The nurse's responsibility in this situation is to
a. determine if patient was advised of the reasons, risks and benefits of the surgery
b. clarify any last minute questions for the patient about the surgery
c. insure at least two unbiased witnesses are present when the patient signs the form
a. determine if patient was advised of the reasons, risks and benefits of the surgery
On physical examination, a neonate is suspected to have transient pustular melanosis. It is anticipated that aspirating the contents of the pustules will reveal a variable number of
a. eosinophils
b. neutrophils
c. staphylococcus
neutrophils
Which milk protein is most difficult to digest?
a. casein
b. lysozyme
c. whey
a. casein
The most prominent and sensitive skin thermal receptors are in the
a. abdomen
b. crown of head
c. trigeminal area of the face
c. trigeminal area of the face
An important point to remember in the interpretation of cord blood gas sample is
a. oxygen levels are higher in the umbilical artery
b. oxygen levels are higher in the umbilical vein
c. oxygen levels are equal in the umbilical vein and artery
oxygen levels are higher in the umbilical vein
In determining the Apgar score of a neonate, the following findings are noted: One minute Color: Pale; Heart rate: 40 bpm; Reflexes: No response; Tone: Limp; Respirations: Weak and irregular. Five minutes Color: Pink/blue extremities; Heart rate: 90 bpm; Reflexes: Grimace; Tone: Limp; Respirations: Weak and irregular. The Apgar scores are
a. 2 at one minute and 4 at 5 minutes
b. 2 at one minute and 5 at 5 minutes
c. 3 at one minute and 6 at 5 minutes
a. 2 at one minute and 4 at 5 minutes
An asymptomatic mother's hepatitis screen reveals that she is HBsAg positive. This neonate
a. is not at risk since the mother is asymptomatic
b. should be vaccinated at birth, 1 month and 6 months of age
c. should not breastfeed
b. should be vaccinated at birth, 1 month and 6 months of age
Specific mechanisms of immune response include
a. alpha- and beta-interferon
b. C3b complement
c. T with B lymphcytes
c. T with B lymphcytes
A neonate is born by emergency cesarean because of fetal-maternal hemorrhage. At delivery, resuscitation is required and the infant fails to respond to all appropriate resuscitation efforts. The next step in the resuscitation should be to administer
a. epinephrine
b. sodium bicarbonate
c. volume expanders
volume expanders
Common clinical manifestations consistent with ABO incompatibility include
a. jaundice in the first 24 hours of life
b. rapidly developing hemolysis
c. severe hepatosplenomegaly
jaundice in the first 24 hours of life
What must be monitored for in an infant with Beckwith-Wiedmann Syndrome?
a. Detached retinas
b. Failure to thrive
c. Wilms tumor
Wilms tumor
The neuropathologic consequences of hemorrhage with the germinal matrix include
a. aqueductal stenosis
b. damage to periventricular white matter
c. dilation of germinal matrix
damage to periventricular white matter
When comparing theophylline and caffeine for treatment of prematurity, the nurse should know that
a. caffeine has a more reliable enteral absorption than theophylline
b. caffeine is a more potent vasodilator
c. the half-life of theophylline is approximately two times that of caffeine
a. caffeine has a more reliable enteral absorption than theophylline
The nurse can facilitate parental adaption to their new role by
a. being a good listener
b. discussing the problems the medical staff deem important
c. providing parents indepth information on their first visit
a. being a good listener
Transporting a neonate from a regional hospital to a community hospital causes a decrease in parental
a. bonding
b. social support
c. trust
trust
In research, groups that bear the burden for research participation should be the group that will ultimately benefit from the results exemplifies the ethical principle of
a. autonomy
b. beneficence
c. justice
justice
Rib fractures are noted on routine chest x-ray on a 3 month old premature infant. The most likely cause of this finding is
a. congenital hypoparathyroidism
b. inadequate calcium and phosphorus intake
c. vitamin D deficiency due to malabsorption
inadequate calcium and phosphorus intake
Which of the following statements describes a practice fundamental to the implementation of an interdisciplinary developmental care team?
a. Care is delivered at regular timely intervals allowing adequate rest time.
b. Infants are prepared for care with hand containment prior to care procedure.
c. Minimize caloric expenditure by limiting movement of extremities with blanket rolls and other positioning aids.
Infants are prepared for care with hand containment prior to care procedure.
An increased incidence of low serum calcium levels occurs in neonates who
a. are dehydrated
b. have a history of asphyxia
c. have adrenal insufficiency
b. have a history of asphyxia
A factor that usually differentiates the pathophysiology between meconium ileus and meconium plug syndrome is
a. bilious vomiting
b. enzymatic deficiency
c. intestinal obstruction
enzymatic deficiency
A reliable indication of hydration status in the extremely low birth weight infant is
a. body weight
b. skin turgor
c. urine volume
b. skin turgor
When speaking to parents about impending neonatal death, the most appropriate term to use is
a. do not resuscitate
b. natural death
c. withdrawal of care
natural death
The most commonly seen neck mass is
a. cystic hygroma
b. goiter
c. thyroglossal duct cyst
cystic hygroma
A characteristic that is present in both omphalocele and gastroschisis is
a. high incidence of congenital malformations
b. nonrotation of the intestine
c. peritoneal sac covering the defect
nonrotation of the intestine
Which of the following is a characteristic of an autosomal recessive disorder?
a. It is expressed in the heterozygous state
b. Parents are phenotypically normal
c. There is a 50% risk for each offspring to be affected
Parents are phenotypically normal
Absorption of an IM injected medication in a neonate is influenced by
a. hemodynamic status
b. membrane permeability
c. muscle mass
muscle mass
When evaluating effects of environmental influences on premature infants which of the following is associated with increased insensible water loss?
a. High ambient temperature
b. Humidification of inspired gases
c. Increasing gestational age
High ambient temperature
A 3 hour old 41 week infant had a cyanotic episode while his father was changing his diaper. He had apgars of 0 and 7 at 1 and 5 minutes respectively. He was meconium stained and required positive airway pressure and oxygen for the first few minutes of life. This infant needs to be evaluated for
a. PDA
b. PPHN
c. TTN
b. PPHN
The scanning modality of choice to evaluate the anatomy of the obstructing tissue in choanal atresia is
a. computerized tomography
b. ultrasound
c. x-ray
a. computerized tomography
Positive pressure ventilation with 21% oxygen is administered at delivery, and the heart rate after 30 seconds is 102 beats per minute and increasing. The next intervention is to
a. continue ventilation for a minimum of one minute
b. discontinue ventilation
c. observe for spontaneous respirations, then discontinue ventilation
observe for spontaneous respirations, then discontinue ventilation
When a parent is to donate blood to their neonate for a blood transfusion, it is imperative that
a. maternal blood donation be limited to plasma
b. parental blood components be irradiated before use
c. the father be eliminated as a donor if the mother has cytotoxic antibodies
b. parental blood components be irradiated before use
Which of the following neuromuscular findings demonstrates early gestational age?
a. 90 percent arm recoil
b. 100 percent arm recoil
c. 90 percent square window
c. 90 percent square window
Which of the following is a contraindiction to breastfeeding?
a. maternal hepatitis B
b. maternal HIV
c. maternal HSV
b. maternal HIV
Most medical and nursing errors occur because of
a. lack of education
b. non-adherence to standard of care
c. system failures
system failures
A 2 day old male is persistently bleeding 12 hours post circumcision. The cause of this bleeding is most likely
a. factor VIII deficiency
b. factor V deficiency
c. poor technique
a. factor VIII deficiency
It is important to breastfeed at night in the early weeks when lactation is being established because
a. progesterone levels are highest at night
b. prolactin levels are highest at night
c. oxytocin levels are highest at night
b. prolactin levels are highest at night
A premature infant demonstrates findings consistent with cholestasis. A primary risk factor for developing this condition is
a. hypercalcemia
b. long term parenteral nutrition
c. structural renal disease
b. long term parenteral nutrition
The primary mechanism of action of glucagon when given for treatment of hypoglycemia is
a. stimulation of gluconeogenesis from protein
b. stimulation of glycogen release from the liver
c. suppression of pancreatic insulin secretion
b. stimulation of glycogen release from the liver
A newborn exposed to rubeola should be given
a. immune globulin
b. measles vaccine
c. Ribavirin
immune globulin
The acid base derangement of respiratory alkalosis represents the presence of
a. decreased ventilation-perfusion ratio
b. increased alveolar ventilation
c. increased loss of H+ ions
b. increased alveolar ventilation
The reason administration of IV 10% calcium gluconate is utilized in the management of hyperkalemia in the neonate is to
a. facilitate renal excretion of potassium
b. increase potassium influx into cells
c. stabilize the myocardium
stabilize the myocardium
Infants of diabetic mothers are at increased risk for hypoglycemia because of insulin-stimulated peripheral glucose uptake and
a. abnormalities in glucose metabolism
b. altered regulation of insulin secretion
c. inhibition of gluconeogenesis
c. inhibition of gluconeogenesis
While caring for an infant born at 38 weeks gestational age who was admitted to NICU to rule out sepsis, the nurse should understand which of the following related to physiology of thermoregulation?
a. Heat production in the neonate results from aerobic metabolism
b. Heat transfer from internal organs to skin surface is decreased in the neonate
c. Non-shivering thermogenesis is dependent on availability of glucose
Non-shivering thermogenesis is dependent on availability of glucose
A two week old full term infant who has been hospitalized since birth due to surgery for intestinal obstruction presents with scaly skin and areas of desquamation. There are areas of irritation and oozing in the neck, groin, and perianal region. These symptoms are most likely caused by
a. acrodermatitis enteropathica
b. essential fatty acid deficiency
c. ichthyosis vulgaris
b. essential fatty acid deficiency
A term neonate who was resuscitated for meconium aspiration at birth has labored breathing. Retractions and respiratory grunting are present. An arterial blood gas reveals: pH 7.23; PCO₂: 49 mm Hg; PO₂: 36 mm Hg; HCO₃: 19 mEq/L. This blood gas represents:
a. partially compensated respiratory acidosis
b. metabolic acidosis
c. mixed acidosis
mixed acidosis
A major advantage of ultrasonography over other diagnostic imaging methods is
a. detection in changes in tissue density
b. two dimensional visualization of anatomy
c. utilizes radio waves to evaluate tissue structure
detection in changes in tissue density
One factor in the etiology of symmetrical intrauterine growth restriction is
a. congenital malformation
b. maternal malnutrition
c. uteroplacental insufficiency
congenital malformation
A term neonate who was resuscitated at birth, intubated and placed on a ventilator in NICU. An arterial blood gas reveals: pH 7.23; PCO₂: 49 mm Hg: PO₂: 36 mm Hg: HCO₃: 19 mEq/L. Initial management of this neonate should include increasing supplemental oxygen and
a. bicarbonate administration
b. increasing peak inspiratory pressure
c. increasing positive end expiratory pressure
b. increasing peak inspiratory pressure
An important principle action of epinephrine during resuscitation is to
a. improve plasma and blood volume expansion
b. increase effects of sympathetic nervous system
c. promote peripheral vasoconstriction
c. promote peripheral vasoconstriction
The most common factor associated with increased mortality for neonates with disseminated herpes simplex virus infection is
a. cutaneous lesions
b. encephalitis
c. pneumonitis
pneumonitis
Post natal weight loss in the first week of life is a result of
a. a contraction of extracellular fluid
b. a contraction of intracellular fluid
c. decrease in intravascular volume
a. a contraction of extracellular fluid
Parental anticipatory grief is not associated with
a. mode of delivery
b. positive feelings about the pregnancy
c. severity of the infant's illness
severity of the infant's illness
Which of the following is used to distinguish between structural congential heart disease and pulmonary hypertension in the newborn?
a. hyperventilation
b. hyperoxia and hyperventilation
c. oxygen exposure up to 10 minutes
b. hyperoxia and hyperventilation
Advanced paternal age is associated with the following
a. childhood obesity
b. deafness
c. schizophrenia
schizophrenia
A neonate receiving IV infusion of calcium gluconate for symptomatic hypocalcemia develops bradycardia. The nurse should
a. recognize this as a transient effect
b. slow the rate of administration
c. stop the infusion immediately
c. stop the infusion immediately
Most research studies regarding the use of soaps, lubricants and antimicrobial skin solutions in premature infants conclude
a. cleansers with alkaline pH and minimal dyes and perfumes are good choices
b. povidone-iodine is a safe agent for surgical skin preparation
c. use of emollient creams may be of benefit
c. use of emollient creams may be of benefit
A term neonate status post abdominal surgery two weeks ago has the following arterial blood gas result. The neonate is on total parenteral nutrition. pH: 7.51; PCO₂: 44 mm Hg; PO₂: 61 mm Hg; HCO₃: 36 mEq/L. When interpreting this blood gas, it should be recognized that
a. PO₂ is inadequate
b. the primary problem is metabolic
c. the primary problem is respiratory
b. the primary problem is metabolic
Toxicology screening on a newborn is performed via hair analysis, the nurse needs to know that
a. a negative test rules out drug exposure
b. maternal drug use during previous 3 months can be determined
c. recent maternal drug use can be detected
b. maternal drug use during previous 3 months can be determined
A term neonate at three days of age has unequal pupils, slow response to light, and tense fontanelles. Labored respirations are present. These findings are consistent with
a. intracerebellar hemorrhage
b. subarachnoid hemorrhage
c. subdural hemorrhage
subdural hemorrhage
A 30 week gestational age neonate is intubated, but air entry is diminished rather than improved as expected. This should lead the nurse to consider that the tube is
a. plugged
b. too high
c. too low
too high
In addition to urinalysis, blood chemistry studies and ultrasound, the neonate with suspected polycystic kidney disease should be further evaluated via
a. cystoscopy
b. family history
c. isotopic renogram
b. family history
Ventricular septal defect should additionally be suspected in the neonate with transposition of the great arteries if
a. a pronounced murmur is heard
b. cyanosis is present
c. the heart is boot shaped
a pronounced murmur is heard
Port wine stains may occur in isolation or in conjunction with
a. amblyopia
b. craniosynostosis
c. mental retardiation
mental retardiation
A 2500 gm neonate with birth asphyxia develops hypocalcemia. This is most likely a result of increased
a. 1,25 dihydroxyvitamin D resistance
b. calcitonin
c. parathyroid hormone
calcitonin
A vigorous neonate is born with thick meconium present in the amniotic fluid. After placing the baby on a warmed radiant warmer and positioning the head, the next step in resuscitation should be
a. bulb syringe suctioning
b. endotracheal suctioning
c. evaluation of respirations
a. bulb syringe suctioning
For the neonate with patent ductus arteriosus the left-to-right shunt is dependent on a decrease in
a. pulmonary artery pressure
b. pulmonary vascular resistance
c. systemic vascular resistance
b. pulmonary vascular resistance
The mother of a newborn with a post-operative gastroschisis repair expresses concern about the nurse's use of a pacifier for her infant. The nurse explains that
a. non-nutritive sucking reduces pain
b. sucking is a reflex response
c. the pacifier will be taken away
a. non-nutritive sucking reduces pain
Clinical manifestations of hyperkalemia include
a. atrial tachycardia
b. peaked T wave
c. narrowed QRS complex
b. peaked T wave
A neonate has a firm, fluctuant mass over the cranial bone which does not cross suture lines. This neonate should also be evaluated for
a. a linear skull fracture
b. increased intracranial pressure
c. subdural hemorrhage
a. a linear skull fracture
On examination of the eyes, a neonate demonstrates symptoms of infantile glaucoma, such as tearing, squinting, photosensitivity, and a cloudy cornea. This neonate should also be evaluated for
a. Klinefelter syndrome
b. neurofibromatosis
c. retinoblastoma
neurofibromatosis
Compared to term breast milk, preterm breast milk is composed of
a. higher carbohydrate content
b. higher lipid content
c. higher protein content
c. higher protein content
A one hour old, 36 week gestation neonate presents with generalized depression, poor muscle tone and diminished respiratory effort. These findings are consistent with infants born to mothers with
a. multiple sclerosis
b. phenylketonuria
c. seizure disorder
seizure disorder
After an initial resuscitation, poor perfusion continues, pulses are thready, and the neonate appears in shock. Dopamine is administered as a continuous IV infusion. The nurse should recognize that
a. beneficial effects are dependent on adequate blood volume
b. increased blood pressure can be expected at low doses
c. the serum half-life is 1-2 minutes
a. beneficial effects are dependent on adequate blood volume
When caring for an infant on total parenteral nutrition, the nurse should recognize that
a. a dextrose concentration of 12.5% or greater requires a central line
b. caloric intakes for parenteral nutrition are about 20% less than those for enteral nutrition
c. monitoring of serum bun is important to identify excess protein
a. a dextrose concentration of 12.5% or greater requires a central line
When introducing trophic feedings to the premature infant, the nurse should recognize that
a. development of the intrinsic GI immune system will be enhanced
b. dilution of breastmilk or formula with sterile water is preferred
c. trophic feedings increase the risk of NEC
...
In comparing neonates with early and late onset of Group B streptococcal infection, the nurse should recognize that
a. ampicillin and gentamicin are most effective antibiotics for treatment
b. meningitis is a complication in both groups of infants
c. mortality rates are the same for both groups of infants
meningitis is a complication in both groups of infants
The x-ray of a neonate with suspected necrotizing enterocolitis shows pneumoperitoneum. This finding is consistent with
a. air in the portal venous system
b. bowel perforation
c. diffuse gaseous intestinal distention
bowel perforation
A newborn with Pierre Robin sequence presents with cyanosis and stridor. The optimal position for this baby is
a. prone
b. side-lying
c. supine
a. prone
Heart sounds indicative of aortic stenosis include
a. a harsh grade IV systolic murmur
b. gallop rhythm
c. systolic click at the apex and upper left sternal border
a. a harsh grade IV systolic murmur
Primary pulmonary tissue dysplasia with failure of terminal bronchioles to canalize is a description of
a. bronchogenic cyst
b. congenital lobar emphysema
c. cystic adenomatoid malformatio
cystic adenomatoid malformation
When an IM injection is necessary for a neonate, the anterior thigh is the site of choice. For an infant weighing <1500 gm, the volume injected into each thigh should not exceed
a. 0.3
b. 0.5
c. 1.0
b. 0.5
A predisposing factor to osteopenia of prematurity is
a. diminished calcium absorption
b. prolonged parenteral nutrition
c. vitamin D deficiency
b. prolonged parenteral nutrition
Medium chain triglycerides are added to preterm formula because they
a. are important for the developing cognition and vision
b. do not require bile salts for absorption
c. improve the growth of healthy preterm infants
do not require bile salts for absorption
A neonate with microcephaly, short stature and absent thumbs develops thrombocytopenia at 1 month of age. Which of the following hematologic disorders is suspected?
a. Blackfan-Diamond anemia
b. Fanconi anemia
c. Kasabach-Merritt syndrome
Fanconi anemia
When repositioning infants who cannot maintain their own posture it is important to provide
a. extension of extremities
b. limitation of movement
c. midline alignment
c. midline alignment
The following are true of subarachnoid hemorrhages:
a. often described as "well baby with seizures"
b. often diagnosed by CT scan
c. most infants have long term neurologic problems
often described as "well baby with seizures"
he length of a drug's half-life is influenced by
a. dosage of the drug given
b. glomerular filtration rate
c. volume of distribution
c. volume of distribution
A function of amniotic fluid is to
a. allow variable pressure on the fetus
b. protect the fetus from outside environmental noise
c. protect the fetus from infection
protect the fetus from infection
When caring for a neonate who is receiving methylxanthine therapy for apnea, the nurse should understand that methylxanthines
a. act by stimulation of central respiratory chemoreceptors
b. decrease hypoxemia secondary to improved pulmonary function
c. increase cerebral blood flow velocity
a. act by stimulation of central respiratory chemoreceptors
Laryngeal mask airway devices may be indicated instead of endotracheal intubation during neonatal resuscitation to
a. decrease risk of tracheal trauma
b. improve ventilation in infants with congenital anomalies
c. increase effectiveness of chest compressions during positive pressure ventilation
b. improve ventilation in infants with congenital anomalies
The diagnostic tool that is most useful in establishing a cardiac cause for respiratory symptoms is
a. arterial blood
b. chest x-ray
c. shunt study
c. shunt study
Which type of heat loss is minimalized by using caps on infants in cribs?
a. conduction
b. convection
c. evaporation
convection
Postnatal transmission of HIV to neonates occurs mainly via
a. breastfeeding
b. blood exposure
c. premastication
a. breastfeeding
A clinical sign that appears in the neonate with congenital heart disease that reflects development of pulmonary edema is
a. cyanosis
b. dyspnea
c. tachypnea
tachypnea
An infant's gastric capacity in the first few days of life is approximately
a. 5-10 mls
b. 20-25 mls
c. 30-35 mls
a. 5-10 mls
The drug of choice when treating opioid withdrawal
a. Diazepam
b. Methadone
c. Phenobarbitol
Methadone
A neonate 48 hours status post-surgery 2° necrotizing enterocolitis is on a ventilator. The neonate is grimacing and eyes are tightly shut. The heart rate is increased and the neonate is breathing over the ventilator. The most appropriate intervention would be to obtain an order for
a. arterial blood gas to assess ventilatory status
b. pain medication
c. sedation to calm infant
b. pain medication
Following treatment of respiratory distress syndrome in premature infants with surfactant therapy, anticipated improvement in oxygenation can be attributed to
a. enhanced matching of ventilation and perfusion
b. improved lung compliance
c. lower surface tension
enhanced matching of ventilation and perfusion
A neutral thermal environment is the environmental temperature in which body temperature is maintained and
a. metabolic rate is maximized
b. oxygen consumption is minimized
c. skin and core temperature gradient is small
...
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