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CCRN NEONATAL ACTUAL EXAM
Clinical presentation of subdural hemorrhage - correct answer>>increased ICP, instrumented delivery, coma Clinical presentation of subgaleal hemorrhage - correct answer>>sever asphyxia, birth trauma, often asympotomatic, seizures on 2nd or 3rd day of life Compared to full term formulas, preterm formulas contain - correct answer>>more calories and increased protein. Complement works with the immune system to - correct answer>>opsonize bacteria to facilitate phagocytosis. Complex/multifactorial anomalies - correct answer>>have a recurrence risk dependent upon how closely related the affected person is to the neonate. complication of chest tube insertion - correct answer>>the tip of the tube (or introducer if used) can cause damage to the lung tissue complication of ET intubation - correct answer>>hypoxia, especially if the attempt is prolonged complication of gastric tube insertion - correct answer>>the tip can perforate the esophagus during insertion complication of umbilical line insertion - correct answer>>if the tip of the catheter enters the heart, it can erode through the heart muscle, allowing fluid to accumulate in the pericardial space.
Complications of percutaneous central venous lines - correct answer>>catheter migration. Continuous positive airway pressure (CPAP) improves oxygenation by - correct answer>>improving the ventilation-perfusion ratio. Damage to the calcaneus is more likely when a heel stick is performed using what part of the foot? - correct answer>>End of the heel Depending on the amount of weight loss, electrolyte values, and markers of renal function, fluid is usually administered at which rate in the first 48 hours of life? - correct answer>> 60 - 100 ml/kg/day Development of the visual system requires - correct answer>>use and visual experience for eye function to mature. ensure opportunities for quiet sleep and dark periods, cycle light to mimic day/night periods, limit intense noiseconsider patterned visual stimulation, eliminate direct light exposure Diagnostic test results that indicate thrombocytopenia include - correct answer>>decreased platelet count. Disadvantages associated with continuous gavage feedings include all of the following EXCEPT? - correct answer>>Decreases in the amount of gastric acid in the stomach Drying and separation of the umbilical cord is best facilitated by - correct answer>>keeping the cord open to the air by folding the diaper down below the cord. Duodenal atresia is strongly suggested when the abdominal x-ray shows
- correct answer>>double-bubble sign. During fetal life, the ductus arteriosus - correct answer>>diverts blood flow from the pulmonary artery to the descending aorta.
includes - correct answer>>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 - correct answer>>hypotonia. Extravasation injury is more common when IV solutions containing _________ are infused. - correct answer>>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
- correct answer>>gonorrhea. Facilitated tucking is a strategy to decrease the pain sensation experienced by preterm infants is to - correct answer>>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 alcohol syndrome? - correct answer>>Fetal alcohol syndrome only happens if the mother is an alcoholic. Following a birth complicated by shoulder dystocia, the neonate should be assessed for - correct answer>>Erb's palsy. For an infant who is displaying signs of neonatal abstinence syndrome, an accurate score assessment is best completed when? - correct answer>>immediately after a feeding. Function of erythrocyte - correct answer>>transports oxygen and carbon dioxide Function of granulocyte - correct answer>>infection response
Function of hemoglobin - correct answer>>oxygen carrying protein Function of immunoglobulin - correct answer>>specific antibody-mediated response Function of T cell - correct answer>>cellular immunity Function of thrombocyte - correct answer>>hemostasis Gastroesophageal reflux is associated with - correct answer>>delayed gastric emptying. Gluconeogenesis is the process of converting - correct answer>>non-glucose precursors to glucose. Hemoglobin values at birth are dependent upon - correct answer>>gestational age and volume of placental transfer. How can the nurse ensure that a family makes an informed feeding decision?
- correct answer>>Share the science of human milk and how human milk affects infant health. How does the neonate respond to increase cardiac output? - correct answer>>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? - correct answer>>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? - correct answer>>within 1 hour Hydrogel dressings such as Vigilon may be - correct answer>>used after irrigation of an infected wound. Hyperpigmented or blue-gray macules are - correct answer>>benign.
In the nine steps of attachment, "confirming the pregnancy" refers to the - correct answer>>beginning of the mother's psychological acceptance that she is pregnant. In which of the following conditions is the neonate MOST at risk for hypokalemia? - correct answer>>Increased gastrointestinal losses Insensible water losses occur primarily through - correct answer>>respiratory and cutaneous routes. Interventions for the family in crisis include which of the following? - correct answer>>Holding discussions when the mother and father are together It is important to evaluate the neonate with critical pulmonary stenosis for - correct answer>>symptoms of right-sided congestive heart failure. 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 - correct answer>>damage to the liver may impair synthesis of enzymes that facilitate glucose homeostasis. Late preterm infants may need additional time to meet the criteria recommended for discharge. Therefore, late preterm infants should NOT be discharged prior to - correct answer>>48 hours of life. Management of the neonate with an intraventricular hemorrhage includes - correct answer>>preventing wide swings in systemic blood pressure. Management of the patient with bladder exstrophy includes - correct answer>>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. - correct answer>>Nitric oxide Maturation of the gastrointestinal tract is MOST influenced by - correct answer>>initiation of feeding. Maturation of the sensory systems occurs in the following order - correct answer>>Tactile, vestibular, gustatory-olfactory, auditory, and visual. Mean airway pressure is defined as the - correct answer>>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 - correct answer>>1 to 1 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 - correct answer>>mixed respiratory and metabolic acidosis. Neonates at risk of hypoglycemia should have their glucose levels evaluated within 2 hours of life because - correct answer>>blood glucose levels reach their lowest point within one to two hours after delivery. Neonates receiving surfactant are at increased risk of developing - correct answer>>pulmonary hemorrhage. NICU nurses who experience secondary traumatic stress may benefit from - correct answer>>participating in a case review or debriefing. Nondisjunction is defined as - correct answer>>the failure of paired chromosomes to separate equally during cell division.
and extremities midline encourage flexion; not hip abduction, not shoulder retraction, not arching, not neck extension Positioning the tip of an umbilical catheter in the heart increases the risk of - correct answer>>arrhythmia. Potential etiologies of Intrarenal AKI - correct answer>>Polycystic kidneys, Asphyxia, Nephrotoxic medications Potential etiologies of Postrenal AKI - correct answer>>Posterior urethral valves, Fungal infections, neurogenic bladder Potential etiologies of Prerenal AKI - correct answer>>Dehydration, Hemorrhage, Capillary leak Predictors of negative parenting outcomes include which of the following? - correct answer>>Infrequent visits that are for short periods of time Predictors of positive parenting outcomes include which of the following? - correct answer>>Asking meaningful questions about the infant Preeclampsia may result in all of the following fetal conditions - correct answer>>growth restriction, hypoxia/neurological injury, prematurity. Preterm neonates have fewer glomeruli and tubular immaturity, which contribute to which of the following physiologic processes? - correct answer>>Retention of sodium and bicarbonate, free water excretion, and decreased renal concentrating capacity Prior to examining an infant for ROP, mydriatic agents may be instilled into the eye. It is important to monitor the infant for which of the following side effects of these agents? - correct answer>>Hypertension, reflex bradycardia, apnea Prior to intubation, an anticholinergic drug may be given to reduce the incidence of - correct answer>>bradycardia.
Pulmonary venous congestion is most commonly identified with which of the following defects? - correct answer>>Hypoplastic left heart Pulse oximetry screening for critical congenital heart disease (CCHD) is most accurate when performed when the infant is how many hours of age?
- correct answer>>24 hours or more Risk factors for hyperbilirubinemia - correct answer>>prematurity, exclusive breastfeeding, infection, hemoglobinopathies, isoimmunization, polycythemia, delayed meconium passage, cephalohematoma Routine nursing interventions to prevent hypoglycemia in the late preterm infant should include - correct answer>>initiation of breastfeeding of all late preterm infants within the first hour of life. Routine postoperative care of an infant with a repair of a tracheoesophageal fistula includes which of the following? - correct answer>>If the orogastric tube is dislodged, call the surgical staff to replace it. sign/symptom of MAS - correct answer>>patchy infiltrates sign/symptom of pneumomediastinum - correct answer>>spinnaker or sail sign sign/symptom of RDS - correct answer>>air bronchograms sign/symptom of TTN
- correct answer>>fluid in the interlobar fissure Signs of polycythemia include - correct answer>>congestive heart failure and pulmonary edema. also poor feeding and hypoglycemia; Signs of renal compromise or severe fluid deficit will often include a urine output of less than - correct answer>>0.5 ml/kg/hour. Skin excoriations should be treated in the following way: - correct answer>>Apply a semi-occlusive layer to increase moisture. dressing should be changed every 8-12 hours; cleanse with warm sterile water,
The Arnold-Chiari II malformation is associated with which of the following neural tube defects? - correct answer>>Myelomeningocele disruption of an already closed neural tube, malformation of the pons and medulla; accounts for 90% of lumbar myelomeningoceles The best option for volume replacement in an infant with disseminated intravascular coagulopathy is - correct answer>>FFP (fresh, frozen plasma). The best treatment for irritant (contact) diaper dermatitis with skin breakdown is - correct answer>>using generous applications of skin barriers containing zinc oxide. barrier ointments; cavilon is the only alcohol-free skin protectant that is FDA approved for use on infants over 30 days of age as a treatment The birth of a infant with congenital anomalies is a situational crisis that may be used to - correct answer>>maximize a family's adaptation and reorganization. The birth or death of a sick or preterm neonate may place families in a state of crisis, defined as - correct answer>>a temporary disequilibrium caused by events so stressful that customary coping skills are ineffective. The bundle of fibers which connects the cerebral hemispheres is the - correct answer>>corpus callosum. The cause of bleeding in a newborn with early stage vitamin K deficiency bleeding is typically related to - correct answer>>maternal medications that impact synthesis and storage. usually occurs in the first 24 hours and is related to maternal medications that may interfere with stores or funtion of vitamin K; anticonvulsants, tuberculostatic agents, vitamin K antagonists.
The clinical presentation of esophageal atresia and tracheoesophageal fistula includes all of the following EXCEPT - correct answer>>history of oligohydramnios. The components of safe sleep include the following EXCEPT - correct answer>>sharing a sleep surface with parents. The compromised neonate has difficulty regulating acid-base homeostasis due to - correct answer>>decreased ability to handle acid load. The condition in which the newborn's immature hypothalamus does not regulate peripheral blood vessels, resulting in a vasoconstriction on one side of the body with a vasodilation on the opposite side of the body is called - correct answer>>harlequin phenomena. The decision to intubate an infant born through thick meconium should be based on the infant's - correct answer>>response to stimulation and bag and mask ventilation. The definition of ischemia is a(n) - correct answer>>decrease in the flow of blood available to perfuse the brain. a decrease in the flow of blood available to perfuse the brain; the ischemic process damages the cerebral blood vesseks as wekk as their surrounding support structures. The depth of insertion for an orogastric tube is determined by measuring the distance from the mouth to ear and then to the bottom of the - correct answer>>xiphoid process. The dermis layer of the skin does not contain - correct answer>>fatty connective tissue. Lies directly beneath the epidermis; made up of collagen/elastin fibers, nerves, blood vessels, sebaceous glands, sweat glands, hair follicles, subcutaneous layer, sensors (nerves)
necrosis by decreasing brain's metabolic rate, awakening excitatory amino acids, slowing the uptake of glutamate, decreasing the production of nitric oxide and free radicals The initial antibiotic choice for infants with suspected meningitis includes - correct answer>>ampicillin and a third generation cephalosporin amp and third gen cephalosporin (cefotax and ceftaz) The initial pharmacologic management of an infant with a seizure disorder is which of these medications? - correct answer>>Phenobarbital loading dose 20 mg/kg IV over 10-15 minutes The late preterm infant population is currently defined as infants who are born between - correct answer>>34 to 36 6/7 weeks of gestation. The late preterm infant should meet the following discharge criteria: Successful feedings for - correct answer>>24 hours and vital signs within normal limits for 12 hours prior to discharge. The late preterm newborn is at risk of developing hypothermia because of - correct answer>>decreased ability to flex extremities The major structural anomaly associated with total anomalous pulmonary venous return (TAPVR) includes pulmonary - correct answer>>veins failing to be incorporated in the left atrium. The MOST accurate predictor of infection when analyzing white blood count is - correct answer>>neutropenia. The MOST common cause of hyperbilirubinemia in the newborn is - correct answer>>hemolytic disease. The most common finding when a neonate presents with gastroschisis is a(n) - correct answer>>intestinal malrotation.
The MOST common screening tests for Down Syndrome offered to parents in the first trimester - correct answer>>maternal serum alpha fetoprotein. The MOST common signs of pyloric stenosis include - correct answer>>non bilious emesis that becomes frequent and projectile. The most significant role of surfactant in neonatal lung development is to - correct answer>>maintain alveolar stability by decreasing surface tension. The neonate born to a mother with uncontrolled diabetes mellitus should be evaluated for - correct answer>>congenital malformations. The neonate displaying a marbling or mottling effect of the skin would be exhibiting which of the following skin conditions? - correct answer>>Cutis marmorata The neonate has difficulty responding to large fluid loads due to a(n) - correct answer>>decreased tubular sensitivity to aldosterone. The neonate with a complicated meconium ileus will MOST often present with which of the following signs? - correct answer>>Respiratory distress and sepsis The new classification for acute kidney injury (AKI) is based on - correct answer>>urine output and change in serum creatinine level. The nurse finds small white or yellow papules with erythematous margins located on the neonate's face and trunk. Management should include - correct answer>>explaining to the parents the rash is a normal newborn finding. The nurse should recognize that the mother is experiencing signs of grief when she - correct answer>>is preoccupied with the image of her lost baby. The nurse should utilize the following interventions to promote successful breastfeeding in the late preterm infant EXCEPT - correct answer>>providing supplementation after every feeding.
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) - correct answer>>pressure support ventilation. The valve located between the left atrium and left ventricle is called the
- correct answer>>mitral. Thyroid hormones are required for maturation of which of these systems? - correct answer>>central nervous system. Topical anesthetics are approved for use in newborns greater than - correct answer>>37 weeks postmenstrual age. Umbilical venous catheters (UVC) provide central venous access for glucose infusions that exceed what concentration? - correct answer>>12.5% Using test weights to evaluate milk transfer during direct breastfeeding has been found to - correct answer>>accurately measure breastfeeding adequacy. Venipuncture is indicated when - correct answer>>the heels are too edematous or damaged. What are the symptoms of congestive heart failure? - correct answer>>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. What is the best treatment option for severe intractable hyperkalemia?
- correct answer>>Peritoneal dialysis What is the MOST common type of acute renal failure in the neonatal period? - correct answer>>Prerenal What is the most important measure in relieving engorgement? - correct answer>>Frequent and effective milk removal via pumping or direct
feeding What is the preferred type of nutrition for vulnerable and premature infants? - correct answer>>Mother's own milk What is the primary cause of skin breakdown in infants within a newborn intensive care setting? - correct answer>>Use of adhesives to secure tubing What is the smallest gauge of needle recommended for transfusion of red blood cells for the neonate? - correct answer>>24 gauge What is the timeframe for early hyponatremia in the neonate? - correct answer>> 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? - correct answer>>Every 15 minutes When collecting free-flowing blood for a serum ammonia test, applying pressure will - correct answer>>result in red blood cell lysis. When compared to full term human milk, preterm human milk has which of the following? - correct answer>>Increased fat, protein, and caloric density When performing a venipuncture, why would it be best to enter the skin at a 15-20 degree angle? - correct answer>>decreases the likelihood of going through the vessel. When performing the initial physical assessment of a newborn, the nurse notices the genitalia are atypical. Which condition might be responsible for this disorder? - correct answer>>Congenital adrenal hyperplasia When providing interventions for families experiencing perinatal loss, the nurse should - correct answer>>be an active listener and provide information regarding support groups.
